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

HALE COUNTY HOSPITAL

Greensboro, AL · CCN 010095 · Rates published

23,596 distinct procedures filed
5 distinct payers
166,726 rate rows
2026-04-01 last MRF observed
Data quality

155,032 of 166,726 rate rows are consumer-grade (93.0%)

11,694 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 10,670
template filing: same amount across many unrelated codes — excluded 600
exceeds 10× this hospital's gross charge — excluded from medians 146
professional (physician) fee — not the facility price 134
percent-of-charges filed in the dollar field — excluded from medians 66
placeholder amount (≤ $0.02) — excluded from medians 54
per-diem day rate — not a per-procedure price 24
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://halecounty.pt.panaceainc.com/MRFDownload/halecounty/halecounty
Found on page https://www.halecountyhospital.com/patient-resources
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-18
Content fingerprint 92eadab343a86d17… · 27,821,571 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
J3391
HCPCS 		Inj, Atidarsagene Autotemcel 5 $4,505,000.00 $4,955,500.00 $4,505,000.00 nat. median
$4,505,000
1.0× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 5 $3,685,266.66 $4,053,793.33 $3,685,266.66 nat. median
$3,710,000
1.0× median
J3389
HCPCS 		Topi Adm Prad Zami Per Treat 5 $3,335,820.00 $3,669,402.00 $3,335,820.00 nat. median
$3,335,820
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 5 $3,327,859.72 $3,660,645.69 $3,327,859.72 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 5 $3,252,508.07 $3,577,758.88 $3,252,508.07 nat. median
$3,286,000
1.0× median
J3387
HCPCS 		Inj Elivaldogene Autotemecel 5 $3,180,000.00 $3,498,000.00 $3,180,000.00 nat. median
$3,180,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 5 $2,939,968.88 $3,233,965.77 $2,939,968.88 nat. median
$3,004,655
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 5 $2,588,981.22 $2,847,879.34 $2,588,981.22 nat. median
$2,468,984
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 5 $2,332,000.00 $2,565,200.00 $2,332,000.00 nat. median
$2,448,600
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 5 $770,620.00 $847,682.00 $770,620.00 nat. median
$824,563
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 5 $587,649.57 $646,414.53 $587,649.57 nat. median
$674,867
0.9× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 5 $566,531.30 $623,184.43 $566,531.30 nat. median
$753,246
0.8× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 5 $562,201.24 $618,421.36 $562,201.24 nat. median
$673,137
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 5 $558,081.72 $613,889.89 $558,081.72 nat. median
$625,184
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 5 $532,192.24 $585,411.46 $532,192.24 nat. median
$634,303
0.8× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 5 $489,450.20 $538,395.22 $489,450.20 nat. median
$619,808
0.8× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 5 $278,250.00 $306,075.00 $278,250.00 nat. median
$324,450
0.9× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 5 $262,677.17 $304,152.51 $276,502.28 nat. median
$370,174
0.7× median
J3403
HCPCS 		Revakinagene, Per Implant 5 $265,000.00 $291,500.00 $265,000.00 nat. median
$265,000
1.0× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 5 $196,799.62 $227,873.24 $207,157.49 nat. median
$265,286
0.8× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 5 $201,669.02 $221,835.92 $201,669.02 nat. median
$209,753
1.0× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 5 $166,116.13 $192,344.99 $174,859.08 nat. median
$206,474
0.8× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 5 $150,301.92 $174,033.81 $158,212.55 nat. median
$202,976
0.8× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 5 $99,905.20 $115,679.71 $105,163.37 nat. median
$133,161
0.8× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 5 $92,808.42 $107,462.38 $97,693.07 nat. median
$117,357
0.8× median
7
MS_DRG 		Lung Transplant 5 $92,580.64 $107,198.64 $97,453.31 nat. median
$122,708
0.8× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 5 $78,437.45 $90,822.31 $82,565.74 nat. median
$108,660
0.8× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve?procedures 5 $77,569.16 $89,816.93 $81,651.75 nat. median
$102,358
0.8× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 5 $75,881.59 $87,862.90 $79,875.36 nat. median
