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

MOUNTAINVIEW HOSPITAL

Las Vegas, NV · CCN 290039 · Rates published

33,897 distinct procedures filed
34 distinct payers
708,720 rate rows
2026-03-01 last MRF observed
Data quality

679,834 of 708,720 rate rows are consumer-grade (95.9%)

28,886 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
per-diem day rate — not a per-procedure price 11,480
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 9,718
template filing: same amount across many unrelated codes — excluded 7,450
placeholder amount (≤ $0.02) — excluded from medians 236
exceeds 10× this hospital's gross charge — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1600397_MOUNTAINVIEW-HOSPITAL-AND-MEDICAL-CENTER_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://sunrisehealthinfo.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-05-18
Content fingerprint a628297a38e65c74… · 474,811,869 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
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 13 $7,723.07 $4,955,500.00 $4,505,000.00 nat. median
$9,966
outlier · 452.1×
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
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 13 $552,790.05 $4,422,320.40 $3,685,267.00 nat. median
$3,746,358
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 14 $13,983.71 $4,002,984.00 $3,335,820.00 nat. median
$22,747
outlier · 146.6×
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
714
OTHER 		Inj Delandistrogene Mox R 14 $9,083.36 $3,993,432.00 $3,327,860.00 nat. median
$13,041
outlier · 255.2×
748
OTHER 		Inj, Lovotibeglogene Auto 14 $17,290.09 $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
906
OTHER 		Inj Elivaldogene Autoteme 14 $12,356.25 $3,816,000.00 $3,180,000.00 nat. median
$20,756
outlier · 153.2×
00906
OTHER 		Inj Elivaldogene Autoteme 1 $3,180,000.00 $3,180,000.00 $3,180,000.00 nat. median
$21
outlier · 153697.4×
746
OTHER 		Inj, Betibeglogene Autote 14 $15,993.52 $3,527,962.80 $2,939,969.00 nat. median
$21,896
outlier · 134.3×
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
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
9141
OTHER 		Inj Onase Abepar-xioi Tre 13 $388,347.15 $3,106,777.20 $2,588,981.00 nat. median
$2,588,981
1.0× 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
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
824
OTHER 		Inj, Exagamglogene Autote 14 $18,728.01 $2,798,400.00 $2,332,000.00 nat. median
$25,250
outlier · 92.4×
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
Q2058
HCPCS 		Obecabtagene Inj 11 $598,237.50 $5,000,000.00 $2,272,500.00 nat. median
$324,450
outlier · 7.0×
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
Q2055
HCPCS 		Idecabtagene 16 $387,752.24 $5,000,000.00 $2,130,000.00 nat. median
$625,184
outlier · 3.4×
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×
Q2056
HCPCS 		Ciltacabtagene 100 Mil 16 $405,756.74 $5,000,000.00 $1,311,723.29 nat. median
$675,122
1.9× median
Q2054
HCPCS 		Lisocabtagene 16 $379,082.81 $5,000,000.00 $1,284,366.33 nat. median
$674,188
1.9× median
Q2041
HCPCS 		Axicabtagene Adult 16 $359,552.00 $4,925,068.00 $1,241,915.91 nat. median
$634,511
2.0× median
Q2042
HCPCS 		Tisagenlecleucel Adult 16 $408,858.00 $4,425,068.00 $1,218,042.30 nat. median
$754,974
1.6× median
Q2053
HCPCS 		Brexucabtagene 16 $359,552.00 $4,479,068.00 $1,135,312.21 nat. median
$620,080
1.8× median
2067
OTHER 		Afamitresgene Autoleucel 13 $115,593.00 $924,744.00 $770,620.00 nat. median
$786,032
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 13 $88,147.44 $705,179.52 $587,649.60 nat. median
$587,650
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $587,649.60 $587,649.60 $587,649.60 nat. median
$554,552
1.1× median
9194
OTHER 		Tisagenlecleucel Car-pos 13 $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
09413
OTHER 		Lisocabtagene Car Pos T 1 $562,201.20 $562,201.20 $562,201.20 nat. median
$534,091
1.1× median
9413
OTHER 		Lisocabtagene Car Pos T 13 $84,330.18 $674,641.44 $562,201.20 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 13 $83,712.27 $669,698.16 $558,081.80 nat. median
$558,082
