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

J PAUL JONES HOSPITAL

Camden, AL · CCN 010781 · Rates published

10,473 distinct procedures filed
4 distinct payers
33,341 rate rows
2026-04-17 last MRF observed
Data quality

29,964 of 33,341 rate rows are consumer-grade (89.9%)

3,377 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 3,237
template filing: same amount across many unrelated codes — excluded 132
placeholder amount (≤ $0.02) — excluded from medians 6
exceeds 10× this hospital's gross charge — excluded from medians 1
percent-of-charges filed in the dollar field — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://jpauljones.pt.panaceainc.com/MRFDownload/jpauljones/jpauljones
Found on page https://jpauljones.com/services/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint e36205e7e4f262ef… · 10,894,721 bytes · first seen 2026-05-08

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 3 $4,505,000.00 $4,505,000.00 $4,505,000.00 nat. median
$4,505,000
1.0× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 3 $3,685,266.66 $3,685,266.66 $3,685,266.66 nat. median
$3,710,000
1.0× median
J3389
HCPCS 		Topi Adm Prad Zami Per Treat 3 $3,335,820.00 $3,335,820.00 $3,335,820.00 nat. median
$3,335,820
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 3 $3,327,859.72 $3,327,859.72 $3,327,859.72 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 3 $3,252,508.07 $3,252,508.07 $3,252,508.07 nat. median
$3,286,000
1.0× median
J3387
HCPCS 		Inj Elivaldogene Autotemecel 3 $3,180,000.00 $3,180,000.00 $3,180,000.00 nat. median
$3,180,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 3 $2,939,968.88 $2,939,968.88 $2,939,968.88 nat. median
$3,004,655
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 3 $2,588,981.22 $2,588,981.22 $2,588,981.22 nat. median
$2,468,984
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 3 $2,332,000.00 $2,332,000.00 $2,332,000.00 nat. median
$2,448,600
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 3 $770,620.00 $770,620.00 $770,620.00 nat. median
$824,563
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 3 $587,649.57 $587,649.57 $587,649.57 nat. median
$674,867
0.9× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 3 $566,531.30 $566,531.30 $566,531.30 nat. median
$753,246
0.8× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 3 $562,201.24 $562,201.24 $562,201.24 nat. median
$673,137
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 3 $558,081.72 $558,081.72 $558,081.72 nat. median
$625,184
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 3 $532,192.24 $532,192.24 $532,192.24 nat. median
$634,303
0.8× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 3 $489,450.20 $489,450.20 $489,450.20 nat. median
$619,808
0.8× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 3 $278,250.00 $278,250.00 $278,250.00 nat. median
$324,450
0.9× median
J3403
HCPCS 		Revakinagene, Per Implant 3 $265,000.00 $265,000.00 $265,000.00 nat. median
$265,000
1.0× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 3 $201,669.02 $201,669.02 $201,669.02 nat. median
$209,753
1.0× median
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 3 $64,274.79 $64,274.79 $64,274.79 nat. median
$69,774
0.9× median
A9543
HCPCS 		Y90 Ibritumomab, Rx 3 $56,824.54 $56,824.54 $56,824.54 nat. median
$62,507
0.9× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 3 $54,404.10 $54,404.10 $54,404.10 nat. median
$66,682
0.8× median
38240
HCPCS 		Transplt Allo Hct/donor 3 $54,211.42 $54,211.42 $54,211.42 nat. median
$15,979
outlier · 3.4×
J9226
HCPCS 		Supprelin La Implant 3 $43,185.33 $43,185.33 $43,185.33 nat. median
$60,368
0.7× median
64568
HCPCS 		Opn Impltj Crnl Nrv Nea&pg 3 $37,961.52 $37,961.52 $37,961.52 nat. median
$27,591
1.4× median
64654
HCPCS 		1st Opn Implt Bat Modulj Sys 3 $37,961.52 $37,961.52 $37,961.52 nat. median
$43,888
0.9× median
0620T
HCPCS 		Evasc Ven Artlz Tibl/prnl Vn 3 $37,961.52 $37,961.52 $37,961.52 nat. median
$33,076
1.1× median
33276
HCPCS 		Insj Phrnc Nrv Stim Sys 3 $37,961.52 $37,961.52 $37,961.52 nat. median
$43,787
0.9× median
0870T
HCPCS 		Imp Subq Prtl Ascts Pmp Sys 3 $29,525.72 $29,525.72 $29,525.72 nat. median
$8,550
outlier · 3.5×
J9266
HCPCS 		Pegaspargase Injection 3 $28,424.05 $28,424.05 $28,424.05 nat. median
$34,109
