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

Galveston Co Mem Hosp

—, TX · CCN 45049E · Rates published

39,509 distinct procedures filed
58 distinct payers
2,400,227 rate rows
2026-03-01 last MRF observed
Data quality

2,343,000 of 2,400,227 rate rows are consumer-grade (97.6%)

57,227 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 26,621
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 19,614
template filing: same amount across many unrelated codes — excluded 8,024
exceeds 10× this hospital's gross charge — excluded from medians 2,765
placeholder amount (≤ $0.02) — excluded from medians 203
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1801360_HCA-HOUSTON-MAINLAND_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.hcahoustonhealthcare.com/cms-hpt.txt
Discovered viaDiscovered by HANK (automated)
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-05-19
Content fingerprint f2602cd34c4a7767… · 1,135,869,004 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
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,850,948.67 $4,850,948.67 $4,850,948.67 nat. median
$3,006,423
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 20 $5,652.40 $4,910,450.00 $4,640,150.00 nat. median
$9,966
outlier · 465.6×
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
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $4,271,819.03 $4,271,819.03 $4,271,819.03 nat. median
$2,469,189
1.7× median
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $3,847,800.00 $3,847,800.00 $3,847,800.00 nat. median
$2,448,600
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 21 $3,611,561.66 $4,790,847.10 $3,795,825.01 nat. median
$3,746,358
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,685,267.00 $3,685,267.00 $3,685,267.00 nat. median
$3,574,709
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 24 $10,234.46 $4,836,939.00 $3,435,894.60 nat. median
$22,747
outlier · 151.0×
714
OTHER 		Inj Delandistrogene Mox R 24 $6,647.98 $4,825,397.00 $3,427,695.80 nat. median
$13,041
outlier · 262.8×
748
OTHER 		Inj, Lovotibeglogene Auto 24 $12,654.36 $4,716,136.60 $3,350,083.24 nat. median
$17,963
outlier · 186.5×
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×
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
906
OTHER 		Inj Elivaldogene Autoteme 24 $9,043.35 $4,929,000.00 $3,275,400.00 nat. median
$20,756
outlier · 157.8×
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
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 25 $11,705.41 $4,792,149.47 $3,028,168.07 nat. median
$21,896
outlier · 138.3×
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
9141
OTHER 		Inj Onase Abepar-xioi Tre 24 $2,537,201.38 $4,220,039.03 $2,692,540.24 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
824
OTHER 		Inj, Exagamglogene Autote 27 $13,706.74 $4,897,200.00 $2,448,600.00 nat. median
$25,250
outlier · 97.0×
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
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 2 $1,271,523.00 $1,978,603.20 $1,509,600.96 nat. median
$824,563
1.8× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 2 $459,112.50 $1,428,840.00 $1,090,152.00 nat. median
$324,450
outlier · 3.4×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $553,169.00 $1,250,478.00 $969,621.79 nat. median
$675,122
1.4× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 $32.24 $1,037,313.00 $934,776.65 nat. median
$754,974
1.2× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $527,622.00 $1,128,119.40 $911,665.19 nat. median
$625,184
1.5× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 $516,442.00 $1,103,378.76 $905,167.53 nat. median
$674,188
1.3× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $8.47 $956,745.00 $878,117.20 nat. median
$634,511
1.4× median
2067
OTHER 		Afamitresgene Autoleucel 27 $755,207.60 $1,656,833.00 $809,151.00 nat. median
$786,032
1.0× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $489,399.00 $1,003,071.60 $805,025.05 nat. median
$620,080
1.3× median
C9301
HCPCS 		Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 1 $545,370.00 $751,275.00 $751,275.00 nat. median
$459,112
1.6× median
9498
OTHER 		Ciltacabtagene Car-pos T 27 $575,896.61 $1,263,446.64 $617,032.08 nat. median
$587,650
1.1× median
9194
OTHER 		Tisagenlecleucel Car-pos 27 $555,200.67 $1,218,042.30 $594,857.87 nat. median
$566,531
1.1× median
9413
OTHER 		Lisocabtagene Car Pos T 27 $550,957.18 $1,208,732.58 $590,311.26 nat. median
