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

VALLEY CHILDREN'S HOSPITAL

Madera, CA · CCN 053300 · Rates published

Your selected procedure

You selected 29916 (HCPCS)

Hip arthro w/labral repair

This hospital’s price: $1,684 across 27 payers · range $885-$16,519

Source: https://www.valleychildrens.org/sites/default/files/2025-10/941294954_Valley-Childrens-Hospital_standardcharges.csv · observed 2026-10-21

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

32,495 distinct procedures filed
58 distinct payers
961,913 rate rows
2026-10-21 last MRF observed
Data quality

912,481 of 961,913 rate rows are consumer-grade (94.9%)

49,432 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 36,416
template filing: same amount across many unrelated codes — excluded 6,287
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 3,891
per-diem day rate — not a per-procedure price 1,138
placeholder amount (≤ $0.02) — excluded from medians 686
exceeds 10× this hospital's gross charge — excluded from medians 560
percent-of-charges filed in the dollar field — excluded from medians 297
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 157
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://share.valleychildrens.org/link/1da4f783-fbd1-4c47-b93c-18c815cfc45e
Found on page https://www.valleychildrens.org/your-visit/billing-and-insurance/financial-assistance/cost-estimates
Discovered viaCMS hospital list
Last fetch not_modified · 2026-11-03
Content fingerprint 1c44c239d8a609e0… · 308,825,493 bytes · first seen 2026-05-18

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 2 $4,335,000.00 $4,335,000.00 $4,335,000.00 nat. median
$4,505,000
1.0× median
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 2 $3,570,000.00 $3,570,000.00 $3,570,000.00 nat. median
$3,710,000
1.0× median
C9172
HCPCS 		Inj, Beqvez, Per Tx Dose 2 $3,570,000.00 $3,570,000.00 $3,570,000.00 nat. median
$3,605,000
1.0× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 2 $3,570,000.00 $3,570,000.00 $3,570,000.00 nat. median
$3,705,478
1.0× median
J3389
HCPCS 		Topi Adm Prad Zami Per Treat 2 $3,209,940.00 $3,209,940.00 $3,209,940.00 nat. median
$3,335,820
1.0× median
J1413
HCPCS 		Delandistrogene Moxeparvo-rokl 70 X 10 Ml Kit 1 Each Box 7 $3,200,000.00 $3,296,000.00 $3,200,620.00 nat. median
$3,324,572
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 2 $3,162,000.00 $3,162,000.00 $3,162,000.00 nat. median
$3,286,000
1.0× median
J3387
HCPCS 		Inj Elivaldogene Autotemecel 2 $3,060,000.00 $3,060,000.00 $3,060,000.00 nat. median
$3,180,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 3 $2,856,000.00 $4,864,551.99 $2,856,000.00 nat. median
$2,994,107
1.0× median
J3399
HCPCS 		Onasemnogene Abeparvovec-xioi 9 X 8.3 Ml Kit 1 Each Box 7 $2,392,705.69 $2,664,228.59 $2,586,629.70 nat. median
$2,467,989
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 3 $2,244,000.00 $3,847,800.00 $2,244,000.00 nat. median
$2,401,965
0.9× median
60923052433
NDC 		Delandistrogene Moxeparvo-rokl 33 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$2,967,840
0.6× median
60923054756
NDC 		Delandistrogene Moxeparvo-rokl 56 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923054958
NDC 		Delandistrogene Moxeparvo-rokl 58 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$12
outlier · 150564.8×
60923050110
NDC 		Delandistrogene Moxeparvo-rokl 10 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923053342
NDC 		Delandistrogene Moxeparvo-rokl 42 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923051524
NDC 		Delandistrogene Moxeparvo-rokl 24 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$2,967,840
0.6× median
60923054049
NDC 		Delandistrogene Moxeparvo-rokl 49 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$2
outlier · 1192631.6×
60923050211
NDC 		Delandistrogene Moxeparvo-rokl 11 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923053443
NDC 		Delandistrogene Moxeparvo-rokl 43 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$3
outlier · 541134.3×
60923053544
NDC 		Delandistrogene Moxeparvo-rokl 44 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$3,325,455
0.5× median
60923052231
NDC 		Delandistrogene Moxeparvo-rokl 31 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923051019
NDC 		Delandistrogene Moxeparvo-rokl 19 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$136
outlier · 13347.1×
60923055059
NDC 		Delandistrogene Moxeparvo-rokl 59 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923050918
NDC 		Delandistrogene Moxeparvo-rokl 18 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$3,325,455
0.5× median
60923053241
NDC 		Delandistrogene Moxeparvo-rokl 41 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$3,325,455
0.5× median
60923050716
NDC 		Delandistrogene Moxeparvo-rokl 16 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923055362
NDC 		Delandistrogene Moxeparvo-rokl 62 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923050817
