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

WOMANS HOSPITAL

Baton Rouge, LA · CCN 190128 · Rates published

20,887 distinct procedures filed
36 distinct payers
608,121 rate rows
2026-10-02 last MRF observed
Data quality

355,533 of 608,121 rate rows are consumer-grade (58.5%)

252,588 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 232,422
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 19,898
percent-of-charges filed in the dollar field — excluded from medians 173
placeholder amount (≤ $0.02) — excluded from medians 76
per-diem day rate — not a per-procedure price 18
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.womans.org/sites/default/files/2026-07/720652905_womans-hospital-foundation_standardcharges.csv
Found on page https://www.womans.org/patient-resources/billing-insurance/hospital-charges
Discovered viaCMS hospital list
Last fetch success · 2026-11-06
Content fingerprint 01ab39bf2e626c26… · 109,082,251 bytes · first seen 2026-11-06

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J3391
HCPCS 		Injection, Atidarsagene Autotemcel, Per Treatment 20 $3,992,781.50 $3,992,781.50 $3,992,781.50 nat. median
$4,505,000
0.9× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 20 $3,266,251.85 $3,266,251.85 $3,266,251.85 nat. median
$3,691,450
0.9× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 20 $2,939,380.79 $2,939,380.79 $2,939,380.79 nat. median
$3,324,572
0.9× median
J3394
HCPCS 		Injection, Lovotibeglogene Autotemcel, Per Treatment 20 $2,879,097.44 $2,879,097.44 $2,879,097.44 nat. median
$3,286,000
0.9× median
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 20 $2,610,809.36 $2,610,809.36 $2,610,809.36 nat. median
$2,983,626
0.9× median
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 20 $2,066,851.60 $2,066,851.60 $2,066,851.60 nat. median
$2,401,960
0.9× median
J3399
HCPCS 		Onasemnogene Abeparvovec-xioi 2 X 10exp13 Vg/ml IV Suspension,kit 15 $1,476,820.20 $2,313,684.98 $1,969,093.60 nat. median
$2,467,989
0.8× median
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 20 $683,000.51 $683,000.51 $683,000.51 nat. median
$813,967
0.8× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 20 $524,446.93 $524,446.93 $524,446.93 nat. median
$739,658
0.7× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 20 $501,529.65 $501,529.65 $501,529.65 nat. median
$646,415
0.8× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 20 $498,577.60 $498,577.60 $498,577.60 nat. median
$637,620
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 20 $493,950.88 $493,950.88 $493,950.88 nat. median
$621,967
0.8× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 20 $472,601.90 $472,601.90 $472,601.90 nat. median
$607,251
0.8× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 20 $433,670.68 $433,670.68 $433,670.68 nat. median
$589,091
0.7× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 20 $246,612.98 $246,612.98 $246,612.98 nat. median
$319,951
0.8× median
Q0480
HCPCS 		Dme Pos 20 $111,492.17 $111,492.17 $111,492.17 nat. median
$111,503
1.0× median
K1007
HCPCS 		Bil Hkaf Pc S/d Micro Sensor 20 $95,081.03 $95,081.03 $95,081.03 nat. median
$97,404
1.0× median
L8702
HCPCS 		Ewhf S/d Uprt Micro Sensor 20 $68,801.71 $68,801.71 $68,801.71 nat. median
$70,178
1.0× median
38240
CPT 		Transplt Allo Hct/donor 20 $56,956.76 $56,956.76 $56,956.76 nat. median
$12,901
outlier · 4.4×
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 20 $56,140.26 $56,140.26 $56,140.26 nat. median
$68,131
0.8× median
A9543
HCPCS 		Y90 Ibritumomab, Rx 20 $50,363.60 $50,363.60 $50,363.60 nat. median
$63,915
0.8× median
L7180
HCPCS 		Dme Pos 20 $50,007.15 $50,007.15 $50,007.15 nat. median
$46,980
1.1× median
L7181
HCPCS 		Dme Pos 20 $49,600.83 $49,600.83 $49,600.83 nat. median
$50,552
1.0× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 20 $48,987.86 $48,987.86 $48,987.86 nat. median
$65,318
0.7× median
J9226
HCPCS 		Supprelin La Implant 20 $39,901.80 $39,901.80 $39,901.80 nat. median
$55,159
0.7× median
620T
OTHER 		Evasc Ven Artlz Tibl/prnl Vn 20 $39,883.94 $39,883.94 $39,883.94 nat. median
$33,558
1.2× median
J9271
HCPCS 		Pembrolizumab (keytruda) 25 Mg/ml Intravenous Solution 15 $29,799.27 $46,685.52 $39,732.36 nat. median
$323
outlier · 123.0×
L2006
HCPCS 		Dme Pos 20 $39,525.62 $39,525.62 $39,525.62 nat. median
$39,926
1.0× median
790
MS_DRG 		Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 1 $37,736.00 $37,736.00 $37,736.00 nat. median
$50,769
0.7× median
L8701
