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

MEDICAL CITY DENTON

Denton, TX · CCN 450634 · Rates published

41,791 distinct procedures filed
59 distinct payers
2,637,989 rate rows
2026-03-01 last MRF observed
Data quality

2,601,927 of 2,637,989 rate rows are consumer-grade (98.6%)

36,062 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 19,540
per-diem day rate — not a per-procedure price 12,780
template filing: same amount across many unrelated codes — excluded 3,419
placeholder amount (≤ $0.02) — excluded from medians 311
exceeds 10× this hospital's gross charge — excluded from medians 12
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1682213_MEDICAL-CITY-DENTON_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.medicalcityhealthcare.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-18
Content fingerprint 3c44011f27030829… · 1,164,750,463 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
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 18 $5,938.97 $4,955,500.00 $4,546,671.25 nat. median
$9,966
outlier · 456.2×
00845
OTHER 		Inj, Atidarsagene Autotem 1 $4,369,850.00 $4,369,850.00 $4,369,850.00 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 20 $3,666,840.67 $4,790,847.10 $3,758,972.34 nat. median
$3,746,358
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,574,708.99 $3,574,708.99 $3,574,708.99 nat. median
$3,574,709
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 22 $6,985.03 $4,991,790.00 $3,494,253.00 nat. median
$13,041
outlier · 267.9×
908
OTHER 		Topi Adm Prad Zami Per Tr 19 $10,753.36 $4,336,566.00 $3,419,215.50 nat. median
$22,747
outlier · 150.3×
748
OTHER 		Inj, Lovotibeglogene Auto 22 $13,295.95 $4,878,762.00 $3,415,133.40 nat. median
$17,963
outlier · 190.1×
906
OTHER 		Inj Elivaldogene Autoteme 20 $9,501.86 $4,770,000.00 $3,339,000.00 nat. median
$20,756
outlier · 160.9×
00908
OTHER 		Topi Adm Prad Zami Per Tr 1 $3,235,745.40 $3,235,745.40 $3,235,745.40 nat. median
$12,675
outlier · 255.3×
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,228,024.20 $3,228,024.20 $3,228,024.20 nat. median
$3,228,024
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $3,154,932.76 $3,154,932.76 $3,154,932.76 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 22 $12,298.88 $4,409,953.50 $3,086,967.45 nat. median
$21,896
outlier · 141.0×
00906
OTHER 		Inj Elivaldogene Autoteme 1 $3,084,600.00 $3,084,600.00 $3,084,600.00 nat. median
$21
outlier · 149086.5×
00746
OTHER 		Inj, Betibeglogene Autote 1 $2,851,769.93 $2,851,769.93 $2,851,769.93 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 23 $2,455,110.00 $4,919,063.90 $2,718,430.05 nat. median
$2,588,981
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 2 $1,271,523.00 $4,067,128.80 $2,528,215.20 nat. median
$824,563
outlier · 3.1×
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,511,311.57 $2,511,311.57 $2,511,311.57 nat. median
$2,457,321
1.0× median
824
OTHER 		Inj, Exagamglogene Autote 24 $14,401.69 $4,617,360.00 $2,448,600.00 nat. median
$25,250
outlier · 97.0×
00824
OTHER 		Inj, Exagamglogene Autote 1 $2,262,040.00 $2,262,040.00 $2,262,040.00 nat. median
$2,332,000
1.0× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 2 $459,112.50 $2,937,060.00 $1,825,740.00 nat. median
$324,450
outlier · 5.6×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $536,573.93 $2,695,474.80 $1,597,833.00 nat. median
$675,122
outlier · 2.4×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $511,793.34 $2,431,724.04 $1,441,485.90 nat. median
$625,184
outlier · 2.3×
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $500,948.74 $2,378,394.22 $1,409,872.86 nat. median
$674,188
outlier · 2.1×
C9301
HCPCS 		Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 1 $959,962.50 $1,544,287.50 $1,405,162.50 nat. median
$459,112
outlier · 3.1×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 $23.68 $2,235,985.80 $1,325,455.50 nat. median
$754,974
1.8× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $474,717.03 $2,162,176.56 $1,281,702.60 nat. median
$620,080
outlier · 2.1×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 3 $6.22 $2,062,317.00 $1,222,507.50 nat. median
$634,511
1.9× median
2067
OTHER 		Afamitresgene Autoleucel 26 $766,766.90 $2,019,024.40 $809,151.00 nat. median
$786,032