0.8× median
69930
HCPCS 		Implant Cochlear Device 3 $28,417.07 $28,417.07 $28,417.07 nat. median
$29,690
1.0× median
33249
HCPCS 		Insj/rplcmt Defib W/lead(s) 3 $27,052.54 $27,052.54 $27,052.54 nat. median
$31,833
0.8× median
0571T
HCPCS 		Insj/rplcmt Icds Ss Eltrd 3 $27,052.54 $27,052.54 $27,052.54 nat. median
$32,221
0.8× median
0408T
HCPCS 		Insj/rplc Cardiac Modulj Sys 3 $27,052.54 $27,052.54 $27,052.54 nat. median
$32,221
0.8× median
0915T
HCPCS 		Insj Perm Ccm-d Sys Pg&eltrd 3 $27,052.54 $27,052.54 $27,052.54 nat. median
$32,560
0.8× median
33264
HCPCS 		Rmvl & Rplcmt Dfb Gen Mlt Ld 3 $27,052.54 $27,052.54 $27,052.54 nat. median
$31,873
0.8× median
33270
HCPCS 		Ins/rep Subq Defibrillator 3 $27,052.54 $27,052.54 $27,052.54 nat. median
$32,221
0.8× median
33231
HCPCS 		Insrt Pulse Gen W/mult Leads 3 $27,052.54 $27,052.54 $27,052.54 nat. median
$30,121
0.9× median
33287
HCPCS 		Rmv&rplcmt Phrnc Nrv Stim Pg 3 $26,594.75 $26,594.75 $26,594.75 nat. median
$29,698
0.9× median
61885
HCPCS 		Insrt/redo Neurostim 1 Array 3 $26,594.75 $26,594.75 $26,594.75 nat. median
$20,011
1.3× median
64582
HCPCS 		Opn Mpltj Hpglsl Nstm Ary Pg 3 $26,594.75 $26,594.75 $26,594.75 nat. median
$28,316
0.9× median
61886
HCPCS 		Implant Neurostim Arrays 3 $26,594.75 $26,594.75 $26,594.75 nat. median
$27,109
1.0× median
64656
HCPCS 		Revj/rplcmt Bat Mod Sys Pg 3 $26,594.75 $26,594.75 $26,594.75 nat. median
$32,994
0.8× median
61891
HCPCS 		Rev/rplcmt Sk-mnt Crnl Nstm 3 $26,594.75 $26,594.75 $26,594.75 nat. median
$20,874
1.3× median
0908T
HCPCS 		Opn Imp Int Nstm Sys Vgs Nrv 3 $26,594.75 $26,594.75 $26,594.75 nat. median
$20,314
1.3× median
63685
HCPCS 		Ins/rplc Spi Npg/rcvr Pocket 3 $26,594.75 $26,594.75 $26,594.75 nat. median
$21,357
1.2× median
0674T
HCPCS 		Laps Insj Nw/rpcmt Prm Isdss 3 $26,594.75 $26,594.75 $26,594.75 nat. median
$25,200
1.1× median
0909T
HCPCS 		Rplcmt Int Nstim Sys Vgs Nrv 3 $26,594.75 $26,594.75 $26,594.75 nat. median
$17,508
1.5× median
33289
HCPCS 		Tcat Impl Wrls P-art Prs Snr 3 $24,720.79 $24,720.79 $24,720.79 nat. median
$28,318
0.9× median
J9600
HCPCS 		Porfimer Sodium Injection 3 $24,228.42 $24,228.42 $24,228.42 nat. median
$31,627
0.8× median

Other procedures at this hospital

Browse this hospital's 10,473 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
             
0202T HCPCS Post Vert Arthrplst 1 Lumbar 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
0219T HCPCS Plmt Post Facet Implt Cerv 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
0220T HCPCS Plmt Post Facet Implt Thor 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
0238T HCPCS Trluml Perip Athrc Iliac Art 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
0308T HCPCS Insj Ocular Telescope Prosth 3 3 — — $14,186.79 $14,186.79 $14,186.79 2026-04-17
0408T HCPCS Insj/rplc Cardiac Modulj Sys 3 3 — — $27,052.54 $27,052.54 $27,052.54 2026-04-17
0409T HCPCS Insj/rplc Car Modulj Pls Gn 3 3 — — $19,170.66 $19,170.66 $19,170.66 2026-04-17
0414T HCPCS Rmvl & Rpl Car Modulj Pls Gn 3 3 — — $19,170.66 $19,170.66 $19,170.66 2026-04-17
0515T HCPCS Insj Wcs Lv Compl Sys 3 3 — — $19,170.66 $19,170.66 $19,170.66 2026-04-17
0525T HCPCS Insj/rplcmt Compl Iims 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
0571T HCPCS Insj/rplcmt Icds Ss Eltrd 3 3 — — $27,052.54 $27,052.54 $27,052.54 2026-04-17
0582T HCPCS Trurl Abltj Mal Prst8 Tiss 3 3 — — $11,370.80 $11,370.80 $11,370.80 2026-04-17
0614T HCPCS Rmvl&rplcmt Ss Impl Dfb Pg 3 3 — — $19,170.66 $19,170.66 $19,170.66 2026-04-17
0620T HCPCS Evasc Ven Artlz Tibl/prnl Vn 3 3 — — $37,961.52 $37,961.52 $37,961.52 2026-04-17
0629T HCPCS Perq Njx Algc CT Lmbr 1st 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
0632T HCPCS Perq Tcat US Abltj Nrv P-art 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
0645T HCPCS Tcat Impltj C Sins Rdctj Dev 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
0656T HCPCS Ant Lmbr Vrt Bdy Teth <7 Seg 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
0657T HCPCS Ant Lmbr Vrt Bdy Teth 8+ Seg 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
0674T HCPCS Laps Insj Nw/rpcmt Prm Isdss 3 3 — — $26,594.75 $26,594.75 $26,594.75 2026-04-17
0680T HCPCS Insj/rplcmt Pg Only Isdss 3 3 — — $16,720.02 $16,720.02 $16,720.02 2026-04-17
