Hospital

Thousand Oaks Surgical Hospital

Thousand Oaks, CA · CCN 050749 · Rates published

32,825 distinct procedures filed

36 distinct payers

805,908 rate rows

2026-03-01 last MRF observed

Data quality

751,676 of 805,908 rate rows are consumer-grade (93.3%)

54,232 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 — reason	Rows
template filing: same amount across many unrelated codes — excluded	29,190
per-diem day rate — not a per-procedure price	16,688
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	5,543
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	1,851
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	665
placeholder amount (≤ $0.02) — excluded from medians	174
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings	63
exceeds 10× this hospital's gross charge — excluded from medians	58

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/95-2321136_LOS-ROBLES-HOSPITAL-AND-MEDICAL-CENTER_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page	https://www.losrobleshospital.com/cms-hpt.txt
Discovered via	Discovered by HANK (automated)
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-09-21
Content fingerprint	06328fc6ff10144b… · 540,839,987 bytes · first seen 2026-05-14

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
J3393 HCPCS	Injection, Betibeglogene Autotemcel, Per Treatment	1	$4,850,948.67	$4,850,948.67	$4,850,948.67	nat. median $2,994,107 1.6× median
00845 OTHER	Inj, Atidarsagene Autotem	1	$4,505,000.00	$4,505,000.00	$4,505,000.00	nat. median $4,414,900 1.0× median
845 OTHER	Inj, Atidarsagene Autotem	16	$8,484.03	$4,595,100.00	$4,505,000.00	nat. median $17,146 outlier · 262.7×
J3399 HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	1	$4,271,819.03	$4,271,819.03	$4,271,819.03	nat. median $2,466,282 1.7× median
J3392 HCPCS	Injection, Exagamglogene Autotemcel, Per Treatment	1	$3,847,800.00	$3,847,800.00	$3,847,800.00	nat. median $2,401,960 1.6× median
9138 OTHER	Inj, Hemgenix, Per Tx Dos	17	$3,648,414.33	$4,790,847.10	$3,685,267.00	nat. median $3,758,972 1.0× median
09138 OTHER	Inj, Hemgenix, Per Tx Dos	1	$3,685,267.00	$3,685,267.00	$3,685,267.00	nat. median $3,574,709 1.0× median
00908 OTHER	Topi Adm Prad Zami Per Tr	1	$3,335,820.00	$3,335,820.00	$3,335,820.00	nat. median $14,694 outlier · 227.0×
908 OTHER	Topi Adm Prad Zami Per Tr	18	$15,361.55	$4,336,566.00	$3,335,820.00	nat. median $30,329 outlier · 110.0×
714 OTHER	Inj Delandistrogene Mox R	18	$9,978.36	$4,326,218.00	$3,327,860.00	nat. median $3,325,455 1.0× median
00714 OTHER	Inj Delandistrogene Mox R	1	$3,327,860.00	$3,327,860.00	$3,327,860.00	nat. median $3,228,024 1.0× median
00748 OTHER	Inj, Lovotibeglogene Auto	1	$3,252,508.00	$3,252,508.00	$3,252,508.00	nat. median $3,187,420 1.0× median
748 OTHER	Inj, Lovotibeglogene Auto	18	$18,993.71	$4,228,260.40	$3,252,508.00	nat. median $3,252,508 1.0× median
906 OTHER	Inj Elivaldogene Autoteme	18	$13,573.73	$4,134,000.00	$3,180,000.00	nat. median $24,952 outlier · 127.4×
00906 OTHER	Inj Elivaldogene Autoteme	1	$3,180,000.00	$3,180,000.00	$3,180,000.00	nat. median $3,084,600 1.0× median
746 OTHER	Inj, Betibeglogene Autote	18	$17,569.39	$3,821,959.70	$2,939,969.00	nat. median $2,939,969 1.0× median
00746 OTHER	Inj, Betibeglogene Autote	1	$2,939,969.00	$2,939,969.00	$2,939,969.00	nat. median $2,878,960 1.0× median
9141 OTHER	Inj Onase Abepar-xioi Tre	17	$2,563,091.19	$3,365,675.30	$2,588,981.00	nat. median $2,588,981 1.0× median
