Price Transparency Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

SKY RIDGE MEDICAL CENTER

Lone Tree, CO · CCN 060112 · Rates published

35,829 distinct procedures filed
31 distinct payers
1,093,073 rate rows
2026-03-01 last MRF observed
Data quality

1,066,832 of 1,093,073 rate rows are consumer-grade (97.6%)

26,241 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 15,111
per-diem day rate — not a per-procedure price 9,333
template filing: same amount across many unrelated codes — excluded 1,691
placeholder amount (≤ $0.02) — excluded from medians 99
exceeds 10× this hospital's gross charge — excluded from medians 7
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-SKY-RIDGE_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 fcb3c55fe40446e3… · 615,196,326 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
$3,006,423
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
$2,469,189
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×
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
$754,974
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
$674,188
1.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $819,605.32 $1,762,948.71 $911,868.41 nat. median
$675,122
1.4× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $782,774.83 $1,674,245.19 $868,284.31 nat. median
$625,184
1.4× 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×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $741,901.04 $1,596,576.72 $825,628.09 nat. median
$634,511
1.3× median
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
$620,080
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 $484,444.00 $367,228.90 nat. median
$370,174
1.0× median
5834
APR_DRG 		Neonate With Ecmo 2 $285,455.19 $390,081.55 $337,768.37 nat. median
$309,665
1.1× median
5833
APR_DRG 		Neonate With Ecmo 2 $226,086.24 $342,642.39 $284,364.32 nat. median
$244,017
1.2× 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×
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $234,151.17 $300,544.34 $267,347.76 nat. median
$246,434
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×
C1825
HCPCS 		System Nrstm Gen Ipg 14 $57,610.28 $341,113.50 $246,359.75 nat. median
$52,021
outlier · 4.7×
24
APR_DRG 		Heart And/or Lung Transplant 2 $216,047.23 $267,232.31 $241,639.77 nat. median
$234,738
1.0× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 20 $1,975.00 $356,319.01 $238,523.60 nat. median
$265,286
0.9× median
1614
APR_DRG 		Implantable Heart Assist Systems 2 $223,876.33 $227,074.08 $225,475.20 nat. median
$207,730
1.1× median
581868
CDM 		Stent Eprsth 15cm 8mm 14 $49,063.17 $290,505.60 $209,809.60 nat. median
$64,000
outlier · 3.3×
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 $169,955.85 $241,870.40 $205,913.12 nat. median
$150,721
1.4× median
863779
CDM 		Set Vntrc 17.4x13.8in 15 $66,279.60 $392,445.00 $202,109.17 nat. median
$71,700
outlier · 2.8×
589193
CDM 		Kit Lo Prfl Comp Shth 7f 15 $66,279.60 $392,445.00 $202,109.17 nat. median
$80,670
outlier · 2.5×
573195
CDM 		Kit Cath Rt Heart 15 $66,279.60 $392,445.00 $202,109.17 nat. median
$61,160
outlier · 3.3×
886
OTHER 		Inj. Remestemcel-l-rknd/ 15 $199,652.31 $211,752.45 $201,669.00 nat. median
$17,985
outlier · 11.2×
5832
APR_DRG 		Neonate With Ecmo 2 $166,716.57 $235,856.24 $201,286.40 nat. median
$156,126
1.3× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 2 $157,878.35 $226,153.03 $192,015.69 nat. median
$160,267
1.2× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 20 $1,975.00 $346,590.07 $181,863.70 nat. median
$206,368
0.9× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 $147,278.00 $214,354.80 $180,816.40 nat. median
$117,173
1.5× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 20 $1,975.00 $1,445,630.10 $180,799.80 nat. median
$202,986
0.9× median
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $150,848.58 $205,887.53 $178,368.05 nat. median