$100,136
0.8× median
215
MS_DRG 		Other Heart Assist System Implant 5 $75,504.73 $87,426.53 $79,478.66 nat. median
$99,019
0.8× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 5 $74,680.61 $86,472.29 $78,611.17 nat. median
$98,894
0.8× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 5 $68,991.18 $79,884.52 $72,622.29 nat. median
$93,672
0.8× median
Q2040
EAPG 		Tisagenlecleucel Car-pos T 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$72,542
1.0× median
Q2053
EAPG 		Brexucabtagene Car Pos T 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$25,396
outlier · 2.9×
C9081
EAPG 		Idecabtagene Car Pos T 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$25,396
outlier · 2.9×
C9073
EAPG 		Brexucabtagene Autoleucel Ca 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$25,396
outlier · 2.9×
C9076
EAPG 		Lisocabtagene Car Pos T 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$25,396
outlier · 2.9×
Q2056
EAPG 		Ciltacabtagene Car-pos T 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$25,396
outlier · 2.9×
Q2042
EAPG 		Tisagenlecleucel Car-pos T 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$25,396
outlier · 2.9×
Q2054
EAPG 		Lisocabtagene Mara Car Pos T 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$25,396
outlier · 2.9×
C9098
EAPG 		Ciltacabtagene Car Pos T 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$25,396
outlier · 2.9×
Q2041
EAPG 		Axicabtagene Ciloleucel Car+ 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$25,396
outlier · 2.9×
Q2055
EAPG 		Idecabtagene Vicleucel Car 1 $72,542.47 $72,542.47 $72,542.47 nat. median
$25,396
outlier · 2.9×
850
MS_DRG 		Acute Leukemia With Other Procedures 5 $65,959.75 $76,374.45 $69,431.32 nat. median
$83,470
0.8× median
38240
HCPCS 		Transplt Allo Hct/donor 5 $64,664.52 $71,130.98 $64,664.52 nat. median
$15,979
outlier · 4.0×
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 5 $64,274.79 $70,702.27 $64,274.79 nat. median
$69,774
0.9× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 5 $60,865.97 $70,476.38 $64,069.44 nat. median
$79,312
0.8× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 5 $60,833.53 $70,438.82 $64,035.29 nat. median
$81,118
0.8× median
A9543
EAPG 		Y90 Ibritumomab, Rx 1 $63,909.23 $63,909.23 $63,909.23 nat. median
$21,588
outlier · 3.0×
A9513
EAPG 		Lutetium Lu 177 Dotatat Ther 1 $63,909.23 $63,909.23 $63,909.23 nat. median
$21,588
outlier · 3.0×

Other procedures at this hospital

Browse this hospital's 23,596 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
             
0254T EAPG Evasc Rpr Iliac Art Bifur 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
0266T EAPG Implt/rpl Crtd Sns Dev Total 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
0268T EAPG Implt/rpl Crtd Sns Dev Gen 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
0312T EAPG Laps Impltj Nstim Vagus 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
0316T EAPG Replc Vagus Nerve Pls Gen 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
0408T HCPCS Insj/rplc Cardiac Modulj Sys 12 5 — — $32,268.84 $35,495.72 $32,268.84 2026-04-01
0409T EAPG Insj/rplc Car Modulj Pls Gn 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
0414T EAPG Rmvl & Rpl Car Modulj Pls Gn 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
0424T EAPG Insj/rplc Nstim Apnea Compl 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
0427T EAPG Insj/rplc Nstim Apnea Pls Gn 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
0431T EAPG Rmvl/rplc Nstim Apnea Pls Gn 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
0466T EAPG Insj Ch Wal Respir Eltrd/ra 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
0520T EAPG Rmv&rplcmt Pg Wcs Lv Battery 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
0571T EAPG Insj/rplcmt Icds Ss Eltrd 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
0571T HCPCS Insj/rplcmt Icds Ss Eltrd 12 5 — — $32,268.84 $35,495.72 $32,268.84 2026-04-01
0614T EAPG Rmvl&rplcmt Ss Impl Dfb Pg 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
0620T HCPCS Evasc Ven Artlz Tibl/prnl Vn 12 5 — — $45,281.30 $49,809.43 $45,281.30 2026-04-01
0674T HCPCS Laps Insj Nw/rpcmt Prm Isdss 12 5 — — $31,722.78 $34,895.06 $31,722.78 2026-04-01
0816T EAPG Opn Insj/rplcmt Ins Ptn Subq 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
0817T EAPG Opn Insj/rplcmt Ins Ptn Subf 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
