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

HCA HEALTHONE ROSE

Denver, CO · CCN 060032 · Rates published

31,133 distinct procedures filed
35 distinct payers
945,500 rate rows
2026-03-01 last MRF observed
Data quality

913,839 of 945,500 rate rows are consumer-grade (96.7%)

31,661 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 19,070
per-diem day rate — not a per-procedure price 10,786
template filing: same amount across many unrelated codes — excluded 1,692
placeholder amount (≤ $0.02) — excluded from medians 101
exceeds 10× this hospital's gross charge — excluded from medians 12
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/84-1321373_HCA-HEALTHONE-ROSE_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.healthonecares.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 75d0ba0a998907c5… · 526,979,021 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
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,850,948.67 $4,850,948.67 $4,850,948.67 nat. median
$3,004,655
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 15 $4,459,950.00 $4,730,250.00 $4,505,000.00 nat. median
$9,966
outlier · 452.1×
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $3,847,800.00 $3,847,800.00 $3,847,800.00 nat. median
$2,448,600
1.6× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 3 $3,670,252.89 $4,271,819.03 $3,824,789.85 nat. median
$2,468,984
1.5× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 15 $3,648,414.33 $3,869,530.35 $3,685,267.00 nat. median
$3,746,358
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 15 $3,302,461.80 $3,502,611.00 $3,335,820.00 nat. median
$22,747
outlier · 146.6×
714
OTHER 		Inj Delandistrogene Mox R 15 $3,294,581.40 $3,494,253.00 $3,327,860.00 nat. median
$13,041
outlier · 255.2×
748
OTHER 		Inj, Lovotibeglogene Auto 15 $3,219,982.92 $3,415,133.40 $3,252,508.00 nat. median
$17,963
outlier · 181.1×
906
OTHER 		Inj Elivaldogene Autoteme 15 $3,148,200.00 $3,339,000.00 $3,180,000.00 nat. median
$20,756
outlier · 153.2×
746
OTHER 		Inj, Betibeglogene Autote 15 $2,910,569.31 $3,086,967.45 $2,939,969.00 nat. median
$21,896
outlier · 134.3×
9141
OTHER 		Inj Onase Abepar-xioi Tre 15 $2,563,091.19 $2,718,430.05 $2,588,981.00 nat. median
$2,588,981
1.0× median
824
OTHER 		Inj, Exagamglogene Autote 15 $2,308,680.00 $2,448,600.00 $2,332,000.00 nat. median
$25,250
outlier · 92.4×
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 2 $1,271,523.00 $2,311,860.00 $2,311,860.00 nat. median
$824,563
outlier · 2.8×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 5 $819,605.32 $1,762,948.71 $1,366,285.25 nat. median
$674,867
outlier · 2.0×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 5 $836,958.70 $1,699,593.90 $1,317,185.27 nat. median
$753,246
1.7× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 5 $765,607.90 $1,686,603.72 $1,307,117.89 nat. median
$673,137
1.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 5 $782,774.83 $1,674,245.19 $1,297,540.02 nat. median
$625,184
outlier · 2.1×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 5 $741,901.04 $1,596,576.72 $1,237,346.96 nat. median
$634,303
2.0× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 2 $459,112.50 $834,750.00 $834,750.00 nat. median
$324,450
outlier · 2.6×
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $725,845.60 $1,468,350.60 $782,000.18 nat. median
$619,808
1.3× median
2067
OTHER 		Afamitresgene Autoleucel 15 $762,913.80 $809,151.00 $770,620.00 nat. median
$786,032
1.0× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 2 $332,753.88 $605,007.06 $605,007.06 nat. median
$209,753
outlier · 2.9×
9498
OTHER 		Ciltacabtagene Car-pos T 15 $581,773.10 $617,032.08 $587,649.60 nat. median
$587,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 15 $560,865.99 $594,857.87 $566,531.30 nat. median
$566,531
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 15 $556,579.19 $590,311.26 $562,201.20 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 15 $552,500.98 $585,985.89 $558,081.80 nat. median
$558,082
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 15 $526,870.28 $558,801.81 $532,192.20 nat. median
$532,192
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 15 $484,555.70 $513,922.71 $489,450.20 nat. median
$489,450
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 18 $1,975.00 $665,965.14 $338,906.00 nat. median
$370,174
0.9× median
5834
APR_DRG 		Neonate With Ecmo 2 $249,850.06 $390,081.55 $319,965.80 nat. median
$309,665
1.0× median
831
OTHER 		Obecbtge Autol Up To 400 15 $275,467.50 $292,162.50 $278,250.00 nat. median
$12,362
outlier · 22.5×
5833
APR_DRG 		Neonate With Ecmo 2 $197,886.26 $342,642.39 $270,264.33 nat. median
