Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
EMICIZUMAB-KXWH 30 MG/ML SUBCU SOLN
Low
$52
Average
$13.6k
Median
$53
High
$96.3k
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
27 hospitals; the 90th percentile is 1160.5× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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53 hospital rates
iThe hospitals that file a Wellmark rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 2 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 3 | $52 | $52 | — | — | — | $52 – $52 |
| 3 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · outpatient | 3 | $52 | $52 | — | — | — | $52 – $52 |
| 4 | Avera Behavioral Health Hospital Sioux Falls, SD fee schedule · outpatient | 2 | $52 | $52 | — | — | — | $52 – $52 |
| 5 | Avera McKennan Hospital Sioux Falls, SD fee schedule · outpatient | 2 | $52 | $52 | — | — | — | $52 – $52 |
| 6 | Avera Specialty Hospital Sioux Falls, SD fee schedule · outpatient | 2 | $52 | $52 | — | — | — | $52 – $52 |
| 7 | Central Iowa Hospital Corporation Des Moines, IA case rate · outpatient | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 8 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 3 | $52 | $52 | — | — | — | $52 – $52 |
| 9 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · outpatient | 3 | $52 | $52 | — | — | — | $52 – $52 |
| 10 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 3 | $52 | $52 | — | — | — | $52 – $52 |
| 11 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · outpatient | 3 | $52 | $52 | — | — | — | $52 – $52 |
| 12 | Grinnell Regional Medical Center Grinnell, IA case rate · outpatient | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 13 | Grinnell Regional Medical Center Grinnell, IA fee schedule · both | 3 | $52 | $52 | — | — | — | $52 – $52 |
| 14 | Grinnell Regional Medical Center Grinnell, IA fee schedule · outpatient | 3 | $52 | $52 | — | — | — | $52 – $52 |
| 15 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · case rate · outpatient | 2 | $57.9k | $57.9k | $2.7k | 5% | — | $55.2k – $60.6k |
| 16 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $67.3k | $96.3k | $91.4k | 95% | — | $7.6k – $284.3k |
| 17 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · case rate · outpatient | 1 | $63.9k | $63.9k | — | — | — | $63.9k – $63.9k |
| 18 | MercyOne Genesis Davenport Medical Center IA 52803; 2140 53rd Avenue Bettendorf, IA facility · fee schedule · outpatient | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 19 | MercyOne Genesis Davenport West Medical Center Davenport, IA facility · fee schedule · outpatient | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 20 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · case rate · outpatient | 1 | $23.6k | $23.6k | — | — | — | $23.6k – $23.6k |
| 21 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · fee schedule · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 22 | Meriter Hospital, Inc Madison, WI case rate · outpatient | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 23 | Meriter Hospital, Inc Madison, WI fee schedule · both | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 24 | Mount Sinai Rehabilitation Hospital, Inc Hartford, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $48.3k | $68.0k | $57.2k | 84% | — | $4.5k – $170.6k |
| 25 | Northwest Iowa Hospital Corporation Sioux City, IA case rate · outpatient | 1 | $59 | $59 | — | — | — | $59 – $59 |
← Payers reporting HCPCS J7170 · Snapshot 20261111T120946Z-9134e7f7