HCPCS 		Ewh S/d Uprt Micro Sensor 20 $34,970.13 $34,970.13 $34,970.13 nat. median
$35,670
1.0× median
L5856
HCPCS 		Dme Pos 20 $29,717.20 $29,717.20 $29,717.20 nat. median
$30,151
1.0× median
L6880
HCPCS 		Dme Pos 20 $29,576.84 $29,576.84 $29,576.84 nat. median
$30,019
1.0× median
L6700
HCPCS 		Upper Extremity Addition, External Powered Feature, Myoelectronic Control Module… 20 $29,510.19 $29,510.19 $29,510.19 nat. median
$30,378
1.0× median
454
OTHER 		Anesth Collar Bone Biopsy 1 $29,286.43 $29,286.43 $29,286.43 nat. median
$11,917
outlier · 2.5×
33249
CPT 		Insj/rplcmt Defib W/lead(s) 20 $28,422.52 $28,422.52 $28,422.52 nat. median
$31,638
0.9× median
571T
OTHER 		Insj/rplcmt Icds Ss Eltrd 20 $28,422.52 $28,422.52 $28,422.52 nat. median
$32,332
0.9× median
408T
OTHER 		Insj/rplc Cardiac Modulj Sys 20 $28,422.52 $28,422.52 $28,422.52 nat. median
$32,332
0.9× median
33270
CPT 		Ins/rep Subq Defibrillator 20 $28,422.52 $28,422.52 $28,422.52 nat. median
$32,114
0.9× median
33231
CPT 		Insrt Pulse Gen W/mult Leads 20 $28,422.52 $28,422.52 $28,422.52 nat. median
$30,088
0.9× median
915T
OTHER 		Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 20 $28,422.52 $28,422.52 $28,422.52 nat. median
$32,922
0.9× median
33264
CPT 		Rmvl & Rplcmt Dfb Gen Mlt Ld 20 $28,422.52 $28,422.52 $28,422.52 nat. median
$31,574
0.9× median
674T
OTHER 		Laps Insj Nw/rpcmt Prm Isdss 20 $27,941.55 $27,941.55 $27,941.55 nat. median
$29,665
0.9× median
909T
OTHER 		Replacement Of Integrated Neurostimulation System, Vagus Nerve, Including Analys… 20 $27,941.55 $27,941.55 $27,941.55 nat. median
$5,297
outlier · 5.3×
908T
OTHER 		Open Implantation Of Integrated Neurostimulation System, Vagus Nerve, Including… 20 $27,941.55 $27,941.55 $27,941.55 nat. median
$5,297
outlier · 5.3×
793
MS_DRG 		Full Term Neonate With Major Problems 1 $26,474.00 $26,474.00 $26,474.00 nat. median
$33,600
0.8× median
J9266
HCPCS 		Pegaspargase Injection 20 $25,192.24 $25,192.24 $25,192.24 nat. median
$33,114
0.8× median
22630
CPT 		Arthrd Pst Tq 1ntrspc Lum 20 $24,569.77 $24,569.77 $24,569.77 nat. median
$16,840
1.5× median
27702
CPT 		Reconstruct Ankle Joint 20 $24,569.77 $24,569.77 $24,569.77 nat. median
$15,294
1.6× median
22558
CPT 		Arthrd Ant Ntrbd Min Dsc Lum 20 $24,569.77 $24,569.77 $24,569.77 nat. median
$8,403
outlier · 2.9×
20696
CPT 		App Mltpln Uni Xtrnl Fix 1st 20 $24,569.77 $24,569.77 $24,569.77 nat. median
$11,481
outlier · 2.1×

Other procedures at this hospital

Browse this hospital's 20,887 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
             
20982 CPT Ablate Bone Tumor(s) Perq 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
55882 CPT Ablation Of Prostate Tissue, Transurethral, Using Thermal Ultrasound, Including … 29 20 — — $11,946.63 $11,946.63 $11,946.63 2026-10-02
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 28 20 — — $683,000.51 $683,000.51 $683,000.51 2026-10-02
29867 CPT Allgrft Implnt Knee W/scope 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
24931 CPT Amputate Upper Arm & Implant 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27290 CPT Amputation Of Leg At Hip 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
27295 CPT Amputation Of Leg At Hip 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
24920 CPT Amputation Of Upper Arm 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
24900 CPT Amputation Of Upper Arm 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
454 OTHER Anesth Collar Bone Biopsy 1 1 — — $29,286.43 $29,286.43 $29,286.43 2026-10-02
22837 CPT Ant Thrc Vrt Body Tethrg 8+ 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22836 CPT Ant Thrc Vrt Body Tethrg <7 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
20696 CPT App Mltpln Uni Xtrnl Fix 1st 29 20 — — $24,569.77 $24,569.77 $24,569.77 2026-10-02
27280 CPT Arthr Si Jt Opn B1grf Instrm 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22808 CPT Arthrd Ant Dfrm 2-3 Vrt Sgm 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22810 CPT Arthrd Ant Dfrm 4-7 Vrt Sgm 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22812 CPT Arthrd Ant Dfrm 8+ Vrt Sgm 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22558 CPT Arthrd Ant Ntrbd Min Dsc Lum 29 20 — — $24,569.77 $24,569.77 $24,569.77 2026-10-02
22556 CPT Arthrd Ant Ntrbd Min Dsc Thc 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22548 CPT Arthrd Ant Toral/xoral C1-c2 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
22633 CPT Arthrd Cmbn 1ntrspc Lumbar 29 20 — — $24,569.77 $24,569.77 $24,569.77 2026-10-02