$244,017
1.1× median
897
OTHER 		Revakinagene, Per Implant 15 $262,350.00 $278,250.00 $265,000.00 nat. median
$9,577
outlier · 27.7×
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $204,945.24 $300,544.34 $252,744.79 nat. median
$246,434
1.0× median
866933
CDM 		Set Pump 21fr 5.0 17 $72,735.80 $430,672.50 $228,256.42 nat. median
$44,167
outlier · 5.2×
589193
CDM 		Kit Lo Prfl Comp Shth 7f 17 $72,735.80 $430,672.50 $228,256.42 nat. median
$80,670
outlier · 2.8×
863779
CDM 		Set Vntrc 17.4x13.8in 17 $72,735.80 $430,672.50 $228,256.42 nat. median
$71,700
outlier · 3.2×
835976
CDM 		Kit Pmp Rt Hrt 22f 170cm 17 $72,735.80 $430,672.50 $228,256.42 nat. median
$21,214
outlier · 10.8×
24
APR_DRG 		Heart And/or Lung Transplant 2 $189,099.42 $267,232.31 $228,165.86 nat. median
$234,729
1.0× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 20 $1,975.00 $432,184.59 $220,245.00 nat. median
$265,286
0.8× median
1614
APR_DRG 		Implantable Heart Assist Systems 2 $195,951.99 $227,074.08 $211,513.03 nat. median
$207,730
1.0× median
494787
CDM 		Graft Bn Dist Fem Rt 16 $48,633.92 $287,964.00 $207,974.00 nat. median
$1,667
outlier · 124.7×
886
OTHER 		Inj. Remestemcel-l-rknd/ 15 $199,652.31 $211,752.45 $201,669.00 nat. median
$17,985
outlier · 11.2×
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 $148,757.07 $241,870.40 $195,313.73 nat. median
$150,721
1.3× median
778799
CDM 		Graft Evas 45x45mm 10cm 16 $44,776.31 $265,122.90 $191,477.65 nat. median
$29,232
outlier · 6.6×
5832
APR_DRG 		Neonate With Ecmo 2 $145,921.83 $235,856.24 $190,889.03 nat. median
$156,126
1.2× median
955647
CDM 		Rmv Icd W Rplc Mult Ld 15 $45,241.89 $267,879.60 $190,492.16 nat. median
$75,421
outlier · 2.5×
C1822
HCPCS 		Pulse Gen Imp 16 $44,319.25 $262,416.60 $189,523.10 nat. median
$31,540
outlier · 6.0×
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 2 $138,186.02 $226,153.03 $182,169.52 nat. median
$160,267
1.1× median
883402
CDM 		Ins/repl Subq Imp Icd Sy 15 $40,819.30 $241,693.20 $171,870.72 nat. median
$107,019
1.6× median

Other procedures at this hospital

Browse this hospital's 31,133 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
             
0819 RC — 1 1 — — $85,000.00 $85,000.00 $85,000.00 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 39 20 — — $1,975.00 $432,184.59 $220,245.00 2026-03-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $63,451.65 $121,745.32 $92,598.49 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $128,907.85 $214,354.80 $171,631.33 2026-03-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $69,886.97 $76,451.17 $73,169.07 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $120,883.96 $164,450.82 $142,667.39 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 33 18 — — $4,253.00 $210,000.00 $94,953.05 2026-03-01
1583 OTHER New Technology - Level 46 21 15 — — $76,665.12 $81,311.50 $77,439.52 2026-03-01
1584 OTHER New Technology - Level 47 21 15 — — $86,887.07 $92,152.96 $87,764.72 2026-03-01
1585 OTHER New Technology - Level 48 21 15 — — $97,109.01 $102,994.41 $98,089.91 2026-03-01
1597 OTHER New Technology - Level 46 21 15 — — $76,665.12 $81,311.50 $77,439.52 2026-03-01
1598 OTHER New Technology - Level 47 21 15 — — $86,887.07 $92,152.96 $87,764.72 2026-03-01
1599 OTHER New Technology - Level 48 21 15 — — $97,109.01 $102,994.41 $98,089.91 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $82,915.92 $123,515.26 $103,215.59 2026-03-01
1611 APR_DRG Implantable Heart Assist Systems 2 2 — — $114,505.62 $119,774.96 $117,140.29 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 2 2 — — $120,533.19 $126,060.92 $123,297.05 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 2 2 — — $150,119.61 $155,337.18 $152,728.39 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 2 2 — — $195,951.99 $227,074.08 $211,513.03 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $78,146.40 $92,263.72 $85,205.06 2026-03-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $66,497.73 $77,870.66 $72,184.20 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 32 18 — — $1,975.00 $665,965.14 $338,906.00 2026-03-01
1901 OTHER New Technology - Level 49 21 15 — — $109,886.44 $116,546.22 $110,996.40 2026-03-01
1902 OTHER New Technology - Level 49 21 15 — — $109,886.44 $116,546.22 $110,996.40 2026-03-01
1903 OTHER New Technology - Level 50 21 15 — — $125,219.36 $132,808.41 $126,484.20 2026-03-01
1904 OTHER New Technology - Level 50 21 15 — — $125,219.36 $132,808.41 $126,484.20 2026-03-01
1905 OTHER New Technology - Level 51 21 15 — — $140,552.28 $149,070.60 $141,972.00 2026-03-01
1906 OTHER New Technology - Level 51 21 15 — — $140,552.28 $149,070.60 $141,972.00 2026-03-01
