Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

METHODIST HOSPITAL

San Antonio, TX · CCN 450388 · Rates published

63,907 distinct procedures filed
76 distinct payers
6,537,829 rate rows
2026-07-31 last MRF observed
Data quality

6,360,145 of 6,537,829 rate rows are consumer-grade (97.3%)

177,684 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 77,431
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 52,191
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 27,243
template filing: same amount across many unrelated codes — excluded 13,151
percent-of-charges filed in the dollar field — excluded from medians 4,490
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 1,694
placeholder amount (≤ $0.02) — excluded from medians 1,207
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 219
exceeds 10× this hospital's gross charge — excluded from medians 58
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.hcadam.com/api/public/content/9b43b6f65d4b49e1a6ea8f90c83e15cb?download=true
Found on page https://sahealth.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-11
Content fingerprint 8e29d9a64fa81f0f… · 936,515,903 bytes · first seen 2026-05-08

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
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,897,200.00 $4,897,200.00 $4,897,200.00 nat. median
$2,997,086
1.6× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $3,884,946.48 $3,884,946.48 $3,884,946.48 nat. median
$2,460,273
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 20 $3,379,068.00 $4,003,461.00 $3,672,900.00 nat. median
$3,758,972
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 3 $3,562,713.00 $3,672,900.00 $3,672,900.00 nat. median
$3,574,709
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 3 $3,496,850.00 $3,605,000.00 $3,605,000.00 nat. median
$3,496,850
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 20 $3,316,600.00 $3,929,450.00 $3,605,000.00 nat. median
$3,646,097
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 23 $5,084.93 $4,655,637.00 $3,342,082.27 nat. median
$3,325,455
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 3 $3,225,691.35 $3,325,455.00 $3,325,455.00 nat. median
$3,228,024
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 23 $8,387.57 $4,600,400.00 $3,302,430.00 nat. median
$3,252,508
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 3 $3,187,420.00 $3,286,000.00 $3,286,000.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 23 $7,449.83 $4,600,400.00 $3,023,204.80 nat. median
$2,939,969
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 3 $2,878,960.00 $2,968,000.00 $2,968,000.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 22 $2,197,524.88 $3,702,351.70 $2,433,042.22 nat. median
$2,588,981
0.9× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 3 $2,316,955.58 $2,388,614.00 $2,388,614.00 nat. median
$2,511,312
1.0× median
Q2056
HCPCS 		Ciltacabtagene 100 Mil 42 $317,587.52 $4,499,156.55 $1,572,058.23 nat. median
$631,793
outlier · 2.5×
Q2055
HCPCS 		Idecabtagene 42 $317,587.52 $4,499,156.55 $1,487,446.32 nat. median
$610,161
outlier · 2.4×
Q2054
HCPCS 		Lisocabtagene 42 $317,587.52 $4,499,156.55 $1,454,825.33 nat. median
$624,417
outlier · 2.3×
Q2053
HCPCS 		Brexucabtagene 42 $317,587.52 $4,499,156.55 $1,326,283.56 nat. median
$577,541
outlier · 2.3×
Q2042
HCPCS 		Tisagenlecleucel Adult 42 $25.48 $4,499,156.55 $1,094,941.50 nat. median
$691,418
1.6× median
111149
CDM 		Kit Hrt Implant Lvas 28 $215,092.36 $1,536,374.00 $960,233.75 nat. median
$52
outlier · 18466.0×
653215
CDM 		Implant Hvas Ordr Set 28 $185,010.28 $1,321,502.00 $825,938.75 nat. median
$825,939
1.0× median
245528
CDM 		Implant Hvas Lng Ordrset 28 $185,010.28 $1,321,502.00 $825,938.75 nat. median
$726,826
1.1× median
Q2041
HCPCS 		Axicabtagene Adult 43 $6.70 $2,284,238.88 $807,075.90 nat. median
$588,565
1.4× median
722763
CDM 		Kit Impl Lvas W/grafts 28 $173,362.70 $1,238,305.00 $773,940.62 nat. median
$773,941
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 24 $486,857.47 $1,322,982.25 $545,068.69 nat. median
$576,820
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 24 $484,953.53 $1,317,808.50 $542,937.10 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 24 $484,460.59 $1,316,469.00 $542,385.23 nat. median
$560,872
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 24 $475,388.01 $1,291,815.25 $532,227.88 nat. median
$562,201
0.9× median
09194
OTHER 		Tisagenlecleucel Car-pos 3 $513,317.11 $529,192.90 $529,192.90 nat. median
$549,535
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 3 $511,309.70 $527,123.40 $527,123.40 nat. median
$570,020
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 3 $510,789.97 $526,587.60 $526,587.60 nat. median
$541,339
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 3 $501,224.32 $516,726.10 $516,726.10 nat. median
$545,335
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 24 $450,299.52 $1,223,640.00 $504,139.68 nat. median
