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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

Kindred Hospital Philadelphia - Havertown

Lawncrest, PA · CCN 392027 · Rates published

1,624 distinct procedures filed
23 distinct payers
58,998 rate rows
2026-04-01 last MRF observed
Data quality

1,627 of 58,998 rate rows are consumer-grade (2.8%)

57,371 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 57,365
placeholder amount (≤ $0.02) — excluded from medians 6
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://hospitalpricedisclosure.com/download.aspx?pi=54DqTHX*_**_*OYEwP*_*wkCJ9HA*-*
Found on page https://hospitalpricedisclosure.com/default.aspx?pi=54DqTHX*_**_*OYEwP*_*wkCJ9HA*-*
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint 11cb6fb0eba95ec7… · 16,659,267 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
438
MS_DRG 		Disorders Of Pancreas Except Malignancy With Mcc 1 $110,886.55 $110,886.55 $110,886.55 nat. median
$16,973
outlier · 6.5×
975
MS_DRG 		HIV With Major Related Condition With Cc 1 $90,400.92 $90,400.92 $90,400.92 nat. median
$14,185
outlier · 6.4×
579
MS_DRG 		Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 1 $83,431.54 $83,431.54 $83,431.54 nat. median
$31,572
outlier · 2.6×
974
MS_DRG 		HIV With Major Related Condition With Mcc 1 $75,284.22 $75,284.22 $75,284.22 nat. median
$29,015
outlier · 2.6×
981
MS_DRG 		Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 10 $31,979.00 $446,016.33 $71,503.15 nat. median
$46,084
1.6× median
207
MS_DRG 		Respiratory System Diagnosis With Ventilator Support >96 Hours 17 $15,368.00 $955,712.78 $70,805.00 nat. median
$62,134
1.1× median
391
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 1 $69,930.91 $69,930.91 $69,930.91 nat. median
$13,246
outlier · 5.3×
808
MS_DRG 		Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 $65,122.88 $65,122.88 $65,122.88 nat. median
$22,208
outlier · 2.9×
464
MS_DRG 		Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective… 1 $64,850.09 $64,850.09 $64,850.09 nat. median
$30,264
outlier · 2.1×
919
MS_DRG 		Complications Of Treatment With Mcc 4 $3,285.61 $142,026.10 $64,006.30 nat. median
$18,329
outlier · 3.5×
393
MS_DRG 		Other Digestive System Diagnoses With Mcc 2 $52,416.10 $65,000.00 $58,708.05 nat. median
$16,482
outlier · 3.6×
592
MS_DRG 		Skin Ulcers With Mcc 1 $58,220.02 $58,220.02 $58,220.02 nat. median
$19,656
outlier · 3.0×
939
MS_DRG 		O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 1 $56,187.00 $56,187.00 $56,187.00 nat. median
$33,732
1.7× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 1 $53,981.46 $53,981.46 $53,981.46 nat. median
$66,682
0.8× median
371
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 2 $44,834.97 $54,357.00 $49,595.99 nat. median
$17,809
outlier · 2.8×
392
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 1 $48,658.66 $48,658.66 $48,658.66 nat. median
$8,731
outlier · 5.6×
93
MS_DRG 		Other Disorders Of Nervous System Without Cc/Mcc 1 $47,863.00 $47,863.00 $47,863.00 nat. median
$9,007
outlier · 5.3×
682
MS_DRG 		Renal Failure With Mcc 1 $44,978.49 $44,978.49 $44,978.49 nat. median
$15,223
outlier · 3.0×
166
MS_DRG 		Other Respiratory System O.r. Procedures With Mcc 4 $21.00 $195,426.30 $44,676.06 nat. median
$37,476
1.2× median
J9226
HCPCS 		Supprelin La Implant 1 $43,324.60 $43,324.60 $43,324.60 nat. median
$60,368
0.7× median
539
MS_DRG 		Osteomyelitis With Mcc 4 $4.89 $46,953.58 $39,977.00 nat. median
$19,718
outlier · 2.0×
83
MS_DRG 		Traumatic Stupor And Coma >1 Hour With Cc 2 $34,877.77 $43,708.62 $39,293.19 nat. median
$14,609
outlier · 2.7×
288
MS_DRG 		Acute And Subacute Endocarditis With Mcc 3 $11,641.00 $90,333.10 $36,341.31 nat. median
$26,899
1.4× median
593
MS_DRG 		Skin Ulcers With Cc 1 $35,461.97 $35,461.97 $35,461.97 nat. median
$12,573
outlier · 2.8×
73
MS_DRG 		Cranial And Peripheral Nerve Disorders With Mcc 1 $35,377.00 $35,377.00 $35,377.00 nat. median
$16,028
outlier · 2.2×
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 8 $7,482.02 $50,491.77 $32,403.45 nat. median