1907 OTHER New Technology - Level 52 21 15 — — $155,885.20 $165,332.79 $157,459.80 2026-03-01
1908 OTHER New Technology - Level 52 21 15 — — $155,885.20 $165,332.79 $157,459.80 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 39 20 — — $1,975.00 $306,400.00 $89,582.39 2026-03-01
2067 OTHER Afamitresgene Autoleucel 21 15 — — $762,913.80 $809,151.00 $770,620.00 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 41 19 — — $1,975.00 $203,626.00 $89,480.63 2026-03-01
21 APR_DRG Heart And/or Lung Transplant 2 2 — — $74,393.10 $100,088.69 $87,240.90 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 44 21 — — $1,975.00 $167,700.37 $85,999.60 2026-03-01
215 MS_DRG Other Heart Assist System Implant 35 21 — — $1,975.00 $342,540.00 $80,397.13 2026-03-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 37 21 — — $1,975.00 $365,685.00 $79,006.26 2026-03-01
22 APR_DRG Heart And/or Lung Transplant 2 2 — — $86,779.39 $114,919.11 $100,849.25 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 2 2 — — $116,936.28 $144,998.05 $130,967.16 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 2 2 — — $189,099.42 $267,232.31 $228,165.86 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 32 20 — — $1,975.00 $336,166.00 $167,026.00 2026-03-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $74,710.31 $96,556.86 $85,633.58 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 32 20 — — $1,975.00 $231,971.00 $109,305.30 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 41 19 — — $1,975.00 $249,105.00 $87,151.08 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 41 19 — — $1,975.00 $249,105.00 $71,404.66 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $84,030.89 $103,331.49 $93,681.19 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $122,793.54 $156,275.14 $139,534.34 2026-03-01
4404 APR_DRG Kidney Transplant 2 2 — — $71,025.38 $85,311.07 $78,168.23 2026-03-01
443074 CDM Spacer Spn 20mm 41mm 23 16 $117,085.00 $117,085.00 $17,796.92 $105,376.50 $76,105.25 2026-03-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 5 3 — — $102,246.85 $106,551.98 $103,412.00 2026-03-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 3 2 — — $70,572.64 $73,544.12 $73,544.12 2026-03-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 3 2 — — $76,526.48 $79,748.65 $79,748.65 2026-03-01
494787 CDM Graft Bn Dist Fem Rt 23 16 $319,960.00 $319,960.00 $48,633.92 $287,964.00 $207,974.00 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 36 18 — — $1,975.00 $159,008.53 $81,587.85 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $80,923.40 $101,268.68 $91,096.04 2026-03-01
551227 CDM Cage Spn Sz A 25mm 23 16 $136,170.00 $136,170.00 $20,697.84 $122,553.00 $88,510.50 2026-03-01
551229 CDM Cage Spn Sz E 13mm 23 16 $136,170.00 $136,170.00 $20,697.84 $122,553.00 $88,510.50 2026-03-01
552490 CDM Cage Spn Interbdy 16mm 23 16 $120,465.00 $120,465.00 $18,310.68 $108,418.50 $78,302.25 2026-03-01
554282 CDM Cage Spn Interbdy 12mm 23 16 $120,465.00 $120,465.00 $18,310.68 $108,418.50 $78,302.25 2026-03-01
562478 CDM Cage Spnl 36x10mm 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
562607 CDM Graft Endo Aaa 36x14mm 23 16 $173,122.00 $173,122.00 $26,314.54 $155,809.80 $112,529.30 2026-03-01
563715 CDM Implant Crnfcl Small 23 16 $197,396.00 $197,396.00 $30,004.19 $177,656.40 $128,307.40 2026-03-01
565377 CDM Graft Endo Aaa 32x14mm 23 16 $173,122.00 $173,122.00 $26,314.54 $155,809.80 $112,529.30 2026-03-01
567634 CDM Spacer Tissue Shldr Med 23 16 $118,535.00 $118,535.00 $18,017.32 $106,681.50 $77,047.75 2026-03-01
568954 CDM Graft Bn Elbw Algrf Frzn 23 16 $195,898.00 $195,898.00 $29,776.50 $176,308.20 $127,333.70 2026-03-01
570741 CDM Graft Drms Ptch 16x20cm 23 16 $118,713.00 $118,713.00 $18,044.38 $106,841.70 $77,163.45 2026-03-01
575080 CDM Endplate Spnl 43-65x20mm 23 16 $130,951.00 $130,951.00 $19,904.55 $117,855.90 $85,118.15 2026-03-01
5831 APR_DRG Neonate With Ecmo 2 2 — — $126,103.00 $148,342.61 $137,222.80 2026-03-01
5832 APR_DRG Neonate With Ecmo 2 2 — — $145,921.83 $235,856.24 $190,889.03 2026-03-01
5833 APR_DRG Neonate With Ecmo 2 2 — — $197,886.26 $342,642.39 $270,264.33 2026-03-01
5834 APR_DRG Neonate With Ecmo 2 2 — — $249,850.06 $390,081.55 $319,965.80 2026-03-01
583745 CDM Cath Vasc Acc 6fr 35 17 $171,312.00 $171,312.00 $26,039.42 $154,180.80 $81,715.82 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $85,100.91 $197,085.00 $141,092.96 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $129,286.48 $197,085.00 $163,185.74 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $132,033.08 $205,887.53 $168,960.30 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $204,945.24 $300,544.34 $252,744.79 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $92,839.89 $118,758.01 $105,798.95 2026-03-01
