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

SOUTH BROOKLYN HEALTH

Brooklyn, NY · CCN 330196 · Rates published

46,112 distinct procedures filed
28 distinct payers
1,969,678 rate rows
2025-09-05 last MRF observed
Data quality

1,482,686 of 1,969,678 rate rows are consumer-grade (75.3%)

486,992 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 451,323
template filing: same amount across many unrelated codes — excluded 15,643
exceeds 10× this hospital's gross charge — excluded from medians 9,046
placeholder amount (≤ $0.02) — excluded from medians 6,831
per-diem day rate — not a per-procedure price 2,617
percent-of-charges filed in the dollar field — excluded from medians 1,532
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://nychh.pt.panaceainc.com/MRFDownload/nychh/south-brooklyn
Found on page https://www.nychealthandhospitals.org/paying-for-your-health-care/facility-charges/
Discovered viaDiscovered by HANK (automated)
Last fetch success · 2026-05-18
Content fingerprint c595713b6b9283c8… · 25,671,251 bytes · first seen 2026-05-17

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
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 5 $3,605,000.00 $4,565,876.22 $4,390,265.60 nat. median
$3,710,000
1.2× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 5 $3,672,900.00 $4,535,437.05 $4,360,997.17 nat. median
$3,710,000
1.2× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 6 $3,325,454.76 $4,722,145.76 $3,934,165.40 nat. median
$3,325,455
1.2× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 6 $3,286,000.00 $4,666,120.00 $3,859,357.05 nat. median
$3,286,000
1.2× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 6 $2,968,000.00 $4,214,560.00 $3,491,724.58 nat. median
$3,006,423
1.2× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 8 $2,388,614.23 $4,352,603.27 $2,901,735.52 nat. median
$2,469,189
1.2× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 8 $2,332,000.00 $4,139,393.28 $2,759,595.52 nat. median
$2,448,600
1.1× median
Q2057
HCPCS 		Afamitresgene Autoleucel 16 $755,207.60 $1,823,841.77 $911,920.88 nat. median
$824,563
1.1× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 16 $529,192.86 $1,368,732.35 $684,366.18 nat. median
$754,974
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 16 $527,123.43 $1,309,692.74 $654,846.37 nat. median
$675,122
1.0× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 16 $516,726.08 $1,281,899.95 $640,949.97 nat. median
$674,188
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 16 $526,587.59 $1,281,011.93 $640,505.97 nat. median
$625,184
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 16 $489,455.96 $1,261,642.77 $630,821.38 nat. median
$634,511
1.0× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 16 $460,530.40 $1,159,030.12 $579,515.06 nat. median
$620,080
0.9× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 21 $17,861.00 $864,490.51 $458,534.59 nat. median
$370,174
1.2× median
0024
APR_DRG 		12 $301,782.83 $2,023,884.20 $352,609.42 nat. median
$372,987
0.9× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 21 $17,861.00 $645,701.94 $343,625.02 nat. median
$265,286
1.3× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 7 $319,950.96 $639,901.92 $326,349.98 nat. median
$324,450
1.0× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 20 $17,861.00 $543,797.74 $290,104.09 nat. median
$206,368
1.4× median
1734
APR_DRG 		1 $270,814.18 $270,814.18 $270,814.18 nat. median
$57,069
outlier · 4.7×
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 21 $17,861.00 $491,276.57 $262,519.53 nat. median
$202,986
1.3× median
5834
APR_DRG 		12 $223,246.82 $638,262.30 $260,846.28 nat. median
$309,665
0.8× median
5884
APR_DRG 		12 $219,395.80 $843,002.42 $256,346.67 nat. median
$246,434
1.0× median
5883
APR_DRG 		12 $219,395.80 $630,070.87 $256,346.67 nat. median
$182,736
1.4× median
6934
APR_DRG 		1 $250,278.99 $250,278.99 $250,278.99 nat. median
$55,384
outlier · 4.5×
1614
APR_DRG 		12 $201,028.63 $840,651.57 $234,886.08 nat. median
$207,730
1.1× median
0034
APR_DRG 		12 $195,309.67 $1,916,540.60 $228,203.93 nat. median