$562,201
1.1× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $587,649.60 $587,649.60 $587,649.60 nat. median
$554,552
1.1× median
9422
OTHER 		Idecabtagene Vicleucel Ca 27 $546,920.16 $1,199,875.87 $585,985.89 nat. median
$558,082
1.1× 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
9035
OTHER 		Axicabtagene Ciloleucel C 27 $521,548.36 $1,144,213.23 $558,801.81 nat. median
$532,192
1.1× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $558,081.80 $558,081.80 $558,081.80 nat. median
$530,178
1.1× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $532,192.20 $532,192.20 $532,192.20 nat. median
$505,583
1.1× median
9391
OTHER 		Brexucabtagene Car Pos T 27 $479,661.20 $1,052,317.93 $513,922.71 nat. median
$489,450
1.1× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $489,450.20 $489,450.20 $489,450.20 nat. median
$464,978
1.1× median
5834
APR_DRG 		Neonate With Ecmo 8 $330,392.83 $421,419.42 $353,992.32 nat. median
$309,665
1.1× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 31 $2,585.00 $633,491.68 $345,938.32 nat. median
$370,174
0.9× median
74
APR_DRG 		Allogeneic Bone Marrow Transplant 7 $321,406.44 $573,940.00 $344,364.05 nat. median
$187,294
1.8× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 $332,753.88 $332,753.88 $332,753.88 nat. median
$209,753
1.6× median
5833
APR_DRG 		Neonate With Ecmo 8 $279,764.50 $356,842.47 $299,747.68 nat. median
$244,017
1.2× median
831
OTHER 		Obecbtge Autol Up To 400 28 $3,870.51 $598,237.50 $292,162.50 nat. median
$12,362
outlier · 23.6×
24
APR_DRG 		Heart And/or Lung Transplant 7 $269,125.53 $480,581.00 $288,348.78 nat. median
$234,738
1.2× median

Other procedures at this hospital

Browse this hospital's 39,509 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
             
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 95 38 — — $28,050.00 $198,952.80 $80,843.36 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 95 38 — — $28,050.00 $171,438.88 $71,672.00 2026-03-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 95 38 — — $28,050.00 $156,153.59 $67,447.00 2026-03-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 95 38 — — $28,050.00 $155,480.43 $65,641.69 2026-03-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 95 38 — — $28,050.00 $133,721.88 $59,177.70 2026-03-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 95 38 — — $28,050.00 $133,721.88 $59,177.70 2026-03-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 95 38 — — $16,045.00 $139,875.85 $56,402.75 2026-03-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 95 38 — — $28,050.00 $156,000.00 $54,351.00 2026-03-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 95 38 — — $28,050.00 $119,349.72 $51,268.04 2026-03-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 95 38 — — $28,050.00 $108,453.15 $50,400.00 2026-03-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 95 38 — — $28,050.00 $111,094.93 $48,499.00 2026-03-01
215 MS_DRG Other Heart Assist System Implant 94 38 — — $2,585.00 $202,495.51 $82,243.33 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 93 37 — — $2,585.00 $205,429.52 $68,429.01 2026-03-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 93 37 — — $2,585.00 $145,773.94 $50,146.10 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 84 38 — — $2,585.00 $159,523.05 $87,906.74 2026-03-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 84 38 — — $2,585.00 $145,010.94 $60,094.10 2026-03-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 84 38 — — $2,585.00 $122,156.22 $50,639.85 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 83 37 — — $2,585.00 $269,424.26 $88,201.67 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 83 37 — — $2,585.00 $220,248.68 $72,497.22 2026-03-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 83 37 — — $2,585.00 $176,465.90 $59,088.65 2026-03-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 83 37 — — $2,585.00 $163,338.39 $54,855.22 2026-03-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 81 37 — — $28,050.00 $124,633.27 $51,474.55 2026-03-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 80 37 — — $2,585.00 $234,000.00 $66,084.82 2026-03-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 80 37 — — $2,585.00 $128,000.00 $64,065.47 2026-03-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 80 37 — — $2,585.00 $138,961.74 $57,770.39 2026-03-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 80 37 — — $2,585.00 $102,836.34 $56,854.54 2026-03-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 80 37 — — $2,585.00 $96,109.04 $54,874.01 2026-03-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 80 37 — — $2,585.00 $129,369.64 $53,936.15 2026-03-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 80 37 — — $2,585.00 $95,684.42 $51,417.48 2026-03-01