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $558,081.80 $558,081.80 $558,081.80 nat. median
$530,178
1.1× median
9035
OTHER 		Axicabtagene Ciloleucel C 13 $79,828.83 $638,630.64 $532,192.20 nat. median
$532,192
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $532,192.20 $532,192.20 $532,192.20 nat. median
$505,583
1.1× 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×
09391
OTHER 		Brexucabtagene Car Pos T 1 $489,450.20 $489,450.20 $489,450.20 nat. median
$464,978
1.1× median
9391
OTHER 		Brexucabtagene Car Pos T 13 $73,417.53 $587,340.24 $489,450.20 nat. median
$489,450
1.0× 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×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 14 $398,845.91 $830,102.96 $419,837.80 nat. median
$370,174
1.1× median

Other procedures at this hospital

Browse this hospital's 33,897 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
             
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $274,091.70 $274,091.70 $274,091.70 2026-03-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $102,764.20 $102,764.20 $102,764.20 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $193,185.30 $193,185.30 $193,185.30 2026-03-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $150,862.50 $150,862.50 $150,862.50 2026-03-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $97,930.09 $97,930.09 $97,930.09 2026-03-01
007 OTHER Lung Transplant 1 1 — — $115,948.10 $115,948.10 $115,948.10 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
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,939,969.00 $2,939,969.00 $2,939,969.00 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
00824 OTHER Inj, Exagamglogene Autote 1 1 — — $2,332,000.00 $2,332,000.00 $2,332,000.00 2026-03-01
00831 OTHER Obecbtge Autol Up To 400 1 1 — — $278,250.00 $278,250.00 $278,250.00 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
00886 OTHER Inj. Remestemcel-l-rknd/ 1 1 — — $201,669.00 $201,669.00 $201,669.00 2026-03-01
00897 OTHER Revakinagene, Per Implant 1 1 — — $265,000.00 $265,000.00 $265,000.00 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
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
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $98,972.57 $98,972.57 $98,972.57 2026-03-01
01583 OTHER New Technology - Level 46 1 1 — — $82,889.05 $82,889.05 $82,889.05 2026-03-01
01584 OTHER New Technology - Level 47 1 1 — — $93,940.85 $93,940.85 $93,940.85 2026-03-01
01585 OTHER New Technology - Level 48 1 1 — — $104,992.70 $104,992.70 $104,992.70 2026-03-01
01597 OTHER New Technology - Level 46 1 1 — — $82,889.05 $82,889.05 $82,889.05 2026-03-01
01598 OTHER New Technology - Level 47 1 1 — — $93,940.85 $93,940.85 $93,940.85 2026-03-01
01599 OTHER New Technology - Level 48 1 1 — — $104,992.70 $104,992.70 $104,992.70 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $311,816.50 $311,816.50 $311,816.50 2026-03-01
01901 OTHER New Technology - Level 49 1 1 — — $118,807.40 $118,807.40 $118,807.40 2026-03-01
01902 OTHER New Technology - Level 49 1 1 — — $118,807.40 $118,807.40 $118,807.40 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
01905 OTHER New Technology - Level 51 1 1 — — $151,962.80 $151,962.80 $151,962.80 2026-03-01
01906 OTHER New Technology - Level 51 1 1 — — $151,962.80 $151,962.80 $151,962.80 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
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $80,764.17 $80,764.17 $80,764.17 2026-03-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $532,192.20 $532,192.20 $532,192.20 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
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,588,981.00 $2,588,981.00 $2,588,981.00 2026-03-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $566,531.30 $566,531.30 $566,531.30 2026-03-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $489,450.20 $489,450.20 $489,450.20 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $562,201.20 $562,201.20 $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
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $587,649.60 $587,649.60 $587,649.60 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 24 17 — — $232,760.00 $538,703.43 $272,679.00 2026-03-01
