Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

MAYO CLINIC HLTH SYSTM FRANCISCAN HLTHCARE SPARTA

Sparta, WI · CCN 521305 · Rates published

Your selected procedure

You selected 93306 (CPT)

HC ECHO TTE 2D W DPLR COMPLETE

This hospital’s price: $3,282 across 141 payers · range $3,265-$3,403

Source: https://mcorgstatic.blob.core.windows.net/cms-price/390806374_mayo-clinic-health-system-franciscan-healthcare-sparta_standardcharges.csv · observed 2026-03-31

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

6,576 distinct procedures filed
385 distinct payers
8,649,222 rate rows
2026-03-31 last MRF observed
Data quality

3,527,517 of 8,649,222 rate rows are consumer-grade (40.8%)

5,121,705 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
professional (physician) fee — not the facility price 5,120,224
per-diem day rate — not a per-procedure price 861
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 423
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 138
placeholder amount (≤ $0.02) — excluded from medians 52
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 4
exceeds 10× this hospital's gross charge — excluded from medians 3
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://mcorgstatic.blob.core.windows.net/cms-price/390806374_mayo-clinic-health-system-franciscan-healthcare-sparta_standardcharges.csv
Found on page https://www.mayoclinichealthsystem.org/for-patients-and-visitors/price-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-21
Content fingerprint fc9cb5d6dbe8192d… · 5,517,042,579 bytes · first seen 2026-05-13

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
J2326
HCPCS 		Nusinersen (pf) 12 Mg/5 Ml Intrathecal Solution 269 $76,163.86 $362,510.68 $347,863.78 nat. median
$2,480
outlier · 140.3×
A9607
HCPCS 		Lutetium Lu-177 Vipivotide Tetraxetan 27 Mci/ml (1,000 Mbq/ml) IV Soln 269 $33,592.00 $159,885.00 $153,425.00 nat. median
$432
outlier · 354.8×
J1823
HCPCS 		Inebilizumab-cdon 10 Mg/ml Intravenous Solution 269 $25,062.25 $119,286.68 $114,467.02 nat. median
$818
outlier · 140.0×
J9359
HCPCS 		Pr Inj Lon Tesirin-lpyl 0.075mg 269 $17,000.55 $80,916.07 $77,646.73 nat. median
$742
outlier · 104.6×
J2507
HCPCS 		Pegloticase 8 Mg/ml Intravenous Solution 270 $16,527.39 $78,664.01 $75,485.67 nat. median
$9,200
outlier · 8.2×
RX-219415
CDM 		Belantamab Mafodotin-blmf 70 Mg Intravenous Solution 269 $13,994.32 $66,607.60 $63,916.38 nat. median
$63,916
1.0× median
RX-707820
CDM 		Belantamab Mafodotin-blmf 70 Mg/1.4 Ml Intravenous Solution (wetted) 269 $13,994.32 $66,607.60 $63,916.38 nat. median
$63,916
1.0× median
J9274
HCPCS 		Pr Inj, Tebentafusp-tebn, 1 Mcg 269 $12,552.13 $59,743.33 $57,329.46 nat. median
$418
outlier · 137.2×
J0638
HCPCS 		Canakinumab (pf) 150 Mg/ml Subcutaneous Solution 270 $11,683.46 $55,608.80 $53,361.98 nat. median
$253
outlier · 211.1×
J2350
HCPCS 		Ocrelizumab 30 Mg/ml Intravenous Solution 270 $11,205.44 $53,333.58 $51,178.69 nat. median
$470
outlier · 109.0×
33289
CPT 		Pr Transcath Impl W-less Pulm Press Sensor, Rhc 270 $292.87 $48,625.83 $46,661.15 nat. median
$27,731
1.7× median
SUP-00886874116562
CDM 		Escp Pls Dv Rgd 0d 8 269 $10,192.00 $48,510.00 $46,550.00 nat. median
$46,550
1.0× median
SUP-00886874116555
CDM 		Escp Pls Dv Rgd 30d 8 269 $10,192.00 $48,510.00 $46,550.00 nat. median
$46,550
1.0× median
33264
CPT 		Pr Rmvl&rplc Icd Gen Multi Lead 270 $365.07 $44,628.21 $42,825.05 nat. median
$31,574
1.4× median
33249
CPT 		Pr Ins/rplc Dfib W Transven Lead 270 $816.94 $44,628.21 $42,825.05 nat. median
$31,620
1.4× median
33270
CPT 		Pr Ins/rplc Subq Icd W Subq Elec 270 $505.52 $44,141.13 $42,357.65 nat. median
$32,114
1.3× median
C2616
HCPCS 		Yttrium-90 Microspheres 3-20 Gbq/0.6 Ml For Intravenous Solution 269 $8,916.96 $42,441.30 $40,726.50 nat. median
$26,836
1.5× median
33230
CPT 		Pr Ins Pulse Gen W Exst Dual Lead 270 $341.22 $41,803.74 $40,114.70 nat. median
$22,483
1.8× median
J9334
HCPCS 		Efgartigimod Alfa 1008 Mg-hyaluron-qvfc 11,200 Unit/5.6 Ml Subcut Soln 269 $8,621.72 $41,036.09 $39,378.07 nat. median
$83
outlier · 475.4×
J9043
HCPCS 		Pr Cabazitaxel Injection 270 $8,619.29 $41,024.51 $39,366.96 nat. median
$735
outlier · 53.6×
0797T
CPT 		Pr Tcat Ins 2chmbr Ldls Pm Rv 269 $8,084.54 $38,479.32 $36,924.60 nat. median
$20,100
1.8× median
0614T
CPT 		Pr Rmv & Replace Substernal Impl Defib Puls Gen 269 $7,930.83 $37,747.71 $36,222.55 nat. median
$23,432
1.5× median
33263
CPT 		Pr Rmvl&rplc Icd Gen Dual Lead 270 $351.79 $37,747.71 $36,222.55 nat. median
$23,376
1.5× median
33262
CPT 		Pr Rmvl&rplc Icd Gen Sngl Lead 270 $338.76 $37,747.71 $36,222.55 nat. median
$23,311
1.6× median
92930
CPT 		Pr Perq Tcat Plmt Ntrac St 2+les 2+st 2+c Segments 270 $554.63 $37,579.41 $36,061.05 nat. median
$27,623
1.3× median
93656
CPT 		Pr Ep Eval Tx Art Fib Pulm Vein 270 $817.79 $37,376.46 $35,866.30 nat. median
$27,236
1.3× median
J3357
HCPCS 		Ustekinumab 45 Mg/0.5 Ml Subcutaneous Syringe 270 $7,847.80 $41,502.78 $35,843.31 nat. median
$14,744
outlier · 2.4×
J9042
HCPCS 		Pr Brentuximab Vedotin Inj 270 $7,721.73 $36,752.46 $35,267.52 nat. median
$951
outlier · 37.1×
0795T
CPT 		Pr Tcat Ins 2chmbr Ldls Pm Cmpl 269 $7,611.76 $36,229.05 $34,765.25 nat. median
$21,629
1.6× median
C9765
HCPCS 		Hc Revasc Intra Lithotrip-stent 269 $7,491.12 $35,654.85 $34,214.25 nat. median
$19,139
1.8× median
J9272
HCPCS 		Dostarlimab-gxly 50 Mg/ml Intravenous Solution 269 $7,200.86 $34,273.31 $32,888.53 nat. median
$786
outlier · 41.8×
J9382
HCPCS 		Zenocutuzumab-zbco 375 Mg/18.75 Ml (20 Mg/ml) Intravenous Solution 269 $7,164.89 $34,102.13 $32,724.27 nat. median
$115
outlier · 284.4×
93654
CPT 		Pr Ep Eval W Vent Tachy Ablate 270 $869.46 $34,043.13 $32,667.65 nat. median
$27,016
1.2× median
J9022
HCPCS 		Atezolizumab 60 Mg/ml Intravenous Solution (wrapper) 270 $7,007.52 $33,353.10 $32,005.50 nat. median
$6,785
outlier · 4.7×
J9024
HCPCS 		Atezolizumab 1,875 Mg-hyaluronidase-tqjs 30,000 Unit/15 Ml Subcut Soln 269 $7,007.50 $33,353.00 $32,005.41 nat. median
$87
outlier · 368.5×
33229
CPT 		Pr Rplc Perm Gen Mult Lead 270 $339.10 $33,252.12 $31,908.60 nat. median
$18,690
1.7× median
C9606
HCPCS 		Hc Perc Translum Revasc Ami Sngl 269 $6,901.23 $32,847.21 $31,520.05 nat. median
$17,846
1.8× median
C9607
HCPCS 		Hc Perc Translum Revasc Cor Sngl 269 $6,901.23 $32,847.21 $31,520.05 nat. median
$20,030
1.6× median
J9119
HCPCS 		Cemiplimab-rwlc 50 Mg/ml Intravenous Solution 270 $6,658.60 $31,692.38 $30,411.88 nat. median
$91
outlier · 334.0×
93653
CPT 		Pr Ep Eval W Supravent Ablate 270 $721.26 $31,648.32 $30,369.60 nat. median
$26,652
1.1× median
J9144
HCPCS 		Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln 270 $6,570.01 $31,270.73 $30,007.27 nat. median
$211
outlier · 141.9×
C9602
HCPCS 		Hc Perc Translum Ather Wangio Sng 269 $6,543.89 $31,146.39 $29,887.95 nat. median
$20,101
1.5× median
33274
CPT 		Pr Rplc/insrt Transcath Leadls Pm 270 $430.26 $30,395.97 $29,167.85 nat. median
$19,643
1.5× median
J2329
HCPCS 		Ublituximab-xiiy 25 Mg/ml Intravenous Solution 269 $6,207.28 $29,544.27 $28,350.57 nat. median
$177
outlier · 160.1×
J9203
HCPCS 		Gemtuzumab Ozogamicin 4.5 Mg/4.5 Ml (1 Mg/ml Initial Concentration) IV Soln (wet… 270 $6,176.08 $29,395.77 $28,208.07 nat. median
$687
outlier · 41.1×
C9766
HCPCS 		Hc Revasc Intra Lithotrip-ather 269 $6,156.59 $29,303.01 $28,119.05 nat. median
$19,268
1.5× median
J3245
HCPCS 		Tildrakizumab-asmn 100 Mg/ml Subcutaneous Syringe 270 $6,127.49 $29,164.51 $27,986.15 nat. median
$256
outlier · 109.3×
92933
CPT 		Pr Ptca Intracor Stnt Sngl Mjr 270 $560.36 $28,890.18 $27,722.90 nat. median
$18,549
1.5× median
J1640
HCPCS 		Pr Hemin 1mg Inj 270 $6,030.52 $28,702.97 $27,543.26 nat. median
$80
outlier · 344.7×
C1767
HCPCS 		Implant Generator Neurostimulator Pain Management Permanent Compatible Sterile 2… 269 $4,209.92 $42,768.00 $27,276.40 nat. median
$23,896
1.1× median