NDC 		Delandistrogene Moxeparvo-rokl 17 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923053140
NDC 		Delandistrogene Moxeparvo-rokl 40 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923051827
NDC 		Delandistrogene Moxeparvo-rokl 27 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$3,325,455
0.5× median
60923052534
NDC 		Delandistrogene Moxeparvo-rokl 34 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$3
outlier · 708125.0×
60923052736
NDC 		Delandistrogene Moxeparvo-rokl 36 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923055766
NDC 		Delandistrogene Moxeparvo-rokl 66 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923055261
NDC 		Delandistrogene Moxeparvo-rokl 61 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923050413
NDC 		Delandistrogene Moxeparvo-rokl 13 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923055564
NDC 		Delandistrogene Moxeparvo-rokl 64 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923050312
NDC 		Delandistrogene Moxeparvo-rokl 12 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923052635
NDC 		Delandistrogene Moxeparvo-rokl 35 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923053645
NDC 		Delandistrogene Moxeparvo-rokl 45 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923054150
NDC 		Delandistrogene Moxeparvo-rokl 50 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923055665
NDC 		Delandistrogene Moxeparvo-rokl 65 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923051221
NDC 		Delandistrogene Moxeparvo-rokl 21 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923051120
NDC 		Delandistrogene Moxeparvo-rokl 20 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$2,967,840
0.6× median
60923051928
NDC 		Delandistrogene Moxeparvo-rokl 28 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923054352
NDC 		Delandistrogene Moxeparvo-rokl 52 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$2
outlier · 1192631.6×
60923050615
NDC 		Delandistrogene Moxeparvo-rokl 15 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$2,967,840
0.6× median
60923053948
NDC 		Delandistrogene Moxeparvo-rokl 48 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923055867
NDC 		Delandistrogene Moxeparvo-rokl 67 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$1,812,800
1.0× median
60923051423
NDC 		Delandistrogene Moxeparvo-rokl 23 X 10 Ml Kit 1 Each Box 22 $1,142,723.20 $4,108,800.00 $1,812,800.00 nat. median
$2,967,840
0.6× median

Other procedures at this hospital

Browse this hospital's 32,495 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J3391 HCPCS Inj, Atidarsagene Autotemcel 3 2 — — $4,335,000.00 $4,335,000.00 $4,335,000.00 2026-04-01
J1414 HCPCS Inj, Beqvez, Per Tx Dose 3 2 — — $3,570,000.00 $3,570,000.00 $3,570,000.00 2026-04-01
C9172 HCPCS Inj, Beqvez, Per Tx Dose 3 2 — — $3,570,000.00 $3,570,000.00 $3,570,000.00 2026-04-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 3 2 — — $3,570,000.00 $3,570,000.00 $3,570,000.00 2026-04-01
J3389 HCPCS Topi Adm Prad Zami Per Treat 3 2 — — $3,209,940.00 $3,209,940.00 $3,209,940.00 2026-04-01
J1413 HCPCS Delandistrogene Moxeparvo-rokl 70 X 10 Ml Kit 1 Each Box 12 7 $3,296,000.00 — $3,200,000.00 $3,296,000.00 $3,200,620.00 2026-04-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 3 2 — — $3,162,000.00 $3,162,000.00 $3,162,000.00 2026-04-01
J3387 HCPCS Inj Elivaldogene Autotemecel 3 2 — — $3,060,000.00 $3,060,000.00 $3,060,000.00 2026-04-01
J3393 HCPCS Inj, Betibeglogene Autotemce 5 3 — — $2,856,000.00 $4,864,551.99 $2,856,000.00 2026-04-01
J3399 HCPCS Onasemnogene Abeparvovec-xioi 9 X 8.3 Ml Kit 1 Each Box 9 7 $2,664,228.59 — $2,392,705.69 $2,664,228.59 $2,586,629.70 2026-04-01
J3392 HCPCS Inj, Exagamglogene Autotem 5 3 — — $2,244,000.00 $3,847,800.00 $2,244,000.00 2026-04-01
60923052433 NDC Delandistrogene Moxeparvo-rokl 33 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923054756 NDC Delandistrogene Moxeparvo-rokl 56 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923054958 NDC Delandistrogene Moxeparvo-rokl 58 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923050110 NDC Delandistrogene Moxeparvo-rokl 10 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923053342 NDC Delandistrogene Moxeparvo-rokl 42 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923051524 NDC Delandistrogene Moxeparvo-rokl 24 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923054049 NDC Delandistrogene Moxeparvo-rokl 49 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923050211 NDC Delandistrogene Moxeparvo-rokl 11 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923053443 NDC Delandistrogene Moxeparvo-rokl 43 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923053544 NDC Delandistrogene Moxeparvo-rokl 44 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923052231 NDC Delandistrogene Moxeparvo-rokl 31 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923051019 