125754 CDM Evas Rpr Ao&infr 4+ Gft 19 15 $211,463.00 $211,463.00 $28,758.97 $211,463.00 $88,814.46 2026-03-01
125764 CDM Evas Rpr Visc Ao 4+ Gft 19 15 $211,464.00 $211,464.00 $28,759.10 $211,464.00 $88,814.88 2026-03-01
127369 CDM Ttvr - Initial Device 19 15 $195,765.00 $195,765.00 $26,624.04 $195,765.00 $82,221.30 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 21 14 — — $111,431.86 $231,020.09 $117,296.70 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 1 1 — — $105,024.66 $105,024.66 $105,024.66 2026-03-01
1583 OTHER New Technology - Level 46 14 13 — — $12,036.45 $96,291.64 $80,243.03 2026-03-01
1584 OTHER New Technology - Level 47 14 13 — — $13,641.30 $109,130.44 $90,942.03 2026-03-01
1585 OTHER New Technology - Level 48 14 13 — — $15,246.15 $121,969.20 $101,641.00 2026-03-01
1597 OTHER New Technology - Level 46 14 13 — — $12,036.45 $96,291.64 $80,243.03 2026-03-01
1598 OTHER New Technology - Level 47 14 13 — — $13,641.30 $109,130.44 $90,942.03 2026-03-01
1599 OTHER New Technology - Level 48 14 13 — — $15,246.15 $121,969.20 $101,641.00 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 1 1 — — $99,580.87 $99,580.87 $99,580.87 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 1 1 — — $142,833.96 $142,833.96 $142,833.96 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 21 14 — — $398,845.91 $830,102.96 $419,837.80 2026-03-01
1901 OTHER New Technology - Level 49 14 13 — — $17,252.22 $138,017.76 $115,014.80 2026-03-01
1902 OTHER New Technology - Level 49 14 13 — — $17,252.22 $138,017.76 $115,014.80 2026-03-01
1903 OTHER New Technology - Level 50 14 13 — — $19,659.49 $157,275.96 $131,063.30 2026-03-01
1904 OTHER New Technology - Level 50 14 13 — — $19,659.49 $157,275.96 $131,063.30 2026-03-01
1905 OTHER New Technology - Level 51 14 13 — — $22,066.77 $176,534.16 $147,111.80 2026-03-01
1906 OTHER New Technology - Level 51 14 13 — — $22,066.77 $176,534.16 $147,111.80 2026-03-01
1907 OTHER New Technology - Level 52 14 13 — — $24,474.04 $195,792.36 $163,160.30 2026-03-01
1908 OTHER New Technology - Level 52 14 13 — — $24,474.04 $195,792.36 $163,160.30 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 24 17 — — $105,104.39 $412,954.00 $111,742.56 2026-03-01
2067 OTHER Afamitresgene Autoleucel 14 13 — — $115,593.00 $924,744.00 $770,620.00 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 23 16 — — $5,995.00 $217,581.29 $110,510.00 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 26 17 — — $5,995.00 $209,032.82 $106,193.00 2026-03-01
215 MS_DRG Other Heart Assist System Implant 33 21 — — $51,900.00 $319,959.00 $97,290.02 2026-03-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 34 22 — — $52,200.00 $272,598.00 $95,598.92 2026-03-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $85,175.14 $85,175.14 $85,175.14 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 1 1 — — $85,185.86 $85,185.86 $85,185.86 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 33 21 — — $62,926.00 $176,508.00 $82,465.30 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
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 26 17 — — $5,995.00 $490,660.00 $206,678.90 2026-03-01
30230C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30230G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Vein, Open Approach 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30230X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Vein, Open Appro… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30230Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Vein, Open Ap… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30233C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30233G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Vein, Percutaneous Approac… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30233X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Vein, Percutaneo… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30233Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Vein, Percuta… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30240C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30240G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Vein, Open