$267,508
0.9× median
5914
APR_DRG 		12 $169,416.16 $484,541.59 $197,949.41 nat. median
$164,279
1.2× median
5881
APR_DRG 		12 $168,819.10 $613,336.49 $197,251.80 nat. median
$124,573
1.6× median
5882
APR_DRG 		12 $168,819.10 $613,336.49 $197,251.80 nat. median
$145,336
1.4× median
8414
APR_DRG 		12 $163,990.62 $1,380,740.40 $191,610.10 nat. median
$160,267
1.2× median
C1833
HCPCS 		Cardiac Monitor Sys 1 $187,725.00 $187,725.00 $187,725.00 nat. median
$9,621
outlier · 19.5×
E0766NU
HCPCS 		Elec Stim Cancer Treatment 1 $185,002.22 $185,002.22 $185,002.22 —
0044
APR_DRG 		12 $158,307.50 $679,244.67 $184,969.81 nat. median
$195,681
0.9× median
0014
APR_DRG 		12 $153,473.89 $1,582,685.00 $179,322.12 nat. median
$190,591
0.9× median
5934
APR_DRG 		12 $152,881.10 $459,027.66 $178,629.49 nat. median
$151,838
1.2× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 21 $17,861.00 $323,901.99 $174,613.02 nat. median
$133,176
1.3× median
6094
APR_DRG 		12 $140,328.40 $572,516.23 $163,962.66 nat. median
$162,982
1.0× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 21 $17,861.00 $300,332.56 $162,234.16 nat. median
$117,303
1.4× median
7
MS_DRG 		Lung Transplant 21 $17,861.00 $299,576.10 $161,836.86 nat. median
$122,708
1.3× median
6024
APR_DRG 		12 $133,141.54 $385,249.02 $155,565.38 nat. median
$118,620
1.3× median
0023
APR_DRG 		12 $132,691.19 $1,257,217.00 $155,039.18 nat. median
$167,082
0.9× median
8413
APR_DRG 		12 $129,058.53 $491,857.60 $150,794.70 nat. median
$66,693
outlier · 2.3×
5833
APR_DRG 		12 $128,627.79 $457,124.72 $150,291.41 nat. median
$244,017
0.6× median
5832
APR_DRG 		12 $126,300.13 $455,157.56 $147,571.73 nat. median
$156,126
0.9× median
5831
APR_DRG 		12 $126,300.13 $455,157.56 $147,571.73 nat. median
$145,122
1.0× median
6034
APR_DRG 		12 $122,976.22 $348,026.77 $143,688.00 nat. median
$109,499
1.3× median
0054
APR_DRG 		12 $121,779.55 $499,327.08 $142,289.79 nat. median
$149,310
1.0× median
5933
APR_DRG 		12 $120,316.76 $371,502.56 $140,580.63 nat. median
$108,996
1.3× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 21 $17,861.00 $252,604.58 $137,167.03 nat. median
$108,660
1.3× median

Other procedures at this hospital

Browse this hospital's 46,112 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
             
C0105 OTHER Stroke M <41.50 And A >=84.50 16 11 — — $59,069.18 $85,590.03 $60,274.67 2025-09-05
2244 APR_DRG — 53 12 — — $51,660.33 $166,713.17 $60,361.01 2025-09-05
2234 APR_DRG — 53 12 — — $51,744.77 $222,906.91 $60,459.68 2025-09-05
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 34 21 — — $17,861.00 $106,635.50 $60,502.86 2025-09-05
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 34 21 — — $17,861.00 $107,268.18 $60,835.14 2025-09-05
B0904 OTHER Other Orthopedic M <44.5 16 11 — — $59,750.30 $86,576.96 $60,969.69 2025-09-05
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 34 21 — — $17,861.00 $107,845.84 $61,138.53 2025-09-05
B1305 OTHER Rheumatoid Other Arthritis M <51.50 And A <64.50 16 11 — — $59,949.07 $86,864.98 $61,172.52 2025-09-05
B1304 OTHER Rheumatoid Other Arthritis M <44.50 And A >=64.50 16 11 — — $60,039.18 $86,995.55 $61,264.47 2025-09-05
4403 APR_DRG — 53 12 — — $52,545.68 $571,740.00 $61,395.48 2025-09-05
6082 APR_DRG — 53 12 — — $52,661.67 $177,823.49 $61,531.01 2025-09-05
0051 APR_DRG — 53 12 — — $52,747.82 $230,360.20 $61,631.66 2025-09-05
D0106 OTHER Stroke M <41.50 And A <84.50 16 11 — — $60,439.36 $87,575.40 $61,672.82 2025-09-05
6504 APR_DRG — 53 12 — — $52,806.67 $247,513.70 $61,700.43 2025-09-05
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 33 20 — — $17,861.00 $108,973.65 $61,730.87 2025-09-05
799 MS_DRG Splenic Procedures With Mcc 34 21 — — $17,861.00 $108,994.28 $61,741.70 2025-09-05
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 34 21 — — $17,861.00 $109,468.79 $61,990.92 2025-09-05
1623 APR_DRG — 53 12 — — $53,094.11 $215,438.54 $62,036.28 2025-09-05
A0404 OTHER Traumatic Spinal Cord Injury M <31.50 And A <61.50 16 11 — — $60,850.16 $88,170.64 $62,092.00 2025-09-05