NDC Delandistrogene Moxeparvo-rokl 19 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923055059 NDC Delandistrogene Moxeparvo-rokl 59 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923050918 NDC Delandistrogene Moxeparvo-rokl 18 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923053241 NDC Delandistrogene Moxeparvo-rokl 41 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923050716 NDC Delandistrogene Moxeparvo-rokl 16 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923055362 NDC Delandistrogene Moxeparvo-rokl 62 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923050817 NDC Delandistrogene Moxeparvo-rokl 17 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923053140 NDC Delandistrogene Moxeparvo-rokl 40 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923051827 NDC Delandistrogene Moxeparvo-rokl 27 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923052534 NDC Delandistrogene Moxeparvo-rokl 34 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923052736 NDC Delandistrogene Moxeparvo-rokl 36 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923055766 NDC Delandistrogene Moxeparvo-rokl 66 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923055261 NDC Delandistrogene Moxeparvo-rokl 61 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923050413 NDC Delandistrogene Moxeparvo-rokl 13 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923055564 NDC Delandistrogene Moxeparvo-rokl 64 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923050312 NDC Delandistrogene Moxeparvo-rokl 12 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923052635 NDC Delandistrogene Moxeparvo-rokl 35 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923053645 NDC Delandistrogene Moxeparvo-rokl 45 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923054150 NDC Delandistrogene Moxeparvo-rokl 50 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923055665 NDC Delandistrogene Moxeparvo-rokl 65 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923051221 NDC Delandistrogene Moxeparvo-rokl 21 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923051120 NDC Delandistrogene Moxeparvo-rokl 20 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923051928 NDC Delandistrogene Moxeparvo-rokl 28 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923054352 NDC Delandistrogene Moxeparvo-rokl 52 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923050615 NDC Delandistrogene Moxeparvo-rokl 15 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923053948 NDC Delandistrogene Moxeparvo-rokl 48 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923055867 NDC Delandistrogene Moxeparvo-rokl 67 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923051423 NDC Delandistrogene Moxeparvo-rokl 23 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923055160 NDC Delandistrogene Moxeparvo-rokl 60 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923056170 NDC Delandistrogene Moxeparvo-rokl 70 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923054655 NDC Delandistrogene Moxeparvo-rokl 55 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923053039 NDC Delandistrogene Moxeparvo-rokl 39 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923054554 NDC Delandistrogene Moxeparvo-rokl 54 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923051726 NDC Delandistrogene Moxeparvo-rokl 26 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923052837 NDC Delandistrogene Moxeparvo-rokl 37 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923052938 NDC Delandistrogene Moxeparvo-rokl 38 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923051625 NDC Delandistrogene Moxeparvo-rokl 25 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923054857 NDC Delandistrogene Moxeparvo-rokl 57 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923053847 NDC Delandistrogene Moxeparvo-rokl 47 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923053746 NDC Delandistrogene Moxeparvo-rokl 46 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923052130 NDC Delandistrogene Moxeparvo-rokl 30 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923050514 NDC Delandistrogene Moxeparvo-rokl 14 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923055968 NDC Delandistrogene Moxeparvo-rokl 68 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923052332 NDC Delandistrogene Moxeparvo-rokl 32 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923052029 NDC Delandistrogene Moxeparvo-rokl 29 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923054251 NDC Delandistrogene Moxeparvo-rokl 51 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923055463 NDC Delandistrogene Moxeparvo-rokl 63 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923054453 NDC Delandistrogene Moxeparvo-rokl 53 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