Approach 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30240X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Vein, Open Approach… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30240Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Vein, Open Appro… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30243C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30243G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Vein, Percutaneous Approach 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30243X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Vein, Percutaneous … 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30243Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Vein, Percutaneo… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30250G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Artery, Open Approach 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30250X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Artery, Open App… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30250Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Artery, Open … 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30253G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Artery, Percutaneous Appro… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30253X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Artery, Percutan… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30253Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Artery, Percu… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30260G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Artery, Open Approach 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30260X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Artery, Open Approa… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30260Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Artery, Open App… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30263G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Artery, Percutaneous Approach… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30263X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Artery, Percutaneou… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
30263Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Artery, Percutan… 1 1 — — $162,750.00 $162,750.00 $162,750.00 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 26 17 — — $5,995.00 $289,726.00 $135,095.90 2026-03-01
407908 CDM Valve Tavr 23mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
407909 CDM Valve Tavr 26mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
407910 CDM Valve Tavr 29mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
409666 CDM Valve Aortic 23mm 14 11 $194,040.00 $194,040.00 $42,300.72 $194,040.00 $119,334.60 2026-03-01
409703 CDM Genrator Imp Pulse 7 14 11 $242,000.00 $242,000.00 $52,756.00 $242,000.00 $148,830.00 2026-03-01
410613 CDM Valve Aortic Cryo 22+mm 14 11 $144,082.00 $144,082.00 $31,409.88 $144,082.00 $88,610.43 2026-03-01
411669 CDM Graft Endo Aaa 36x14mm 14 11 $168,192.00 $168,192.00 $36,665.86 $168,192.00 $103,438.08 2026-03-01
411781 CDM Graft Endo Aaa 28.5x12mm 14 11 $164,089.00 $164,089.00 $35,771.40 $164,089.00 $100,914.74 2026-03-01
415281 CDM Valve Aor Tavr 26mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
415283 CDM Valve Aor Tavr 34mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
415925 CDM Occluder Cv 18x18mm 14 11 $138,531.00 $138,531.00 $30,199.76 $138,531.00 $85,196.57 2026-03-01
416212 CDM Valve Heart Trnscth 23mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
417417 CDM Device Clsr 20mm 14 11 $193,324.00 $193,324.00 $42,144.63 $193,324.00 $118,894.26 2026-03-01
417418 CDM Device Clsr 24mm 14 11 $193,324.00 $193,324.00 $42,144.63 $193,324.00 $118,894.26 2026-03-01
417419 CDM Device Clsr 27mm 14 11 $193,324.00 $193,324.00 $42,144.63 $193,324.00 $118,894.26 2026-03-01
417420 CDM Device Clsr 31mm 14 11 $193,324.00 $193,324.00 $42,144.63 $193,324.00 $118,894.26 2026-03-01
417421 CDM Device Clsr 35mm 14 11 $193,324.00 $193,324.00 $42,144.63 $193,324.00 $118,894.26 2026-03-01