$533,230
0.9× median
09035
OTHER 		Axicabtagene Ciloleucel C 3 $474,772.32 $489,456.00 $489,456.00 nat. median
$516,226
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 24 $423,687.97 $1,151,326.00 $474,346.31 nat. median
$492,768
1.0× median
127179
CDM 		Implant Sacral Cust My3d 28 $106,013.49 $757,239.20 $473,274.50 nat. median
$467
outlier · 1014.3×
09391
OTHER 		Brexucabtagene Car Pos T 3 $446,714.49 $460,530.40 $460,530.40 nat. median
$474,767
1.0× median
111486
CDM 		Custom Sacro-iliac Imp 28 $96,383.83 $688,455.94 $430,284.96 nat. median
$30
outlier · 14487.7×
102119
CDM 		Patient Kit 200 G090024 45 $65,285.58 $1,088,093.00 $412,387.24 nat. median
$1,162
outlier · 355.0×
108937
CDM 		Tavr Heart Valve 29mm 33 $86,162.30 $615,445.00 $369,267.00 nat. median
$153,861
outlier · 2.4×
127164
CDM 		Valve Plm Trnscth 22mm 28 $82,529.02 $589,493.00 $368,433.12 nat. median
$368,433
1.0× median
127165
CDM 		Valve Plm Trnscth 25mm 28 $82,529.02 $589,493.00 $368,433.12 nat. median
$368,433
1.0× median
107267
CDM 		Organ Acquisition - Dual 45 $56,410.20 $940,170.00 $356,324.43 nat. median
$246,795
1.4× median
30230X4
OTHER 		Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Peripheral Vein… 2 $272,400.00 $359,000.00 $327,753.00 nat. median
$296,860
1.1× median
30233X4
OTHER 		Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Peripheral Vein… 2 $272,400.00 $359,000.00 $327,753.00 nat. median
$296,860
1.1× median
30240X4
OTHER 		Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Central Vein, O… 2 $272,400.00 $359,000.00 $327,753.00 nat. median
$296,860
1.1× median
30243X4
OTHER 		Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Central Vein, P… 2 $272,400.00 $359,000.00 $327,753.00 nat. median
$296,860
1.1× median
131211
CDM 		Graft Vsc 23x30mm 150mm 28 $72,667.00 $519,050.00 $324,406.25 nat. median
$5,124
outlier · 63.3×
131370
CDM 		Graft Vsc 26x28mm 100mm 28 $72,667.00 $519,050.00 $324,406.25 nat. median
$7,582
outlier · 42.8×
136585
CDM 		Graft Vasc 30mm 150mm 28 $72,667.00 $519,050.00 $324,406.25 nat. median
$324,406
1.0× median

Other procedures at this hospital

Browse this hospital's 63,907 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
             
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 12 1 — — $4,897,200.00 $4,897,200.00 $4,897,200.00 2025-01-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 12 1 $4,463,735.93 — $3,884,946.48 $3,884,946.48 $3,884,946.48 2026-07-31
09138 OTHER Inj, Hemgenix, Per Tx Dos 6 3 — — $3,562,713.00 $3,672,900.00 $3,672,900.00 2025-01-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 97 20 — — $3,379,068.00 $4,003,461.00 $3,672,900.00 2025-01-01
773 OTHER Inj, Beqvez, Per Tx Dose 97 20 — — $3,316,600.00 $3,929,450.00 $3,605,000.00 2025-01-01
00773 OTHER Inj, Beqvez, Per Tx Dose 6 3 — — $3,496,850.00 $3,605,000.00 $3,605,000.00 2025-01-01
714 OTHER Inj Delandistrogene Mox R 105 23 $10,120.00 — $5,084.93 $4,655,637.00 $3,342,082.27 2026-07-31
00714 OTHER Inj Delandistrogene Mox R 6 3 — — $3,225,691.35 $3,325,455.00 $3,325,455.00 2025-01-01
748 OTHER Inj, Lovotibeglogene Auto 105 23 $13,071.00 — $8,387.57 $4,600,400.00 $3,302,430.00 2026-07-31
00748 OTHER Inj, Lovotibeglogene Auto 6 3 — — $3,187,420.00 $3,286,000.00 $3,286,000.00 2025-01-01
746 OTHER Inj, Betibeglogene Autote 111 23 $11,693.00 — $7,449.83 $4,600,400.00 $3,023,204.80 2026-07-31
00746 OTHER Inj, Betibeglogene Autote 6 3 — — $2,878,960.00 $2,968,000.00 $2,968,000.00 2025-01-01
9141 OTHER Inj Onase Abepar-xioi Tre 108 22 — — $2,197,524.88 $3,702,351.70 $2,433,042.22 2025-01-01
09141 OTHER Inj Onase Abepar-xioi Tre 6 3 — — $2,316,955.58 $2,388,614.00 $2,388,614.00 2025-01-01
Q2056 HCPCS Ciltacabtagene 100 Mil 107 42 $813,285.00 — $317,587.52 $4,499,156.55 $1,572,058.23 2026-07-31
Q2055 HCPCS Idecabtagene 107 42 $733,705.50 — $317,587.52 $4,499,156.55 $1,487,446.32 2026-07-31
Q2054 HCPCS Lisocabtagene 107 42 $717,614.70 — $317,587.52 $4,499,156.55 $1,454,825.33 2026-07-31
Q2053 HCPCS Brexucabtagene 107 42 $740,441.46 — $317,587.52 $4,499,156.55 $1,326,283.56 2026-07-31
Q2042 HCPCS Tisagenlecleucel Adult 106 42 $772,928.48 — $25.48 $4,499,156.55 $1,094,941.50 2026-07-31
111149 CDM Kit Hrt Implant Lvas 36 28 $1,536,374.00 $1,536,374.00 $215,092.36 $1,536,374.00 $960,233.75 2025-01-01
653215 CDM Implant Hvas Ordr Set 36 28 $1,321,502.00 $1,321,502.00 $185,010.28 $1,321,502.00 $825,938.75 2025-01-01
245528 CDM Implant Hvas Lng Ordrset 36 28 $1,321,502.00 $1,321,502.00 $185,010.28 $1,321,502.00 $825,938.75 2025-01-01
Q2041 HCPCS Axicabtagene Adult 107 43 $2,284,238.88 $2,284,238.88 $6.70 $2,284,238.88 $807,075.90 2026-07-31
722763 CDM Kit Impl Lvas W/grafts 36 28 $1,238,305.00 $1,238,305.00 $173,362.70 $1,238,305.00 $773,940.62 2025-01-01
9194 OTHER Tisagenlecleucel Car-pos 113 24 $456,125.88 — $486,857.47 $1,322,982.25 $545,068.69 2026-07-31