$182,736
1.0× median

Other procedures at this hospital

Browse this hospital's 35,829 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
850 MS_DRG Acute Leukemia With Other Procedures 43 19 — — $1,975.00 $95,133.27 $74,111.84 2026-03-01
2067 OTHER Afamitresgene Autoleucel 21 15 — — $762,913.80 $809,151.00 $770,620.00 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
74 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $141,637.11 $185,485.48 $163,561.29 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 34 18 — — $4,200.00 $210,000.00 $102,626.00 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $83,470.40 $94,001.30 $88,735.85 2026-03-01
72 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $65,291.24 $74,627.94 $69,959.59 2026-03-01
84 APR_DRG Autologous Bone Marrow Transplant 2 2 — — $71,648.27 $93,180.78 $82,414.52 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 21 15 — — $526,870.28 $558,801.81 $532,192.20 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 6 4 — — $741,901.04 $1,596,576.72 $825,628.09 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
C2616 HCPCS Brachytx Ns Yttrium 90 27 13 $208,946.00 $208,946.00 $8,688.00 $188,051.40 $94,025.70 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
9391 OTHER Brexucabtagene Car Pos T 21 15 — — $484,555.70 $513,922.71 $489,450.20 2026-03-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 2 2 — — $79,787.70 $102,546.31 $91,167.01 2026-03-01
868031 CDM Cannula Prfsn Dil Str Ti 34 15 $200,583.00 $200,583.00 $30,488.62 $180,524.70 $92,970.22 2026-03-01
867974 CDM Cannula W Dilatr 20d Ang 34 15 $200,583.00 $200,583.00 $30,488.62 $180,524.70 $92,970.22 2026-03-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 37 21 — — $1,975.00 $365,685.00 $85,322.10 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $89,282.74 $92,263.72 $90,773.23 2026-03-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $75,974.06 $77,870.66 $76,922.36 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 33 18 — — $1,975.00 $484,444.00 $367,228.90 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $147,278.00 $214,354.80 $180,816.40 2026-03-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $72,493.90 $121,745.32 $97,119.61 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 6 4 — — $819,605.32 $1,762,948.71 $911,868.41 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 21 15 — — $581,773.10 $617,032.08 $587,649.60 2026-03-01
889597 CDM Cnnla Prfsn 22fr 20d 34 15 $226,746.00 $226,746.00 $34,465.39 $204,071.40 $105,096.77 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 43 19 — — $1,975.00 $249,105.00 $77,084.34 2026-03-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 3 2 — — $77,173.70 $80,423.12 $80,423.12 2026-03-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 5 3 — — $103,412.00 $116,518.39 $111,810.57 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 43 19 — — $1,975.00 $203,626.00 $96,690.40 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 46 21 — — $1,975.00 $141,623.74 $92,914.71 2026-03-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $69,476.69 $71,540.93 $70,508.81 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 35 21 — — $1,975.00 $250,636.00 $72,162.44 2026-03-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 2 2 — — $67,560.96 $102,702.09 $85,131.52 2026-03-01
C1882 HCPCS Crt-d Crd 5.37x8.08x0.99 399 14 $140,871.00 $140,871.00 $15,564.80 $147,044.70 $93,146.40 2026-03-01
953124 CDM Cth Plc/inj R&lhc/grafts 28 14 $160,304.65 $160,304.65 $24,366.31 $144,274.18 $89,530.15 2026-03-01
953123 CDM Cth Plc/inj R&lhc/l Vent 28 14 $145,549.80 $145,549.80 $22,123.57 $130,994.82 $81,289.56 2026-03-01
C1772 HCPCS Defib Card 40j Unify 84 14 $112,687.00 $112,687.00 $13,167.00 $139,771.80 $72,961.00 2026-03-01
978221 CDM Defib Card Fortify .5m/s 21 14 $112,857.00 $112,857.00 $17,154.26 $101,571.30 $73,357.05 2026-03-01