Other procedures at this hospital

Browse this hospital's 6,576 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
             
J2326 HCPCS Nusinersen (pf) 12 Mg/5 Ml Intrathecal Solution 400 269 $366,172.40 $329,555.16 $76,163.86 $362,510.68 $347,863.78 2026-03-31
A9607 HCPCS Lutetium Lu-177 Vipivotide Tetraxetan 27 Mci/ml (1,000 Mbq/ml) IV Soln 400 269 $161,500.00 $145,350.00 $33,592.00 $159,885.00 $153,425.00 2026-03-31
J1823 HCPCS Inebilizumab-cdon 10 Mg/ml Intravenous Solution 398 269 $120,491.60 $108,442.44 $25,062.25 $119,286.68 $114,467.02 2026-03-31
J9359 HCPCS Pr Inj Lon Tesirin-lpyl 0.075mg 398 269 $81,733.40 $73,560.06 $17,000.55 $80,916.07 $77,646.73 2026-03-31
J2507 HCPCS Pegloticase 8 Mg/ml Intravenous Solution 400 270 $79,458.60 $71,512.74 $16,527.39 $78,664.01 $75,485.67 2026-03-31
RX-707820 CDM Belantamab Mafodotin-blmf 70 Mg/1.4 Ml Intravenous Solution (wetted) 400 269 $67,280.40 $60,552.36 $13,994.32 $66,607.60 $63,916.38 2026-03-31
RX-219415 CDM Belantamab Mafodotin-blmf 70 Mg Intravenous Solution 400 269 $67,280.40 $60,552.36 $13,994.32 $66,607.60 $63,916.38 2026-03-31
J9274 HCPCS Pr Inj, Tebentafusp-tebn, 1 Mcg 398 269 $60,346.80 $54,312.12 $12,552.13 $59,743.33 $57,329.46 2026-03-31
J0638 HCPCS Canakinumab (pf) 150 Mg/ml Subcutaneous Solution 400 270 $56,170.50 $50,553.45 $11,683.46 $55,608.80 $53,361.98 2026-03-31
J2350 HCPCS Ocrelizumab 30 Mg/ml Intravenous Solution 400 270 $53,872.30 $48,485.07 $11,205.44 $53,333.58 $51,178.69 2026-03-31
33289 CPT Pr Transcath Impl W-less Pulm Press Sensor, Rhc 402 270 $49,117.00 $44,205.30 $292.87 $48,625.83 $46,661.15 2026-03-31
SUP-00886874116555 CDM Escp Pls Dv Rgd 30d 8 400 269 $49,000.00 $44,100.00 $10,192.00 $48,510.00 $46,550.00 2026-03-31
SUP-00886874116562 CDM Escp Pls Dv Rgd 0d 8 400 269 $49,000.00 $44,100.00 $10,192.00 $48,510.00 $46,550.00 2026-03-31
33249 CPT Pr Ins/rplc Dfib W Transven Lead 402 270 $45,079.00 $40,571.10 $816.94 $44,628.21 $42,825.05 2026-03-31
33264 CPT Pr Rmvl&rplc Icd Gen Multi Lead 402 270 $45,079.00 $40,571.10 $365.07 $44,628.21 $42,825.05 2026-03-31
33270 CPT Pr Ins/rplc Subq Icd W Subq Elec 402 270 $44,587.00 $40,128.30 $505.52 $44,141.13 $42,357.65 2026-03-31
C2616 HCPCS Yttrium-90 Microspheres 3-20 Gbq/0.6 Ml For Intravenous Solution 400 269 $42,870.00 $38,583.00 $8,916.96 $42,441.30 $40,726.50 2026-03-31
33230 CPT Pr Ins Pulse Gen W Exst Dual Lead 402 270 $42,226.00 $38,003.40 $341.22 $41,803.74 $40,114.70 2026-03-31
J9334 HCPCS Efgartigimod Alfa 1008 Mg-hyaluron-qvfc 11,200 Unit/5.6 Ml Subcut Soln 398 269 $41,450.60 $37,305.54 $8,621.72 $41,036.09 $39,378.07 2026-03-31
J9043 HCPCS Pr Cabazitaxel Injection 400 270 $41,438.90 $37,295.01 $8,619.29 $41,024.51 $39,366.96 2026-03-31
0797T CPT Pr Tcat Ins 2chmbr Ldls Pm Rv 400 269 $38,868.00 $34,981.20 $8,084.54 $38,479.32 $36,924.60 2026-03-31
33262 CPT Pr Rmvl&rplc Icd Gen Sngl Lead 402 270 $38,129.00 $34,316.10 $338.76 $37,747.71 $36,222.55 2026-03-31
0614T CPT Pr Rmv & Replace Substernal Impl Defib Puls Gen 400 269 $38,129.00 $34,316.10 $7,930.83 $37,747.71 $36,222.55 2026-03-31
33263 CPT Pr Rmvl&rplc Icd Gen Dual Lead 402 270 $38,129.00 $34,316.10 $351.79 $37,747.71 $36,222.55 2026-03-31
92930 CPT Pr Perq Tcat Plmt Ntrac St 2+les 2+st 2+c Segments 402 270 $37,959.00 $34,163.10 $554.63 $37,579.41 $36,061.05 2026-03-31
93656 CPT Pr Ep Eval Tx Art Fib Pulm Vein 402 270 $37,754.00 $33,978.60 $817.79 $37,376.46 $35,866.30 2026-03-31
J3357 HCPCS Ustekinumab 45 Mg/0.5 Ml Subcutaneous Syringe 402 270 $37,729.80 $33,956.82 $7,847.80 $41,502.78 $35,843.31 2026-03-31
J9042 HCPCS Pr Brentuximab Vedotin Inj 400 270 $37,123.70 $33,411.33 $7,721.73 $36,752.46 $35,267.52 2026-03-31
0795T CPT Pr Tcat Ins 2chmbr Ldls Pm Cmpl 400 269 $36,595.00 $32,935.50 $7,611.76 $36,229.05 $34,765.25 2026-03-31
C9765 HCPCS Hc Revasc Intra Lithotrip-stent 400 269 $36,015.00 $32,413.50 $7,491.12 $35,654.85 $34,214.25 2026-03-31
J9272 HCPCS Dostarlimab-gxly 50 Mg/ml Intravenous Solution 398 269 $34,619.50 $31,157.55 $7,200.86 $34,273.31 $32,888.53 2026-03-31
J9382 HCPCS Zenocutuzumab-zbco 375 Mg/18.75 Ml (20 Mg/ml) Intravenous Solution 398 269 $34,446.60 $31,001.94 $7,164.89 $34,102.13 $32,724.27 2026-03-31
93654 CPT Pr Ep Eval W Vent Tachy Ablate 402 270 $34,387.00 $30,948.30 $869.46 $34,043.13 $32,667.65 2026-03-31
J9022 HCPCS Atezolizumab 60 Mg/ml Intravenous Solution (wrapper) 400 270 $33,690.00 $30,321.00 $7,007.52 $33,353.10 $32,005.50 2026-03-31
J9024 HCPCS Atezolizumab 1,875 Mg-hyaluronidase-tqjs 30,000 Unit/15 Ml Subcut Soln 398 269 $33,689.90 $30,320.91 $7,007.50 $33,353.00 $32,005.41 2026-03-31
33229 CPT Pr Rplc Perm Gen Mult Lead 402 270 $33,588.00 $30,229.20 $339.10 $33,252.12 $31,908.60 2026-03-31
C9606 HCPCS Hc Perc Translum Revasc Ami Sngl 400 269 $33,179.00 $29,861.10 $6,901.23 $32,847.21 $31,520.05 2026-03-31
C9607 HCPCS Hc Perc Translum Revasc Cor Sngl 400 269 $33,179.00 $29,861.10 $6,901.23 $32,847.21 $31,520.05 2026-03-31
J9119 HCPCS Cemiplimab-rwlc 50 Mg/ml Intravenous Solution 400 270 $32,012.50 $28,811.25 $6,658.60 $31,692.38 $30,411.88 2026-03-31
93653 CPT Pr Ep Eval W Supravent Ablate 402 270 $31,968.00 $28,771.20 $721.26 $31,648.32 $30,369.60 2026-03-31