417429 CDM Implant Cranial Med 14 11 $167,157.00 $167,157.00 $36,440.23 $167,157.00 $102,801.55 2026-03-01
417872 CDM Pump Heart 21fr 85mm 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $91,777.29 $91,777.29 $91,777.29 2026-03-01
423151 CDM Device Clsr 24mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
423152 CDM Device Clsr 27mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
425245 CDM Graft Evas 10cm 14.5mm 14 11 $142,689.00 $142,689.00 $31,106.20 $142,689.00 $87,753.74 2026-03-01
425292 CDM Graft Evas 10cm 10mm 14 11 $142,689.00 $142,689.00 $31,106.20 $142,689.00 $87,753.74 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 29 18 — — $20,650.00 $211,860.53 $107,621.00 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 29 18 — — $20,650.00 $173,191.54 $88,092.89 2026-03-01
429 OTHER Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 1 1 — — $81,705.35 $81,705.35 $81,705.35 2026-03-01
435578 CDM Cath Vasc Assist Strl 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
437039 CDM Valve Tavr 26mm 14 11 $242,000.00 $242,000.00 $52,756.00 $242,000.00 $148,830.00 2026-03-01
437377 CDM Valve Tavr 34mm 14 11 $242,000.00 $242,000.00 $52,756.00 $242,000.00 $148,830.00 2026-03-01
437378 CDM Valve Tavr 29mm 14 11 $242,000.00 $242,000.00 $52,756.00 $242,000.00 $148,830.00 2026-03-01
437579 CDM Valve Tavr 23mm 14 11 $242,000.00 $242,000.00 $52,756.00 $242,000.00 $148,830.00 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 1 1 — — $97,509.36 $97,509.36 $97,509.36 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 31 20 — — $24,000.00 $147,974.49 $82,208.05 2026-03-01
474 OTHER Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 1 1 — — $88,643.29 $88,643.29 $88,643.29 2026-03-01
483136 CDM Cannula W Dltr Buble Trp 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
483137 CDM Cann W Dilator Strgt Tip 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
483795 CDM Valve Aortic 25mm 14 11 $194,040.00 $194,040.00 $42,300.72 $194,040.00 $119,334.60 2026-03-01
483829 CDM Valve Aortic 27mm 14 11 $194,040.00 $194,040.00 $42,300.72 $194,040.00 $119,334.60 2026-03-01
484319 CDM Occluder Cardiac Lt 28mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
484320 CDM Occluder Cardiac Lt 31mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
484399 CDM Graft Endo Aaa 32x14mm 14 11 $164,089.00 $164,089.00 $35,771.40 $164,089.00 $100,914.74 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 21 14 — — $95,685.61 $198,198.74 $100,721.70 2026-03-01
5831 APR_DRG Neonate With Ecmo 1 1 — — $97,858.39 $97,858.39 $97,858.39 2026-03-01
5832 APR_DRG Neonate With Ecmo 1 1 — — $123,852.29 $123,852.29 $123,852.29 2026-03-01
5833 APR_DRG Neonate With Ecmo 1 1 — — $182,534.43 $182,534.43 $182,534.43 2026-03-01
5834 APR_DRG Neonate With Ecmo 1 1 — — $227,217.11 $227,217.11 $227,217.11 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
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
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
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 1 1 — — $102,018.76 $102,018.76 $102,018.76 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 1 1 — — $78,947.04 $78,947.04 $78,947.04 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 1 1 — — $95,570.84 $95,570.84 $95,570.84 2026-03-01
607634 CDM Graft Stnt 70mm 28-16mm 14 11 $149,619.00 $149,619.00 $32,616.94 $149,619.00 $92,015.68 2026-03-01
608699 CDM Gft Bif 25-13x124mm 18fr 14 11 $138,254.00 $138,254.00 $30,139.37 $138,254.00 $85,026.21 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
609505 CDM Gft Bif 23-16x166mm 18fr 14 11 $138,254.00 $138,254.00 $30,139.37 $138,254.00 $85,026.21 2026-03-01
609975 CDM Gft Bif 25-16x145mm 18fr 14 11 $138,261.00 $138,261.00 $30,140.90 $138,261.00 $85,030.51 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 1 1 — — $103,363.67 $103,363.67 $103,363.67 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 1 1 — — $107,322.40 $107,322.40 $107,322.40 2026-03-01
64 APR_DRG Pancreas Transplant 1 1 — — $86,801.47 $86,801.47 $86,801.47 2026-03-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $135,203.90 $135,203.90 $135,203.90 2026-03-01
