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

SUNRISE HOSPITAL AND MEDICAL CENTER

Las Vegas, NV · CCN 290003 · Rates published

38,263 distinct procedures filed
35 distinct payers
1,269,494 rate rows
2026-03-01 last MRF observed
Data quality

750,336 of 1,269,494 rate rows are consumer-grade (59.1%)

519,158 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
professional (physician) fee — not the facility price 495,816
per-diem day rate — not a per-procedure price 11,355
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 9,286
placeholder amount (≤ $0.02) — excluded from medians 2,032
template filing: same amount across many unrelated codes — excluded 567
exceeds 10× this hospital's gross charge — excluded from medians 102
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://core.secure.ehc.com/src/util/detail-price-list/62-1762537_sunrise-hospital-and-medical-center_standardcharges.csv
Found on page https://mountainview-hospital.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-06-18

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
00845
OTHER 		Inj, Atidarsagene Autotem 1 $4,505,000.00 $4,505,000.00 $4,505,000.00 nat. median
$4,505,000
1.0× median
845
OTHER 		Inj, Atidarsagene Autotem 12 $6,236.64 $4,955,500.00 $4,505,000.00 nat. median
$9,966
outlier · 452.1×
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 12 $552,790.05 $4,422,320.40 $3,685,267.00 nat. median
$3,746,358
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,685,267.00 $3,685,267.00 $3,685,267.00 nat. median
$3,574,709
1.0× median
J1414
HCPCS 		Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose 1 $3,500,490.28 $3,500,490.28 $3,500,490.28 nat. median
$3,710,000
0.9× median
00908
OTHER 		Topi Adm Prad Zami Per Tr 1 $3,335,820.00 $3,335,820.00 $3,335,820.00 nat. median
$12,675
outlier · 263.2×
908
OTHER 		Topi Adm Prad Zami Per Tr 13 $11,292.32 $4,002,984.00 $3,335,820.00 nat. median
$22,747
outlier · 146.6×
714
OTHER 		Inj Delandistrogene Mox R 13 $7,335.12 $3,993,432.00 $3,327,860.00 nat. median
$13,041
outlier · 255.2×
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,327,860.00 $3,327,860.00 $3,327,860.00 nat. median
$3,228,024
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 13 $13,962.33 $3,903,009.60 $3,252,508.00 nat. median
$17,963
outlier · 181.1×
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $3,252,508.00 $3,252,508.00 $3,252,508.00 nat. median
$3,187,420
1.0× median
J1411
HCPCS 		Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 3 $2,968,000.00 $3,444,000.00 $3,206,000.00 nat. median
$3,710,000
0.9× median
C9172
HCPCS 		Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose 2 $2,884,000.00 $3,500,490.28 $3,192,245.14 nat. median
$3,570,000
0.9× median
00906
OTHER 		Inj Elivaldogene Autoteme 1 $3,180,000.00 $3,180,000.00 $3,180,000.00 nat. median
$21
outlier · 153697.4×
906
OTHER 		Inj Elivaldogene Autoteme 13 $9,978.09 $3,816,000.00 $3,180,000.00 nat. median
$20,756
outlier · 153.2×
00746
OTHER 		Inj, Betibeglogene Autote 1 $2,939,969.00 $2,939,969.00 $2,939,969.00 nat. median
$2,878,960
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 13 $12,915.31 $3,527,962.80 $2,939,969.00 nat. median
$21,896
outlier · 134.3×
J1413
HCPCS 		Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 2 $2,636,800.00 $3,200,490.28 $2,918,645.14 nat. median
$3,325,455
0.9× median
J3394
HCPCS 		Injection, Lovotibeglogene Autotemcel, Per Treatment 2 $2,628,800.00 $3,100,490.28 $2,864,645.14 nat. median
$3,286,000
0.9× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,588,981.00 $2,588,981.00 $2,588,981.00 nat. median
$2,457,321
1.1× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 12 $388,347.15 $3,106,777.20 $2,588,981.00 nat. median
$2,588,981
1.0× median
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 2 $2,374,400.00 $2,800,490.28 $2,587,445.14 nat. median
$3,006,423
0.9× median
00824
OTHER 		Inj, Exagamglogene Autote 1 $2,332,000.00 $2,332,000.00 $2,332,000.00 nat. median
$2,332,000
1.0× median
824
OTHER 		Inj, Exagamglogene Autote 13 $15,123.50 $2,798,400.00 $2,332,000.00 nat. median
$25,250
outlier · 92.4×
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $2,200,490.28 $2,200,490.28 $2,200,490.28 nat. median
$2,448,600
0.9× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 3 $1,842,227.74 $2,322,534.64 $2,082,381.19 nat. median
$2,469,189
0.8× median
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 4 $732,102.01 $1,656,833.00 $1,656,833.00 nat. median