J9144 HCPCS Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln 400 270 $31,586.60 $28,427.94 $6,570.01 $31,270.73 $30,007.27 2026-03-31
C9602 HCPCS Hc Perc Translum Ather Wangio Sng 400 269 $31,461.00 $28,314.90 $6,543.89 $31,146.39 $29,887.95 2026-03-31
33274 CPT Pr Rplc/insrt Transcath Leadls Pm 402 270 $30,703.00 $27,632.70 $430.26 $30,395.97 $29,167.85 2026-03-31
J2329 HCPCS Ublituximab-xiiy 25 Mg/ml Intravenous Solution 398 269 $29,842.70 $26,858.43 $6,207.28 $29,544.27 $28,350.57 2026-03-31
J9203 HCPCS Gemtuzumab Ozogamicin 4.5 Mg/4.5 Ml (1 Mg/ml Initial Concentration) IV Soln (wet… 400 270 $29,692.70 $26,723.43 $6,176.08 $29,395.77 $28,208.07 2026-03-31
C9766 HCPCS Hc Revasc Intra Lithotrip-ather 400 269 $29,599.00 $26,639.10 $6,156.59 $29,303.01 $28,119.05 2026-03-31
J3245 HCPCS Tildrakizumab-asmn 100 Mg/ml Subcutaneous Syringe 400 270 $29,459.10 $26,513.19 $6,127.49 $29,164.51 $27,986.15 2026-03-31
92933 CPT Pr Ptca Intracor Stnt Sngl Mjr 402 270 $29,182.00 $26,263.80 $560.36 $28,890.18 $27,722.90 2026-03-31
J1640 HCPCS Pr Hemin 1mg Inj 400 270 $28,992.90 $26,093.61 $6,030.52 $28,702.97 $27,543.26 2026-03-31
C1767 HCPCS Implant Generator Neurostimulator Pain Management Permanent Compatible Sterile 2… 1,600 269 $32,285.00 $29,056.50 $4,209.92 $42,768.00 $27,276.40 2026-03-31
J7314 HCPCS Fluocinolone 0.18 Mg Intravitreal Implant 400 270 $28,127.60 $25,314.84 $5,850.54 $27,846.32 $26,721.22 2026-03-31
RX-38305 CDM Sufentanil Citrate (bulk) Powder 400 269 $27,756.20 $24,980.58 $5,773.29 $27,478.64 $26,368.39 2026-03-31
J3263 HCPCS Toripalimab-tpzi 240 Mg/6 Ml (40 Mg/ml) Intravenous Solution 398 269 $27,620.10 $24,858.09 $5,744.98 $27,343.90 $26,239.10 2026-03-31
J9228 HCPCS Pr Ipilimumab Inj 1 Mg 400 270 $26,168.10 $23,551.29 $5,442.96 $25,906.42 $24,859.70 2026-03-31
92941 CPT Pr Perc Revasc Trans Mi Sngl Vesl 402 270 $25,775.00 $23,197.50 $597.08 $25,517.25 $24,486.25 2026-03-31
J2327 HCPCS Risankizumab-rzaa 60 Mg/ml Intravenous Solution 398 269 $25,675.30 $23,107.77 $5,340.46 $25,418.55 $24,391.54 2026-03-31
J3380 HCPCS Vedolizumab 300 Mg Intravenous Solution 400 270 $25,557.80 $23,002.02 $5,316.02 $25,302.22 $24,279.91 2026-03-31
J1930 HCPCS Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe 400 270 $25,148.30 $22,633.47 $4,883.54 $24,896.82 $23,890.89 2026-03-31
37288 CPT Hc Revsc Evsc Tpvt Athrc Sf 1st 402 270 $24,658.00 $22,192.20 $622.43 $24,411.42 $23,425.10 2026-03-31
J2267 HCPCS Mirikizumab-mrkz 300 Mg/15 Ml (20 Mg/ml) Intravenous Solution 398 269 $24,276.20 $21,848.58 $5,049.45 $24,033.44 $23,062.39 2026-03-31
545 MS_DRG Connective Tissue Disorders With Mcc 1 1 — — $23,046.97 $23,046.97 $23,046.97 2026-03-31
J9301 HCPCS Obinutuzumab 1,000 Mg/40 Ml Intravenous Solution 400 270 $24,133.80 $21,720.42 $5,019.83 $23,892.46 $22,927.11 2026-03-31
92945 CPT Pr Perq Trluml Revsc Chrnc Tot Occls 1 Antgrd&rtrgr 402 270 $23,904.00 $21,513.60 $693.45 $23,664.96 $22,708.80 2026-03-31
J9223 HCPCS Pr Inj. Lurbinectedin, 0.1 Mg 400 270 $23,868.50 $21,481.65 $4,964.65 $23,629.82 $22,675.08 2026-03-31
33214 CPT Pr Upgrade Impl Pcmkr Sys 402 270 $23,396.00 $21,056.40 $438.05 $23,162.04 $22,226.20 2026-03-31
92924 CPT Pr Ptca W Cor Angio Sngl Mjr 402 270 $23,158.00 $20,842.20 $475.27 $22,926.42 $22,000.10 2026-03-31
37282 CPT Pr Rvsc Evsc Tpvt Angio Cplx 1 402 270 $23,121.00 $20,808.90 $566.03 $22,889.79 $21,964.95 2026-03-31
J9289 HCPCS Nivolumab 600 Mg-hyaluronidase-nvhy 10,000 Unit/5 Ml Subcut Solution 398 269 $23,010.70 $20,709.63 $4,786.23 $22,780.59 $21,860.17 2026-03-31
36906 CPT Pr Av Fistula Stent Thrombectomy 402 270 $22,649.00 $20,384.10 $469.45 $22,422.51 $21,516.55 2026-03-31
J2323 HCPCS Natalizumab 300 Mg/15 Ml Intravenous Solution 400 270 $22,623.10 $20,360.79 $4,705.60 $22,396.87 $21,491.95 2026-03-31
Q3027 HCPCS Interferon Beta-1a 30 Mcg/0.5 Ml Intramuscular (wrapper) 402 270 $22,532.40 $20,279.16 $4,686.74 $24,785.64 $21,405.78 2026-03-31
C1772 HCPCS Pump Infusion Thk19.5mm Dia87.5mm 20ml Titanium Progmmable Ii 400 269 $22,400.00 $20,160.00 $4,659.20 $22,176.00 $21,280.00 2026-03-31
C1822 HCPCS Generator Neurostimulator Pulse Reactiv8 800 269 $25,103.00 $22,592.70 $4,553.54 $28,030.86 $21,235.24 2026-03-31
37243 CPT Pr Vasc Embl/occlude Tmr Infarct 402 270 $22,154.00 $19,938.60 $517.37 $21,932.46 $21,046.30 2026-03-31
92928 CPT Pr Plc Intracor Stnt Sngl 402 270 $22,117.00 $19,905.30 $469.43 $21,895.83 $21,011.15 2026-03-31
C9600 HCPCS Hc Perc Transcath Plct Drug Stnt Sng 400 269 $21,848.00 $19,663.20 $4,544.38 $21,629.52 $20,755.60 2026-03-31
C9604 HCPCS Hc Perc Translum Revasc Sngl Vssl 400 269 $21,848.00 $19,663.20 $4,544.38 $21,629.52 $20,755.60 2026-03-31
J1323 HCPCS Elranatamab-bcmm 40 Mg/ml Subcutaneous Solution 796 269 $29,051.30 $26,146.17 $4,431.27 $36,430.42 $20,665.07 2026-03-31
J9308 HCPCS Pr Ramucirumab Inj 5 Mg 400 270 $21,658.90 $19,493.01 $4,505.05 $21,442.31 $20,575.96 2026-03-31
36903 CPT Pr Av Fistula Stent 402 270 $21,633.00 $19,469.70 $290.12 $21,416.67 $20,551.35 2026-03-31
J9273 HCPCS Pr Inj Tisotu Vedotin-tftv, 1mg 398 269 $21,058.30 $18,952.47 $4,380.13 $20,847.72 $20,005.39 2026-03-31
J3101 HCPCS Tenecteplase 50 Mg Intravenous Solution 400 270 $20,226.50 $18,203.85 $4,207.11 $20,024.24 $19,215.18 2026-03-31