9498 OTHER Ciltacabtagene Car-pos T 113 24 $481,344.75 — $484,953.53 $1,317,808.50 $542,937.10 2026-07-31
9422 OTHER Idecabtagene Vicleucel Ca 113 24 $446,893.35 — $484,460.59 $1,316,469.00 $542,385.23 2026-07-31
9413 OTHER Lisocabtagene Car Pos T 113 24 $437,092.59 — $475,388.01 $1,291,815.25 $532,227.88 2026-07-31
09194 OTHER Tisagenlecleucel Car-pos 6 3 — — $513,317.11 $529,192.90 $529,192.90 2025-01-01
09498 OTHER Ciltacabtagene Car-pos T 6 3 — — $511,309.70 $527,123.40 $527,123.40 2025-01-01
09422 OTHER Idecabtagene Vicleucel Ca 6 3 — — $510,789.97 $526,587.60 $526,587.60 2025-01-01
09413 OTHER Lisocabtagene Car Pos T 6 3 — — $501,224.32 $516,726.10 $516,726.10 2025-01-01
9035 OTHER Axicabtagene Ciloleucel C 113 24 $424,999.19 — $450,299.52 $1,223,640.00 $504,139.68 2026-07-31
09035 OTHER Axicabtagene Ciloleucel C 6 3 — — $474,772.32 $489,456.00 $489,456.00 2025-01-01
9391 OTHER Brexucabtagene Car Pos T 113 24 $425,054.70 — $423,687.97 $1,151,326.00 $474,346.31 2026-07-31
127179 CDM Implant Sacral Cust My3d 36 28 $757,239.20 $757,239.20 $106,013.49 $757,239.20 $473,274.50 2025-01-01
09391 OTHER Brexucabtagene Car Pos T 6 3 — — $446,714.49 $460,530.40 $460,530.40 2025-01-01
111486 CDM Custom Sacro-iliac Imp 36 28 $688,455.94 $688,455.94 $96,383.83 $688,455.94 $430,284.96 2025-01-01
102119 CDM Patient Kit 200 G090024 82 45 $1,088,093.00 $1,088,093.00 $65,285.58 $1,088,093.00 $412,387.24 2025-01-01
108937 CDM Tavr Heart Valve 29mm 80 33 $615,445.00 $615,445.00 $86,162.30 $615,445.00 $369,267.00 2025-01-01
127164 CDM Valve Plm Trnscth 22mm 36 28 $589,493.00 $589,493.00 $82,529.02 $589,493.00 $368,433.12 2025-01-01
127165 CDM Valve Plm Trnscth 25mm 36 28 $589,493.00 $589,493.00 $82,529.02 $589,493.00 $368,433.12 2025-01-01
107267 CDM Organ Acquisition - Dual 82 45 $940,170.00 $940,170.00 $56,410.20 $940,170.00 $356,324.43 2025-01-01
30240X4 OTHER Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Central Vein, O… 8 2 — — $272,400.00 $359,000.00 $327,753.00 2025-01-01
30243X4 OTHER Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Central Vein, P… 8 2 — — $272,400.00 $359,000.00 $327,753.00 2025-01-01
30230X4 OTHER Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Peripheral Vein… 8 2 — — $272,400.00 $359,000.00 $327,753.00 2025-01-01
30233X4 OTHER Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Peripheral Vein… 8 2 — — $272,400.00 $359,000.00 $327,753.00 2025-01-01
131370 CDM Graft Vsc 26x28mm 100mm 36 28 $519,050.00 $519,050.00 $72,667.00 $519,050.00 $324,406.25 2025-01-01
136585 CDM Graft Vasc 30mm 150mm 36 28 $519,050.00 $519,050.00 $72,667.00 $519,050.00 $324,406.25 2025-01-01
131211 CDM Graft Vsc 23x30mm 150mm 36 28 $519,050.00 $519,050.00 $72,667.00 $519,050.00 $324,406.25 2025-01-01
74 APR_DRG Allogeneic Bone Marrow Transplant 45 7 — — $274,449.00 $480,287.00 $321,106.00 2025-01-01
107266 CDM Organ Acquisition - Sgl 82 45 $839,437.50 $839,437.50 $50,366.25 $839,437.50 $318,146.81 2025-01-01
0274 RC — 41 8 — — $37.59 $312,000.00 $312,000.00 2025-01-01
0278 RC — 128 24 — — $710.24 $312,000.00 $312,000.00 2025-01-01
0275 RC — 68 22 — — $14,316.60 $312,000.00 $312,000.00 2025-01-01
30253X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Peripheral Artery, Percu… 10 3 — — $221,450.00 $359,000.00 $305,296.00 2025-01-01
30260X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Central Artery, Open App… 10 3 — — $221,450.00 $359,000.00 $305,296.00 2025-01-01
30250X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Peripheral Artery, Open … 10 3 — — $221,450.00 $359,000.00 $305,296.00 2025-01-01
30263X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Central Artery, Percutan… 10 3 — — $221,450.00 $359,000.00 $305,296.00 2025-01-01
119941 CDM Valve Tavr 29mm 90 33 $504,220.00 $504,220.00 $70,590.80 $504,220.00 $302,532.00 2025-01-01
119940 CDM Valve Tavr 26mm 80 33 $504,220.00 $504,220.00 $70,590.80 $504,220.00 $302,532.00 2025-01-01
119939 CDM Valve Tavr 23mm 80 33 $504,220.00 $504,220.00 $70,590.80 $504,220.00 $302,532.00 2025-01-01
119938 CDM Valve Tavr 20mm 80 33 $504,220.00 $504,220.00 $70,590.80 $504,220.00 $302,532.00 2025-01-01
130553 CDM Kit Aor Tavr 20mm 36 28 $481,975.00 $481,975.00 $67,476.50 $481,975.00 $301,234.38 2025-01-01
130631 CDM Kit Aor Tavr 26mm 36 28 $481,975.00 $481,975.00 $67,476.50 $481,975.00 $301,234.38 2025-01-01
130444 CDM Stent Grft 20cm 40mm 8mm 36 28 $474,560.00 $474,560.00 $66,438.40 $474,560.00 $296,600.00 2025-01-01
5834 APR_DRG Neonate With Ecmo 45 7 — — $282,123.00 $352,653.75 $296,229.15 2025-01-01
C1825 HCPCS System Gen Neo2 31 25 $441,700.00 $441,700.00 $61,838.00 $441,700.00 $295,939.00 2025-01-01
100352 CDM Valve Heart Trnscth 20mm 80 33 $481,975.00 $481,975.00 $67,476.50 $481,975.00 $289,185.00 2025-01-01
100353 CDM Valve Heart Trnscth 23mm 80 33 $481,975.00 $481,975.00 $67,476.50 $481,975.00 $289,185.00 2025-01-01
775554 CDM Kit Aor Vlv 14fr 29mm 80 33 $481,975.00 $481,975.00 $67,476.50 $481,975.00 $289,185.00 2025-01-01