3094 APR_DRG — 53 12 — — $53,165.76 $211,076.65 $62,120.00 2025-09-05
B0704 OTHER Fracture Of Lower Extremity M <41.50 16 11 — — $61,048.92 $88,458.64 $62,294.82 2025-09-05
3084 APR_DRG — 53 12 — — $53,367.91 $177,487.83 $62,356.19 2025-09-05
2294 APR_DRG — 53 12 — — $53,521.44 $224,164.20 $62,535.58 2025-09-05
6 MS_DRG Liver Transplant Without Mcc 34 21 — — $17,861.00 $111,158.21 $62,878.22 2025-09-05
471 MS_DRG Cervical Spinal Fusion With Mcc 34 21 — — $17,861.00 $111,343.89 $62,975.74 2025-09-05
0052 APR_DRG — 53 12 — — $54,005.90 $237,061.37 $63,101.64 2025-09-05
B1504 OTHER Pulmonary M <45.50 16 11 — — $61,899.66 $89,691.35 $63,162.92 2025-09-05
245 MS_DRG Aicd Generator Procedures 36 22 — — $17,861.00 $112,020.12 $63,330.90 2025-09-05
3814 APR_DRG — 53 12 — — $54,510.85 $132,492.42 $63,691.62 2025-09-05
0434 APR_DRG — 53 12 — — $54,637.94 $155,527.32 $63,840.12 2025-09-05
6303 APR_DRG — 53 12 — — $54,704.47 $198,760.90 $63,917.85 2025-09-05
9524 APR_DRG — 53 12 — — $54,756.49 $224,201.90 $63,978.64 2025-09-05
B1004 OTHER Amputation Lower Extremity M <47.50 16 11 — — $62,803.41 $91,000.86 $64,085.11 2025-09-05
A0406 OTHER Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 16 11 — — $62,880.26 $91,112.21 $64,163.53 2025-09-05
B0305 OTHER Non-traumatic Brain Injury M <42.50 And A <78.50 16 11 — — $62,938.57 $91,196.70 $64,223.03 2025-09-05
1714 APR_DRG — 53 12 — — $55,031.14 $222,454.51 $64,299.55 2025-09-05
0494 APR_DRG — 53 12 — — $55,062.70 $190,748.81 $64,336.42 2025-09-05
5184 APR_DRG — 53 12 — — $55,151.40 $165,690.98 $64,440.06 2025-09-05
228 MS_DRG Other Cardiothoracic Procedures With Mcc 36 22 — — $17,861.00 $114,232.19 $64,492.70 2025-09-05
90288 HCPCS Botulism Ig IV 2 1 — — $48,705.00 $80,363.25 $64,534.12 2025-09-05
C0505 OTHER Non-traumatic Spinal Cord Injury M <39.50 16 11 — — $63,383.81 $91,841.85 $64,677.36 2025-09-05
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 34 21 — — $17,861.00 $114,644.80 $64,709.40 2025-09-05
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 34 21 — — $17,861.00 $114,690.65 $64,733.48 2025-09-05
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 34 21 — — $17,861.00 $114,780.05 $64,780.44 2025-09-05
7114 APR_DRG — 53 12 — — $55,646.11 $252,591.89 $65,018.08 2025-09-05
6071 APR_DRG — 53 12 — — $55,691.32 $178,660.04 $65,070.91 2025-09-05
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 34 21 — — $17,861.00 $115,460.86 $65,138.01 2025-09-05
5194 APR_DRG — 53 12 — — $55,756.14 $135,441.79 $65,146.64 2025-09-05
2624 APR_DRG — 53 12 — — $55,797.08 $187,730.92 $65,194.48 2025-09-05
3014 APR_DRG — 53 12 — — $55,797.93 $207,238.79 $65,195.47 2025-09-05
1214 APR_DRG — 53 12 — — $55,826.93 $236,124.53 $65,229.36 2025-09-05
6903 APR_DRG — 53 12 — — $55,876.41 $194,831.72 $65,287.17 2025-09-05
1304 APR_DRG — 53 12 — — $55,960.84 $227,106.69 $65,385.83 2025-09-05
1204 APR_DRG — 53 12 — — $56,114.37 $247,836.03 $65,565.21 2025-09-05
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 34 21 — — $17,861.00 $116,425.92 $65,644.86 2025-09-05
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 34 21 — — $17,861.00 $116,783.52 $65,832.68 2025-09-05
1612 APR_DRG — 53 12 — — $56,428.25 $245,342.18 $65,931.96 2025-09-05
2614 APR_DRG — 53 12 — — $56,539.14 $216,062.47 $66,061.52 2025-09-05
1731 APR_DRG — 1 1 — — $66,148.42 $66,148.42 $66,148.42 2025-09-05
2644 APR_DRG — 53 12 — — $56,658.55 $270,337.28 $66,201.04 2025-09-05
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 34 17 — — $54,827.05 $132,408.45 $66,204.22 2025-09-05
B0604 OTHER Neurological M <43.50 16 11 — — $64,931.58 $94,084.53 $66,256.71 2025-09-05
0011 APR_DRG — 53 12 — — $56,732.76 $782,844.40 $66,287.75 2025-09-05
0012 APR_DRG — 53 12 — — $56,732.76 $797,529.20 $66,287.75 2025-09-05
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 34 21 — — $17,861.00 $117,663.76 $66,294.99 2025-09-05
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 29 18 — — $61,845.80 $118,055.74 $66,500.86 2025-09-05
4444 APR_DRG — 53 12 — — $56,925.52 $239,751.27 $66,512.98 2025-09-05