589193 CDM Kit Lo Prfl Comp Shth 7f 35 17 $478,525.00 $478,525.00 $72,735.80 $430,672.50 $228,256.42 2026-03-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $84,400.65 $114,461.64 $99,431.14 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $76,728.16 $108,971.34 $92,849.75 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $75,617.60 $137,036.42 $106,327.01 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $129,073.74 $189,805.36 $159,439.55 2026-03-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $68,126.82 $105,620.11 $86,873.46 2026-03-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $85,954.40 $119,568.94 $102,761.67 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $133,662.80 $175,247.53 $154,455.16 2026-03-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $75,548.59 $96,874.47 $86,211.53 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $95,810.00 $129,939.46 $112,874.73 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $107,442.20 $161,568.68 $134,505.44 2026-03-01
606060 CDM Pack Cath Gd Vasc 100cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606061 CDM Pack Cath Gd Vasc 100cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606062 CDM Pack Cath Gd Vasc 100cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606063 CDM Pack Cath Gd Vasc 100cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606065 CDM Pack Cath Gd Vasc 115cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606066 CDM Pack Cath Gd Vasc 115cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606067 CDM Pack Cath Gd Vasc 115cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606069 CDM Pack Cath Gd Vasc 80cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606070 CDM Pack Cath Gd Vasc 80cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606071 CDM Pack Cath Gd Vasc 80cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606072 CDM Pack Cath Gd Vasc 100cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606073 CDM Pack Cath Gd Vasc 100cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606074 CDM Pack Cath Gd Vasc 100cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606075 CDM Pack Cath Gd Vasc 100cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
606089 CDM Pack Cath Vasc 80cm 35 17 $191,391.00 $191,391.00 $29,091.43 $172,251.90 $91,293.51 2026-03-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $73,590.27 $101,808.06 $87,699.17 2026-03-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $63,894.85 $85,624.47 $74,759.66 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $128,250.65 $184,979.66 $156,615.15 2026-03-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 2 2 — — $55,922.88 $89,622.37 $72,772.62 2026-03-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 2 2 — — $52,467.16 $89,972.97 $71,220.07 2026-03-01
63 APR_DRG Pancreas Transplant 2 2 — — $75,064.23 $80,734.50 $77,899.36 2026-03-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $71,875.70 $99,720.04 $85,797.87 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $148,757.07 $241,870.40 $195,313.73 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $123,125.94 $186,317.79 $154,721.86 2026-03-01
64 APR_DRG Pancreas Transplant 2 2 — — $106,754.61 $126,246.35 $116,500.48 2026-03-01
7 MS_DRG Lung Transplant 36 18 — — $1,975.00 $199,717.98 $102,250.90 2026-03-01
714 OTHER Inj Delandistrogene Mox R 21 15 — — $3,294,581.40 $3,494,253.00 $3,327,860.00 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $73,059.05 $94,001.30 $83,530.18 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $123,970.55 $185,485.48 $154,728.02 2026-03-01
746 OTHER Inj, Betibeglogene Autote 21 15 — — $2,910,569.31 $3,086,967.45 $2,939,969.00 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 21 15 — — $3,219,982.92 $3,415,133.40 $3,252,508.00 2026-03-01
771793 CDM Cage Spnl 36x24x10mm 12d 23 16 $120,465.00 $120,465.00 $18,310.68 $108,418.50 $78,302.25 2026-03-01
771810 CDM Matrix Tiss 20x16cm 23 16 $139,618.94 $139,618.94 $21,222.08 $125,657.05 $90,752.31 2026-03-01
772718 CDM Cage Spnl 36x12mm 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
772920 CDM Cage Spnl 40x13mm 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
773834 CDM Cage Spnl 40x13mm 23 16 $120,465.00 $120,465.00 $18,310.68 $108,418.50 $78,302.25 2026-03-01
775018 CDM Cage Spnl Cntrpc 13mm 23 16 $136,170.00 $136,170.00 $20,697.84 $122,553.00 $88,510.50 2026-03-01
776941 CDM Allograft Dermis 16x20cm 23 16 $109,919.00 $109,919.00 $16,707.69 $98,927.10 $71,447.35 2026-03-01