09141 OTHER	Inj Onase Abepar-xioi Tre	1	$2,588,981.00	$2,588,981.00	$2,588,981.00	nat. median $2,511,312 1.0× median
824 OTHER	Inj, Exagamglogene Autote	18	$20,573.31	$3,031,600.00	$2,332,000.00	nat. median $2,262,040 1.0× median
00824 OTHER	Inj, Exagamglogene Autote	1	$2,332,000.00	$2,332,000.00	$2,332,000.00	nat. median $2,285,360 1.0× median
2067 OTHER	Afamitresgene Autoleucel	17	$762,913.80	$1,001,806.00	$770,620.00	nat. median $789,886 1.0× median
9498 OTHER	Ciltacabtagene Car-pos T	17	$581,773.10	$763,944.48	$587,649.60	nat. median $587,650 1.0× median
09498 OTHER	Ciltacabtagene Car-pos T	1	$587,649.60	$587,649.60	$587,649.60	nat. median $570,020 1.0× median
9194 OTHER	Tisagenlecleucel Car-pos	17	$560,865.99	$736,490.69	$566,531.30	nat. median $577,003 1.0× median
09194 OTHER	Tisagenlecleucel Car-pos	1	$566,531.30	$566,531.30	$566,531.30	nat. median $549,535 1.0× median
9413 OTHER	Lisocabtagene Car Pos T	17	$556,579.19	$730,861.56	$562,201.20	nat. median $562,201 1.0× median
09413 OTHER	Lisocabtagene Car Pos T	1	$562,201.20	$562,201.20	$562,201.20	nat. median $545,335 1.0× median
9422 OTHER	Idecabtagene Vicleucel Ca	17	$552,500.98	$725,506.34	$558,081.80	nat. median $562,826 1.0× median
09422 OTHER	Idecabtagene Vicleucel Ca	1	$558,081.80	$558,081.80	$558,081.80	nat. median $541,339 1.0× median
9035 OTHER	Axicabtagene Ciloleucel C	17	$526,870.28	$691,849.86	$532,192.20	nat. median $533,230 1.0× median
09035 OTHER	Axicabtagene Ciloleucel C	1	$532,192.20	$532,192.20	$532,192.20	nat. median $516,226 1.0× median
Q2056 HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	5	$101,414.37	$969,621.79	$527,123.43	nat. median $646,415 0.8× median
Q2055 HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	5	$96,730.79	$920,834.85	$526,587.59	nat. median $622,245 0.8× median
Q2054 HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	5	$94,681.08	$927,632.05	$516,584.04	nat. median $640,950 0.8× median
Q2041 HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	5	$92,187.47	$878,117.20	$489,455.96	nat. median $608,101 0.8× median
9391 OTHER	Brexucabtagene Car Pos T	17	$484,555.70	$636,285.26	$489,450.20	nat. median $492,768 1.0× median
09391 OTHER	Brexucabtagene Car Pos T	1	$489,450.20	$489,450.20	$489,450.20	nat. median $474,767 1.0× median
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	25	$17,476.00	$704,391.60	$469,594.40	nat. median $359,358 1.3× median
415481 CDM	Valve Aor Tavr 26mm	11	$58,320.00	$583,200.00	$466,560.00	nat. median $153,317 outlier · 3.0×
437039 CDM	Valve Tavr 26mm	11	$58,320.00	$583,200.00	$466,560.00	nat. median $193,600 outlier · 2.4×
437378 CDM	Valve Tavr 29mm	11	$58,320.00	$583,200.00	$466,560.00	nat. median $10,348 outlier · 45.1×
437377 CDM	Valve Tavr 34mm	11	$58,320.00	$583,200.00	$466,560.00	nat. median $132,667 outlier · 3.5×
C1825 HCPCS	System Nrstm Gen Ipg	11	$58,320.00	$583,200.00	$466,560.00	nat. median $53,125 outlier · 8.8×
437579 CDM	Valve Tavr 23mm	11	$58,320.00	$583,200.00	$466,560.00	nat. median $126,434 outlier · 3.7×
919614 CDM	Valve Mitral 35l	11	$58,320.00	$583,200.00	$466,560.00	nat. median $432,000 1.1× median
627137 CDM	Valve Aor Tavr 26mm	11	$57,781.30	$577,813.00	$462,250.40	nat. median $430,000 1.1× median
629383 CDM	Valve Xt Sapien 23mm Ta	11	$57,781.30	$577,813.00	$462,250.40	nat. median $430,000 1.1× median
629964 CDM	Valve Aor 23x18-20mm	11	$57,781.30	$577,813.00	$462,250.40	nat. median $55,766 outlier · 8.3×
416530 CDM	Valve Aor With Intro 23mm	11	$57,781.30	$577,813.00	$462,250.40	nat. median $198 outlier · 2334.6×

