Price Transparency 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

COMMUNITY HOSPITAL

Mccook, NE · CCN 281363 · Rates published

6,196 distinct procedures filed
11 distinct payers
121,322 rate rows
2025-12-27 last MRF observed
Data quality

108,420 of 121,322 rate rows are consumer-grade (89.4%)

12,902 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 7,444
professional (physician) fee — not the facility price 4,442
placeholder amount (≤ $0.02) — excluded from medians 824
per-diem day rate — not a per-procedure price 128
percent-of-charges filed in the dollar field — excluded from medians 54
exceeds 10× this hospital's gross charge — excluded from medians 10
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://communitymccook.pt.panaceainc.com/MRFDownload/communitymccook/communitymccook
Found on page https://chmccook.org/patients/price-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-16
Content fingerprint 91fe5337ed4b0f8f… · 20,339,979 bytes · first seen 2026-05-09

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
67279
HCPCS 		Inebilizumab-cdon 10 Mg/ml Vial 9 $71,289.55 $131,611.48 $130,240.53 nat. median
$242
outlier · 537.2×
01261
CDM 		Membrance Wrap 4x6cm 9 $22,651.20 $41,817.60 $41,382.00 nat. median
$41,382
1.0× median
67409
HCPCS 		Tremelimumab-actl 20 Mg/ml Vial 9 $21,099.31 $38,952.58 $38,546.82 nat. median
$70
outlier · 549.3×
66659
HCPCS 		Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Soln 9 $17,747.53 $32,764.68 $32,423.38 nat. median
$32,423
1.0× median
66908
HCPCS 		Ledipasvir-sofosbuvir 90-400 Mg Tab 9 $15,164.60 $27,996.19 $27,704.57 nat. median
$300
outlier · 92.5×
66685
HCPCS 		Ustekinumab 90 Mg/ml Syrg 9 $13,971.55 $25,793.63 $25,524.94 nat. median
$31
outlier · 823.4×
28361
CDM 		Mesh Permacol 20x30 9 $13,295.07 $24,544.74 $24,289.07 nat. median
$844
outlier · 28.8×
67344
HCPCS 		Lenvatinib 10 Mg/day (10 Mg X 1) Cap 9 $12,612.60 $23,284.80 $23,042.25 nat. median
$10,086
outlier · 2.3×
67303
HCPCS 		Lenvatinib 8 Mg/day (4 Mg X 2) Cap 9 $12,190.88 $22,506.24 $22,271.80 nat. median
$4
outlier · 6186.6×
66570
HCPCS 		SORAfenib 200 Mg Tab 9 $10,795.20 $19,929.60 $19,722.00 nat. median
$130
outlier · 152.0×
66206
HCPCS 		Lenalidomide 10 Mg Cap 9 $10,126.15 $18,694.44 $18,499.70 nat. median
$18,500
1.0× median
539
MS_DRG 		Osteomyelitis With Mcc 1 $17,881.00 $17,881.00 $17,881.00 nat. median
$19,718
0.9× median
66731
HCPCS 		Crizotinib 250 Mg Cap 9 $9,665.04 $17,843.15 $17,657.28 nat. median
$2,295
outlier · 7.7×
540
MS_DRG 		Osteomyelitis With Cc 1 $17,007.00 $17,007.00 $17,007.00 nat. median
$13,478
1.3× median
66969
HCPCS 		Ocrelizumab 300mg/10ml Vial 9 $9,254.33 $17,084.91 $16,906.94 nat. median
$611
outlier · 27.7×
67398
HCPCS 		Teprotumumab-trbw 500 Mg Solr 9 $9,105.79 $16,810.68 $16,635.57 nat. median
$16,636
1.0× median
03140
CDM 		Lithrotripsy 9 $8,636.55 $15,944.40 $15,778.31 nat. median
$15,778
1.0× median
24209
CDM 		Interstim Neurostimulator 9 $8,420.10 $15,544.80 $15,382.88 nat. median
$960
outlier · 16.0×
67448
HCPCS 		Acalabrutinib Maleate 100 Mg Tab 9 $8,231.16 $15,195.98 $15,037.69 nat. median
$15,038
1.0× median
67340
HCPCS 		Quizartinib 26.5 Mg Tab 9 $7,949.76 $14,676.48 $14,523.60 nat. median
$2,073
outlier · 7.0×
67104
HCPCS 		Polatuzumab Vedotin-piiq 140 Mg Solr 9 $7,800.00 $14,400.00 $14,250.00 nat. median
$7,460
1.9× median
67430
HCPCS 		Enzalutamide 80 Mg Tab 9 $7,751.00 $14,309.54 $14,160.48 nat. median
$4,118
outlier · 3.4×
66935
HCPCS 		Niraparib 100 Mg Cap 9 $7,670.00 $14,160.00 $14,012.50 nat. median
$136
outlier · 103.0×
67443
HCPCS 		Guselkumab 200 Mg/20 Ml (10 Mg/ml) Vial 9 $7,570.76 $13,976.79 $13,831.20 nat. median
$13,831
1.0× median
67420
HCPCS 		Pertuzumab-trastuzumab-hy-zzxf (1200mg-600mg-30000u/15ml) 1200 Mg-600mg-30000 Un… 9 $7,236.60 $13,359.87 $13,220.70 nat. median
$4,213
outlier · 3.1×
67239
HCPCS 		Nivolumab/relatlimab (240-80/20ml) 240-80mg/20ml Vial 9 $7,121.02 $13,146.50 $13,009.56 nat. median
$13,010
1.0× median
541
MS_DRG 		Osteomyelitis Without Cc/mcc 1 $12,928.00 $12,928.00 $12,928.00 nat. median
$9,247
1.4× median
67294
HCPCS 		Dabrafenib 75 Mg Cap 9 $7,013.87 $12,948.68 $12,813.80 nat. median
$3
outlier · 4745.9×
66756
HCPCS 		Ustekinumab 45 Mg/0.5 Ml Syrg 9 $6,985.77 $12,896.81 $12,762.47 nat. median
$2,295
outlier · 5.6×
67017
HCPCS 		Venetoclax 100 Mg Tab 9 $6,712.23 $12,391.81 $12,262.73 nat. median
$6,712
1.8× median
66906
HCPCS 		Everolimus 10 Mg Tab 9 $6,693.82 $12,357.83 $12,229.10 nat. median
$400
outlier · 30.6×
66905
HCPCS 		Everolimus 5 Mg Tab 9 $6,693.82 $12,357.83 $12,229.10 nat. median
$7,460
1.6× median
805
MS_DRG 		Vaginal Delivery Without Sterilization Or D&c With Mcc 1 $12,174.00 $12,174.00 $12,174.00 nat. median
$10,237