0870T HCPCS Imp Subq Prtl Ascts Pmp Sys 12 5 — — $35,218.90 $38,740.79 $35,218.90 2026-04-01
0908T HCPCS Opn Imp Int Nstm Sys Vgs Nrv 12 5 — — $31,722.78 $34,895.06 $31,722.78 2026-04-01
0909T HCPCS Rplcmt Int Nstim Sys Vgs Nrv 12 5 — — $31,722.78 $34,895.06 $31,722.78 2026-04-01
0915T HCPCS Insj Perm Ccm-d Sys Pg&eltrd 12 5 — — $32,268.84 $35,495.72 $32,268.84 2026-04-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 12 5 — — $196,799.62 $227,873.24 $207,157.49 2026-04-01
10 MS_DRG Pancreas Transplant 12 5 — — $57,408.68 $66,473.21 $60,430.19 2026-04-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 12 5 — — $39,621.16 $45,877.13 $41,706.48 2026-04-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 12 5 — — $30,702.20 $35,549.92 $32,318.11 2026-04-01
14 MS_DRG Allogeneic Bone Marrow Transplant 12 5 — — $92,808.42 $107,462.38 $97,693.07 2026-04-01
140 MS_DRG Major Head And Neck Procedures With Mcc 12 5 — — $31,568.42 $36,552.91 $33,229.92 2026-04-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 12 5 — — $44,038.53 $50,991.99 $46,356.35 2026-04-01
163 MS_DRG Major Chest Procedures With Mcc 12 5 — — $34,191.24 $39,589.86 $35,990.78 2026-04-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 12 5 — — $28,953.20 $33,524.76 $30,477.05 2026-04-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 12 5 — — $44,038.53 $50,991.99 $46,356.35 2026-04-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 5 — — $262,677.17 $304,152.51 $276,502.28 2026-04-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 12 5 — — $57,093.25 $66,107.98 $60,098.16 2026-04-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 12 5 — — $78,437.45 $90,822.31 $82,565.74 2026-04-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 12 5 — — $58,016.76 $67,177.30 $61,070.27 2026-04-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 12 5 — — $47,015.42 $54,438.91 $49,489.92 2026-04-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 12 5 — — $40,528.10 $46,927.28 $42,661.16 2026-04-01
212 MS_DRG Concomitant Aortic And Mitral Valve?procedures 12 5 — — $77,569.16 $89,816.93 $81,651.75 2026-04-01
215 MS_DRG Other Heart Assist System Implant 12 5 — — $75,504.73 $87,426.53 $79,478.66 2026-04-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 5 — — $68,991.18 $79,884.52 $72,622.29 2026-04-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 5 — — $46,951.24 $54,364.60 $49,422.36 2026-04-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 5 — — $43,440.80 $50,299.88 $45,727.16 2026-04-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 5 — — $55,783.22 $64,591.10 $58,719.18 2026-04-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 5 — — $38,936.46 $45,084.33 $40,985.75 2026-04-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 5 — — $34,076.66 $39,457.19 $35,870.17 2026-04-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 12 5 — — $36,773.33 $42,579.65 $38,708.77 2026-04-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 12 5 — — $41,755.30 $48,348.25 $43,952.95 2026-04-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 12 5 — — $60,865.97 $70,476.38 $64,069.44 2026-04-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 12 5 — — $44,541.01 $51,573.80 $46,885.27 2026-04-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 12 5 — — $56,327.81 $65,221.67 $59,292.43 2026-04-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 12 5 — — $39,098.67 $45,272.14 $41,156.49 2026-04-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 12 5 — — $42,991.47 $49,779.60 $45,254.18 2026-04-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 12 5 — — $30,760.18 $35,617.05 $32,379.14 2026-04-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 12 5 — — $37,143.29 $43,008.02 $39,098.20 2026-04-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 12 5 — — $28,617.75 $33,136.35 $30,123.95 2026-04-01