$13,021
outlier · 2.5×
949
MS_DRG 		Aftercare With Cc/Mcc 5 $21.00 $57,653.62 $29,680.23 nat. median
$12,475
outlier · 2.4×
64
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Mcc 4 $14,300.00 $34,380.00 $27,912.00 nat. median
$20,254
1.4× median
950
MS_DRG 		Aftercare Without Cc/Mcc 1 $27,309.00 $27,309.00 $27,309.00 nat. median
$7,554
outlier · 3.6×
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 2 $25,600.00 $28,756.66 $27,178.33 nat. median
$12,148
outlier · 2.2×
551
MS_DRG 		Medical Back Problems With Mcc 2 $15,600.00 $86,143.15 $26,000.00 nat. median
$16,881
1.5× median
920
MS_DRG 		Complications Of Treatment With Cc 1 $25,872.00 $25,872.00 $25,872.00 nat. median
$10,965
outlier · 2.4×
65
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 7 $3,921.00 $45,402.77 $25,640.14 nat. median
$11,174
outlier · 2.3×
552
MS_DRG 		Medical Back Problems Without Mcc 3 $20,810.00 $27,468.29 $25,384.04 nat. median
$10,424
outlier · 2.4×
536
MS_DRG 		Fractures Of Hip And Pelvis Without Mcc 2 $21,138.70 $29,134.00 $25,136.35 nat. median
$8,981
outlier · 2.8×
563
MS_DRG 		Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 2 $21,044.30 $29,134.00 $25,089.15 nat. median
$9,671
outlier · 2.6×
542
MS_DRG 		Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 1 $24,700.00 $24,700.00 $24,700.00 nat. median
$18,074
1.4× median
728
MS_DRG 		Inflammation Of The Male Reproductive System Without Mcc 1 $24,000.00 $24,000.00 $24,000.00 nat. median
$9,015
outlier · 2.7×
206
MS_DRG 		Other Respiratory System Diagnoses Without Mcc 1 $23,802.00 $23,802.00 $23,802.00 nat. median
$10,000
outlier · 2.4×
637
MS_DRG 		Diabetes With Mcc 2 $9,100.00 $38,281.39 $23,690.69 nat. median
$14,789
1.6× median
J9266
HCPCS 		Pegaspargase Injection 1 $23,577.01 $23,577.01 $23,577.01 nat. median
$34,109
0.7× median
570
MS_DRG 		Skin Debridement With Mcc 1 $21,824.26 $21,824.26 $21,824.26 nat. median
$29,069
0.8× median
558
MS_DRG 		Tendonitis, Myositis And Bursitis Without Mcc 1 $12,600.00 $30,762.92 $21,681.46 nat. median
$9,624
outlier · 2.3×
394
MS_DRG 		Other Digestive System Diagnoses With Cc 1 $20,857.89 $20,857.89 $20,857.89 nat. median
$10,260
outlier · 2.0×
71
MS_DRG 		Other Cerebrovascular Disorders With Cc 1 $20,810.00 $20,810.00 $20,810.00 nat. median
$11,209
1.9× median
964
MS_DRG 		Other Multiple Significant Trauma With Cc 1 $20,810.00 $20,810.00 $20,810.00 nat. median
$15,735
1.3× median
314
MS_DRG 		Other Circulatory System Diagnoses With Mcc 3 $8,324.00 $44,648.51 $20,332.40 nat. median
$20,753
1.0× median
303
MS_DRG 		Atherosclerosis Without Mcc 1 $20,139.35 $20,139.35 $20,139.35 nat. median
$7,838
outlier · 2.6×
557
MS_DRG 		Tendonitis, Myositis And Bursitis With Mcc 1 $19,684.12 $19,684.12 $19,684.12 nat. median
$15,341
1.3× median
561
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 1 $9,100.00 $27,143.62 $18,121.81 nat. median
$9,193
2.0× median

Other procedures at this hospital

Browse this hospital's 1,624 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
             
438 MS_DRG Disorders Of Pancreas Except Malignancy With Mcc 1 1 — — $110,886.55 $110,886.55 $110,886.55 2026-04-01
975 MS_DRG HIV With Major Related Condition With Cc 1 1 — — $90,400.92 $90,400.92 $90,400.92 2026-04-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 1 1 — — $83,431.54 $83,431.54 $83,431.54 2026-04-01
974 MS_DRG HIV With Major Related Condition With Mcc 1 1 — — $75,284.22 $75,284.22 $75,284.22 2026-04-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 12 10 — — $31,979.00 $446,016.33 $71,503.15 2026-04-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 26 17 — — $15,368.00 $955,712.78 $70,805.00 2026-04-01
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 1 1 — — $69,930.91 $69,930.91 $69,930.91 2026-04-01
808 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 1 — — $65,122.88 $65,122.88 $65,122.88 2026-04-01
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 1 1 — — $64,850.09 $64,850.09 $64,850.09 2026-04-01