100354 CDM Valve Heart Trnscth 26mm 80 33 $481,975.00 $481,975.00 $67,476.50 $481,975.00 $289,185.00 2025-01-01
30243X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Per… 34 4 — — $166,000.00 $502,840.00 $289,134.00 2025-01-01
30240X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Ope… 34 4 — — $166,000.00 $502,840.00 $289,134.00 2025-01-01
30230X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein, … 34 4 — — $166,000.00 $502,840.00 $289,134.00 2025-01-01
30233X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein, … 34 4 — — $166,000.00 $502,840.00 $289,134.00 2025-01-01
134662 CDM Valve Tavr 23mm 90 33 $467,145.00 $467,145.00 $65,400.30 $467,145.00 $280,287.00 2025-01-01
134663 CDM Valve Tavr 31mm 90 33 $467,145.00 $467,145.00 $65,400.30 $467,145.00 $280,287.00 2025-01-01
134664 CDM Valve Tavr 26mm 90 33 $467,145.00 $467,145.00 $65,400.30 $467,145.00 $280,287.00 2025-01-01
134434 CDM Valve Tavr 29mm 90 33 $467,145.00 $467,145.00 $65,400.30 $467,145.00 $280,287.00 2025-01-01
30233G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Peripheral Vein, Percutaneo… 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30230U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30240Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein, … 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30233Y3 OTHER Transfusion Of Allogeneic Unrelated Hamatopoietic Stem Cells Into Peripheral Vei… 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30243U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30233U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30230G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Peripheral Vein, Open Appro… 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30230Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Peripheral Vei… 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30240G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Open Approach… 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30243Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein, … 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30243G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Percutaneous … 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30240U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 26 4 — — $166,000.00 $502,840.00 $275,600.00 2025-01-01
30233X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Vein, Percutaneo… 50 4 — — $101,679.00 $502,840.00 $272,400.00 2025-01-01
30260X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Artery, Open Approa… 50 4 — — $101,679.00 $502,840.00 $272,400.00 2025-01-01
30230X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Vein, Open Appro… 50 4 — — $101,679.00 $502,840.00 $272,400.00 2025-01-01
30240X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Vein, Open Approach… 50 4 — — $101,679.00 $502,840.00 $272,400.00 2025-01-01
30250X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Artery, Open App… 50 4 — — $101,679.00 $502,840.00 $272,400.00 2025-01-01
30243X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Vein, Percutaneous … 50 4 — — $101,679.00 $502,840.00 $272,400.00 2025-01-01
30253X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Artery, Percutan… 50 4 — — $101,679.00 $502,840.00 $272,400.00 2025-01-01
30263X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Artery, Percutaneou… 50 4 — — $101,679.00 $502,840.00 $272,400.00 2025-01-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 121 24 — — $3,938.00 $516,177.22 $271,908.13 2025-01-01
24 APR_DRG Heart And/or Lung Transplant 45 7 — — $229,807.00 $402,162.00 $268,874.00 2025-01-01
111425 CDM Valve Tavr Sz 26mm 90 33 $444,900.00 $444,900.00 $62,286.00 $444,900.00 $266,940.00 2025-01-01
246026 CDM Valve Triclip 1sgc 2cds 80 33 $444,900.00 $444,900.00 $62,286.00 $444,900.00 $266,940.00 2025-01-01
111427 CDM Valve Tavr Size 34mm 90 33 $444,900.00 $444,900.00 $62,286.00 $444,900.00 $266,940.00 2025-01-01
111424 CDM Valve Tavr Sz 23mm 90 33 $444,900.00 $444,900.00 $62,286.00 $444,900.00 $266,940.00 2025-01-01
111426 CDM Valve Tavr Sz 29mm 90 33 $444,900.00 $444,900.00 $62,286.00 $444,900.00 $266,940.00 2025-01-01
112513 CDM 3d Custom Pelvic Implant 36 28 $414,252.79 $414,252.79 $57,995.39 $414,252.79 $258,907.99 2025-01-01
134331 CDM Stent Evas 22fr 16cm 80 33 $430,070.00 $430,070.00 $60,209.80 $430,070.00 $258,042.00 2025-01-01