777462 CDM Cage Spnl Endo 36x14mm 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
778799 CDM Graft Evas 45x45mm 10cm 23 16 $294,581.00 $294,581.00 $44,776.31 $265,122.90 $191,477.65 2026-03-01
779092 CDM Perc Oclsn Lt Artrl Apnd 29 15 $205,580.00 $205,580.00 $31,248.16 $185,022.00 $131,571.20 2026-03-01
779721 CDM Kit Prfsn Bypass Tube 35 17 $248,833.00 $248,833.00 $37,822.62 $223,949.70 $118,693.34 2026-03-01
783359 CDM Stnt Thorac 28x28mm 10cm 23 16 $257,365.00 $257,365.00 $39,119.48 $231,628.50 $167,287.25 2026-03-01
786191 CDM Pacemaker Card U228 23 16 $167,147.00 $167,147.00 $25,406.34 $150,432.30 $108,645.55 2026-03-01
791942 CDM Valve Aortic 29mm 23 16 $124,296.00 $124,296.00 $18,892.99 $111,866.40 $80,792.40 2026-03-01
791943 CDM Valve Aortic 19mm 23 16 $124,296.00 $124,296.00 $18,892.99 $111,866.40 $80,792.40 2026-03-01
792605 CDM Valve Aortic 21mm 23 16 $116,911.00 $116,911.00 $17,770.47 $105,219.90 $75,992.15 2026-03-01
793098 CDM Valve Aortic 25mm 23 16 $124,296.00 $124,296.00 $18,892.99 $111,866.40 $80,792.40 2026-03-01
793589 CDM Valve Aortic 23mm 23 16 $116,911.00 $116,911.00 $17,770.47 $105,219.90 $75,992.15 2026-03-01
794827 CDM Valve Aortic 27mm 23 16 $116,911.00 $116,911.00 $17,770.47 $105,219.90 $75,992.15 2026-03-01
796086 CDM Graft Endo Aaa 23x12mm 23 16 $177,451.00 $177,451.00 $26,972.55 $159,705.90 $115,343.15 2026-03-01
796249 CDM Graft Endo Aaa 28.5x12mm 23 16 $177,451.00 $177,451.00 $26,972.55 $159,705.90 $115,343.15 2026-03-01
798749 CDM Graft Endo Aaa 26x12mm 23 16 $177,451.00 $177,451.00 $26,972.55 $159,705.90 $115,343.15 2026-03-01
818842 CDM Cage Spnl 16-25mm 12mm S 23 16 $110,970.00 $110,970.00 $16,867.44 $99,873.00 $72,130.50 2026-03-01
819686 CDM Stent Eprsth 31mm 10cm 23 16 $217,883.00 $217,883.00 $33,118.22 $196,094.70 $141,623.95 2026-03-01
820466 CDM Cage Spnl 27-38mm 20mm 23 16 $116,519.00 $116,519.00 $17,710.89 $104,867.10 $75,737.35 2026-03-01
824 OTHER Inj, Exagamglogene Autote 21 15 — — $2,308,680.00 $2,448,600.00 $2,332,000.00 2026-03-01
824217 CDM Graft Nrv 2-3mm 70mm 23 16 $113,247.00 $113,247.00 $17,213.54 $101,922.30 $73,610.55 2026-03-01
831 OTHER Obecbtge Autol Up To 400 21 15 — — $275,467.50 $292,162.50 $278,250.00 2026-03-01
831890 CDM Cage Spnl 41x12x27mm 12d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
834677 CDM Spcr Spn 12x16-25 Sm Ti 23 16 $110,970.00 $110,970.00 $16,867.44 $99,873.00 $72,130.50 2026-03-01
835665 CDM Graft Bn Rt Hum Hd Algrf 23 16 $113,104.00 $113,104.00 $17,191.81 $101,793.60 $73,517.60 2026-03-01
835878 CDM Stent Eprsth 34mm 10cm 23 16 $217,883.00 $217,883.00 $33,118.22 $196,094.70 $141,623.95 2026-03-01
835976 CDM Kit Pmp Rt Hrt 22f 170cm 35 17 $478,525.00 $478,525.00 $72,735.80 $430,672.50 $228,256.42 2026-03-01
836160 CDM Cage Spnl 41x16x27mm 6d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
836325 CDM Spacer Vert Ti 6d Sm H24 23 16 $110,970.00 $110,970.00 $16,867.44 $99,873.00 $72,130.50 2026-03-01
839360 CDM Cage Spnl 37x12x27mm 12d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
84 APR_DRG Autologous Bone Marrow Transplant 2 2 — — $62,711.50 $93,180.78 $77,946.14 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $138,186.02 $226,153.03 $182,169.52 2026-03-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 2 2 — — $69,835.69 $102,546.31 $86,191.00 2026-03-01
842507 CDM Cage Spnl 37x12x27mm 6d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
844420 CDM Graft Evas 31x14.5m 13cm 23 16 $150,544.00 $150,544.00 $22,882.69 $135,489.60 $97,853.60 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 21 15 — — $4,459,950.00 $4,730,250.00 $4,505,000.00 2026-03-01
846461 CDM Cage Spnl 30x12x25mm 6d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
846462 CDM Cage Spnl 37x14x27mm 6d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
846653 CDM Cage Spnl 37x12x27mm 12d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
846892 CDM Cage Spnl 41x16x27mm 12d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
847814 CDM Cage Spnl 30x14mm Mag+ 1 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
849160 CDM Cage Spnl 37x14mm Mag+ 1 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
851330 CDM Cage Spnl 30x12x25mm 12d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
851481 CDM Graft Evas 35x14.5m 16cm 23 16 $153,384.00 $153,384.00 $23,314.37 $138,045.60 $99,699.60 2026-03-01
862138 CDM Graft Evas 23x14.5m14cm 23 16 $150,544.00 $150,544.00 $22,882.69 $135,489.60 $97,853.60 2026-03-01
862822 CDM Graft Evas 35x14.5m 14cm 23 16 $153,384.00 $153,384.00 $23,314.37 $138,045.60 $99,699.60 2026-03-01