$824,563
outlier · 2.0×
2067
OTHER 		Afamitresgene Autoleucel 12 $115,593.00 $924,744.00 $770,620.00 nat. median
$786,032
1.0× median
415455
CDM 		Kit Hrt Implant Lvas 10 $243,777.39 $1,166,399.00 $717,335.39 nat. median
$717,335
1.0× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 2 $598,237.50 $598,237.50 $598,237.50 nat. median
$324,450
1.8× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $587,649.60 $587,649.60 $587,649.60 nat. median
$554,552
1.1× median
9498
OTHER 		Ciltacabtagene Car-pos T 12 $88,147.44 $705,179.52 $587,649.60 nat. median
$587,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 12 $84,979.70 $679,837.56 $566,531.30 nat. median
$566,531
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $566,531.30 $566,531.30 $566,531.30 nat. median
$538,205
1.1× median
9413
OTHER 		Lisocabtagene Car Pos T 12 $84,330.18 $674,641.44 $562,201.20 nat. median
$562,201
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $562,201.20 $562,201.20 $562,201.20 nat. median
$534,091
1.1× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $558,081.80 $558,081.80 $558,081.80 nat. median
$530,178
1.1× median
9422
OTHER 		Idecabtagene Vicleucel Ca 12 $83,712.27 $669,698.16 $558,081.80 nat. median
$558,082
1.0× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 8 $405,756.74 $1,263,446.58 $553,169.00 nat. median
$675,122
0.8× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 8 $408,858.00 $1,218,042.30 $538,217.75 nat. median
$754,974
0.7× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $532,192.20 $532,192.20 $532,192.20 nat. median
$505,583
1.1× median
9035
OTHER 		Axicabtagene Ciloleucel C 12 $79,828.83 $638,630.64 $532,192.20 nat. median
$532,192
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 7 $387,752.24 $1,199,875.72 $530,190.66 nat. median
$625,184
0.8× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 8 $379,082.81 $1,208,732.67 $516,726.08 nat. median
$674,188
0.8× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 8 $359,552.00 $1,144,213.32 $502,841.00 nat. median
$634,511
0.8× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 1 $501,787.64 $501,787.64 $501,787.64 nat. median
$160,267
outlier · 3.1×
9391
OTHER 		Brexucabtagene Car Pos T 12 $73,417.53 $587,340.24 $489,450.20 nat. median
$489,450
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $489,450.20 $489,450.20 $489,450.20 nat. median
$464,978
1.1× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 8 $359,552.00 $1,052,317.93 $464,990.71 nat. median
$620,080
0.7× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 4 $191,598.58 $433,588.39 $433,588.39 nat. median
$209,753
outlier · 2.1×

Other procedures at this hospital

Browse this hospital's 38,263 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
415455 CDM Kit Hrt Implant Lvas 12 10 $1,166,399.00 $1,166,399.00 $243,777.39 $1,166,399.00 $717,335.39 2026-03-01
C1827 HCPCS Generator Pulse Implnt 12 10 $424,122.00 $424,122.00 $88,641.50 $424,122.00 $260,835.03 2026-03-01
418418 CDM Pump Heart 21fr 85mm 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
435578 CDM Cath Vasc Assist Strl 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
435041 CDM Kit Lo Prfl Comp Shth 7f 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
421214 CDM Kit Cath Rt Heart 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
589717 CDM Set Pump Asst 2.5in 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
439901 CDM System Hrt Vlv Transcath 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
576313 CDM Set Vntrc Asst 2.5in 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
920215 CDM Kit Cath Rt Heart 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
C2624 HCPCS System Mntr 2x15mm 4.5cm 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
418417 CDM Kit Bld Pump Cann 29fr 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
589716 CDM Set Vntrc 17.4x13.8in 22 16 $325,404.00 $325,404.00 $44,254.94 $325,404.00 $149,685.84 2026-03-01
423409 CDM Bundle Surg Gd Mdl Cstm 22 16 $261,002.00 $261,002.00 $35,496.27 $261,002.00 $120,060.92 2026-03-01
C2616 HCPCS Brachytx Ns Yttrium 90 103 9 $244,409.00 $244,409.00 $12,613.29 $221,924.00 $148,524.00 2026-03-01
409703 CDM Genrator Imp Pulse 7 12 10 $242,000.00 $242,000.00 $50,578.00 $242,000.00 $148,830.00 2026-03-01
437039 CDM Valve Tavr 26mm 12 10 $242,000.00 $242,000.00 $50,578.00 $242,000.00 $148,830.00 2026-03-01
