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

NORTH CANYON MEDICAL CENTER

Gooding, ID · CCN 131302 · Rates published

20,174 distinct procedures filed
11 distinct payers
338,762 rate rows
2026-04-13 last MRF observed
Data quality

164,968 of 338,762 rate rows are consumer-grade (48.7%)

173,794 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 167,633
per-diem day rate — not a per-procedure price 6,117
exceeds 10× this hospital's gross charge — excluded from medians 41
placeholder amount (≤ $0.02) — excluded from medians 3
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://mrfs.hyvehealthcare.com/NorthCanyonMedicalCenter/261938641_north-canyon-medical-center-inc._standardcharges.csv
Found on page https://northcanyon.org/patient-info/billing/pricing-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint 9272d8e106ffab6e… · 72,768,408 bytes · first seen 2026-05-09

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
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 11 $3,672,900.00 $3,672,900.00 $3,672,900.00 nat. median
$3,710,000
1.0× median
J1414
HCPCS 		Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose 11 $3,605,000.00 $3,605,000.00 $3,605,000.00 nat. median
$3,710,000
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 11 $3,325,454.76 $3,325,454.76 $3,325,454.76 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Injection, Lovotibeglogene Autotemcel, Per Treatment 11 $3,286,000.00 $3,286,000.00 $3,286,000.00 nat. median
$3,286,000
1.0× median
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 11 $2,968,000.00 $2,968,000.00 $2,968,000.00 nat. median
$3,004,655
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 11 $2,388,614.23 $2,388,614.23 $2,388,614.23 nat. median
$2,468,984
1.0× median
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 11 $2,332,000.00 $2,332,000.00 $2,332,000.00 nat. median
$2,448,600
1.0× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 11 $529,192.86 $529,192.86 $529,192.86 nat. median
$753,246
0.7× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 11 $527,123.43 $527,123.43 $527,123.43 nat. median
$674,867
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 11 $526,587.59 $526,587.59 $526,587.59 nat. median
$625,184
0.8× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 11 $516,726.08 $516,726.08 $516,726.08 nat. median
$673,137
0.8× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 11 $489,455.96 $489,455.96 $489,455.96 nat. median
$634,303
0.8× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 11 $460,530.40 $460,530.40 $460,530.40 nat. median
$619,808
0.7× median
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 11 $63,354.77 $63,354.77 $63,354.77 nat. median
$69,774
0.9× median
38240
CPT 		Transplt Allo Hct/donor 11 $59,142.33 $59,142.33 $59,142.33 nat. median
$15,979
outlier · 3.7×
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 11 $55,015.23 $55,015.23 $55,015.23 nat. median
$66,682
0.8× median
J9226
HCPCS 		Supprelin La Implant 11 $45,350.22 $45,350.22 $45,350.22 nat. median
$60,368
0.8× median
33276
CPT 		Insj Phrnc Nrv Stim Sys 11 $45,000.50 $45,000.50 $45,000.50 nat. median
$43,787
1.0× median
C2616
HCPCS 		Brachytx, Non-str,yttrium-90 11 $17,485.10 $70,511.31 $43,998.21 nat. median
$28,140
1.6× median
620T
CPT 		Evasc Ven Artlz Tibl/prnl Vn 11 $35,000.50 $35,000.50 $35,000.50 —
C1820
HCPCS 		Generator Neuro Rechg Bat Sy 5 $25,482.16 $83,246.10 $34,140.65 nat. median
$22,013
1.6× median
915T
CPT 		Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 11 $32,061.58 $32,061.58 $32,061.58 —
33264
CPT 		Rmvl & Rplcmt Dfb Gen Mlt Ld 11 $32,061.58 $32,061.58 $32,061.58 nat. median
$31,873
1.0× median
408T
CPT 		Insj/rplc Cardiac Modulj Sys 11 $32,061.58 $32,061.58 $32,061.58 —
33249
CPT 		Insj/rplcmt Defib W/lead(s) 11 $32,061.58 $32,061.58 $32,061.58 nat. median
$31,833
1.0× median
33270
CPT 		Ins/rep Subq Defibrillator 11 $32,061.58 $32,061.58 $32,061.58 nat. median
$32,221
1.0× median
33231
CPT 		Insrt Pulse Gen W/mult Leads 11 $32,061.58 $32,061.58 $32,061.58 nat. median
$30,121
1.1× median
571T
CPT 		Insj/rplcmt Icds Ss Eltrd 11 $32,061.58 $32,061.58 $32,061.58 —
69930
CPT 		Implant Cochlear Device 11 $31,807.82 $31,807.82 $31,807.82 nat. median
$29,690
1.1× median
61886