863779 CDM Set Vntrc 17.4x13.8in 35 17 $478,525.00 $478,525.00 $72,735.80 $430,672.50 $228,256.42 2026-03-01
864322 CDM Graft Evas 26x12mm 18cm 23 16 $161,133.00 $161,133.00 $24,492.22 $145,019.70 $104,736.45 2026-03-01
865425 CDM Graft Algrf Disc 20mm 23 16 $129,200.00 $129,200.00 $19,638.40 $116,280.00 $83,980.00 2026-03-01
865761 CDM Graft Evas 26x14.5m 12cm 23 16 $157,988.00 $157,988.00 $24,014.18 $142,189.20 $102,692.20 2026-03-01
866168 CDM Graft Evas 31x14.5m 17cm 23 16 $153,384.00 $153,384.00 $23,314.37 $138,045.60 $99,699.60 2026-03-01
866765 CDM Graft Evas 31x14.5m 15cm 23 16 $153,384.00 $153,384.00 $23,314.37 $138,045.60 $99,699.60 2026-03-01
866933 CDM Set Pump 21fr 5.0 35 17 $478,525.00 $478,525.00 $72,735.80 $430,672.50 $228,256.42 2026-03-01
867110 CDM Graft Evas 14.5mm 12cm 23 16 $157,988.00 $157,988.00 $24,014.18 $142,189.20 $102,692.20 2026-03-01
869160 CDM Graft Nrv 1-2mm 70mm 23 16 $113,247.00 $113,247.00 $17,213.54 $101,922.30 $73,610.55 2026-03-01
872005 CDM Graft Evas 23x14.5m 12cm 23 16 $150,544.00 $150,544.00 $22,882.69 $135,489.60 $97,853.60 2026-03-01
872008 CDM Graft Evas 26x12mm 14cm 23 16 $146,157.00 $146,157.00 $22,215.86 $131,541.30 $95,002.05 2026-03-01
872010 CDM Graft Evas 26x14.5m 14cm 23 16 $197,057.00 $197,057.00 $29,952.66 $177,351.30 $128,087.05 2026-03-01
872011 CDM Graft Evas 14.5mm 14cm 23 16 $157,988.00 $157,988.00 $24,014.18 $142,189.20 $102,692.20 2026-03-01
872013 CDM Graft Evas 35x14.5m 18cm 23 16 $150,544.00 $150,544.00 $22,882.69 $135,489.60 $97,853.60 2026-03-01
872014 CDM Graft Evas 23x14.5m 16cm 23 16 $150,544.00 $150,544.00 $22,882.69 $135,489.60 $97,853.60 2026-03-01
872018 CDM Graft Evas 14.5mm 16cm 23 16 $146,157.00 $146,157.00 $22,215.86 $131,541.30 $95,002.05 2026-03-01
872020 CDM Graft Evas 23x14.5m 18cm 23 16 $150,544.00 $150,544.00 $22,882.69 $135,489.60 $97,853.60 2026-03-01
872021 CDM Graft Evas 26x14.5m 18cm 23 16 $150,544.00 $150,544.00 $22,882.69 $135,489.60 $97,853.60 2026-03-01
872022 CDM Graft Evas 28.5x12m 18cm 23 16 $153,384.00 $153,384.00 $23,314.37 $138,045.60 $99,699.60 2026-03-01
872023 CDM Graft Evas 14.5mm 18cm 23 16 $153,384.00 $153,384.00 $23,314.37 $138,045.60 $99,699.60 2026-03-01
872798 CDM Guide Dev 6140 Episense 35 17 $224,429.00 $224,429.00 $34,113.21 $201,986.10 $107,052.63 2026-03-01
879796 CDM Graft Evas 10cm 12mm 23 16 $154,302.00 $154,302.00 $23,453.90 $138,871.80 $100,296.30 2026-03-01
879797 CDM Graft Evas 10cm 14.5mm 23 16 $150,544.00 $150,544.00 $22,882.69 $135,489.60 $97,853.60 2026-03-01
883402 CDM Ins/repl Subq Imp Icd Sy 29 15 $268,548.00 $268,548.00 $40,819.30 $241,693.20 $171,870.72 2026-03-01
883569 CDM Tiss Abl Lmtd Without Bypass 29 15 $126,499.00 $126,499.00 $19,227.85 $113,849.10 $80,959.36 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 21 15 — — $199,652.31 $211,752.45 $201,669.00 2026-03-01
891884 CDM Occluder Cv 18x18mm 23 16 $153,384.00 $153,384.00 $23,314.37 $138,045.60 $99,699.60 2026-03-01
891885 CDM Occluder Cv 35x18mm 23 16 $153,384.00 $153,384.00 $23,314.37 $138,045.60 $99,699.60 2026-03-01
891892 CDM Occluder Cv 25x18mm 23 16 $153,384.00 $153,384.00 $23,314.37 $138,045.60 $99,699.60 2026-03-01
893115 CDM Per Clos Para Leak Aor 29 16 $112,238.00 $112,238.00 $17,060.18 $101,014.20 $71,832.32 2026-03-01
895204 CDM Graft Evas 10cm 10mm 23 16 $154,302.00 $154,302.00 $23,453.90 $138,871.80 $100,296.30 2026-03-01
897 OTHER Revakinagene, Per Implant 21 15 — — $262,350.00 $278,250.00 $265,000.00 2026-03-01
897552 CDM Coag Dvc Kit Cdp-4330-1 35 17 $204,809.00 $204,809.00 $31,130.97 $184,328.10 $97,693.89 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 21 15 — — $526,870.28 $558,801.81 $532,192.20 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 21 15 — — $3,148,200.00 $3,339,000.00 $3,180,000.00 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 21 15 — — $3,302,461.80 $3,502,611.00 $3,335,820.00 2026-03-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 2 2 — — $67,560.96 $89,891.95 $78,726.46 2026-03-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 2 2 — — $67,986.07 $84,924.89 $76,455.48 2026-03-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 2 2 — — $60,259.70 $82,512.60 $71,386.15 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 21 15 — — $3,648,414.33 $3,869,530.35 $3,685,267.00 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 21 15 — — $2,563,091.19 $2,718,430.05 $2,588,981.00 2026-03-01