27286 CPT Arthrd Hip Jt Sbtrchc Osteot 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
22533 CPT Arthrd Lat Xtrcvtry Tq Lmbr 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22532 CPT Arthrd Lat Xtrcvtry Tq Thrc 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
22586 CPT Arthrd Pre-sac Ntrbdy L5-s1 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22804 CPT Arthrd Pst Dfrm 13+ Vrt Sgm 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22802 CPT Arthrd Pst Dfrm 7-12 Vrt Sgm 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22800 CPT Arthrd Pst Dfrm<6 Vrt Sgm 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22600 CPT Arthrd Pst Tq 1ntrspc Crv 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22630 CPT Arthrd Pst Tq 1ntrspc Lum 29 20 — — $24,569.77 $24,569.77 $24,569.77 2026-10-02
22612 CPT Arthrd Pst Tq 1ntrspc Lumbar 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22610 CPT Arthrd Pst Tq 1ntrspc Thrc 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22595 CPT Arthrd Pst Tq Atlas-axis 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
22590 CPT Arthrd Pst Tq Craniocervical 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
C9781 HCPCS Arthro/shoul Surg; W/spacer 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27284 CPT Arthrodesis Hip Joint 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 28 20 — — $472,601.90 $472,601.90 $472,601.90 2026-10-02
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 29 20 — — $95,081.03 $95,081.03 $95,081.03 2026-10-02
C9783 HCPCS Blind Cor Sinus Reducer Impl 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
C9758 HCPCS Blind Interatrial Shunt Ide 29 20 — — $15,510.69 $15,510.69 $15,510.69 2026-10-02
C9782 HCPCS Blind Myocar Trpl Bon Marrow 29 20 — — $15,510.69 $15,510.69 $15,510.69 2026-10-02
C2616 HCPCS Brachytx, Non-str,yttrium-90 28 20 — — $15,750.45 $15,750.45 $15,750.45 2026-10-02
585 MS_DRG Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/mcc 1 1 $49,233.81 $49,233.81 $9,872.00 $9,872.00 $9,872.00 2026-03-01
Q2053 HCPCS Brexucabtagene Car Pos T 28 20 — — $433,670.68 $433,670.68 $433,670.68 2026-10-02
C8005 HCPCS Bronchoscopy, Rigid Or Flexible, Non-thermal Transbronchial Ablation Of Lesion(s… 29 20 — — $15,510.69 $15,510.69 $15,510.69 2026-10-02
Q2056 HCPCS Ciltacabtagene Car-pos T 28 20 — — $501,529.65 $501,529.65 $501,529.65 2026-10-02
J7195 HCPCS Coagulation Factor Ix (recomb) 3,000 Unit Intravenous Solution 19 15 $21,052.80 $21,052.80 $14,736.96 $19,789.63 $16,842.24 2026-10-02
J7189 HCPCS Coagulation Factor Viia Recomb 2 Mg (2,000 Mcg) Intravenous Solution 19 15 $21,217.92 $21,217.92 $14,852.54 $19,944.84 $16,974.34 2026-10-02
93656 CPT Compre Ep Eval Abltj Atr Fib 29 20 — — $23,667.75 $23,667.75 $23,667.75 2026-10-02
93653 CPT Compre Ep Eval Tx Svt 29 20 — — $23,667.75 $23,667.75 $23,667.75 2026-10-02
93654 CPT Compre Ep Eval Tx Vt 29 20 — — $23,667.75 $23,667.75 $23,667.75 2026-10-02
J1162 HCPCS Digoxin Immune Fab 40 Mg Intravenous Solution 20 15 $20,532.68 $20,532.68 $12,319.61 $19,300.72 $16,426.14 2026-10-02
23920 CPT Disarticulation Shoulder 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
Q0480 HCPCS Dme Pos 29 20 — — $111,492.17 $111,492.17 $111,492.17 2026-10-02
L7180 HCPCS Dme Pos 29 20 — — $50,007.15 $50,007.15 $50,007.15 2026-10-02
L7181 HCPCS Dme Pos 29 20 — — $49,600.83 $49,600.83 $49,600.83 2026-10-02
L2006 HCPCS Dme Pos 29 20 — — $39,525.62 $39,525.62 $39,525.62 2026-10-02
L5856 HCPCS Dme Pos 29 20 — — $29,717.20 $29,717.20 $29,717.20 2026-10-02
L6880 HCPCS Dme Pos 29 20 — — $29,576.84 $29,576.84 $29,576.84 2026-10-02
L8614 HCPCS Dme Pos 29 20 — — $23,695.45 $23,695.45 $23,695.45 2026-10-02
L6975 HCPCS Dme Pos 29 20 — — $23,640.73 $23,640.73 $23,640.73 2026-10-02
L6970 HCPCS Dme Pos 29 20 — — $23,514.53 $23,514.53 $23,514.53 2026-10-02
Q0483 HCPCS Dme Pos 29 20 — — $23,210.23 $23,210.23 $23,210.23 2026-10-02
L6965 HCPCS Dme Pos 29 20 — — $23,134.38 $23,134.38 $23,134.38 2026-10-02
L5858 HCPCS Dme Pos 29 20 — — $23,006.91 $23,006.91 $23,006.91 2026-10-02
L5973 HCPCS Dme Pos 29 20 — — $21,297.95 $21,297.95 $21,297.95 2026-10-02
Q0489 HCPCS Dme Pos 29 20 — — $20,122.03 $20,122.03 $20,122.03 2026-10-02
Q0481 HCPCS Dme Pos 29 20 — — $17,987.99 $17,987.99 $17,987.99 2026-10-02
L5859 HCPCS Dme Pos 29 20 — — $17,961.29 $17,961.29 $17,961.29 2026-10-02
E0766 HCPCS Dme Pos 29 20 — — $16,384.73 $16,384.73 $16,384.73 2026-10-02