CPT 		Implant Neurostim Arrays 11 $30,473.59 $30,473.59 $30,473.59 nat. median
$27,109
1.1× median
674T
CPT 		Laps Insj Nw/rpcmt Prm Isdss 11 $30,473.59 $30,473.59 $30,473.59 —
33287
CPT 		Rmv&rplcmt Phrnc Nrv Stim Pg 11 $30,473.59 $30,473.59 $30,473.59 nat. median
$29,698
1.0× median
64568
CPT 		Opn Impltj Crnl Nrv Nea&pg 11 $30,473.59 $30,473.59 $30,473.59 nat. median
$27,591
1.1× median
64582
CPT 		Opn Mpltj Hpglsl Nstm Ary Pg 11 $30,473.59 $30,473.59 $30,473.59 nat. median
$28,316
1.1× median
33289
CPT 		Tcat Impl Wrls P-art Prs Snr 11 $28,428.33 $28,428.33 $28,428.33 nat. median
$28,318
1.0× median
C9760
HCPCS 		Non-blind Interatrial Shunt 11 $27,500.50 $27,500.50 $27,500.50 nat. median
$28,405
1.0× median
J9266
HCPCS 		Pegaspargase Injection 11 $27,070.53 $27,070.53 $27,070.53 nat. median
$34,109
0.8× median
266T
CPT 		Implt/rpl Crtd Sns Dev Total 11 $4,335.45 $45,000.50 $24,667.97 —
93656
CPT 		Compre Ep Eval Abltj Atr Fib 11 $24,532.30 $24,532.30 $24,532.30 nat. median
$26,811
0.9× median
93654
CPT 		Compre Ep Eval Tx Vt 11 $24,532.30 $24,532.30 $24,532.30 nat. median
$26,704
0.9× median
93653
CPT 		Compre Ep Eval Tx Svt 11 $24,532.30 $24,532.30 $24,532.30 nat. median
$26,156
0.9× median
J9600
HCPCS 		Porfimer Sodium Injection 11 $23,870.14 $23,870.14 $23,870.14 nat. median
$31,627
0.8× median
C1778
HCPCS 		Lead, Neurostimulator 1 $22,842.75 $22,842.75 $22,842.75 nat. median
$4,308
outlier · 5.3×
515T
CPT 		Insj Wcs Lv Compl Sys 11 $22,446.19 $22,446.19 $22,446.19 —
414T
CPT 		Rmvl & Rpl Car Modulj Pls Gn 11 $22,446.19 $22,446.19 $22,446.19 —
614T
CPT 		Rmvl&rplcmt Ss Impl Dfb Pg 11 $22,446.19 $22,446.19 $22,446.19 —
409T
CPT 		Insj/rplc Car Modulj Pls Gn 11 $22,446.19 $22,446.19 $22,446.19 —
916T
CPT 		Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 11 $22,446.19 $22,446.19 $22,446.19 —
923T
CPT 		Removal And Replacement Of Permanent Cardiac Contractility Modulation-defibrilla… 11 $22,446.19 $22,446.19 $22,446.19 —
33240
CPT 		Insrt Pulse Gen W/singl Lead 11 $22,446.19 $22,446.19 $22,446.19 nat. median
$22,137
1.0× median

Other procedures at this hospital

Browse this hospital's 20,174 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
             
19357 CPT Tiss Xpndr Plmt Brst Rcnstj 16 11 — — $17,398.35 $17,398.35 $17,398.35 2026-04-13
20982 CPT Ablate Bone Tumor(s) Perq 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
21243 CPT Reconstruction Of Jaw Joint 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
22554 CPT Arthrd Ant Ntrbd Min Dsc Crv 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
22630 CPT Arthrd Pst Tq 1ntrspc Lum 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
22856 CPT Tot Disc Arthrp 1ntrspc Crv 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
22867 CPT Insj Stablj Dev W/dcmprn 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
22869 CPT Insj Stablj Dev Without Dcmprn 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
23470 CPT Reconstruct Shoulder Joint 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
23485 CPT Revision Of Collar Bone 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
23491 CPT Reinforce Shoulder Bones 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
234T CPT Trluml Perip Athrc Renal Art 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
23616 CPT Optx Prx Hmrl Fx Fix Rpr Rpl 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
23680 CPT Optx Sho Dislc Neck Fx Fixj 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
236T CPT Trluml Perip Athrc Abd Aorta 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
237T CPT Trluml Perip Athrc Brchiocph 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
23802 CPT Arthrd Glenohumeral Jt W/grf 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
238T CPT Trluml Perip Athrc Iliac Art 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
24346 CPT Reconstruct Elbow Med Ligmnt 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24361 CPT Reconstruct Elbow Joint 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
24362 CPT Reconstruct Elbow Joint 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24363 CPT Replace Elbow Joint 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