0686T HCPCS Histotripsy Mal Hepatcel Tis 3 3 — — $14,763.07 $14,763.07 $14,763.07 2026-04-17
0737T HCPCS Xenograft Impltj Artclr Surf 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
0790T HCPCS Revj Rplcmt/rmvl Vrt Tethrg 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
0793T HCPCS Prq Tcat Thrm Ablt Nrv P-art 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
0795T HCPCS Tcat Ins 2chmbr Ldls Pm Cmpl 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
0796T HCPCS Tcat Ins 2chmbr Ldls Pm Ra 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
0797T HCPCS Tcat Ins 2chmbr Ldls Pm Rv 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
0801T HCPCS Tcat Rmv&rpl 2chmbr Ldls Pm 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
0802T HCPCS Tcat Rmv&rpl2chmb Ldls Pm Ra 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
0803T HCPCS Tcat Rmv&rpl2chmb Ldls Pm Rv 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
0816T HCPCS Opn Insj/rplcmt Ins Ptn Subq 3 3 — — $16,720.02 $16,720.02 $16,720.02 2026-04-17
0817T HCPCS Opn Insj/rplcmt Ins Ptn Subf 3 3 — — $16,720.02 $16,720.02 $16,720.02 2026-04-17
0823T HCPCS Tcat Ins 1chmbr Ldls Pm Ra 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
0825T HCPCS Tcat Rmv&rpl1chmb Ldls Pm Ra 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
0870T HCPCS Imp Subq Prtl Ascts Pmp Sys 3 3 — — $29,525.72 $29,525.72 $29,525.72 2026-04-17
0871T HCPCS Rplcmt Subq Prtl Ascites Pmp 3 3 — — $23,198.87 $23,198.87 $23,198.87 2026-04-17
0888T HCPCS Histotripsy Mal Renal Tissue 3 3 — — $14,763.07 $14,763.07 $14,763.07 2026-04-17
0908T HCPCS Opn Imp Int Nstm Sys Vgs Nrv 3 3 — — $26,594.75 $26,594.75 $26,594.75 2026-04-17
0909T HCPCS Rplcmt Int Nstim Sys Vgs Nrv 3 3 — — $26,594.75 $26,594.75 $26,594.75 2026-04-17
0915T HCPCS Insj Perm Ccm-d Sys Pg&eltrd 3 3 — — $27,052.54 $27,052.54 $27,052.54 2026-04-17
0916T HCPCS Insj Perm Ccm-d Sys Pg Only 3 3 — — $19,170.66 $19,170.66 $19,170.66 2026-04-17
0923T HCPCS Rmvl&rplcmt Perm Ccm-d Pg 3 3 — — $19,170.66 $19,170.66 $19,170.66 2026-04-17
0956T HCPCS Prt Crn Ch Cr&tun Elt S-sclp 3 3 — — $23,385.50 $23,385.50 $23,385.50 2026-04-17
0960T HCPCS Rpl S-sclp Eltr Ra Rcvr&tlmt 3 3 — — $23,385.50 $23,385.50 $23,385.50 2026-04-17
0981T HCPCS Tcat Impl Wrls Ivc Snr 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
1003T HCPCS Arthrp 1st Crp/mtcrpl Prostc 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
1013T HCPCS Lap Srg Imp/rpl Eso Nea&pg/r 3 3 — — $16,720.02 $16,720.02 $16,720.02 2026-04-17
19298 HCPCS Place Breast Rad Tube/caths 3 3 — — $11,877.13 $11,877.13 $11,877.13 2026-04-17
19357 HCPCS Tiss Xpndr Plmt Brst Rcnstj 3 3 — — $11,877.13 $11,877.13 $11,877.13 2026-04-17
20696 HCPCS App Mltpln Uni Xtrnl Fix 1st 3 3 — — $23,385.50 $23,385.50 $23,385.50 2026-04-17
20802 HCPCS Replantation Arm Complete 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
20805 HCPCS Replant Forearm Complete 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
20808 HCPCS Replantation Hand Complete 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
20838 HCPCS Replantation Foot Complete 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
20982 HCPCS Ablate Bone Tumor(s) Perq 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
21243 HCPCS Reconstruction Of Jaw Joint 3 3 — — $23,385.50 $23,385.50 $23,385.50 2026-04-17
22318 HCPCS Treat Odontoid Fx Without Graft 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
22319 HCPCS Treat Odontoid Fx W/graft 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
22325 HCPCS Treat Spine Fracture 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
22326 HCPCS Treat Neck Spine Fracture 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
22532 HCPCS Arthrd Lat Xtrcvtry Tq Thrc 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
22533 HCPCS Arthrd Lat Xtrcvtry Tq Lmbr 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22548 HCPCS Arthrd Ant Toral/xoral C1-c2 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
22551 HCPCS Arthrd Ant Ntrbdy Cervical 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
22554 HCPCS Arthrd Ant Ntrbd Min Dsc Crv 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
22556 HCPCS Arthrd Ant Ntrbd Min Dsc Thc 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22558 HCPCS Arthrd Ant Ntrbd Min Dsc Lum 3 3 — — $23,385.50 $23,385.50 $23,385.50 2026-04-17