245 MS_DRG Aicd Generator Procedures 12 5 — — $36,107.28 $41,808.43 $38,007.66 2026-04-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 12 5 — — $33,246.33 $38,495.75 $34,996.14 2026-04-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 12 5 — — $43,727.25 $50,631.55 $46,028.68 2026-04-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 12 5 — — $34,850.39 $40,353.08 $36,684.62 2026-04-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 12 5 — — $48,398.61 $56,040.50 $50,945.91 2026-04-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 12 5 — — $31,095.63 $36,005.46 $32,732.24 2026-04-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 12 5 — — $37,806.58 $43,776.04 $39,796.40 2026-04-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 12 5 — — $29,367.33 $34,004.28 $30,912.98 2026-04-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 12 5 — — $51,155.33 $59,232.49 $53,847.72 2026-04-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc 12 5 — — $45,132.52 $52,258.71 $47,507.92 2026-04-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 12 5 — — $34,485.96 $39,931.11 $36,301.01 2026-04-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 12 5 — — $36,911.38 $42,739.49 $38,854.08 2026-04-01
28 MS_DRG Spinal Procedures With Mcc 12 5 — — $44,339.46 $51,340.43 $46,673.12 2026-04-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 12 5 — — $150,301.92 $174,033.81 $158,212.55 2026-04-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 12 5 — — $31,302.00 $36,244.42 $32,949.47 2026-04-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 12 5 — — $45,077.30 $52,194.77 $47,449.79 2026-04-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 12 5 — — $32,697.61 $37,860.39 $34,418.54 2026-04-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 12 5 — — $31,776.86 $36,794.26 $33,449.33 2026-04-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 12 5 — — $37,433.87 $43,344.48 $39,404.07 2026-04-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 12 5 — — $34,071.83 $39,451.59 $35,865.08 2026-04-01
33230 EAPG Insrt Pulse Gen W/dual Leads 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
33231 EAPG Insrt Pulse Gen W/mult Leads 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
33231 HCPCS Insrt Pulse Gen W/mult Leads 12 5 — — $32,268.84 $35,495.72 $32,268.84 2026-04-01
33240 EAPG Insrt Pulse Gen W/singl Lead 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
33249 EAPG Insj/rplcmt Defib W/lead(s) 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
33249 HCPCS Insj/rplcmt Defib W/lead(s) 12 5 — — $32,268.84 $35,495.72 $32,268.84 2026-04-01
33262 EAPG Rmvl& Replc Pulse Gen 1 Lead 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
33263 EAPG Rmvl & Rplcmt Dfb Gen 2 Lead 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
33264 EAPG Rmvl & Rplcmt Dfb Gen Mlt Ld 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
33264 HCPCS Rmvl & Rplcmt Dfb Gen Mlt Ld 12 5 — — $32,268.84 $35,495.72 $32,268.84 2026-04-01
33270 EAPG Ins/rep Subq Defibrillator 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
33270 HCPCS Ins/rep Subq Defibrillator 12 5 — — $32,268.84 $35,495.72 $32,268.84 2026-04-01
33276 HCPCS Insj Phrnc Nrv Stim Sys 12 5 — — $45,281.30 $49,809.43 $45,281.30 2026-04-01
33276 EAPG Insj Phrnc Nrv Stim Sys 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
33287 EAPG Rmv&rplcmt Phrnc Nrv Stim Pg 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
33287 HCPCS Rmv&rplcmt Phrnc Nrv Stim Pg 12 5 — — $31,722.78 $34,895.06 $31,722.78 2026-04-01
33289 EAPG Tcat Impl Wrls P-art Prs Snr 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
33289 HCPCS Tcat Impl Wrls P-art Prs Snr 12 5 — — $29,487.48 $32,436.23 $29,487.48 2026-04-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 12 5 — — $27,387.10 $31,711.38 $28,828.53 2026-04-01
33502 EAPG Coronary Artery Correction 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33503 EAPG Coronary Artery Graft 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33504 EAPG Coronary Artery Graft 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33505 EAPG Repair Artery W/tunnel 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33506 EAPG Repair Artery Translocation 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33507 EAPG Repair Art Intramural 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33508 EAPG Endoscopic Vein Harvest 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33509 EAPG Ndsc Hrv Uxtr Art 1 Sgm Cab 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33510 EAPG Cabg Vein Single 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33511 EAPG Cabg Vein Two 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33512 EAPG Cabg Vein Three 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33513 EAPG Cabg Vein Four 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33514 EAPG Cabg Vein Five 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33516 EAPG Cabg Vein Six Or More 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33517 EAPG Cabg