918244 CDM Per Cl Con Int Com W/imp 29 16 $112,238.00 $112,238.00 $17,060.18 $101,014.20 $71,832.32 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 21 15 — — $560,865.99 $594,857.87 $566,531.30 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 30 20 — — $1,975.00 $329,267.41 $168,006.90 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 21 15 — — $484,555.70 $513,922.71 $489,450.20 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $120,217.89 $173,879.40 $147,048.64 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 21 15 — — $556,579.19 $590,311.26 $562,201.20 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 21 15 — — $552,500.98 $585,985.89 $558,081.80 2026-03-01
943426 CDM Inst/rp Gen Sg/dl Icd 29 15 $258,820.00 $258,820.00 $39,340.64 $232,938.00 $165,644.80 2026-03-01
949704 CDM Ins Temp Pacer Dual 29 15 $137,792.00 $137,792.00 $20,944.38 $124,012.80 $88,186.88 2026-03-01
949743 CDM Per Cl Con Vt Sp Df W/im 29 16 $112,238.00 $112,238.00 $17,060.18 $101,014.20 $71,832.32 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 21 15 — — $581,773.10 $617,032.08 $587,649.60 2026-03-01
952975 CDM Trns Peri Ath Brch Trnk 29 15 $122,718.00 $122,718.00 $18,653.14 $110,446.20 $78,539.52 2026-03-01
953000 CDM Revasc Fem/pop Stnt/ath 29 15 $124,682.00 $124,682.00 $18,951.66 $112,213.80 $79,796.48 2026-03-01
953002 CDM Revasc Tib W Ath Init 29 15 $122,718.00 $122,718.00 $18,653.14 $110,446.20 $78,539.52 2026-03-01
953003 CDM Revasc Tib W Stntplc Ini 29 15 $122,718.00 $122,718.00 $18,653.14 $110,446.20 $78,539.52 2026-03-01
953004 CDM Revasc Tib Stnt/ath Init 29 15 $122,718.00 $122,718.00 $18,653.14 $110,446.20 $78,539.52 2026-03-01
953005 CDM Revasc Tib Angio Ea Add 29 15 $118,442.00 $118,442.00 $18,003.18 $106,597.80 $75,802.88 2026-03-01
953007 CDM Revasc Tib Stntplc Add 29 15 $118,442.00 $118,442.00 $18,003.18 $106,597.80 $75,802.88 2026-03-01
953008 CDM Revasc Tib Stnt/ath Add 29 15 $118,442.00 $118,442.00 $18,003.18 $106,597.80 $75,802.88 2026-03-01
953009 CDM Trns Peri Ath Iliac Art 29 15 $122,718.00 $122,718.00 $18,653.14 $110,446.20 $78,539.52 2026-03-01
953034 CDM Revasc Fem/pop Stnt/ath 29 15 $124,682.00 $124,682.00 $18,951.66 $112,213.80 $79,796.48 2026-03-01
953036 CDM Revasc Tib W Ath Init 29 15 $122,718.00 $122,718.00 $18,653.14 $110,446.20 $78,539.52 2026-03-01
953037 CDM Revasc Tib W Stntplc Ini 29 15 $122,718.00 $122,718.00 $18,653.14 $110,446.20 $78,539.52 2026-03-01
953038 CDM Revasc Tib Stnt/ath Init 29 15 $122,718.00 $122,718.00 $18,653.14 $110,446.20 $78,539.52 2026-03-01
953039 CDM Revasc Tib Angio Ea Add 29 15 $118,442.00 $118,442.00 $18,003.18 $106,597.80 $75,802.88 2026-03-01
953041 CDM Revasc Tib Stntplc Add 29 15 $118,442.00 $118,442.00 $18,003.18 $106,597.80 $75,802.88 2026-03-01
953042 CDM Revasc Tib Stnt/ath Add 29 15 $118,442.00 $118,442.00 $18,003.18 $106,597.80 $75,802.88 2026-03-01
953043 CDM Trns Peri Ath Iliac Art 29 15 $122,718.00 $122,718.00 $18,653.14 $110,446.20 $78,539.52 2026-03-01
955639 CDM Insrt Pm Gen Exst Mlt Ld 29 15 $137,792.00 $137,792.00 $20,944.38 $124,012.80 $88,186.88 2026-03-01
955642 CDM Rmv Ppm W Rplc Mult Ld 29 15 $142,051.00 $142,051.00 $21,591.75 $127,845.90 $90,912.64 2026-03-01
955643 CDM Ins Icd Gen W Dual Lead 29 15 $192,457.00 $192,457.00 $29,253.46 $173,211.30 $123,172.48 2026-03-01
955644 CDM Ins Icd Gen W Mult Lead 29 15 $258,820.00 $258,820.00 $39,340.64 $232,938.00 $165,644.80 2026-03-01
955645 CDM Rmv Icd W Rplc Sgl Ld 29 15 $184,173.00 $184,173.00 $27,994.30 $165,755.70 $117,870.72 2026-03-01
955646 CDM Rmv Icd W Rplc Dual Ld 29 15 $184,173.00 $184,173.00 $27,994.30 $165,755.70 $117,870.72 2026-03-01
955647 CDM Rmv Icd W Rplc Mult Ld 29 15 $297,644.00 $297,644.00 $45,241.89 $267,879.60 $190,492.16 2026-03-01
957892 CDM Prc D-el Cor Stnt Ath Sl 29 16 $112,238.00 $112,238.00 $17,060.18 $101,014.20 $71,832.32 2026-03-01
957973 CDM Prc D-el Cor Stnt Ath Ld 29 16 $112,238.00 $112,238.00 $17,060.18 $101,014.20 $71,832.32 2026-03-01
957974 CDM Prc D-el Cor Stnt Ath Lc 29 16 $112,238.00 $112,238.00 $17,060.18 $101,014.20 $71,832.32 2026-03-01
957975 CDM Prc D-el Cor Stnt Ath Rc 29 16 $112,238.00 $112,238.00 $17,060.18 $101,014.20 $71,832.32 2026-03-01
957976 CDM Prc D-el Cor Stnt Ath Ri 29 16 $112,238.00 $112,238.00 $17,060.18 $101,014.20 $71,832.32 2026-03-01
957979 CDM Prc D-e Cor Revsc Ami Lc 29 16 $129,073.00 $129,073.00 $19,619.10 $116,165.70 $82,606.72 2026-03-01
957980 CDM Prc D-e Cor Revsc Ami Ld 29 16 $129,073.00 $129,073.00 $19,619.10 $116,165.70 $82,606.72 2026-03-01
957981 CDM Prc D-e Cor Revsc Ami Lm 29 16 $129,073.00 $129,073.00 $19,619.10 $116,165.70 $82,606.72 2026-03-01
957982 CDM Prc D-e Cor Revsc Ami Rc 29 16 $129,073.00 $129,073.00 $19,619.10 $116,165.70 $82,606.72 2026-03-01
957986 CDM Prc D-e Cor Revsc Chrnlc 29 16 $129,073.00 $129,073.00 $19,619.10 $116,165.70 $82,606.72 2026-03-01