22586 HCPCS Arthrd Pre-sac Ntrbdy L5-s1 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22590 HCPCS Arthrd Pst Tq Craniocervical 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
22595 HCPCS Arthrd Pst Tq Atlas-axis 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
22600 HCPCS Arthrd Pst Tq 1ntrspc Crv 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22610 HCPCS Arthrd Pst Tq 1ntrspc Thrc 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22612 HCPCS Arthrd Pst Tq 1ntrspc Lumbar 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22630 HCPCS Arthrd Pst Tq 1ntrspc Lum 3 3 — — $23,385.50 $23,385.50 $23,385.50 2026-04-17
22633 HCPCS Arthrd Cmbn 1ntrspc Lumbar 3 3 — — $23,385.50 $23,385.50 $23,385.50 2026-04-17
22800 HCPCS Arthrd Pst Dfrm<6 Vrt Sgm 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22802 HCPCS Arthrd Pst Dfrm 7-12 Vrt Sgm 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22804 HCPCS Arthrd Pst Dfrm 13+ Vrt Sgm 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22808 HCPCS Arthrd Ant Dfrm 2-3 Vrt Sgm 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22810 HCPCS Arthrd Ant Dfrm 4-7 Vrt Sgm 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22812 HCPCS Arthrd Ant Dfrm 8+ Vrt Sgm 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22818 HCPCS Kyphectomy 1-2 Segments 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22819 HCPCS Kyphectomy 3 Or More 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22836 HCPCS Ant Thrc Vrt Body Tethrg <7 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22837 HCPCS Ant Thrc Vrt Body Tethrg 8+ 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22838 HCPCS Rev Rplc/rmv Thrc Vrt Tethrg 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22856 HCPCS Tot Disc Arthrp 1ntrspc Crv 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22857 HCPCS Tot Disc Arthrp 1ntrspc Lmbr 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22861 HCPCS Rev Rplcm Arthrp 1ntrspc Crv 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22862 HCPCS Rev Rplcm Rthrp 1ntrspc Lmbr 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22867 HCPCS Insj Stablj Dev W/dcmprn 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
22869 HCPCS Insj Stablj Dev Without Dcmprn 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
23470 HCPCS Reconstruct Shoulder Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
23472 HCPCS Reconstruct Shoulder Joint 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
23473 HCPCS Revis Reconst Shoulder Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
23474 HCPCS Revis Reconst Shoulder Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
23485 HCPCS Revision Of Collar Bone 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
23491 HCPCS Reinforce Shoulder Bones 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
23615 HCPCS Optx Prox Humrl Fx W/int Fix 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
23616 HCPCS Optx Prx Hmrl Fx Fix Rpr Rpl 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
23680 HCPCS Optx Sho Dislc Neck Fx Fixj 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
23802 HCPCS Arthrd Glenohumeral Jt W/grf 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
23900 HCPCS Interthoracoscplr Amputation 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
23920 HCPCS Disarticulation Shoulder 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24346 HCPCS Reconstruct Elbow Med Ligmnt 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24361 HCPCS Reconstruct Elbow Joint 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
24362 HCPCS Reconstruct Elbow Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24363 HCPCS Replace Elbow Joint 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
24365 HCPCS Reconstruct Head Of Radius 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24366 HCPCS Reconstruct Head Of Radius 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24370 HCPCS Revise Reconst Elbow Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24371 HCPCS Revise Reconst Elbow Joint 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