Other procedures at this hospital

Browse this hospital's 32,825 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

J3393	HCPCS	Injection, Betibeglogene Autotemcel, Per Treatment	1	1	—	—	$4,850,948.67	$4,850,948.67	$4,850,948.67	2026-03-01
00845	OTHER	Inj, Atidarsagene Autotem	1	1	—	—	$4,505,000.00	$4,505,000.00	$4,505,000.00	2026-03-01
845	OTHER	Inj, Atidarsagene Autotem	20	16	—	—	$8,484.03	$4,595,100.00	$4,505,000.00	2026-03-01
J3399	HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	1	1	—	—	$4,271,819.03	$4,271,819.03	$4,271,819.03	2026-03-01
J3392	HCPCS	Injection, Exagamglogene Autotemcel, Per Treatment	1	1	—	—	$3,847,800.00	$3,847,800.00	$3,847,800.00	2026-03-01
9138	OTHER	Inj, Hemgenix, Per Tx Dos	22	17	—	—	$3,648,414.33	$4,790,847.10	$3,685,267.00	2026-03-01
09138	OTHER	Inj, Hemgenix, Per Tx Dos	1	1	—	—	$3,685,267.00	$3,685,267.00	$3,685,267.00	2026-03-01
908	OTHER	Topi Adm Prad Zami Per Tr	23	18	—	—	$15,361.55	$4,336,566.00	$3,335,820.00	2026-03-01
00908	OTHER	Topi Adm Prad Zami Per Tr	1	1	—	—	$3,335,820.00	$3,335,820.00	$3,335,820.00	2026-03-01
714	OTHER	Inj Delandistrogene Mox R	23	18	—	—	$9,978.36	$4,326,218.00	$3,327,860.00	2026-03-01
00714	OTHER	Inj Delandistrogene Mox R	1	1	—	—	$3,327,860.00	$3,327,860.00	$3,327,860.00	2026-03-01
748	OTHER	Inj, Lovotibeglogene Auto	23	18	—	—	$18,993.71	$4,228,260.40	$3,252,508.00	2026-03-01
00748	OTHER	Inj, Lovotibeglogene Auto	1	1	—	—	$3,252,508.00	$3,252,508.00	$3,252,508.00	2026-03-01
906	OTHER	Inj Elivaldogene Autoteme	23	18	—	—	$13,573.73	$4,134,000.00	$3,180,000.00	2026-03-01
00906	OTHER	Inj Elivaldogene Autoteme	1	1	—	—	$3,180,000.00	$3,180,000.00	$3,180,000.00	2026-03-01
00746	OTHER	Inj, Betibeglogene Autote	1	1	—	—	$2,939,969.00	$2,939,969.00	$2,939,969.00	2026-03-01
746	OTHER	Inj, Betibeglogene Autote	23	18	—	—	$17,569.39	$3,821,959.70	$2,939,969.00	2026-03-01
09141	OTHER	Inj Onase Abepar-xioi Tre	1	1	—	—	$2,588,981.00	$2,588,981.00	$2,588,981.00	2026-03-01
9141	OTHER	Inj Onase Abepar-xioi Tre	22	17	—	—	$2,563,091.19	$3,365,675.30	$2,588,981.00	2026-03-01
00824	OTHER	Inj, Exagamglogene Autote	1	1	—	—	$2,332,000.00	$2,332,000.00	$2,332,000.00	2026-03-01
824	OTHER	Inj, Exagamglogene Autote	23	18	—	—	$20,573.31	$3,031,600.00	$2,332,000.00	2026-03-01
2067	OTHER	Afamitresgene Autoleucel	22	17	—	—	$762,913.80	$1,001,806.00	$770,620.00	2026-03-01
9498	OTHER	Ciltacabtagene Car-pos T	22	17	—	—	$581,773.10	$763,944.48	$587,649.60	2026-03-01
09498	OTHER	Ciltacabtagene Car-pos T	1	1	—	—	$587,649.60	$587,649.60	$587,649.60	2026-03-01
09194	OTHER	Tisagenlecleucel Car-pos	1	1	—	—	$566,531.30	$566,531.30	$566,531.30	2026-03-01
9194	OTHER	Tisagenlecleucel Car-pos	22	17	—	—	$560,865.99	$736,490.69	$566,531.30	2026-03-01
9413	OTHER	Lisocabtagene Car Pos T	22	17	—	—	$556,579.19	$730,861.56	$562,201.20	2026-03-01
09413	OTHER	Lisocabtagene Car Pos T	1	1	—	—	$562,201.20	$562,201.20	$562,201.20	2026-03-01
09422	OTHER	Idecabtagene Vicleucel Ca	1	1	—	—	$558,081.80	$558,081.80	$558,081.80	2026-03-01
9422	OTHER	Idecabtagene Vicleucel Ca	22	17	—	—	$552,500.98	$725,506.34	$558,081.80	2026-03-01
09035	OTHER	Axicabtagene Ciloleucel C	1	1	—	—	$532,192.20	$532,192.20	$532,192.20	2026-03-01
9035	OTHER	Axicabtagene Ciloleucel C	22	17	—	—	$526,870.28	$691,849.86	$532,192.20	2026-03-01
Q2056	HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	6	5	—	—	$101,414.37	$969,621.79	$527,123.43	2026-03-01
Q2055	HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	6	5	—	—	$96,730.79	$920,834.85	$526,587.59	2026-03-01
Q2054	HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	6	5	—	—	$94,681.08	$927,632.05	$516,584.04	2026-03-01
Q2041	HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	6	5	—	—	$92,187.47	$878,117.20	$489,455.96	2026-03-01
09391	OTHER	Brexucabtagene Car Pos T	1	1	—	—	$489,450.20	$489,450.20	$489,450.20	2026-03-01
9391	OTHER	Brexucabtagene Car Pos T	22	17	—	—	$484,555.70	$636,285.26	$489,450.20	2026-03-01
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	34	25	—	—	$17,476.00	$704,391.60	$469,594.40	2026-03-01
C1825	HCPCS	System Nrstm Gen Ipg	16	11	$583,200.00	$583,200.00	$58,320.00	$583,200.00	$466,560.00	2026-03-01
919614	CDM	Valve Mitral 35l	16	11	$583,200.00	$583,200.00	$58,320.00	$583,200.00	$466,560.00	2026-03-01
437377	CDM	Valve Tavr 34mm	16	11	$583,200.00	$583,200.00	$58,320.00	$583,200.00	$466,560.00	2026-03-01
437378	CDM	Valve Tavr 29mm	16	11	$583,200.00	$583,200.00	$58,320.00	$583,200.00	$466,560.00	2026-03-01
437039	CDM	Valve Tavr 26mm	16	11	$583,200.00	$583,200.00	$58,320.00	$583,200.00	$466,560.00	2026-03-01
415481	CDM	Valve Aor Tavr 26mm	16	11	$583,200.00	$583,200.00	$58,320.00	$583,200.00	$466,560.00	2026-03-01
437579	CDM	Valve Tavr 23mm	16	11	$583,200.00	$583,200.00	$58,320.00	$583,200.00	$466,560.00	2026-03-01
637992	CDM	Valve Aor Tavr 29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