30230G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Vein, Open Approach Pediat… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30250G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Artery, Open Approach Pedi… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30243C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30240Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Vein, Open Appro… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30233C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30240C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30243G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Vein, Percutaneous Approach P… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30260Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Artery, Open App… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30263Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Artery, Percutan… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30260G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Artery, Open Approach Pediatr… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30233Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Vein, Percuta… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30230C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30240G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Vein, Open Approach Pediatric 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30233G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Vein, Percutaneous Approac… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30250Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Artery, Open … 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30263G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Artery, Percutaneous Approach… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30253Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Artery, Percu… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30253G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Artery, Percutaneous Appro… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30243Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Vein, Percutaneo… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
30230Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Vein, Open Ap… 44 4 — — $101,679.00 $502,840.00 $256,650.00 2025-01-01
132562 CDM System Trcsd 1clip 1cath 36 28 $403,840.00 $403,840.00 $56,537.60 $403,840.00 $252,400.00 2025-01-01
30243X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Central Vein, Percu… 38 4 — — $148,280.00 $448,964.00 $251,421.00 2025-01-01
30230X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Op… 38 4 — — $148,280.00 $448,964.00 $251,421.00 2025-01-01
02YA0Z1 OTHER Transplantation Of Heart, Syngeneic, Open Approach 10 3 — — $105,000.00 $412,000.00 $251,421.00 2025-01-01
30233X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Pe… 38 4 — — $148,280.00 $448,964.00 $251,421.00 2025-01-01
30240X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Central Vein, Open … 38 4 — — $148,280.00 $448,964.00 $251,421.00 2025-01-01
02YA0Z2 OTHER Transplantation Of Heart, Zooplastic, Open Approach 10 3 — — $105,000.00 $412,000.00 $251,421.00 2025-01-01
02YA0Z0 OTHER Transplantation Of Heart, Allogeneic, Open Approach 10 3 — — $105,000.00 $412,000.00 $251,421.00 2025-01-01
5833 APR_DRG Neonate With Ecmo 45 7 — — $238,891.00 $298,613.75 $250,835.55 2025-01-01
649089 CDM Valve Pulm 18mm 80 33 $378,165.00 $378,165.00 $52,943.10 $378,165.00 $226,899.00 2025-01-01
C1823 HCPCS Generator Pulse Implnt 76 30 $359,805.00 $359,805.00 $50,372.70 $359,805.00 $215,883.00 2025-01-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 193 35 — — $50,000.00 $398,851.20 $203,414.11 2025-01-01
30233U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30240Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Central Vein, Op… 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30243Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Central Vein, Pe… 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30233G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Percutaneous… 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30230U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30240G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Central Vein, Open Approach P… 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30243G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Central Vein, Percutaneous Ap… 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30240U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30230G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Open Approac… 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30243U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30230Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Peripheral Vein,… 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
30233Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Peripheral Vein,… 30 4 — — $148,280.00 $448,964.00 $203,400.00 2025-01-01
135188 CDM Implant Generator Pulse 36 28 $300,356.00 $300,356.00 $42,049.84 $300,356.00 $187,722.50 2025-01-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 45 7 — — $178,579.00 $223,223.75 $187,507.95 2025-01-01
500206 CDM Liver Cadaver Organ Acq 172 49 $483,516.00 $483,516.00 $29,010.96 $483,516.00 $186,395.42 2025-01-01