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 25 $565,868.90 $1,539,641.95 $617,032.08 nat. median
$587,650
1.1× median
9194
OTHER 		Tisagenlecleucel Car-pos 25 $563,698.64 $1,484,312.01 $594,857.87 nat. median
$566,531
1.1× median
9413
OTHER 		Lisocabtagene Car Pos T 25 $559,390.19 $1,472,967.14 $590,311.26 nat. median
$562,201
1.1× median
9422
OTHER 		Idecabtagene Vicleucel Ca 25 $555,291.39 $1,462,174.32 $585,985.89 nat. median
$558,082
1.1× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $570,020.11 $570,020.11 $570,020.11 nat. median
$554,552
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 25 $529,531.24 $1,394,343.56 $558,801.81 nat. median
$532,192
1.1× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $549,535.36 $549,535.36 $549,535.36 nat. median
$538,205
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $545,335.16 $545,335.16 $545,335.16 nat. median
$534,091
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $541,339.35 $541,339.35 $541,339.35 nat. median
$530,178
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $516,226.43 $516,226.43 $516,226.43 nat. median
$505,583
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 25 $487,002.95 $1,282,359.52 $513,922.71 nat. median
$489,450
1.1× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $474,766.69 $474,766.69 $474,766.69 nat. median
$464,978
1.0× median
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 4 $61,338.53 $931,200.00 $405,600.00 nat. median
$69,774
outlier · 5.8×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 21 $332,962.06 $1,273,072.13 $356,745.06 nat. median
$370,174
1.0× median
245978
CDM 		Stent Eprsth 24f 34mm 24 $93,640.05 $693,630.00 $346,815.00 nat. median
$246,026
1.4× 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
90288
CPT 		Botulism Immune Globulin, Human, For Intravenous Use 1 $294,713.96 $416,525.16 $329,245.80 nat. median
$55,037
outlier · 6.0×
5834
APR_DRG 		Neonate With Ecmo 10 $308,225.50 $391,149.11 $328,565.25 nat. median
$309,665
1.1× median
74
APR_DRG 		Allogeneic Bone Marrow Transplant 11 $299,842.05 $532,714.00 $324,194.79 nat. median
$187,294
1.7× median

Other procedures at this hospital

Browse this hospital's 41,791 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
             
C1882 HCPCS Crt-d Crd 5.37x8.18x0.99 1,521 24 $282,207.00 $282,207.00 $14.58 $542,376.00 $106,899.00 2026-03-01
C1820 HCPCS Nrstm Impl 1.9inx.6in 897 24 $333,518.00 $333,518.00 $2,574.59 $546,750.00 $120,934.94 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 72 31 — — $164,540.28 $712,935.00 $186,748.18 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 72 31 — — $108,209.15 $416,386.94 $122,814.06 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 66 32 — — $60,607.00 $507,900.98 $96,504.19 2026-03-01
248063 CDM Kit Cath Rt Heart 64 35 $630,990.00 $630,990.00 $44,169.30 $630,990.00 $201,285.81 2026-03-01
422506 CDM Kit Pmp Rt Hrt 22f 170cm 64 35 $384,750.00 $384,750.00 $26,932.50 $384,750.00 $122,735.25 2026-03-01
254667 CDM Cath Vasc Assist Strl 64 35 $384,750.00 $384,750.00 $26,932.50 $384,750.00 $122,735.25 2026-03-01
244953 CDM Kit Cath Rt Heart 64 35 $384,750.00 $384,750.00 $26,932.50 $384,750.00 $122,735.25 2026-03-01
862710 CDM Set Vntrc 17.4x13.8in 64 35 $384,750.00 $384,750.00 $26,932.50 $384,750.00 $122,735.25 2026-03-01
751731 CDM Set Pump Asst 2.5in 64 35 $307,800.00 $307,800.00 $21,546.00 $307,800.00 $98,188.20 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 61 27 — — $9,825.00 $641,817.38 $179,373.62 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 58 26 — — $216,920.75 $842,426.46 $245,695.95 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 58 31 — — $75,983.00 $333,689.54 $95,403.59 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 53 26 — — $80,850.00 $249,112.22 $99,835.05 2026-03-01
J9999 HCPCS Carmustine Wafers 8/box 50 26 $475,992.96 $475,992.96 $33,319.51 $475,992.96 $160,171.63 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 47 26 — — $108,147.24 $629,884.36 $117,066.60 2026-03-01
2067 OTHER Afamitresgene Autoleucel 45 26 — — $766,766.90 $2,019,024.40 $809,151.00 2026-03-01
1907 OTHER New Technology - Level 52 45 26 — — $146,662.80 $392,862.71 $157,444.98 2026-03-01
1908 OTHER New Technology - Level 52 45 26 — — $146,662.80 $392,862.71 $157,444.98 2026-03-01
1905 OTHER New Technology - Level 51 45 26 — — $132,237.00 $354,220.59 $141,958.64 2026-03-01