L6955 HCPCS Dme Pos 29 20 — — $16,060.21 $16,060.21 $16,060.21 2026-10-02
L6960 HCPCS Dme Pos 29 20 — — $15,836.16 $15,836.16 $15,836.16 2026-10-02
L7191 HCPCS Dme Pos 29 20 — — $14,868.87 $14,868.87 $14,868.87 2026-10-02
Q0479 HCPCS Dme Pos 29 20 — — $14,823.51 $14,823.51 $14,823.51 2026-10-02
L7186 HCPCS Dme Pos 29 20 — — $13,988.06 $13,988.06 $13,988.06 2026-10-02
L6945 HCPCS Dme Pos 29 20 — — $13,617.48 $13,617.48 $13,617.48 2026-10-02
L6950 HCPCS Dme Pos 29 20 — — $12,798.41 $12,798.41 $12,798.41 2026-10-02
L7190 HCPCS Dme Pos 29 20 — — $12,331.36 $12,331.36 $12,331.36 2026-10-02
L6940 HCPCS Dme Pos 29 20 — — $12,037.72 $12,037.72 $12,037.72 2026-10-02
L5991 HCPCS Dme Pos 29 20 — — $11,755.04 $11,755.04 $11,755.04 2026-10-02
E0783 HCPCS Dme Pos 29 20 — — $11,667.45 $11,667.45 $11,667.45 2026-10-02
E0786 HCPCS Dme Pos 29 20 — — $10,970.16 $10,970.16 $10,970.16 2026-10-02
L6935 HCPCS Dme Pos 29 20 — — $10,594.92 $10,594.92 $10,594.92 2026-10-02
L5857 HCPCS Dme Pos 29 20 — — $10,544.80 $10,544.80 $10,544.80 2026-10-02
L8679 HCPCS Dme Pos 29 20 — — $10,329.20 $10,329.20 $10,329.20 2026-10-02
L8619 HCPCS Dme Pos 29 20 — — $10,172.28 $10,172.28 $10,172.28 2026-10-02
L7185 HCPCS Dme Pos 29 20 — — $9,692.10 $9,692.10 $9,692.10 2026-10-02
E2510 HCPCS Dme Pos 29 20 — — $9,645.69 $9,645.69 $9,645.69 2026-10-02
L6930 HCPCS Dme Pos 29 20 — — $9,631.82 $9,631.82 $9,631.82 2026-10-02
C9785 HCPCS Endo Outlet Restrict W/tube 29 20 — — $9,625.28 $9,625.28 $9,625.28 2026-10-02
C9901 HCPCS Endoscopic Defect Closure Within The Entire Gastrointestinal Tract, Including Up… 29 20 — — $9,625.28 $9,625.28 $9,625.28 2026-10-02
61623 CPT Endovasc Tempory Vessel Occl 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
505T OTHER Ev Fempop Artl Revsc 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
620T OTHER Evasc Ven Artlz Tibl/prnl Vn 29 20 — — $39,883.94 $39,883.94 $39,883.94 2026-10-02
L8701 HCPCS Ewh S/d Uprt Micro Sensor 29 20 — — $34,970.13 $34,970.13 $34,970.13 2026-10-02
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 29 20 — — $68,801.71 $68,801.71 $68,801.71 2026-10-02
81416 CPT Exome Sequence Analysis 29 20 — — $12,000.00 $12,000.00 $12,000.00 2026-10-02
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 1 1 $102,070.76 $102,070.76 $37,736.00 $37,736.00 $37,736.00 2026-03-01
J1437 HCPCS Ferric Derisomaltose 100 Mg Iron/ml Intravenous Solution 20 15 $15,076.22 $15,076.22 $9,045.73 $14,171.65 $12,060.98 2026-10-02
793 MS_DRG Full Term Neonate With Major Problems 1 1 $19,335.25 $19,335.25 $26,474.00 $26,474.00 $26,474.00 2026-03-01
27580 CPT Fusion Of Knee 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
C1767 HCPCS Generator, Neuro Non-recharg 20 16 $16,940.00 $16,940.00 $11,858.00 $15,923.60 $13,552.00 2026-10-02
47490 CPT Hc Ir Cholecystostomy 19 15 $12,494.00 $12,494.00 $7,496.40 $11,744.36 $9,995.20 2026-03-01
37244 CPT Hc Vasc Embolization 19 15 $17,750.00 $17,750.00 $10,650.00 $16,685.00 $14,200.00 2026-03-01
37242 CPT Hc Vascular Embolization Or Occlusion Arterial Rs&I 19 15 $34,196.10 $34,196.10 $11,532.00 $18,066.80 $15,376.00 2026-03-01
37241 CPT Hc Vascular Embolization Or Occlusion Venous Rs&I 19 15 $16,681.00 $16,681.00 $10,008.60 $15,680.14 $13,344.80 2026-03-01
37243 CPT Hc Vascular Embolize/Occlude Organ Tumor Infarct - Uterine Fibroid 21 15 $37,168.28 $37,168.28 $12,139.20 $19,018.08 $16,185.60 2026-03-01
888T OTHER Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 29 20 — — $15,510.69 $15,510.69 $15,510.69 2026-10-02
686T OTHER Histotripsy Mal Hepatcel Tis 29 20 — — $15,510.69 $15,510.69 $15,510.69 2026-10-02
Q2055 HCPCS Idecabtagene Vicleucel Car 28 20 — — $493,950.88 $493,950.88 $493,950.88 2026-10-02
63655 CPT Implant Neuroelectrodes 29 20 — — $17,566.74 $17,566.74 $17,566.74 2026-10-02
66683 CPT Implantation Of Iris Prosthesis, Including Suture Fixation And Repair Or Removal… 29 20 — — $14,905.23 $14,905.23 $14,905.23 2026-10-02
C8003 HCPCS Implantation Of Medial Knee Extraarticular Implantable Shock Absorber Spanning T… 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
J1413 HCPCS Inj Delandistrogene Mox Rokl 28 20 — — $2,939,380.79 $2,939,380.79 $2,939,380.79 2026-10-02
J1412 HCPCS Inj Roctavian Ml 2x10^13vc G 28 20 — — $11,126.35 $11,126.35 $11,126.35 2026-10-02
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 28 20 — — $3,266,251.85 $3,266,251.85 $3,266,251.85 2026-10-02
J3391 HCPCS Injection, Atidarsagene Autotemcel, Per Treatment 28 20 — — $3,992,781.50 $3,992,781.50 $3,992,781.50 2026-10-02