500506 CDM Kidney Cadaver Organ Acq 172 49 $477,411.00 $477,411.00 $28,644.66 $477,411.00 $184,041.94 2025-01-01
500509 CDM Kidney Live Dnr Orgn Acq 172 49 $477,411.00 $477,411.00 $28,644.66 $477,411.00 $184,041.94 2025-01-01
500406 CDM Heart Organ Acq 82 45 $483,516.00 $483,516.00 $29,010.96 $483,516.00 $183,252.57 2025-01-01
1614 APR_DRG Implantable Heart Assist Systems 55 8 — — $173,412.00 $216,765.00 $182,082.60 2025-01-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 3 2 $323,356.00 — $172,357.94 $177,688.60 $177,688.60 2026-07-31
653407 CDM Graft Art St Tis 6-32mm 36 28 $281,073.00 $281,073.00 $39,350.22 $281,073.00 $175,670.62 2025-01-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 149 28 — — $3,938.00 $342,628.40 $171,523.20 2025-01-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 45 7 — — $162,460.00 $203,075.00 $170,583.00 2025-01-01
131697 CDM Transcth Aortic Vlv 29mm 36 28 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $166,837.50 2025-01-01
131694 CDM Transcth Aortic Vlv 23mm 36 28 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $166,837.50 2025-01-01
131695 CDM Transcth Aortic Vlv 25mm 36 28 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $166,837.50 2025-01-01
131696 CDM Transcth Aortic Vlv 27mm 36 28 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $166,837.50 2025-01-01
100842 CDM Graft Evas 45x45mm 15cm 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
100840 CDM Graft Stnt 15cm 37mm 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
220979 CDM Stent Thor 37x37mm 20cm 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
100837 CDM Stent 20fr 31x31mm 10cm 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
248662 CDM Stent Graft 20cm 34x20mm 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
100833 CDM Stent Thor 20f 26x21x10 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
100836 CDM Stent Thor 31x26mm 10cm 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
248803 CDM Graft Evas 34x34x10cm 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
129067 CDM Stent Thor 31x31mm 20cm 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
246542 CDM Stent Thor Act Cntrl 40x 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
100839 CDM Stent Gft Thor Act 37x37 36 28 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $163,130.00 2025-01-01
119923 CDM Kit Cath Rt Heart 172 49 $421,480.00 $421,480.00 $25,288.80 $421,480.00 $162,480.54 2025-01-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 189 30 — — $3,938.00 $309,516.38 $160,734.57 2025-01-01
105661 CDM Occluder Cardiac Lt 34mm 90 33 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $160,164.00 2025-01-01
105656 CDM Occluder Cardiac Lt 20mm 90 33 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $160,164.00 2025-01-01
105655 CDM Occluder Cardiac Lt 18mm 90 33 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $160,164.00 2025-01-01
105657 CDM Occluder Cardiac Lt 22mm 90 33 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $160,164.00 2025-01-01
105659 CDM Occluder Cardiac Lt 28mm 90 33 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $160,164.00 2025-01-01
105658 CDM Occluder Cardiac Lt 25mm 90 33 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $160,164.00 2025-01-01
105654 CDM Occluder Cardiac Lt 16mm 90 33 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $160,164.00 2025-01-01
105660 CDM Occluder Cardiac Lt 31mm 90 33 $266,940.00 $266,940.00 $37,371.60 $266,940.00 $160,164.00 2025-01-01
223088 CDM Kit Cath Rt Heart 118 45 $421,480.00 $421,480.00 $25,288.80 $421,480.00 $158,687.22 2025-01-01
100841 CDM Graft Evas 45x45mm 10cm 80 33 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $156,604.80 2025-01-01
100843 CDM Stent Graft 20cm 45x45mm 80 33 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $156,604.80 2025-01-01
100834 CDM Stnt Thorac 28x28mm 10cm 90 33 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $156,604.80 2025-01-01
245979 CDM Stnt Thorac 26x26mm 10cm 80 33 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $156,604.80 2025-01-01
100832 CDM Stent Graft 10cm 21x21mm 80 33 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $156,604.80 2025-01-01
245660 CDM Stent 34mmx34mmx15cm 80 33 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $156,604.80 2025-01-01
100838 CDM Stent Graft 15cm 31x31mm 90 33 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $156,604.80 2025-01-01
100835 CDM Stent Graft 15cn 28x28mm 90 33 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $156,604.80 2025-01-01
220978 CDM Stent Thor 40x40mm 20cm 80 33 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $156,604.80 2025-01-01
245658 CDM Graft Evas 40x40x10cm 80 33 $261,008.00 $261,008.00 $36,541.12 $261,008.00 $156,604.80 2025-01-01
120331 CDM Stent Graft 20f 32x155mm 36 28 $236,539.00 $236,539.00 $33,115.46 $236,539.00 $147,836.88 2025-01-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 2 $240,266.24 — $142,220.72 $146,619.30 $146,619.30 2026-07-31