1.2× median
77373
HCPCS 		Radiation Tx Delivery, Sb 9 $6,367.92 $11,756.16 $11,633.70 nat. median
$3,714
outlier · 3.1×
67062
HCPCS 		Ibrutinib 420 Mg Tab 9 $6,277.81 $11,589.81 $11,469.08 nat. median
$180
outlier · 63.5×
67362
HCPCS 		Luspatercept-aamt 75 Mg Solr 9 $6,167.31 $11,385.81 $11,267.21 nat. median
$11,267
1.0× median
43534
CDM 		Zimmer Knee Coated Basepl 9 $6,082.44 $11,229.12 $11,112.15 nat. median
$6,082
1.8× median
28344
CDM 		Mesh Permacol Large 9 $6,043.22 $11,156.71 $11,040.49 nat. median
$45
outlier · 247.2×
77295
HCPCS 		3-d Radiotherapy Plan 9 $5,753.93 $10,622.64 $10,511.99 nat. median
$1,863
outlier · 5.6×
77301
HCPCS 		Radiotherapy Dose Plan IM 9 $5,753.80 $10,622.40 $10,511.75 nat. median
$2,773
outlier · 3.8×
67423
HCPCS 		Cemiplimab-rwlc 50 Mg/ml Vial 9 $5,680.98 $10,487.96 $10,378.71 nat. median
$10,379
1.0× median
66959
HCPCS 		Enzalutamide 40 Mg Cap 9 $5,670.70 $10,468.98 $10,359.93 nat. median
$266
outlier · 38.9×
43501
CDM 		Zimmer Hip Epoch Stem 9 $5,616.00 $10,368.00 $10,260.00 nat. median
$5,616
1.8× median
43527
CDM 		Zimmer Hip Acetabular Rev 9 $5,503.68 $10,160.64 $10,054.80 nat. median
$10,055
1.0× median
67213
HCPCS 		Abiraterone 500 Mg Tab 9 $5,463.11 $10,085.74 $9,980.68 nat. median
$7,460
1.3× median
67415
HCPCS 		Paliperidone Palm (3 Month) 819 Mg/2.63 Ml Syrg 9 $5,373.00 $9,919.38 $9,816.06 nat. median
$2,450
outlier · 4.0×
67224
HCPCS 		Selpercatinib 80 Mg Cap 9 $5,356.00 $9,888.00 $9,785.00 nat. median
$7,875
1.2× median
67406
HCPCS 		Imetelstat 188 Mg Vial 9 $5,293.87 $9,773.30 $9,671.49 nat. median
$21
outlier · 456.6×
43529
CDM 		Zimmer Hip Acetabular Cag 9 $5,235.36 $9,665.28 $9,564.60 nat. median
$2,256
outlier · 4.2×
67391
HCPCS 		Risankizumab-rzaa 60 Mg/ml Vial 9 $5,205.02 $9,609.27 $9,509.18 nat. median
$2,344
outlier · 4.1×

Other procedures at this hospital

Browse this hospital's 6,196 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
66511 HCPCS Interferon Beta-1b 0.3 Mg Kit 18 9 $3,402.51 $3,062.26 $1,769.31 $3,266.41 $3,232.38 2025-12-27
37547 CDM Sinuplasty Balloon Spin 18 9 $3,412.50 $3,071.25 $1,774.50 $3,276.00 $3,241.88 2025-12-27
67408 HCPCS Tremelimumab-actl 20 Mg/ml Vial 18 9 $3,448.93 $3,104.04 $1,793.44 $3,310.97 $3,276.48 2025-12-27
66995 HCPCS Plazomicin 500mg/10ml Vial 18 9 $3,459.00 $3,113.10 $1,798.68 $3,320.64 $3,286.05 2025-12-27
70498 HCPCS CT Angio Neck 18 9 $3,464.75 $3,118.28 $1,801.67 $3,326.16 $3,291.51 2025-12-27
43818 CDM Knee Tibia Insert 18 9 $3,465.00 $3,118.50 $1,801.80 $3,326.40 $3,291.75 2025-12-27
70496 HCPCS CT Angio Brain 18 9 $3,467.50 $3,120.75 $1,803.10 $3,328.80 $3,294.13 2025-12-27
71270 HCPCS Chest Without W/contrast 18 9 $3,472.75 $3,125.48 $1,805.83 $3,333.84 $3,299.11 2025-12-27
66837 HCPCS Pegfilgrastim (Onpro Kit) 6 Mg/0.6 Ml Syin 18 9 $3,488.05 $3,139.25 $1,813.79 $3,348.53 $3,313.65 2025-12-27
65683 HCPCS Pegfilgrastim 6 Mg/0.6ml Syrg 18 9 $3,488.05 $3,139.25 $1,813.79 $3,348.53 $3,313.65 2025-12-27
72194 HCPCS Pelvis Without -w/contrast 18 9 $3,496.50 $3,146.85 $1,818.18 $3,356.64 $3,321.68 2025-12-27
43816 CDM Knee Taper Stem 18 9 $3,497.82 $3,148.04 $1,818.87 $3,357.91 $3,322.93 2025-12-27
43819 CDM Knee Modular Stem 18 9 $3,497.82 $3,148.04 $1,818.87 $3,357.91 $3,322.93 2025-12-27
08163 HCPCS Penicillin G Benzathine 1200000 Unit/2 Ml Syrg 18 9 $3,505.61 $3,155.05 $1,822.92 $3,365.39 $3,330.33 2025-12-27
38979 CDM Dynanite Pip, Straight, 1 18 9 $3,505.75 $3,155.18 $1,822.99 $3,365.52 $3,330.46 2025-12-27
38980 CDM Dynanite Pip, Straight, 1 18 9 $3,505.75 $3,155.18 $1,822.99 $3,365.52 $3,330.46 2025-12-27
38981 CDM Dynanite Pip, Straight, 1 18 9 $3,505.75 $3,155.18 $1,822.99 $3,365.52 $3,330.46 2025-12-27
40040 CDM Dbm Putty, Allosync, 2.5c 18 9 $3,505.75 $3,155.18 $1,822.99 $3,365.52 $3,330.46 2025-12-27
43599 CDM Staple Kit, Fuseforce, La 18 9 $3,514.40 $3,162.96 $1,827.49 $3,373.82 $3,338.68 2025-12-27
09508 CDM Arthroflex, 4x7 18 9 $3,519.00 $3,167.10 $1,829.88 $3,378.24 $3,343.05 2025-12-27
73725 HCPCS Angiography Lower Extrem 18 9 $3,519.25 $3,167.33 $1,830.01 $3,378.48 $3,343.29 2025-12-27
66562 HCPCS Carfilzomib 60 Mg Solr 18 9 $3,537.19 $3,183.47 $1,839.34 $3,395.70 $3,360.33 2025-12-27
43790 CDM Biomet Hip Partial Endopr 18 9 $3,540.00 $3,186.00 $1,840.80 $3,398.40 $3,363.00 2025-12-27
43630 CDM Depuy Hip Partial Endopro 18 9 $3,540.00 $3,186.00 $1,840.80 $3,398.40 $3,363.00 2025-12-27
28359 CDM Physiomesh 15x20 18 9 $3,571.70 $3,214.53 $1,857.28 $3,428.83 $3,393.12 2025-12-27
639 MS_DRG Diabetes Without Cc/mcc 2 1 — — $3,402.00 $3,402.00 $3,402.00 2025-12-27
67226 HCPCS Inclisiran 284 Mg/1.5 Ml Syrg 18 9 $3,587.73 $3,228.96 $1,865.62 $3,444.22 $3,408.34 2025-12-27
73225 HCPCS Angio Upper Ext Wo Or W C 18 9 $3,590.50 $3,231.45 $1,867.06 $3,446.88 $3,410.98 2025-12-27