437377 CDM Valve Tavr 34mm 12 10 $242,000.00 $242,000.00 $50,578.00 $242,000.00 $148,830.00 2026-03-01
437378 CDM Valve Tavr 29mm 12 10 $242,000.00 $242,000.00 $50,578.00 $242,000.00 $148,830.00 2026-03-01
593386 CDM Valve 26mm Thv 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
417745 CDM Valve Aor Tavr 29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
416371 CDM Valve Aor Tavr 23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
485167 CDM Stent Eprsth 12x37mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
409892 CDM Transcth Aortic Vlv 27mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410563 CDM Stent 20fr 31x31mm 10cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
408706 CDM Graft Evas 45x45mm 10cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
596320 CDM Valve Tavr 34mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
593933 CDM Kit Aor Vlv 14fr 20mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
594399 CDM Valve Tavr 26mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
416373 CDM Valve Aor Tavr 27mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410350 CDM Occluder Cardiac Lt 31mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
589828 CDM Kit Aor Vlv 20fr 29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
485896 CDM Implant Generator Pulse 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
589706 CDM Valve Aor 29x23-26mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410559 CDM Stent Graft 10cm 21x21mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
597719 CDM Valve Tavr 26mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
438779 CDM Stent Vasc 600mm 40mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
409890 CDM Transcth Aortic Vlv 25mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
589825 CDM Valve 29mm Ascendra Aor 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
407910 CDM Valve Tavr 29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
409893 CDM Transcth Aortic Vlv 29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410345 CDM Occluder Cardiac Lt 18mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
482967 CDM Valve Tavr 29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410352 CDM Occluder Cardiac Lt 34mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
583134 CDM Valve Aor Tavr 26mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
416251 CDM Valve Aor With Intro 23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410522 CDM Stent Thor 20f 26x21x10 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
593753 CDM Valve 23mm Thv 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
417746 CDM Valve Aor Tavr 34mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
437462 CDM Stent Vasc 600mm 50mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
416253 CDM Valve Aor With Intro 27mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
417393 CDM Valve Heart Trnscth 20mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
590894 CDM Valve Xt Sapien 26mm Ta 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
587800 CDM Valve Aor Tavr 23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
593387 CDM Kit Aor Vlv 14fr 29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
434124 CDM System Trcsd 1clip 1cath 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
419449 CDM Valve Plm Trnscth 22mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
573152 CDM Valve Aor Cndt 24mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410346 CDM Occluder Cardiac Lt 20mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410562 CDM Stent Eprsth 31x31x20cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
583135 CDM Valve Aor Tavr 23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
439902 CDM Valve Pulm 16mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
419450 CDM Valve Plm Trnscth 25mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
589710 CDM Valve Aor 23x18-20mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
920463 CDM Stent Graft 20cm 45x45mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
412374 CDM Stent Eprsth 37x37x20cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410348 CDM Occluder Cardiac Lt 25mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
417395 CDM Valve Heart Trnscth 26mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