Artery-vein Single 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33518 EAPG Cabg Artery-vein Two 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33519 EAPG Cabg Artery-vein Three 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33521 EAPG Cabg Artery-vein Four 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33522 EAPG Cabg Artery-vein Five 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33523 EAPG Cabg Art-vein Six Or More 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33530 EAPG Coronary Artery Bypass/reop 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33533 EAPG Cabg Arterial Single 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33534 EAPG Cabg Arterial Two 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33535 EAPG Cabg Arterial Three 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33536 EAPG Cabg Arterial Four Or More 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33572 EAPG Open Coronary Endarterectomy 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
33880 EAPG Endovasc Taa Repr Incl Subcl 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
33881 EAPG Endovasc Taa Repr Without Subcl 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
33883 EAPG Insert Endovasc Prosth Taa 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
33886 EAPG Endovasc Prosth Delayed 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
33895 EAPG Evasc St Rpr Thrc/aa X Crsg 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 12 5 — — $29,218.24 $33,831.64 $30,756.04 2026-04-01
34701 EAPG Evasc Rpr A-ao Ndgft 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
34702 EAPG Evasc Rpr A-ao Ndgft Rpt 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
34710 EAPG Dlyd Plmt Xtn Prosth 1st Vsl 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
34718 EAPG Evasc Rpr N/a A-iliac Ndgft 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
34813 EAPG Femoral Endovas Graft Add-on 2 1 — — $28,698.21 $28,698.21 $28,698.21 2026-04-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 12 5 — — $31,820.35 $36,844.61 $33,495.10 2026-04-01
35600 EAPG Open Hrv Uxtr Art 1 Sgm Cab 2 1 — — $34,655.60 $34,655.60 $34,655.60 2026-04-01
38240 HCPCS Transplt Allo Hct/donor 12 5 — — $64,664.52 $71,130.98 $64,664.52 2026-04-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 12 5 — — $99,905.20 $115,679.71 $105,163.37 2026-04-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 12 5 — — $28,413.45 $32,899.78 $29,908.89 2026-04-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 12 5 — — $29,380.44 $34,019.46 $30,926.78 2026-04-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 12 5 — — $39,847.55 $46,139.27 $41,944.79 2026-04-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 12 5 — — $30,451.65 $35,259.81 $32,054.37 2026-04-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 5 — — $74,680.61 $86,472.29 $78,611.17 2026-04-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 5 — — $51,401.75 $59,517.81 $54,107.10 2026-04-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 5 — — $40,367.97 $46,741.86 $42,492.60 2026-04-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 12 5 — — $59,945.91 $69,411.06 $63,100.96 2026-04-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 12 5 — — $40,136.06 $46,473.33 $42,248.48 2026-04-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 12 5 — — $48,654.69 $56,337.01 $51,215.46 2026-04-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 12 5 — — $30,562.78 $35,388.49 $32,171.35 2026-04-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 12 5 — — $37,924.61 $43,912.70 $39,920.64 2026-04-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 12 5 — — $60,833.53 $70,438.82 $64,035.29 2026-04-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 12 5 — — $41,992.04 $48,622.37 $44,202.15 2026-04-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 12 5 — — $32,181.34 $37,262.60 $33,875.09 2026-04-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 12 5 — — $44,734.27 $51,797.57 $47,088.70 2026-04-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 12 5 — — $39,656.35 $45,917.88 $41,743.53 2026-04-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 12 5 — — $37,541.54 $43,469.15 $39,517.41 2026-04-01