872236 CDM Device Embl 18x3.5mm Pip 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
868006 CDM Device Embl 20mm 4.5mm 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
872238 CDM Device Embl 20x2.5mm Pip 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
869593 CDM Device Embl 25x4mm Pline 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
894505 CDM Device Embl 3.25x16mm Pl 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
872245 CDM Device Embl 3.5x35mm Pl 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
867883 CDM Device Embl 3.75x18mm Pl 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
867880 CDM Device Embl 4.25x1mm Pln 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
872235 CDM Device Embl 4.5x16mm Pl 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
872237 CDM Device Embl 4.75x18mm Pl 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
867959 CDM Device Embl 4.75x20mm Pl 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
872248 CDM Device Embl 4.75x35mm Pl 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
566237 CDM Device Embl 5mm 35mm 21 14 $145,102.00 $145,102.00 $22,055.50 $130,591.80 $94,316.30 2026-03-01
867960 CDM Device Embl 5x16mm Pipln 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
867962 CDM Device Embl 5x25mm Pipln 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
869127 CDM Device Embl 5x30mm Pipel 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
867963 CDM Device Embl 5x35mm Pipln 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
C1820 HCPCS Device Neurostimulator 357 14 $165,684.00 $165,684.00 $15,638.82 $255,348.00 $106,037.76 2026-03-01
987414 CDM Device Ventric Ast Tandm 34 15 $340,119.00 $340,119.00 $51,698.09 $306,107.10 $157,645.15 2026-03-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 2 2 — — $65,515.48 $70,086.42 $67,800.95 2026-03-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $85,356.97 $96,556.86 $90,956.92 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
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 33 20 — — $1,975.00 $1,445,630.10 $180,799.80 2026-03-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 2 2 — — $67,986.07 $97,027.20 $82,506.64 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 30 20 — — $1,975.00 $346,590.07 $181,863.70 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $157,878.35 $226,153.03 $192,015.69 2026-03-01
1784 APR_DRG External Heart Assist Devices 2 2 — — $75,466.97 $75,623.86 $75,545.42 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $137,349.66 $173,879.40 $155,614.53 2026-03-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $63,303.40 $77,952.72 $70,628.06 2026-03-01
C1767 HCPCS Gen Nrstm 52x52x6.9mm 462 14 $167,725.50 $167,725.50 $13,788.53 $361,366.20 $89,921.39 2026-03-01
C1824 HCPCS Gen Pls Card Mod Sys 21 14 $227,194.00 $227,194.00 $34,533.49 $204,474.60 $147,676.10 2026-03-01
C1823 HCPCS Generator Pulse Implnt 42 14 $186,800.50 $186,800.50 $14,814.07 $248,526.00 $82,841.93 2026-03-01
566572 CDM Gft Evs 15f 20x14.5x12mm 21 14 $131,410.00 $131,410.00 $19,974.32 $118,269.00 $85,416.50 2026-03-01
890951 CDM Graft Bn Cndyl Plg Latrl 21 14 $118,395.00 $118,395.00 $17,996.04 $106,555.50 $76,956.75 2026-03-01
773643 CDM Graft Bn Fem Cndyl Algrf 21 14 $118,395.00 $118,395.00 $17,996.04 $106,555.50 $76,956.75 2026-03-01
895716 CDM Graft Bn Fem Condyl Lt 21 14 $118,395.00 $118,395.00 $17,996.04 $106,555.50 $76,956.75 2026-03-01
547138 CDM Graft Bn Fem Condyl Rt 21 14 $118,395.00 $118,395.00 $17,996.04 $106,555.50 $76,956.75 2026-03-01
475890 CDM Graft Bn Lt Mdl Fem Hemi 21 14 $118,172.00 $118,172.00 $17,962.14 $106,354.80 $76,811.80 2026-03-01
578953 CDM Graft Bn Ptla Left 21 14 $131,908.00 $131,908.00 $20,050.02 $118,717.20 $85,740.20 2026-03-01
780616 CDM Graft Bn Ptla Lt Ostchnd 21 14 $130,755.00 $130,755.00 $19,874.76 $117,679.50 $84,990.75 2026-03-01