28 MS_DRG Spinal Procedures With Mcc 80 37 — — $2,585.00 $95,213.51 $50,509.35 2026-03-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 80 37 — — $2,585.00 $178,243.00 $49,356.11 2026-03-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 80 37 — — $2,585.00 $104,000.00 $48,734.96 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 79 37 — — $2,585.00 $312,394.03 $172,800.92 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 79 37 — — $2,585.00 $203,200.04 $113,540.91 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 76 36 — — $2,585.00 $166,046.80 $90,812.51 2026-03-01
850 MS_DRG Acute Leukemia With Other Procedures 70 37 — — $2,585.00 $263,179.52 $71,131.93 2026-03-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 70 37 — — $2,585.00 $135,983.35 $55,959.75 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 68 35 — — $2,585.00 $313,211.84 $170,497.34 2026-03-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 68 35 — — $2,585.00 $105,223.51 $58,726.80 2026-03-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 58 33 — — $2,585.00 $104,664.58 $58,993.68 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 56 31 — — $2,585.00 $633,491.68 $345,938.32 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 55 31 — — $2,585.00 $411,110.61 $220,940.87 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 55 31 — — $2,585.00 $184,000.00 $91,515.02 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 53 28 — — $93,179.38 $204,424.15 $99,835.05 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 53 30 — — $2,585.00 $176,302.59 $96,923.88 2026-03-01
7 MS_DRG Lung Transplant 52 29 — — $2,585.00 $189,979.43 $104,273.70 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 52 29 — — $2,585.00 $151,255.04 $83,463.61 2026-03-01
10 MS_DRG Pancreas Transplant 52 29 — — $2,585.00 $105,267.52 $58,750.45 2026-03-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 51 28 — — $2,585.00 $86,988.70 $48,927.63 2026-03-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 51 28 — — $6,270.00 $89,487.00 $48,560.34 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 50 28 — — $109,262.16 $857,608.46 $117,066.60 2026-03-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 50 28 — — $49,007.06 $384,659.87 $52,507.56 2026-03-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 50 28 — — $48,608.78 $381,534.40 $52,080.84 2026-03-01
831 OTHER Obecbtge Autol Up To 400 48 28 — — $3,870.51 $598,237.50 $292,162.50 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 48 28 — — $8,469.32 $433,588.35 $211,752.45 2026-03-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 48 28 — — $67,425.67 $147,923.65 $72,241.79 2026-03-01
717 OTHER Instill Adstiladrin, Tx D 48 28 — — $12,547.92 $138,190.80 $67,488.53 2026-03-01
824 OTHER Inj, Exagamglogene Autote 47 27 — — $13,706.74 $4,897,200.00 $2,448,600.00 2026-03-01
2067 OTHER Afamitresgene Autoleucel 47 27 — — $755,207.60 $1,656,833.00 $809,151.00 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 47 27 — — $575,896.61 $1,263,446.64 $617,032.08 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 47 27 — — $555,200.67 $1,218,042.30 $594,857.87 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 47 27 — — $550,957.18 $1,208,732.58 $590,311.26 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 47 27 — — $546,920.16 $1,199,875.87 $585,985.89 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 47 27 — — $521,548.36 $1,144,213.23 $558,801.81 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 47 27 — — $479,661.20 $1,052,317.93 $513,922.71 2026-03-01
897 OTHER Revakinagene, Per Implant 47 27 — — $259,700.00 $569,750.00 $278,250.00 2026-03-01
1907 OTHER New Technology - Level 52 47 27 — — $146,948.65 $322,387.34 $157,444.98 2026-03-01
1908 OTHER New Technology - Level 52 47 27 — — $146,948.65 $322,387.34 $157,444.98 2026-03-01
1905 OTHER New Technology - Level 51 47 27 — — $132,494.73 $290,677.21 $141,958.64 2026-03-01
1906 OTHER New Technology - Level 51 47 27 — — $132,494.73 $290,677.21 $141,958.64 2026-03-01