92943 CPT Pr Perc Revasc Trans Chr Sngl Vesl 402 270 $20,174.00 $18,156.60 $642.06 $19,972.26 $19,165.30 2026-03-31
J9331 HCPCS Sirolimus-protein Bound 100 Mg Intravenous Suspension 398 269 $20,018.00 $18,016.20 $4,163.74 $19,817.82 $19,017.10 2026-03-31
J9306 HCPCS Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Intravenous Solution 400 270 $19,632.30 $17,669.07 $4,083.52 $19,435.98 $18,650.69 2026-03-31
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 1 — — $18,607.13 $18,607.13 $18,607.13 2026-03-31
J9063 HCPCS Inj, Elahere, 1 Mg 398 269 $19,572.30 $17,615.07 $4,071.04 $19,376.58 $18,593.69 2026-03-31
33228 CPT Pr Rplc Perm Gen Dual Lead 402 270 $19,353.00 $17,417.70 $324.09 $19,159.47 $18,385.35 2026-03-31
33208 CPT Pr Ins/rplc Pcmkr Atrial & Vent 402 270 $19,353.00 $17,417.70 $467.02 $19,159.47 $18,385.35 2026-03-31
33206 CPT Pr Ins/rplc Pcmkr Atrial 402 270 $19,321.00 $17,388.90 $413.57 $19,127.79 $18,354.95 2026-03-31
33212 CPT Pr Ins Pcmkr Pls Gen Exist 1 Lead 402 270 $19,248.00 $17,323.20 $300.89 $19,055.52 $18,285.60 2026-03-31
J0775 HCPCS Pr Collagenase, Clost Hist Inj 400 270 $18,888.10 $16,999.29 $3,928.72 $18,699.22 $17,943.70 2026-03-31
37244 CPT Pr Vasc Embl/occlude Hemorrhage 402 270 $18,459.00 $16,613.10 $607.15 $18,274.41 $17,536.05 2026-03-31
J9347 HCPCS Tremelimumab-actl 20 Mg/ml Intravenous Solution 796 269 $64,435.90 $57,992.31 $2,141.15 $117,392.02 $17,427.62 2026-03-31
22514 CPT Pr Perc Vert Agmntj Cav Crtj Lmbr 402 270 $18,092.00 $16,282.80 $443.95 $17,911.08 $17,187.40 2026-03-31
22513 CPT Pr Perc Vertebplsty Cavty Img Guid 1 402 270 $18,092.00 $16,282.80 $474.11 $17,911.08 $17,187.40 2026-03-31
33207 CPT Pr Ins/rplc Pcmkr Vent 402 270 $17,818.00 $16,036.20 $432.96 $17,639.82 $16,927.10 2026-03-31
C9764 HCPCS Hc Revasc Intravasc Lithotripsy 400 269 $17,809.00 $16,028.10 $3,704.27 $17,630.91 $16,918.55 2026-03-31
J2427 HCPCS Paliperidone Palmitate (3 Month) 546 Mg/1.75 Ml Intramuscular Syringe 796 269 $21,172.35 $19,055.11 $3,540.80 $25,068.38 $16,512.41 2026-03-31
J9271 HCPCS Pembrolizumab 25 Mg/ml Intravenous Solution 400 270 $17,201.30 $15,481.17 $3,577.87 $17,029.29 $16,341.24 2026-03-31
J1303 HCPCS Ravulizumab-cwvz 100 Mg/ml Intravenous Solution 800 270 $38,528.80 $34,675.92 $3,485.08 $59,699.38 $16,252.54 2026-03-31
33224 CPT Pr Ins Pacing Elctd Lv Lead Conn 402 270 $16,938.00 $15,244.20 $448.75 $16,768.62 $16,091.10 2026-03-31
J9302 HCPCS Ofatumumab 20 Mg/ml Intravenous Solution (wrapper) 402 270 $16,922.00 $15,229.80 $3,519.78 $16,922.00 $16,075.90 2026-03-31
J9039 HCPCS Pr Blinatumomab Inj 400 270 $16,850.20 $15,165.18 $3,504.84 $16,681.70 $16,007.69 2026-03-31
93459 CPT Pr Cath Plc Arty/grft Ang W L Hrt 402 270 $16,577.00 $14,919.30 $1,175.91 $16,411.23 $15,748.15 2026-03-31
J9311 HCPCS Rituximab 1,400 Mg/11.7 Ml (120 Mg/ml)-hyaluronidase Subcutaneous Soln 400 270 $16,565.60 $14,909.04 $3,445.64 $16,399.94 $15,737.32 2026-03-31
36905 CPT Pr Av Fistula Pta Thrombectomy 402 270 $16,343.00 $14,708.70 $406.97 $16,179.57 $15,525.85 2026-03-31
393 MS_DRG Other Digestive System Diagnoses With Mcc 1 1 — — $15,422.11 $15,422.11 $15,422.11 2026-03-31
93457 CPT Pr Cath Plc Arty/grft Ang W R Hrt 402 270 $16,211.00 $14,589.90 $1,292.01 $16,048.89 $15,400.45 2026-03-31
J9332 HCPCS Pr Inj Efgartigimod 2mg 398 269 $16,210.50 $14,589.45 $3,371.78 $16,048.40 $15,399.98 2026-03-31
93655 CPT Pr Ablt Arrhythmia Add On 402 270 $15,778.00 $14,200.20 $264.33 $15,620.22 $14,989.10 2026-03-31
93461 CPT Pr Cath Plc Art/grft Ang W R&l Hrt 402 270 $15,764.00 $14,187.60 $1,437.58 $15,606.36 $14,975.80 2026-03-31
J1299 HCPCS Eculizumab 300 Mg/30 Ml Intravenous Solution 398 269 $15,591.00 $14,031.90 $3,242.93 $15,435.09 $14,811.45 2026-03-31
93657 CPT Pr Ablt Atrium Add Linear Cath 402 270 $15,569.00 $14,012.10 $264.33 $15,413.31 $14,790.55 2026-03-31
J0717 HCPCS Pr Certolizumab Pegol Inj 1mg 400 270 $15,549.50 $13,994.55 $1,778.82 $15,394.01 $14,772.03 2026-03-31
557 MS_DRG Tendonitis, Myositis And Bursitis With Mcc 1 1 — — $14,378.97 $14,378.97 $14,378.97 2026-03-31
682 MS_DRG Renal Failure With Mcc 1 1 — — $14,324.21 $14,324.21 $14,324.21 2026-03-31
33285 CPT Pr Impl Pt Actv Card Event Record 402 270 $15,028.00 $13,525.20 $76.95 $14,877.72 $14,276.60 2026-03-31
37236 CPT Pr Plc Opn/perc Stent Init 402 270 $14,958.00 $13,462.20 $394.37 $14,808.42 $14,210.10 2026-03-31
33227 CPT Pr Rplc Perm Gen Sngl Lead 402 270 $14,743.00 $13,268.70 $310.71 $14,595.57 $14,005.85 2026-03-31
637 MS_DRG Diabetes With Mcc 1 1 — — $13,913.11 $13,913.11 $13,913.11 2026-03-31
33216 CPT Pr Ins Sngl Eltrd/ppcmkr/icd 402 270 $14,634.00 $13,170.60 $341.67 $14,487.66 $13,902.30 2026-03-31
562 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 1 1 — — $13,802.66 $13,802.66 $13,802.66 2026-03-31
33217 CPT Pr Insert Electrode Implant Dual 402 270 $14,513.00 $13,061.70 $340.52 $14,367.87 $13,787.35 2026-03-31
J9011 HCPCS Datopotamab Deruxtecan, 1 Mg 398 269 $14,341.70 $12,907.53 $2,983.07 $14,198.28 $13,624.62 2026-03-31
93458 CPT Pr Cath Plc Arty/vent Ang W L Hrt 402 270 $14,316.00 $12,884.40 $1,093.36 $14,172.84 $13,600.20 2026-03-31
J0491 HCPCS Anifrolumab-fnia 300 Mg/2 Ml (150 Mg/ml) Intravenous Solution 398 269 $14,154.70 $12,739.23 $2,944.18 $14,013.15 $13,446.97 2026-03-31