638026	CDM	Valve Aor Tavr 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
629964	CDM	Valve Aor 23x18-20mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
627137	CDM	Valve Aor Tavr 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
627349	CDM	Valve Hrt Sapien Xt 29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
631120	CDM	Valve Tavr 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
638867	CDM	Valve Hrt W/cert Sys 23a	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
627134	CDM	Valve Aor Tavr 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
635361	CDM	Valve Tavr 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
630787	CDM	Valve Tavr 29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
633885	CDM	Vavle Aor Enveor 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
417189	CDM	Valve Tavr 27mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
416530	CDM	Valve Aor With Intro 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
634969	CDM	Valve Hrt W Cert Sys 26a	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
415240	CDM	Valve Aor Tavr 34mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
627135	CDM	Valve Aor Tavr 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
415939	CDM	Valve Aor Tavr 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
421038	CDM	Valve Tavr Sz 29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
627348	CDM	Valve Hrt Sapien Xt 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
635363	CDM	Valve Tavr 29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
629383	CDM	Valve Xt Sapien 23mm Ta	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
407909	CDM	Valve Tavr 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
635362	CDM	Valve Tavr 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
629968	CDM	Valve Aor 29x23-26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
630018	CDM	Valve Xt Sapien 26mm Ta	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
631359	CDM	Kit Aor Vlv 14fr 29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
407910	CDM	Valve Tavr 29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
419221	CDM	Valve Heart Trnscth 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
629967	CDM	Valve Aor 31x26-29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
416528	CDM	Valve Aor With Intro 25mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
633886	CDM	Vavle Aor Enveor 29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
629969	CDM	Valve Aor 26x20-23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
631358	CDM	Kit Aor Vlv 14fr 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
421037	CDM	Valve Tavr Sz 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
421039	CDM	Valve Tavr Size 34mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
633884	CDM	Valve Aor Enveor 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
634804	CDM	Kit Aor Vlv 14fr 20mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
631357	CDM	Kit Aor Vlv 14fr 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
627136	CDM	Valve Aor Tavr 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
635891	CDM	Valve Aor Evolut R 34mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
634405	CDM	Valve Tavr 34mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
421036	CDM	Valve Tavr Sz 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
415940	CDM	Valve Aor Tavr 29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
434124	CDM	System Trcsd 1clip 1cath	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
627347	CDM	Valve Hrt Sapien Xt 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
416529	CDM	Valve Aor With Intro 27mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
635645	CDM	Kit Vlv Aor 18fr 29mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
407908	CDM	Valve Tavr 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
631158	CDM	Valve Tavr 26mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
419448	CDM	Valve Heart Trnscth 23mm	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
630019	CDM	Valve 29mm Ascendra Aor	16	11	$577,813.00	$577,813.00	$57,781.30	$577,813.00	$462,250.40	2026-03-01
Q2053	HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	6	5	—	—	$107,667.81	$807,592.83	$460,530.40	2026-03-01
641422	CDM	Impl Crnl Lg	16	11	$559,187.00	$559,187.00	$55,918.70	$559,187.00	$447,349.60	2026-03-01
417201	CDM	Valve Tavr 25mm	16	11	$551,639.00	$551,639.00	$55,163.90	$551,639.00	$441,311.20	2026-03-01
419845	CDM	Valve Aor Del Sys 35mm	16	11	$549,024.00	$549,024.00	$54,902.40	$549,024.00	$439,219.20	2026-03-01
C1822	HCPCS	Implant Pulse 8.5x15.5in	32	11	$555,828.00	$555,828.00	$53,384.30	$577,813.00	$427,074.40	2026-03-01
409889	CDM	Transcth Aortic Vlv 23mm	16	11	$532,494.00	$532,494.00	$53,249.40	$532,494.00	$425,995.20	2026-03-01