411366 CDM Stent Eprsth 37x37x15cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410209 CDM Occluder Cardiac Lt 16mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
417394 CDM Valve Heart Trnscth 23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
420974 CDM Tavr Heart Valve 29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410347 CDM Occluder Cardiac Lt 22mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
423152 CDM Device Clsr 27mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
437689 CDM Stnt Thorac 28x28mm 10cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
578830 CDM Valve Pulm 18mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
423154 CDM Device Clsr 35mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
598197 CDM Valve Pulm 23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
587801 CDM Valve Aor Tavr 26mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
598198 CDM Valve Pulm 24mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
591646 CDM Valve Aor 31x26-29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
437762 CDM Stent Vasc 250mm 16mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
593876 CDM Valve Tavr 29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
589707 CDM Valve Aor 26x20-23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
918199 CDM Stent Graft 15cn 28x28mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
593480 CDM Valve Tavr 23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
438780 CDM Stent Vasc Vo3 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410349 CDM Occluder Cardiac Lt 28mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
481027 CDM Valve Aor 25mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
429795 CDM Stent Eprsth 37x37x10cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
590895 CDM Valve Xt Sapien 23mm Ta 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
437690 CDM Graft Evas 34x34x10cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
481469 CDM Stent Thor 31x26mm 10cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
574447 CDM Valve Aor 21mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
589826 CDM Valve Novaflx+ Trnfml 23 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
919971 CDM Stnt Thorac 26x26mm 10cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
439727 CDM Graft Evas 40x40x10cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
917537 CDM Valve Tavr Sz 26mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
409871 CDM Stent Eprsth 40x40x15cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
916616 CDM Valve Tavr Sz 29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
574759 CDM Graft Art St Tis 6-32mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
917536 CDM Valve Tavr Sz 23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
917538 CDM Valve Tavr Size 34mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
416372 CDM Valve Aor Tavr 25mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
413134 CDM Valve Tavr 20mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
407909 CDM Valve Tavr 26mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
416252 CDM Valve Aor With Intro 25mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
407908 CDM Valve Tavr 23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
437463 CDM Stent Vasc 250mm 12mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
418381 CDM Stent Eprsth 34x34x20cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
423155 CDM Device Clsr 40mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
597871 CDM Valve Tavr 29mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
410975 CDM Stent Eprsth 40x40x20cm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
409889 CDM Transcth Aortic Vlv 23mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
417744 CDM Valve Aor Tavr 26mm 12 10 $233,280.00 $233,280.00 $48,755.52 $233,280.00 $143,467.20 2026-03-01
C1822 HCPCS Pulse Gen Imp 24 10 $228,033.00 $228,033.00 $46,562.27 $233,280.00 $140,161.59 2026-03-01
573151 CDM Valve Aor Cndt 23mm 12 10 $227,160.00 $227,160.00 $47,476.44 $227,160.00 $139,703.40 2026-03-01
584033 CDM Valve Aor Cndt 18mm 12 10 $227,160.00 $227,160.00 $47,476.44 $227,160.00 $139,703.40 2026-03-01
418550 CDM Stent 34mmx34mmx15cm 12 10 $222,192.00 $222,192.00 $46,438.13 $222,192.00 $136,648.08 2026-03-01
485245 CDM Stent Graft 15cm 40x34mm 12 10 $222,192.00 $222,192.00 $46,438.13 $222,192.00 $136,648.08 2026-03-01