1906 OTHER New Technology - Level 51 45 26 — — $132,237.00 $354,220.59 $141,958.64 2026-03-01
1903 OTHER New Technology - Level 50 45 26 — — $117,811.20 $315,578.48 $126,472.29 2026-03-01
1904 OTHER New Technology - Level 50 45 26 — — $117,811.20 $315,578.48 $126,472.29 2026-03-01
1901 OTHER New Technology - Level 49 45 26 — — $103,385.40 $276,936.36 $110,985.94 2026-03-01
1902 OTHER New Technology - Level 49 45 26 — — $103,385.40 $276,936.36 $110,985.94 2026-03-01
1585 OTHER New Technology - Level 48 45 26 — — $91,363.88 $244,734.72 $98,080.71 2026-03-01
1599 OTHER New Technology - Level 48 45 26 — — $91,363.88 $244,734.72 $98,080.71 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 45 25 — — $89,142.87 $554,970.00 $95,510.22 2026-03-01
245763 CDM Stent Eprsth 34mm 15mm 44 26 $693,630.00 $693,630.00 $93,640.05 $693,630.00 $310,052.61 2026-03-01
437822 CDM Valve Aor Tavr 23mm 44 26 $693,630.00 $693,630.00 $93,640.05 $693,630.00 $310,052.61 2026-03-01
471570 CDM Stent Eprsth 40x40x15cm 44 26 $498,168.00 $498,168.00 $67,252.68 $498,168.00 $222,681.10 2026-03-01
466919 CDM Stent Graft 15cn 28x28mm 44 26 $498,168.00 $498,168.00 $67,252.68 $498,168.00 $222,681.10 2026-03-01
483550 CDM Stnt Thorac 26x26mm 10cm 44 26 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $218,314.80 2026-03-01
471891 CDM Graft Evas 45x45x15cm 44 26 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $218,314.80 2026-03-01
473088 CDM Stent 20fr 31x31mm 10cm 44 26 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $218,314.80 2026-03-01
101317 CDM Stent Graft 15cm 31x31mm 44 26 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $218,314.80 2026-03-01
467548 CDM Stent Eprsth 34x34x20cm 44 26 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $218,314.80 2026-03-01
459729 CDM Stent Eprsth 37x37x15cm 44 26 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $218,314.80 2026-03-01
101241 CDM Graft Evas 45x45mm 10cm 44 26 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $218,314.80 2026-03-01
472308 CDM Stent Eprsth 31x31x20cm 44 26 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $218,314.80 2026-03-01
469404 CDM Stent Graft 10cm 21x21mm 44 26 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $218,314.80 2026-03-01
473613 CDM Stent Eprsth 37x37x20cm 44 26 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $218,314.80 2026-03-01
258384 CDM Cage Spn 12d 34x28x13mm 44 26 $481,140.00 $481,140.00 $64,953.90 $481,140.00 $215,069.58 2026-03-01
248168 CDM Graft Bn Fem Whole Left 44 26 $466,925.00 $466,925.00 $63,034.88 $466,925.00 $208,715.48 2026-03-01
473614 CDM Stent Thor 40x40mm 20cm 44 26 $440,572.00 $440,572.00 $59,477.22 $440,572.00 $196,935.68 2026-03-01
250110 CDM Graft Evas 34mm 199mm 44 26 $437,840.00 $437,840.00 $59,108.40 $437,840.00 $195,714.48 2026-03-01
730191 CDM Device Ast Vent 00551042 44 26 $415,800.00 $415,800.00 $56,133.00 $415,800.00 $185,862.60 2026-03-01
472852 CDM Stent 34mmx34mmx15cm 44 26 $392,611.00 $392,611.00 $53,002.49 $392,611.00 $175,497.11 2026-03-01
473532 CDM Device Embl 5x20mm Pipln 44 26 $380,175.00 $380,175.00 $51,323.63 $380,175.00 $169,938.23 2026-03-01
216750 CDM Graft Endo Aaa 36x14mm 44 26 $336,747.00 $336,747.00 $45,460.85 $336,747.00 $150,525.91 2026-03-01
211753 CDM Graft Endo Aaa 28.5x12mm 44 26 $336,747.00 $336,747.00 $45,460.85 $336,747.00 $150,525.91 2026-03-01
216719 CDM Graft Endo Aaa 26x12mm 44 26 $336,747.00 $336,747.00 $45,460.85 $336,747.00 $150,525.91 2026-03-01
216652 CDM Graft Endo Aaa 32x14mm 44 26 $336,747.00 $336,747.00 $45,460.85 $336,747.00 $150,525.91 2026-03-01
247343 CDM Graft Endo Aaa 28.5x12mm 44 26 $328,533.00 $328,533.00 $44,351.96 $328,533.00 $146,854.25 2026-03-01
222589 CDM Gft Evs 15f 20x14.5x12mm 44 26 $328,533.00 $328,533.00 $44,351.96 $328,533.00 $146,854.25 2026-03-01
231788 CDM Graft Endo Aaa 23x12mm 44 26 $328,533.00 $328,533.00 $44,351.96 $328,533.00 $146,854.25 2026-03-01
741560 CDM Gft Evas 26x116mm 44 26 $327,504.00 $327,504.00 $44,213.04 $327,504.00 $146,394.29 2026-03-01
216683 CDM Coil Emb Endo Sn Ly 10mm 44 26 $326,957.00 $326,957.00 $44,139.19 $326,957.00 $146,149.78 2026-03-01
245569 CDM Stent Eprsth 4.2x34mm 5c 44 26 $305,250.00 $305,250.00 $41,208.75 $305,250.00 $136,446.75 2026-03-01