1903 OTHER New Technology - Level 50 47 27 — — $118,040.80 $258,967.07 $126,472.29 2026-03-01
1904 OTHER New Technology - Level 50 47 27 — — $118,040.80 $258,967.07 $126,472.29 2026-03-01
1901 OTHER New Technology - Level 49 47 27 — — $103,586.88 $227,256.93 $110,985.94 2026-03-01
1902 OTHER New Technology - Level 49 47 27 — — $103,586.88 $227,256.93 $110,985.94 2026-03-01
1585 OTHER New Technology - Level 48 47 27 — — $91,542.00 $200,831.93 $98,080.71 2026-03-01
1599 OTHER New Technology - Level 48 47 27 — — $91,542.00 $200,831.93 $98,080.71 2026-03-01
1584 OTHER New Technology - Level 47 47 27 — — $81,906.04 $179,691.82 $87,756.47 2026-03-01
1598 OTHER New Technology - Level 47 47 27 — — $81,906.04 $179,691.82 $87,756.47 2026-03-01
1583 OTHER New Technology - Level 46 47 27 — — $72,270.09 $158,551.73 $77,432.24 2026-03-01
1597 OTHER New Technology - Level 46 47 27 — — $72,270.09 $158,551.73 $77,432.24 2026-03-01
1596 OTHER New Technology - Level 45 47 27 — — $62,634.14 $137,411.64 $67,108.01 2026-03-01
1582 OTHER New Technology - Level 45 47 27 — — $62,634.14 $137,411.64 $67,108.01 2026-03-01
5244 OTHER Level 4 Blood Product Exc 47 27 — — $61,923.99 $135,853.66 $66,347.14 2026-03-01
1643 OTHER Y90 Ibritumomab, Rx 47 27 — — $55,688.06 $122,172.78 $59,665.78 2026-03-01
9273 OTHER Sipuleucel-t Auto Cd54+ 47 27 — — $53,316.03 $116,968.84 $57,124.32 2026-03-01
1595 OTHER New Technology - Level 44 47 27 — — $52,998.19 $116,271.55 $56,783.78 2026-03-01
1581 OTHER New Technology - Level 44 47 27 — — $52,998.19 $116,271.55 $56,783.78 2026-03-01
746 OTHER Inj, Betibeglogene Autote 45 25 — — $11,705.41 $4,792,149.47 $3,028,168.07 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 44 24 — — $9,043.35 $4,929,000.00 $3,275,400.00 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 44 24 — — $2,537,201.38 $4,220,039.03 $2,692,540.24 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 42 24 — — $10,234.46 $4,836,939.00 $3,435,894.60 2026-03-01
714 OTHER Inj Delandistrogene Mox R 42 24 — — $6,647.98 $4,825,397.00 $3,427,695.80 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 42 24 — — $12,654.36 $4,716,136.60 $3,350,083.24 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 39 21 — — $3,611,561.66 $4,790,847.10 $3,795,825.01 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 38 20 — — $5,652.40 $4,910,450.00 $4,640,150.00 2026-03-01
B0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 26 12 — — $59,345.39 $64,306.15 $61,243.95 2026-03-01
B0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 26 12 — — $58,368.29 $63,247.37 $60,235.59 2026-03-01
B0106 OTHER Stroke; M > 30.05 & M < 34.25 26 12 — — $52,918.56 $57,342.10 $54,611.52 2026-03-01
B1903 OTHER Guillian Barre; M < 18.05 26 12 — — $51,558.47 $55,868.31 $53,207.91 2026-03-01
B0205 OTHER Traumatic Brain Injury; M > 28.75 & M < 40.65 26 12 — — $50,906.44 $55,161.78 $52,535.03 2026-03-01
C0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 26 12 — — $48,507.59 $52,562.41 $50,059.44 2026-03-01
B2102 OTHER Burns; M=12-45 26 12 — — $47,549.17 $51,523.87 $49,070.36 2026-03-01
D0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 26 12 — — $47,231.57 $51,179.72 $48,742.59 2026-03-01
B0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 26 12 — — $47,007.38 $50,936.79 $48,511.23 2026-03-01
C0106 OTHER Stroke; M > 30.05 & M < 34.25 26 12 — — $46,992.43 $50,920.59 $48,495.80 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 20 9 — — $203,082.72 $259,034.09 $217,588.63 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 20 9 — — $105,849.46 $135,012.06 $113,410.13 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 20 9 — — $94,260.43 $120,230.14 $100,993.32 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 20 9 — — $82,226.38 $104,880.59 $88,099.69 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 20 9 — — $76,089.30 $97,052.68 $81,524.25 2026-03-01
1611 APR_DRG Implantable Heart Assist Systems 20 9 — — $72,163.80 $92,045.66 $77,318.36 2026-03-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 20 9 — — $62,486.19 $79,701.77 $66,949.49 2026-03-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 20 9 — — $49,006.18 $62,507.89 $52,506.63 2026-03-01
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 20 9 — — $46,264.33 $59,010.63 $49,568.93 2026-03-01
5834 APR_DRG Neonate With Ecmo 15 8 — — $330,392.83 $421,419.42 $353,992.32 2026-03-01