60923051322 NDC Delandistrogene Moxeparvo-rokl 22 X 10 Ml Kit 1 Each Box 23 22 $3,296,000.00 $3,296,000.00 $1,142,723.20 $4,108,800.00 $1,812,800.00 2026-10-21
71894014009 NDC Onasemnogene Abeparvovec-xioi 1 X 5.5 Ml & 8 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894012002 NDC Onasemnogene Abeparvovec-xioi 2 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894012303 NDC Onasemnogene Abeparvovec-xioi 3 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894012905 NDC Onasemnogene Abeparvovec-xioi 5 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894013708 NDC Onasemnogene Abeparvovec-xioi 1 X 5.5 Ml & 7 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894013006 NDC Onasemnogene Abeparvovec-xioi 2 X 5.5 Ml & 4 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894012203 NDC Onasemnogene Abeparvovec-xioi 1 X 5.5 Ml & 2 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894013507 NDC Onasemnogene Abeparvovec-xioi 7 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894013808 NDC Onasemnogene Abeparvovec-xioi 8 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894012705 NDC Onasemnogene Abeparvovec-xioi 2 X 5.5 Ml & 3 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894014109 NDC Onasemnogene Abeparvovec-xioi 9 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894013608 NDC Onasemnogene Abeparvovec-xioi 2 X 5.5 Ml & 6 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894012103 NDC Onasemnogene Abeparvovec-xioi 2 X 5.5 Ml & 1 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894013909 NDC Onasemnogene Abeparvovec-xioi 2 X 5.5 Ml & 7 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894013206 NDC Onasemnogene Abeparvovec-xioi 6 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894012404 NDC Onasemnogene Abeparvovec-xioi 2 X 5.5 Ml & 2 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894012604 NDC Onasemnogene Abeparvovec-xioi 4 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894013407 NDC Onasemnogene Abeparvovec-xioi 1 X 5.5 Ml & 6 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894012805 NDC Onasemnogene Abeparvovec-xioi 1 X 5.5 Ml & 4 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894013307 NDC Onasemnogene Abeparvovec-xioi 2 X 5.5 Ml & 5 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894012504 NDC Onasemnogene Abeparvovec-xioi 1 X 5.5 Ml & 3 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
71894013106 NDC Onasemnogene Abeparvovec-xioi 1 X 5.5 Ml & 5 X 8.3 Ml Kit 1 Each Box 16 16 $2,463,456.86 $2,463,456.86 $225,000.00 $2,323,044.36 $1,515,025.97 2026-10-21
5834 APR_DRG Neonate With Ecmo 14 13 — — $1,011,367.21 $2,424,369.39 $1,444,968.65 2026-10-21
Q0480 HCPCS Driver Pneumatic Vad, Rep 1 1 — — $979,602.30 $979,602.30 $979,602.30 2026-04-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 13 — — $754,348.99 $1,532,292.20 $913,274.27 2026-10-21
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 1 1 — — $860,483.36 $860,483.36 $860,483.36 2026-04-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $679,624.06 $1,144,205.70 $777,583.67 2026-04-01
5833 APR_DRG Neonate With Ecmo 14 13 — — $670,151.05 $1,219,810.37 $760,029.86 2026-10-21
24 APR_DRG Heart And/or Lung Transplant 7 7 — — $617,199.84 $1,039,109.13 $706,161.74 2026-04-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 14 13 — — $476,797.55 $1,077,517.44 $642,220.17 2026-10-21
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 14 13 — — $490,954.90 $1,054,311.58 $628,389.05 2026-10-21
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 1 1 — — $622,655.50 $622,655.50 $622,655.50 2026-04-01
1614 APR_DRG Implantable Heart Assist Systems 7 7 — — $513,188.16 $863,996.51 $587,158.04 2026-04-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 14 13 — — $495,900.95 $930,652.16 $571,610.89 2026-10-21
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 14 13 — — $482,312.12 $919,652.48 $560,284.10 2026-10-21
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 14 13 — — $464,164.44 $881,460.39 $546,627.94 2026-10-21
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $439,032.83 $739,149.61 $502,314.11 2026-04-01
94 APR_DRG Extracorporeal Membrane Oxygenation (Ecmo) 14 13 — — $341,717.87 $831,515.56 $495,598.54 2026-10-21
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 13 — — $368,122.38 $826,588.17 $492,661.72 2026-10-21
5832 APR_DRG Neonate With Ecmo 14 13 — — $420,536.27 $765,457.72 $476,936.39 2026-10-21
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 13 — — $358,332.61 $797,195.90 $475,143.39 2026-10-21
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $409,202.14 $688,927.07 $468,183.69 2026-04-01
L7181 HCPCS Electronic Elbo Simultaneous 1 1 — — $435,807.23 $435,807.23 $435,807.23 2026-04-01
74 APR_DRG Allogeneic Bone Marrow Transplant 7 7 — — $380,207.82 $640,112.64 $435,010.19 2026-04-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 14 13 — — $357,833.74 $679,735.59 $414,914.65 2026-10-21