24365 CPT Reconstruct Head Of Radius 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24370 CPT Revise Reconst Elbow Joint 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24371 CPT Revise Reconst Elbow Joint 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
24410 CPT Revision Of Humerus 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24430 CPT Repair Of Humerus 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24498 CPT Reinforce Humerus 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24516 CPT Treat Humerus Fracture 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24546 CPT Treat Humerus Fracture 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24579 CPT Treat Humerus Fracture 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24587 CPT Treat Elbow Fracture 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24666 CPT Treat Radius Fracture 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
24802 CPT Fusion/graft Of Elbow Joint 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
25365 CPT Revise Radius & Ulna 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
25391 CPT Lengthen Radius Or Ulna 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
25441 CPT Reconstruct Wrist Joint 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
25442 CPT Reconstruct Wrist Joint 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
25444 CPT Reconstruct Wrist Joint 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
25491 CPT Reinforce Ulna 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
266T CPT Implt/rpl Crtd Sns Dev Total 16 11 — — $4,335.45 $45,000.50 $24,667.97 2026-04-13
268T CPT Implt/rpl Crtd Sns Dev Gen 16 11 — — $9,295.81 $30,473.59 $19,884.70 2026-04-13
27278 CPT Arthrd Si Jt Prq Wo Tfxj Dev 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
27356 CPT Remove Femur Lesion/graft 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
27415 CPT Osteochondral Knee Allograft 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
27429 CPT Reconstruction Knee 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
27440 CPT Revision Of Knee Joint 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
27441 CPT Revision Of Knee Joint 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
27443 CPT Revision Of Knee Joint 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
27702 CPT Reconstruct Ankle Joint 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
27709 CPT Incision Of Tibia & Fibula 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
27828 CPT Treat Lower Leg Fracture 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
27871 CPT Fusion Of Tibiofibular Joint 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
28320 CPT Repair Of Foot Bones 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
28420 CPT Treat/graft Heel Fracture 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
28705 CPT Fusion Of Foot Bones 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
28715 CPT Fusion Of Foot Bones 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
28735 CPT Fusion Of Foot Bones 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
29856 CPT Tibial Arthroscopy/surgery 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
29867 CPT Allgrft Implnt Knee W/scope 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
308T CPT Insj Ocular Telescope Prosth 16 11 — — $16,416.44 $16,416.44 $16,416.44 2026-04-13
32604 CPT Thoracoscopy Wbx Sac 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
32607 CPT Thoracoscopy W/bx Infiltrate 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
32608 CPT Thoracoscopy W/bx Nodule 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
32994 CPT Ablate Pulm Tumor Perq Crybl 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
33206 CPT Insert Heart Pm Atrial 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
33207 CPT Insert Heart Pm Ventricular 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
33208 CPT Insrt Heart Pm Atrial & Vent 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
33213 CPT Insert Pulse Gen Dual Leads 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
33214 CPT Upgrade Of Pacemaker System 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
33221 CPT Insert Pulse Gen Mult Leads 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