778160 CDM Graft Bn Ptla Rt 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
784085 CDM Graft Bn Trochlea Lt Ost 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
796086 CDM Graft Endo Aaa 23x12mm 21 14 $128,205.00 $128,205.00 $19,487.16 $115,384.50 $83,333.25 2026-03-01
798749 CDM Graft Endo Aaa 26x12mm 21 14 $122,406.00 $122,406.00 $18,605.71 $110,165.40 $79,563.90 2026-03-01
796249 CDM Graft Endo Aaa 28.5x12mm 21 14 $119,420.00 $119,420.00 $18,151.84 $107,478.00 $77,623.00 2026-03-01
565377 CDM Graft Endo Aaa 32x14mm 21 14 $131,410.00 $131,410.00 $19,974.32 $118,269.00 $85,416.50 2026-03-01
562607 CDM Graft Endo Aaa 36x14mm 21 14 $119,420.00 $119,420.00 $18,151.84 $107,478.00 $77,623.00 2026-03-01
895204 CDM Graft Evas 10cm 10mm 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
879796 CDM Graft Evas 10cm 12mm 21 14 $113,624.00 $113,624.00 $17,270.85 $102,261.60 $73,855.60 2026-03-01
879797 CDM Graft Evas 10cm 14.5mm 21 14 $113,624.00 $113,624.00 $17,270.85 $102,261.60 $73,855.60 2026-03-01
867110 CDM Graft Evas 14.5mm 12cm 21 14 $111,485.00 $111,485.00 $16,945.72 $100,336.50 $72,465.25 2026-03-01
872011 CDM Graft Evas 14.5mm 14cm 21 14 $103,846.00 $103,846.00 $15,784.59 $93,461.40 $67,499.90 2026-03-01
872023 CDM Graft Evas 14.5mm 18cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
851481 CDM Graft Evas 16cm 35mm 14. 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
872019 CDM Graft Evas 18cm 23mm 12m 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
864322 CDM Graft Evas 18cm 26x12mm 21 14 $108,236.00 $108,236.00 $16,451.87 $97,412.40 $70,353.40 2026-03-01
865762 CDM Graft Evas 23x12mm 16cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872005 CDM Graft Evas 23x14.5m 12cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872014 CDM Graft Evas 23x14.5m 16cm 21 14 $103,846.00 $103,846.00 $15,784.59 $93,461.40 $67,499.90 2026-03-01
872020 CDM Graft Evas 23x14.5m 18cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
862138 CDM Graft Evas 23x14.5m14cm 21 14 $111,485.00 $111,485.00 $16,945.72 $100,336.50 $72,465.25 2026-03-01
872008 CDM Graft Evas 26x12mm 14cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
865761 CDM Graft Evas 26x14.5m 12cm 21 14 $113,624.00 $113,624.00 $17,270.85 $102,261.60 $73,855.60 2026-03-01
872010 CDM Graft Evas 26x14.5m 14cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872016 CDM Graft Evas 26x14.5m 16cm 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
872021 CDM Graft Evas 26x14.5m 18cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
844420 CDM Graft Evas 31x14.5m 13cm 21 14 $113,624.00 $113,624.00 $17,270.85 $102,261.60 $73,855.60 2026-03-01
866168 CDM Graft Evas 31x14.5m 17cm 21 14 $103,846.00 $103,846.00 $15,784.59 $93,461.40 $67,499.90 2026-03-01
774713 CDM Graft Evas 34x34x10cm 21 14 $190,591.00 $190,591.00 $28,969.83 $171,531.90 $123,884.15 2026-03-01
862822 CDM Graft Evas 35x14.5m 14cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872013 CDM Graft Evas 35x14.5m 18cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
997676 CDM Graft Hemi Cndyl Mdl Lt 21 14 $132,447.00 $132,447.00 $20,131.94 $119,202.30 $86,090.55 2026-03-01
849531 CDM Graft Hemi Cndyl Mdl Rt 21 14 $132,447.00 $132,447.00 $20,131.94 $119,202.30 $86,090.55 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 2 2 — — $216,047.23 $267,232.31 $241,639.77 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 2 2 — — $133,600.40 $144,998.05 $139,299.22 2026-03-01
22 APR_DRG Heart And/or Lung Transplant 2 2 — — $99,145.98 $114,919.11 $107,032.54 2026-03-01
21 APR_DRG Heart And/or Lung Transplant 2 2 — — $84,994.56 $100,088.69 $92,541.62 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 41 20 — — $1,975.00 $356,319.01 $238,523.60 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 41 20 — — $1,975.00 $306,157.00 $96,800.77 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