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 28 20 — — $2,610,809.36 $2,610,809.36 $2,610,809.36 2026-10-02
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 28 20 — — $2,066,851.60 $2,066,851.60 $2,066,851.60 2026-10-02
J3394 HCPCS Injection, Lovotibeglogene Autotemcel, Per Treatment 28 20 — — $2,879,097.44 $2,879,097.44 $2,879,097.44 2026-10-02
33270 CPT Ins/rep Subq Defibrillator 29 20 — — $28,422.52 $28,422.52 $28,422.52 2026-10-02
64590 CPT Ins/rpl Prph Sac/gstr Npg/r 2 2 — — $2,190.40 $17,165.77 $9,678.09 2026-10-02
784T OTHER Ins/rplmt Eltrd Ra Spi Nstim 29 20 — — $10,089.67 $10,089.67 $10,089.67 2026-10-02
37182 CPT Insert Hepatic Shunt (tips) 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
54405 CPT Insert Multi-comp Penis Pros 29 20 — — $18,767.44 $18,767.44 $18,767.44 2026-10-02
33221 CPT Insert Pulse Gen Mult Leads 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
54401 CPT Insert Self-contd Prosthesis 29 20 — — $18,767.44 $18,767.44 $18,767.44 2026-10-02
54400 CPT Insert Semi-rigid Prosthesis 29 20 — — $11,946.63 $11,946.63 $11,946.63 2026-10-02
915T OTHER Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 29 20 — — $28,422.52 $28,422.52 $28,422.52 2026-10-02
916T OTHER Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 29 20 — — $20,141.49 $20,141.49 $20,141.49 2026-10-02
308T OTHER Insj Ocular Telescope Prosth 29 20 — — $14,905.23 $14,905.23 $14,905.23 2026-10-02
515T OTHER Insj Wcs Lv Compl Sys 29 20 — — $20,141.49 $20,141.49 $20,141.49 2026-10-02
409T OTHER Insj/rplc Car Modulj Pls Gn 29 20 — — $20,141.49 $20,141.49 $20,141.49 2026-10-02
408T OTHER Insj/rplc Cardiac Modulj Sys 29 20 — — $28,422.52 $28,422.52 $28,422.52 2026-10-02
525T OTHER Insj/rplcmt Compl Iims 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
33249 CPT Insj/rplcmt Defib W/lead(s) 29 20 — — $28,422.52 $28,422.52 $28,422.52 2026-10-02
571T OTHER Insj/rplcmt Icds Ss Eltrd 29 20 — — $28,422.52 $28,422.52 $28,422.52 2026-10-02
680T OTHER Insj/rplcmt Pg Only Isdss 29 20 — — $17,566.74 $17,566.74 $17,566.74 2026-10-02
786T OTHER Insj/rplcmt Prq Ra Sac Nstim 29 20 — — $10,089.67 $10,089.67 $10,089.67 2026-10-02
33230 CPT Insrt Pulse Gen W/dual Leads 29 20 — — $20,141.49 $20,141.49 $20,141.49 2026-10-02
33231 CPT Insrt Pulse Gen W/mult Leads 29 20 — — $28,422.52 $28,422.52 $28,422.52 2026-10-02
33240 CPT Insrt Pulse Gen W/singl Lead 29 20 — — $20,141.49 $20,141.49 $20,141.49 2026-10-02
J9029 HCPCS Instill Adstiladrin, Tx Dose 28 20 — — $56,140.26 $56,140.26 $56,140.26 2026-10-02
23900 CPT Interthoracoscplr Amputation 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
22818 CPT Kyphectomy 1-2 Segments 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22819 CPT Kyphectomy 3 Or More 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
43647 CPT Lap Impl Electrode Antrum 29 20 — — $10,089.67 $10,089.67 $10,089.67 2026-10-02
43775 CPT Lap Sleeve Gastrectomy 7 6 $46,562.96 $46,562.96 $10,022.25 $26,951.40 $14,831.32 2026-10-02
50542 CPT Laparo Ablate Renal Mass 29 20 — — $9,625.28 $9,625.28 $9,625.28 2026-10-02
45400 CPT Laparoscopic Proc 1 1 — — $23,000.00 $23,000.00 $23,000.00 2026-10-02
675T OTHER Laps Insj Nw/rpcmt Isdss 1ld 29 20 — — $10,089.67 $10,089.67 $10,089.67 2026-10-02
674T OTHER Laps Insj Nw/rpcmt Prm Isdss 29 20 — — $27,941.55 $27,941.55 $27,941.55 2026-10-02
55866 CPT Laps Surg Prst8ect Rpbic Rad 29 20 — — $9,625.28 $9,625.28 $9,625.28 2026-10-02
Q2054 HCPCS Lisocabtagene Mara Car Pos T 28 20 — — $498,577.60 $498,577.60 $498,577.60 2026-10-02
61715 CPT Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS), Ster… 29 20 — — $10,089.67 $10,089.67 $10,089.67 2026-10-02
58140 CPT Myomectomy Abdom Method 2 2 $26,515.14 $26,515.14 $8,876.80 $20,421.91 $14,649.35 2026-10-02
C9760 HCPCS Non-blind Interatrial Shunt 29 20 — — $24,373.69 $24,373.69 $24,373.69 2026-10-02
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 28 20 — — $246,612.98 $246,612.98 $246,612.98 2026-10-02
J3399 HCPCS Onasemnogene Abeparvovec-xioi 2 X 10exp13 Vg/ml IV Suspension,kit 20 15 $2,461,367.00 $2,461,367.00 $1,476,820.20 $2,313,684.98 $1,969,093.60 2026-10-02
908T OTHER Open Implantation Of Integrated Neurostimulation System, Vagus Nerve, Including … 29 20 — — $27,941.55 $27,941.55 $27,941.55 2026-10-02
37236 CPT Open/perq Place Stent 1st 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
37238 CPT Open/perq Place Stent Same 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