14 APR_DRG Liver Transplant And/or Intestinal Transplant 7 7 — — $349,923.76 $589,126.81 $400,361.05 2026-04-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 14 13 — — $244,565.00 $667,571.09 $397,884.62 2026-10-21
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $345,789.84 $582,167.00 $395,631.27 2026-04-01
5831 APR_DRG Neonate With Ecmo 14 13 — — $340,556.68 $645,855.22 $394,564.28 2026-10-21
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 14 13 — — $335,398.87 $635,235.08 $388,337.77 2026-10-21
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 14 13 — — $292,011.74 $639,522.53 $375,927.76 2026-10-21
1613 APR_DRG Implantable Heart Assist Systems 7 7 — — $318,561.85 $536,326.34 $364,478.70 2026-04-01
L2006 HCPCS Kaf Sng/dbl Swg/stn Mcpr Cus 1 1 — — $361,439.90 $361,439.90 $361,439.90 2026-04-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 14 13 — — $254,145.82 $554,032.73 $330,213.67 2026-10-21
5891 APR_DRG Neonate Birth Weight < 500 Grams Or Birth Weight 500-999 Grams And Gestational … 14 13 — — $136,563.50 $678,182.18 $318,796.91 2026-10-21
L8701 HCPCS Ewh S/d Uprt Micro Sensor 1 1 — — $316,479.67 $316,479.67 $316,479.67 2026-04-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 13 — — $238,331.27 $530,224.54 $316,023.55 2026-10-21
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 14 13 — — $278,162.58 $505,968.92 $315,360.04 2026-10-21
23 APR_DRG Heart And/or Lung Transplant 7 7 — — $257,471.63 $433,475.68 $294,583.06 2026-04-01
5892 APR_DRG Neonate Birth Weight < 500 Grams Or Birth Weight 500-999 Grams And Gestational … 14 13 — — $99,456.77 $678,182.18 $286,900.79 2026-10-21
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 14 13 — — $144,565.29 $542,058.45 $285,248.34 2026-10-21
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 14 13 — — $241,391.28 $456,798.25 $279,375.71 2026-10-21
5893 APR_DRG Neonate Birth Weight < 500 Grams Or Birth Weight 500-999 Grams And Gestational … 14 13 — — $83,521.40 $678,182.18 $273,203.11 2026-10-21
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 14 13 — — $230,288.26 $451,870.86 $271,335.06 2026-10-21
64 APR_DRG Pancreas Transplant 7 7 — — $235,972.51 $397,280.06 $269,985.10 2026-04-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 7 7 — — $234,780.84 $395,273.78 $268,621.66 2026-04-01
C9301 HCPCS Obecabtagene Car Pos T 5 3 — — $267,750.00 $459,112.50 $267,750.00 2026-04-01
L6700 HCPCS Ue Add Ext Power Myoel 1 1 — — $267,067.23 $267,067.23 $267,067.23 2026-04-01
L6880 HCPCS Elec Hand Ind Art Digits 1 1 — — $259,870.74 $259,870.74 $259,870.74 2026-04-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 14 13 — — $197,605.96 $430,770.93 $256,747.38 2026-10-21
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 14 13 — — $210,970.24 $426,373.43 $254,126.39 2026-10-21
8634 APR_DRG Neonatal Aftercare 14 13 — — $221,574.40 $406,803.33 $252,400.16 2026-10-21
1612 APR_DRG Implantable Heart Assist Systems 7 7 — — $215,308.82 $362,490.96 $246,342.99 2026-04-01
1611 APR_DRG Implantable Heart Assist Systems 7 7 — — $215,308.82 $362,490.96 $246,342.99 2026-04-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 14 13 — — $205,675.98 $394,848.06 $239,725.70 2026-10-21
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 14 13 — — $210,073.16 $363,303.83 $235,011.98 2026-10-21
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 14 13 — — $204,956.76 $354,888.77 $229,568.49 2026-10-21
22 APR_DRG Heart And/or Lung Transplant 7 7 — — $198,732.56 $334,583.40 $227,377.46 2026-04-01
4404 APR_DRG Kidney Transplant 7 7 — — $195,124.80 $328,509.43 $223,249.69 2026-04-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 14 13 — — $187,891.38 $360,479.26 $222,113.52 2026-10-21
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 14 13 — — $185,594.11 $348,619.01 $217,366.08 2026-10-21
Q0483 HCPCS Monitor Elec Vad, Rep 1 1 — — $203,931.99 $203,931.99 $203,931.99 2026-04-01
93 APR_DRG Extracorporeal Membrane Oxygenation (Ecmo) 14 13 — — $110,532.79 $362,882.26 $202,782.11 2026-10-21
73 APR_DRG Allogeneic Bone Marrow Transplant 7 7 — — $174,752.17 $294,210.35 $199,940.59 2026-04-01
2994 APR_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 7 7 — — $169,992.10 $286,196.35 $194,494.41 2026-04-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 14 13 — — $174,658.01 $303,342.58 $194,233.24 2026-10-21
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 14 13 — — $158,340.32 $324,836.01 $193,608.22 2026-10-21
1784 APR_DRG External Heart Assist Devices 7 7 — — $168,055.29 $282,935.57 $192,278.43 2026-04-01
84 APR_DRG Autologous Bone Marrow Transplant 7 7 — — $165,211.96 $278,148.57 $189,025.27 2026-04-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 14 13 — — $161,642.33 $295,489.78 $186,762.00 2026-10-21
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 7 7 — — $161,534.73 $271,957.64 $184,818.01 2026-04-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 14 13 — — $164,780.12 $291,926.26 $184,338.40 2026-10-21