24410 HCPCS Mlt Osteot Rlgnm Imed Rd Hum 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24430 HCPCS Rpr Non/mal Humerus Wo Graft 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24435 HCPCS Rpr Non/mal Hum With Agrft 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24498 HCPCS Proph Tx W/wo Mthylmthcrylt 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24516 HCPCS Tx Humrl Shaft Fx Imed Implt 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24545 HCPCS Optx Hum Fx Wo Ntrcndylr Xtn 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24546 HCPCS Optx Hum Fx W/ntrcndylr Xtn 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24575 HCPCS Optx Humeral Epcndylr Fx 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24586 HCPCS Optx Partclr Fx&/dislc Elbow 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24587 HCPCS Optx Partclr Fx&/dslc Elbw W 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
24666 HCPCS Optx Radial Head/nck Fx Rplc 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
25442 HCPCS Arthrp W/prostc Dstl Ulna 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
25446 HCPCS Arthrp W/prostc Dst Rds&crps 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
27130 HCPCS Total Hip Arthroplasty 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27278 HCPCS Arthrd Si Jt Plmt Iartic Dev 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
27279 HCPCS Arthrd Si Jt Plmt Tartclr Dv 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
27280 HCPCS Arthr Si Jt Opn B1grf Instrm 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
27284 HCPCS Arthrodesis Hip Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27286 HCPCS Arthrd Hip Jt Sbtrchc Osteot 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27290 HCPCS Amputation Of Leg At Hip 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
27295 HCPCS Amputation Of Leg At Hip 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
27356 HCPCS Remove Femur Lesion/graft 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27415 HCPCS Osteochondral Knee Allograft 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27428 HCPCS Reconstruction Knee 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27429 HCPCS Reconstruction Knee 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27438 HCPCS Revise Kneecap With Implant 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27440 HCPCS Revision Of Knee Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27441 HCPCS Revision Of Knee Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27442 HCPCS Revision Of Knee Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27443 HCPCS Revision Of Knee Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27446 HCPCS Revision Of Knee Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27447 HCPCS Total Knee Arthroplasty 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27486 HCPCS Revise/replace Knee Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27487 HCPCS Revise/replace Knee Joint 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
27488 HCPCS Removal Of Knee Prosthesis 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27511 HCPCS Treatment Of Thigh Fracture 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27513 HCPCS Treatment Of Thigh Fracture 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27514 HCPCS Treatment Of Thigh Fracture 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27580 HCPCS Fusion Of Knee 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27702 HCPCS Reconstruct Ankle Joint 3 3 — — $23,385.50 $23,385.50 $23,385.50 2026-04-17
27703 HCPCS Reconstruction Ankle Joint 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
27709 HCPCS Osteotomy Tibia & Fibula 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27715 HCPCS Ostpl Tibfib Lngth/shrt 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27758 HCPCS Treatment Of Tibia Fracture 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27759 HCPCS Treatment Of Tibia Fracture 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27827 HCPCS Treat Lower Leg Fracture 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27828 HCPCS Treat Lower Leg Fracture 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27870 HCPCS Fusion Of Ankle Joint Open 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