455631 CDM Device Embl 5x35mm 44 26 $299,619.00 $299,619.00 $40,448.57 $299,619.00 $133,929.70 2026-03-01
222530 CDM Device Embl 35mm 4.25mm 44 26 $299,619.00 $299,619.00 $40,448.57 $299,619.00 $133,929.70 2026-03-01
473664 CDM Device Embl 16mm 4mm 44 26 $299,619.00 $299,619.00 $40,448.57 $299,619.00 $133,929.70 2026-03-01
423709 CDM Device Embl 5x30mm 44 26 $299,619.00 $299,619.00 $40,448.57 $299,619.00 $133,929.70 2026-03-01
482702 CDM Device Embl 4.75x35mm Pl 44 26 $299,619.00 $299,619.00 $40,448.57 $299,619.00 $133,929.70 2026-03-01
432741 CDM Device Embl Pipln 4x18mm 44 26 $299,619.00 $299,619.00 $40,448.57 $299,619.00 $133,929.70 2026-03-01
222543 CDM Device Embl16x3.75mm Pip 44 26 $299,619.00 $299,619.00 $40,448.57 $299,619.00 $133,929.70 2026-03-01
856438 CDM Graft Evas 14cm 26mm 44 26 $298,313.00 $298,313.00 $40,272.25 $298,313.00 $133,345.91 2026-03-01
437120 CDM Graft Evas 10cm 10mm 44 26 $292,818.00 $292,818.00 $39,530.43 $292,818.00 $130,889.65 2026-03-01
849424 CDM Graft Evas 18cm 26mm 44 26 $291,375.00 $291,375.00 $39,335.63 $291,375.00 $130,244.62 2026-03-01
859347 CDM Graft Evas 16cm 26mm 44 26 $291,375.00 $291,375.00 $39,335.63 $291,375.00 $130,244.62 2026-03-01
869126 CDM Graft Evas 16cm 26mm 44 26 $291,375.00 $291,375.00 $39,335.63 $291,375.00 $130,244.62 2026-03-01
858921 CDM Graft Evas 12cm 28.5mm 44 26 $291,375.00 $291,375.00 $39,335.63 $291,375.00 $130,244.62 2026-03-01
747478 CDM Graft Evas 18cm 26mm 44 26 $291,375.00 $291,375.00 $39,335.63 $291,375.00 $130,244.62 2026-03-01
856437 CDM Graft Evas 16cm 25.5mm 44 26 $291,375.00 $291,375.00 $39,335.63 $291,375.00 $130,244.62 2026-03-01
747574 CDM Graft Evas 14cm 23mm 44 26 $291,375.00 $291,375.00 $39,335.63 $291,375.00 $130,244.62 2026-03-01
753429 CDM Graft Evas 18cm 28.5mm 44 26 $291,375.00 $291,375.00 $39,335.63 $291,375.00 $130,244.62 2026-03-01
754009 CDM Graft Evas 12cm 26mm 44 26 $291,375.00 $291,375.00 $39,335.63 $291,375.00 $130,244.62 2026-03-01
742791 CDM Stent Aaa Exldr C3 23x12 44 26 $291,375.00 $291,375.00 $39,335.63 $291,375.00 $130,244.62 2026-03-01
258440 CDM Cage Spn 7dg 14x16x7mm 44 26 $290,106.00 $290,106.00 $39,164.31 $290,106.00 $129,677.38 2026-03-01
258441 CDM Cage Spn 7dg 14x16x8mm 44 26 $290,106.00 $290,106.00 $39,164.31 $290,106.00 $129,677.38 2026-03-01
873077 CDM Graft Evas 26x12mm 18cm 44 26 $285,687.00 $285,687.00 $38,567.75 $285,687.00 $127,702.09 2026-03-01
857566 CDM Graft Evas 31x14.5m 15cm 44 26 $285,687.00 $285,687.00 $38,567.75 $285,687.00 $127,702.09 2026-03-01
858902 CDM Graft Evas 31x14.5m 13cm 44 26 $285,687.00 $285,687.00 $38,567.75 $285,687.00 $127,702.09 2026-03-01
857807 CDM Graft Evas 35x14.5m 14cm 44 26 $285,687.00 $285,687.00 $38,567.75 $285,687.00 $127,702.09 2026-03-01
870599 CDM Graft Evas 14.5mm 12cm 44 26 $285,687.00 $285,687.00 $38,567.75 $285,687.00 $127,702.09 2026-03-01
870031 CDM Graft Evas 26x14.5m 18cm 44 26 $285,687.00 $285,687.00 $38,567.75 $285,687.00 $127,702.09 2026-03-01
436531 CDM Graft Evas 28.5x12m 12cm 44 26 $285,687.00 $285,687.00 $38,567.75 $285,687.00 $127,702.09 2026-03-01
870013 CDM Graft Evas 14.5mm 18cm 44 26 $285,687.00 $285,687.00 $38,567.75 $285,687.00 $127,702.09 2026-03-01
851642 CDM Cage Spn Std 1 Lvl Kit 44 26 $285,336.00 $285,336.00 $38,520.36 $285,336.00 $127,545.19 2026-03-01
860921 CDM Graft Evas 12cm 23mm 44 26 $284,299.00 $284,299.00 $38,380.36 $284,299.00 $127,081.65 2026-03-01
749679 CDM Graft Evas 14cm 23x14.5m 44 26 $284,299.00 $284,299.00 $38,380.36 $284,299.00 $127,081.65 2026-03-01
747006 CDM Graft Evas 13cm 31mm 44 26 $284,299.00 $284,299.00 $38,380.36 $284,299.00 $127,081.65 2026-03-01
738989 CDM Graft Evas 14cm 28.5mm 44 26 $284,299.00 $284,299.00 $38,380.36 $284,299.00 $127,081.65 2026-03-01
859730 CDM Graft Evas 31x14.5m 17cm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
870836 CDM Graft Evas 23x12mm 18cm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
871572 CDM Graft Evas 14.5mm 16cm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
873698 CDM Graft Evas 14.5mm 14cm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
270066 CDM Pump Pain Infn 148gm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
872483 CDM Graft Evas 26x12mm 14cm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
870719 CDM Graft Evas 28.5x12m 18cm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