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 14 13 — — $155,064.27 $305,876.94 $183,184.62 2026-10-21
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 14 13 — — $159,266.99 $296,105.48 $182,597.82 2026-10-21
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 14 13 — — $159,561.20 $288,655.52 $180,396.68 2026-10-21
63 APR_DRG Pancreas Transplant 7 7 — — $154,926.24 $260,831.67 $177,256.98 2026-04-01
Q0489 HCPCS Pwr Pck Base Combo Vad, Rep 1 1 — — $176,797.84 $176,797.84 $176,797.84 2026-04-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 14 13 — — $158,232.30 $275,743.77 $175,966.58 2026-10-21
21 APR_DRG Heart And/or Lung Transplant 7 7 — — $152,342.67 $256,482.02 $174,301.03 2026-04-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 7 7 — — $149,074.33 $250,979.48 $170,561.59 2026-04-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 14 13 — — $147,167.95 $261,162.51 $168,614.43 2026-10-21
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $146,079.89 $245,938.08 $167,135.54 2026-04-01
1834 APR_DRG Percutaneous Structural Cardiac Procedures 14 13 — — $149,125.74 $257,927.43 $166,846.67 2026-10-21
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 14 13 — — $137,098.73 $277,606.55 $164,699.52 2026-10-21
Q2053 HCPCS Brexucabtagene Car Pos T 20 18 — — $97,860.92 $807,508.61 $163,623.46 2026-04-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 14 13 — — $138,107.48 $261,827.10 $162,504.88 2026-10-21
Q2057 HCPCS Afamitresgene Autoleucel 20 18 — — $96,327.50 $1,271,523.00 $161,059.58 2026-04-01
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 7 7 — — $139,681.14 $235,165.24 $159,814.49 2026-04-01
1794 APR_DRG Defibrillator Implants 7 7 — — $139,543.94 $234,934.25 $159,657.51 2026-04-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 14 13 — — $143,554.76 $246,792.87 $159,644.01 2026-10-21
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 7 7 — — $138,847.23 $233,761.28 $158,860.38 2026-04-01
Q0481 HCPCS Microprcsr Cu Elec Vad, Rep 1 1 — — $158,047.18 $158,047.18 $158,047.18 2026-04-01
L5859 HCPCS Knee-shin Pro Flex/ext Cont 1 1 — — $157,812.99 $157,812.99 $157,812.99 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 20 18 — — $94,311.49 $912,729.35 $157,688.81 2026-04-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 20 18 — — $93,756.37 $852,129.78 $156,760.65 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 20 18 — — $92,886.32 $870,577.06 $155,305.93 2026-04-01
6804 APR_DRG Major O.r. Procedures For Lymphatic Hematopoietic Or Other Neoplasms 14 13 — — $134,467.91 $241,542.02 $155,006.55 2026-10-21
914 APR_DRG Other Major Head And Neck Procedures 14 13 — — $136,633.36 $238,768.77 $154,453.42 2026-10-21
Q2042 HCPCS Tisagenlecleucel Car-pos T 18 17 — — $98,621.03 $954,972.35 $154,341.92 2026-04-01
62 APR_DRG Pancreas Transplant 7 7 — — $131,006.02 $220,559.93 $149,888.96 2026-04-01
72 APR_DRG Allogeneic Bone Marrow Transplant 7 7 — — $130,068.06 $218,980.79 $148,815.80 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 20 18 — — $88,871.70 $829,687.20 $148,593.48 2026-04-01
E0766RR OTHER Elec Stim Cancer Treatment 1 1 — — $148,281.80 $148,281.80 $148,281.80 2026-04-01
64406005801 NDC Injection, Nusinersen, 0.1 Mg 25 24 $295,797.20 $295,797.20 $1,149.17 $251,427.62 $147,898.60 2026-10-21
3004 APR_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 7 7 — — $128,539.14 $216,406.72 $147,066.50 2026-04-01
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 14 13 — — $122,357.51 $247,467.25 $146,904.37 2026-10-21
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 14 13 — — $116,480.84 $245,931.10 $146,579.45 2026-10-21
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 14 13 — — $128,084.16 $223,168.30 $142,439.50 2026-10-21
1694 APR_DRG Major Abdominal Vascular Procedures 14 13 — — $126,118.13 $219,443.94 $141,952.68 2026-10-21
214 APR_DRG Open Craniotomy Except Trauma 14 13 — — $124,958.76 $214,823.48 $138,963.83 2026-10-21
234 APR_DRG Spinal Procedures 14 13 — — $121,537.06 $213,660.42 $138,211.47 2026-10-21
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 14 13 — — $99,592.00 $234,961.96 $138,116.67 2026-10-21
12 APR_DRG Liver Transplant And/or Intestinal Transplant 7 7 — — $120,281.68 $202,504.57 $137,618.83 2026-04-01
1204 APR_DRG Major Respiratory And Chest Procedures 14 13 — — $114,166.45 $216,734.20 $134,427.04 2026-10-21
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 14 13 — — $120,349.56 $211,945.79 $134,232.11 2026-10-21
67979000201 NDC Histrelin Acetate (cpp) Per 50 Mg 32 30 $268,220.54 $268,220.54 $44,575.94 $227,987.46 $134,110.27 2026-10-21
2204 APR_DRG Major Stomach Esophageal And Duodenal Procedures 14 13 — — $115,831.57 $206,921.53 $133,153.75 2026-10-21
2604 APR_DRG Major Pancreas Liver And Shunt Procedures 14 13 — — $119,164.48 $205,367.54 $132,847.02 2026-10-21