919 MS_DRG Complications Of Treatment With Mcc 4 4 — — $3,285.61 $142,026.10 $64,006.30 2026-04-01
393 MS_DRG Other Digestive System Diagnoses With Mcc 2 2 — — $52,416.10 $65,000.00 $58,708.05 2026-04-01
592 MS_DRG Skin Ulcers With Mcc 1 1 — — $58,220.02 $58,220.02 $58,220.02 2026-04-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 1 1 — — $56,187.00 $56,187.00 $56,187.00 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 2 1 — — $53,981.46 $53,981.46 $53,981.46 2026-04-01
371 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 2 2 — — $44,834.97 $54,357.00 $49,595.99 2026-04-01
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 1 1 — — $48,658.66 $48,658.66 $48,658.66 2026-04-01
93 MS_DRG Other Disorders Of Nervous System Without Cc/Mcc 1 1 — — $47,863.00 $47,863.00 $47,863.00 2026-04-01
682 MS_DRG Renal Failure With Mcc 1 1 — — $44,978.49 $44,978.49 $44,978.49 2026-04-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 5 4 — — $21.00 $195,426.30 $44,676.06 2026-04-01
J9226 HCPCS Supprelin La Implant 2 1 — — $43,324.60 $43,324.60 $43,324.60 2026-04-01
539 MS_DRG Osteomyelitis With Mcc 6 4 — — $4.89 $46,953.58 $39,977.00 2026-04-01
83 MS_DRG Traumatic Stupor And Coma >1 Hour With Cc 2 2 — — $34,877.77 $43,708.62 $39,293.19 2026-04-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 4 3 — — $11,641.00 $90,333.10 $36,341.31 2026-04-01
593 MS_DRG Skin Ulcers With Cc 1 1 — — $35,461.97 $35,461.97 $35,461.97 2026-04-01
73 MS_DRG Cranial And Peripheral Nerve Disorders With Mcc 1 1 — — $35,377.00 $35,377.00 $35,377.00 2026-04-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 11 8 — — $7,482.02 $50,491.77 $32,403.45 2026-04-01
949 MS_DRG Aftercare With Cc/Mcc 6 5 — — $21.00 $57,653.62 $29,680.23 2026-04-01
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 4 4 — — $14,300.00 $34,380.00 $27,912.00 2026-04-01
950 MS_DRG Aftercare Without Cc/Mcc 1 1 — — $27,309.00 $27,309.00 $27,309.00 2026-04-01
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 2 2 — — $25,600.00 $28,756.66 $27,178.33 2026-04-01
551 MS_DRG Medical Back Problems With Mcc 3 2 — — $15,600.00 $86,143.15 $26,000.00 2026-04-01
920 MS_DRG Complications Of Treatment With Cc 1 1 — — $25,872.00 $25,872.00 $25,872.00 2026-04-01
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 7 7 — — $3,921.00 $45,402.77 $25,640.14 2026-04-01
552 MS_DRG Medical Back Problems Without Mcc 3 3 — — $20,810.00 $27,468.29 $25,384.04 2026-04-01
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 2 2 — — $21,138.70 $29,134.00 $25,136.35 2026-04-01
563 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 2 2 — — $21,044.30 $29,134.00 $25,089.15 2026-04-01
542 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 1 1 — — $24,700.00 $24,700.00 $24,700.00 2026-04-01
728 MS_DRG Inflammation Of The Male Reproductive System Without Mcc 1 1 — — $24,000.00 $24,000.00 $24,000.00 2026-04-01
206 MS_DRG Other Respiratory System Diagnoses Without Mcc 1 1 — — $23,802.00 $23,802.00 $23,802.00 2026-04-01
637 MS_DRG Diabetes With Mcc 2 2 — — $9,100.00 $38,281.39 $23,690.69 2026-04-01
J9266 HCPCS Pegaspargase Injection 2 1 — — $23,577.01 $23,577.01 $23,577.01 2026-04-01
570 MS_DRG Skin Debridement With Mcc 1 1 — — $21,824.26 $21,824.26 $21,824.26 2026-04-01
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 2 1 — — $12,600.00 $30,762.92 $21,681.46 2026-04-01
394 MS_DRG Other Digestive System Diagnoses With Cc 1 1 — — $20,857.89 $20,857.89 $20,857.89 2026-04-01
71 MS_DRG Other Cerebrovascular Disorders With Cc 1 1 — — $20,810.00 $20,810.00 $20,810.00 2026-04-01
964 MS_DRG Other Multiple Significant Trauma With Cc 1 1 — — $20,810.00 $20,810.00 $20,810.00 2026-04-01
314 MS_DRG Other Circulatory System Diagnoses With Mcc 4 3 — — $8,324.00 $44,648.51 $20,332.40 2026-04-01
303 MS_DRG Atherosclerosis Without Mcc 1 1 — — $20,139.35 $20,139.35 $20,139.35 2026-04-01
557 MS_DRG Tendonitis, Myositis And Bursitis With Mcc 1 1 — — $19,684.12 $19,684.12 $19,684.12 2026-04-01