67001 HCPCS Mepolizumab 100 Mg Solr 18 9 $3,602.82 $3,242.54 $1,873.47 $3,458.71 $3,422.68 2025-12-27
72195 HCPCS Pelvis Without Contrast 36 9 $4,190.88 $3,771.79 $1,867.06 $4,599.60 $3,428.93 2025-12-27
73222 HCPCS Upper Extremity W/contras 18 9 $3,610.00 $3,249.00 $1,877.20 $3,465.60 $3,429.50 2025-12-27
74181 HCPCS Abdomen 18 9 $3,619.25 $3,257.33 $1,882.01 $3,474.48 $3,438.29 2025-12-27
43535 CDM Zimmer Knee Tibia Uncoate 18 9 $3,630.00 $3,267.00 $1,887.60 $3,484.80 $3,448.50 2025-12-27
43780 CDM Biomet Hip Cup 18 9 $3,630.00 $3,267.00 $1,887.60 $3,484.80 $3,448.50 2025-12-27
43620 CDM Depuy Hip Cup 18 9 $3,630.00 $3,267.00 $1,887.60 $3,484.80 $3,448.50 2025-12-27
65995 HCPCS Octreotide Acetate 20 Mg Kit 18 9 $3,634.70 $3,271.23 $1,890.04 $3,489.31 $3,452.97 2025-12-27
12385 CDM Implant, Hyprocure Sinus 18 9 $3,661.60 $3,295.44 $1,904.03 $3,515.14 $3,478.52 2025-12-27
70542 HCPCS Orbit, Face, Neck, Soft T 18 9 $3,666.75 $3,300.08 $1,906.71 $3,520.08 $3,483.41 2025-12-27
73206 HCPCS CT Upper Ext Angiograph A 18 9 $3,678.00 $3,310.20 $1,912.56 $3,530.88 $3,494.10 2025-12-27
77338 HCPCS Design Mlc Device For Imr 18 9 $3,680.25 $3,312.23 $1,913.73 $3,533.04 $3,496.24 2025-12-27
66281 HCPCS Nitazoxanide 500 Mg Tab 18 9 $3,684.78 $3,316.30 $1,916.09 $3,537.39 $3,500.54 2025-12-27
70547 HCPCS Angiography Neck Without Cont 18 9 $3,687.00 $3,318.30 $1,917.24 $3,539.52 $3,502.65 2025-12-27
28333 CDM Gore Tex Dual Mesh Lg 18 9 $3,712.50 $3,341.25 $1,930.50 $3,564.00 $3,526.88 2025-12-27
74170 HCPCS Abdomen Without W/contrast 18 9 $3,715.25 $3,343.73 $1,931.93 $3,566.64 $3,529.49 2025-12-27
74175 HCPCS CT Angio Aorta W/contrast 18 9 $3,725.50 $3,352.95 $1,937.26 $3,576.48 $3,539.23 2025-12-27
65998 HCPCS Darbepoetin Alfa 500 Mcg/ml Syrg 18 9 $3,729.73 $3,356.76 $1,939.46 $3,580.54 $3,543.24 2025-12-27
73706 HCPCS CT Lower Ext Angiogram An 18 9 $3,746.50 $3,371.85 $1,948.18 $3,596.64 $3,559.18 2025-12-27
67425 HCPCS Abacavir-dolutegravir-lamivud 600-50-300 Mg Tab 18 9 $3,761.02 $3,384.92 $1,955.73 $3,610.58 $3,572.97 2025-12-27
73722 HCPCS Lower Ext Joints W/contr 18 9 $3,762.25 $3,386.03 $1,956.37 $3,611.76 $3,574.14 2025-12-27
71551 HCPCS Chest W Contrast 18 9 $3,776.50 $3,398.85 $1,963.78 $3,625.44 $3,587.68 2025-12-27
67390 HCPCS Pegfilgrastim-apgf 6 Mg/0.6 Ml Syrg 18 9 $3,787.63 $3,408.87 $1,969.57 $3,636.12 $3,598.25 2025-12-27
67209 HCPCS Pegfilgrastim-bmez 6 Mg/0.6 Ml Syrg 18 9 $3,788.14 $3,409.33 $1,969.83 $3,636.61 $3,598.73 2025-12-27
67195 HCPCS Bezlotoxumab 25 Mg/ml Soln 18 9 $3,800.00 $3,420.00 $1,976.00 $3,648.00 $3,610.00 2025-12-27
71275 HCPCS CT Angio Chest 18 9 $3,800.50 $3,420.45 $1,976.26 $3,648.48 $3,610.48 2025-12-27
43805 CDM Hip Bipolar Head Liner Se 18 9 $3,811.50 $3,430.35 $1,981.98 $3,659.04 $3,620.93 2025-12-27
73218 HCPCS Upper Extremity Without Contr 36 9 $3,818.50 $3,436.65 $1,985.62 $3,665.76 $3,627.58 2025-12-27
72196 HCPCS Pelvis W Contrast 18 9 $3,839.00 $3,455.10 $1,996.28 $3,685.44 $3,647.05 2025-12-27
70548 HCPCS Angiography Neck W/contra 18 9 $3,868.00 $3,481.20 $2,011.36 $3,713.28 $3,674.60 2025-12-27
70544 HCPCS Angiography Head Without Cont 18 9 $3,871.75 $3,484.58 $2,013.31 $3,716.88 $3,678.16 2025-12-27
28347 CDM Mesh Permacol 10x10 18 9 $3,873.87 $3,486.48 $2,014.41 $3,718.92 $3,680.18 2025-12-27
795 MS_DRG Normal Newborn 2 1 — — $3,715.00 $3,715.00 $3,715.00 2025-12-27
19081 HCPCS Breast Biopsy, W Plcmt Lc 18 9 $3,924.00 $3,531.60 $2,040.48 $3,767.04 $3,727.80 2025-12-27
01245 CDM Ignite Power Mixer 18 9 $3,948.00 $3,553.20 $2,052.96 $3,790.08 $3,750.60 2025-12-27
77049 HCPCS Breast Bilateral W Without Co 18 9 $3,959.25 $3,563.33 $2,058.81 $3,800.88 $3,761.29 2025-12-27
01254 CDM Beads, Stimulan, Rapid Cu 18 9 $3,960.00 $3,564.00 $2,059.20 $3,801.60 $3,762.00 2025-12-27
43506 CDM Zimmer Hip Head >36mm 18 9 $3,960.00 $3,564.00 $2,059.20 $3,801.60 $3,762.00 2025-12-27
01248 CDM Allograft 18 9 $3,968.94 $3,572.05 $2,063.85 $3,810.18 $3,770.49 2025-12-27
67310 HCPCS Nivolumab 120 Mg/12 Ml Vial 18 9 $3,971.53 $3,574.38 $2,065.20 $3,812.67 $3,772.95 2025-12-27
72141 HCPCS Cervical Spine 18 9 $3,979.75 $3,581.78 $2,069.47 $3,820.56 $3,780.76 2025-12-27
67148 HCPCS Ado-trastuzumab Emtansine 100 Mg Solr 18 9 $3,989.63 $3,590.67 $2,074.61 $3,830.04 $3,790.15 2025-12-27
75635 HCPCS CT Angio Aorta W/runoff 18 9 $4,005.25 $3,604.73 $2,082.73 $3,845.04 $3,804.99 2025-12-27
67333 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6 Ml Syrg 18 9 $4,028.88 $3,625.99 $2,095.02 $3,867.72 $3,827.44 2025-12-27
70551 HCPCS Brain 18 9 $4,043.00 $3,638.70 $2,102.36 $3,881.28 $3,840.85 2025-12-27
73720 HCPCS Lower Ext Wo/w Contrast L 36 9 $4,048.50 $3,643.65 $2,105.22 $3,886.56 $3,846.08 2025-12-27