5114 APR_DRG — 53 12 — — $57,270.96 $219,455.47 $66,916.59 2025-09-05
1664 APR_DRG — 53 12 — — $57,311.89 $335,784.48 $66,964.42 2025-09-05
B2102 OTHER Burns M <52.50 16 11 — — $65,625.95 $95,090.66 $66,965.25 2025-09-05
1824 APR_DRG — 52 12 — — $57,659.90 $139,950.70 $67,067.57 2025-09-05
B1805 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 16 11 — — $65,726.65 $95,236.57 $67,068.01 2025-09-05
6113 APR_DRG — 53 12 — — $57,607.01 $183,949.74 $67,309.25 2025-09-05
9514 APR_DRG — 53 12 — — $57,686.34 $248,561.76 $67,401.93 2025-09-05
0264 APR_DRG — 53 12 — — $57,693.16 $247,257.34 $67,409.90 2025-09-05
A1806 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 16 11 — — $66,293.81 $96,058.37 $67,646.74 2025-09-05
3054 APR_DRG — 53 12 — — $57,914.07 $267,326.93 $67,668.02 2025-09-05
3174 APR_DRG — 53 12 — — $58,052.25 $258,970.73 $67,829.47 2025-09-05
7104 APR_DRG — 53 12 — — $58,072.72 $254,214.87 $67,853.39 2025-09-05
6914 APR_DRG — 53 12 — — $58,178.48 $225,704.25 $67,976.97 2025-09-05
1774 APR_DRG — 53 12 — — $58,193.84 $268,111.09 $67,994.90 2025-09-05
C0106 OTHER Stroke M <41.50 And A <84.50 16 11 — — $66,641.00 $96,561.45 $68,001.02 2025-09-05
B0105 OTHER Stroke M <41.50 And A >=84.50 16 11 — — $66,707.25 $96,657.44 $68,068.62 2025-09-05
6123 APR_DRG — 53 12 — — $58,265.49 $179,533.77 $68,078.62 2025-09-05
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 36 22 — — $17,861.00 $125,517.20 $68,265.83 2025-09-05
4424 APR_DRG — 53 12 — — $58,546.10 $243,651.33 $68,406.49 2025-09-05
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 36 22 — — $17,861.00 $121,954.94 $68,548.75 2025-09-05
5104 APR_DRG — 53 12 — — $58,830.98 $207,517.77 $68,739.36 2025-09-05
D0404 OTHER Traumatic Spinal Cord Injury M <31.50 And A <61.50 16 11 — — $67,433.43 $97,709.66 $68,809.62 2025-09-05
B1705 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 16 11 — — $67,454.63 $97,740.38 $68,831.25 2025-09-05
3134 APR_DRG — 53 12 — — $59,359.80 $265,174.26 $69,357.24 2025-09-05
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 34 21 — — $17,861.00 $123,676.46 $69,452.91 2025-09-05
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 34 21 — — $17,861.00 $123,690.22 $69,460.13 2025-09-05
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 34 21 — — $17,861.00 $123,807.12 $69,521.53 2025-09-05
9114 APR_DRG — 53 12 — — $59,521.86 $249,837.90 $69,546.59 2025-09-05
6021 APR_DRG — 53 12 — — $59,542.33 $258,422.97 $69,570.52 2025-09-05
B0405 OTHER Traumatic Spinal Cord Injury M >=31.50 And M <41.50 16 11 — — $68,339.82 $99,023.00 $69,734.51 2025-09-05
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 34 21 — — $17,861.00 $124,442.09 $69,855.02 2025-09-05
A9543 HCPCS Y90 Ibritumomab, Rx 15 11 — — $14,774.74 $134,487.80 $69,933.66 2025-09-05
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 34 21 — — $17,861.00 $124,726.34 $70,004.31 2025-09-05
A1904 OTHER Guillain-barr? M <38.50 16 11 — — $68,933.47 $99,883.20 $70,340.28 2025-09-05
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 29 18 — — $65,433.19 $125,400.27 $70,358.27 2025-09-05
4034 APR_DRG — 53 12 — — $60,258.80 $266,742.58 $70,407.66 2025-09-05
1814 APR_DRG — 52 12 — — $60,598.27 $146,909.99 $70,485.35 2025-09-05
C0404 OTHER Traumatic Spinal Cord Injury M <31.50 And A <61.50 16 11 — — $69,230.31 $100,313.30 $70,643.17 2025-09-05
2214 APR_DRG — 53 12 — — $60,528.33 $246,446.79 $70,722.57 2025-09-05
7914 APR_DRG — 53 12 — — $60,548.80 $242,852.09 $70,746.49 2025-09-05
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 29 18 — — $65,809.39 $126,170.48 $70,762.79 2025-09-05
D1904 OTHER Guillain-barr? M <38.50 16 11 — — $69,402.57 $100,562.91 $70,818.95 2025-09-05
0031 APR_DRG — 53 12 — — $60,675.88 $628,128.80 $70,894.98 2025-09-05
1674 APR_DRG — 53 12 — — $60,723.65 $256,128.15 $70,950.79 2025-09-05
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 34 21 — — $17,861.00 $126,702.30 $71,042.10 2025-09-05
834 MS_DRG Acute Leukemia Without Major O.r. Procedures With Mcc 34 21 — — $17,861.00 $126,702.30 $71,042.10 2025-09-05