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 2 1 — — $9,100.00 $27,143.62 $18,121.81 2026-04-01
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 1 1 — — $16,900.00 $16,900.00 $16,900.00 2026-04-01
603 MS_DRG Cellulitis Without Mcc 1 1 — — $16,900.00 $16,900.00 $16,900.00 2026-04-01
60 MS_DRG Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc 1 1 — — $16,400.00 $16,400.00 $16,400.00 2026-04-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 5 4 — — $2,400.00 $35,679.78 $14,732.23 2026-04-01
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc 3 3 — — $2,140.32 $19,100.00 $14,567.00 2026-04-01
177 MS_DRG Respiratory Infections And Inflammations With Mcc 1 1 — — $11,720.39 $11,720.39 $11,720.39 2026-04-01
Q4244 HCPCS Procenta, Per 200 Mg 2 1 — — $10,480.26 $10,480.26 $10,480.26 2026-04-01
300 MS_DRG Peripheral Vascular Disorders With Cc 1 1 — — $10,400.00 $10,400.00 $10,400.00 2026-04-01
999 MS_DRG Ungroupable 2 2 — — $8,529.21 $11,700.00 $10,114.60 2026-04-01
548 MS_DRG Septic Arthritis With Mcc 1 1 — — $9,100.00 $9,100.00 $9,100.00 2026-04-01
J0600 HCPCS Edetate Calcium Disodium Inj 2 1 — — $5,708.59 $5,708.59 $5,708.59 2026-04-01
J1162 HCPCS Digoxin Immune Fab (ovine) 2 1 — — $4,597.02 $4,597.02 $4,597.02 2026-04-01
J0480 HCPCS Basiliximab 2 1 — — $4,238.69 $4,238.69 $4,238.69 2026-04-01
J0800 HCPCS Corticotropin Injection 2 1 — — $3,870.32 $3,870.32 $3,870.32 2026-04-01
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 1 — — $3,296.46 $3,296.46 $3,296.46 2026-04-01
549 MS_DRG Septic Arthritis With Cc 1 1 — — $3,215.52 $3,215.52 $3,215.52 2026-04-01
J2507 HCPCS Pegloticase Injection 2 1 — — $3,194.98 $3,194.98 $3,194.98 2026-04-01
J7504 HCPCS Lymphocyte Immune Globulin 2 1 — — $3,002.83 $3,002.83 $3,002.83 2026-04-01
Q4246 HCPCS Coretext Or Protext, Per Cc 2 1 — — $2,968.00 $2,968.00 $2,968.00 2026-04-01
J9200 HCPCS Floxuridine Injection 2 1 — — $2,890.17 $2,890.17 $2,890.17 2026-04-01
82 MS_DRG Traumatic Stupor And Coma >1 Hour With Mcc 1 1 — — $2,606.00 $2,606.00 $2,606.00 2026-04-01
J9229 HCPCS Inj Inotuzumab Ozogam 0.1 Mg 2 1 — — $2,477.62 $2,477.62 $2,477.62 2026-04-01
Q0222 HCPCS Bebtelovimab 175 Mg 2 1 — — $2,394.00 $2,394.00 $2,394.00 2026-04-01
J9268 HCPCS Pentostatin Injection 2 1 — — $2,320.12 $2,320.12 $2,320.12 2026-04-01
J0202 HCPCS Injection, Alemtuzumab 2 1 — — $2,244.92 $2,244.92 $2,244.92 2026-04-01
J0840 HCPCS Crotalidae Poly Immune Fab 2 1 — — $2,112.09 $2,112.09 $2,112.09 2026-04-01
J0630 HCPCS Calcitonin 200u/ml Inj 2 1 — — $1,937.89 $1,937.89 $1,937.89 2026-04-01
J3240 HCPCS Thyrotropin Injection 2 1 — — $1,924.94 $1,924.94 $1,924.94 2026-04-01
Q9991 HCPCS Buprenorph Xr 100 Mg Or Less 2 1 — — $1,825.83 $1,825.83 $1,825.83 2026-04-01
Q9992 HCPCS Buprenorphine Xr Over 100 Mg 2 1 — — $1,825.83 $1,825.83 $1,825.83 2026-04-01
J0850 HCPCS Cytogam 2.5gm Inj 2 1 — — $1,769.57 $1,769.57 $1,769.57 2026-04-01
Q4114 HCPCS Integra Flowable Wound Matri 2 1 — — $1,576.52 $1,576.52 $1,576.52 2026-04-01
J1950 HCPCS Leuprolide Acetate /3.75 Mg 2 1 — — $1,474.18 $1,474.18 $1,474.18 2026-04-01
J9357 HCPCS Valrubicin Injection 2 1 — — $1,431.38 $1,431.38 $1,431.38 2026-04-01
A9589 HCPCS Insti Hexaminolevulinate Hcl 2 1 — — $1,230.84 $1,230.84 $1,230.84 2026-04-01
J0841 HCPCS Inj Crotalidae IM F(ab')2 Eq 2 1 — — $987.00 $987.00 $987.00 2026-04-01
J0178 HCPCS Aflibercept Injection 2 1 — — $898.33 $898.33 $898.33 2026-04-01
J7511 HCPCS Antithymocyte Globuln Rabbit 2 1 — — $888.99 $888.99 $888.99 2026-04-01
Q4210 HCPCS Axolotl Graf Dualgraf Sq Cm 2 1 — — $848.00 $848.00 $848.00 2026-04-01
J7327 HCPCS Monovisc Inj Per Dose 2 1 — — $712.18 $712.18 $712.18 2026-04-01
J7686 HCPCS Treprostinil, Non-comp Unit 2 1 — — $704.65 $704.65 $704.65 2026-04-01
Q4231 HCPCS Corplex P, Per Cc 2 1 — — $677.33 $677.33 $677.33 2026-04-01
J1212 HCPCS Dimethyl Sulfoxide 50% 50 Ml 2 1 — — $637.71 $637.71 $637.71 2026-04-01
J0740 HCPCS Cidofovir Injection 2 1 — — $629.78 $629.78 $629.78 2026-04-01
J9120 HCPCS Dactinomycin Injection 2 1 — — $604.79 $604.79 $604.79 2026-04-01