67386 HCPCS Bictegrav-emtricit-tenofov Ala 50-200-25 Mg Tab 18 9 $4,068.54 $3,661.69 $2,115.64 $3,905.80 $3,865.11 2025-12-27
66961 HCPCS Nelarabine 250 Mg/50 Ml Vial 18 9 $4,084.37 $3,675.93 $2,123.87 $3,921.00 $3,880.15 2025-12-27
71550 HCPCS Chest 18 9 $4,091.50 $3,682.35 $2,127.58 $3,927.84 $3,886.93 2025-12-27
794 MS_DRG Neonate With Other Significant Problems 2 1 — — $3,895.00 $3,895.00 $3,895.00 2025-12-27
74182 HCPCS Abdomen W/contrast 18 9 $4,100.75 $3,690.68 $2,132.39 $3,936.72 $3,895.71 2025-12-27
72146 HCPCS Thoracic Spine 18 9 $4,108.50 $3,697.65 $2,136.42 $3,944.16 $3,903.08 2025-12-27
67363 HCPCS Luspatercept-aamt 25 Mg Solr 18 9 $4,113.14 $3,701.83 $2,138.83 $3,948.61 $3,907.48 2025-12-27
43611 CDM Depuy Hip Head >36mm 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43664 CDM Depuy Knee Tibia Poly 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43600 CDM Depuy Hip Stem Fracture 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43776 CDM Biomet Hip Head Metal >36 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43770 CDM Biomet Stem Hip Fracture 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43626 CDM Depuy Hip Liner Crosslink 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43700 CDM Stryker Knee Scorpio Ceme 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
73723 HCPCS Low Ext Joints Wo/w Cont 18 9 $4,179.50 $3,761.55 $2,173.34 $4,012.32 $3,970.53 2025-12-27
73219 HCPCS Upper Extremity W/contras 18 9 $4,202.50 $3,782.25 $2,185.30 $4,034.40 $3,992.38 2025-12-27
01256 CDM Viaflow Flowable Placenta 18 9 $4,207.50 $3,786.75 $2,187.90 $4,039.20 $3,997.13 2025-12-27
67188 HCPCS Enfortumab-vedotin-ejfv 30 Mg/3 Ml Solr 18 9 $4,213.50 $3,792.15 $2,191.02 $4,044.96 $4,002.83 2025-12-27
72142 HCPCS Cervical Spine With Contr 18 9 $4,278.75 $3,850.88 $2,224.95 $4,107.60 $4,064.81 2025-12-27
72147 HCPCS Thoracic Spine With Contr 18 9 $4,278.75 $3,850.88 $2,224.95 $4,107.60 $4,064.81 2025-12-27
77470 HCPCS Special Radiation Trmt 18 9 $4,287.75 $3,858.98 $2,229.63 $4,116.24 $4,073.36 2025-12-27
43500 CDM Zimmer Hip Fracture Stem 18 9 $4,290.00 $3,861.00 $2,230.80 $4,118.40 $4,075.50 2025-12-27
43510 CDM Zimmer Hip Non Metal 18 9 $4,290.00 $3,861.00 $2,230.80 $4,118.40 $4,075.50 2025-12-27
43541 CDM Zimmer Knee Insert Flex, 18 9 $4,290.00 $3,861.00 $2,230.80 $4,118.40 $4,075.50 2025-12-27
67033 HCPCS Durvalumab 50 Mg/ml Soln 18 9 $4,294.66 $3,865.19 $2,233.22 $4,122.87 $4,079.93 2025-12-27
70543 HCPCS Orbits, Face, Neck, Soft 18 9 $4,324.25 $3,891.83 $2,248.61 $4,151.28 $4,108.04 2025-12-27
43811 CDM Hip Liner Acetabular High 18 9 $4,331.25 $3,898.13 $2,252.25 $4,158.00 $4,114.69 2025-12-27
43812 CDM Hip Stem Fracture 18 9 $4,331.25 $3,898.13 $2,252.25 $4,158.00 $4,114.69 2025-12-27
43803 CDM Hip Head Metal >36mm 18 9 $4,331.25 $3,898.13 $2,252.25 $4,158.00 $4,114.69 2025-12-27
70545 HCPCS Angiography Head W/contr 18 9 $4,350.25 $3,915.23 $2,262.13 $4,176.24 $4,132.74 2025-12-27
67253 HCPCS Tezepelumab-ekko 210 Mg/1.91 Ml Syrg 18 9 $4,368.52 $3,931.67 $2,271.63 $4,193.78 $4,150.09 2025-12-27
73220 HCPCS Upper Extr Wo/w Contrast 36 9 $4,401.25 $3,961.13 $2,288.65 $4,225.20 $4,181.19 2025-12-27
73223 HCPCS Upper Ext Jts Wo/w Contr 36 9 $4,403.00 $3,962.70 $2,289.56 $4,226.88 $4,182.85 2025-12-27
77386 HCPCS Radiation Tx Delivery, IM 18 9 $4,408.00 $3,967.20 $2,292.16 $4,231.68 $4,187.60 2025-12-27
70552 HCPCS Brain With Contrast 18 9 $4,437.25 $3,993.53 $2,307.37 $4,259.76 $4,215.39 2025-12-27
01244 CDM Ureteroscope, Lithovue, S 18 9 $4,440.00 $3,996.00 $2,308.80 $4,262.40 $4,218.00 2025-12-27
74185 HCPCS Angiography Abdomen 18 9 $4,440.75 $3,996.68 $2,309.19 $4,263.12 $4,218.71 2025-12-27
71552 HCPCS Chest Without W Contrast 18 9 $4,448.50 $4,003.65 $2,313.22 $4,270.56 $4,226.08 2025-12-27
43777 CDM Biomet Hip Head Non-metal 18 9 $4,455.00 $4,009.50 $2,316.60 $4,276.80 $4,232.25 2025-12-27
43520 CDM Zimmer Hip Liner 18 9 $4,455.00 $4,009.50 $2,316.60 $4,276.80 $4,232.25 2025-12-27
43556 CDM Zimmer Uni Knee Tibia 18 9 $4,455.00 $4,009.50 $2,316.60 $4,276.80 $4,232.25 2025-12-27
43612 CDM Depuy Hip Head Non Metal 18 9 $4,455.00 $4,009.50 $2,316.60 $4,276.80 $4,232.25 2025-12-27
66607 HCPCS Dalfampridine 10 Mg Tb12 18 9 $4,469.76 $4,022.78 $2,324.28 $4,290.97 $4,246.27 2025-12-27
67311 HCPCS Lanreotide (cipla) 120 Mg/0.5 Ml Syrg 18 9 $4,528.37 $4,075.53 $2,354.75 $4,347.24 $4,301.95 2025-12-27
18220 HCPCS Digoxin Immune Fab 40 Mg Solr 18 9 $4,535.30 $4,081.77 $2,358.36 $4,353.89 $4,308.54 2025-12-27
70553 HCPCS Brain, Wo/w Contrast 18 9 $4,570.25 $4,113.23 $2,376.53 $4,387.44 $4,341.74 2025-12-27
70546 HCPCS Angiography Head Wo/w Con 18 9 $4,584.75 $4,126.28 $2,384.07 $4,401.36 $4,355.51 2025-12-27