5833 APR_DRG Neonate With Ecmo 15 8 — — $279,764.50 $356,842.47 $299,747.68 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 15 8 — — $209,133.23 $266,751.58 $224,071.32 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 15 8 — — $190,256.53 $242,674.15 $203,846.29 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 15 8 — — $155,609.07 $198,480.96 $166,724.01 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 15 8 — — $154,230.10 $196,722.06 $165,246.53 2026-03-01
5832 APR_DRG Neonate With Ecmo 15 8 — — $139,400.27 $177,806.46 $149,357.43 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 15 8 — — $132,369.68 $168,838.88 $141,824.65 2026-03-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 15 8 — — $123,007.88 $156,897.81 $131,794.16 2026-03-01
5831 APR_DRG Neonate With Ecmo 15 8 — — $122,744.71 $156,562.13 $131,512.18 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 15 8 — — $112,214.05 $143,130.16 $120,229.34 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 15 8 — — $111,701.17 $142,475.99 $119,679.83 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 15 8 — — $111,412.33 $142,107.56 $119,370.35 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 15 8 — — $110,933.38 $141,496.66 $118,857.20 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 15 8 — — $109,825.42 $140,083.45 $117,670.10 2026-03-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 15 8 — — $106,932.19 $136,393.10 $114,570.20 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 15 8 — — $105,974.30 $135,171.30 $113,543.89 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 15 8 — — $105,290.03 $134,298.51 $112,810.75 2026-03-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 15 8 — — $94,313.06 $120,297.28 $101,049.71 2026-03-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 15 8 — — $93,472.63 $119,225.29 $100,149.24 2026-03-01
2464 APR_DRG Gastrointestinal Vascular Insufficiency 15 8 — — $91,406.34 $116,589.73 $97,935.37 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 15 8 — — $90,934.80 $115,988.26 $97,430.14 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 15 8 — — $88,242.53 $112,554.25 $94,545.57 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 15 8 — — $87,978.49 $112,217.46 $94,262.67 2026-03-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 15 8 — — $85,525.04 $109,088.06 $91,633.97 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 15 8 — — $80,876.99 $103,159.42 $86,653.92 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 15 8 — — $80,220.57 $102,322.15 $85,950.61 2026-03-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 15 8 — — $76,801.85 $97,961.54 $82,287.69 2026-03-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 15 8 — — $75,219.28 $95,942.96 $80,592.09 2026-03-01
8634 APR_DRG Neonatal Aftercare 15 8 — — $74,052.60 $94,454.85 $79,342.07 2026-03-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 15 8 — — $73,341.36 $93,547.65 $78,580.03 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 15 8 — — $71,656.58 $91,398.70 $76,774.91 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 15 8 — — $71,632.22 $91,367.63 $76,748.81 2026-03-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 15 8 — — $69,783.87 $89,010.04 $74,768.43 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 15 8 — — $69,783.87 $89,010.04 $74,768.43 2026-03-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 15 8 — — $69,585.94 $88,757.57 $74,556.36 2026-03-01
4414 APR_DRG Major Bladder Procedures 15 8 — — $68,124.32 $86,893.26 $72,990.34 2026-03-01
1784 APR_DRG External Heart Assist Devices 15 8 — — $63,806.00 $81,385.20 $68,363.57 2026-03-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 15 8 — — $62,835.93 $80,147.88 $67,324.22 2026-03-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 15 8 — — $62,763.73 $80,055.78 $67,246.85 2026-03-01
6904 APR_DRG Acute Leukemia 15 8 — — $61,925.03 $78,986.01 $66,348.25 2026-03-01
434 APR_DRG Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies 15 8 — — $61,545.71 $78,502.18 $65,941.83 2026-03-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 15 8 — — $61,476.54 $78,413.95 $65,867.72 2026-03-01
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 15 8 — — $59,619.93 $76,045.83 $63,878.49 2026-03-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 15 8 — — $58,366.67 $74,447.29 $62,535.72 2026-03-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 15 8 — — $58,010.84 $73,993.41 $62,154.47 2026-03-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 15 8 — — $57,617.59 $73,491.82 $61,733.13 2026-03-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 15 8 — — $57,053.82 $72,772.73 $61,129.09 2026-03-01