64580 CPT Opn Impltj Nea Neuromuscular 29 20 — — $17,566.74 $17,566.74 $17,566.74 2026-10-02
64575 CPT Opn Impltj Nea Perph Nerve 29 20 — — $10,089.67 $10,089.67 $10,089.67 2026-10-02
817T OTHER Opn Insj/rplcmt Ins Ptn Subf 29 20 — — $17,566.74 $17,566.74 $17,566.74 2026-10-02
816T OTHER Opn Insj/rplcmt Ins Ptn Subq 29 20 — — $17,566.74 $17,566.74 $17,566.74 2026-10-02
27415 CPT Osteochondral Knee Allograft 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
818 MS_DRG Other Antepartum Diagnoses With O.r. Procedures With Cc 1 1 $30,452.20 $30,452.20 $11,925.75 $11,925.75 $11,925.75 2026-03-01
817 MS_DRG Other Antepartum Diagnoses With O.r. Procedures With Mcc 1 1 $39,921.59 $39,921.59 $23,473.50 $23,473.50 $23,473.50 2026-03-01
908 MS_DRG Other O.r. Procedures For Injuries With Cc 1 1 $36,916.51 $36,916.51 $14,614.00 $14,614.00 $14,614.00 2026-03-01
J2426 HCPCS Paliperidone Palmitate 234 Mg/1.5 Ml Intramuscular Syringe 20 15 $14,733.46 $14,733.46 $8,840.08 $13,849.45 $11,786.77 2026-10-02
956T OTHER Partial Craniectomy, Channel Creation, And Tunneling Of Electrode For Sub-scalp … 29 20 — — $24,569.77 $24,569.77 $24,569.77 2026-10-02
27125 CPT Partial Hip Replacement 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
J9266 HCPCS Pegaspargase Injection 28 20 — — $25,192.24 $25,192.24 $25,192.24 2026-10-02
J9271 HCPCS Pembrolizumab (keytruda) 25 Mg/ml Intravenous Solution 22 15 $49,665.45 $49,665.45 $29,799.27 $46,685.52 $39,732.36 2026-10-02
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
C9604 HCPCS Perc D-e Cor Revasc T Cabg S 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
C9602 HCPCS Perc D-e Cor Stent Ather S 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
C9600 HCPCS Perc Drug-el Cor Stent Sing 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
913T OTHER Percutaneous Transcatheter Therapeutic Drug Delivery By Intracoronary Drug-deliv… 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
629T OTHER Perq Njx Algc CT Lmbr 1st 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
627T OTHER Perq Njx Algc Fluor Lmbr 1st 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
632T OTHER Perq Tcat US Abltj Nrv P-art 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
93582 CPT Perq Transcath Closure Pda 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
93591 CPT Perq Transcath Cls Aortic 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
93590 CPT Perq Transcath Cls Mitral 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
219T OTHER Plmt Post Facet Implt Cerv 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
220T OTHER Plmt Post Facet Implt Thor 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
J9600 HCPCS Porfimer Sodium Injection 28 20 — — $21,473.65 $21,473.65 $21,473.65 2026-10-02
202T OTHER Post Vert Arthrplst 1 Lumbar 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
769 MS_DRG Postpartum And Post Abortion Diagnoses With O.r. Procedures 1 1 $23,630.05 $23,630.05 $16,339.00 $16,339.00 $16,339.00 2026-03-01
791 MS_DRG Prematurity With Major Problems 1 1 $48,305.06 $48,305.06 $17,752.12 $17,752.12 $17,752.12 2026-03-01
792 MS_DRG Prematurity Without Major Problems 1 1 $5,701.75 $5,701.75 $15,551.00 $15,551.00 $15,551.00 2026-03-01
37184 CPT Prim Art M-thrmbc 1st Vsl 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
92924 CPT Prq Card Angio/athrect 1 Art 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
92943 CPT Prq Card Revasc Chronic 1vsl 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
92928 CPT Prq Card Stent W/angio 1 Vsl 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
92933 CPT Prq Card Stent/ath/angio 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
92937 CPT Prq Revasc Byp Graft 1 Vsl 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
793T OTHER Prq Tcat Thrm Ablt Nrv P-art 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
92997 CPT Pul Art Balloon Repr Percut 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
27712 CPT Realignment Of Lower Leg 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27702 CPT Reconstruct Ankle Joint 29 20 — — $24,569.77 $24,569.77 $24,569.77 2026-10-02
24346 CPT Reconstruct Elbow Med Ligmnt 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
23472 CPT Reconstruct Shoulder Joint 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
23470 CPT Reconstruct Shoulder Joint 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27703 CPT Reconstruction Ankle Joint 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