70549 HCPCS Angiography Neck Wo/w Con 18 9 $4,596.00 $4,136.40 $2,389.92 $4,412.16 $4,366.20 2025-12-27
43542 CDM Zimmer Knee Insert Mobile 18 9 $4,620.00 $4,158.00 $2,402.40 $4,435.20 $4,389.00 2025-12-27
77385 HCPCS Radiation Tx Delivery, IM 18 9 $4,635.50 $4,171.95 $2,410.46 $4,450.08 $4,403.73 2025-12-27
03087 CDM Surgery Room Major Level 18 9 $4,650.00 $4,185.00 $2,418.00 $4,464.00 $4,417.50 2025-12-27
43810 CDM Hip Head Ceramic 18 9 $4,677.75 $4,209.98 $2,432.43 $4,490.64 $4,443.86 2025-12-27
66461 HCPCS RiTUXimab 500 Mg/50 Ml Vial 18 9 $4,697.60 $4,227.84 $2,442.75 $4,509.70 $4,462.72 2025-12-27
72158 HCPCS L-spine Wo/w Contrast 18 9 $4,707.25 $4,236.53 $2,447.77 $4,518.96 $4,471.89 2025-12-27
95810 HCPCS Sleep Study Baseline 36 9 $4,711.25 $4,240.13 $2,449.85 $4,522.80 $4,475.69 2025-12-27
72197 HCPCS Prostate W Without Contrast 18 9 $4,766.25 $4,289.63 $2,478.45 $4,575.60 $4,527.94 2025-12-27
43677 CDM Depuy Uni Knee Tibia 18 9 $4,785.00 $4,306.50 $2,488.20 $4,593.60 $4,545.75 2025-12-27
43782 CDM Biomet Hip Cup Highly Por 18 9 $4,800.00 $4,320.00 $2,496.00 $4,608.00 $4,560.00 2025-12-27
74183 HCPCS Abdomen W Without Contrast 18 9 $4,818.00 $4,336.20 $2,505.36 $4,625.28 $4,577.10 2025-12-27
39937 HCPCS Filgrastim 480 Mcg/1.6 Ml Soln 18 9 $4,832.99 $4,349.69 $2,513.15 $4,639.67 $4,591.34 2025-12-27
66642 HCPCS Fingolimod 0.5 Mg Cap 18 9 $4,872.68 $4,385.41 $2,533.79 $4,677.77 $4,629.05 2025-12-27
72156 HCPCS C-spine, Wo/w Contrast 18 9 $4,890.25 $4,401.23 $2,542.93 $4,694.64 $4,645.74 2025-12-27
43671 CDM Depuy Knee Insert Rp Or R 18 9 $4,960.00 $4,464.00 $2,579.20 $4,761.60 $4,712.00 2025-12-27
72157 HCPCS T-spine Wo/w Contrast 18 9 $4,964.75 $4,468.28 $2,581.67 $4,766.16 $4,716.51 2025-12-27
01255 CDM Graft Jacket, 5x5 Standar 18 9 $5,057.25 $4,551.53 $2,629.77 $4,854.96 $4,804.39 2025-12-27
66821 HCPCS IdaruCIZUMAB 5 Gram Soln 18 9 $5,076.90 $4,569.21 $2,639.99 $4,873.82 $4,823.06 2025-12-27
72149 HCPCS Lumbar Spine With Contras 18 9 $5,093.00 $4,583.70 $2,648.36 $4,889.28 $4,838.35 2025-12-27
66667 HCPCS Valganciclovir 450 Mg Tab 18 9 $5,118.50 $4,606.65 $2,661.62 $4,913.76 $4,862.58 2025-12-27
43624 CDM Depuy Hip Cup Gription 18 9 $5,120.00 $4,608.00 $2,662.40 $4,915.20 $4,864.00 2025-12-27
67301 HCPCS Pimavanserin 34 Mg Cap 18 9 $5,120.00 $4,608.00 $2,662.40 $4,915.20 $4,864.00 2025-12-27
43650 CDM Depuy Knee Femur Uncoated 18 9 $5,120.00 $4,608.00 $2,662.40 $4,915.20 $4,864.00 2025-12-27
43676 CDM Depuy Uni Knee Femur 18 9 $5,120.00 $4,608.00 $2,662.40 $4,915.20 $4,864.00 2025-12-27
39921 CDM Bone Matrix, Bio4 Vialble 18 9 $5,167.80 $4,651.02 $2,687.26 $4,961.09 $4,909.41 2025-12-27
66808 HCPCS Tolvaptan 15 Mg Tab 18 9 $5,201.97 $4,681.77 $2,705.02 $4,993.89 $4,941.87 2025-12-27
43826 CDM Knee, Attune Insert 18 9 $5,208.00 $4,687.20 $2,708.16 $4,999.68 $4,947.60 2025-12-27
66874 HCPCS Leuprolide (3 Month) 11.25 Mg Sykt 18 9 $5,214.26 $4,692.83 $2,711.42 $5,005.69 $4,953.55 2025-12-27
67126 HCPCS Capecitabine 500 Mg Tab 18 9 $5,286.76 $4,758.08 $2,749.12 $5,075.29 $5,022.42 2025-12-27
26475 CDM Lad Ligament Augmentation 18 9 $5,298.81 $4,768.93 $2,755.38 $5,086.86 $5,033.87 2025-12-27
95811 HCPCS Sleep Study Split Night 36 9 $5,359.00 $4,823.10 $2,786.68 $5,144.64 $5,091.05 2025-12-27
43821 CDM Knee Femoral Adapter Bolt 18 9 $5,376.00 $4,838.40 $2,795.52 $5,160.96 $5,107.20 2025-12-27
43824 CDM Knee, Attune Femur 18 9 $5,376.00 $4,838.40 $2,795.52 $5,160.96 $5,107.20 2025-12-27
43804 CDM Hip Acetabular Shell Cup 18 9 $5,376.00 $4,838.40 $2,795.52 $5,160.96 $5,107.20 2025-12-27
66885 HCPCS Sirolimus 2 Mg Tab 18 9 $5,395.76 $4,856.18 $2,805.80 $5,179.93 $5,125.97 2025-12-27
66227 HCPCS Tolvaptan 30 Mg Tab 18 9 $5,396.43 $4,856.79 $2,806.14 $5,180.57 $5,126.61 2025-12-27
43515 CDM Zimmer Hip Cup 18 9 $5,440.00 $4,896.00 $2,828.80 $5,222.40 $5,168.00 2025-12-27
43651 CDM Depuy Knee Femur Pfj 18 9 $5,440.00 $4,896.00 $2,828.80 $5,222.40 $5,168.00 2025-12-27
43601 CDM Depuy Hip Stem Cemented 18 9 $5,600.00 $5,040.00 $2,912.00 $5,376.00 $5,320.00 2025-12-27
43771 CDM Biomet Hip Stem Cemented 18 9 $5,600.00 $5,040.00 $2,912.00 $5,376.00 $5,320.00 2025-12-27
66592 HCPCS Certolizumab Pegol 200 Mg/ml X 2 Sykt 18 9 $5,702.61 $5,132.35 $2,965.36 $5,474.51 $5,417.48 2025-12-27
43721 CDM Stryker Knee X3 Inserts 18 9 $5,760.00 $5,184.00 $2,995.20 $5,529.60 $5,472.00 2025-12-27
43660 CDM Depuy Knee Tibia Uncoated 18 9 $5,760.00 $5,184.00 $2,995.20 $5,529.60 $5,472.00 2025-12-27
43710 CDM Stryker Knee Cemented Tib 18 9 $5,760.00 $5,184.00 $2,995.20 $5,529.60 $5,472.00 2025-12-27
65917 HCPCS Crotalidae Polyvalent Immune Fab Vial 18 9 $5,831.88 $5,248.69 $3,032.58 $5,598.60 $5,540.29 2025-12-27
67068 HCPCS Tofacitinib 11 Mg Tb24 18 9 $5,860.59 $5,274.53 $3,047.51 $5,626.17 $5,567.56 2025-12-27