33224 CPT Insert Pacing Lead & Connect 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
33228 CPT Remv&replc Pm Gen Dual Lead 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
33229 CPT Remv&replc Pm Gen Mult Leads 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
33230 CPT Insrt Pulse Gen W/dual Leads 16 11 — — $22,446.19 $22,446.19 $22,446.19 2026-04-13
33231 CPT Insrt Pulse Gen W/mult Leads 16 11 — — $32,061.58 $32,061.58 $32,061.58 2026-04-13
33240 CPT Insrt Pulse Gen W/singl Lead 16 11 — — $22,446.19 $22,446.19 $22,446.19 2026-04-13
33249 CPT Insj/rplcmt Defib W/lead(s) 16 11 — — $32,061.58 $32,061.58 $32,061.58 2026-04-13
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 16 11 — — $22,446.19 $22,446.19 $22,446.19 2026-04-13
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 16 11 — — $22,446.19 $22,446.19 $22,446.19 2026-04-13
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 16 11 — — $32,061.58 $32,061.58 $32,061.58 2026-04-13
33270 CPT Ins/rep Subq Defibrillator 16 11 — — $32,061.58 $32,061.58 $32,061.58 2026-04-13
33274 CPT Tcat Insj/rpl Perm Ldls Pm 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
33276 CPT Insj Phrnc Nrv Stim Sys 16 11 — — $45,000.50 $45,000.50 $45,000.50 2026-04-13
33287 CPT Rmv&rplcmt Phrnc Nrv Stim Pg 16 11 — — $30,473.59 $30,473.59 $30,473.59 2026-04-13
33288 CPT Rmv&rplcmt Phrnc Nrv Stim Ld 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
33289 CPT Tcat Impl Wrls P-art Prs Snr 16 11 — — $28,428.33 $28,428.33 $28,428.33 2026-04-13
33900 CPT Perq P-art Revsc 1 Nm Nt Uni 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
33901 CPT Perq P-art Revsc 1 Nm Nt Bi 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
33902 CPT Perq P-art Revsc 1 Abnor Uni 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
33903 CPT Perq P-art Revsc 1 Abnor Bi 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
36903 CPT Intro Cath Dialysis Circuit 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
36905 CPT Thrmbc/nfs Dialysis Circuit 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
36906 CPT Thrmbc/nfs Dialysis Circuit 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
37184 CPT Prim Art M-thrmbc 1st Vsl 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
37187 CPT Venous Mech Thrombectomy 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
37221 CPT Iliac Revasc W/stent 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
37225 CPT Fem/popl Revas W/ather 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
37226 CPT Fem/popl Revasc W/stent 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
37227 CPT Fem/popl Revasc Stnt & Ather 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
37228 CPT Tib/per Revasc W/tla 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
37229 CPT Tib/per Revasc W/ather 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
37230 CPT Tib/per Revasc W/stent 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
37231 CPT Tib/per Revasc Stent & Ather 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
37236 CPT Open/perq Place Stent 1st 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
37238 CPT Open/perq Place Stent Same 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
37241 CPT Vasc Embolize/occlude Venous 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
37242 CPT Vasc Embolize/occlude Artery 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
37243 CPT Vasc Embolize/occlude Organ 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
37244 CPT Vasc Embolize/occlude Bleed 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
38120 CPT Laparoscopy Splenectomy 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
38240 CPT Transplt Allo Hct/donor 16 11 — — $59,142.33 $59,142.33 $59,142.33 2026-04-13
38571 CPT Laparoscopy Lymphadenectomy 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
38572 CPT Laparoscopy Lymphadenectomy 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
38573 CPT Laps Pelvic Lymphadec 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
408T CPT Insj/rplc Cardiac Modulj Sys 16 11 — — $32,061.58 $32,061.58 $32,061.58 2026-04-13
409T CPT Insj/rplc Car Modulj Pls Gn 16 11 — — $22,446.19 $22,446.19 $22,446.19 2026-04-13