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 15 8 — — $54,367.21 $69,345.94 $58,250.59 2026-03-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 15 8 — — $54,070.97 $68,968.07 $57,933.18 2026-03-01
4474 APR_DRG Other Kidney, Urinary Tract And Related Non-percutaneous Procedures 15 8 — — $53,944.38 $68,806.61 $57,797.55 2026-03-01
234 APR_DRG Spinal Procedures 15 8 — — $53,145.27 $67,787.34 $56,941.36 2026-03-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 15 8 — — $52,953.01 $67,542.10 $56,735.36 2026-03-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 15 8 — — $52,272.65 $66,674.30 $56,006.41 2026-03-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 15 8 — — $52,270.48 $66,671.52 $56,004.08 2026-03-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 15 8 — — $51,618.83 $65,840.35 $55,305.89 2026-03-01
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 15 8 — — $51,380.89 $65,536.85 $55,050.95 2026-03-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 15 8 — — $49,611.72 $63,280.25 $53,155.41 2026-03-01
264 APR_DRG Other Nervous System And Related Procedures 15 8 — — $49,581.70 $63,241.96 $53,123.25 2026-03-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 15 8 — — $49,367.68 $62,968.97 $52,893.94 2026-03-01
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 15 8 — — $49,074.91 $62,595.55 $52,580.26 2026-03-01
1824 APR_DRG Other Upper Vascular Procedures 15 8 — — $49,035.33 $62,545.06 $52,537.85 2026-03-01
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 15 8 — — $48,204.02 $61,484.72 $51,647.17 2026-03-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 15 8 — — $48,192.28 $61,469.75 $51,634.59 2026-03-01
2054 APR_DRG Cardiomyopathy 15 8 — — $48,056.12 $61,296.07 $51,488.70 2026-03-01
6954 APR_DRG Chemotherapy For Acute Leukemia 15 8 — — $47,994.35 $61,217.29 $51,422.52 2026-03-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 15 8 — — $47,945.20 $61,154.59 $51,369.85 2026-03-01
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 15 8 — — $47,139.57 $60,127.00 $50,506.68 2026-03-01
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 15 8 — — $46,981.66 $59,925.59 $50,337.49 2026-03-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 15 8 — — $46,835.06 $59,738.60 $50,180.42 2026-03-01
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition… 15 8 — — $46,343.06 $59,111.05 $49,653.28 2026-03-01
214 APR_DRG Open Craniotomy Except Trauma 15 8 — — $46,154.71 $58,870.80 $49,451.47 2026-03-01
2304 APR_DRG Major Small Bowel Procedures 15 8 — — $45,988.10 $58,658.29 $49,272.96 2026-03-01
224 APR_DRG Ventricular Shunt Procedures 15 8 — — $45,806.70 $58,426.91 $49,078.61 2026-03-01
4424 APR_DRG Kidney And Urinary Tract Procedures For Malignancy 15 8 — — $45,555.70 $58,106.76 $48,809.68 2026-03-01
9524 APR_DRG Non-extensive O.r. Procedure Unrelated To Principal Diagnosis 15 8 — — $45,275.99 $57,749.99 $48,509.99 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 14 7 — — $321,406.44 $573,940.00 $344,364.05 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 14 7 — — $269,125.53 $480,581.00 $288,348.78 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 14 5 — — $57,017.10 $422,905.25 $140,983.85 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 14 7 — — $113,412.06 $202,522.00 $121,512.92 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 14 7 — — $96,405.45 $172,153.00 $103,291.56 2026-03-01
84 APR_DRG Autologous Bone Marrow Transplant 14 7 — — $96,019.17 $171,463.00 $102,877.68 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 14 5 — — $45,212.00 $310,073.39 $99,222.35 2026-03-01
64 APR_DRG Pancreas Transplant 14 7 — — $88,249.50 $157,588.00 $94,553.04 2026-03-01
72 APR_DRG Allogeneic Bone Marrow Transplant 14 7 — — $76,200.23 $136,072.00 $81,643.11 2026-03-01
4404 APR_DRG Kidney Transplant 14 7 — — $71,985.44 $128,545.00 $77,127.26 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 14 7 — — $66,285.54 $118,367.00 $71,020.23 2026-03-01
83 APR_DRG Autologous Bone Marrow Transplant 14 7 — — $64,901.78 $115,896.00 $69,537.63 2026-03-01
63 APR_DRG Pancreas Transplant 14 7 — — $57,030.33 $101,840.00 $61,103.92 2026-03-01