C9601 HCPCS Hc Perc Transcath Plct Drug Stnt Add 400 269 $14,042.00 $12,637.80 $2,920.74 $13,901.58 $13,339.90 2026-03-31
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 1 1 — — $13,327.50 $13,327.50 $13,327.50 2026-03-31
47534 CPT Pr Plc Biliary Drn Cath Intrnl-extrnl 402 270 $13,940.00 $12,546.00 $340.69 $13,800.60 $13,243.00 2026-03-31
RX-166064 CDM Uridine Triacetate 10 Gram Oral Granules In Packet 401 269 $13,921.40 $12,529.26 $2,895.65 $15,313.54 $13,225.33 2026-03-31
93456 CPT Pr Cath Plc Cor Arty/ang W Rt Hrt 402 270 $13,872.00 $12,484.80 $1,185.08 $13,733.28 $13,178.40 2026-03-31
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 1 1 — — $12,974.85 $12,974.85 $12,974.85 2026-03-31
93619 CPT Pr Ep Eval Wo Arrhythmia 402 270 $13,576.00 $12,218.40 $751.42 $13,440.24 $12,897.20 2026-03-31
33210 CPT Pr Ins/rplc Temp Elec/pcmkr Sngl 402 270 $13,487.00 $12,138.30 $143.49 $13,352.13 $12,812.65 2026-03-31
C9358 HCPCS Graft Biological Tissue W20xl16cm Thk3mm Nondenatured Collagen Bovine Rectangula… 1,200 269 $13,440.00 $12,096.00 $2,396.16 $21,384.00 $12,768.00 2026-03-31
J9227 HCPCS Pr Inj. Isatuximab-irfc 10 Mg 400 270 $13,349.20 $12,014.28 $2,776.63 $13,215.71 $12,681.74 2026-03-31
93460 CPT Pr Cath Plc Art/ven Ang W R&l Hrt 402 270 $13,228.00 $11,905.20 $1,304.61 $13,095.72 $12,566.60 2026-03-31
291 MS_DRG Heart Failure And Shock With Mcc 1 1 — — $12,494.13 $12,494.13 $12,494.13 2026-03-31
33233 CPT Pr Rmvl Pcmkr Pulse Gen Only 402 270 $13,067.00 $11,760.30 $221.00 $12,936.33 $12,413.65 2026-03-31
J7504 HCPCS Lymphocyte,anti-thymo Immune Globulin 50 Mg/ml Intravenous Solution 400 270 $12,738.30 $11,464.47 $2,649.57 $12,610.92 $12,101.39 2026-03-31
37191 CPT Pr Insert Evasc Vena Cava Filter 402 270 $12,657.00 $11,391.30 $201.53 $12,530.43 $12,024.15 2026-03-31
J9038 HCPCS Axatilimab-csfr 50 Mg/ml Intravenous Solution 796 269 $20,965.20 $18,868.68 $2,569.13 $29,283.01 $11,981.05 2026-03-31
37248 CPT Pr Pta Venous Initial 402 270 $12,580.00 $11,322.00 $272.87 $12,454.20 $11,951.00 2026-03-31
J9309 HCPCS Pr Inj, Polatuzumab Vedotin 1mg 800 270 $33,803.35 $30,423.01 $2,542.13 $54,831.05 $11,855.15 2026-03-31
J7189 HCPCS Coagulation Factor Viia Recomb 1 Mg (1,000 Mcg) Intravenous Solution 1,200 270 $12,475.00 $11,227.50 $1,341.60 $30,244.50 $11,851.25 2026-03-31
92937 CPT Pr Perc Revasc Trans Cor Sngl Vesl 402 270 $12,465.00 $11,218.50 $530.10 $12,340.35 $11,841.75 2026-03-31
93624 CPT Pr Ep Follow Up Study W Arryth 402 270 $12,400.00 $11,160.00 $335.31 $12,276.00 $11,780.00 2026-03-31
A9608 HCPCS Flotufolastat F 18 296-5,846 Mbq/ml (8-158 Mci/ml) IV Solution 400 269 $12,295.60 $11,066.04 $2,557.48 $12,172.64 $11,680.82 2026-03-31
J9354 HCPCS Pr Inj, Ado-trastuzumab Emt 1mg 800 270 $15,470.15 $13,923.13 $2,496.83 $18,746.94 $11,643.88 2026-03-31
J9200 HCPCS Pr Floxuridine Injection 400 270 $12,145.60 $10,931.04 $2,526.28 $12,024.14 $11,538.32 2026-03-31
77373 CPT Hc Stereotactic Body Radtn Del 402 270 $12,049.00 $10,844.10 $1,071.94 $11,928.51 $11,446.55 2026-03-31
0913T CPT Pr Prq Tcat Ther Rx Ntrac Balo1 400 269 $12,036.00 $10,832.40 $2,503.49 $11,915.64 $11,434.20 2026-03-31
J1162 HCPCS Digoxin Immune Fab 40 Mg Intravenous Solution 400 270 $11,949.80 $10,754.82 $2,485.56 $11,830.30 $11,352.31 2026-03-31
C9360 HCPCS Graft Biological Tissue W30xl20cm Thk3mm Nondenatured Collagen Bovine Rectangula… 800 269 $18,450.00 $16,605.00 $2,433.60 $24,948.00 $11,349.00 2026-03-31
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 1 1 — — $11,348.00 $11,348.00 $11,348.00 2026-03-31
A9572 HCPCS Indium 111-pentetreotide 3 Mci/ml-10 Mcg Intravenous Kit 400 269 $11,901.00 $10,710.90 $2,475.41 $11,781.99 $11,305.95 2026-03-31
50593 CPT Pr Ablation Renal Tumor Perc Cryo 402 270 $11,891.00 $10,701.90 $429.62 $11,772.09 $11,296.45 2026-03-31
546 MS_DRG Connective Tissue Disorders With Cc 1 1 — — $11,283.97 $11,283.97 $11,283.97 2026-03-31
J2356 HCPCS Tezepelumab-ekko 210 Mg/1.91 Ml (110 Mg/ml) Subcutaneous Syringe 398 269 $11,836.50 $10,652.85 $2,461.99 $11,718.14 $11,244.68 2026-03-31
A9548 HCPCS Pentetate Indium Disodium In-111 1.5 Mci/1.5 Ml Intrathecal Solution 402 270 $11,758.00 $10,582.20 $2,445.66 $11,640.42 $11,170.10 2026-03-31
37246 CPT Pr Pta Arterial Initial 402 270 $11,756.00 $10,580.40 $317.20 $11,638.44 $11,168.20 2026-03-31
47533 CPT Pr Plc Biliary Drn Cath Extrnl 402 270 $11,725.00 $10,552.50 $244.10 $11,607.75 $11,138.75 2026-03-31
J2506 HCPCS Pegfilgrastim 6 Mg/0.6 Ml Subcutaneous Syringe 398 269 $11,722.90 $10,550.61 $1,842.56 $11,605.67 $11,136.76 2026-03-31
A9595 HCPCS Piflufolastat F 18 37 Mbq/ml To 2,960 Mbq/ml (1-80 Mci/ml) IV Solution 400 269 $11,500.00 $10,350.00 $2,392.00 $11,385.00 $10,925.00 2026-03-31
J9352 HCPCS Pr Injection Trabectedin 0.1mg 400 270 $11,442.50 $10,298.25 $2,380.04 $11,328.08 $10,870.38 2026-03-31
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 1 1 — — $10,859.82 $10,859.82 $10,859.82 2026-03-31
SUP-00643169143821 CDM Tamp Bone For First Fracture Augmentation Kit Expander Sterile Size 2 400 269 $11,400.00 $10,260.00 $2,371.20 $11,286.00 $10,830.00 2026-03-31
33234 CPT Pr Rmvl Pcmkr Elec 1 Lead Sys 402 270 $11,341.00 $10,206.90 $440.96 $11,227.59 $10,773.95 2026-03-31