422734 CDM Graft Evas 10cm 12mm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
870622 CDM Graft Evas 26x14.5m 12cm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
424455 CDM Graft Evas 30x124mm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
870461 CDM Graft Evas 26x14.5m 16cm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
876981 CDM Graft Evas 26x14.5m 14cm 44 26 $272,376.00 $272,376.00 $36,770.76 $272,376.00 $121,752.07 2026-03-01
423117 CDM Graft Evas 10cm 14.5mm 44 26 $272,264.00 $272,264.00 $36,755.64 $272,264.00 $121,702.01 2026-03-01
870971 CDM Graft Evas 26x12mm 16cm 44 26 $272,264.00 $272,264.00 $36,755.64 $272,264.00 $121,702.01 2026-03-01
444727 CDM Occluder Cv 35x18mm 44 26 $272,264.00 $272,264.00 $36,755.64 $272,264.00 $121,702.01 2026-03-01
875911 CDM Graft Evas 23x14.5m14cm 44 26 $272,264.00 $272,264.00 $36,755.64 $272,264.00 $121,702.01 2026-03-01
442513 CDM Occluder Cv 25x18mm 44 26 $272,264.00 $272,264.00 $36,755.64 $272,264.00 $121,702.01 2026-03-01
861960 CDM Graft Evas 35x14.5m 16cm 44 26 $272,264.00 $272,264.00 $36,755.64 $272,264.00 $121,702.01 2026-03-01
856502 CDM Gft Bif 36-16x166mm 20fr 44 26 $271,719.00 $271,719.00 $36,682.07 $271,719.00 $121,458.40 2026-03-01
563181 CDM Cnla Vntrc Art 42f 44 26 $266,112.00 $266,112.00 $35,925.12 $266,112.00 $118,952.07 2026-03-01
481326 CDM Graft Hemi Cndyl Mdl Lt 44 26 $255,223.00 $255,223.00 $34,455.11 $255,223.00 $114,084.68 2026-03-01
715204 CDM Gft Bfur 36-18x155 24fr 44 26 $254,694.00 $254,694.00 $34,383.69 $254,694.00 $113,848.22 2026-03-01
271184 CDM Graft Bn Sub 12.5cc 44 26 $248,508.00 $248,508.00 $33,548.58 $248,508.00 $111,083.08 2026-03-01
435427 CDM Algrft Bn 25x20mm 44 26 $248,508.00 $248,508.00 $33,548.58 $248,508.00 $111,083.08 2026-03-01
588642 CDM Graft Evas 14cm 28.5mm 44 26 $247,884.00 $247,884.00 $33,464.34 $247,884.00 $110,804.15 2026-03-01
222739 CDM Cage Spn 5d 10x13x30mm 44 26 $245,216.00 $245,216.00 $33,104.16 $245,216.00 $109,611.55 2026-03-01
100505 CDM Cage Tlif 30x10x11mm 44 26 $245,216.00 $245,216.00 $33,104.16 $245,216.00 $109,611.55 2026-03-01
476763 CDM Cage Spnl 30x10x12mm 5d 44 26 $245,216.00 $245,216.00 $33,104.16 $245,216.00 $109,611.55 2026-03-01
465179 CDM Cage Spnl 24mmx10mmx13mm 44 26 $242,363.00 $242,363.00 $32,719.01 $242,363.00 $108,336.26 2026-03-01
588662 CDM Graft Evas 18cm 28.5mm 44 26 $241,892.00 $241,892.00 $32,655.42 $241,892.00 $108,125.73 2026-03-01
257394 CDM Spacer Spn 12mm 44 26 $239,652.00 $239,652.00 $32,353.02 $239,652.00 $107,124.45 2026-03-01
742019 CDM Graft Evas 18cm 28.5mm 44 26 $238,581.00 $238,581.00 $32,208.44 $238,581.00 $106,645.71 2026-03-01
866807 CDM Graft Evas 18cm 23mm 44 26 $238,581.00 $238,581.00 $32,208.44 $238,581.00 $106,645.71 2026-03-01
737806 CDM Graft Evas 15cm 31mm 44 26 $238,581.00 $238,581.00 $32,208.44 $238,581.00 $106,645.71 2026-03-01
741966 CDM Graft Evas 18cm 23mm 44 26 $238,581.00 $238,581.00 $32,208.44 $238,581.00 $106,645.71 2026-03-01
870014 CDM Graft Evas 23x12mm 16cm 44 26 $238,581.00 $238,581.00 $32,208.44 $238,581.00 $106,645.71 2026-03-01
879051 CDM Graft Evas 28.5x12m 16cm 44 26 $238,581.00 $238,581.00 $32,208.44 $238,581.00 $106,645.71 2026-03-01
870016 CDM Graft Evas 23x14.5m 16cm 44 26 $238,581.00 $238,581.00 $32,208.44 $238,581.00 $106,645.71 2026-03-01
857849 CDM Graft Evas 35x14.5m 18cm 44 26 $238,581.00 $238,581.00 $32,208.44 $238,581.00 $106,645.71 2026-03-01
741446 CDM Graft Evas 17cm 31mm 44 26 $238,581.00 $238,581.00 $32,208.44 $238,581.00 $106,645.71 2026-03-01
706935 CDM Spacer 26/32 13.5x8 Deg 44 26 $238,226.00 $238,226.00 $32,160.51 $238,226.00 $106,487.02 2026-03-01
706936 CDM Spacer Cage Peek 12d 32x 44 26 $238,226.00 $238,226.00 $32,160.51 $238,226.00 $106,487.02 2026-03-01
856703 CDM Gft Bif 36-20x166mm 20fr 44 26 $238,104.00 $238,104.00 $32,144.04 $238,104.00 $106,432.49 2026-03-01
743834 CDM Gft Bif 36-16x145mm 20fr 44 26 $238,104.00 $238,104.00 $32,144.04 $238,104.00 $106,432.49 2026-03-01
747544 CDM Gft Bif 23-16x145mm 18fr 44 26 $238,104.00 $238,104.00 $32,144.04 $238,104.00 $106,432.49 2026-03-01
740373 CDM Gft Bif 32-20x145mm 20fr 44 26 $238,104.00 $238,104.00 $32,144.04 $238,104.00 $106,432.49 2026-03-01
743368 CDM Gft Bif 32-16x166mm 20fr 44 26 $238,104.00 $238,104.00 $32,144.04 $238,104.00 $106,432.49 2026-03-01
257996 CDM Cage Spn 4.5x12x6 7mm 3d 44 26 $228,240.00 $228,240.00 $30,812.40 $228,240.00 $102,023.28 2026-03-01