418382 CDM Stent Graft 15cm 31x31mm 12 10 $222,192.00 $222,192.00 $46,438.13 $222,192.00 $136,648.08 2026-03-01
C1882 HCPCS Crt-d Crd 5.37x8.08x0.99 216 10 $220,338.00 $220,338.00 $33,015.31 $242,000.00 $118,483.50 2026-03-01
419776 CDM Valve Aortic 23mm 12 10 $217,378.00 $217,378.00 $45,432.00 $217,378.00 $133,687.47 2026-03-01
419840 CDM Valve Aortic 27mm 12 10 $217,378.00 $217,378.00 $45,432.00 $217,378.00 $133,687.47 2026-03-01
419839 CDM Valve Aortic 25mm 12 10 $217,378.00 $217,378.00 $45,432.00 $217,378.00 $133,687.47 2026-03-01
419838 CDM Valve Aortic 21mm 12 10 $217,378.00 $217,378.00 $45,432.00 $217,378.00 $133,687.47 2026-03-01
419512 CDM Implant Cust Cranial Lge 12 10 $217,229.00 $217,229.00 $45,400.86 $217,229.00 $133,595.83 2026-03-01
581498 CDM Valve Pulmonary >23mm 12 10 $211,478.00 $211,478.00 $44,198.90 $211,478.00 $130,058.97 2026-03-01
417835 CDM Device Clsr 24mm 12 10 $210,409.00 $210,409.00 $43,975.48 $210,409.00 $129,401.54 2026-03-01
417834 CDM Device Clsr 20mm 12 10 $210,409.00 $210,409.00 $43,975.48 $210,409.00 $129,401.54 2026-03-01
417837 CDM Device Clsr 31mm 12 10 $210,409.00 $210,409.00 $43,975.48 $210,409.00 $129,401.54 2026-03-01
417836 CDM Device Clsr 27mm 12 10 $210,409.00 $210,409.00 $43,975.48 $210,409.00 $129,401.54 2026-03-01
417838 CDM Device Clsr 35mm 12 10 $210,409.00 $210,409.00 $43,975.48 $210,409.00 $129,401.54 2026-03-01
417735 CDM Kit Impl Crnl Cstm Lg 12 10 $206,601.00 $206,601.00 $43,179.61 $206,601.00 $127,059.62 2026-03-01
594740 CDM Valve Aor 12mm Av0012 12 10 $204,569.00 $204,569.00 $42,754.92 $204,569.00 $125,809.93 2026-03-01
594551 CDM Valve Aor Cndt 9mm 12 10 $204,569.00 $204,569.00 $42,754.92 $204,569.00 $125,809.93 2026-03-01
593591 CDM Valve Aor Cndt 17mm 12 10 $204,569.00 $204,569.00 $42,754.92 $204,569.00 $125,809.93 2026-03-01
586171 CDM Valve Aor Cndt 11mm 12 10 $204,569.00 $204,569.00 $42,754.92 $204,569.00 $125,809.93 2026-03-01
597392 CDM Valve Aor Cndt 10mm 12 10 $204,569.00 $204,569.00 $42,754.92 $204,569.00 $125,809.93 2026-03-01
586606 CDM Valve Aor Cndt 14mm 12 10 $204,569.00 $204,569.00 $42,754.92 $204,569.00 $125,809.93 2026-03-01
598338 CDM Valve Aor Crvlv 9-17mm 12 10 $201,774.00 $201,774.00 $42,170.77 $201,774.00 $124,091.01 2026-03-01
913728 CDM Valve Mitral Size 33 12 10 $197,909.00 $197,909.00 $41,362.98 $197,909.00 $121,714.04 2026-03-01
598339 CDM Valve Aortic 6-30mm 12 10 $196,029.00 $196,029.00 $40,970.06 $196,029.00 $120,557.83 2026-03-01
415919 CDM Valve Aor Crvlvcndt 16mm 12 10 $196,029.00 $196,029.00 $40,970.06 $196,029.00 $120,557.83 2026-03-01
586414 CDM Valve Aor Crvlv 26mm 12 10 $196,029.00 $196,029.00 $40,970.06 $196,029.00 $120,557.83 2026-03-01
595303 CDM Valve Aortic 20mm 12 10 $196,029.00 $196,029.00 $40,970.06 $196,029.00 $120,557.83 2026-03-01
913241 CDM Coil Embol Neuro 4x2mm 12 10 $193,951.00 $193,951.00 $40,535.76 $193,951.00 $119,279.87 2026-03-01
419694 CDM Device Embl 10mm 2.5mm 12 10 $191,844.00 $191,844.00 $40,095.40 $191,844.00 $117,984.06 2026-03-01
J9999 HCPCS Carmustine Wafers 8/box 11 9 $190,939.00 $190,939.00 $28,640.85 $190,939.00 $120,291.57 2026-03-01
411781 CDM Graft Endo Aaa 28.5x12mm 12 10 $188,421.00 $188,421.00 $39,379.99 $188,421.00 $115,878.92 2026-03-01
918878 CDM Graft Endo Aaa 26x12mm 12 10 $188,421.00 $188,421.00 $39,379.99 $188,421.00 $115,878.92 2026-03-01
411669 CDM Graft Endo Aaa 36x14mm 12 10 $188,421.00 $188,421.00 $39,379.99 $188,421.00 $115,878.92 2026-03-01
914107 CDM Graft Endo Aaa 32x14mm 12 10 $188,421.00 $188,421.00 $39,379.99 $188,421.00 $115,878.92 2026-03-01
913391 CDM Graft Endo Aaa 23x12mm 12 10 $188,421.00 $188,421.00 $39,379.99 $188,421.00 $115,878.92 2026-03-01
585062 CDM Valve Aortic 13mm Cryo 12 10 $186,014.00 $186,014.00 $38,876.93 $186,014.00 $114,398.61 2026-03-01
303496 CDM Valve Aortic =16mm 12 10 $182,197.00 $182,197.00 $38,079.17 $182,197.00 $112,051.15 2026-03-01
591903 CDM Coil Embl 30x4mm 12 10 $180,507.00 $180,507.00 $37,725.96 $180,507.00 $111,011.80 2026-03-01
587841 CDM Coil Embl 5x25mm 12 10 $180,507.00 $180,507.00 $37,725.96 $180,507.00 $111,011.80 2026-03-01
301096 CDM Valve Pulmonary Sm 12 10 $180,401.00 $180,401.00 $37,703.81 $180,401.00 $110,946.62 2026-03-01
419815 CDM Device Embl 3.5mm 10mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419703 CDM Device Embl 3.25x12mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419726 CDM Device Embl 4.5mm 30mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