J9202 HCPCS Goserelin Acetate Implant 2 1 — — $567.93 $567.93 $567.93 2026-04-01
J1743 HCPCS Idursulfase Injection 2 1 — — $542.88 $542.88 $542.88 2026-04-01
Q4247 HCPCS Amniotext Patch, Per Sq Cm 2 1 — — $530.00 $530.00 $530.00 2026-04-01
J1670 HCPCS Tetanus Immune Globulin Inj 2 1 — — $524.41 $524.41 $524.41 2026-04-01
J7314 HCPCS Inj., Yutiq, 0.01 Mg 2 1 — — $523.54 $523.54 $523.54 2026-04-01
J7326 HCPCS Gel-one 2 1 — — $517.39 $517.39 $517.39 2026-04-01
J1290 HCPCS Ecallantide Injection 2 1 — — $516.60 $516.60 $516.60 2026-04-01
J2770 HCPCS Quinupristin/dalfopristin 2 1 — — $493.97 $493.97 $493.97 2026-04-01
J7313 HCPCS Fluocinol Acet Intravit Imp 2 1 — — $490.95 $490.95 $490.95 2026-04-01
J1554 HCPCS Inj. Asceniv 2 1 — — $481.77 $481.77 $481.77 2026-04-01
J1560 HCPCS Gamma Globulin > 10 Cc Inj 2 1 — — $478.70 $478.70 $478.70 2026-04-01
J1454 HCPCS Inj Fosnetupitant, Palonoset 2 1 — — $467.06 $467.06 $467.06 2026-04-01
J1823 HCPCS Inj. Inebilizumab-cdon, 1 Mg 2 1 — — $462.87 $462.87 $462.87 2026-04-01
Q4159 HCPCS Affinity1 Square Cm 2 1 — — $460.50 $460.50 $460.50 2026-04-01
J1430 HCPCS Ethanolamine Oleate 100 Mg 2 1 — — $457.00 $457.00 $457.00 2026-04-01
J2760 HCPCS Phentolaine Mesylate Inj 2 1 — — $450.36 $450.36 $450.36 2026-04-01
J1458 HCPCS Galsulfase Injection 2 1 — — $432.80 $432.80 $432.80 2026-04-01
J0584 HCPCS Injection, Burosumab-twza 1m 2 1 — — $411.02 $411.02 $411.02 2026-04-01
J8655 HCPCS Netupitant Palonosetron Oral 2 1 — — $409.53 $409.53 $409.53 2026-04-01
J2562 HCPCS Plerixafor Injection 2 1 — — $401.92 $401.92 $401.92 2026-04-01
J9210 HCPCS Inj., Emapalumab-lzsg, 1 Mg 2 1 — — $391.32 $391.32 $391.32 2026-04-01
J7308 HCPCS Aminolevulinic Acid Hcl Top 2 1 — — $390.60 $390.60 $390.60 2026-04-01
J3315 HCPCS Triptorelin Pamoate 2 1 — — $374.55 $374.55 $374.55 2026-04-01
Q4132 HCPCS Grafix Core 2 1 — — $373.33 $373.33 $373.33 2026-04-01
J9320 HCPCS Streptozocin Injection 2 1 — — $370.18 $370.18 $370.18 2026-04-01
J3385 HCPCS Velaglucerase Alfa 2 1 — — $357.53 $357.53 $357.53 2026-04-01
Q4254 HCPCS Novafix Dl Per Sq Cm 2 1 — — $355.88 $355.88 $355.88 2026-04-01
J1410 HCPCS Conjucated Estrogens 25mg Inj 2 1 — — $355.52 $355.52 $355.52 2026-04-01
90675 HCPCS Rabies Vaccine IM 2 1 — — $355.22 $355.22 $355.22 2026-04-01
J2783 HCPCS Rasburicase 2 1 — — $340.86 $340.86 $340.86 2026-04-01
J9307 HCPCS Pralatrexate Injection 2 1 — — $339.33 $339.33 $339.33 2026-04-01
J7311 HCPCS Fluocinolone Acetonide Implt 2 1 — — $336.02 $336.02 $336.02 2026-04-01
J9352 HCPCS Injection Trabectedin 0.1mg 2 1 — — $331.83 $331.83 $331.83 2026-04-01
J3241 HCPCS Inj. Teprotumumab-trbw 10 Mg 2 1 — — $321.88 $321.88 $321.88 2026-04-01
90376 HCPCS Rabies Ig Heat Treated 2 1 — — $320.86 $320.86 $320.86 2026-04-01
J9269 HCPCS Inj. Tagraxofusp-erzs 10 Mcg 2 1 — — $319.99 $319.99 $319.99 2026-04-01
J9340 HCPCS Thiotepa Injection 2 1 — — $318.17 $318.17 $318.17 2026-04-01
Q4199 HCPCS Cygnus Matrix, Per Sq Cm 2 1 — — $317.24 $317.24 $317.24 2026-04-01
J0179 HCPCS Inj, Brolucizumab-dbll, 1 Mg 2 1 — — $313.48 $313.48 $313.48 2026-04-01
J0224 HCPCS Inj. Lumasiran, 0.5 Mg 2 1 — — $310.90 $310.90 $310.90 2026-04-01
Q4232 HCPCS Corplex, Per Sq Cm 2 1 — — $297.40 $297.40 $297.40 2026-04-01
J9281 HCPCS Mitomycin Instillation 2 1 — — $290.30 $290.30 $290.30 2026-04-01
Q4227 HCPCS Amniocore Per Sq Cm 2 1 — — $288.29 $288.29 $288.29 2026-04-01
90677 HCPCS Pcv20 Vaccine IM 2 1 — — $283.72 $283.72 $283.72 2026-04-01
90375 HCPCS Rabies Ig Im/sc 2 1 — — $278.24 $278.24 $278.24 2026-04-01
J1322 HCPCS Elosulfase Alfa, Injection 2 1 — — $262.72 $262.72 $262.72 2026-04-01
90670 HCPCS Pcv13 Vaccine IM 2 1 — — $257.99 $257.99 $257.99 2026-04-01
90377 HCPCS Rabies Ig Ht&sol Human Im/sc 2 1 — — $247.29 $247.29 $247.29 2026-04-01
90671 HCPCS Pcv15 Vaccine IM 2 1 — — $246.20 $246.20 $246.20 2026-04-01
J9050 HCPCS Carmustine Injection 2 1 — — $245.96 $245.96 $245.96 2026-04-01
Q4187 HCPCS Epicord 1 Sq Cm 2 1 — — $241.75 $241.75 $241.75 2026-04-01
J2778 HCPCS Ranibizumab Injection 2 1 — — $237.20 $237.20 $237.20 2026-04-01