67073 HCPCS Tofacitinib 5 Mg Tab 18 9 $5,860.59 $5,274.53 $3,047.51 $5,626.17 $5,567.56 2025-12-27
43808 CDM Hip Stem Cemented 18 9 $5,880.00 $5,292.00 $3,057.60 $5,644.80 $5,586.00 2025-12-27
66852 HCPCS Glatiramer 40 Mg/ml Syrg 18 9 $5,909.28 $5,318.35 $3,072.83 $5,672.91 $5,613.82 2025-12-27
24207 CDM Interstim Lead (28-33-41) 18 9 $5,913.00 $5,321.70 $3,074.76 $5,676.48 $5,617.35 2025-12-27
43786 CDM Biomet Hip Ceramic Or E1 18 9 $6,000.00 $5,400.00 $3,120.00 $5,760.00 $5,700.00 2025-12-27
43662 CDM Depuy Knee Tibia Coated 18 9 $6,000.00 $5,400.00 $3,120.00 $5,760.00 $5,700.00 2025-12-27
43536 CDM Zimmer Knee Tibia Uncoat 18 9 $6,000.00 $5,400.00 $3,120.00 $5,760.00 $5,700.00 2025-12-27
43711 CDM Stryker Knee Cementless T 18 9 $6,000.00 $5,400.00 $3,120.00 $5,760.00 $5,700.00 2025-12-27
66602 HCPCS Ixabepilone 45 Mg Solr 18 9 $6,043.68 $5,439.31 $3,142.71 $5,801.93 $5,741.50 2025-12-27
43813 CDM Knee Tibia Tray Uncoated 18 9 $6,048.00 $5,443.20 $3,144.96 $5,806.08 $5,745.60 2025-12-27
43701 CDM Stryker Knee Triathlon/pk 18 9 $6,080.00 $5,472.00 $3,161.60 $5,836.80 $5,776.00 2025-12-27
66778 HCPCS Deferasirox 500 Mg Tbdp 18 9 $6,173.29 $5,555.96 $3,210.11 $5,926.36 $5,864.63 2025-12-27
66124 HCPCS Leuprolide (3 Month) 22.5 Mg Kit 18 9 $6,213.52 $5,592.17 $3,231.03 $5,964.98 $5,902.84 2025-12-27
43552 CDM Zimmer Knee Femoral Block 18 9 $6,237.00 $5,613.30 $3,243.24 $5,987.52 $5,925.15 2025-12-27
00258 CDM Augment Bone Graft 18 9 $6,300.00 $5,670.00 $3,276.00 $6,048.00 $5,985.00 2025-12-27
67365 HCPCS Efgartigimod Alfa-fcab 20 Mg/ml Vial 18 9 $6,314.19 $5,682.77 $3,283.38 $6,061.62 $5,998.48 2025-12-27
26470 CDM Optilume, 30fr X 5cm, Dcb 18 9 $6,336.25 $5,702.63 $3,294.85 $6,082.80 $6,019.44 2025-12-27
26469 CDM Optilume, 24fr X 5cm, Dcb 18 9 $6,336.25 $5,702.63 $3,294.85 $6,082.80 $6,019.44 2025-12-27
66023 HCPCS Octreotide Acetate 30 Mg Kit 18 9 $6,337.09 $5,703.38 $3,295.29 $6,083.61 $6,020.24 2025-12-27
66608 HCPCS Ado-trastuzumab Emtansine 160 Mg Solr 18 9 $6,383.40 $5,745.06 $3,319.37 $6,128.06 $6,064.23 2025-12-27
74174 HCPCS CT Angio Abdomen/pelvis 18 9 $6,383.50 $5,745.15 $3,319.42 $6,128.16 $6,064.33 2025-12-27
67105 HCPCS Rituximab-hyaluronidasehuman 1400 Mg/11.7 Ml (120 Mg/ml) Soln 18 9 $6,576.58 $5,918.92 $3,419.82 $6,313.52 $6,247.75 2025-12-27
43652 CDM Depuy Knee Femur Coated 18 9 $6,600.00 $5,940.00 $3,432.00 $6,336.00 $6,270.00 2025-12-27
43604 CDM Depuy Hip Stem Modular 18 9 $6,600.00 $5,940.00 $3,432.00 $6,336.00 $6,270.00 2025-12-27
03088 CDM Surgery Room Major Level 18 9 $6,640.00 $5,976.00 $3,452.80 $6,374.40 $6,308.00 2025-12-27
43621 CDM Depuy Hip Cup Acetabular 18 9 $6,674.82 $6,007.34 $3,470.91 $6,407.83 $6,341.08 2025-12-27
66156 HCPCS Adalimumab 40 Mg/0.8 Ml Pnkt 18 9 $6,680.33 $6,012.30 $3,473.77 $6,413.12 $6,346.31 2025-12-27
43817 CDM Knee Femoral Adapter 18 9 $6,722.26 $6,050.03 $3,495.58 $6,453.37 $6,386.15 2025-12-27
43661 CDM Depuy Knee Tibia Uncoated 18 9 $6,750.00 $6,075.00 $3,510.00 $6,480.00 $6,412.50 2025-12-27
78608 HCPCS PET CT Brain Imaging, Met 18 9 $6,760.00 $6,084.00 $3,515.20 $6,489.60 $6,422.00 2025-12-27
67339 HCPCS Mirvetuximab Soravtansine-gynx 5 Mg/ml Vial 18 9 $6,782.35 $6,104.12 $3,526.82 $6,511.06 $6,443.23 2025-12-27
66637 HCPCS Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Vial 18 9 $6,820.49 $6,138.44 $3,546.65 $6,547.67 $6,479.47 2025-12-27
43555 CDM Zimmer Uni Knee Femur 18 9 $6,900.00 $6,210.00 $3,588.00 $6,624.00 $6,555.00 2025-12-27
66726 HCPCS Panitumumab 400 Mg/20 Ml (20 Mg/ml) Soln 18 9 $6,992.28 $6,293.05 $3,635.99 $6,712.59 $6,642.67 2025-12-27
66145 HCPCS Tobramycin 300 Mg/5 Ml Nebu 18 9 $7,003.75 $6,303.38 $3,641.95 $6,723.60 $6,653.56 2025-12-27
43825 CDM Knee, Attune Tibial Basep 18 9 $7,087.50 $6,378.75 $3,685.50 $6,804.00 $6,733.13 2025-12-27
43702 CDM Stryker Knee Cemented Fem 18 9 $7,200.00 $6,480.00 $3,744.00 $6,912.00 $6,840.00 2025-12-27
43663 CDM Depuy Knee Tibia Coated R 18 9 $7,200.00 $6,480.00 $3,744.00 $6,912.00 $6,840.00 2025-12-27
43781 CDM Biomet Hip Cup Metal On M 18 9 $7,500.00 $6,750.00 $3,900.00 $7,200.00 $7,125.00 2025-12-27
66868 HCPCS Ramucirumab 10 Mg/ml Soln 18 9 $7,503.93 $6,753.54 $3,902.04 $7,203.77 $7,128.73 2025-12-27
66641 HCPCS Teriflunomide 14 Mg Tab 18 9 $7,521.93 $6,769.74 $3,911.40 $7,221.05 $7,145.83 2025-12-27
78815 HCPCS PET CT Skull Base - Mid T 18 9 $7,701.50 $6,931.35 $4,004.78 $7,393.44 $7,316.43 2025-12-27
66358 HCPCS Lenalidomide 5 Mg Cap 18 9 $7,774.62 $6,997.16 $4,042.80 $7,463.64 $7,385.89 2025-12-27
43772 CDM Biomet Hip Stem Cementles 18 9 $7,800.00 $7,020.00 $4,056.00 $7,488.00 $7,410.00 2025-12-27
43773 CDM Biomet Hip Stem Modular 18 9 $7,800.00 $7,020.00 $4,056.00 $7,488.00 $7,410.00 2025-12-27