93622 CPT Pr Ep Eval W Lt Vent Pacing 402 270 $11,325.00 $10,192.50 $571.22 $11,211.75 $10,758.75 2026-03-31
93650 CPT Pr Ablt Av Node 402 270 $11,303.00 $10,172.70 $504.98 $11,189.97 $10,737.85 2026-03-31
445 MS_DRG Disorders Of The Biliary Tract With Cc 1 1 — — $10,736.40 $10,736.40 $10,736.40 2026-03-31
J0896 HCPCS Pr Inj Luspatercept-aamt 0.25mg 800 270 $21,286.65 $19,157.99 $2,258.03 $31,400.23 $10,530.22 2026-03-31
J9061 HCPCS Amivantamab-vmjw 50 Mg/ml Intravenous Solution 398 269 $11,050.10 $9,945.09 $2,298.42 $10,939.60 $10,497.60 2026-03-31
J0739 HCPCS Cabotegravir ER 600 Mg/3 Ml (200 Mg/ml) IM Suspension,extended Release 398 269 $10,939.40 $9,845.46 $2,275.40 $10,830.01 $10,392.43 2026-03-31
SUP-08714729994183 CDM Diagnostic Peripheral Radiopaque Sterile Digital Discover 10.5frx65cm 400 269 $10,917.64 $9,825.88 $2,270.87 $10,808.46 $10,371.76 2026-03-31
93455 CPT Pr Cath Plc Cor Arty/grft Angio 402 270 $10,835.00 $9,751.50 $1,060.27 $10,726.65 $10,293.25 2026-03-31
36251 CPT Pr Sel Cath Renal Arty&angio Unilat 402 270 $10,769.00 $9,692.10 $231.58 $10,661.31 $10,230.55 2026-03-31
93612 CPT Pr Pacing Intra Ventricular 402 270 $10,668.00 $9,601.20 $239.41 $10,561.32 $10,134.60 2026-03-31
J9276 HCPCS Inj Zanidatamab-hrii, 2 Mg 398 269 $10,641.70 $9,577.53 $2,213.47 $10,535.28 $10,109.62 2026-03-31
644 MS_DRG Endocrine Disorders With Cc 1 1 — — $10,092.34 $10,092.34 $10,092.34 2026-03-31
J2997 HCPCS Pr Alteplase Recombinant 1,200 270 $10,620.30 $9,558.27 $119.70 $20,607.35 $10,089.29 2026-03-31
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 1 1 — — $10,076.57 $10,076.57 $10,076.57 2026-03-31
66180 CPT Pr Shnt Aqus Extraocl Rsrvr W Grft 400 268 $10,566.00 $9,509.40 $1,063.74 $10,460.34 $10,037.70 2026-03-31
RX-707829 CDM Denileukin Diftitox-cxdl 150 Mcg/ml Intravenous Solution (wetted) 400 269 $10,558.20 $9,502.38 $2,196.11 $10,452.62 $10,030.29 2026-03-31
699 MS_DRG Other Kidney And Urinary Tract Diagnoses With Cc 1 1 — — $9,999.54 $9,999.54 $9,999.54 2026-03-31
37184 CPT Pr Thrmbct Mech Prim Perc Init Vsl 402 270 $10,465.00 $9,418.50 $390.24 $10,360.35 $9,941.75 2026-03-31
93620 CPT Pr Ep Eval W Arrhythmia 402 270 $10,410.00 $9,369.00 $1,023.22 $10,305.90 $9,889.50 2026-03-31
66183 CPT Pr Ins Antr Drn Wo Extrclr Rsrvr 400 268 $10,403.00 $9,362.70 $965.89 $10,298.97 $9,882.85 2026-03-31
93453 CPT Pr Rt&lt Hrt Cath W Ventriclgrphy 402 270 $10,402.00 $9,361.80 $1,208.52 $10,297.98 $9,881.90 2026-03-31
36902 CPT Pr Av Fistula Pta 402 270 $10,400.00 $9,360.00 $221.08 $10,296.00 $9,880.00 2026-03-31
92920 CPT Pr Ptca Sngl Mjr Arty/brnch 402 270 $10,298.00 $9,268.20 $391.93 $10,195.02 $9,783.10 2026-03-31
J2353 HCPCS Octreotide,microspheres ER 10 Mg Intramuscular Susp, Extended Release 1,200 270 $10,265.30 $9,238.77 $1,650.63 $15,008.50 $9,752.04 2026-03-31
66989 CPT Pr Xcpsl Ctrc Rmvl Cplx Insj 1+ 400 268 $10,250.00 $9,225.00 $788.00 $10,147.50 $9,737.50 2026-03-31
93462 CPT Pr Lt Hrt Cath Txsptl Punc 402 270 $10,114.00 $9,102.60 $179.42 $10,012.86 $9,608.30 2026-03-31
SUP-00643169430815 CDM Spacer Spinal W10xh8xl28mm 11deg Intervertebral Lumbar Extra Lordotic 400 269 $10,110.00 $9,099.00 $2,102.88 $10,008.90 $9,604.50 2026-03-31
SUP-00643169430440 CDM Spacer Spinal H8xl23mm Standard Posterior Self Expanding 400 269 $10,110.00 $9,099.00 $2,102.88 $10,008.90 $9,604.50 2026-03-31
SUP-00643169430785 CDM Spacer Spinal H9xl23mm Lordotic Lumbar For Bone 400 269 $10,110.00 $9,099.00 $2,102.88 $10,008.90 $9,604.50 2026-03-31
SUP-00643169430686 CDM Spacer Spinal H9xl23mm Standard Posterior Self Expanding 400 269 $10,110.00 $9,099.00 $2,102.88 $10,008.90 $9,604.50 2026-03-31
SUP-00643169430655 CDM Spacer Spinal W10xh7x28mm Lumbar Sacral Interbody With Tantalum Marker 400 269 $10,110.00 $9,099.00 $2,102.88 $10,008.90 $9,604.50 2026-03-31
SUP-00643169430648 CDM Spacer Spinal H8x28mm Anterior H12mm Standard Expandable 400 269 $10,110.00 $9,099.00 $2,102.88 $10,008.90 $9,604.50 2026-03-31
SUP-00643169430822 CDM Spacer Spinal W10xh9xl28mm 11deg Intervertebral Lumbar Extra Lordotic 400 269 $10,110.00 $9,099.00 $2,102.88 $10,008.90 $9,604.50 2026-03-31
36252 CPT Pr Sel Cath Renal Arty&angio Bil 402 270 $10,048.00 $9,043.20 $314.77 $9,947.52 $9,545.60 2026-03-31
315 MS_DRG Other Circulatory System Diagnoses With Cc 1 1 — — $9,519.74 $9,519.74 $9,519.74 2026-03-31
J1950 HCPCS Leuprolide 11.25 Mg Intramuscular Kit 1,966 270 $9,995.10 $8,995.59 $653.49 $28,843.95 $9,495.35 2026-03-31
37193 CPT Pr Rtrev/rmvl Evasc Venacava Fltr 402 270 $9,955.00 $8,959.50 $317.10 $9,855.45 $9,457.25 2026-03-31
J0597 HCPCS C1 Esterase Inhibitor 500 Unit/10 Ml Intravenous Solution (wrapper) 400 270 $9,875.00 $8,887.50 $2,054.00 $9,776.25 $9,381.25 2026-03-31
J0565 HCPCS Bezlotoxumab 25 Mg/ml Intravenous Solution 400 270 $9,872.60 $8,885.34 $2,053.50 $9,773.87 $9,378.97 2026-03-31
206 MS_DRG Other Respiratory System Diagnoses Without Mcc 1 1 — — $9,313.71 $9,313.71 $9,313.71 2026-03-31
SUP-15420045501133 CDM Handpiece Novasure 400 269 $9,777.00 $8,799.30 $2,033.62 $9,679.23 $9,288.15 2026-03-31
33272 CPT Pr Rmvl Sq Iplt Dfb Elec 402 270 $9,766.00 $8,789.40 $319.65 $9,668.34 $9,277.70 2026-03-31