6904 APR_DRG Acute Leukemia 14 13 — — $114,387.03 $205,406.62 $131,837.66 2026-10-21
24338005008 NDC Carmustine In Polifeprosan 7.7 Mg Wafer 8 Each Box 24 22 $232,319.78 $232,319.78 $101,059.10 $197,471.81 $131,260.67 2026-10-21
894 APR_DRG Major Cranial Or Facial Bone Procedures 14 13 — — $116,310.39 $202,572.29 $131,038.85 2026-10-21
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 14 13 — — $117,586.59 $204,799.27 $130,765.40 2026-10-21
J3403 HCPCS Revakinagene, Per Implant 20 18 — — $83,333.33 $315,050.00 $130,416.66 2026-04-01
Q0479 HCPCS Power Module Combo Vad, Rep 1 1 — — $130,200.58 $130,200.58 $130,200.58 2026-04-01
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 14 13 — — $113,539.68 $201,814.83 $130,191.83 2026-10-21
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 14 13 — — $115,869.69 $201,687.94 $128,856.07 2026-10-21
204 APR_DRG Open Craniotomy For Trauma 14 13 — — $111,608.25 $201,785.52 $128,822.87 2026-10-21
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 14 13 — — $113,010.08 $206,474.94 $128,412.29 2026-10-21
6814 APR_DRG Other O.r. Procedures For Lymphatic Hematopoietic Or Other Neoplasms 14 13 — — $108,694.99 $206,985.05 $128,184.62 2026-10-21
3124 APR_DRG Skin Graft Except Hand For Musculoskeletal And Connective Tissue Diagnoses 14 13 — — $110,317.06 $201,946.78 $127,549.07 2026-10-21
4414 APR_DRG Major Bladder Procedures 14 13 — — $110,265.95 $198,714.14 $127,273.51 2026-10-21
6224 APR_DRG Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 14 13 — — $108,393.17 $195,242.10 $125,111.89 2026-10-21
5204 APR_DRG Other GYN Procedures For Malignancy 7 7 — — $109,060.82 $183,613.30 $124,780.62 2026-04-01
71 APR_DRG Allogeneic Bone Marrow Transplant 7 7 — — $108,268.66 $182,279.62 $123,874.28 2026-04-01
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 14 13 — — $103,877.19 $199,295.69 $122,797.17 2026-10-21
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 14 13 — — $103,088.14 $202,577.93 $121,551.99 2026-10-21
61 APR_DRG Pancreas Transplant 7 7 — — $105,716.22 $177,982.37 $120,953.94 2026-04-01
2614 APR_DRG Major Biliary Tract Procedures 14 13 — — $105,553.05 $186,844.13 $120,783.45 2026-10-21
4014 APR_DRG Adrenal Procedures 14 13 — — $106,229.16 $193,504.31 $120,522.60 2026-10-21
4854 APR_DRG Prostatectomy Procedures 7 7 — — $105,232.95 $177,168.75 $120,401.01 2026-04-01
1783 APR_DRG External Heart Assist Devices 7 7 — — $105,126.89 $176,990.17 $120,279.66 2026-04-01
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 14 13 — — $104,190.30 $186,858.80 $120,008.61 2026-10-21
2993 APR_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 7 7 — — $102,811.02 $173,091.21 $117,629.98 2026-04-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $102,416.75 $172,427.42 $117,178.89 2026-04-01
274 APR_DRG Other Open Craniotomy 14 13 — — $98,954.48 $190,453.03 $116,977.85 2026-10-21
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 14 13 — — $98,970.62 $187,677.33 $116,468.94 2026-10-21
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 14 13 — — $99,868.94 $190,664.46 $116,085.39 2026-10-21
8514 APR_DRG Gender Related Procedures 7 7 — — $100,927.41 $169,919.99 $115,474.88 2026-04-01
4403 APR_DRG Kidney Transplant 7 7 — — $100,200.48 $168,696.15 $114,643.17 2026-04-01
92 APR_DRG Extracorporeal Membrane Oxygenation (Ecmo) 14 13 — — $64,534.56 $199,133.15 $114,612.02 2026-10-21
6954 APR_DRG Chemotherapy For Acute Leukemia 14 13 — — $99,027.11 $176,677.16 $113,763.55 2026-10-21
1814 APR_DRG Lower Extremity Vascular Procedures 7 7 — — $98,868.40 $166,453.47 $113,119.08 2026-04-01
11 APR_DRG Liver Transplant And/or Intestinal Transplant 7 7 — — $98,835.05 $166,397.32 $113,080.92 2026-04-01
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 14 13 — — $98,322.33 $175,778.00 $113,069.70 2026-10-21
187001050 NDC Sodium Benzoate-sodium Phenylacetate 10-10 % Solution 50 Ml Vial 25 23 $205,473.15 $205,473.15 $71,237.54 $174,652.18 $113,010.23 2026-10-21
2304 APR_DRG Major Small Bowel Procedures 14 13 — — $99,067.45 $174,106.70 $112,625.18 2026-10-21
3214 APR_DRG Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 14 13 — — $100,630.74 $172,999.84 $111,909.18 2026-10-21
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 14 13 — — $100,581.00 $173,261.24 $111,853.87 2026-10-21
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 14 13 — — $96,764.05 $176,039.42 $111,689.07 2026-10-21
1214 APR_DRG Other Respiratory And Chest Procedures 14 13 — — $96,525.40 $173,715.77 $111,375.09 2026-10-21
5114 APR_DRG Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 14 13 — — $97,278.60 $172,332.80 $111,358.92 2026-10-21
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 14 13 — — $97,036.34 $180,166.83 $111,174.61 2026-10-21
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 14 13 — — $99,425.22 $171,792.81 $111,128.39 2026-10-21
5124 APR_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy 7 7 — — $96,802.48 $162,975.32 $110,755.39 2026-04-01