9422 OTHER Idecabtagene Vicleucel Ca 21 15 — — $552,500.98 $585,985.89 $558,081.80 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 6 4 — — $782,774.83 $1,674,245.19 $868,284.31 2026-03-01
605913 CDM Implant Bn Crnm Sphn 21 14 $162,435.00 $162,435.00 $24,690.12 $146,191.50 $105,582.75 2026-03-01
781500 CDM Implant Crnl 22.0mm 21 14 $136,673.00 $136,673.00 $20,774.30 $123,005.70 $88,837.45 2026-03-01
647922 CDM Implant Crnl Bn Cstm 21 14 $211,166.00 $211,166.00 $32,097.23 $190,049.40 $137,257.90 2026-03-01
588855 CDM Implant Crnl Custm 21 14 $106,525.00 $106,525.00 $16,191.80 $95,872.50 $69,241.25 2026-03-01
872873 CDM Implant Crnl Peek 20 21 14 $179,578.00 $179,578.00 $27,295.86 $161,620.20 $116,725.70 2026-03-01
847625 CDM Implant Crnl Peek-optma 21 14 $137,388.00 $137,388.00 $20,882.98 $123,649.20 $89,302.20 2026-03-01
C1822 HCPCS Implant Pulse 8.5x15.5in 63 14 $205,751.00 $205,751.00 $28,451.36 $298,258.20 $140,385.00 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 2 2 — — $223,876.33 $227,074.08 $225,475.20 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 2 2 — — $155,337.18 $171,512.55 $163,424.86 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 2 2 — — $126,060.92 $137,709.89 $131,885.40 2026-03-01
1611 APR_DRG Implantable Heart Assist Systems 2 2 — — $119,774.96 $130,823.35 $125,299.15 2026-03-01
819738 CDM Implnt Crnl Peek Ptspc S 21 14 $127,301.00 $127,301.00 $19,349.75 $114,570.90 $82,745.65 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
906 OTHER Inj Elivaldogene Autoteme 21 15 — — $3,148,200.00 $3,339,000.00 $3,180,000.00 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
845 OTHER Inj, Atidarsagene Autotem 21 15 — — $4,459,950.00 $4,730,250.00 $4,505,000.00 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
824 OTHER Inj, Exagamglogene Autote 21 15 — — $2,308,680.00 $2,448,600.00 $2,332,000.00 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
748 OTHER Inj, Lovotibeglogene Auto 21 15 — — $3,219,982.92 $3,415,133.40 $3,252,508.00 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 21 15 — — $199,652.31 $211,752.45 $201,669.00 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
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 1 1 — — $3,847,800.00 $3,847,800.00 $3,847,800.00 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
906360 CDM Ins Uterin Tand/ov Cl Br 27 13 $134,626.00 $134,626.00 $20,463.15 $121,163.40 $86,160.64 2026-03-01
943426 CDM Inst/rp Gen Sg/dl Icd 27 13 $118,146.53 $118,146.53 $17,958.27 $106,331.88 $75,613.78 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
599964 CDM Ipg Dbs Rchrgbl Battery 21 14 $257,731.00 $257,731.00 $39,175.11 $231,957.90 $167,525.15 2026-03-01
4404 APR_DRG Kidney Transplant 2 2 — — $81,146.92 $85,311.07 $83,228.99 2026-03-01
573195 CDM Kit Cath Rt Heart 34 15 $436,050.00 $436,050.00 $66,279.60 $392,445.00 $202,109.17 2026-03-01
589611 CDM Kit Impl Gel18g 20cm 21 14 $129,565.00 $129,565.00 $19,693.88 $116,608.50 $84,217.25 2026-03-01
589193 CDM Kit Lo Prfl Comp Shth 7f 34 15 $436,050.00 $436,050.00 $66,279.60 $392,445.00 $202,109.17 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 21 15 — — $556,579.19 $590,311.26 $562,201.20 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
14 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $138,110.65 $164,450.82 $151,280.73 2026-03-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $76,451.17 $79,846.29 $78,148.73 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 38 18 — — $1,975.00 $136,091.96 $88,129.52 2026-03-01
7 MS_DRG Lung Transplant 38 18 — — $1,975.00 $161,290.67 $110,541.70 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $94,731.93 $123,515.26 $109,123.60 2026-03-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 2 2 — — $61,230.20 $75,601.25 $68,415.73 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 43 19 — — $1,975.00 $249,105.00 $94,163.65 2026-03-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 2 2 — — $60,259.70 $94,271.14 $77,265.42 2026-03-01