22 APR_DRG Heart And/or Lung Transplant 14 7 — — $53,249.24 $95,087.90 $57,052.76 2026-03-01
62 APR_DRG Pancreas Transplant 14 7 — — $51,583.16 $92,112.80 $55,267.67 2026-03-01
61 APR_DRG Pancreas Transplant 14 7 — — $50,917.17 $90,923.50 $54,554.12 2026-03-01
71 APR_DRG Allogeneic Bone Marrow Transplant 14 7 — — $50,035.84 $89,349.70 $53,609.83 2026-03-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 14 7 — — $49,670.44 $88,697.20 $53,218.33 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 13 4 — — $93,760.51 $551,754.93 $147,245.34 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 13 4 — — $74,830.84 $325,380.58 $138,148.31 2026-03-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 13 4 — — $39,976.89 $204,927.75 $58,512.24 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 12 4 — — $553,169.00 $1,250,478.00 $969,621.79 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 12 4 — — $527,622.00 $1,128,119.40 $911,665.19 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 12 4 — — $516,442.00 $1,103,378.76 $905,167.53 2026-03-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 12 4 — — $489,399.00 $1,003,071.60 $805,025.05 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 12 4 — — $63,235.60 $432,000.00 $172,200.00 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 11 4 — — $32.24 $1,037,313.00 $934,776.65 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 11 4 — — $8.47 $956,745.00 $878,117.20 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 8 2 — — $1,271,523.00 $1,978,603.20 $1,509,600.96 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 8 2 — — $459,112.50 $1,428,840.00 $1,090,152.00 2026-03-01
C9301 HCPCS Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 5 1 — — $545,370.00 $751,275.00 $751,275.00 2026-03-01
E0767 HCPCS Intrabuccal, Systemic Delivery Of Amplitude-modulated, Radiofrequency Electromag… 5 1 — — $94,790.81 $146,008.42 $130,719.58 2026-03-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc Pediatric 5 1 — — $102,556.46 $150,232.99 $128,200.16 2026-03-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 5 1 — — $88,749.06 $130,006.80 $110,940.30 2026-03-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 5 1 — — $83,928.19 $122,944.80 $104,914.00 2026-03-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc Pediatric 5 1 — — $75,159.33 $110,099.46 $93,952.53 2026-03-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc Pediatric 5 1 — — $73,278.53 $107,344.32 $91,601.45 2026-03-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc Pediatric 5 1 — — $68,011.18 $99,628.28 $85,017.02 2026-03-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 5 1 — — $64,723.97 $94,812.91 $80,907.87 2026-03-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 5 1 — — $62,705.88 $91,856.65 $78,385.16 2026-03-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc Pediat… 5 1 — — $58,177.46 $85,223.05 $72,724.43 2026-03-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc Pediatric 5 1 — — $53,368.87 $78,179.04 $66,713.48 2026-03-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc Pediatric 5 1 — — $43,874.47 $64,270.88 $54,845.06 2026-03-01
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 3 1 — — $4,850,948.67 $4,850,948.67 $4,850,948.67 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 3 1 — — $4,271,819.03 $4,271,819.03 $4,271,819.03 2026-03-01
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 3 1 — — $3,847,800.00 $3,847,800.00 $3,847,800.00 2026-03-01
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 3 1 — — $332,753.88 $332,753.88 $332,753.88 2026-03-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 3 1 — — $117,866.10 $151,959.60 $127,607.10 2026-03-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 1 — — $77,046.96 $77,046.96 $77,046.96 2026-03-01
L5969 HCPCS Addition, Endoskeletal Ankle-foot Or Ankle System, Power Assist, Includes Any Ty… 2 1 — — $134,238.24 $134,238.24 $134,238.24 2026-03-01
00845 OTHER Inj, Atidarsagene Autotem 1 1 — — $4,505,000.00 $4,505,000.00 $4,505,000.00 2026-03-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,685,267.00 $3,685,267.00 $3,685,267.00 2026-03-01
00908 OTHER Topi Adm Prad Zami Per Tr 1 1 — — $3,335,820.00 $3,335,820.00 $3,335,820.00 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,327,860.00 $3,327,860.00 $3,327,860.00 2026-03-01
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
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