Q5124 HCPCS Inj. Byooviz, 0.1 Mg 2 1 — — $235.95 $235.95 $235.95 2026-04-01
J7525 HCPCS Tacrolimus Injection 2 1 — — $233.75 $233.75 $233.75 2026-04-01
J1300 HCPCS Eculizumab Injection 2 1 — — $227.04 $227.04 $227.04 2026-04-01
J9272 HCPCS Inj, Dostarlimab-gxly, 10 Mg 2 1 — — $223.97 $223.97 $223.97 2026-04-01
J1303 HCPCS Inj., Ravulizumab-cwvz 10 Mg 2 1 — — $222.68 $222.68 $222.68 2026-04-01
Q4203 HCPCS Derma-gide, 1 Sq Cm 2 1 — — $222.39 $222.39 $222.39 2026-04-01
J9245 HCPCS Inj Melphalan Hydrochl 50 Mg 2 1 — — $220.66 $220.66 $220.66 2026-04-01
J7340 HCPCS Carbidopa Levodopa ENT 100ml 2 1 — — $219.39 $219.39 $219.39 2026-04-01
J9153 HCPCS Inj Daunorubicin, Cytarabine 2 1 — — $219.06 $219.06 $219.06 2026-04-01
J9204 HCPCS Inj Mogamulizumab-kpkc, 1 Mg 2 1 — — $217.57 $217.57 $217.57 2026-04-01
J9203 HCPCS Gemtuzumab Ozogamicin 0.1 Mg 2 1 — — $217.43 $217.43 $217.43 2026-04-01
J9042 HCPCS Brentuximab Vedotin Inj 2 1 — — $213.65 $213.65 $213.65 2026-04-01
J0180 HCPCS Agalsidase Beta Injection 2 1 — — $208.32 $208.32 $208.32 2026-04-01
J7351 HCPCS Inj Bimatoprost Itc Imp 1mcg 2 1 — — $206.14 $206.14 $206.14 2026-04-01
J2353 HCPCS Octreotide Acet 1,000mcg/ml In 2 1 — — $205.64 $205.64 $205.64 2026-04-01
J7312 HCPCS Dexamethasone Intra Implant 2 1 — — $199.97 $199.97 $199.97 2026-04-01
J9043 HCPCS Cabazitaxel Injection 2 1 — — $199.21 $199.21 $199.21 2026-04-01
J9274 HCPCS Inj, Tebentafusp-tebn, 1 Mcg 2 1 — — $198.86 $198.86 $198.86 2026-04-01
J9359 HCPCS Inj Lon Tesirin-lpyl 0.075mg 2 1 — — $188.98 $188.98 $188.98 2026-04-01
J0221 HCPCS Lumizyme Injection 2 1 — — $188.44 $188.44 $188.44 2026-04-01
J9217 HCPCS Leuprolide Acet 7.5mg Kit Sus 2 1 — — $188.33 $188.33 $188.33 2026-04-01
J9223 HCPCS Inj. Lurbinectedin, 0.1 Mg 2 1 — — $185.98 $185.98 $185.98 2026-04-01
J0475 HCPCS Baclofen 10 Mg Injection 2 1 — — $185.92 $185.92 $185.92 2026-04-01
J9298 HCPCS Inj Nivol Relatlimab 3mg/1mg 2 1 — — $180.38 $180.38 $180.38 2026-04-01
Q4197 HCPCS Puraply Xt 1 Sq Cm 2 1 — — $178.34 $178.34 $178.34 2026-04-01
A9606 HCPCS Radium Ra223 Dichloride Ther 2 1 — — $176.64 $176.64 $176.64 2026-04-01
Q4252 HCPCS Vendaje, Per Square Centimet 2 1 — — $175.72 $175.72 $175.72 2026-04-01
J1610 HCPCS Glucagen Hcl 1mg Inj 2 1 — — $173.78 $173.78 $173.78 2026-04-01
J1305 HCPCS Inj, Evinacumab-dgnb, 5mg 2 1 — — $172.25 $172.25 $172.25 2026-04-01
Q4201 HCPCS Matrion 1 Sq Cm 2 1 — — $170.26 $170.26 $170.26 2026-04-01
J0517 HCPCS Inj., Benralizumab, 1 Mg 2 1 — — $168.25 $168.25 $168.25 2026-04-01
Q4180 HCPCS Revita, Per Sq Cm 2 1 — — $166.13 $166.13 $166.13 2026-04-01
J9228 HCPCS Ipilimumab Injection 2 1 — — $165.77 $165.77 $165.77 2026-04-01
J1611 HCPCS Inj Glucagon Hcl, Fresenius 2 1 — — $162.01 $162.01 $162.01 2026-04-01
Q4153 HCPCS Dermavest, Plurivest Sq Cm 2 1 — — $160.65 $160.65 $160.65 2026-04-01
Q4154 HCPCS Biovance 1 Square Cm 2 1 — — $158.17 $158.17 $158.17 2026-04-01
J9273 HCPCS Inj Tisotu Vedotin-tftv, 1mg 2 1 — — $156.00 $156.00 $156.00 2026-04-01
J3357 HCPCS Ustekinumab Sub Cu Inj, 1 Mg 2 1 — — $155.00 $155.00 $155.00 2026-04-01
Q4186 HCPCS Epifix 1 Sq Cm 2 1 — — $153.46 $153.46 $153.46 2026-04-01
90739 HCPCS Hepb Vacc 2 Dose Adult IM 2 1 — — $152.08 $152.08 $152.08 2026-04-01
Q4235 HCPCS Amniorepair Or Altiply Sq Cm 2 1 — — $150.55 $150.55 $150.55 2026-04-01
Q5122 HCPCS Inj, Nyvepria 2 1 — — $146.65 $146.65 $146.65 2026-04-01
90740 HCPCS Hepb Vacc 3 Dose Immunsup IM 2 1 — — $146.33 $146.33 $146.33 2026-04-01
J3101 HCPCS Tenecteplase Injection 2 1 — — $143.65 $143.65 $143.65 2026-04-01
J9303 HCPCS Panitumumab Injection 2 1 — — $143.51 $143.51 $143.51 2026-04-01
90586 HCPCS Bcg Vaccine Intravesical 2 1 — — $143.21 $143.21 $143.21 2026-04-01
90747 HCPCS Hepb Vacc 4 Dose Immunsup IM 2 1 — — $140.75 $140.75 $140.75 2026-04-01
Q4074 HCPCS Iloprost Non-comp Unit Dose 2 1 — — $139.51 $139.51 $139.51 2026-04-01
Q5111 HCPCS Injection, Udenyca 0.5 Mg 2 1 — — $137.66 $137.66 $137.66 2026-04-01
J3245 HCPCS Inj., Tildrakizumab, 1 Mg 2 1 — — $137.43 $137.43 $137.43 2026-04-01