8634 APR_DRG Neonatal Aftercare 2 2 — — $62,637.89 $77,892.95 $70,265.42 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $122,753.36 $161,568.68 $142,161.02 2026-03-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $59,735.71 $81,511.10 $70,623.40 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $109,463.50 $129,939.46 $119,701.48 2026-03-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $86,314.72 $96,874.47 $91,594.60 2026-03-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $65,861.25 $77,832.42 $71,846.83 2026-03-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $84,077.32 $101,808.06 $92,942.69 2026-03-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $65,407.69 $71,654.06 $68,530.88 2026-03-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 2 2 — — $59,944.04 $89,972.97 $74,958.51 2026-03-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 2 2 — — $63,892.23 $89,622.37 $76,757.30 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $146,527.13 $184,979.66 $165,753.40 2026-03-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $73,000.26 $85,624.47 $79,312.36 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $147,467.52 $189,805.36 $168,636.44 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $86,393.57 $137,036.42 $111,715.00 2026-03-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $45,972.01 $100,572.04 $73,272.02 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $152,710.55 $175,247.53 $163,979.04 2026-03-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $98,203.42 $119,568.94 $108,886.18 2026-03-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $77,835.31 $105,620.11 $91,727.71 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $234,151.17 $300,544.34 $267,347.76 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $150,848.58 $205,887.53 $178,368.05 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $147,710.57 $197,085.00 $172,397.79 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $97,228.31 $197,085.00 $147,156.65 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $106,070.14 $118,758.01 $112,414.07 2026-03-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $96,428.25 $114,461.64 $105,444.95 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $87,662.37 $108,971.34 $98,316.85 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $169,955.85 $241,870.40 $205,913.12 2026-03-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $82,118.42 $99,720.04 $90,919.23 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $140,672.13 $186,317.79 $163,494.96 2026-03-01
5834 APR_DRG Neonate With Ecmo 2 2 — — $285,455.19 $390,081.55 $337,768.37 2026-03-01
5833 APR_DRG Neonate With Ecmo 2 2 — — $226,086.24 $342,642.39 $284,364.32 2026-03-01
5832 APR_DRG Neonate With Ecmo 2 2 — — $166,716.57 $235,856.24 $201,286.40 2026-03-01
5831 APR_DRG Neonate With Ecmo 2 2 — — $144,073.44 $148,342.61 $146,208.02 2026-03-01
1583 OTHER New Technology - Level 46 21 15 — — $76,665.12 $81,311.50 $77,439.52 2026-03-01
1597 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
1598 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
1599 OTHER New Technology - Level 48 21 15 — — $97,109.01 $102,994.41 $98,089.91 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
1908 OTHER New Technology - Level 52 21 15 — — $155,885.20 $165,332.79 $157,459.80 2026-03-01
1907 OTHER New Technology - Level 52 21 15 — — $155,885.20 $165,332.79 $157,459.80 2026-03-01
999395 CDM Nrstm Impl 60mm Fsn Spn 21 14 $109,458.00 $109,458.00 $16,637.62 $98,512.20 $71,147.70 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
831 OTHER Obecbtge Autol Up To 400 21 15 — — $275,467.50 $292,162.50 $278,250.00 2026-03-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 2 2 — — $68,339.54 $79,986.33 $74,162.93 2026-03-01