690446 CDM Gft Bif 23-13x145mm 18fr 14 11 $138,254.00 $138,254.00 $30,139.37 $138,254.00 $85,026.21 2026-03-01
690560 CDM Gft Bif 28-13x166mm 20fr 14 11 $138,261.00 $138,261.00 $30,140.90 $138,261.00 $85,030.51 2026-03-01
694722 CDM Unit Suc Ultsnc Excl 24 17 $172,684.00 $172,684.00 $23,485.02 $172,684.00 $85,478.58 2026-03-01
696640 CDM Graft Extn Limb Rt 80c 14 11 $147,522.00 $147,522.00 $32,159.80 $147,522.00 $90,726.03 2026-03-01
699323 CDM Set Vntrc 17.4x13.8in 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
7 MS_DRG Lung Transplant 21 14 — — $120,029.93 $248,941.69 $126,347.30 2026-03-01
700339 CDM Set Pump Asst 2.5in 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
700512 CDM Imp Bs Spn Xp 7.5x18x50 14 11 $148,220.00 $148,220.00 $32,311.96 $148,220.00 $91,155.30 2026-03-01
700513 CDM Imp Bs Spn Xp 7.5x18x55 14 11 $148,220.00 $148,220.00 $32,311.96 $148,220.00 $91,155.30 2026-03-01
700528 CDM Set Inst Wrst Plt Sys 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
701674 CDM Transducr Ultsnd Rbtc 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
702221 CDM Kit Aor Vlv 14fr 26mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
702222 CDM Kit Aor Vlv 14fr 29mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
705933 CDM Set Pump 21fr 5.0 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
706543 CDM Valve Tavr 34mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
706733 CDM Impl Crnl Lg 14 11 $203,526.00 $203,526.00 $44,368.67 $203,526.00 $125,168.49 2026-03-01
707210 CDM Kit Pmp Rt Hrt 22f 170cm 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
707218 CDM Valve Tavr 23mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
707220 CDM Valve Tavr 26mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
707221 CDM Valve Tavr 29mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
707834 CDM Valve Aor 21mm 14 11 $144,075.00 $144,075.00 $31,408.35 $144,075.00 $88,606.12 2026-03-01
708747 CDM Device Sut Lariat 12f 24 17 $162,888.00 $162,888.00 $22,152.77 $162,888.00 $80,629.56 2026-03-01
709356 CDM Kit Vlv Aor 18fr 23mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
709358 CDM Kit Vlv Aor 18fr 29mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
709387 CDM Valve Aortic 19mm 14 11 $166,320.00 $166,320.00 $36,257.76 $166,320.00 $102,286.80 2026-03-01
709388 CDM Valve Aortic 21mm 14 11 $166,320.00 $166,320.00 $36,257.76 $166,320.00 $102,286.80 2026-03-01
709389 CDM Valve Aortic 23mm 14 11 $166,320.00 $166,320.00 $36,257.76 $166,320.00 $102,286.80 2026-03-01
709797 CDM Kit Impl Crnl Cstm Lg 14 11 $159,958.00 $159,958.00 $34,870.84 $159,958.00 $98,374.17 2026-03-01
710796 CDM Valve Aortic 25mm 14 11 $166,320.00 $166,320.00 $36,257.76 $166,320.00 $102,286.80 2026-03-01
710797 CDM Valve Aortic 19mm 14 11 $152,460.00 $152,460.00 $33,236.28 $152,460.00 $93,762.90 2026-03-01
711930 CDM Occluder Cv 25x18mm 14 11 $138,531.00 $138,531.00 $30,199.76 $138,531.00 $85,196.57 2026-03-01
711931 CDM Occluder Cv 35x18mm 14 11 $138,531.00 $138,531.00 $30,199.76 $138,531.00 $85,196.57 2026-03-01
714 OTHER Inj Delandistrogene Mox R 15 14 — — $9,083.36 $3,993,432.00 $3,327,860.00 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 1 1 — — $122,909.77 $122,909.77 $122,909.77 2026-03-01
746 OTHER Inj, Betibeglogene Autote 15 14 — — $15,993.52 $3,527,962.80 $2,939,969.00 2026-03-01
746255 CDM Rem/replace Icd Gen Mult 19 15 $201,491.00 $201,491.00 $27,402.78 $201,491.00 $84,626.22 2026-03-01
746260 CDM Rem/replace Icd Gen Dual 19 15 $201,491.00 $201,491.00 $27,402.78 $201,491.00 $84,626.22 2026-03-01
746265 CDM Rem/replace Icd Gen Sgl 19 15 $202,099.00 $202,099.00 $27,485.46 $202,099.00 $84,881.58 2026-03-01
746270 CDM Ins Icd Gen Only Mult Ld 19 15 $201,491.00 $201,491.00 $27,402.78 $201,491.00 $84,626.22 2026-03-01
746275 CDM Ins Icd Gen Only Dual Ld 19 15 $201,491.00 $201,491.00 $27,402.78 $201,491.00 $84,626.22 2026-03-01
746547 CDM Ins/repl Sq Icd With Elec 19 15 $238,432.00 $238,432.00 $32,426.75 $238,432.00 $100,141.44 2026-03-01
746726 CDM Sp Unlst Proc Card Surg 19 15 $197,328.00 $197,328.00 $26,836.61 $197,328.00 $82,877.76 2026-03-01