420247 CDM Device Embl 3.25mm 14mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
420950 CDM Device Embl 4.75mm 25mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419814 CDM Device Embl 2.75mm 12mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419720 CDM Device Embl 4.25mm 18mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419728 CDM Device Embl 4.75mm 18mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419729 CDM Device Embl 5mm 12mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419704 CDM Device Embl 3.5mm 14mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419721 CDM Device Embl 4.25mm 20mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419727 CDM Device Embl 4.75mm 16mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419723 CDM Device Embl 4.50x16mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419714 CDM Device Embl 4mm 16mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419715 CDM Device Embl 4mm 18mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419732 CDM Device Embl 5mm 18mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419722 CDM Device Embl 4.5mm 12mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419708 CDM Device Embl 3.75mm 12mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419724 CDM Device Embl 4.5mm 18mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419733 CDM Device Embl 5.0x20mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419725 CDM Device Embl 4.5mm 20mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419706 CDM Device Embl 3.5mm 18mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419695 CDM Device Embl 2.5mm 12mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419705 CDM Device Embl 3.5mm 16mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419736 CDM Device Embl 5mm 35mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419716 CDM Device Embl 4.00x2mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419730 CDM Device Emb 5mm 14mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419709 CDM Device Embl 3.75mm 14mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419701 CDM Device Embl 3mm 16mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419710 CDM Device Embl 3.75x16mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419731 CDM Device Embl 5.0x16mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
420399 CDM Device Embl 4.50x25mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419696 CDM Device Embl 2.5mm 14mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419700 CDM Device Embl 3mm 14mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419713 CDM Device Embl 4mm 14mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
420246 CDM Device Embl 3mm 12mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419702 CDM Device Embl 3mm 18mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419719 CDM Device Emb 4.25mm 16mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
419698 CDM Device Embl 2.75mm 14mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
421593 CDM Device Embl 4mm 10mm 12 10 $178,044.00 $178,044.00 $37,211.20 $178,044.00 $109,497.06 2026-03-01
00845 OTHER Inj, Atidarsagene Autotem 1 1 — — $4,505,000.00 $4,505,000.00 $4,505,000.00 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 13 12 — — $6,236.64 $4,955,500.00 $4,505,000.00 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 13 12 — — $552,790.05 $4,422,320.40 $3,685,267.00 2026-03-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,685,267.00 $3,685,267.00 $3,685,267.00 2026-03-01
J1414 HCPCS Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose 1 1 — — $3,500,490.28 $3,500,490.28 $3,500,490.28 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 14 13 — — $11,292.32 $4,002,984.00 $3,335,820.00 2026-03-01
00908 OTHER Topi Adm Prad Zami Per Tr 1 1 — — $3,335,820.00 $3,335,820.00 $3,335,820.00 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,327,860.00 $3,327,860.00 $3,327,860.00 2026-03-01
714 OTHER Inj Delandistrogene Mox R 14 13 — — $7,335.12 $3,993,432.00 $3,327,860.00 2026-03-01
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,252,508.00 $3,252,508.00 $3,252,508.00 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 14 13 — — $13,962.33 $3,903,009.60 $3,252,508.00 2026-03-01
J1411 HCPCS Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 4 3 — — $2,968,000.00 $3,444,000.00 $3,206,000.00 2026-03-01