27871 HCPCS Fusion Of Tibiofibular Joint 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
28297 HCPCS Cor Hlx Vlgs Jt Arthrd 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
28320 HCPCS Repair Of Foot Bones 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
28420 HCPCS Optx Calcaneal Fx W/bone Grf 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
28705 HCPCS Arthrodesis Pantalar 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
28715 HCPCS Arthrodesis Triple 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
28725 HCPCS Arthrodesis Subtalar 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
28730 HCPCS Fusion Of Foot Bones 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
28735 HCPCS Fusion Of Foot Bones 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
28737 HCPCS Revision Of Foot Bones 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
29856 HCPCS Tibial Arthroscopy/surgery 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
29867 HCPCS Allgrft Implnt Knee W/scope 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
29889 HCPCS Arthrs Aid Pcl Rpr/agmntj 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
29907 HCPCS Subtalar Arthro W/fusion 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
33221 HCPCS Insert Pulse Gen Mult Leads 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
33229 HCPCS Remv&replc Pm Gen Mult Leads 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
33230 HCPCS Insrt Pulse Gen W/dual Leads 3 3 — — $19,170.66 $19,170.66 $19,170.66 2026-04-17
33231 HCPCS Insrt Pulse Gen W/mult Leads 3 3 — — $27,052.54 $27,052.54 $27,052.54 2026-04-17
33240 HCPCS Insrt Pulse Gen W/singl Lead 3 3 — — $19,170.66 $19,170.66 $19,170.66 2026-04-17
33249 HCPCS Insj/rplcmt Defib W/lead(s) 3 3 — — $27,052.54 $27,052.54 $27,052.54 2026-04-17
33262 HCPCS Rmvl& Replc Pulse Gen 1 Lead 3 3 — — $19,170.66 $19,170.66 $19,170.66 2026-04-17
33263 HCPCS Rmvl & Rplcmt Dfb Gen 2 Lead 3 3 — — $19,170.66 $19,170.66 $19,170.66 2026-04-17
33264 HCPCS Rmvl & Rplcmt Dfb Gen Mlt Ld 3 3 — — $27,052.54 $27,052.54 $27,052.54 2026-04-17
33270 HCPCS Ins/rep Subq Defibrillator 3 3 — — $27,052.54 $27,052.54 $27,052.54 2026-04-17
33274 HCPCS Tcat Insj/rpl Perm Ldls Pm 3 3 — — $16,600.72 $16,600.72 $16,600.72 2026-04-17
33276 HCPCS Insj Phrnc Nrv Stim Sys 3 3 — — $37,961.52 $37,961.52 $37,961.52 2026-04-17
33287 HCPCS Rmv&rplcmt Phrnc Nrv Stim Pg 3 3 — — $26,594.75 $26,594.75 $26,594.75 2026-04-17
33289 HCPCS Tcat Impl Wrls P-art Prs Snr 3 3 — — $24,720.79 $24,720.79 $24,720.79 2026-04-17
33902 HCPCS Perq P-art Revsc 1 Abnor Uni 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
36836 HCPCS Prq Av Fstl Crtj Uxtr 1 Acs 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
36837 HCPCS Prq Av Fstl Crt Uxtr Sep Acs 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
36906 HCPCS Thrmbc/nfs Dialysis Circuit 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37182 HCPCS Insert Hepatic Shunt (tips) 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37184 HCPCS Prim Art M-thrmbc 1st Vsl 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37242 HCPCS Vasc Embolize/occlude Artery 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37271 HCPCS Revsc Evsc Fpvt Athrc Sf 1st 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37273 HCPCS Revsc Evsc Fpvt Athrc Cplx 1 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37275 HCPCS Rvsc Evsc Fpvt St Athrc Sf 1 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37277 HCPCS Rvsc Evsc Fpvt St Athr Cpx 1 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37284 HCPCS Revsc Evasc Tpvt St Sf 1st 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37286 HCPCS Revsc Evasc Tpvt St Cplx 1st 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37288 HCPCS Revsc Evsc Tpvt Athrc Sf 1st 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37290 HCPCS Revsc Evsc Tpvt Athrc Cplx 1 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37292 HCPCS Rvsc Evsc Tpvt St Athrc Sf 1 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
37294 HCPCS Rvsc Evsc Tpvt St Athr Cpx 1 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
38240 HCPCS Transplt Allo Hct/donor 3 3 — — $54,211.42 $54,211.42 $54,211.42 2026-04-17
53440 HCPCS Male Sling Procedure 3 3 — — $11,370.80 $11,370.80 $11,370.80 2026-04-17