746730 CDM Tmvi Perc 19 15 $188,360.00 $188,360.00 $25,616.96 $188,360.00 $79,111.20 2026-03-01
746783 CDM Insrt Replac Implnt Icd 21 16 $190,080.00 $190,080.00 $25,850.88 $190,080.00 $93,139.20 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 15 14 — — $17,290.09 $3,903,009.60 $3,252,508.00 2026-03-01
824 OTHER Inj, Exagamglogene Autote 15 14 — — $18,728.01 $2,798,400.00 $2,332,000.00 2026-03-01
831 OTHER Obecbtge Autol Up To 400 15 14 — — $5,288.42 $333,900.00 $278,250.00 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
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 1 1 — — $129,533.11 $129,533.11 $129,533.11 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
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 1 1 — — $501,787.64 $501,787.64 $501,787.64 2026-03-01
8423 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 1 1 — — $101,600.71 $101,600.71 $101,600.71 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
8434 APR_DRG Extensive Third Degree Burns Without Skin Graft 1 1 — — $124,196.61 $124,196.61 $124,196.61 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 14 13 — — $7,723.07 $4,955,500.00 $4,505,000.00 2026-03-01
850 MS_DRG Acute Leukemia With Other Procedures 25 16 — — $5,995.00 $166,461.57 $84,694.20 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 15 14 — — $11,571.94 $242,002.80 $201,669.00 2026-03-01
897 OTHER Revakinagene, Per Implant 14 13 — — $39,750.00 $318,000.00 $265,000.00 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 14 13 — — $79,828.83 $638,630.64 $532,192.20 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 15 14 — — $12,356.25 $3,816,000.00 $3,180,000.00 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 15 14 — — $13,983.71 $4,002,984.00 $3,335,820.00 2026-03-01
913391 CDM Graft Endo Aaa 23x12mm 14 11 $168,192.00 $168,192.00 $36,665.86 $168,192.00 $103,438.08 2026-03-01
913449 CDM Device Embl 5mm 35mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
913620 CDM Device Embl 4.00x2mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
913621 CDM Device Embl 4mm 12mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 14 13 — — $552,790.05 $4,422,320.40 $3,685,267.00 2026-03-01
913892 CDM Sphere Injection 13.5gbq 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 14 13 — — $388,347.15 $3,106,777.20 $2,588,981.00 2026-03-01
914688 CDM Device Embl 10mm 2.5mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914689 CDM Device Embl 3mm 12mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914690 CDM Device Embl 3.5mm 14mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914691 CDM Device Embl 3.75mm 14mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914692 CDM Device Embl 4mm 16mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914693 CDM Device Embl 4.25mm 12mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914694 CDM Device Emb 4.25mm 16mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914695 CDM Device Embl 4.25mm 20mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914696 CDM Device Embl 4.5mm 12mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914697 CDM Device Embl 4.50x16mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914698 CDM Device Embl 4.5mm 20mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914699 CDM Device Embl 4.75mm 14mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914700 CDM Device Embl 4.75mm 20mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914701 CDM Device Embl 5mm 12mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914702 CDM Device Embl 5.0x16mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914703 CDM Device Embl 5.0x20mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
914704 CDM Device Embl 5mm 25mm 14 11 $163,587.00 $163,587.00 $35,661.97 $163,587.00 $100,606.01 2026-03-01
916271 CDM Valve Aortic 29mm 14 11 $194,040.00 $194,040.00 $42,300.72 $194,040.00 $119,334.60 2026-03-01
916377 CDM Gft Evs 15f 20x14.5x12mm 14 11 $138,000.00 $138,000.00 $30,084.00 $138,000.00 $84,870.00 2026-03-01
916616 CDM Valve Tavr Sz 29mm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