D0406 OTHER Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 16 11 — — $69,680.85 $100,966.13 $71,102.91 2025-09-05
0204 APR_DRG — 53 12 — — $61,225.18 $251,945.33 $71,536.79 2025-09-05
653 MS_DRG Major Bladder Procedures With Mcc 34 21 — — $17,861.00 $127,786.56 $71,611.56 2025-09-05
D1806 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 16 11 — — $70,568.69 $102,252.60 $72,008.87 2025-09-05
4414 APR_DRG — 53 12 — — $61,850.39 $288,962.96 $72,267.29 2025-09-05
6214 APR_DRG — 53 12 — — $62,096.03 $194,025.52 $72,554.31 2025-09-05
0244 APR_DRG — 53 12 — — $62,108.82 $262,642.71 $72,569.26 2025-09-05
0894 APR_DRG — 53 12 — — $62,322.06 $229,726.84 $72,818.41 2025-09-05
6083 APR_DRG — 53 12 — — $62,364.71 $216,036.08 $72,868.24 2025-09-05
C0406 OTHER Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 16 11 — — $71,538.69 $103,658.10 $72,998.66 2025-09-05
3104 APR_DRG — 53 12 — — $62,523.35 $220,680.72 $73,053.60 2025-09-05
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 34 21 — — $17,861.00 $130,778.01 $73,182.70 2025-09-05
B0205 OTHER Traumatic Brain Injury M <35.50 16 11 — — $72,023.69 $104,360.86 $73,493.56 2025-09-05
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 34 21 — — $17,861.00 $131,564.27 $73,595.65 2025-09-05
6032 APR_DRG — 53 12 — — $63,003.55 $218,057.32 $73,614.68 2025-09-05
4014 APR_DRG — 53 12 — — $63,764.38 $332,549.82 $74,503.64 2025-09-05
3033 APR_DRG — 53 12 — — $63,766.94 $248,931.22 $74,506.63 2025-09-05
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 34 21 — — $17,861.00 $133,464.58 $74,593.71 2025-09-05
69930 CPT Implant Cochlear Device 4 2 — — $50,424.74 $74,900.36 $74,900.36 2025-09-05
J9029 HCPCS Instill Adstiladrin, Tx Dose 32 17 — — $62,162.43 $150,123.53 $75,061.77 2025-09-05
1634 APR_DRG — 53 12 — — $64,270.17 $382,515.51 $75,094.62 2025-09-05
B1903 OTHER Guillain-barr? M >=38.50 And M <51.50 16 11 — — $73,648.30 $106,714.89 $75,151.33 2025-09-05
3214 APR_DRG — 53 12 — — $64,416.88 $300,052.42 $75,266.04 2025-09-05
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 36 22 — — $17,861.00 $134,883.52 $75,338.95 2025-09-05
1654 APR_DRG — 53 12 — — $64,522.64 $319,245.49 $75,389.61 2025-09-05
8412 APR_DRG — 53 12 — — $64,567.84 $487,923.80 $75,442.43 2025-09-05
2204 APR_DRG — 53 12 — — $64,617.32 $282,878.18 $75,500.24 2025-09-05
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 29 19 — — $17,861.00 $113,682.41 $76,068.53 2025-09-05
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 34 21 — — $17,861.00 $136,375.80 $76,122.71 2025-09-05
6084 APR_DRG — 53 12 — — $65,425.05 $232,251.63 $76,444.00 2025-09-05
9104 APR_DRG — 53 12 — — $65,425.90 $261,291.16 $76,445.00 2025-09-05
1694 APR_DRG — 53 12 — — $65,429.31 $277,453.15 $76,448.99 2025-09-05
0041 APR_DRG — 53 12 — — $65,477.93 $285,624.63 $76,505.80 2025-09-05
0042 APR_DRG — 53 12 — — $65,477.93 $286,090.22 $76,505.80 2025-09-05
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 34 21 — — $17,861.00 $137,327.11 $76,622.34 2025-09-05
B0106 OTHER Stroke M <41.50 And A <84.50 16 11 — — $75,257.02 $109,045.89 $76,792.88 2025-09-05
0214 APR_DRG — 53 12 — — $65,928.28 $288,849.86 $77,031.99 2025-09-05
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 34 21 — — $17,861.00 $138,360.94 $77,165.32 2025-09-05
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 34 21 — — $17,861.00 $138,360.94 $77,165.32 2025-09-05
0924 APR_DRG — 53 12 — — $66,883.57 $161,796.24 $77,444.14 2025-09-05
6093 APR_DRG — 53 12 — — $66,283.96 $230,406.15 $77,447.57 2025-09-05
28 MS_DRG Spinal Procedures With Mcc 34 21 — — $17,861.00 $139,360.38 $77,690.23 2025-09-05
0063 APR_DRG — 53 12 — — $66,549.22 $608,155.60 $77,757.51 2025-09-05
232 MS_DRG Coronary Bypass With Ptca Without Mcc 34 21 — — $17,861.00 $140,029.73 $78,041.78 2025-09-05
6954 APR_DRG — 52 12 — — $67,168.46 $162,470.97 $78,127.52 2025-09-05
6933 APR_DRG — 1 1 — — $78,316.10 $78,316.10 $78,316.10 2025-09-05
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 34 21 — — $17,861.00 $140,671.57 $78,378.88 2025-09-05
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 34 21 — — $17,861.00 $141,164.42 $78,637.73 2025-09-05