747440 CDM Graft Nrv 4-5mm 70mm 44 26 $225,141.00 $225,141.00 $30,394.03 $225,141.00 $100,638.02 2026-03-01
477509 CDM Cage Spnl Cntrpc 13mm 44 26 $221,108.00 $221,108.00 $29,849.58 $221,108.00 $98,835.27 2026-03-01
588512 CDM Graft Evas 14cm 23mm 44 26 $217,217.00 $217,217.00 $29,324.29 $217,217.00 $97,096.00 2026-03-01
717974 CDM Graft Evas 13cm 31mm 44 26 $217,217.00 $217,217.00 $29,324.29 $217,217.00 $97,096.00 2026-03-01
588632 CDM Graft Evas 18cm 28.5mm 44 26 $217,217.00 $217,217.00 $29,324.29 $217,217.00 $97,096.00 2026-03-01
588652 CDM Graft Evas 16cm 28.5mm 44 26 $217,217.00 $217,217.00 $29,324.29 $217,217.00 $97,096.00 2026-03-01
588592 CDM Graft Evas 16cm 26mm 44 26 $217,217.00 $217,217.00 $29,324.29 $217,217.00 $97,096.00 2026-03-01
869124 CDM Graft Evas 17cm 31mm 44 26 $217,217.00 $217,217.00 $29,324.29 $217,217.00 $97,096.00 2026-03-01
272699 CDM Cage Spn 0-20d 20-24mm 44 26 $215,623.00 $215,623.00 $29,109.10 $215,623.00 $96,383.48 2026-03-01
275144 CDM Cage Spnl 13x16x18-21mm 44 26 $215,623.00 $215,623.00 $29,109.10 $215,623.00 $96,383.48 2026-03-01
259911 CDM Cage Spn 12x14mm 32-46mm 44 26 $215,623.00 $215,623.00 $29,109.10 $215,623.00 $96,383.48 2026-03-01
254556 CDM Cage Spn 12x14mm 18-21mm 44 26 $215,623.00 $215,623.00 $29,109.10 $215,623.00 $96,383.48 2026-03-01
590994 CDM Graft Evas 18cm 23mm 44 26 $211,966.00 $211,966.00 $28,615.41 $211,966.00 $94,748.80 2026-03-01
588522 CDM Graft Evas 16cm 23mm 44 26 $211,966.00 $211,966.00 $28,615.41 $211,966.00 $94,748.80 2026-03-01
588532 CDM Graft Evas 18cm 23mm 44 26 $211,966.00 $211,966.00 $28,615.41 $211,966.00 $94,748.80 2026-03-01
709536 CDM Graft Evas 12cm 26mm 44 26 $211,966.00 $211,966.00 $28,615.41 $211,966.00 $94,748.80 2026-03-01
158329 CDM Graft Evas 14cm 26mm 44 26 $211,966.00 $211,966.00 $28,615.41 $211,966.00 $94,748.80 2026-03-01
588602 CDM Graft Evas 18cm 26mm 44 26 $211,966.00 $211,966.00 $28,615.41 $211,966.00 $94,748.80 2026-03-01
588582 CDM Graft Evas 18cm 26mm 44 26 $211,966.00 $211,966.00 $28,615.41 $211,966.00 $94,748.80 2026-03-01
588572 CDM Graft Evas 16cm 26mm 44 26 $211,966.00 $211,966.00 $28,615.41 $211,966.00 $94,748.80 2026-03-01
869123 CDM Graft Evas 15cm 31mm 44 26 $211,966.00 $211,966.00 $28,615.41 $211,966.00 $94,748.80 2026-03-01
483904 CDM Cage Spn Szc 13mm 44 26 $210,053.00 $210,053.00 $28,357.15 $210,053.00 $93,893.69 2026-03-01
240332 CDM Cage Spn Szc 25mm 44 26 $210,053.00 $210,053.00 $28,357.15 $210,053.00 $93,893.69 2026-03-01
249219 CDM Cage Spnl 25mm D Centerp 44 26 $210,053.00 $210,053.00 $28,357.15 $210,053.00 $93,893.69 2026-03-01
831 OTHER Obecbtge Autol Up To 400 43 25 — — $4,066.75 $729,015.00 $292,162.50 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 43 25 — — $8,898.72 $528,372.78 $211,752.45 2026-03-01
7 MS_DRG Lung Transplant 43 25 — — $101,531.72 $381,784.85 $108,783.99 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 43 25 — — $94,394.95 $354,299.71 $101,137.45 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 42 25 — — $565,868.90 $1,539,641.95 $617,032.08 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 42 25 — — $563,698.64 $1,484,312.01 $594,857.87 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 42 25 — — $559,390.19 $1,472,967.14 $590,311.26 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 42 25 — — $555,291.39 $1,462,174.32 $585,985.89 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 42 25 — — $529,531.24 $1,394,343.56 $558,801.81 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 42 25 — — $487,002.95 $1,282,359.52 $513,922.71 2026-03-01
714 OTHER Inj Delandistrogene Mox R 40 22 — — $6,985.03 $4,991,790.00 $3,494,253.00 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 40 22 — — $13,295.95 $4,878,762.00 $3,415,133.40 2026-03-01
746 OTHER Inj, Betibeglogene Autote 40 22 — — $12,298.88 $4,409,953.50 $3,086,967.45 2026-03-01
824 OTHER Inj, Exagamglogene Autote 40 24 — — $14,401.69 $4,617,360.00 $2,448,600.00 2026-03-01
897 OTHER Revakinagene, Per Implant 40 24 — — $263,675.00 $694,300.00 $278,250.00 2026-03-01
245978 CDM Stent Eprsth 24f 34mm 39 24 $693,630.00 $693,630.00 $93,640.05 $693,630.00 $346,815.00 2026-03-01
C2624 HCPCS System Mntr 2x15mm 4.5cm 39 24 $582,750.00 $582,750.00 $78,671.25 $582,750.00 $291,375.00 2026-03-01