27120 CPT Reconstruction Of Hip Socket 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
22849 CPT Reinsert Spinal Fixation 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
54411 CPT Remov/replc Penis Pros Comp 29 20 — — $18,767.44 $18,767.44 $18,767.44 2026-10-02
923T OTHER Removal And Replacement Of Permanent Cardiac Contractility Modulation-defibrilla… 29 20 — — $20,141.49 $20,141.49 $20,141.49 2026-10-02
27091 CPT Removal Of Hip Prosthesis 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27488 CPT Removal Of Knee Prosthesis 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
33229 CPT Remv&replc Pm Gen Mult Leads 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
54417 CPT Remv/replc Penis Pros Compl 29 20 — — $18,767.44 $18,767.44 $18,767.44 2026-10-02
909T OTHER Replacement Of Integrated Neurostimulation System, Vagus Nerve, Including Analys… 29 20 — — $27,941.55 $27,941.55 $27,941.55 2026-10-02
960T OTHER Replacement Of Sub-scalp Implanted Electrode Array, Receiver, And Telemetry Unit… 29 20 — — $24,569.77 $24,569.77 $24,569.77 2026-10-02
20805 CPT Replant Forearm Complete 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
20802 CPT Replantation Arm Complete 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
20838 CPT Replantation Foot Complete 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
20808 CPT Replantation Hand Complete 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22838 CPT Rev Rplc/rmv Thrc Vrt Tethrg 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22861 CPT Rev Rplcm Arthrp 1ntrspc Crv 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22862 CPT Rev Rplcm Rthrp 1ntrspc Lmbr 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
C9766 HCPCS Revasc Intra Lithotrip-ather 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
C9765 HCPCS Revasc Intra Lithotrip-stent 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
C9764 HCPCS Revasc Intravasc Lithotripsy 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
C9775 HCPCS Revasc Lith-sten-ath Tib/per 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
C9774 HCPCS Revasc Lithotr-ather Tib/per 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
C9773 HCPCS Revasc Lithotr-stent Tib/per 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
C9772 HCPCS Revasc Lithotrip Tibi/perone 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
C9767 HCPCS Revasc Lithotrip-stent-ather 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
23474 CPT Revis Reconst Shoulder Joint 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27138 CPT Revise Hip Joint Replacement 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27137 CPT Revise Hip Joint Replacement 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27134 CPT Revise Hip Joint Replacement 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27487 CPT Revise/replace Knee Joint 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
27486 CPT Revise/replace Knee Joint 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27446 CPT Revision Of Knee Joint 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27440 CPT Revision Of Knee Joint 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27715 CPT Revision Of Lower Leg 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
92987 CPT Revision Of Mitral Valve 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
92990 CPT Revision Of Pulmonary Valve 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
24940 CPT Revision Of Upper Arm 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
790T OTHER Revj Rplcmt/rmvl Vrt Tethrg 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
Q5119 HCPCS Rituximab-pvvr 10 Mg/ml Intravenous Solution 20 15 $14,794.76 $14,794.76 $8,876.86 $13,907.07 $11,835.81 2026-10-02
414T OTHER Rmvl & Rpl Car Modulj Pls Gn 29 20 — — $20,141.49 $20,141.49 $20,141.49 2026-10-02
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 29 20 — — $20,141.49 $20,141.49 $20,141.49 2026-10-02
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 29 20 — — $28,422.52 $28,422.52 $28,422.52 2026-10-02
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 29 20 — — $20,141.49 $20,141.49 $20,141.49 2026-10-02
614T OTHER Rmvl&rplcmt Ss Impl Dfb Pg 29 20 — — $20,141.49 $20,141.49 $20,141.49 2026-10-02
J3111 HCPCS Romosozumab-aqqg (evenity) 210 Mg/2.34 Ml(105 Mg/1.17 Ml X2) Subcutaneous Syring… 20 15 $19,478.28 $19,478.28 $11,686.97 $18,309.58 $15,582.62 2026-03-01