471 MS_DRG Cervical Spinal Fusion With Mcc 12 5 — — $35,903.66 $41,572.66 $37,793.33 2026-04-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 12 5 — — $33,331.92 $38,594.85 $35,086.23 2026-04-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 12 5 — — $75,881.59 $87,862.90 $79,875.36 2026-04-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 12 5 — — $44,882.66 $51,969.40 $47,244.91 2026-04-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 12 5 — — $39,617.01 $45,872.33 $41,702.12 2026-04-01
6 MS_DRG Liver Transplant Without Mcc 12 5 — — $35,847.76 $41,507.93 $37,734.48 2026-04-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 12 5 — — $29,054.66 $33,642.24 $30,583.85 2026-04-01
61850 EAPG Implant Neuroelectrodes 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
61860 EAPG Implant Neuroelectrodes 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
61863 EAPG Implant Neuroelectrode 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
61864 EAPG Implant Neuroelectrde Addl 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
61867 EAPG Implant Neuroelectrode 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
61868 EAPG Implant Neuroelectrde Addl 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
61870 EAPG Implant Neuroelectrodes 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
61885 EAPG Insrt/redo Neurostim 1 Array 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
61885 HCPCS Insrt/redo Neurostim 1 Array 12 5 — — $31,722.78 $34,895.06 $31,722.78 2026-04-01
61886 EAPG Implant Neurostim Arrays 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
61886 HCPCS Implant Neurostim Arrays 12 5 — — $31,722.78 $34,895.06 $31,722.78 2026-04-01
61889 EAPG Ins Sk-mnt Crnl Nstm Pg/rcvr 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
61891 HCPCS Rev/rplcmt Sk-mnt Crnl Nstm 12 5 — — $31,722.78 $34,895.06 $31,722.78 2026-04-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 12 5 — — $28,205.70 $32,659.23 $29,690.21 2026-04-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 12 5 — — $29,611.66 $34,287.19 $31,170.17 2026-04-01
63655 EAPG Implant Neuroelectrodes 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
63664 EAPG Revise Spine Eltrd Plate 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
63685 EAPG Ins/rplc Spi Npg/rcvr Pocket 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
63685 HCPCS Ins/rplc Spi Npg/rcvr Pocket 12 5 — — $31,722.78 $34,895.06 $31,722.78 2026-04-01
64553 EAPG Implant Neuroelectrodes 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
64568 HCPCS Opn Impltj Crnl Nrv Nea&pg 12 5 — — $45,281.30 $49,809.43 $45,281.30 2026-04-01
64568 EAPG Opn Impltj Crnl Nrv Nea&pg 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
64569 EAPG Revise/repl Vagus N Eltrd 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
64575 EAPG Opn Impltj Nea Perph Nerve 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
64580 EAPG Opn Impltj Nea Neuromuscular 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
64582 EAPG Opn Mpltj Hpglsl Nstm Ary Pg 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
64582 HCPCS Opn Mpltj Hpglsl Nstm Ary Pg 12 5 — — $31,722.78 $34,895.06 $31,722.78 2026-04-01
64590 EAPG Ins/rpl Prph Sac/gstr Npg/r 2 1 — — $33,151.22 $33,151.22 $33,151.22 2026-04-01
64654 HCPCS 1st Opn Implt Bat Modulj Sys 12 5 — — $45,281.30 $49,809.43 $45,281.30 2026-04-01
64656 HCPCS Revj/rplcmt Bat Mod Sys Pg 12 5 — — $31,722.78 $34,895.06 $31,722.78 2026-04-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 12 5 — — $34,178.12 $39,574.67 $35,976.97 2026-04-01
653 MS_DRG Major Bladder Procedures With Mcc 12 5 — — $40,854.57 $47,305.29 $43,004.81 2026-04-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 12 5 — — $31,295.10 $36,236.43 $32,942.21 2026-04-01
69930 EAPG Implant Cochlear Device 2 1 — — $45,017.45 $45,017.45 $45,017.45 2026-04-01
69930 HCPCS Implant Cochlear Device 12 5 — — $33,896.48 $37,286.13 $33,896.48 2026-04-01
7 MS_DRG Lung Transplant 12 5 — — $92,580.64 $107,198.64 $97,453.31 2026-04-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 12 5 — — $29,555.75 $34,222.45 $31,111.32 2026-04-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 12 5 — — $29,854.61 $34,568.50 $31,425.91 2026-04-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 12 5 — — $43,409.75 $50,263.92 $45,694.47 2026-04-01
791 MS_DRG Prematurity With Major Problems 12 5 — — $30,399.89 $35,199.87 $31,999.88 2026-04-01
793 MS_DRG Full Term Neonate With Major Problems 12 5 — — $31,163.27 $36,083.78 $32,803.44 2026-04-01
