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.

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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
             
00845 OTHER Inj, Atidarsagene Autotem 1 1 — — $4,505,000.00 $4,505,000.00 $4,505,000.00 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
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
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,252,508.00 $3,252,508.00 $3,252,508.00 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
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,939,969.00 $2,939,969.00 $2,939,969.00 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
00824 OTHER Inj, Exagamglogene Autote 1 1 — — $2,332,000.00 $2,332,000.00 $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
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $587,649.60 $587,649.60 $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
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
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $532,192.20 $532,192.20 $532,192.20 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
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
00831 OTHER Obecbtge Autol Up To 400 1 1 — — $278,250.00 $278,250.00 $278,250.00 2026-03-01
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
00897 OTHER Revakinagene, Per Implant 1 1 — — $265,000.00 $265,000.00 $265,000.00 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
5834 APR_DRG Neonate With Ecmo 1 1 — — $227,217.11 $227,217.11 $227,217.11 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
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
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
01908 OTHER New Technology - Level 52 1 1 — — $168,540.50 $168,540.50 $168,540.50 2026-03-01
01907 OTHER New Technology - Level 52 1 1 — — $168,540.50 $168,540.50 $168,540.50 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
24 APR_DRG Heart And/or Lung Transplant 1 1 — — $162,058.85 $162,058.85 $162,058.85 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
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
1614 APR_DRG Implantable Heart Assist Systems 1 1 — — $142,833.96 $142,833.96 $142,833.96 2026-03-01
01904 OTHER New Technology - Level 50 1 1 — — $135,385.10 $135,385.10 $135,385.10 2026-03-01
01903 OTHER New Technology - Level 50 1 1 — — $135,385.10 $135,385.10 $135,385.10 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
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
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
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
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
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
007 OTHER Lung Transplant 1 1 — — $115,948.10 $115,948.10 $115,948.10 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
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
14 APR_DRG Liver Transplant And/or Intestinal Transplant 1 1 — — $105,024.66 $105,024.66 $105,024.66 2026-03-01
01585 OTHER New Technology - Level 48 1 1 — — $104,992.70 $104,992.70 $104,992.70 2026-03-01
01599 OTHER New Technology - Level 48 1 1 — — $104,992.70 $104,992.70 $104,992.70 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
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
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
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
1613 APR_DRG Implantable Heart Assist Systems 1 1 — — $99,580.87 $99,580.87 $99,580.87 2026-03-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $98,972.57 $98,972.57 $98,972.57 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
5831 APR_DRG Neonate With Ecmo 1 1 — — $97,858.39 $97,858.39 $97,858.39 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
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
01584 OTHER New Technology - Level 47 1 1 — — $93,940.85 $93,940.85 $93,940.85 2026-03-01
01598 OTHER New Technology - Level 47 1 1 — — $93,940.85 $93,940.85 $93,940.85 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
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
64 APR_DRG Pancreas Transplant 1 1 — — $86,801.47 $86,801.47 $86,801.47 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
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
01597 OTHER New Technology - Level 46 1 1 — — $82,889.05 $82,889.05 $82,889.05 2026-03-01
01583 OTHER New Technology - Level 46 1 1 — — $82,889.05 $82,889.05 $82,889.05 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
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
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
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
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
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 2 2 — — $2,374,400.00 $2,800,490.28 $2,587,445.14 2026-03-01
J3403 HCPCS Revakinagene Taroretcel-lwey, Per Implant 2 2 — — $251,763.01 $265,013.70 $258,388.36 2026-03-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 2 — — $100,394.53 $100,394.53 $100,394.53 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
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
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 5 4 — — $191,598.58 $433,588.39 $433,588.39 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
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 7 5 — — $59,694.36 $180,011.44 $143,236.05 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
919923 CDM Stent 34mmx34mmx15cm 8 7 $233,280.00 $233,280.00 $50,855.04 $146,966.40 $78,732.00 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
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
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
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