745290 CDM Stent Eprsth 34mm 15cm 39 24 $488,400.00 $488,400.00 $65,934.00 $488,400.00 $244,200.00 2026-03-01
C1822 HCPCS Pulse Gen Imp 39 24 $415,530.00 $415,530.00 $56,096.55 $415,530.00 $207,765.00 2026-03-01
871762 CDM Stent Eprsth 37mm 15cm 39 24 $413,475.00 $413,475.00 $55,819.13 $413,475.00 $206,737.50 2026-03-01
866977 CDM Stent Eprsth 31mm 15cm 39 24 $413,475.00 $413,475.00 $55,819.13 $413,475.00 $206,737.50 2026-03-01
437204 CDM Stent Eprsth 21mm 10cm 39 24 $413,475.00 $413,475.00 $55,819.13 $413,475.00 $206,737.50 2026-03-01
754486 CDM Stent Eprsth 10cm 26mm 39 24 $413,475.00 $413,475.00 $55,819.13 $413,475.00 $206,737.50 2026-03-01
751780 CDM Stent Eprsth 45mm 15cm 39 24 $413,475.00 $413,475.00 $55,819.13 $413,475.00 $206,737.50 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 38 23 — — $2,455,110.00 $4,919,063.90 $2,718,430.05 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 38 21 — — $332,962.06 $1,273,072.13 $356,745.06 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 35 20 — — $9,501.86 $4,770,000.00 $3,339,000.00 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 34 11 — — $299,842.05 $532,714.00 $324,194.79 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 34 11 — — $251,068.87 $446,061.00 $271,460.43 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 34 11 — — $105,802.81 $187,975.00 $114,395.86 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 34 11 — — $89,937.24 $159,787.00 $97,241.79 2026-03-01
84 APR_DRG Autologous Bone Marrow Transplant 34 11 — — $89,576.87 $159,147.00 $96,852.17 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 31 20 — — $3,666,840.67 $4,790,847.10 $3,758,972.34 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 30 18 — — $5,938.97 $4,955,500.00 $4,546,671.25 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 30 19 — — $10,753.36 $4,336,566.00 $3,419,215.50 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 30 11 — — $189,457.12 $240,427.81 $201,959.36 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 30 11 — — $98,747.61 $125,314.23 $105,263.95 2026-03-01
5834 APR_DRG Neonate With Ecmo 25 10 — — $308,225.50 $391,149.11 $328,565.25 2026-03-01
5833 APR_DRG Neonate With Ecmo 25 10 — — $260,994.03 $331,210.70 $278,216.99 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 25 10 — — $195,101.69 $247,590.98 $207,976.42 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 25 10 — — $177,491.49 $225,243.01 $189,204.13 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 25 10 — — $145,168.66 $184,224.19 $154,748.32 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 25 10 — — $143,882.21 $182,591.64 $153,376.98 2026-03-01
5832 APR_DRG Neonate With Ecmo 25 10 — — $130,047.36 $165,034.73 $138,629.17 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 25 10 — — $123,488.48 $156,711.27 $131,637.47 2026-03-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 25 10 — — $114,754.81 $145,627.94 $122,327.47 2026-03-01
5831 APR_DRG Neonate With Ecmo 25 10 — — $114,509.29 $145,316.36 $122,065.74 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 25 10 — — $104,685.18 $132,849.21 $111,593.34 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 25 10 — — $104,206.72 $132,242.02 $111,083.30 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 25 10 — — $103,937.25 $131,900.06 $110,796.05 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 25 10 — — $103,490.44 $131,333.05 $110,319.76 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 25 10 — — $102,456.81 $130,021.34 $109,217.92 2026-03-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 25 10 — — $99,757.70 $126,596.06 $106,340.69 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 25 10 — — $98,864.08 $125,462.02 $105,388.10 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 25 10 — — $98,225.73 $124,651.94 $104,707.63 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 18 4 — — $55,306.59 $478,449.94 $316,658.49 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 18 4 — — $43,855.64 $389,632.46 $199,363.43 2026-03-01
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 18 4 — — $26,258.38 $243,082.56 $95,052.46 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 17 4 — — $61,338.53 $931,200.00 $405,600.00 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 17 4 — — $93,760.51 $582,739.61 $302,670.97 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 17 4 — — $131,717.55 $574,167.94 $211,893.45 2026-03-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 17 4 — — $39,976.89 $203,447.46 $120,275.16 2026-03-01