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 7 7 — — $95,072.80 $160,063.26 $108,776.40 2026-04-01
1764 APR_DRG Insertion Revision And Replacements Of Pacemaker And Other Cardiac Devices 14 13 — — $86,101.64 $183,235.23 $107,710.37 2026-10-21
L5991 HCPCS Low Pros Ext Osseo Connector 1 1 — — $106,383.12 $106,383.12 $106,383.12 2026-04-01
6092 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 14 13 — — $89,908.62 $176,570.92 $105,979.63 2026-10-21
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 14 13 — — $91,745.27 $165,567.02 $105,896.18 2026-10-21
1704 APR_DRG Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock 7 7 — — $92,552.27 $155,819.72 $105,892.56 2026-04-01
4284 APR_DRG Genetic Disorders 7 7 — — $92,503.85 $155,738.21 $105,837.17 2026-04-01
4034 APR_DRG Procedures For Obesity 7 7 — — $92,487.71 $155,711.04 $105,818.70 2026-04-01
E0783NU OTHER Programmable Infusion Pump 1 1 — — $105,590.46 $105,590.46 $105,590.46 2026-04-01
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 14 13 — — $93,829.94 $167,232.43 $105,285.05 2026-10-21
1653 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 7 7 — — $91,868.78 $154,669.01 $105,110.56 2026-04-01
2644 APR_DRG Other Hepatobiliary Pancreas And Abdominal Procedures 14 13 — — $91,180.36 $162,121.85 $104,569.48 2026-10-21
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 18 17 — — $68,546.67 $197,880.00 $104,533.67 2026-04-01
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 14 13 — — $82,747.21 $177,248.92 $104,191.46 2026-10-21
4054 APR_DRG Other Procedures For Endocrine Nutritional And Metabolic Disorders 14 13 — — $93,205.94 $160,399.24 $103,758.18 2026-10-21
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 14 13 — — $92,526.62 $164,578.53 $103,717.55 2026-10-21
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 14 13 — — $92,825.09 $159,580.71 $103,228.68 2026-10-21
4044 APR_DRG Thyroid Parathyroid And Thyroglossal Procedures 14 13 — — $89,273.15 $159,807.93 $102,730.42 2026-10-21
1754 APR_DRG Percutaneous Cardiac Intervention Without Ami 14 13 — — $91,495.10 $157,733.50 $102,033.78 2026-10-21
A9543 HCPCS Y90 Ibritumomab, Rx 19 17 — — $67,806.71 $135,511.71 $101,659.21 2026-04-01
8633 APR_DRG Neonatal Aftercare 14 13 — — $89,786.40 $156,929.30 $99,849.43 2026-10-21
2314 APR_DRG Major Large Bowel Procedures 14 13 — — $86,690.74 $154,921.14 $99,673.38 2026-10-21
E0786NU OTHER Implantable Pump Replacement 1 1 — — $99,279.96 $99,279.96 $99,279.96 2026-04-01
6504 APR_DRG Splenectomy 14 13 — — $88,936.91 $153,423.34 $99,245.65 2026-10-21
4402 APR_DRG Kidney Transplant 7 7 — — $86,487.92 $145,609.87 $98,954.11 2026-04-01
4474 APR_DRG Other Kidney, Urinary Tract And Related Non-percutaneous Procedures 14 13 — — $88,369.31 $152,880.91 $98,894.76 2026-10-21
2324 APR_DRG Gastric Fundoplication 14 13 — — $70,526.52 $167,993.33 $98,750.79 2026-10-21
4424 APR_DRG Kidney And Urinary Tract Procedures For Malignancy 14 13 — — $88,140.66 $152,252.96 $98,488.55 2026-10-21
4484 APR_DRG Other Kidney, Urinary Tract And Related Percutaneous Procedures 7 7 — — $85,805.74 $144,461.35 $98,173.60 2026-04-01
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 14 13 — — $77,267.78 $164,688.89 $98,157.60 2026-10-21
224 APR_DRG Ventricular Shunt Procedures 14 13 — — $87,935.89 $152,921.26 $97,791.51 2026-10-21
3232822 NDC Ipilimumab Per 1 Mg 32 30 $195,297.96 $195,297.96 $172.42 $166,003.27 $97,648.98 2026-10-21
264 APR_DRG Other Nervous System And Related Procedures 14 13 — — $83,201.81 $155,839.86 $97,305.33 2026-10-21
3254 APR_DRG Non-elective Or Complex Knee Joint Replacement 7 7 — — $84,893.83 $142,926.08 $97,130.25 2026-04-01
1782 APR_DRG External Heart Assist Devices 7 7 — — $84,746.87 $142,678.67 $96,962.11 2026-04-01
294 APR_DRG Other Percutaneous Intracranial Procedures 14 13 — — $86,278.67 $153,034.48 $96,577.21 2026-10-21
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 14 13 — — $82,181.14 $159,961.95 $96,442.35 2026-10-21
91 APR_DRG Extracorporeal Membrane Oxygenation (Ecmo) 14 13 — — $61,306.82 $161,114.85 $96,027.41 2026-10-21
83 APR_DRG Autologous Bone Marrow Transplant 7 7 — — $83,595.17 $140,739.67 $95,644.40 2026-04-01
9514 APR_DRG Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 14 13 — — $85,880.72 $147,642.26 $95,506.01 2026-10-21
7114 APR_DRG Post-operative Post-trauma Other Device Infections With O.r. Procedure 14 13 — — $84,647.05 $152,409.49 $95,471.08 2026-10-21
3134 APR_DRG Knee And Lower Leg Procedures Except Foot 14 13 — — $83,067.31 $148,221.36 $95,434.74 2026-10-21
50633021011 NDC Glucarpidase Per 10 Units 31 29 $185,283.00 $185,283.00 $399.73 $157,490.55 $95,420.75 2026-10-21
L8679 HCPCS Imp Neurosti Pls Gn Any Type 1 1 — — $95,295.95 $95,295.95 $95,295.95 2026-04-01
4804 APR_DRG Major Male Pelvic Procedures 7 7 — — $85,391.80 $146,801.73 $94,911.18 2026-10-21
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