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
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
845 OTHER Inj, Atidarsagene Autotem 14 13 — — $7,723.07 $4,955,500.00 $4,505,000.00 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
9141 OTHER Inj Onase Abepar-xioi Tre 14 13 — — $388,347.15 $3,106,777.20 $2,588,981.00 2026-03-01
2067 OTHER Afamitresgene Autoleucel 14 13 — — $115,593.00 $924,744.00 $770,620.00 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 14 13 — — $88,147.44 $705,179.52 $587,649.60 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 14 13 — — $84,979.70 $679,837.56 $566,531.30 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
9035 OTHER Axicabtagene Ciloleucel C 14 13 — — $79,828.83 $638,630.64 $532,192.20 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 14 13 — — $73,417.53 $587,340.24 $489,450.20 2026-03-01
897 OTHER Revakinagene, Per Implant 14 13 — — $39,750.00 $318,000.00 $265,000.00 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
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
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
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
1906 OTHER New Technology - Level 51 14 13 — — $22,066.77 $176,534.16 $147,111.80 2026-03-01
1905 OTHER New Technology - Level 51 14 13 — — $22,066.77 $176,534.16 $147,111.80 2026-03-01
1904 OTHER New Technology - Level 50 14 13 — — $19,659.49 $157,275.96 $131,063.30 2026-03-01
1903 OTHER New Technology - Level 50 14 13 — — $19,659.49 $157,275.96 $131,063.30 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
1585 OTHER New Technology - Level 48 14 13 — — $15,246.15 $121,969.20 $101,641.00 2026-03-01
1599 OTHER New Technology - Level 48 14 13 — — $15,246.15 $121,969.20 $101,641.00 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
1598 OTHER New Technology - Level 47 14 13 — — $13,641.30 $109,130.44 $90,942.03 2026-03-01
1584 OTHER New Technology - Level 47 14 13 — — $13,641.30 $109,130.44 $90,942.03 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
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
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
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
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
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
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
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
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
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
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
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
1583 OTHER New Technology - Level 46 14 13 — — $12,036.45 $96,291.64 $80,243.03 2026-03-01
1597 OTHER New Technology - Level 46 14 13 — — $12,036.45 $96,291.64 $80,243.03 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
714 OTHER Inj Delandistrogene Mox R 15 14 — — $9,083.36 $3,993,432.00 $3,327,860.00 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 15 14 — — $17,290.09 $3,903,009.60 $3,252,508.00 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 15 14 — — $12,356.25 $3,816,000.00 $3,180,000.00 2026-03-01
746 OTHER Inj, Betibeglogene Autote 15 14 — — $15,993.52 $3,527,962.80 $2,939,969.00 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
886 OTHER Inj. Remestemcel-l-rknd/ 15 14 — — $11,571.94 $242,002.80 $201,669.00 2026-03-01
Q2058 HCPCS Obecabtagene Inj 16 11 — — $598,237.50 $5,000,000.00 $2,272,500.00 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
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
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
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
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
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
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
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
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
746730 CDM Tmvi Perc 19 15 $188,360.00 $188,360.00 $25,616.96 $188,360.00 $79,111.20 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
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
7 MS_DRG Lung Transplant 21 14 — — $120,029.93 $248,941.69 $126,347.30 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 21 14 — — $111,431.86 $231,020.09 $117,296.70 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 21 14 — — $95,685.61 $198,198.74 $100,721.70 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
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
Q2054 HCPCS Lisocabtagene 22 16 — — $379,082.81 $5,000,000.00 $1,284,366.33 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
209 MS_DRG Complex Aortic Arch Procedures 23 16 — — $5,995.00 $217,581.29 $110,510.00 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
850 MS_DRG Acute Leukemia With Other Procedures 25 16 — — $5,995.00 $166,461.57 $84,694.20 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
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
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 26 17 — — $5,995.00 $209,032.82 $106,193.00 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
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
215 MS_DRG Other Heart Assist System Implant 33 21 — — $51,900.00 $319,959.00 $97,290.02 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
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
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
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
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
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
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
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
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