957987 CDM Prc D-e Cor Revsc Chrnld 29 16 $129,073.00 $129,073.00 $19,619.10 $116,165.70 $82,606.72 2026-03-01
957988 CDM Prc D-e Cor Revsc Chrnlm 29 16 $129,073.00 $129,073.00 $19,619.10 $116,165.70 $82,606.72 2026-03-01
957989 CDM Prc D-e Cor Revsc Chrnrc 29 16 $129,073.00 $129,073.00 $19,619.10 $116,165.70 $82,606.72 2026-03-01
957990 CDM Prc D-e Cor Revsc Chrnri 29 16 $129,073.00 $129,073.00 $19,619.10 $116,165.70 $82,606.72 2026-03-01
958000 CDM Prc D-el Cor Stnt Ath Lm 29 16 $112,238.00 $112,238.00 $17,060.18 $101,014.20 $71,832.32 2026-03-01
958005 CDM Prc D-e Cor Revsc Ami Ri 29 16 $129,073.00 $129,073.00 $19,619.10 $116,165.70 $82,606.72 2026-03-01
959471 CDM Perc Clsr Lt Atrl W/imp 29 15 $209,089.00 $209,089.00 $31,781.53 $188,180.10 $133,816.96 2026-03-01
967441 CDM Graft Bn Fem Medial Left 23 16 $177,384.00 $177,384.00 $26,962.37 $159,645.60 $115,299.60 2026-03-01
975513 CDM Gft Bfur 36-18x155 24fr 23 16 $127,418.00 $127,418.00 $19,367.54 $114,676.20 $82,821.70 2026-03-01
975598 CDM Graft Bn Hemi Condrl Rt 23 16 $162,640.00 $162,640.00 $24,721.28 $146,376.00 $105,716.00 2026-03-01
982439 CDM Pump Contrl Urn Ab Sys 23 16 $110,543.00 $110,543.00 $16,802.54 $99,488.70 $71,852.95 2026-03-01
998953 CDM Cage Spnl 30x10x25mm 6d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
998955 CDM Cage Spnl 37x14x27mm 6d 23 16 $109,121.00 $109,121.00 $16,586.39 $98,208.90 $70,928.65 2026-03-01
999395 CDM Nrstm Impl 60mm Fsn Spn 23 16 $167,695.00 $167,695.00 $25,489.64 $150,925.50 $109,001.75 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 6 4 — — $93,760.51 $170,473.65 $110,197.09 2026-03-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 2 — — $77,046.96 $140,085.39 $140,085.39 2026-03-01
C1721 HCPCS Defib Card .99cm 5.37x7. 276 16 $141,827.50 $141,827.50 $10,702.89 $156,071.70 $88,945.74 2026-03-01
C1722 HCPCS Defib Card .99cm 5.37x7. 299 16 $154,180.00 $154,180.00 $19,773.83 $251,278.20 $104,690.60 2026-03-01
C1735 HCPCS Catheter Renal 6fr 32 16 $306,256.00 $306,256.00 $46,550.91 $275,630.40 $153,893.64 2026-03-01
C1767 HCPCS Gen Single Pin Sentiva 276 16 $176,786.00 $176,786.00 $6,779.52 $512,099.10 $115,371.20 2026-03-01
C1820 HCPCS Device Neurostimulator 184 16 $239,398.00 $239,398.00 $22,162.06 $254,676.60 $146,305.35 2026-03-01
C1822 HCPCS Pulse Gen Imp 23 16 $291,574.00 $291,574.00 $44,319.25 $262,416.60 $189,523.10 2026-03-01
C1882 HCPCS Compia MRI Quad Crt-d Dt 368 16 $223,700.00 $223,700.00 $18,387.90 $230,896.80 $147,973.22 2026-03-01
C2616 HCPCS Brachytx Ns Yttrium 90 29 15 $260,882.00 $260,882.00 $8,688.00 $234,793.80 $117,396.90 2026-03-01
C9293 HCPCS Glucarpidase 1000 U Inj 34 18 $229,617.00 $229,617.00 $740.34 $206,655.30 $103,327.65 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
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 1 1 — — $4,850,948.67 $4,850,948.67 $4,850,948.67 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 4 3 — — $3,670,252.89 $4,271,819.03 $3,824,789.85 2026-03-01
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 3 2 — — $332,753.88 $605,007.06 $605,007.06 2026-03-01
J7330 HCPCS Autolog Chondro Implant 38 18 $271,868.00 $271,868.00 $41,323.94 $251,178.75 $140,847.30 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 9 5 — — $102,561.22 $192,824.37 $149,438.89 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 13 6 — — $51,183.44 $129,556.02 $75,026.04 2026-03-01
J9999 HCPCS Carmustine Wafers 8/box 31 17 $255,501.00 $255,501.00 $38,836.15 $229,950.90 $163,520.64 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 21 15 — — $94,130.19 $99,835.05 $95,081.00 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 21 15 — — $111,218.58 $117,959.10 $112,342.00 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 9 5 — — $741,901.04 $1,596,576.72 $1,237,346.96 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 9 5 — — $836,958.70 $1,699,593.90 $1,317,185.27 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 10 5 — — $65,075.48 $163,212.33 $89,662.14 2026-03-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 6 4 — — $725,845.60 $1,468,350.60 $782,000.18 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 9 5 — — $765,607.90 $1,686,603.72 $1,307,117.89 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 9 5 — — $782,774.83 $1,674,245.19 $1,297,540.02 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 9 5 — — $819,605.32 $1,762,948.71 $1,366,285.25 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 3 2 — — $1,271,523.00 $2,311,860.00 $2,311,860.00 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 3 2 — — $459,112.50 $834,750.00 $834,750.00 2026-03-01
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