C1806 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 16 11 — — $77,141.36 $111,776.25 $78,715.67 2025-09-05
2604 APR_DRG — 53 12 — — $67,507.07 $290,063.80 $78,876.68 2025-09-05
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 29 18 — — $73,448.83 $141,810.85 $78,977.24 2025-09-05
276 MS_DRG Cardiac Defibrillator Implant With Mcc 34 21 — — $17,861.00 $141,994.23 $79,073.55 2025-09-05
6072 APR_DRG — 53 12 — — $67,949.75 $208,730.21 $79,393.92 2025-09-05
5124 APR_DRG — 53 12 — — $68,162.98 $197,683.72 $79,643.07 2025-09-05
9124 APR_DRG — 53 12 — — $68,787.33 $272,863.18 $80,372.57 2025-09-05
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 33 20 — — $17,861.00 $144,971.93 $80,637.46 2025-09-05
8504 APR_DRG — 53 12 — — $69,214.65 $250,218.67 $80,871.86 2025-09-05
4474 APR_DRG — 53 12 — — $69,247.92 $263,711.50 $80,910.73 2025-09-05
C1904 OTHER Guillain-barr? M <38.50 16 11 — — $79,309.27 $114,917.52 $80,927.83 2025-09-05
0064 APR_DRG — 53 12 — — $69,318.72 $675,490.40 $80,993.45 2025-09-05
0032 APR_DRG — 53 12 — — $70,356.73 $712,602.80 $82,206.29 2025-09-05
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 22 — — $17,861.00 $148,034.44 $82,245.92 2025-09-05
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 34 21 — — $17,861.00 $148,247.63 $82,357.89 2025-09-05
B0505 OTHER Non-traumatic Spinal Cord Injury M <39.50 16 11 — — $82,367.69 $119,349.10 $84,048.66 2025-09-05
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 34 21 — — $17,861.00 $152,841.39 $84,770.57 2025-09-05
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 33 20 — — $17,861.00 $153,100.42 $84,906.62 2025-09-05
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 29 18 — — $79,252.02 $153,691.84 $85,217.23 2025-09-05
0234 APR_DRG — 53 12 — — $73,098.94 $318,289.79 $85,410.34 2025-09-05
9504 APR_DRG — 53 12 — — $73,373.58 $306,320.04 $85,731.24 2025-09-05
1732 APR_DRG — 1 1 — — $85,871.18 $85,871.18 $85,871.18 2025-09-05
955 MS_DRG Craniotomy For Multiple Significant Trauma 33 20 — — $17,861.00 $156,525.12 $86,705.30 2025-09-05
6114 APR_DRG — 53 12 — — $74,221.40 $322,600.72 $86,721.85 2025-09-05
A0407 OTHER Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 11 — — $86,043.61 $124,675.43 $87,799.60 2025-09-05
0013 APR_DRG — 53 12 — — $75,524.70 $804,533.60 $88,244.64 2025-09-05
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 34 21 — — $17,861.00 $159,463.85 $88,248.74 2025-09-05
B0404 OTHER Traumatic Spinal Cord Injury M <31.50 And A <61.50 16 11 — — $86,510.06 $125,351.31 $88,275.57 2025-09-05
4054 APR_DRG — 53 12 — — $75,708.93 $294,502.98 $88,459.91 2025-09-05
6124 APR_DRG — 53 12 — — $76,438.19 $250,108.17 $89,311.99 2025-09-05
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 34 21 — — $17,861.00 $161,996.84 $89,579.09 2025-09-05
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 2 1 — — $67,727.85 $111,750.95 $89,739.40 2025-09-05
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 29 18 — — $83,708.27 $162,815.19 $90,008.89 2025-09-05
8424 APR_DRG — 53 12 — — $77,837.86 $626,797.60 $90,947.39 2025-09-05
B0406 OTHER Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 16 11 — — $89,393.55 $129,529.43 $91,217.91 2025-09-05
6904 APR_DRG — 53 12 — — $78,822.16 $343,567.64 $92,097.47 2025-09-05
5911 APR_DRG — 53 12 — — $79,984.71 $192,825.25 $93,455.82 2025-09-05
6804 APR_DRG — 53 12 — — $80,470.04 $406,996.01 $94,022.88 2025-09-05
6814 APR_DRG — 53 12 — — $80,682.41 $305,786.59 $94,271.02 2025-09-05
6033 APR_DRG — 53 12 — — $80,744.68 $281,177.13 $94,343.78 2025-09-05
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 33 20 — — $17,861.00 $171,101.86 $94,361.12 2025-09-05
3124 APR_DRG — 53 12 — — $80,947.68 $815,773.40 $94,580.97 2025-09-05
B1806 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 16 11 — — $93,819.50 $135,942.54 $95,734.18 2025-09-05
4604 APR_DRG — 1 1 — — $95,937.92 $95,937.92 $95,937.92 2025-09-05
6073 APR_DRG — 53 12 — — $82,199.79 $256,411.87 $96,043.96 2025-09-05
3044 APR_DRG — 53 12 — — $82,482.12 $351,908.77 $96,373.84 2025-09-05