215 MS_DRG Other Heart Assist System Implant 35 21 — — $1,975.00 $342,540.00 $86,830.71 2026-03-01
606060 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606062 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606072 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606073 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606074 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606061 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606067 CDM Pack Cath Gd Vasc 115cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606065 CDM Pack Cath Gd Vasc 115cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606066 CDM Pack Cath Gd Vasc 115cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606071 CDM Pack Cath Gd Vasc 80cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606070 CDM Pack Cath Gd Vasc 80cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606069 CDM Pack Cath Gd Vasc 80cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
64 APR_DRG Pancreas Transplant 2 2 — — $121,967.78 $126,246.35 $124,107.07 2026-03-01
63 APR_DRG Pancreas Transplant 2 2 — — $80,734.50 $85,761.34 $83,247.92 2026-03-01
62 APR_DRG Pancreas Transplant 2 2 — — $70,524.24 $74,449.18 $72,486.71 2026-03-01
872252 CDM Ped Flex 3.25mm X 30mm 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
872254 CDM Ped Flex 4.25mm X 30mm 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
872255 CDM Ped Flex 4.50mm X 30mm 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
872257 CDM Ped Flex 4.75mm X 25mm 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 21 15 — — $68,113.68 $72,241.79 $68,801.70 2026-03-01
957974 CDM Prc D-el Cor Stnt Ath Lc 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957973 CDM Prc D-el Cor Stnt Ath Ld 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
958000 CDM Prc D-el Cor Stnt Ath Lm 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957975 CDM Prc D-el Cor Stnt Ath Rc 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957976 CDM Prc D-el Cor Stnt Ath Ri 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957892 CDM Prc D-el Cor Stnt Ath Sl 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
875074 CDM Probe 154mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875080 CDM Probe 175mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875084 CDM Probe 196mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875086 CDM Probe 217mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875088 CDM Probe 238mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875090 CDM Probe 259mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875052 CDM Probe Lsr 3.3mm 133mm 34 15 $177,281.00 $177,281.00 $26,946.71 $159,552.90 $82,169.74 2026-03-01
563822 CDM Probe Lsr Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875050 CDM Probe Sz00 Neuroblate Sy 34 15 $177,281.00 $177,281.00 $26,946.71 $159,552.90 $82,169.74 2026-03-01
875055 CDM Probe Sz1 Neuroblate Sys 34 15 $177,281.00 $177,281.00 $26,946.71 $159,552.90 $82,169.74 2026-03-01
875053 CDM Probe Sz1 Neuroblate Sys 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875056 CDM Probe Sz2 Neuroblate Sys 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875058 CDM Probe Sz3 Neuroblate Sys 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875059 CDM Probe Sz3 Sdefr 3.3 Ldp 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875060 CDM Probe Sz4 Neuroblate Sys 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875061 CDM Probe Sz4 Sdefr 3.3 Ldp 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875062 CDM Probe Sz5 Neuroblate Sys 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875063 CDM Probe Sz5 Sdefr 3.3 Ldp 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
647588 CDM Prosthesis Tmj Bilat 21 14 $223,078.00 $223,078.00 $33,907.86 $200,770.20 $145,000.70 2026-03-01