53444 HCPCS Insert Tandem Cuff 3 3 — — $17,862.84 $17,862.84 $17,862.84 2026-04-17
53445 HCPCS Insert Uro/ves Nck Sphincter 3 3 — — $17,862.84 $17,862.84 $17,862.84 2026-04-17
53447 HCPCS Remove/replace Ur Sphincter 3 3 — — $17,862.84 $17,862.84 $17,862.84 2026-04-17
53451 HCPCS Tprnl Balo Cntnc Dev Bi 3 3 — — $11,370.80 $11,370.80 $11,370.80 2026-04-17
54400 HCPCS Insert Semi-rigid Prosthesis 3 3 — — $11,370.80 $11,370.80 $11,370.80 2026-04-17
54401 HCPCS Insert Self-contd Prosthesis 3 3 — — $17,862.84 $17,862.84 $17,862.84 2026-04-17
54405 HCPCS Insert Multi-comp Penis Pros 3 3 — — $17,862.84 $17,862.84 $17,862.84 2026-04-17
54410 HCPCS Remove/replace Penis Prosth 3 3 — — $17,862.84 $17,862.84 $17,862.84 2026-04-17
54411 HCPCS Remov/replc Penis Pros Comp 3 3 — — $17,862.84 $17,862.84 $17,862.84 2026-04-17
54416 HCPCS Remv/repl Penis Contain Pros 3 3 — — $17,862.84 $17,862.84 $17,862.84 2026-04-17
54417 HCPCS Remv/replc Penis Pros Compl 3 3 — — $17,862.84 $17,862.84 $17,862.84 2026-04-17
55882 HCPCS Ablt Trurl Prst8 Tis Trnsdcr 3 3 — — $11,370.80 $11,370.80 $11,370.80 2026-04-17
61624 HCPCS Tcat Perm Occls/embolj Cns 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
61885 HCPCS Insrt/redo Neurostim 1 Array 3 3 — — $26,594.75 $26,594.75 $26,594.75 2026-04-17
61886 HCPCS Implant Neurostim Arrays 3 3 — — $26,594.75 $26,594.75 $26,594.75 2026-04-17
61891 HCPCS Rev/rplcmt Sk-mnt Crnl Nstm 3 3 — — $26,594.75 $26,594.75 $26,594.75 2026-04-17
62360 HCPCS Insert Spine Infusion Device 3 3 — — $15,533.88 $15,533.88 $15,533.88 2026-04-17
62361 HCPCS Implant Spine Infusion Pump 3 3 — — $15,533.88 $15,533.88 $15,533.88 2026-04-17
62362 HCPCS Implant Spine Infusion Pump 3 3 — — $15,533.88 $15,533.88 $15,533.88 2026-04-17
63655 HCPCS Implant Neuroelectrodes 3 3 — — $16,720.02 $16,720.02 $16,720.02 2026-04-17
63685 HCPCS Ins/rplc Spi Npg/rcvr Pocket 3 3 — — $26,594.75 $26,594.75 $26,594.75 2026-04-17
64568 HCPCS Opn Impltj Crnl Nrv Nea&pg 3 3 — — $37,961.52 $37,961.52 $37,961.52 2026-04-17
64580 HCPCS Opn Impltj Nea Neuromuscular 3 3 — — $16,720.02 $16,720.02 $16,720.02 2026-04-17
64582 HCPCS Opn Mpltj Hpglsl Nstm Ary Pg 3 3 — — $26,594.75 $26,594.75 $26,594.75 2026-04-17
64590 HCPCS Ins/rpl Prph Sac/gstr Npg/r 3 3 — — $16,720.02 $16,720.02 $16,720.02 2026-04-17
64628 HCPCS Trml Dstrj Ios Bvn 1st 2 L/s 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
64654 HCPCS 1st Opn Implt Bat Modulj Sys 3 3 — — $37,961.52 $37,961.52 $37,961.52 2026-04-17
64656 HCPCS Revj/rplcmt Bat Mod Sys Pg 3 3 — — $26,594.75 $26,594.75 $26,594.75 2026-04-17
65770 HCPCS Keratoprosthesis 3 3 — — $12,502.11 $12,502.11 $12,502.11 2026-04-17
66683 HCPCS Implantation Iris Prosthesis 3 3 — — $14,186.79 $14,186.79 $14,186.79 2026-04-17
67027 HCPCS Implant Eye Drug System 3 3 — — $12,025.38 $12,025.38 $12,025.38 2026-04-17
69714 HCPCS Impl Oi Implt Skull Perq Esp 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
69716 HCPCS Impl Oi Implt Sk Tc Esp<100 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
69719 HCPCS Rplcm Oi Implt Sk Tc Esp<100 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
69729 HCPCS Impl Oi Implt Sk Tc Esp>=100 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
69730 HCPCS Rplc Oi Implt Sk Tc Esp>=100 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
69930 HCPCS Implant Cochlear Device 3 3 — — $28,417.07 $28,417.07 $28,417.07 2026-04-17
81416 HCPCS Exome Sequence Analysis 3 3 — — $12,000.00 $12,000.00 $12,000.00 2026-04-17
92930 HCPCS Prq Tcat Plmt Ntrac St 2+les 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
92933 HCPCS Prq Trlml C Athrc St Angiop1 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
93580 HCPCS Transcath Closure Of Asd 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
93581 HCPCS Transcath Closure Of Vsd 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
93582 HCPCS Perq Transcath Closure Pda 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
93590 HCPCS Perq Transcath Cls Mitral 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
93591 HCPCS Perq Transcath Cls Aortic 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
93653 HCPCS Compre Ep Eval Tx Svt 3 3 — — $22,526.95 $22,526.95 $22,526.95 2026-04-17
93654 HCPCS Compre Ep Eval Tx Vt 3 3 — — $22,526.95 $22,526.95 $22,526.95 2026-04-17