414T CPT Rmvl & Rpl Car Modulj Pls Gn 16 11 — — $22,446.19 $22,446.19 $22,446.19 2026-04-13
43210 CPT Egd Esophagogastrc Fndoplsty 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
43280 CPT Laparoscopy Fundoplasty 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
43282 CPT Lap Paraesoph Her Rpr W/mesh 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
43284 CPT Laps Esophgl Sphnctr Agmntj 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
43647 CPT Lap Impl Electrode Antrum 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
43648 CPT Lap Revise/remv Eltrd Antrum 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
43770 CPT Lap Place Gastr Adj Device 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
47370 CPT Laparo Ablate Liver Tumor Rf 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
47371 CPT Laparo Ablate Liver Cryosurg 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
47383 CPT Perq Abltj Lvr Cryoablation 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
47554 CPT Biliary Endoscopy Thru Skin 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
47556 CPT Biliary Endoscopy Thru Skin 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
47564 CPT Laparo Cholecystectomy/explr 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
49616 CPT Rpr Aa Hrn Rcr 3-10 Ncr/strn 1 1 — — $10,068.10 $10,068.10 $10,068.10 2026-04-13
50541 CPT Laparo Ablate Renal Cyst 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
50542 CPT Laparo Ablate Renal Mass 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
50543 CPT Laparo Partial Nephrectomy 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
50544 CPT Laparoscopy Pyeloplasty 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
50593 CPT Perc Cryo Ablate Renal Tum 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
505T CPT Ev Fempop Artl Revsc 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
50947 CPT Laparo New Ureter/bladder 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
50948 CPT Laparo New Ureter/bladder 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
515T CPT Insj Wcs Lv Compl Sys 16 11 — — $22,446.19 $22,446.19 $22,446.19 2026-04-13
516T CPT Insj Wcs Lv Eltrd Only 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
517T CPT Insj Wcs Lv Both Compnt Pg 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
519T CPT Rmv&rplcmt Pg Wcs Lv Both 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
520T CPT Rmv&rplcmt Pg Wcs Lv Battery 16 11 — — $10,465.33 $10,465.33 $10,465.33 2026-04-13
525T CPT Insj/rplcmt Compl Iims 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
53440 CPT Male Sling Procedure 16 11 — — $12,992.42 $12,992.42 $12,992.42 2026-04-13
53444 CPT Insert Tandem Cuff 16 11 — — $20,128.56 $20,128.56 $20,128.56 2026-04-13
53445 CPT Insert Uro/ves Nck Sphincter 16 11 — — $20,128.56 $20,128.56 $20,128.56 2026-04-13
53447 CPT Remove/replace Ur Sphincter 16 11 — — $20,128.56 $20,128.56 $20,128.56 2026-04-13
53451 CPT Tprnl Balo Cntnc Dev Bi 16 11 — — $12,992.42 $12,992.42 $12,992.42 2026-04-13
54400 CPT Insert Semi-rigid Prosthesis 16 11 — — $12,992.42 $12,992.42 $12,992.42 2026-04-13
54401 CPT Insert Self-contd Prosthesis 16 11 — — $20,128.56 $20,128.56 $20,128.56 2026-04-13
54405 CPT Insert Multi-comp Penis Pros 16 11 — — $20,128.56 $20,128.56 $20,128.56 2026-04-13
54410 CPT Remove/replace Penis Prosth 16 11 — — $20,128.56 $20,128.56 $20,128.56 2026-04-13
54411 CPT Remov/replc Penis Pros Comp 16 11 — — $20,128.56 $20,128.56 $20,128.56 2026-04-13
54416 CPT Remv/repl Penis Contain Pros 16 11 — — $20,128.56 $20,128.56 $20,128.56 2026-04-13
54417 CPT Remv/replc Penis Pros Compl 16 11 — — $12,992.42 $12,992.42 $12,992.42 2026-04-13
55866 CPT Laps Surg Prst8ect Rpbic Rad 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
55867 CPT Laps Surg Prst8ect Smpl Stot 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
55882 CPT Ablation Of Prostate Tissue, Transurethral, Using Thermal Ultrasound, Including … 16 11 — — $12,992.42 $12,992.42 $12,992.42 2026-04-13
571T CPT Insj/rplcmt Icds Ss Eltrd 16 11 — — $32,061.58 $32,061.58 $32,061.58 2026-04-13
57423 CPT Repair Paravag Defect Lap 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
57425 CPT Laparoscopy Surg Colpopexy 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