0053 APR_DRG — 53 12 — — $82,912.85 $348,485.61 $96,877.11 2025-09-05
D0407 OTHER Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 11 — — $95,348.70 $138,158.32 $97,294.59 2025-09-05
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 36 22 — — $17,861.00 $177,366.71 $97,651.47 2025-09-05
Q0480 HCPCS Driver Pneumatic Vad, Rep 8 3 — — $35,858.53 $122,219.08 $97,904.99 2025-09-05
1624 APR_DRG — 53 12 — — $84,209.31 $410,688.72 $98,391.93 2025-09-05
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 36 22 — — $17,861.00 $179,175.34 $98,601.38 2025-09-05
6022 APR_DRG — 53 12 — — $85,056.28 $262,810.21 $99,381.55 2025-09-05
C0407 OTHER Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 11 — — $97,890.31 $141,841.06 $99,888.07 2025-09-05
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 34 21 — — $17,861.00 $181,717.50 $99,936.54 2025-09-05
10 MS_DRG Pancreas Transplant 34 21 — — $17,861.00 $182,765.08 $100,486.74 2025-09-05
3614 APR_DRG — 53 12 — — $86,049.96 $637,127.40 $100,542.58 2025-09-05
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 34 21 — — $17,861.00 $184,784.60 $101,547.41 2025-09-05
1613 APR_DRG — 53 12 — — $88,089.33 $407,908.35 $102,925.43 2025-09-05
1604 APR_DRG — 53 12 — — $88,978.95 $396,047.93 $103,964.88 2025-09-05
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 29 18 — — $97,568.54 $191,191.57 $104,912.41 2025-09-05
0043 APR_DRG — 53 12 — — $90,059.62 $401,316.50 $105,227.56 2025-09-05
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 34 21 — — $17,861.00 $194,139.47 $106,460.67 2025-09-05
231 MS_DRG Coronary Bypass With Ptca With Mcc 36 22 — — $17,861.00 $194,247.21 $106,517.25 2025-09-05
4404 APR_DRG — 53 12 — — $92,733.59 $832,863.20 $108,351.87 2025-09-05
6314 APR_DRG — 53 12 — — $93,836.43 $335,154.04 $109,640.46 2025-09-05
5931 APR_DRG — 53 12 — — $96,304.83 $343,193.37 $112,524.60 2025-09-05
3034 APR_DRG — 53 12 — — $97,086.98 $399,422.08 $113,438.47 2025-09-05
5912 APR_DRG — 53 12 — — $98,173.62 $236,376.92 $114,708.12 2025-09-05
B1904 OTHER Guillain-barr? M <38.50 16 11 — — $113,073.69 $163,841.47 $115,381.32 2025-09-05
850 MS_DRG Acute Leukemia With Other Procedures 29 18 — — $107,324.13 $211,164.38 $115,402.29 2025-09-05
5932 APR_DRG — 53 12 — — $99,198.86 $345,530.64 $115,906.03 2025-09-05
6023 APR_DRG — 53 12 — — $99,369.44 $331,109.87 $116,105.35 2025-09-05
0904 APR_DRG — 53 12 — — $99,952.00 $240,116.20 $116,786.02 2025-09-05
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 22 — — $17,861.00 $221,232.17 $120,689.97 2025-09-05
5913 APR_DRG — 53 12 — — $104,936.57 $356,392.27 $122,610.10 2025-09-05
0033 APR_DRG — 53 12 — — $105,007.37 $957,325.20 $122,692.82 2025-09-05
B0407 OTHER Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 11 — — $122,323.14 $177,243.73 $124,819.53 2025-09-05
0021 APR_DRG — 53 12 — — $107,370.01 $737,557.60 $125,453.38 2025-09-05
5891 APR_DRG — 53 12 — — $107,700.95 $302,236.22 $125,840.06 2025-09-05
5892 APR_DRG — 53 12 — — $107,700.95 $302,236.22 $125,840.06 2025-09-05
6304 APR_DRG — 53 12 — — $108,473.71 $425,944.22 $126,742.96 2025-09-05
6074 APR_DRG — 53 12 — — $109,463.97 $360,864.01 $127,900.01 2025-09-05
1733 APR_DRG — 1 1 — — $129,491.96 $129,491.96 $129,491.96 2025-09-05
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 29 18 — — $121,471.03 $240,127.59 $130,614.01 2025-09-05
215 MS_DRG Other Heart Assist System Implant 34 21 — — $17,861.00 $242,864.60 $132,051.51 2025-09-05
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 34 21 — — $17,861.00 $244,116.20 $132,708.86 2025-09-05
0022 APR_DRG — 53 12 — — $113,730.37 $770,910.40 $132,884.96 2025-09-05
212 MS_DRG Concomitant Aortic And Mitral Valve?procedures 34 21 — — $17,861.00 $249,720.87 $135,652.48 2025-09-05
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 34 21 — — $17,861.00 $252,604.58 $137,167.03 2025-09-05
5933 APR_DRG — 53 12 — — $120,316.76 $371,502.56 $140,580.63 2025-09-05
0054 APR_DRG — 53 12 — — $121,779.55 $499,327.08 $142,289.79 2025-09-05
6034 APR_DRG — 53 12 — — $122,976.22 $348,026.77 $143,688.00 2025-09-05