439515 CDM Cord Blood Acquisition 82 45 $384,659.63 $384,659.63 $23,079.58 $384,659.63 $145,786.00 2025-01-01
107767 CDM Cord Blood Acquisition 82 45 $384,659.63 $384,659.63 $23,079.58 $384,659.63 $145,786.00 2025-01-01
1908 OTHER New Technology - Level 52 113 24 $143,120.06 — $129,845.30 $352,840.50 $145,370.29 2026-07-31
1907 OTHER New Technology - Level 52 113 24 $143,120.06 — $129,845.30 $352,840.50 $145,370.29 2026-07-31
128374 CDM Kit Fem Ostm Pt Cstm 82 45 $379,127.00 $379,127.00 $22,747.62 $379,127.00 $143,689.14 2025-01-01
245233 CDM Impl Crnl Ostmtch150-200 36 28 $225,861.00 $225,861.00 $31,620.54 $225,861.00 $141,163.12 2025-01-01
01907 OTHER New Technology - Level 52 6 3 — — $136,902.11 $141,136.20 $141,136.20 2025-01-01
01908 OTHER New Technology - Level 52 6 3 — — $136,902.11 $141,136.20 $141,136.20 2025-01-01
247905 CDM Stent Gft 31x31mm 20cm 36 28 $224,576.00 $224,576.00 $31,440.64 $224,576.00 $140,360.00 2025-01-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 45 7 — — $132,875.00 $166,093.75 $139,518.75 2025-01-01
C2616 HCPCS Brachytx Ns Yttrium 90 103 30 $224,005.00 $224,005.00 $13,612.00 $231,514.00 $138,908.40 2026-07-31
773520 CDM Implant Cust Cranial Lge 36 28 $221,494.00 $221,494.00 $31,009.16 $221,494.00 $138,433.75 2025-01-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 45 7 — — $131,697.00 $164,621.25 $138,281.85 2025-01-01
245384 CDM Implant Custm Crani Flap 36 28 $218,576.60 $218,576.60 $30,600.72 $218,576.60 $136,610.38 2025-01-01
C1822 HCPCS Pulse Gen Imp 124 25 $212,541.00 $212,541.00 $23,851.80 $239,780.00 $134,087.50 2025-01-01
325112 CDM Sapien 20mm Ide G210075 82 45 $353,100.00 $353,100.00 $21,186.00 $353,100.00 $133,824.90 2025-01-01
325115 CDM Sapien 29mm Ide G210075 82 45 $353,100.00 $353,100.00 $21,186.00 $353,100.00 $133,824.90 2025-01-01
325114 CDM Sapien 26mm Ide G210075 82 45 $353,100.00 $353,100.00 $21,186.00 $353,100.00 $133,824.90 2025-01-01
325113 CDM Sapien 23mm Ide G210075 82 45 $353,100.00 $353,100.00 $21,186.00 $353,100.00 $133,824.90 2025-01-01
111861 CDM Device Embl 4.75mm 20mm 36 28 $213,330.00 $213,330.00 $29,866.20 $213,330.00 $133,331.25 2025-01-01
103969 CDM Stent Grft 23x12mm 12cm 36 28 $212,040.00 $212,040.00 $29,685.60 $212,040.00 $132,525.00 2025-01-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 48 6 — — $61,600.24 $662,400.00 $131,376.00 2025-01-01
1905 OTHER New Technology - Level 51 113 24 $129,042.72 — $117,073.68 $318,135.00 $131,071.62 2026-07-31
1906 OTHER New Technology - Level 51 113 24 $129,042.72 — $117,073.68 $318,135.00 $131,071.62 2026-07-31
101326 CDM Valve Aortic 25mm 36 28 $207,620.00 $207,620.00 $29,066.80 $207,620.00 $129,762.50 2025-01-01
101491 CDM Valve Aortic 21mm 36 28 $207,620.00 $207,620.00 $29,066.80 $207,620.00 $129,762.50 2025-01-01
101325 CDM Valve Aortic 23mm 36 28 $207,620.00 $207,620.00 $29,066.80 $207,620.00 $129,762.50 2025-01-01
132841 CDM Implant Crnl Cstm 36 28 $203,716.00 $203,716.00 $28,520.24 $203,716.00 $127,322.50 2025-01-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 54 6 $88,490.11 — $53,789.99 $334,251.46 $127,289.01 2026-07-31
01906 OTHER New Technology - Level 51 6 3 — — $123,436.38 $127,254.00 $127,254.00 2025-01-01
01905 OTHER New Technology - Level 51 6 3 — — $123,436.38 $127,254.00 $127,254.00 2025-01-01
5832 APR_DRG Neonate With Ecmo 45 7 — — $119,034.00 $148,792.50 $124,985.70 2025-01-01
134073 CDM Graft Vasc 36/28 199mm 36 28 $199,119.00 $199,119.00 $27,876.66 $199,119.00 $124,449.38 2025-01-01
104830 CDM Triluminate Pvtl G170118 82 45 $327,000.00 $327,000.00 $19,620.00 $327,000.00 $123,933.00 2025-01-01
112416 CDM Coil Emb 7x5mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
119883 CDM Coil Embol Neuro 4x2.6mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
111554 CDM Coil Emb Neuro 6x3mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
119884 CDM Device 17 Sng Sphr 5 .0 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
119886 CDM Coil Embl 5.6mm 7mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
119867 CDM Coil Embz .017 4.5mm 2mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
108762 CDM Coil Embl 4x3mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
108761 CDM Coil Embol Neuro 4x2mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
110044 CDM Coil Embol Neuro 7x3mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
119885 CDM Coil Emb Neuro 6x4.6mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
112368 CDM Coil Embl 5mm 2mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
119869 CDM Device Endo Sng 5x3mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
119870 CDM Coil Emb Neuro 7x4mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
107699 CDM Coil Emb Neuro 6x4mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
119868 CDM Coil Embl 4.5mm 3mm 36 28 $197,759.00 $197,759.00 $27,686.26 $197,759.00 $123,599.38 2025-01-01