58544 CPT Lsh W/t/o Uterus Above 250 G 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
58546 CPT Laparo-myomectomy Complex 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
58552 CPT Laparo-vag Hyst Incl T/o 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
58553 CPT Laparo-vag Hyst Complex 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
58554 CPT Laparo-vag Hyst W/t/o Compl 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
58572 CPT Tlh Uterus Over 250 G 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
58573 CPT Tlh W/t/o Uterus Over 250 G 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
58673 CPT Laparoscopy Salpingostomy 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
58674 CPT Laps Abltj Uterine Fibroids 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
600T CPT Ire Abltj 1+tum Organ Perq 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
601T CPT Ire Abltj 1+tumors Open 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 16 11 — — $22,446.19 $22,446.19 $22,446.19 2026-04-13
61623 CPT Endovasc Tempory Vessel Occl 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
61626 CPT Transcath Occlusion Non-cns 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
61715 CPT Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS), Ster… 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
61885 CPT Insrt/redo Neurostim 1 Array 16 11 — — $21,444.39 $21,444.39 $21,444.39 2026-04-13
61886 CPT Implant Neurostim Arrays 16 11 — — $30,473.59 $30,473.59 $30,473.59 2026-04-13
61888 CPT Revise/remove Neuroreceiver 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
61891 CPT Rev/rplcmt Sk-mnt Crnl Nstm 16 11 — — $21,444.39 $21,444.39 $21,444.39 2026-04-13
620T CPT Evasc Ven Artlz Tibl/prnl Vn 16 11 — — $35,000.50 $35,000.50 $35,000.50 2026-04-13
62360 CPT Insert Spine Infusion Device 16 11 — — $17,674.12 $17,674.12 $17,674.12 2026-04-13
62361 CPT Implant Spine Infusion Pump 16 11 — — $17,674.12 $17,674.12 $17,674.12 2026-04-13
627T CPT Perq Njx Algc Fluor Lmbr 1st 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
629T CPT Perq Njx Algc CT Lmbr 1st 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
632T CPT Perq Tcat US Abltj Nrv P-art 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
63655 CPT Implant Neuroelectrodes 16 11 — — $21,444.39 $21,444.39 $21,444.39 2026-04-13
63664 CPT Revise Spine Eltrd Plate 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
64553 CPT Implant Neuroelectrodes 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
64568 CPT Opn Impltj Crnl Nrv Nea&pg 16 11 — — $30,473.59 $30,473.59 $30,473.59 2026-04-13
64569 CPT Revise/repl Vagus N Eltrd 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
64575 CPT Opn Impltj Nea Perph Nerve 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
64580 CPT Opn Impltj Nea Neuromuscular 16 11 — — $21,444.39 $21,444.39 $21,444.39 2026-04-13
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 16 11 — — $30,473.59 $30,473.59 $30,473.59 2026-04-13
64583 CPT Rev/rplct Hpglsl Nstm Ary Pg 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
64596 CPT Ins/rplcmt Prq Eltrd Ra Pn 1 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
645T CPT Tcat Impltj C Sins Rdctj Dev 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
65770 CPT Revise Cornea With Implant 16 11 — — $14,289.31 $14,289.31 $14,289.31 2026-04-13
66683 CPT Implantation Of Iris Prosthesis, Including Suture Fixation And Repair Or Removal… 16 11 — — $16,416.44 $16,416.44 $16,416.44 2026-04-13
67027 CPT Implant Eye Drug System 16 11 — — $15,364.83 $15,364.83 $15,364.83 2026-04-13
674T CPT Laps Insj Nw/rpcmt Prm Isdss 16 11 — — $30,473.59 $30,473.59 $30,473.59 2026-04-13
675T CPT Laps Insj Nw/rpcmt Isdss 1ld 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
677T CPT Laps Repos Lead Isdss 1st Ld 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
679T CPT Laps Rmvl Lead Isdss 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
680T CPT Insj/rplcmt Pg Only Isdss 16 11 — — $21,444.39 $21,444.39 $21,444.39 2026-04-13
686T CPT Histotripsy Mal Hepatcel Tis 16 11 — — $17,500.50 $17,500.50 $17,500.50 2026-04-13
69714 CPT Impl Oi Implt Skull Perq Esp 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