C9172 HCPCS Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose 2 2 — — $2,884,000.00 $3,500,490.28 $3,192,245.14 2026-03-01
00906 OTHER Inj Elivaldogene Autoteme 1 1 — — $3,180,000.00 $3,180,000.00 $3,180,000.00 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 14 13 — — $9,978.09 $3,816,000.00 $3,180,000.00 2026-03-01
746 OTHER Inj, Betibeglogene Autote 14 13 — — $12,915.31 $3,527,962.80 $2,939,969.00 2026-03-01
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,939,969.00 $2,939,969.00 $2,939,969.00 2026-03-01
J1413 HCPCS Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 2 2 — — $2,636,800.00 $3,200,490.28 $2,918,645.14 2026-03-01
J3394 HCPCS Injection, Lovotibeglogene Autotemcel, Per Treatment 2 2 — — $2,628,800.00 $3,100,490.28 $2,864,645.14 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 13 12 — — $388,347.15 $3,106,777.20 $2,588,981.00 2026-03-01
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,588,981.00 $2,588,981.00 $2,588,981.00 2026-03-01
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 2 2 — — $2,374,400.00 $2,800,490.28 $2,587,445.14 2026-03-01
00824 OTHER Inj, Exagamglogene Autote 1 1 — — $2,332,000.00 $2,332,000.00 $2,332,000.00 2026-03-01
824 OTHER Inj, Exagamglogene Autote 14 13 — — $15,123.50 $2,798,400.00 $2,332,000.00 2026-03-01
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 1 1 — — $2,200,490.28 $2,200,490.28 $2,200,490.28 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 4 3 — — $1,842,227.74 $2,322,534.64 $2,082,381.19 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 5 4 — — $732,102.01 $1,656,833.00 $1,656,833.00 2026-03-01
2067 OTHER Afamitresgene Autoleucel 13 12 — — $115,593.00 $924,744.00 $770,620.00 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 3 2 — — $598,237.50 $598,237.50 $598,237.50 2026-03-01
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $587,649.60 $587,649.60 $587,649.60 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 13 12 — — $88,147.44 $705,179.52 $587,649.60 2026-03-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $566,531.30 $566,531.30 $566,531.30 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 13 12 — — $84,979.70 $679,837.56 $566,531.30 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $562,201.20 $562,201.20 $562,201.20 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 13 12 — — $84,330.18 $674,641.44 $562,201.20 2026-03-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $558,081.80 $558,081.80 $558,081.80 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 13 12 — — $83,712.27 $669,698.16 $558,081.80 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 11 8 — — $405,756.74 $1,263,446.58 $553,169.00 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 11 8 — — $408,858.00 $1,218,042.30 $538,217.75 2026-03-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $532,192.20 $532,192.20 $532,192.20 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 13 12 — — $79,828.83 $638,630.64 $532,192.20 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 9 7 — — $387,752.24 $1,199,875.72 $530,190.66 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 11 8 — — $379,082.81 $1,208,732.67 $516,726.08 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 11 8 — — $359,552.00 $1,144,213.32 $502,841.00 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 1 1 — — $501,787.64 $501,787.64 $501,787.64 2026-03-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $489,450.20 $489,450.20 $489,450.20 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 13 12 — — $73,417.53 $587,340.24 $489,450.20 2026-03-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 11 8 — — $359,552.00 $1,052,317.93 $464,990.71 2026-03-01
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 5 4 — — $191,598.58 $433,588.39 $433,588.39 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 19 12 — — $361,046.42 $830,102.96 $379,657.06 2026-03-01
00831 OTHER Obecbtge Autol Up To 400 1 1 — — $278,250.00 $278,250.00 $278,250.00 2026-03-01
831 OTHER Obecbtge Autol Up To 400 14 13 — — $4,270.57 $333,900.00 $278,250.00 2026-03-01
897 OTHER Revakinagene, Per Implant 13 12 — — $39,750.00 $318,000.00 $265,000.00 2026-03-01
00897 OTHER Revakinagene, Per Implant 1 1 — — $265,000.00 $265,000.00 $265,000.00 2026-03-01