SUP-08714729965404 CDM Ercp Delivery For Ds Ii 400 269 $9,726.64 $8,753.98 $2,023.14 $9,629.37 $9,240.31 2026-03-31
202 MS_DRG Bronchitis And Asthma With Cc/mcc 1 1 — — $9,163.72 $9,163.72 $9,163.72 2026-03-31
605 MS_DRG Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc 1 1 — — $9,080.79 $9,080.79 $9,080.79 2026-03-31
J9358 HCPCS Pr Inj Fam-trastu Deru-nxki 1mg 400 270 $9,474.40 $8,526.96 $1,970.68 $9,379.66 $9,000.68 2026-03-31
67904 CPT Pr Rpr Blepharopt Levat Rsect Ext 400 268 $9,408.00 $8,467.20 $556.00 $9,313.92 $8,937.60 2026-03-31
43276 CPT Pr Ercp Stent Exchange W Dil 402 270 $9,384.00 $8,445.60 $451.25 $9,290.16 $8,914.80 2026-03-31
638 MS_DRG Diabetes With Cc 1 1 — — $8,897.03 $8,897.03 $8,897.03 2026-03-31
563 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 1 1 — — $8,890.53 $8,890.53 $8,890.53 2026-03-31
J9319 HCPCS Pr Romidepsin Lyophil 0.1mg Inj 398 269 $9,357.00 $8,421.30 $1,946.26 $9,263.43 $8,889.15 2026-03-31
37187 CPT Pr Thrmbct Mech Trluml Vein 402 270 $9,267.00 $8,340.30 $360.40 $9,174.33 $8,803.65 2026-03-31
683 MS_DRG Renal Failure With Cc 1 1 — — $8,707.69 $8,707.69 $8,707.69 2026-03-31
43274 CPT Pr Ercp Duct Stent Plc W Dil 402 270 $9,147.00 $8,232.30 $433.41 $9,055.53 $8,689.65 2026-03-31
J1306 HCPCS Inclisiran 284 Mg/1.5 Ml Subcutaneous Syringe 398 269 $9,098.80 $8,188.92 $1,892.55 $9,007.81 $8,643.86 2026-03-31
J9205 HCPCS Pr Inj Irinotecan Liposome 1 Mg 400 270 $8,951.40 $8,056.26 $1,861.89 $8,861.89 $8,503.83 2026-03-31
292 MS_DRG Heart Failure And Shock With Cc 1 1 — — $8,458.98 $8,458.98 $8,458.98 2026-03-31
J0139 HCPCS Adalimumab 40 Mg/0.8 Ml Subcutaneous Injection (wrapper) (restricted) 401 269 $8,862.00 $7,975.80 $1,843.30 $9,748.20 $8,418.90 2026-03-31
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 1 1 — — $8,403.30 $8,403.30 $8,403.30 2026-03-31
J2182 HCPCS Mepolizumab 100 Mg Subcutaneous Solution 783 270 $8,648.00 $7,783.20 $1,798.78 $10,244.12 $8,388.56 2026-03-31
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 1 1 — — $8,386.60 $8,386.60 $8,386.60 2026-03-31
43266 CPT Pr Egd W Stent Plc 402 270 $8,821.00 $7,938.90 $206.14 $8,732.79 $8,379.95 2026-03-31
RX-188401 CDM Adalimumab (citrate Free) 40 Mg/0.4 Ml Subcutaneous Pen Kit (restricted) 401 269 $8,753.80 $7,878.42 $1,820.79 $9,629.18 $8,316.11 2026-03-31
PX-360000008 CDM Hc Or Level 12 542 269 $8,715.00 $7,843.50 $1,812.72 $8,627.85 $8,279.25 2026-03-31
SUP-00850002250404 CDM Cryotherapy Device 400 269 $8,685.28 $7,816.75 $1,806.54 $8,598.43 $8,251.02 2026-03-31
22515 CPT Pr Perc Vert Agmnt Mech Ea Add 402 270 $8,679.00 $7,811.10 $194.84 $8,592.21 $8,245.05 2026-03-31
45347 CPT Pr Sigmoidoscopy W Plcmt Stent 402 270 $8,670.00 $7,803.00 $147.29 $8,583.30 $8,236.50 2026-03-31
43240 CPT Pr Egd W Transmural Drn 402 270 $8,670.00 $7,803.00 $368.33 $8,583.30 $8,236.50 2026-03-31
43265 CPT Pr Ercp W Destruct Calculi 402 270 $8,670.00 $7,803.00 $405.82 $8,583.30 $8,236.50 2026-03-31
J9326 HCPCS Telisotuzumab Vedotin-tllv 20 Mg/ml Intravenous Solution (wrapper) 796 269 $23,807.30 $21,426.57 $1,713.05 $38,985.01 $8,172.11 2026-03-31
93452 CPT Pr Lt Hrt Cath W Ventriculography 402 270 $8,559.00 $7,703.10 $949.82 $8,473.41 $8,131.05 2026-03-31
C1883 HCPCS Implant Lead Neurostimulator Percutaneous Spine 8 Electrode Titanium 8 Enhanced … 400 269 $8,550.00 $7,695.00 $1,778.40 $8,464.50 $8,122.50 2026-03-31
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 1 1 — — $8,092.40 $8,092.40 $8,092.40 2026-03-31
A9592 HCPCS Copper Cu-64 Dotatate 148 Mbq/4 Ml (4 Mci/4 Ml) Intravenous Solution 400 269 $8,500.00 $7,650.00 $1,768.00 $8,415.00 $8,075.00 2026-03-31
45389 CPT Pr Colonoscopy Flex Stent Plc 402 270 $8,495.00 $7,645.50 $272.69 $8,410.05 $8,070.25 2026-03-31
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 1 1 — — $8,059.00 $8,059.00 $8,059.00 2026-03-31
176 MS_DRG Pulmonary Embolism Without Mcc 1 1 — — $8,050.65 $8,050.65 $8,050.65 2026-03-31
66991 CPT Pr Xcapsl Ctrc Rmvl Insj 1+ 401 269 $8,473.00 $7,625.70 $638.68 $8,388.27 $8,049.35 2026-03-31
Q4114 HCPCS Graft Biological Bovine Sterile Cross Linked Tendon Collagen And Glycosaminoglyc… 400 269 $8,463.00 $7,616.70 $1,760.30 $8,378.37 $8,039.85 2026-03-31
J9177 HCPCS Pr Inj Enfort Vedo-ejfv 0.25mg 800 270 $10,227.50 $9,204.75 $1,720.58 $12,061.17 $8,023.84 2026-03-31
Q5111 HCPCS Pr Udenyca 0.5mg Inj 802 270 $8,261.00 $7,434.90 $1,718.29 $10,697.15 $8,013.17 2026-03-31
66982 CPT Pr Rmvl Cataract Extracap Cmplx 403 270 $8,366.00 $7,529.40 $691.14 $8,282.34 $7,947.70 2026-03-31
36904 CPT Pr Av Fistula Thrombectomy 402 270 $8,288.00 $7,459.20 $336.84 $8,205.12 $7,873.60 2026-03-31
J9286 HCPCS Glofitamab-gxbm 1 Mg/ml Intravenous Solution 796 269 $19,601.00 $17,640.90 $1,686.96 $30,780.68 $7,867.09 2026-03-31
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 1 1 — — $7,814.94 $7,814.94 $7,814.94 2026-03-31
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 1 — — $7,801.93 $7,801.93 $7,801.93 2026-03-31
L8614 HCPCS Kit Processor Hearing Device Cochlear Implant Bone Anchored Nonsterile 2 399 269 $8,113.30 $7,301.97 $1,687.57 $30,137.26 $7,707.64 2026-03-31
J0870 HCPCS Injection, Imetelstat, 1 Mg 796 269 $18,974.25 $17,076.82 $1,634.82 $29,787.91 $7,623.91 2026-03-31