69716 CPT Impl Oi Implt Sk Tc Esp<100 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
69719 CPT Rplcm Oi Implt Sk Tc Esp<100 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
69729 CPT Impl Oi Implt Sk Tc Esp>=100 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
69730 CPT Rplc Oi Implt Sk Tc Esp>=100 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
69930 CPT Implant Cochlear Device 16 11 — — $31,807.82 $31,807.82 $31,807.82 2026-04-13
737T CPT Xenograft Impltj Artclr Surf 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
77371 CPT Srs Multisource 16 11 — — $7,644.49 $35,593.74 $21,619.12 2026-04-13
784T CPT Ins/rplmt Eltrd Ra Spi Nstim 16 11 — — $12,470.31 $12,470.31 $12,470.31 2026-04-13
793T CPT Prq Tcat Thrm Ablt Nrv P-art 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
795T CPT Tcat Ins 2chmbr Ldls Pm Cmpl 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
796T CPT Tcat Ins 2chmbr Ldls Pm Ra 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
797T CPT Tcat Ins 2chmbr Ldls Pm Rv 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
801T CPT Tcat Rmv&rpl 2chmbr Ldls Pm 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
802T CPT Tcat Rmv&rpl2chmb Ldls Pm Ra 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
803T CPT Tcat Rmv&rpl2chmb Ldls Pm Rv 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
81416 CPT Exome Sequence Analysis 16 11 — — $12,000.00 $12,000.00 $12,000.00 2026-04-13
816T CPT Opn Insj/rplcmt Ins Ptn Subq 16 11 — — $21,444.39 $21,444.39 $21,444.39 2026-04-13
817T CPT Opn Insj/rplcmt Ins Ptn Subf 16 11 — — $21,444.39 $21,444.39 $21,444.39 2026-04-13
823T CPT Tcat Ins 1chmbr Ldls Pm Ra 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
825T CPT Tcat Rmv&rpl1chmb Ldls Pm Ra 16 11 — — $19,071.16 $19,071.16 $19,071.16 2026-04-13
888T CPT Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 16 11 — — $17,500.50 $17,500.50 $17,500.50 2026-04-13
915T CPT Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 16 11 — — $32,061.58 $32,061.58 $32,061.58 2026-04-13
916T CPT Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 16 11 — — $22,446.19 $22,446.19 $22,446.19 2026-04-13
923T CPT Removal And Replacement Of Permanent Cardiac Contractility Modulation-defibrilla… 16 11 — — $22,446.19 $22,446.19 $22,446.19 2026-04-13
92924 CPT Prq Card Angio/athrect 1 Art 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
92928 CPT Prq Card Stent W/angio 1 Vsl 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
92933 CPT Prq Card Stent/ath/angio 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
92937 CPT Prq Revasc Byp Graft 1 Vsl 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
92943 CPT Prq Card Revasc Chronic 1vsl 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
92987 CPT Revision Of Mitral Valve 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
92990 CPT Revision Of Pulmonary Valve 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
92997 CPT Pul Art Balloon Repr Percut 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
93580 CPT Transcath Closure Of Asd 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
93581 CPT Transcath Closure Of Vsd 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
93582 CPT Perq Transcath Closure Pda 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
93590 CPT Perq Transcath Cls Mitral 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
93591 CPT Perq Transcath Cls Aortic 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
93653 CPT Compre Ep Eval Tx Svt 16 11 — — $24,532.30 $24,532.30 $24,532.30 2026-04-13
93654 CPT Compre Ep Eval Tx Vt 16 11 — — $24,532.30 $24,532.30 $24,532.30 2026-04-13
93656 CPT Compre Ep Eval Abltj Atr Fib 16 11 — — $24,532.30 $24,532.30 $24,532.30 2026-04-13
A9543 HCPCS Y90 Ibritumomab, Rx 16 11 — — $14,774.74 $14,774.74 $14,774.74 2026-04-13
C1778 HCPCS Lead, Neurostimulator 1 1 — — $22,842.75 $22,842.75 $22,842.75 2026-04-13
C1820 HCPCS Generator Neuro Rechg Bat Sy 7 5 — — $25,482.16 $83,246.10 $34,140.65 2026-04-13
C1889 HCPCS Implant/insert Device, Noc 1 1 — — $21,016.83 $21,016.83 $21,016.83 2026-04-13
C2616 HCPCS Brachytx, Non-str,yttrium-90 16 11 — — $17,485.10 $70,511.31 $43,998.21 2026-04-13