409892	CDM	Transcth Aortic Vlv 27mm	16	11	$532,494.00	$532,494.00	$53,249.40	$532,494.00	$425,995.20	2026-03-01
409893	CDM	Transcth Aortic Vlv 29mm	16	11	$532,494.00	$532,494.00	$53,249.40	$532,494.00	$425,995.20	2026-03-01
409890	CDM	Transcth Aortic Vlv 25mm	16	11	$532,494.00	$532,494.00	$53,249.40	$532,494.00	$425,995.20	2026-03-01
418539	CDM	Stent Graft 10cm 21x21mm	16	11	$494,508.00	$494,508.00	$49,450.80	$494,508.00	$395,606.40	2026-03-01
639569	CDM	Cage Spn Latmap 4 Nuvamp	16	11	$479,675.00	$479,675.00	$47,967.50	$479,675.00	$383,740.00	2026-03-01
417182	CDM	Device Clsr 35mm	16	11	$477,649.00	$477,649.00	$47,764.90	$477,649.00	$382,119.20	2026-03-01
417187	CDM	Device Clsr 20mm	16	11	$477,649.00	$477,649.00	$47,764.90	$477,649.00	$382,119.20	2026-03-01
417181	CDM	Device Clsr 31mm	16	11	$477,649.00	$477,649.00	$47,764.90	$477,649.00	$382,119.20	2026-03-01
417179	CDM	Device Clsr 24mm	16	11	$477,649.00	$477,649.00	$47,764.90	$477,649.00	$382,119.20	2026-03-01
417180	CDM	Device Clsr 27mm	16	11	$477,649.00	$477,649.00	$47,764.90	$477,649.00	$382,119.20	2026-03-01
439061	CDM	Valve Aor 29mm	16	11	$470,592.00	$470,592.00	$47,059.20	$470,592.00	$376,473.60	2026-03-01
482474	CDM	Valve Aor 27mm	16	11	$470,592.00	$470,592.00	$47,059.20	$470,592.00	$376,473.60	2026-03-01
439062	CDM	Valve Aor 35mm	16	11	$470,592.00	$470,592.00	$47,059.20	$470,592.00	$376,473.60	2026-03-01
481027	CDM	Valve Aor 25mm	16	11	$470,592.00	$470,592.00	$47,059.20	$470,592.00	$376,473.60	2026-03-01
421074	CDM	Stnt Thorac 26x26mm 10cm	16	11	$469,338.00	$469,338.00	$46,933.80	$469,338.00	$375,470.40	2026-03-01
421075	CDM	Stnt Thorac 28x28mm 10cm	16	11	$460,135.00	$460,135.00	$46,013.50	$460,135.00	$368,108.00	2026-03-01
919923	CDM	Stent 34mmx34mmx15cm	16	11	$460,135.00	$460,135.00	$46,013.50	$460,135.00	$368,108.00	2026-03-01
420742	CDM	Graft Evas 34x34x10cm	16	11	$460,135.00	$460,135.00	$46,013.50	$460,135.00	$368,108.00	2026-03-01
421076	CDM	Stent 20fr 31x31mm 10cm	16	11	$460,135.00	$460,135.00	$46,013.50	$460,135.00	$368,108.00	2026-03-01
419935	CDM	Device Embl 4.5mm 30mm	16	11	$449,552.00	$449,552.00	$44,955.20	$449,552.00	$359,641.60	2026-03-01
423155	CDM	Device Clsr 40mm	16	11	$444,448.00	$444,448.00	$44,444.80	$444,448.00	$355,558.40	2026-03-01
423153	CDM	Device Clsr 31mm	16	11	$444,448.00	$444,448.00	$44,444.80	$444,448.00	$355,558.40	2026-03-01
423152	CDM	Device Clsr 27mm	16	11	$444,448.00	$444,448.00	$44,444.80	$444,448.00	$355,558.40	2026-03-01
423154	CDM	Device Clsr 35mm	16	11	$444,448.00	$444,448.00	$44,444.80	$444,448.00	$355,558.40	2026-03-01
423151	CDM	Device Clsr 24mm	16	11	$444,448.00	$444,448.00	$44,444.80	$444,448.00	$355,558.40	2026-03-01
423150	CDM	Device Clsr 20mm	16	11	$444,448.00	$444,448.00	$44,444.80	$444,448.00	$355,558.40	2026-03-01
632273	CDM	Dev Embl Ped 3.50x30mm	16	11	$434,942.00	$434,942.00	$43,494.20	$434,942.00	$347,953.60	2026-03-01
632614	CDM	Device Embl 5x25mm Pipln	16	11	$434,942.00	$434,942.00	$43,494.20	$434,942.00	$347,953.60	2026-03-01
633335	CDM	Device Embl 5x30mm	16	11	$434,942.00	$434,942.00	$43,494.20	$434,942.00	$347,953.60	2026-03-01
018	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$342,540.20	$342,540.20	$342,540.20	2026-03-01
J3402	HCPCS	Injection, Remestemcel-l-rknd, Per Therapeutic Dose	1	1	—	—	$332,753.88	$332,753.88	$332,753.88	2026-03-01
632211	CDM	Dev Embl Pipeln 14x3mm	16	11	$412,605.00	$412,605.00	$41,260.50	$412,605.00	$330,084.00	2026-03-01
437463	CDM	Stent Vasc 250mm 12mm	16	11	$405,232.00	$405,232.00	$40,523.20	$405,232.00	$324,185.60	2026-03-01
437762	CDM	Stent Vasc 250mm 16mm	16	11	$405,232.00	$405,232.00	$40,523.20	$405,232.00	$324,185.60	2026-03-01
914694	CDM	Device Emb 4.25mm 16mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420485	CDM	Device Embl 4mm 18mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
413300	CDM	Device Embl 3.5mm 25mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
430707	CDM	Device Embl 2.5mm 16mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
914693	CDM	Device Embl 4.25mm 12mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420544	CDM	Device Embl 4mm 25mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419957	CDM	Device Embl 3.75mm 18mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
412999	CDM	Device Embl 2.75mm 12mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
913449	CDM	Device Embl 5mm 35mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420484	CDM	Device Embl 4mm 16mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
914700	CDM	Device Embl 4.75mm 20mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
916573	CDM	Device Embl 4.25mm 14mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