799 MS_DRG Splenic Procedures With Mcc 12 5 — — $35,196.19 $40,753.48 $37,048.62 2026-04-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 12 5 — — $39,933.14 $46,238.37 $42,034.88 2026-04-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 12 5 — — $42,564.24 $49,284.91 $44,804.46 2026-04-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 12 5 — — $34,676.46 $40,151.69 $36,501.54 2026-04-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 12 5 — — $35,339.07 $40,918.92 $37,199.02 2026-04-01
834 MS_DRG Acute Leukemia Without Major O.r. Procedures With Mcc 12 5 — — $40,528.10 $46,927.28 $42,661.16 2026-04-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 12 5 — — $36,938.29 $42,770.65 $38,882.41 2026-04-01
850 MS_DRG Acute Leukemia With Other Procedures 12 5 — — $65,959.75 $76,374.45 $69,431.32 2026-04-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 12 5 — — $36,897.57 $42,723.51 $38,839.55 2026-04-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 12 5 — — $33,517.59 $38,809.84 $35,281.67 2026-04-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 12 5 — — $50,392.65 $58,349.38 $53,044.89 2026-04-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 12 5 — — $29,500.54 $34,158.52 $31,053.20 2026-04-01
901 MS_DRG Wound Debridements For Injuries With Mcc 12 5 — — $32,957.83 $38,161.70 $34,692.45 2026-04-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 12 5 — — $29,027.74 $33,611.07 $30,555.52 2026-04-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 12 5 — — $29,873.95 $34,590.89 $31,446.26 2026-04-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 12 5 — — $166,116.13 $192,344.99 $174,859.08 2026-04-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 12 5 — — $48,476.61 $56,130.81 $51,028.01 2026-04-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 12 5 — — $32,242.76 $37,333.73 $33,939.75 2026-04-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 12 5 — — $27,561.72 $31,913.57 $29,012.34 2026-04-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 12 5 — — $49,507.80 $57,324.82 $52,113.47 2026-04-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 12 5 — — $28,760.63 $33,301.79 $30,274.35 2026-04-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 12 5 — — $53,896.87 $62,406.91 $56,733.55 2026-04-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 12 5 — — $30,744.31 $35,598.67 $32,362.43 2026-04-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 12 5 — — $46,029.12 $53,296.87 $48,451.70 2026-04-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 12 5 — — $35,189.98 $40,746.29 $37,042.08 2026-04-01
A9513 EAPG Lutetium Lu 177 Dotatat Ther 2 1 — — $63,909.23 $63,909.23 $63,909.23 2026-04-01
A9543 EAPG Y90 Ibritumomab, Rx 2 1 — — $63,909.23 $63,909.23 $63,909.23 2026-04-01
A9543 HCPCS Y90 Ibritumomab, Rx 12 5 — — $56,824.54 $62,506.99 $56,824.54 2026-04-01
A9607 EAPG Lutetium Lu 177 Vipivotide 2 1 — — $63,909.23 $63,909.23 $63,909.23 2026-04-01
C9031 EAPG Lutetium Lu 177 Dotatate, Tx 2 1 — — $63,909.23 $63,909.23 $63,909.23 2026-04-01
C9052 EAPG Injection, Ravulizumab-cwv 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
C9073 EAPG Brexucabtagene Autoleucel Ca 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
C9076 EAPG Lisocabtagene Car Pos T 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
C9081 EAPG Idecabtagene Car Pos T 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
C9085 EAPG Inj Avalglucosid Alfa-ngpt 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
C9098 EAPG Ciltacabtagene Car Pos T 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
C9146 EAPG Inj, Elahere, 1 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
C9149 EAPG Inj, Teplizumab-mzwv, 5 Mcg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
C9741 EAPG Impl Pressure Sensor W/angio 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
G0448 EAPG Place Perm Pacing Cardiovert 2 1 — — $39,937.47 $39,937.47 $39,937.47 2026-04-01
J0217 EAPG Inj Velmanase Alfa-tycv 1 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J0219 EAPG Inj Aval Alfa-nqpt 4mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J0221 EAPG Lumizyme Injection 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J0223 EAPG Inj Givosiran 0.5 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J1300 EAPG Eculizumab Injection 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J1303 EAPG Inj., Ravulizumab-cwvz 10 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 12 5 — — $3,685,266.66 $4,053,793.33 $3,685,266.66 2026-04-01