5831 APR_DRG — 53 12 — — $126,300.13 $455,157.56 $147,571.73 2025-09-05
5832 APR_DRG — 53 12 — — $126,300.13 $455,157.56 $147,571.73 2025-09-05
5833 APR_DRG — 53 12 — — $128,627.79 $457,124.72 $150,291.41 2025-09-05
8413 APR_DRG — 53 12 — — $129,058.53 $491,857.60 $150,794.70 2025-09-05
0023 APR_DRG — 53 12 — — $132,691.19 $1,257,217.00 $155,039.18 2025-09-05
6024 APR_DRG — 53 12 — — $133,141.54 $385,249.02 $155,565.38 2025-09-05
7 MS_DRG Lung Transplant 34 21 — — $17,861.00 $299,576.10 $161,836.86 2025-09-05
14 MS_DRG Allogeneic Bone Marrow Transplant 34 21 — — $17,861.00 $300,332.56 $162,234.16 2025-09-05
6094 APR_DRG — 53 12 — — $140,328.40 $572,516.23 $163,962.66 2025-09-05
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 34 21 — — $17,861.00 $323,901.99 $174,613.02 2025-09-05
5934 APR_DRG — 53 12 — — $152,881.10 $459,027.66 $178,629.49 2025-09-05
0014 APR_DRG — 53 12 — — $153,473.89 $1,582,685.00 $179,322.12 2025-09-05
0044 APR_DRG — 53 12 — — $158,307.50 $679,244.67 $184,969.81 2025-09-05
E0766NU HCPCS Elec Stim Cancer Treatment 3 1 — — $185,002.22 $185,002.22 $185,002.22 2025-09-05
C1833 HCPCS Cardiac Monitor Sys 1 1 — — $187,725.00 $187,725.00 $187,725.00 2025-09-05
8414 APR_DRG — 53 12 — — $163,990.62 $1,380,740.40 $191,610.10 2025-09-05
5882 APR_DRG — 53 12 — — $168,819.10 $613,336.49 $197,251.80 2025-09-05
5881 APR_DRG — 53 12 — — $168,819.10 $613,336.49 $197,251.80 2025-09-05
5914 APR_DRG — 53 12 — — $169,416.16 $484,541.59 $197,949.41 2025-09-05
0034 APR_DRG — 53 12 — — $195,309.67 $1,916,540.60 $228,203.93 2025-09-05
1614 APR_DRG — 53 12 — — $201,028.63 $840,651.57 $234,886.08 2025-09-05
6934 APR_DRG — 1 1 — — $250,278.99 $250,278.99 $250,278.99 2025-09-05
5884 APR_DRG — 53 12 — — $219,395.80 $843,002.42 $256,346.67 2025-09-05
5883 APR_DRG — 53 12 — — $219,395.80 $630,070.87 $256,346.67 2025-09-05
5834 APR_DRG — 53 12 — — $223,246.82 $638,262.30 $260,846.28 2025-09-05
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 34 21 — — $17,861.00 $491,276.57 $262,519.53 2025-09-05
1734 APR_DRG — 1 1 — — $270,814.18 $270,814.18 $270,814.18 2025-09-05
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 33 20 — — $17,861.00 $543,797.74 $290,104.09 2025-09-05
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 8 7 — — $319,950.96 $639,901.92 $326,349.98 2025-09-05
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 34 21 — — $17,861.00 $645,701.94 $343,625.02 2025-09-05
0024 APR_DRG — 53 12 — — $301,782.83 $2,023,884.20 $352,609.42 2025-09-05
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 34 21 — — $17,861.00 $864,490.51 $458,534.59 2025-09-05
Q2053 HCPCS Brexucabtagene Car Pos T 31 16 — — $460,530.40 $1,159,030.12 $579,515.06 2025-09-05
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 31 16 — — $489,455.96 $1,261,642.77 $630,821.38 2025-09-05
Q2055 HCPCS Idecabtagene Vicleucel Car 31 16 — — $526,587.59 $1,281,011.93 $640,505.97 2025-09-05
Q2054 HCPCS Lisocabtagene Mara Car Pos T 31 16 — — $516,726.08 $1,281,899.95 $640,949.97 2025-09-05
Q2056 HCPCS Ciltacabtagene Car-pos T 31 16 — — $527,123.43 $1,309,692.74 $654,846.37 2025-09-05
Q2042 HCPCS Tisagenlecleucel Car-pos T 31 16 — — $529,192.86 $1,368,732.35 $684,366.18 2025-09-05
Q2057 HCPCS Afamitresgene Autoleucel 30 16 — — $755,207.60 $1,823,841.77 $911,920.88 2025-09-05
J3392 HCPCS Inj, Exagamglogene Autotem 9 8 — — $2,332,000.00 $4,139,393.28 $2,759,595.52 2025-09-05
J3399 HCPCS Inj Onase Abepar-xioi Treat 9 8 — — $2,388,614.23 $4,352,603.27 $2,901,735.52 2025-09-05
J3393 HCPCS Inj, Betibeglogene Autotemce 7 6 — — $2,968,000.00 $4,214,560.00 $3,491,724.58 2025-09-05
J3394 HCPCS Inj, Lovotibeglogene Autotem 7 6 — — $3,286,000.00 $4,666,120.00 $3,859,357.05 2025-09-05
J1413 HCPCS Inj Delandistrogene Mox Rokl 7 6 — — $3,325,454.76 $4,722,145.76 $3,934,165.40 2025-09-05
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 6 5 — — $3,672,900.00 $4,535,437.05 $4,360,997.17 2025-09-05
J1414 HCPCS Inj, Beqvez, Per Tx Dose 6 5 — — $3,605,000.00 $4,565,876.22 $4,390,265.60 2025-09-05
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