916574	CDM	Device Embl 3mm 10mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419938	CDM	Device Embl 5.0x20mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419937	CDM	Device Embl 5.0x16mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
421096	CDM	Device Embl 3.25mm 16mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420486	CDM	Device Embl 4.00x2mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419939	CDM	Device Embl 5.0x.0mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
919704	CDM	Device Embl 5mm 18mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
915331	CDM	Device Embl 4mm 10mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420483	CDM	Device Embl 4mm 14mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420831	CDM	Device Embl 2.5mm 14mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420921	CDM	Device Embl 4.5mm 35mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
914699	CDM	Device Embl 4.75mm 14mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419902	CDM	Device Embl 3mm 16mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
411116	CDM	Device Embl 3.50x12mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420490	CDM	Device Embl 4.50x16mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420489	CDM	Device Embl 4.5mm 12mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419934	CDM	Device Embl 3.75mm 14mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
409932	CDM	Device Embl 4.25mm 18mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
422346	CDM	Device Embl 4.5mm 18mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420273	CDM	Device Embl 10mm 2.5mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420491	CDM	Device Embl 4.5mm 20mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
413086	CDM	Device Embl 3.75mm 12mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419932	CDM	Device Embl 3.25mm 20mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419933	CDM	Device Embl 3.5mm 20mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
434061	CDM	Device Embl 4.50x25mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420488	CDM	Device Embl 4.25mm 20mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
914689	CDM	Device Embl 3mm 12mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
914701	CDM	Device Embl 5mm 12mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
408976	CDM	Device Embl 3.25x12mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420482	CDM	Device Embl 3.75x16mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
915600	CDM	Device Embl 4.5mm 14mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419930	CDM	Device Embl 3mm 14mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419956	CDM	Device Embl 3.5mm 14mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
431511	CDM	Device Embl 3.75mm 20mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420481	CDM	Device Embl 3.5mm 16mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
434062	CDM	Device Embl 4.75x30mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420493	CDM	Device Embl 5mm 25mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420487	CDM	Device Embl 4mm 30mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419931	CDM	Device Embl 3mm 20mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419936	CDM	Device Embl 4.75mm 16mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420492	CDM	Device Emb 5mm 14mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
420563	CDM	Device Embl 3.5mm 18mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
439930	CDM	Device Embl 3.5mm 10mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
419929	CDM	Device Embl 2.5mm 12mm	16	11	$404,176.00	$404,176.00	$40,417.60	$404,176.00	$323,340.80	2026-03-01
629875	CDM	Dev Embol Piplne 20x4.5	16	11	$399,540.00	$399,540.00	$39,954.00	$399,540.00	$319,632.00	2026-03-01
Q2042	HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	8	6	—	—	$3,337.00	$934,776.65	$317,650.45	2026-03-01
415922	CDM	Implant Crnl Psi	16	11	$394,061.00	$394,061.00	$39,406.10	$394,061.00	$315,248.80	2026-03-01
418551	CDM	Valve Aortic 29mm	16	11	$393,358.00	$393,358.00	$39,335.80	$393,358.00	$314,686.40	2026-03-01
639975	CDM	Stent Eprsth 45mm 15cm	16	11	$389,546.00	$389,546.00	$38,954.60	$389,546.00	$311,636.80	2026-03-01
638973	CDM	Stent Eprsth 40mm 20cm	16	11	$389,546.00	$389,546.00	$38,954.60	$389,546.00	$311,636.80	2026-03-01
638974	CDM	Stent Eprsth 40mm 15cm	16	11	$389,546.00	$389,546.00	$38,954.60	$389,546.00	$311,636.80	2026-03-01
C1820	HCPCS	Nrstm Impl 1.9inx.6in	224	11	$436,642.00	$436,642.00	$1,830.30	$516,985.00	$310,913.05	2026-03-01
620829	CDM	Stent Eprsth 40mm 10cm	16	11	$385,624.00	$385,624.00	$38,562.40	$385,624.00	$308,499.20	2026-03-01
622039	CDM	Stent Eprsth 37mm 15cm	16	11	$385,624.00	$385,624.00	$38,562.40	$385,624.00	$308,499.20	2026-03-01