Q4133 HCPCS Grafix Prime 2 1 — — $137.13 $137.13 $137.13 2026-04-01
Q5108 HCPCS Injection, Fulphila 2 1 — — $136.54 $136.54 $136.54 2026-04-01
J9039 HCPCS Injection, Blinatumomab 2 1 — — $135.62 $135.62 $135.62 2026-04-01
J9261 HCPCS Nelarabine Injection 2 1 — — $135.28 $135.28 $135.28 2026-04-01
J2506 HCPCS Inj Pegfilgrast Ex Bio 0.5mg 2 1 — — $135.17 $135.17 $135.17 2026-04-01
Q4248 HCPCS Dermacyte Amn Mem Allo Sq Cm 2 1 — — $133.97 $133.97 $133.97 2026-04-01
90732 HCPCS Ppsv23 Vacc 2 Yrs+ Subq/im 2 1 — — $133.47 $133.47 $133.47 2026-04-01
J2860 HCPCS Injection, Siltuximab 2 1 — — $133.11 $133.11 $133.11 2026-04-01
J1951 HCPCS Inj Fensolvi 0.25 Mg 2 1 — — $132.76 $132.76 $132.76 2026-04-01
Q4176 HCPCS Neopatch, Per Sq Centimeter 2 1 — — $129.62 $129.62 $129.62 2026-04-01
J7323 HCPCS Euflexxa Inj Per Dose 2 1 — — $129.58 $129.58 $129.58 2026-04-01
90371 HCPCS Hep B Ig IM 2 1 — — $128.05 $128.05 $128.05 2026-04-01
Q4161 HCPCS Bio-connekt Per Square Cm 2 1 — — $127.20 $127.20 $127.20 2026-04-01
J9179 HCPCS Eribulin Mesylate Injection 2 1 — — $126.63 $126.63 $126.63 2026-04-01
J1190 HCPCS Dexrazoxane Hcl Injection 2 1 — — $125.25 $125.25 $125.25 2026-04-01
J0791 HCPCS Inj Crizanlizumab-tmca 5mg 2 1 — — $125.13 $125.13 $125.13 2026-04-01
J7324 HCPCS Orthovisc Inj Per Dose 2 1 — — $123.64 $123.64 $123.64 2026-04-01
J2805 HCPCS Sincalide Injection 2 1 — — $123.09 $123.09 $123.09 2026-04-01
Q4151 HCPCS Amnioband, Guardian 1 Sq Cm 2 1 — — $120.84 $120.84 $120.84 2026-04-01
J0638 HCPCS Canakinumab Injection 2 1 — — $119.56 $119.56 $119.56 2026-04-01
J9207 HCPCS Ixabepilone Injection 2 1 — — $118.65 $118.65 $118.65 2026-04-01
J9309 HCPCS Inj, Polatuzumab Vedotin 1mg 2 1 — — $118.11 $118.11 $118.11 2026-04-01
J0223 HCPCS Inj Givosiran 0.5 Mg 2 1 — — $109.82 $109.82 $109.82 2026-04-01
Q4196 HCPCS Puraply Am 1 Sq Cm 2 1 — — $109.76 $109.76 $109.76 2026-04-01
J9185 HCPCS Fludarabine Phosphate Inj 2 1 — — $105.60 $105.60 $105.60 2026-04-01
Q4163 HCPCS Amnio Bio And Woundex Sq Cm 2 1 — — $104.78 $104.78 $104.78 2026-04-01
J9331 HCPCS Inj Sirolimus Prot Part 1 Mg 2 1 — — $104.52 $104.52 $104.52 2026-04-01
J8705 HCPCS Topotecan Oral 2 1 — — $104.36 $104.36 $104.36 2026-04-01
Q2050 HCPCS Doxorubicin Inj 10mg 2 1 — — $102.24 $102.24 $102.24 2026-04-01
J0222 HCPCS Inj., Patisiran, 0.1 Mg 2 1 — — $100.75 $100.75 $100.75 2026-04-01
Q4137 HCPCS Amnioexcel Or Biodexcel, 1cm 2 1 — — $99.91 $99.91 $99.91 2026-04-01
J2545 HCPCS Pentamidine Isethionate 300 Pd 2 1 — — $99.77 $99.77 $99.77 2026-04-01
J2690 HCPCS Procainamide Hcl Injection 2 1 — — $95.44 $95.44 $95.44 2026-04-01
Q4160 HCPCS Nushield 1 Square Cm 2 1 — — $94.06 $94.06 $94.06 2026-04-01
J0714 HCPCS Avycaz 2gm/0.5gm Inj 2 1 — — $91.37 $91.37 $91.37 2026-04-01
J2796 HCPCS Romiplostim Injection 2 1 — — $91.24 $91.24 $91.24 2026-04-01
Q5120 HCPCS Inj Pegfilgrastim-bmez 0.5mg 2 1 — — $89.94 $89.94 $89.94 2026-04-01
J9023 HCPCS Injection, Avelumab, 10 Mg 2 1 — — $89.34 $89.34 $89.34 2026-04-01
J1952 HCPCS Leuprolide Inj, Camcevi, 1mg 2 1 — — $88.75 $88.75 $88.75 2026-04-01
Q4126 HCPCS Memoderm/derma/tranz/integup 2 1 — — $88.18 $88.18 $88.18 2026-04-01
J2997 HCPCS Alteplase Recomb 2mg Inj 2 1 — — $88.03 $88.03 $88.03 2026-04-01
J1364 HCPCS Erythro Lactobionate /500 Mg 2 1 — — $83.57 $83.57 $83.57 2026-04-01
J9355 HCPCS Trastuzumab Injection 2 1 — — $82.74 $82.74 $82.74 2026-04-01
J2779 HCPCS Inj, Susvimo 0.1 Mg 2 1 — — $82.07 $82.07 $82.07 2026-04-01
J2790 HCPCS Rho D Immune Globulin Inj 2 1 — — $81.77 $81.77 $81.77 2026-04-01
J9312 HCPCS Inj., Rituximab, 10 Mg 2 1 — — $81.75 $81.75 $81.75 2026-04-01
J9304 HCPCS Inj. Pemetrexed, 10 Mg 2 1 — — $81.56 $81.56 $81.56 2026-04-01
Q4170 HCPCS Cygnus, Per Sq Cm 2 1 — — $81.11 $81.11 $81.11 2026-04-01
J9022 HCPCS Inj, Atezolizumab,10 Mg 2 1 — — $80.80 $80.80 $80.80 2026-04-01
J9173 HCPCS Inj., Durvalumab, 10 Mg 2 1 — — $78.90 $78.90 $78.90 2026-04-01
J7321 HCPCS Hyalgan/supartz Inj Per Dose 2 1 — — $78.68 $78.68 $78.68 2026-04-01