106342 CDM Valve Mtrl 48mm G160020 82 45 $325,000.00 $325,000.00 $19,500.00 $325,000.00 $123,175.00 2025-01-01
106341 CDM Valve Mtrl 42mm G160020 82 45 $325,000.00 $325,000.00 $19,500.00 $325,000.00 $123,175.00 2025-01-01
135588 CDM Implant Pros Crnl Bn 36 28 $195,610.00 $195,610.00 $27,385.40 $195,610.00 $122,256.25 2025-01-01
664270 CDM Valve Aortic L5.6cm Od16 36 28 $192,716.00 $192,716.00 $26,980.24 $192,716.00 $120,447.50 2025-01-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 48 4 $103,458.96 — $85,139.17 $257,170.92 $120,116.70 2026-07-31
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 3 2 $135,119.43 — $115,445.42 $119,015.90 $119,015.90 2026-07-31
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 45 7 — — $113,030.00 $141,287.50 $118,681.50 2025-01-01
1903 OTHER New Technology - Level 50 113 24 $114,965.38 — $104,302.06 $283,429.50 $116,772.95 2026-07-31
1904 OTHER New Technology - Level 50 113 24 $114,965.38 — $104,302.06 $283,429.50 $116,772.95 2026-07-31
247444 CDM Valve Aortic 27mm 46 28 $207,620.00 $207,620.00 $29,066.80 $207,620.00 $114,191.00 2025-01-01
247680 CDM Valve Aortic 29mm 46 28 $207,620.00 $207,620.00 $29,066.80 $207,620.00 $114,191.00 2025-01-01
105161 CDM Gft Evs 15f 20x14.5x12mm 80 33 $175,573.00 $175,573.00 $24,580.22 $212,040.00 $114,122.45 2025-01-01
107770 CDM Stemcell/bm Acquisition 82 45 $299,740.03 $299,740.03 $17,984.40 $299,740.03 $113,601.47 2025-01-01
439505 CDM Stemcell/bm Acquisition 82 45 $299,740.03 $299,740.03 $17,984.40 $299,740.03 $113,601.47 2025-01-01
107768 CDM Donor Leuk Acquisition 82 45 $299,740.03 $299,740.03 $17,984.40 $299,740.03 $113,601.47 2025-01-01
439555 CDM Bone Marrow Acquisition 82 45 $299,740.03 $299,740.03 $17,984.40 $299,740.03 $113,601.47 2025-01-01
439525 CDM Donor Leuk Acquisition 82 45 $299,740.03 $299,740.03 $17,984.40 $299,740.03 $113,601.47 2025-01-01
107766 CDM Bone Marrow Acquisition 82 45 $299,740.03 $299,740.03 $17,984.40 $299,740.03 $113,601.47 2025-01-01
108996 CDM Device Embl 4.25mm 18mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
129201 CDM Device Embl 4.25mm 25mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
108995 CDM Device Embl 3.75mm 16mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
128262 CDM Device Embl 4.5mm 14mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
110194 CDM Device Embl 4.25mm 14mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
125118 CDM Device Embl 3.5mm 12mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
127788 CDM Device Embl 4.5mm 16mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
127410 CDM Device Embl 5mm 35mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
127854 CDM Device Embl 4.75mm 12mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
127738 CDM Device Embl 4.5mm 20mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
128230 CDM Device Embl 4mm 16mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
132407 CDM Device Embl 2.75mm 16mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
108329 CDM Device Embl 4.5mm 12mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
128231 CDM Device Embl 5mm 25mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
128837 CDM Device Embl 3mm 14mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
109426 CDM Device Emb 5mm 14mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
126185 CDM Device Embl 3.25mm 12mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
119505 CDM Device Embl 4.25mm 12mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
127888 CDM Device Embl 4.75mm 14mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
111418 CDM Device Embl 4mm 12mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
129662 CDM Device Embl 4mm 14mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
108998 CDM Device Embl 4.50x25mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
128232 CDM Device Embl 5mm 12mm 36 28 $181,539.00 $181,539.00 $25,415.46 $181,539.00 $113,461.88 2025-01-01
01903 OTHER New Technology - Level 50 6 3 — — $109,970.65 $113,371.80 $113,371.80 2025-01-01
01904 OTHER New Technology - Level 50 6 3 — — $109,970.65 $113,371.80 $113,371.80 2025-01-01
73 APR_DRG Allogeneic Bone Marrow Transplant 45 7 — — $96,842.00 $169,475.00 $113,306.00 2025-01-01
119888 CDM Coil Emb Endo Sn Ly Sphr 36 28 $179,236.00 $179,236.00 $25,093.04 $179,236.00 $112,022.50 2025-01-01
107700 CDM Coil Embl Endo 8mm 36 28 $179,236.00 $179,236.00 $25,093.04 $179,236.00 $112,022.50 2025-01-01
222298 CDM Coil Emboli Sph 27 9x7.6 36 28 $179,236.00 $179,236.00 $25,093.04 $179,236.00 $112,022.50 2025-01-01
119882 CDM Coil Embl Endo 11mm 36 28 $179,236.00 $179,236.00 $25,093.04 $179,236.00 $112,022.50 2025-01-01
119878 CDM Coil Emb Endo Sn Ly 10mm 36 28 $179,236.00 $179,236.00 $25,093.04 $179,236.00 $112,022.50 2025-01-01
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