J1411 EAPG Inj, Hemgenix, Per Tx Dose 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J1412 EAPG Inj Roctavian Ml 2x10^13vc G 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J1413 HCPCS Inj Delandistrogene Mox Rokl 12 5 — — $3,327,859.72 $3,660,645.69 $3,327,859.72 2026-04-01
J1413 EAPG Inj Delandistrogene Mox Rokl 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J1747 EAPG Inj, Spesolimab-sbzo, 1 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J2326 EAPG Inj, Nusinersen, 0.1mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J2350 EAPG Injection, Ocrelizumab, 1 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J2840 EAPG Inj Sebelipase Alfa 1 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J3387 HCPCS Inj Elivaldogene Autotemecel 12 5 — — $3,180,000.00 $3,498,000.00 $3,180,000.00 2026-04-01
J3389 HCPCS Topi Adm Prad Zami Per Treat 12 5 — — $3,335,820.00 $3,669,402.00 $3,335,820.00 2026-04-01
J3391 HCPCS Inj, Atidarsagene Autotemcel 12 5 — — $4,505,000.00 $4,955,500.00 $4,505,000.00 2026-04-01
J3392 HCPCS Inj, Exagamglogene Autotem 12 5 — — $2,332,000.00 $2,565,200.00 $2,332,000.00 2026-04-01
J3393 HCPCS Inj, Betibeglogene Autotemce 12 5 — — $2,939,968.88 $3,233,965.77 $2,939,968.88 2026-04-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 12 5 — — $3,252,508.07 $3,577,758.88 $3,252,508.07 2026-04-01
J3399 HCPCS Inj Onase Abepar-xioi Treat 12 5 — — $2,588,981.22 $2,847,879.34 $2,588,981.22 2026-04-01
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 12 5 — — $201,669.02 $221,835.92 $201,669.02 2026-04-01
J3403 HCPCS Revakinagene, Per Implant 12 5 — — $265,000.00 $291,500.00 $265,000.00 2026-04-01
J7170 EAPG Inj., Emicizumab-kxwh 0.5 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J7175 EAPG Inj, Factor X, (human), 1iu 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J7180 EAPG Factor Xiii Anti-hem Factor 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J9029 HCPCS Instill Adstiladrin, Tx Dose 12 5 — — $64,274.79 $70,702.27 $64,274.79 2026-04-01
J9029 EAPG Inj, Adstiladrin, Per Tx Dos 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J9210 EAPG Inj., Emapalumab-lzsg, 1 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J9226 HCPCS Supprelin La Implant 12 5 — — $43,185.33 $47,503.86 $43,185.33 2026-04-01
J9226 EAPG Supprelin La Implant 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J9269 EAPG Inj. Tagraxofusp-erzs 10 Mcg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J9298 EAPG Inj Nivol Relatlimab 3mg/1mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J9350 EAPG Inj Mosunetuzumab-axgb, 1 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J9381 EAPG Inj Teplizumab Mzwv 5 Mcg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
J9600 EAPG Porfimer Sodium Injection 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
Q2040 EAPG Tisagenlecleucel Car-pos T 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 12 5 — — $532,192.24 $585,411.46 $532,192.24 2026-04-01
Q2041 EAPG Axicabtagene Ciloleucel Car+ 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 12 5 — — $566,531.30 $623,184.43 $566,531.30 2026-04-01
Q2042 EAPG Tisagenlecleucel Car-pos T 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 12 5 — — $54,404.10 $59,844.51 $54,404.10 2026-04-01
Q2043 EAPG Sipuleucel-t Auto Cd54+ 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 12 5 — — $489,450.20 $538,395.22 $489,450.20 2026-04-01
Q2053 EAPG Brexucabtagene Car Pos T 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 12 5 — — $562,201.24 $618,421.36 $562,201.24 2026-04-01
Q2054 EAPG Lisocabtagene Mara Car Pos T 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 12 5 — — $558,081.72 $613,889.89 $558,081.72 2026-04-01
Q2055 EAPG Idecabtagene Vicleucel Car 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 12 5 — — $587,649.57 $646,414.53 $587,649.57 2026-04-01
Q2056 EAPG Ciltacabtagene Car-pos T 2 1 — — $72,542.47 $72,542.47 $72,542.47 2026-04-01
Q2057 HCPCS Afamitresgene Autoleucel 12 5 — — $770,620.00 $847,682.00 $770,620.00 2026-04-01
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 12 5 — — $278,250.00 $306,075.00 $278,250.00 2026-04-01
Q9995 EAPG Inj. Emicizumab-kxwh, 0.5 Mg 2 1 — — $39,828.99 $39,828.99 $39,828.99 2026-04-01
S2235 EAPG Implant Auditory Brain Imp 2 1 — — $45,017.45 $45,017.45 $45,017.45 2026-04-01
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