Q4127 HCPCS Talymed 2 1 — — $77.31 $77.31 $77.31 2026-04-01
J8560 HCPCS Etoposide Oral 50 Mg 2 1 — — $76.40 $76.40 $76.40 2026-04-01
Q4150 HCPCS Allowrap Ds Or Dry 1 Sq Cm 2 1 — — $74.30 $74.30 $74.30 2026-04-01
90743 HCPCS Hepb Vacc 2 Dose Adolesc IM 2 1 — — $73.85 $73.85 $73.85 2026-04-01
90759 HCPCS Hep B Vac 3ag 10mcg 3 Dos IM 2 1 — — $73.82 $73.82 $73.82 2026-04-01
J1566 HCPCS Immune Globulin 10gm Inj 2 1 — — $73.59 $73.59 $73.59 2026-04-01
J0219 HCPCS Inj Aval Alfa-nqpt 4mg 2 1 — — $72.51 $72.51 $72.51 2026-04-01
J9227 HCPCS Inj. Isatuximab-irfc 10 Mg 2 1 — — $71.95 $71.95 $71.95 2026-04-01
90694 HCPCS Vacc Aiiv4 No Prsrv 0.5ml IM 2 1 — — $71.68 $71.68 $71.68 2026-04-01
Q4195 HCPCS Puraply 1 Sq Cm 2 1 — — $71.23 $71.23 $71.23 2026-04-01
J9118 HCPCS Inj. Calaspargase Pegol-mknl 2 1 — — $70.76 $70.76 $70.76 2026-04-01
J9035 HCPCS Bevacizumab Injection 2 1 — — $70.75 $70.75 $70.75 2026-04-01
J1556 HCPCS Inj, Imm Glob Bivigam, 500mg 2 1 — — $70.49 $70.49 $70.49 2026-04-01
90746 HCPCS Hepb Vaccine 3 Dose Adult IM 2 1 — — $70.38 $70.38 $70.38 2026-04-01
J9055 HCPCS Cetuximab Injection 2 1 — — $70.35 $70.35 $70.35 2026-04-01
90632 HCPCS Hepa Vaccine Adult IM 2 1 — — $70.17 $70.17 $70.17 2026-04-01
90682 HCPCS Riv4 Vacc Recombinant DNA IM 2 1 — — $69.94 $69.94 $69.94 2026-04-01
90662 HCPCS Iiv No Prsv Increased Ag IM 2 1 — — $69.94 $69.94 $69.94 2026-04-01
J1746 HCPCS Inj., Ibalizumab-uiyk, 10 Mg 2 1 — — $69.61 $69.61 $69.61 2026-04-01
J1571 HCPCS HepaGam B IM Injection 2 1 — — $69.43 $69.43 $69.43 2026-04-01
J9316 HCPCS Pertuzu, Trastuzu, 10 Mg 2 1 — — $69.06 $69.06 $69.06 2026-04-01
J9301 HCPCS Obinutuzumab Inj 2 1 — — $66.95 $66.95 $66.95 2026-04-01
J9308 HCPCS Injection, Ramucirumab 2 1 — — $66.86 $66.86 $66.86 2026-04-01
J9356 HCPCS Inj. Herceptin Hylecta, 10mg 2 1 — — $65.49 $65.49 $65.49 2026-04-01
J9302 HCPCS Ofatumumab Injection 2 1 — — $63.96 $63.96 $63.96 2026-04-01
Q4175 HCPCS Miroderm 2 1 — — $63.38 $63.38 $63.38 2026-04-01
J9325 HCPCS Inj Talimogene Laherparepvec 2 1 — — $62.68 $62.68 $62.68 2026-04-01
J0775 HCPCS Collagenase, Clost Hist Inj 2 1 — — $62.51 $62.51 $62.51 2026-04-01
J1930 HCPCS Lanreotide Injection 2 1 — — $61.56 $61.56 $61.56 2026-04-01
Q4258 HCPCS Enverse, Per Sq Cm 2 1 — — $61.23 $61.23 $61.23 2026-04-01
J2785 HCPCS Regadenoson Injection 2 1 — — $61.15 $61.15 $61.15 2026-04-01
J0597 HCPCS C-1 Esterase, Berinert 2 1 — — $60.77 $60.77 $60.77 2026-04-01
J0598 HCPCS C-1 Esterase, Cinryze 2 1 — — $60.71 $60.71 $60.71 2026-04-01
J1932 HCPCS Inj, Lanreotide, (cipla) 1mg 2 1 — — $60.38 $60.38 $60.38 2026-04-01
J9205 HCPCS Inj Irinotecan Liposome 1 Mg 2 1 — — $60.06 $60.06 $60.06 2026-04-01
J0476 HCPCS Baclofen Intrathecal Trial 2 1 — — $59.70 $59.70 $59.70 2026-04-01
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 2 1 — — $59.65 $59.65 $59.65 2026-04-01
J9145 HCPCS Injection, Daratumumab 10 Mg 2 1 — — $58.92 $58.92 $58.92 2026-04-01
Q5112 HCPCS Inj Ontruzant 10 Mg 2 1 — — $58.34 $58.34 $58.34 2026-04-01
J1110 HCPCS Inj Dihydroergotamine Mesylt 2 1 — — $57.32 $57.32 $57.32 2026-04-01
J2820 HCPCS Sargramostim Injection 2 1 — — $56.50 $56.50 $56.50 2026-04-01
J3285 HCPCS Treprostinil Injection 2 1 — — $55.53 $55.53 $55.53 2026-04-01
J9293 HCPCS Mitoxantrone Hydrochl / 5 Mg 2 1 — — $54.88 $54.88 $54.88 2026-04-01
Q3027 HCPCS Inj Beta Interferon IM 1 Mcg 2 1 — — $54.42 $54.42 $54.42 2026-04-01
J9271 HCPCS Inj Pembrolizumab 2 1 — — $53.91 $53.91 $53.91 2026-04-01
P9045 HCPCS Albumin (human), 5%, 250 Ml 2 1 — — $52.77 $52.77 $52.77 2026-04-01
P9047 HCPCS Albumin (human), 25%, 50ml 2 1 — — $52.77 $52.77 $52.77 2026-04-01
J1557 HCPCS Gammaplex Injection 2 1 — — $52.38 $52.38 $52.38 2026-04-01
J0490 HCPCS Belimumab Injection 2 1 — — $50.20 $50.20 $50.20 2026-04-01
J7639 HCPCS Dornase Alfa 2.5mg/2.5ml Sol 2 1 — — $50.12 $50.12 $50.12 2026-04-01
J7516 HCPCS Cyclosporin Parenteral 250mg 2 1 — — $50.12 $50.12 $50.12 2026-04-01
J7170 HCPCS Inj., Emicizumab-kxwh 0.5 Mg 2 1 — — $49.94 $49.94 $49.94 2026-04-01
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