842179 CDM Prosthesis Tmj Pt Cstm 21 14 $200,120.00 $200,120.00 $30,418.24 $180,108.00 $130,078.00 2026-03-01
957952 CDM Ptca Cor Sgl Arty Lc 28 14 $156,006.95 $156,006.95 $23,713.06 $140,406.26 $87,129.89 2026-03-01
957953 CDM Ptca Cor Sgl Arty Ld 28 14 $156,006.95 $156,006.95 $23,713.06 $140,406.26 $87,129.89 2026-03-01
957954 CDM Ptca Cor Sgl Arty Rc 28 14 $156,006.95 $156,006.95 $23,713.06 $140,406.26 $87,129.89 2026-03-01
957971 CDM Ptca Cor W Ang Sgl Lm 28 14 $156,006.95 $156,006.95 $23,713.06 $140,406.26 $87,129.89 2026-03-01
957972 CDM Ptca Cor W Ang Sgl Ri 28 14 $156,006.95 $156,006.95 $23,713.06 $140,406.26 $87,129.89 2026-03-01
957883 CDM Ptca Stent W Ath Sgl 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
958397 CDM Ptca Stn W Ath Sgl Lc 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
958398 CDM Ptca Stn W Ath Sgl Ld 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957977 CDM Ptca Stn W Ath Sgl Lm 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
958399 CDM Ptca Stn W Ath Sgl Rc 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957978 CDM Ptca Stn W Ath Sgl Ri 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
833716 CDM Pump Cath Lv Impella 9fr 34 15 $348,840.00 $348,840.00 $53,023.68 $313,956.00 $161,687.34 2026-03-01
594774 CDM Pump Pain Infn 148gm 21 14 $121,144.00 $121,144.00 $18,413.89 $109,029.60 $78,743.60 2026-03-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 2 — — $77,046.96 $140,085.39 $140,085.39 2026-03-01
897 OTHER Revakinagene, Per Implant 21 15 — — $262,350.00 $278,250.00 $265,000.00 2026-03-01
864734 CDM Sensor Pa Cardiomems 21 14 $176,523.00 $176,523.00 $26,831.50 $158,870.70 $114,739.95 2026-03-01
843718 CDM Set Exfx Rgd Distrt 34 15 $202,328.00 $202,328.00 $30,753.86 $182,095.20 $93,779.03 2026-03-01
863779 CDM Set Vntrc 17.4x13.8in 34 15 $436,050.00 $436,050.00 $66,279.60 $392,445.00 $202,109.17 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 10 5 — — $80,684.58 $163,212.33 $89,662.14 2026-03-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 3 2 — — $83,684.44 $87,207.99 $87,207.99 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 35 21 — — $1,975.00 $298,034.00 $73,376.20 2026-03-01
866765 CDM Stent Aaa 31x14.5 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
581868 CDM Stent Eprsth 15cm 8mm 21 14 $322,784.00 $322,784.00 $49,063.17 $290,505.60 $209,809.60 2026-03-01
780834 CDM Stent Eprsth 37x37x10cm 21 14 $177,532.00 $177,532.00 $26,984.86 $159,778.80 $115,395.80 2026-03-01
558473 CDM Stent Thor 20f 26x21x10 21 14 $177,532.00 $177,532.00 $26,984.86 $159,778.80 $115,395.80 2026-03-01
C1825 HCPCS System Nrstm Gen Ipg 21 14 $379,015.00 $379,015.00 $57,610.28 $341,113.50 $246,359.75 2026-03-01
875078 CDM Sz #000 Neuroblat Fulfre 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
C1840 HCPCS Telescope Impt Wa2.7x St 21 14 $124,684.00 $124,684.00 $18,951.97 $112,215.60 $81,044.60 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 21 15 — — $560,865.99 $594,857.87 $566,531.30 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
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
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 32 20 — — $1,975.00 $239,323.00 $118,193.20 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $140,292.35 $156,275.14 $148,283.74 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $96,005.80 $103,331.49 $99,668.65 2026-03-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $66,004.48 $71,576.31 $68,790.39 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $92,455.46 $101,268.68 $96,862.07 2026-03-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $68,082.75 $73,338.55 $70,710.65 2026-03-01
A9543 HCPCS Y90 Ibritum Tiu Tx 40mci 36 15 $298,867.00 $298,867.00 $45,427.78 $268,980.30 $126,570.17 2026-03-01
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