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $489,450.20 $489,450.20 $489,450.20 2026-03-01
00831 OTHER Obecbtge Autol Up To 400 1 1 — — $278,250.00 $278,250.00 $278,250.00 2026-03-01
00897 OTHER Revakinagene, Per Implant 1 1 — — $265,000.00 $265,000.00 $265,000.00 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $228,213.70 $228,213.70 $228,213.70 2026-03-01
00886 OTHER Inj. Remestemcel-l-rknd/ 1 1 — — $201,669.00 $201,669.00 $201,669.00 2026-03-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $200,603.50 $200,603.50 $200,603.50 2026-03-01
01908 OTHER New Technology - Level 52 1 1 — — $152,747.50 $152,747.50 $152,747.50 2026-03-01
01907 OTHER New Technology - Level 52 1 1 — — $152,747.50 $152,747.50 $152,747.50 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $141,389.40 $141,389.40 $141,389.40 2026-03-01
01905 OTHER New Technology - Level 51 1 1 — — $137,723.20 $137,723.20 $137,723.20 2026-03-01
01906 OTHER New Technology - Level 51 1 1 — — $137,723.20 $137,723.20 $137,723.20 2026-03-01
01904 OTHER New Technology - Level 50 1 1 — — $122,699.00 $122,699.00 $122,699.00 2026-03-01
01903 OTHER New Technology - Level 50 1 1 — — $122,699.00 $122,699.00 $122,699.00 2026-03-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $110,413.90 $110,413.90 $110,413.90 2026-03-01
01902 OTHER New Technology - Level 49 1 1 — — $107,674.60 $107,674.60 $107,674.60 2026-03-01
01901 OTHER New Technology - Level 49 1 1 — — $107,674.60 $107,674.60 $107,674.60 2026-03-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $98,953.68 $98,953.68 $98,953.68 2026-03-01
01585 OTHER New Technology - Level 48 1 1 — — $95,154.40 $95,154.40 $95,154.40 2026-03-01
01599 OTHER New Technology - Level 48 1 1 — — $95,154.40 $95,154.40 $95,154.40 2026-03-01
01598 OTHER New Technology - Level 47 1 1 — — $85,138.20 $85,138.20 $85,138.20 2026-03-01
01584 OTHER New Technology - Level 47 1 1 — — $85,138.20 $85,138.20 $85,138.20 2026-03-01
007 OTHER Lung Transplant 1 1 — — $84,860.66 $84,860.66 $84,860.66 2026-03-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $75,211.59 $75,211.59 $75,211.59 2026-03-01
01597 OTHER New Technology - Level 46 1 1 — — $75,122.00 $75,122.00 $75,122.00 2026-03-01
01583 OTHER New Technology - Level 46 1 1 — — $75,122.00 $75,122.00 $75,122.00 2026-03-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $72,436.52 $72,436.52 $72,436.52 2026-03-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $71,673.53 $71,673.53 $71,673.53 2026-03-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $67,170.39 $67,170.39 $67,170.39 2026-03-01
01582 OTHER New Technology - Level 45 1 1 — — $65,105.80 $65,105.80 $65,105.80 2026-03-01
01596 OTHER New Technology - Level 45 1 1 — — $65,105.80 $65,105.80 $65,105.80 2026-03-01
474 OTHER Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 1 1 — — $64,876.67 $64,876.67 $64,876.67 2026-03-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $64,367.62 $64,367.62 $64,367.62 2026-03-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $64,274.79 $64,274.79 $64,274.79 2026-03-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $62,338.38 $62,338.38 $62,338.38 2026-03-01
429 OTHER Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 1 1 — — $59,798.90 $59,798.90 $59,798.90 2026-03-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $59,110.07 $59,110.07 $59,110.07 2026-03-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $56,824.55 $56,824.55 $56,824.55 2026-03-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $55,951.11 $55,951.11 $55,951.11 2026-03-01
275 OTHER Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 1 1 — — $55,770.53 $55,770.53 $55,770.53 2026-03-01
01595 OTHER New Technology - Level 44 1 1 — — $55,089.60 $55,089.60 $55,089.60 2026-03-01
01581 OTHER New Technology - Level 44 1 1 — — $55,089.60 $55,089.60 $55,089.60 2026-03-01
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $54,404.11 $54,404.11 $54,404.11 2026-03-01
850 OTHER Acute Leukemia With Other Procedures 1 1 — — $52,419.64 $52,419.64 $52,419.64 2026-03-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $50,680.80 $50,680.80 $50,680.80 2026-03-01
233 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 1 — — $50,016.48 $50,016.48 $50,016.48 2026-03-01
447 OTHER Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 1 1 — — $48,638.22 $48,638.22 $48,638.22 2026-03-01
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