622038	CDM	Stent Eprsth 34mm 20cm	16	11	$385,624.00	$385,624.00	$38,562.40	$385,624.00	$308,499.20	2026-03-01
634607	CDM	Device Embl Pln 4.5x12mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
643292	CDM	Device Embl 4.25x14mm Pl	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
634902	CDM	Device Embl Piplin 4mmx2	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642477	CDM	Device Embl 5x20mm Pipln	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
629316	CDM	Dev Emb Pipeln 2.50x16mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
635566	CDM	Device Embl 3.75x18mm Pl	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
641247	CDM	Device Embl 4.5mm 16mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642435	CDM	Device Embl 16x4.25mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
635177	CDM	Device Embl 16mm 4mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
638030	CDM	Device Embl 18x4.75mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642472	CDM	Device Embl 30mm 4.75mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
636635	CDM	Device Embl 20mm 2.5mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
633762	CDM	Device Embl 5x35mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642572	CDM	Device Embl 14mm 2.5mm P	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
640276	CDM	Dev Embl Pipln 14x2.75mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
638451	CDM	Dev Embl Ped 12x3.25mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642129	CDM	Dev Embl Ppln 35x4.5mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
635567	CDM	Device Embl Pipln 4x18mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
637218	CDM	Dev Embl 16x5mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
638589	CDM	Device Embl 4.25mmx12mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
632411	CDM	Device Embl 25x4mm Pline	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
635414	CDM	Device Embl16x3.75mm Pip	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
640780	CDM	Dev Embl Pipln 14x3.75mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642476	CDM	Dev Embl 16x4.75mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
632607	CDM	Device Embl 12mm 3.75mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
635415	CDM	Device Embl 25mm 3.75mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
638547	CDM	Device Embl 18mm 4.5mm P	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
636512	CDM	Dev Embl Ped 2.75x18mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
635176	CDM	Device Embl Pipln 14x4mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
633431	CDM	Device Embl Pl 4.75x20mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
641892	CDM	Device Embl 30mm 4.5mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642575	CDM	Device Embl Flx 14x5mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642475	CDM	Device Embl 5x18mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
418997	CDM	Device Embl Ped25x4.75mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642473	CDM	Device Embl 18mm 3mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642573	CDM	Device Embl Flx 4.5x14mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
419232	CDM	Device Embl 25mm 3.5mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
642574	CDM	Device Emb 20mm 3mm Pip	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
640008	CDM	Device Embl Pipln 16x3.5	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
417255	CDM	Device Embl 20mm 3.75mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
415616	CDM	Device Embl Pl 4.75x14mm	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
417170	CDM	Device Embl Pln 30x4.25	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
632210	CDM	Device Embl 14x3.5mm Pl	16	11	$384,929.00	$384,929.00	$38,492.90	$384,929.00	$307,943.20	2026-03-01
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	33	25	—	—	$8,580.00	$457,280.40	$304,853.60	2026-03-01
C1882	HCPCS	Crt-d Crd 5.37x8.08x0.99	336	11	$414,488.00	$414,488.00	$27,084.80	$502,911.00	$302,054.40	2026-03-01
001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	1	1	—	—	$301,098.30	$301,098.30	$301,098.30	2026-03-01
628093	CDM	Dev Embl Sys Mesh 20x4.5	16	11	$373,691.00	$373,691.00	$37,369.10	$373,691.00	$298,952.80	2026-03-01
627917	CDM	Dev Emb Pipeln 5x18mm	16	11	$373,691.00	$373,691.00	$37,369.10	$373,691.00	$298,952.80	2026-03-01
628092	CDM	Dev Embl Mesh 18 4.5	16	11	$373,691.00	$373,691.00	$37,369.10	$373,691.00	$298,952.80	2026-03-01
90288	CPT	Botulism Ig Human IV	13	10	$366,443.82	$366,443.82	$36,644.38	$366,443.82	$293,155.06	2026-03-01
917246	CDM	Valve Aortic 27mm	16	11	$366,016.00	$366,016.00	$36,601.60	$366,016.00	$292,812.80	2026-03-01
919964	CDM	Valve Aortic 21mm	16	11	$366,016.00	$366,016.00	$36,601.60	$366,016.00	$292,812.80	2026-03-01