J3403 HCPCS Revakinagene Taroretcel-lwey, Per Implant 2 2 — — $251,763.01 $265,013.70 $258,388.36 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $251,802.30 $251,802.30 $251,802.30 2026-03-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 1 1 — — $249,535.74 $249,535.74 $249,535.74 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 22 15 — — $221,393.00 $538,703.43 $242,044.70 2026-03-01
5834 APR_DRG Neonate With Ecmo 1 1 — — $227,217.11 $227,217.11 $227,217.11 2026-03-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $221,338.20 $221,338.20 $221,338.20 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 14 13 — — $9,344.73 $242,002.80 $201,669.00 2026-03-01
00886 OTHER Inj. Remestemcel-l-rknd/ 1 1 — — $201,669.00 $201,669.00 $201,669.00 2026-03-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 1 1 — — $199,330.81 $199,330.81 $199,330.81 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 24 15 — — $138,108.00 $490,660.00 $190,093.17 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 16 12 — — $177,166.52 $345,498.86 $184,740.90 2026-03-01
5833 APR_DRG Neonate With Ecmo 1 1 — — $182,534.43 $182,534.43 $182,534.43 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 1 1 — — $179,983.28 $179,983.28 $179,983.28 2026-03-01
01907 OTHER New Technology - Level 52 1 1 — — $168,540.50 $168,540.50 $168,540.50 2026-03-01
01908 OTHER New Technology - Level 52 1 1 — — $168,540.50 $168,540.50 $168,540.50 2026-03-01
1908 OTHER New Technology - Level 52 13 12 — — $24,474.04 $195,792.36 $163,160.30 2026-03-01
1907 OTHER New Technology - Level 52 13 12 — — $24,474.04 $195,792.36 $163,160.30 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 1 1 — — $162,058.85 $162,058.85 $162,058.85 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $156,003.70 $156,003.70 $156,003.70 2026-03-01
01906 OTHER New Technology - Level 51 1 1 — — $151,962.80 $151,962.80 $151,962.80 2026-03-01
01905 OTHER New Technology - Level 51 1 1 — — $151,962.80 $151,962.80 $151,962.80 2026-03-01
1906 OTHER New Technology - Level 51 13 12 — — $22,066.77 $176,534.16 $147,111.80 2026-03-01
1905 OTHER New Technology - Level 51 13 12 — — $22,066.77 $176,534.16 $147,111.80 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 7 5 — — $59,694.36 $180,011.44 $143,236.05 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 1 1 — — $142,833.96 $142,833.96 $142,833.96 2026-03-01
01903 OTHER New Technology - Level 50 1 1 — — $135,385.10 $135,385.10 $135,385.10 2026-03-01
01904 OTHER New Technology - Level 50 1 1 — — $135,385.10 $135,385.10 $135,385.10 2026-03-01
C9150 HCPCS Xenon Xe-129 Hyperpolarized Gas, Diagnostic, Per Study Dose 1 1 — — $132,600.00 $132,600.00 $132,600.00 2026-03-01
1904 OTHER New Technology - Level 50 13 12 — — $19,659.49 $157,275.96 $131,063.30 2026-03-01
1903 OTHER New Technology - Level 50 13 12 — — $19,659.49 $157,275.96 $131,063.30 2026-03-01
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 1 1 — — $129,533.11 $129,533.11 $129,533.11 2026-03-01
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 1 1 — — $129,533.11 $129,533.11 $129,533.11 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 24 15 — — $115,412.58 $344,947.00 $127,567.61 2026-03-01
8434 APR_DRG Extensive Third Degree Burns Without Skin Graft 1 1 — — $124,196.61 $124,196.61 $124,196.61 2026-03-01
5832 APR_DRG Neonate With Ecmo 1 1 — — $123,852.29 $123,852.29 $123,852.29 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 1 1 — — $122,909.77 $122,909.77 $122,909.77 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 1 1 — — $122,883.00 $122,883.00 $122,883.00 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 6 4 — — $52,381.27 $157,514.42 $122,172.78 2026-03-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $121,826.50 $121,826.50 $121,826.50 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 1 1 — — $120,376.27 $120,376.27 $120,376.27 2026-03-01
01902 OTHER New Technology - Level 49 1 1 — — $118,807.40 $118,807.40 $118,807.40 2026-03-01
01901 OTHER New Technology - Level 49 1 1 — — $118,807.40 $118,807.40 $118,807.40 2026-03-01
1901 OTHER New Technology - Level 49 13 12 — — $17,252.22 $138,017.76 $115,014.80 2026-03-01
1902 OTHER New Technology - Level 49 13 12 — — $17,252.22 $138,017.76 $115,014.80 2026-03-01
7 MS_DRG Lung Transplant 19 12 — — $109,230.05 $248,941.69 $114,860.47 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 1 1 — — $111,058.85 $111,058.85 $111,058.85 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 1 1 — — $109,710.92 $109,710.92 $109,710.92 2026-03-01
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