55874 CPT Pr Tprnl Plmt Biodegrdabl Matrl 402 270 $7,988.00 $7,189.20 $153.65 $7,908.12 $7,588.60 2026-03-31
179 MS_DRG Respiratory Infections And Inflammations Without Cc/mcc 1 1 — — $7,586.62 $7,586.62 $7,586.62 2026-03-31
544 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 1 1 — — $7,582.92 $7,582.92 $7,582.92 2026-03-31
PX-360000006 CDM Hc Or Level 11 542 269 $7,923.00 $7,130.70 $1,647.98 $7,843.77 $7,526.85 2026-03-31
SUP-00840663100132 CDM Kt Vlvltm Otw 2x100 400 269 $7,916.00 $7,124.40 $1,646.53 $7,836.84 $7,520.20 2026-03-31
50433 CPT Pr Plc Nephroureteral Cath Perc New 402 270 $7,899.00 $7,109.10 $236.46 $7,820.01 $7,504.05 2026-03-31
93454 CPT Pr Cath Plc Cor Arty Angio S&i 402 270 $7,897.00 $7,107.30 $951.22 $7,818.03 $7,502.15 2026-03-31
RX-9062 CDM Aminocaproic Acid 250 Mg/ml (25 %) Oral Solution 401 269 $7,861.10 $7,074.99 $1,635.11 $8,647.21 $7,468.05 2026-03-31
36582 CPT Pr Rplc Complt Tunl Cvad W Port 402 270 $7,811.00 $7,029.90 $272.69 $7,732.89 $7,420.45 2026-03-31
SUP-00827002565722 CDM Spray Hemostatic Endoscopic 2.8 7fr 400 269 $7,800.00 $7,020.00 $1,622.40 $7,722.00 $7,410.00 2026-03-31
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 1 1 — — $7,407.51 $7,407.51 $7,407.51 2026-03-31
49418 CPT Pr Ins Intraperitoneal Cath W Img 402 270 $7,789.00 $7,010.10 $187.69 $7,711.11 $7,399.55 2026-03-31
J2799 HCPCS Risperidone ER 125 Mg/0.35 Ml Subcutaneous Extend Release Susp Syringe 398 269 $7,783.00 $7,004.70 $1,618.86 $7,705.17 $7,393.85 2026-03-31
J2802 HCPCS Inj, Romiplostim 1 Microgram 796 269 $11,204.30 $10,083.87 $1,583.13 $14,649.43 $7,382.86 2026-03-31
Q5136 HCPCS Denosumab-bbdz 120 Mg/1.7 Ml (70 Mg/ml) Subcutaneous Solution 400 269 $7,709.90 $6,938.91 $1,603.66 $7,632.80 $7,324.41 2026-03-31
66850 CPT Pr Rmvl Lens Material Phacofragm 400 268 $7,676.00 $6,908.40 $734.29 $7,599.24 $7,292.20 2026-03-31
J9268 HCPCS Pentostatin 10 Mg/5 Ml Intravenous Solution (wetted) 400 270 $7,634.10 $6,870.69 $1,587.89 $7,557.76 $7,252.40 2026-03-31
37252 CPT Pr Intravasc US Noncoronary Init Vsl 402 270 $7,552.00 $6,796.80 $80.81 $7,476.48 $7,174.40 2026-03-31
SUP-00643169143869 CDM Tray Biopsy Size 2 Balloon L10mm Ibt Additional Fracture 400 269 $7,536.00 $6,782.40 $1,567.49 $7,460.64 $7,159.20 2026-03-31
SUP-00643169143838 CDM Tray Biopsy Size 2 Balloon L15mm Ibt Additional Fracture 400 269 $7,536.00 $6,782.40 $1,567.49 $7,460.64 $7,159.20 2026-03-31
SUP-ZMEDTKEX202NB CDM Kt Vbs Kyp 20x2 400 269 $7,536.00 $6,782.40 $1,567.49 $7,460.64 $7,159.20 2026-03-31
J9321 HCPCS Epcoritamab-bysp 0.8 Mg/ml Subcutaneous Dilution 796 269 $25,804.95 $23,224.46 $904.97 $46,786.51 $7,068.59 2026-03-31
SUP-08714729953180 CDM Stent Biliary Rapid Exchange Platinol 0.035in Guidewire Compatible Selfexpanding… 400 269 $7,301.32 $6,571.19 $1,518.67 $7,228.31 $6,936.25 2026-03-31
SUP-08714729953173 CDM Stent Biliary Rapid Exchange Platinol 0.035in Guidewire Compatible Selfexpanding… 400 269 $7,301.32 $6,571.19 $1,518.67 $7,228.31 $6,936.25 2026-03-31
50432 CPT Pr Plc Nephrostomy Cath Perc New 402 270 $7,299.00 $6,569.10 $191.33 $7,226.01 $6,934.05 2026-03-31
J9026 HCPCS Tarlatamab-dlle 10 Mg Intravenous Solution 796 269 $24,112.15 $21,700.94 $988.46 $43,037.38 $6,873.44 2026-03-31
Q5116 HCPCS Pr Trazimera 10 Mg Inj 402 270 $7,212.90 $6,491.61 $396.30 $7,140.77 $6,852.26 2026-03-31
PX-360000004 CDM Hc Or Level 10 542 269 $7,202.00 $6,481.80 $1,498.02 $7,129.98 $6,841.90 2026-03-31
J9176 HCPCS Pr Inj Elotuzumab 1 Mg 800 270 $8,141.60 $7,327.44 $1,464.90 $9,148.00 $6,831.52 2026-03-31
J3315 HCPCS Triptorelin Pamoate 11.25 Mg IM Suspension 400 270 $7,145.20 $6,430.68 $1,486.20 $7,073.75 $6,787.94 2026-03-31
J9350 HCPCS Mosunetuzumab-axgb 1 Mg/ml Intravenous Solution 796 269 $28,309.80 $25,478.82 $467.46 $53,828.48 $6,767.17 2026-03-31
93229 CPT Pr Remote 30 Day ECG Tech Supp 402 270 $7,109.00 $6,398.10 $833.93 $7,037.91 $6,753.55 2026-03-31
C1821 HCPCS Implant Spinal Disc Intervertebral Cervical Titanium Sterile 7x18mm 400 269 $7,100.00 $6,390.00 $1,476.80 $7,029.00 $6,745.00 2026-03-31
J0401 HCPCS Aripiprazole ER 400 Mg Suspension, Extended Rel.intramuscular Syringe 400 270 $7,079.30 $6,371.37 $1,472.49 $7,008.51 $6,725.34 2026-03-31
37247 CPT Pr Pta Arterial Ea Add 402 270 $6,995.00 $6,295.50 $157.45 $6,925.05 $6,645.25 2026-03-31
33225 CPT Pr Ins Pacing Elctd Lv Lead Add 402 270 $6,975.00 $6,277.50 $399.99 $6,905.25 $6,626.25 2026-03-31
J1932 HCPCS Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe (cipla) 398 269 $6,948.10 $6,253.29 $1,445.20 $6,878.62 $6,600.70 2026-03-31
47536 CPT Pr Exchg Bil Drn Cath Perc W Img 402 270 $6,910.00 $6,219.00 $123.33 $6,840.90 $6,564.50 2026-03-31
43264 CPT Pr Ercp W Rmvl Stone 402 270 $6,907.00 $6,216.30 $342.02 $6,837.93 $6,561.65 2026-03-31
43261 CPT Pr Ercp W Bx 402 270 $6,907.00 $6,216.30 $318.61 $6,837.93 $6,561.65 2026-03-31
43262 CPT Pr Ercp Sphinc/papillot 402 270 $6,907.00 $6,216.30 $335.71 $6,837.93 $6,561.65 2026-03-31
43275 CPT Pr Ercp W Rmvl Fb/stnt Duct 402 270 $6,907.00 $6,216.30 $353.54 $6,837.93 $6,561.65 2026-03-31
RX-163412 CDM Idarucizumab 2.5 Gram/50 Ml Intravenous Solution 400 269 $6,890.70 $6,201.63 $1,433.27 $6,821.79 $6,546.17 2026-03-31
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