C8004 HCPCS Simulation Angiogram With Use Of A Pressure-generating Catheter (e.g., One-way V… 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 28 20 — — $48,987.86 $48,987.86 $48,987.86 2026-10-02
C9757 HCPCS Spine Device Implant Surgery 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
29907 CPT Subtalar Arthro W/fusion 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
J9226 HCPCS Supprelin La Implant 28 20 — — $39,901.80 $39,901.80 $39,901.80 2026-10-02
645T OTHER Tcat Impltj C Sins Rdctj Dev 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
823T OTHER Tcat Ins 1chmbr Ldls Pm Ra 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
795T OTHER Tcat Ins 2chmbr Ldls Pm Cmpl 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
796T OTHER Tcat Ins 2chmbr Ldls Pm Ra 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
797T OTHER Tcat Ins 2chmbr Ldls Pm Rv 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
801T OTHER Tcat Rmv&rpl 2chmbr Ldls Pm 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
825T OTHER Tcat Rmv&rpl1chmb Ldls Pm Ra 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
802T OTHER Tcat Rmv&rpl2chmb Ldls Pm Ra 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
803T OTHER Tcat Rmv&rpl2chmb Ldls Pm Rv 29 20 — — $17,441.40 $17,441.40 $17,441.40 2026-10-02
Q2042 HCPCS Tisagenlecleucel Car-pos T 28 20 — — $524,446.93 $524,446.93 $524,446.93 2026-10-02
22856 CPT Tot Disc Arthrp 1ntrspc Crv 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
22857 CPT Tot Disc Arthrp 1ntrspc Lmbr 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
27130 CPT Total Hip Arthroplasty 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27132 CPT Total Hip Arthroplasty 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27447 CPT Total Knee Arthroplasty 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
53451 CPT Tprnl Balo Cntnc Dev Bi 29 20 — — $11,946.63 $11,946.63 $11,946.63 2026-10-02
93580 CPT Transcath Closure Of Asd 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
93581 CPT Transcath Closure Of Vsd 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
61624 CPT Transcath Occlusion Cns 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
61626 CPT Transcath Occlusion Non-cns 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
981T OTHER Transcatheter Implantation Of Wireless Inferior Vena Cava Sensor For Long-term H… 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
38240 CPT Transplt Allo Hct/donor 29 20 — — $56,956.76 $56,956.76 $56,956.76 2026-10-02
22326 CPT Treat Neck Spine Fracture 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
22319 CPT Treat Odontoid Fx W/graft 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
22318 CPT Treat Odontoid Fx Without Graft 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
22325 CPT Treat Spine Fracture 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
22327 CPT Treat Thorax Spine Fracture 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27514 CPT Treatment Of Thigh Fracture 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27511 CPT Treatment Of Thigh Fracture 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
27513 CPT Treatment Of Thigh Fracture 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
236T OTHER Trluml Perip Athrc Abd Aorta 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
237T OTHER Trluml Perip Athrc Brchiocph 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
238T OTHER Trluml Perip Athrc Iliac Art 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
234T OTHER Trluml Perip Athrc Renal Art 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
582T OTHER Trurl Abltj Mal Prst8 Tiss 29 20 — — $11,946.63 $11,946.63 $11,946.63 2026-10-02
C9734 HCPCS U/s Trtmt, Not Leiomyomata 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
L6700 HCPCS Upper Extremity Addition, External Powered Feature, Myoelectronic Control Module… 29 20 — — $29,510.19 $29,510.19 $29,510.19 2026-10-02
C9797 HCPCS Vasc Emb/occ W/prs Cath 29 20 — — $16,599.24 $16,599.24 $16,599.24 2026-10-02
37187 CPT Venous Mech Thrombectomy 29 20 — — $10,453.23 $10,453.23 $10,453.23 2026-10-02
657T OTHER Vrt Bdy Tethering Ant 8+ Seg 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
656T OTHER Vrt Bdy Tethering Ant <7 Seg 29 20 — — $15,876.81 $15,876.81 $15,876.81 2026-10-02
737T OTHER Xenograft Impltj Artclr Surf 29 20 — — $11,625.38 $11,625.38 $11,625.38 2026-10-02
A9543 HCPCS Y90 Ibritumomab, Rx 28 20 — — $50,363.60 $50,363.60 $50,363.60 2026-10-02
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