918878 CDM Graft Endo Aaa 26x12mm 14 11 $168,192.00 $168,192.00 $36,665.86 $168,192.00 $103,438.08 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 14 13 — — $84,979.70 $679,837.56 $566,531.30 2026-03-01
919923 CDM Stent 34mmx34mmx15cm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 2026-03-01
919964 CDM Valve Aortic 21mm 14 11 $194,040.00 $194,040.00 $42,300.72 $194,040.00 $119,334.60 2026-03-01
920215 CDM Kit Cath Rt Heart 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
920793 CDM Kit Cath Rt Heart 24 17 $293,001.00 $293,001.00 $39,848.14 $293,001.00 $145,035.49 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 21 15 — — $5,995.00 $374,211.54 $207,895.30 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 14 13 — — $73,417.53 $587,340.24 $489,450.20 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 1 1 — — $111,058.85 $111,058.85 $111,058.85 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 14 13 — — $84,330.18 $674,641.44 $562,201.20 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 14 13 — — $83,712.27 $669,698.16 $558,081.80 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 14 13 — — $88,147.44 $705,179.52 $587,649.60 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
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 2 — — $100,394.53 $100,394.53 $100,394.53 2026-03-01
C1721 HCPCS Defib Card 2.5v 500 60 266 11 $157,181.00 $157,181.00 $23,506.72 $189,610.00 $90,387.08 2026-03-01
C1722 HCPCS Icd Defib Card 7.36cm 238 11 $157,181.00 $157,181.00 $16,613.13 $242,000.00 $89,408.96 2026-03-01
C1767 HCPCS Nrstm Impl 2.4inx2.2in 190 11 $185,148.00 $185,148.00 $22,245.37 $242,000.00 $82,713.79 2026-03-01
C1820 HCPCS Device Neurostimulator 218 11 $173,423.00 $173,423.00 $2,661.34 $230,565.00 $89,936.46 2026-03-01
C1822 HCPCS Pulse Gen Imp 42 11 $204,696.00 $204,696.00 $42,144.63 $216,068.00 $125,888.04 2026-03-01
C1882 HCPCS Crt-d Crd 5.37x8.08x0.99 294 11 $215,400.00 $215,400.00 $30,343.64 $242,000.00 $113,214.50 2026-03-01
C2616 HCPCS Brachytx Ns Yttrium 90 43 10 $208,620.00 $208,620.00 $12,613.29 $175,538.40 $125,172.00 2026-03-01
C2624 HCPCS System Mntr 2x15mm 4.5cm 24 17 $512,253.00 $512,253.00 $69,666.41 $512,253.00 $253,565.23 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
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
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
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
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
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 1 1 — — $2,200,490.28 $2,200,490.28 $2,200,490.28 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
J3394 HCPCS Injection, Lovotibeglogene Autotemcel, Per Treatment 2 2 — — $2,628,800.00 $3,100,490.28 $2,864,645.14 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
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 5 4 — — $191,598.58 $433,588.39 $433,588.39 2026-03-01
J3403 HCPCS Revakinagene Taroretcel-lwey, Per Implant 2 2 — — $251,763.01 $265,013.70 $258,388.36 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 7 5 — — $59,694.36 $180,011.44 $143,236.05 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 12 9 — — $49,440.00 $153,000.00 $82,754.24 2026-03-01
J9999 HCPCS Carmustine Wafers 8/box 13 10 $325,353.00 $325,353.00 $48,802.95 $325,353.00 $204,972.39 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 16 14 — — $14,262.15 $114,097.20 $95,081.00 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 16 14 — — $16,236.45 $129,891.60 $108,243.00 2026-03-01
Q2041 HCPCS Axicabtagene Adult 22 16 — — $359,552.00 $4,925,068.00 $1,241,915.91 2026-03-01
Q2042 HCPCS Tisagenlecleucel Adult 22 16 — — $408,858.00 $4,425,068.00 $1,218,042.30 2026-03-01
Q2053 HCPCS Brexucabtagene 22 16 — — $359,552.00 $4,479,068.00 $1,135,312.21 2026-03-01
Q2054 HCPCS Lisocabtagene 22 16 — — $379,082.81 $5,000,000.00 $1,284,366.33 2026-03-01
Q2055 HCPCS Idecabtagene 22 16 — — $387,752.24 $5,000,000.00 $2,130,000.00 2026-03-01
Q2056 HCPCS Ciltacabtagene 100 Mil 22 16 — — $405,756.74 $5,000,000.00 $1,311,723.29 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
Q2058 HCPCS Obecabtagene Inj 16 11 — — $598,237.50 $5,000,000.00 $2,272,500.00 2026-03-01
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