67225 HCPCS Selpercatinib 40 Mg Cap 18 9 $7,909.16 $7,118.24 $4,112.76 $7,592.79 $7,513.70 2025-12-27
66951 HCPCS Nivolumab 240mg/24ml Vial 18 9 $7,943.08 $7,148.77 $4,130.40 $7,625.36 $7,545.93 2025-12-27
57384 HCPCS Tenecteplase 50 Mg Vial 18 9 $8,089.83 $7,280.85 $4,206.71 $7,766.24 $7,685.34 2025-12-27
67451 HCPCS Nivolumab-hyaluronidase-nvhy 600 Mg-10000 Unit/5 Ml Vial 18 9 $8,101.94 $7,291.75 $4,213.01 $7,777.86 $7,696.84 2025-12-27
67107 HCPCS Atezolizumab 840 Mg/14 Ml (60 Mg/ml) Soln 18 9 $8,112.56 $7,301.30 $4,218.53 $7,788.06 $7,706.93 2025-12-27
66949 HCPCS Imatinib 100 Mg Tab 18 9 $8,132.48 $7,319.23 $4,228.89 $7,807.18 $7,725.86 2025-12-27
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 2 1 — — $7,739.00 $7,739.00 $7,739.00 2025-12-27
28346 CDM Permacol Mesh 15x20 18 9 $8,190.00 $7,371.00 $4,258.80 $7,862.40 $7,780.50 2025-12-27
67435 HCPCS Lurbinectedin 4 Mg Solr 18 9 $8,250.00 $7,425.00 $4,290.00 $7,920.00 $7,837.50 2025-12-27
66878 HCPCS Dimethyl Fumarate 240 Mg Cpdr 18 9 $8,275.89 $7,448.30 $4,303.46 $7,944.85 $7,862.10 2025-12-27
66329 HCPCS Leuprolide (4 Month) 30 Mg Sykt 18 9 $8,284.72 $7,456.25 $4,308.05 $7,953.33 $7,870.48 2025-12-27
66676 HCPCS Nilotinib 150 Mg Cap 18 9 $8,290.47 $7,461.42 $4,311.04 $7,958.85 $7,875.95 2025-12-27
43602 CDM Depuy Hip Stem Cementless 18 9 $8,400.00 $7,560.00 $4,368.00 $8,064.00 $7,980.00 2025-12-27
542 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 2 1 — — $8,025.00 $8,025.00 $8,025.00 2025-12-27
00640 HCPCS Alteplase 100 Mg Solr 18 9 $8,492.35 $7,643.12 $4,416.02 $8,152.66 $8,067.73 2025-12-27
67229 HCPCS Ofatumumab 20 Mg/0.4 Ml Pnij 18 9 $8,522.66 $7,670.39 $4,431.78 $8,181.75 $8,096.53 2025-12-27
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 2 1 — — $8,101.00 $8,101.00 $8,101.00 2025-12-27
43530 CDM Zimmer Knee Femur 18 9 $8,550.00 $7,695.00 $4,446.00 $8,208.00 $8,122.50 2025-12-27
43623 CDM Depuy Hip Cup Duraloc 18 9 $8,557.17 $7,701.45 $4,449.73 $8,214.88 $8,129.31 2025-12-27
66370 HCPCS Imatinib 400 Mg Tab 18 9 $8,782.29 $7,904.06 $4,566.79 $8,431.00 $8,343.18 2025-12-27
66080 HCPCS Natalizumab 300 Mg/15 Ml Vial 18 9 $8,879.22 $7,991.30 $4,617.19 $8,524.05 $8,435.26 2025-12-27
78816 HCPCS PET CT Whole Body 18 9 $8,884.50 $7,996.05 $4,619.94 $8,529.12 $8,440.28 2025-12-27
202 MS_DRG Bronchitis And Asthma With Cc/mcc 2 1 — — $8,536.00 $8,536.00 $8,536.00 2025-12-27
67364 HCPCS Obinutuzumab 1000 Mg/40 Ml Vial 18 9 $9,000.29 $8,100.26 $4,680.15 $8,640.28 $8,550.28 2025-12-27
66658 HCPCS Ipilimumab 50 Mg/10 Ml (5 Mg/ml) Soln 18 9 $9,054.74 $8,149.27 $4,708.46 $8,692.55 $8,602.00 2025-12-27
67421 HCPCS Pertuzumab-trastuzumab-hy-zzxf (600mg-600mg-20000u/10ml) 600 Mg-600 Mg-20000 Uni… 18 9 $9,277.32 $8,349.59 $4,824.21 $8,906.23 $8,813.45 2025-12-27
66751 HCPCS Vedolizumab 300 Mg Vial 18 9 $9,359.91 $8,423.92 $4,867.15 $8,985.51 $8,891.91 2025-12-27
66902 HCPCS Cabazitaxel 10 Mg/ml (first Dilution) Soln 18 9 $9,667.84 $8,701.06 $5,027.28 $9,281.13 $9,184.45 2025-12-27
791 MS_DRG Prematurity With Major Problems 2 1 — — $9,237.00 $9,237.00 $9,237.00 2025-12-27
66520 HCPCS Leuprolide (6 Month) 45 Mg Sykt 18 9 $9,816.91 $8,835.22 $5,104.79 $9,424.23 $9,326.06 2025-12-27
66838 HCPCS Sildenafil 10 Mg/ml Susr 18 9 $9,817.01 $8,835.31 $5,104.85 $9,424.33 $9,326.16 2025-12-27
66990 HCPCS Atezolizumab 1200 Mg/20 Ml (60 Mg/ml) Soln 18 9 $9,848.64 $8,863.78 $5,121.29 $9,454.69 $9,356.21 2025-12-27
66768 HCPCS Pembrolizumab 100mg/4ml Vial 18 9 $9,869.92 $8,882.93 $5,132.36 $9,475.12 $9,376.42 2025-12-27
66272 HCPCS Dasatinib 100 Mg Tab 18 9 $9,875.35 $8,887.82 $5,135.18 $9,480.34 $9,381.58 2025-12-27
66919 HCPCS Lanreotide 120 Mg/0.5 Ml Syrg 18 9 $9,944.00 $8,949.60 $5,170.88 $9,546.24 $9,446.80 2025-12-27
67247 HCPCS Daratumumab-hyaluronidase-fihj 1800 Mg-30000 Unit/15 Ml Vial 18 9 $9,972.52 $8,975.27 $5,185.71 $9,573.62 $9,473.89 2025-12-27
66747 HCPCS Abiraterone 250 Mg Tab 18 9 $9,976.36 $8,978.72 $5,187.71 $9,577.31 $9,477.54 2025-12-27
67391 HCPCS Risankizumab-rzaa 60 Mg/ml Vial 18 9 $10,009.66 $9,008.69 $5,205.02 $9,609.27 $9,509.18 2025-12-27
43529 CDM Zimmer Hip Acetabular Cag 18 9 $10,068.00 $9,061.20 $5,235.36 $9,665.28 $9,564.60 2025-12-27
67406 HCPCS Imetelstat 188 Mg Vial 18 9 $10,180.52 $9,162.47 $5,293.87 $9,773.30 $9,671.49 2025-12-27
67224 HCPCS Selpercatinib 80 Mg Cap 18 9 $10,300.00 $9,270.00 $5,356.00 $9,888.00 $9,785.00 2025-12-27
67415 HCPCS Paliperidone Palm (3 Month) 819 Mg/2.63 Ml Syrg 18 9 $10,332.69 $9,299.42 $5,373.00 $9,919.38 $9,816.06 2025-12-27
67213 HCPCS Abiraterone 500 Mg Tab 18 9 $10,505.98 $9,455.38 $5,463.11 $10,085.74 $9,980.68 2025-12-27
43527 CDM Zimmer Hip Acetabular Rev 18 9 $10,584.00 $9,525.60 $5,503.68 $10,160.64 $10,054.80 2025-12-27