409666	CDM	Valve Aortic 23mm	16	11	$366,016.00	$366,016.00	$36,601.60	$366,016.00	$292,812.80	2026-03-01
420317	CDM	Valve Aortic 25mm	16	11	$366,016.00	$366,016.00	$36,601.60	$366,016.00	$292,812.80	2026-03-01
486081	CDM	Device Spn 38mm Lg	16	11	$364,373.00	$364,373.00	$36,437.30	$364,373.00	$291,498.40	2026-03-01
438690	CDM	Device Imp Spn 30mm	16	11	$364,373.00	$364,373.00	$36,437.30	$364,373.00	$291,498.40	2026-03-01
914529	CDM	Coil Embl 1x1mm	16	11	$363,997.00	$363,997.00	$36,399.70	$363,997.00	$291,197.60	2026-03-01
639568	CDM	Cage Spn Latmap 3 Nuvamp	16	11	$363,355.00	$363,355.00	$36,335.50	$363,355.00	$290,684.00	2026-03-01
614726	CDM	Stent Eprsth 31x10x22cm	16	11	$358,237.00	$358,237.00	$35,823.70	$358,237.00	$286,589.60	2026-03-01
417518	CDM	System Imp 5mm 15mm	16	11	$354,655.00	$354,655.00	$35,465.50	$354,655.00	$283,724.00	2026-03-01
00831	OTHER	Obecbtge Autol Up To 400	1	1	—	—	$278,250.00	$278,250.00	$278,250.00	2026-03-01
831	OTHER	Obecbtge Autol Up To 400	23	18	—	—	$5,809.49	$361,725.00	$278,250.00	2026-03-01
C1767	HCPCS	Generator Nrstm 5 Ipg	128	11	$391,223.50	$391,223.50	$26,706.20	$577,813.00	$276,475.20	2026-03-01
J9999	HCPCS	Carmustine Wafers 8/box	13	10	$341,000.21	$341,000.21	$34,100.02	$341,000.21	$272,800.17	2026-03-01
897	OTHER	Revakinagene, Per Implant	22	17	—	—	$262,350.00	$344,500.00	$265,000.00	2026-03-01
00897	OTHER	Revakinagene, Per Implant	1	1	—	—	$265,000.00	$265,000.00	$265,000.00	2026-03-01
631416	CDM	Graft Hemi Cndyl Mdl Lt	16	11	$321,711.00	$321,711.00	$32,171.10	$321,711.00	$257,368.80	2026-03-01
626500	CDM	Graft Bn Hemi Condrl Rt	16	11	$321,009.00	$321,009.00	$32,100.90	$321,009.00	$256,807.20	2026-03-01
627399	CDM	Graft Bn Fem Hemi Cndyl	16	11	$321,009.00	$321,009.00	$32,100.90	$321,009.00	$256,807.20	2026-03-01
638830	CDM	Algraft Tis 3-7mm 91cm	16	11	$318,311.00	$318,311.00	$31,831.10	$318,311.00	$254,648.80	2026-03-01
411669	CDM	Graft Endo Aaa 36x14mm	16	11	$317,258.00	$317,258.00	$31,725.80	$317,258.00	$253,806.40	2026-03-01
914107	CDM	Graft Endo Aaa 32x14mm	16	11	$317,258.00	$317,258.00	$31,725.80	$317,258.00	$253,806.40	2026-03-01
918878	CDM	Graft Endo Aaa 26x12mm	16	11	$317,258.00	$317,258.00	$31,725.80	$317,258.00	$253,806.40	2026-03-01
420736	CDM	Graft Endo Aaa 28.5x12mm	16	11	$317,258.00	$317,258.00	$31,725.80	$317,258.00	$253,806.40	2026-03-01
913391	CDM	Graft Endo Aaa 23x12mm	16	11	$317,258.00	$317,258.00	$31,725.80	$317,258.00	$253,806.40	2026-03-01
638659	CDM	Implant Cranial Peek	16	11	$312,865.00	$312,865.00	$31,286.50	$312,865.00	$250,292.00	2026-03-01
639708	CDM	Implant Crnl Pk Ptspc	16	11	$302,072.00	$302,072.00	$30,207.20	$302,072.00	$241,657.60	2026-03-01
636824	CDM	Implant Cranial Peek	16	11	$296,952.00	$296,952.00	$29,695.20	$296,952.00	$237,561.60	2026-03-01
635080	CDM	Implant Cranial Peek	16	11	$296,427.00	$296,427.00	$29,642.70	$296,427.00	$237,141.60	2026-03-01
420892	CDM	Pump Heart 21fr 85mm	23	14	$578,988.00	$578,988.00	$57,898.80	$578,988.00	$235,648.12	2026-03-01
920215	CDM	Kit Cath Rt Heart	23	14	$578,988.00	$578,988.00	$57,898.80	$578,988.00	$235,648.12	2026-03-01
C1721	HCPCS	Icd Dual Chmbr 35mm	288	11	$318,609.00	$318,609.00	$19,220.90	$503,651.00	$233,860.50	2026-03-01
927	MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	33	24	—	—	$8,580.00	$355,886.12	$232,329.80	2026-03-01
481732	CDM	Implant Bn Crnl Mdfc 42	16	11	$290,210.00	$290,210.00	$29,021.00	$290,210.00	$232,168.00	2026-03-01
418819	CDM	Graft Evas 35x14.5m 16cm	16	11	$289,259.00	$289,259.00	$28,925.90	$289,259.00	$231,407.20	2026-03-01
420916	CDM	Graft Evas 14.5mm 12cm	16	11	$289,259.00	$289,259.00	$28,925.90	$289,259.00	$231,407.20	2026-03-01
639053	CDM	Graft Evas 31x14.5m 13cm	16	11	$289,259.00	$289,259.00	$28,925.90	$289,259.00	$231,407.20	2026-03-01
639307	CDM	Graft Evas 23x12mm 18cm	16	11	$289,259.00	$289,259.00	$28,925.90	$289,259.00	$231,407.20	2026-03-01
425292	CDM	Graft Evas 10cm 10mm	16	11	$289,259.00	$289,259.00	$28,925.90	$289,259.00	$231,407.20	2026-03-01
416054	CDM	Graft Evas 26x14.5m 12cm	16	11	$289,259.00	$289,259.00	$28,925.90	$289,259.00	$231,407.20	2026-03-01
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	42	26	—	—	$7,918.00	$569,005.00	$230,968.10	2026-03-01
635925	CDM	Implant Cranial Peek	16	11	$285,174.00	$285,174.00	$28,517.40	$285,174.00	$228,139.20	2026-03-01
439745	CDM	Impl Crnl Ostmtch 20-100	16	11	$283,709.00	$283,709.00	$28,370.90	$283,709.00	$226,967.20	2026-03-01
642808	CDM	Graft Evas 26x14.5m 18cm	16	11	$280,830.00	$280,830.00	$28,083.00	$280,830.00	$224,664.00	2026-03-01
415522	CDM	Graft Evas 23x12mm 12cm	16	11	$280,830.00	$280,830.00	$28,083.00	$280,830.00	$224,664.00	2026-03-01
626014	CDM	Graft Evas 14cm 26mm	16	11	$280,830.00	$280,830.00	$28,083.00	$280,830.00	$224,664.00	2026-03-01

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