C8003 HCPCS Implantation Of Medial Knee Extraarticular Implantable Shock Absorber Spanning T… 16 11 — — $18,390.05 $18,390.05 $18,390.05 2026-04-13
C9600 HCPCS Perc Drug-el Cor Stent Sing 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
C9602 HCPCS Perc D-e Cor Stent Ather S 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
C9604 HCPCS Perc D-e Cor Revasc T Cabg S 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
C9757 HCPCS Spine Device Implant Surgery 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
C9758 HCPCS Blind Interatrial Shunt Ide 16 11 — — $17,500.50 $17,500.50 $17,500.50 2026-04-13
C9760 HCPCS Non-blind Interatrial Shunt 16 11 — — $27,500.50 $27,500.50 $27,500.50 2026-04-13
C9764 HCPCS Revasc Intravasc Lithotripsy 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
C9765 HCPCS Revasc Intra Lithotrip-stent 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
C9766 HCPCS Revasc Intra Lithotrip-ather 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
C9767 HCPCS Revasc Lithotrip-stent-ather 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
C9772 HCPCS Revasc Lithotrip Tibi/perone 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
C9773 HCPCS Revasc Lithotr-stent Tib/per 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
C9774 HCPCS Revasc Lithotr-ather Tib/per 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
C9775 HCPCS Revasc Lith-sten-ath Tib/per 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
C9781 HCPCS Arthro/shoul Surg; W/spacer 16 11 — — $12,866.82 $12,866.82 $12,866.82 2026-04-13
C9782 HCPCS Blind Myocar Trpl Bon Marrow 16 11 — — $17,500.50 $17,500.50 $17,500.50 2026-04-13
C9783 HCPCS Blind Cor Sinus Reducer Impl 16 11 — — $11,340.57 $11,340.57 $11,340.57 2026-04-13
C9784 HCPCS Endo Sleeve Gastro W/tube 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
C9785 HCPCS Endo Outlet Restrict W/tube 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
C9797 HCPCS Vasc Emb/occ W/prs Cath 16 11 — — $17,956.72 $17,956.72 $17,956.72 2026-04-13
C9901 HCPCS Endoscopic Defect Closure Within The Entire Gastrointestinal Tract, Including Up… 16 11 — — $10,411.22 $10,411.22 $10,411.22 2026-04-13
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 16 11 — — $3,672,900.00 $3,672,900.00 $3,672,900.00 2026-04-13
J1412 HCPCS Inj Roctavian Ml 2x10^13vc G 16 11 — — $12,007.81 $12,007.81 $12,007.81 2026-04-13
J1413 HCPCS Inj Delandistrogene Mox Rokl 16 11 — — $3,325,454.76 $3,325,454.76 $3,325,454.76 2026-04-13
J1414 HCPCS Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose 16 11 — — $3,605,000.00 $3,605,000.00 $3,605,000.00 2026-04-13
J3101 HCPCS Tenecteplase 50 Mg Rec 30 11 $27,898.07 $22,318.46 $157.72 $26,503.16 $11,438.20 2026-04-13
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 16 11 — — $2,332,000.00 $2,332,000.00 $2,332,000.00 2026-04-13
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 16 11 — — $2,968,000.00 $2,968,000.00 $2,968,000.00 2026-04-13
J3394 HCPCS Injection, Lovotibeglogene Autotemcel, Per Treatment 16 11 — — $3,286,000.00 $3,286,000.00 $3,286,000.00 2026-04-13
J3399 HCPCS Inj Onase Abepar-xioi Treat 16 11 — — $2,388,614.23 $2,388,614.23 $2,388,614.23 2026-04-13
J9029 HCPCS Instill Adstiladrin, Tx Dose 16 11 — — $63,354.77 $63,354.77 $63,354.77 2026-04-13
J9226 HCPCS Supprelin La Implant 16 11 — — $45,350.22 $45,350.22 $45,350.22 2026-04-13
J9266 HCPCS Pegaspargase Injection 16 11 — — $27,070.53 $27,070.53 $27,070.53 2026-04-13
J9600 HCPCS Porfimer Sodium Injection 16 11 — — $23,870.14 $23,870.14 $23,870.14 2026-04-13
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 16 11 — — $489,455.96 $489,455.96 $489,455.96 2026-04-13
Q2042 HCPCS Tisagenlecleucel Car-pos T 16 11 — — $529,192.86 $529,192.86 $529,192.86 2026-04-13
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 16 11 — — $55,015.23 $55,015.23 $55,015.23 2026-04-13
Q2053 HCPCS Brexucabtagene Car Pos T 16 11 — — $460,530.40 $460,530.40 $460,530.40 2026-04-13
Q2054 HCPCS Lisocabtagene Mara Car Pos T 16 11 — — $516,726.08 $516,726.08 $516,726.08 2026-04-13
Q2055 HCPCS Idecabtagene Vicleucel Car 16 11 — — $526,587.59 $526,587.59 $526,587.59 2026-04-13
Q2056 HCPCS Ciltacabtagene Car-pos T 16 11 — — $527,123.43 $527,123.43 $527,123.43 2026-04-13
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