43501 CDM Zimmer Hip Epoch Stem 18 9 $10,800.00 $9,720.00 $5,616.00 $10,368.00 $10,260.00 2025-12-27
66959 HCPCS Enzalutamide 40 Mg Cap 18 9 $10,905.19 $9,814.67 $5,670.70 $10,468.98 $10,359.93 2025-12-27
67423 HCPCS Cemiplimab-rwlc 50 Mg/ml Vial 18 9 $10,924.96 $9,832.46 $5,680.98 $10,487.96 $10,378.71 2025-12-27
77301 HCPCS Radiotherapy Dose Plan IM 18 9 $11,065.00 $9,958.50 $5,753.80 $10,622.40 $10,511.75 2025-12-27
77295 HCPCS 3-d Radiotherapy Plan 18 9 $11,065.25 $9,958.73 $5,753.93 $10,622.64 $10,511.99 2025-12-27
28344 CDM Mesh Permacol Large 18 9 $11,621.57 $10,459.41 $6,043.22 $11,156.71 $11,040.49 2025-12-27
43534 CDM Zimmer Knee Coated Basepl 18 9 $11,697.00 $10,527.30 $6,082.44 $11,229.12 $11,112.15 2025-12-27
67362 HCPCS Luspatercept-aamt 75 Mg Solr 18 9 $11,860.22 $10,674.20 $6,167.31 $11,385.81 $11,267.21 2025-12-27
67062 HCPCS Ibrutinib 420 Mg Tab 18 9 $12,072.72 $10,865.45 $6,277.81 $11,589.81 $11,469.08 2025-12-27
77373 HCPCS Radiation Tx Delivery, Sb 18 9 $12,246.00 $11,021.40 $6,367.92 $11,756.16 $11,633.70 2025-12-27
805 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Mcc 2 1 — — $12,174.00 $12,174.00 $12,174.00 2025-12-27
66905 HCPCS Everolimus 5 Mg Tab 18 9 $12,872.74 $11,585.47 $6,693.82 $12,357.83 $12,229.10 2025-12-27
66906 HCPCS Everolimus 10 Mg Tab 18 9 $12,872.74 $11,585.47 $6,693.82 $12,357.83 $12,229.10 2025-12-27
67017 HCPCS Venetoclax 100 Mg Tab 18 9 $12,908.14 $11,617.33 $6,712.23 $12,391.81 $12,262.73 2025-12-27
66756 HCPCS Ustekinumab 45 Mg/0.5 Ml Syrg 18 9 $13,434.18 $12,090.76 $6,985.77 $12,896.81 $12,762.47 2025-12-27
67294 HCPCS Dabrafenib 75 Mg Cap 18 9 $13,488.21 $12,139.39 $7,013.87 $12,948.68 $12,813.80 2025-12-27
541 MS_DRG Osteomyelitis Without Cc/mcc 2 1 — — $12,928.00 $12,928.00 $12,928.00 2025-12-27
67239 HCPCS Nivolumab/relatlimab (240-80/20ml) 240-80mg/20ml Vial 18 9 $13,694.27 $12,324.84 $7,121.02 $13,146.50 $13,009.56 2025-12-27
67420 HCPCS Pertuzumab-trastuzumab-hy-zzxf (1200mg-600mg-30000u/15ml) 1200 Mg-600mg-30000 Un… 18 9 $13,916.53 $12,524.88 $7,236.60 $13,359.87 $13,220.70 2025-12-27
67443 HCPCS Guselkumab 200 Mg/20 Ml (10 Mg/ml) Vial 18 9 $14,559.16 $13,103.24 $7,570.76 $13,976.79 $13,831.20 2025-12-27
66935 HCPCS Niraparib 100 Mg Cap 18 9 $14,750.00 $13,275.00 $7,670.00 $14,160.00 $14,012.50 2025-12-27
67430 HCPCS Enzalutamide 80 Mg Tab 18 9 $14,905.77 $13,415.19 $7,751.00 $14,309.54 $14,160.48 2025-12-27
67104 HCPCS Polatuzumab Vedotin-piiq 140 Mg Solr 18 9 $15,000.00 $13,500.00 $7,800.00 $14,400.00 $14,250.00 2025-12-27
67340 HCPCS Quizartinib 26.5 Mg Tab 18 9 $15,288.00 $13,759.20 $7,949.76 $14,676.48 $14,523.60 2025-12-27
67448 HCPCS Acalabrutinib Maleate 100 Mg Tab 18 9 $15,829.15 $14,246.24 $8,231.16 $15,195.98 $15,037.69 2025-12-27
24209 CDM Interstim Neurostimulator 18 9 $16,192.50 $14,573.25 $8,420.10 $15,544.80 $15,382.88 2025-12-27
03140 CDM Lithrotripsy 18 9 $16,608.75 $14,947.88 $8,636.55 $15,944.40 $15,778.31 2025-12-27
67398 HCPCS Teprotumumab-trbw 500 Mg Solr 18 9 $17,511.13 $15,760.02 $9,105.79 $16,810.68 $16,635.57 2025-12-27
66969 HCPCS Ocrelizumab 300mg/10ml Vial 18 9 $17,796.78 $16,017.10 $9,254.33 $17,084.91 $16,906.94 2025-12-27
540 MS_DRG Osteomyelitis With Cc 2 1 — — $17,007.00 $17,007.00 $17,007.00 2025-12-27
66731 HCPCS Crizotinib 250 Mg Cap 18 9 $18,586.61 $16,727.95 $9,665.04 $17,843.15 $17,657.28 2025-12-27
539 MS_DRG Osteomyelitis With Mcc 2 1 — — $17,881.00 $17,881.00 $17,881.00 2025-12-27
66206 HCPCS Lenalidomide 10 Mg Cap 18 9 $19,473.37 $17,526.03 $10,126.15 $18,694.44 $18,499.70 2025-12-27
66570 HCPCS SORAfenib 200 Mg Tab 18 9 $20,760.00 $18,684.00 $10,795.20 $19,929.60 $19,722.00 2025-12-27
67303 HCPCS Lenvatinib 8 Mg/day (4 Mg X 2) Cap 18 9 $23,444.00 $21,099.60 $12,190.88 $22,506.24 $22,271.80 2025-12-27
67344 HCPCS Lenvatinib 10 Mg/day (10 Mg X 1) Cap 18 9 $24,255.00 $21,829.50 $12,612.60 $23,284.80 $23,042.25 2025-12-27
28361 CDM Mesh Permacol 20x30 18 9 $25,567.44 $23,010.70 $13,295.07 $24,544.74 $24,289.07 2025-12-27
66685 HCPCS Ustekinumab 90 Mg/ml Syrg 18 9 $26,868.36 $24,181.52 $13,971.55 $25,793.63 $25,524.94 2025-12-27
66908 HCPCS Ledipasvir-sofosbuvir 90-400 Mg Tab 18 9 $29,162.70 $26,246.43 $15,164.60 $27,996.19 $27,704.57 2025-12-27
66659 HCPCS Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Soln 18 9 $34,129.87 $30,716.88 $17,747.53 $32,764.68 $32,423.38 2025-12-27
67409 HCPCS Tremelimumab-actl 20 Mg/ml Vial 18 9 $40,575.60 $36,518.04 $21,099.31 $38,952.58 $38,546.82 2025-12-27
01261 CDM Membrance Wrap 4x6cm 18 9 $43,560.00 $39,204.00 $22,651.20 $41,817.60 $41,382.00 2025-12-27
67279 HCPCS Inebilizumab-cdon 10 Mg/ml Vial 18 9 $137,095.29 $123,385.76 $71,289.55 $131,611.48 $130,240.53 2025-12-27
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