93656 HCPCS Compre Ep Eval Abltj Atr Fib 3 3 — — $22,526.95 $22,526.95 $22,526.95 2026-04-17
A9543 HCPCS Y90 Ibritumomab, Rx 3 3 — — $56,824.54 $56,824.54 $56,824.54 2026-04-17
C2616 HCPCS Brachytx, Non-str,yttrium-90 3 3 — — $14,991.27 $14,991.27 $14,991.27 2026-04-17
C8003 HCPCS Imp Extar Knee Shck Absrb 3 3 — — $15,111.55 $15,111.55 $15,111.55 2026-04-17
C8005 HCPCS Pef Bronch Ablt 3d Nav Ebus 3 3 — — $14,763.07 $14,763.07 $14,763.07 2026-04-17
C9602 HCPCS Perc D-e Cor Stent Ather S 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
C9734 HCPCS U/s Trtmt, Not Leiomyomata 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
C9757 HCPCS Spine Device Implant Surgery 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
C9758 HCPCS Blind Interatrial Shunt Ide 3 3 — — $14,763.07 $14,763.07 $14,763.07 2026-04-17
C9760 HCPCS Non-blind Interatrial Shunt 3 3 — — $23,198.87 $23,198.87 $23,198.87 2026-04-17
C9765 HCPCS Revasc Intra Lithotrip-stent 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
C9766 HCPCS Revasc Intra Lithotrip-ather 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
C9767 HCPCS Revasc Lithotrip-stent-ather 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
C9773 HCPCS Revasc Lithotr-stent Tib/per 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
C9774 HCPCS Revasc Lithotr-ather Tib/per 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
C9775 HCPCS Revasc Lith-sten-ath Tib/per 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
C9781 HCPCS Arthro/shoul Surg; W/spacer 3 3 — — $11,065.04 $11,065.04 $11,065.04 2026-04-17
C9782 HCPCS Blind Myocar Trpl Bon Marrow 3 3 — — $14,763.07 $14,763.07 $14,763.07 2026-04-17
C9797 HCPCS Vasc Emb/occ W/prs Cath 3 3 — — $15,799.15 $15,799.15 $15,799.15 2026-04-17
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 3 3 — — $3,685,266.66 $3,685,266.66 $3,685,266.66 2026-04-17
J1412 HCPCS Inj Roctavian Ml 2x10^13vc G 3 3 — — $12,553.71 $12,553.71 $12,553.71 2026-04-17
J1413 HCPCS Inj Delandistrogene Mox Rokl 3 3 — — $3,327,859.72 $3,327,859.72 $3,327,859.72 2026-04-17
J3387 HCPCS Inj Elivaldogene Autotemecel 3 3 — — $3,180,000.00 $3,180,000.00 $3,180,000.00 2026-04-17
J3389 HCPCS Topi Adm Prad Zami Per Treat 3 3 — — $3,335,820.00 $3,335,820.00 $3,335,820.00 2026-04-17
J3391 HCPCS Inj, Atidarsagene Autotemcel 3 3 — — $4,505,000.00 $4,505,000.00 $4,505,000.00 2026-04-17
J3392 HCPCS Inj, Exagamglogene Autotem 3 3 — — $2,332,000.00 $2,332,000.00 $2,332,000.00 2026-04-17
J3393 HCPCS Inj, Betibeglogene Autotemce 3 3 — — $2,939,968.88 $2,939,968.88 $2,939,968.88 2026-04-17
J3394 HCPCS Inj, Lovotibeglogene Autotem 3 3 — — $3,252,508.07 $3,252,508.07 $3,252,508.07 2026-04-17
J3399 HCPCS Inj Onase Abepar-xioi Treat 3 3 — — $2,588,981.22 $2,588,981.22 $2,588,981.22 2026-04-17
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 3 3 — — $201,669.02 $201,669.02 $201,669.02 2026-04-17
J3403 HCPCS Revakinagene, Per Implant 3 3 — — $265,000.00 $265,000.00 $265,000.00 2026-04-17
J9029 HCPCS Instill Adstiladrin, Tx Dose 3 3 — — $64,274.79 $64,274.79 $64,274.79 2026-04-17
J9226 HCPCS Supprelin La Implant 3 3 — — $43,185.33 $43,185.33 $43,185.33 2026-04-17
J9266 HCPCS Pegaspargase Injection 3 3 — — $28,424.05 $28,424.05 $28,424.05 2026-04-17
J9600 HCPCS Porfimer Sodium Injection 3 3 — — $24,228.42 $24,228.42 $24,228.42 2026-04-17
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 3 3 — — $532,192.24 $532,192.24 $532,192.24 2026-04-17
Q2042 HCPCS Tisagenlecleucel Car-pos T 3 3 — — $566,531.30 $566,531.30 $566,531.30 2026-04-17
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 3 3 — — $54,404.10 $54,404.10 $54,404.10 2026-04-17
Q2053 HCPCS Brexucabtagene Car Pos T 3 3 — — $489,450.20 $489,450.20 $489,450.20 2026-04-17
Q2054 HCPCS Lisocabtagene Mara Car Pos T 3 3 — — $562,201.24 $562,201.24 $562,201.24 2026-04-17
Q2055 HCPCS Idecabtagene Vicleucel Car 3 3 — — $558,081.72 $558,081.72 $558,081.72 2026-04-17
Q2056 HCPCS Ciltacabtagene Car-pos T 3 3 — — $587,649.57 $587,649.57 $587,649.57 2026-04-17
Q2057 HCPCS Afamitresgene Autoleucel 3 3 — — $770,620.00 $770,620.00 $770,620.00 2026-04-17
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 3 3 — — $278,250.00 $278,250.00 $278,250.00 2026-04-17
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