J7310 HCPCS Ganciclovir, 4.5 Mg, Long-acting Implant 14 3 — — $54,979.20 $145,041.92 $97,686.24 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 12 3 — — $23.68 $2,235,985.80 $1,325,455.50 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 12 3 — — $6.22 $2,062,317.00 $1,222,507.50 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 11 3 — — $536,573.93 $2,695,474.80 $1,597,833.00 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 11 3 — — $511,793.34 $2,431,724.04 $1,441,485.90 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 11 3 — — $500,948.74 $2,378,394.22 $1,409,872.86 2026-03-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 11 3 — — $474,717.03 $2,162,176.56 $1,281,702.60 2026-03-01
0874T CPT Removal Of A Peritoneal Ascites Pump System, Including Implanted Peritoneal Asci… 10 2 — — $4,729.65 $123,407.40 $112,310.93 2026-03-01
0871T CPT Replacement Of A Subcutaneous Peritoneal Ascites Pump, Including Reconnection Be… 10 2 — — $4,729.65 $123,407.40 $112,310.93 2026-03-01
0873T CPT Revision Of A Subcutaneously Implanted Peritoneal Ascites Pump System, Any Compo… 10 2 — — $4,729.65 $123,407.40 $112,310.93 2026-03-01
0870T CPT Implantation Of Subcutaneous Peritoneal Ascites Pump System, Percutaneous, Inclu… 10 2 — — $4,729.65 $123,407.40 $112,310.93 2026-03-01
0894T CPT Cannulation Of The Liver Allograft In Preparation For Connection To The Normothe… 10 2 — — $4,729.65 $123,407.40 $112,310.93 2026-03-01
0872T CPT Replacement Of Indwelling Bladder And Peritoneal Catheters, Including Tunneling … 10 2 — — $4,729.65 $123,407.40 $112,310.93 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 9 2 — — $1,271,523.00 $4,067,128.80 $2,528,215.20 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 9 2 — — $459,112.50 $2,937,060.00 $1,825,740.00 2026-03-01
0968T CPT Insertion Or Replacement Of Epicranial Neurostimulator System, Including Electro… 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0909T CPT Replacement Of Integrated Neurostimulation System, Vagus Nerve, Including Analys… 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0941T CPT Cystourethroscopy, Flexible; With Insertion And Expansion Of Prostatic Urethral … 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0901T CPT Placement Of Bone Marrow Sampling Port, Including Imaging Guidance When Performe… 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0953T CPT Totally Implantable Active Middle Ear Hearing Implant; Revision Or Replacement, … 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0942T CPT Cystourethroscopy, Flexible; With Removal And Replacement Of Prostatic Urethral … 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0952T CPT Totally Implantable Active Middle Ear Hearing Implant; Revision Or Replacement, … 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0954T CPT Totally Implantable Active Middle Ear Hearing Implant; Replacement Of Sound Proc… 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0955T CPT Totally Implantable Active Middle Ear Hearing Implant; Removal, Including Remova… 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0935T CPT Cystourethroscopy With Renal Pelvic Sympathetic Denervation, Radiofrequency Abla… 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0943T CPT Cystourethroscopy, Flexible; With Removal Of Prostatic Urethral Scaffold 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0969T CPT Removal Of Epicranial Neurostimulator System 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0951T CPT Totally Implantable Active Middle Ear Hearing Implant; Initial Placement, Includ… 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0910T CPT Removal Of Integrated Neurostimulation System, Vagus Nerve 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0908T CPT Open Implantation Of Integrated Neurostimulation System, Vagus Nerve, Including … 9 2 — — $7,977.00 $123,407.40 $112,310.93 2026-03-01
0895T CPT Connection Of Liver Allograft To Normothermic Machine Perfusion Device, Hemostas… 7 1 — — $4,729.65 $123,407.40 $117,877.36 2026-03-01
0896T CPT Connection Of Liver Allograft To Normothermic Machine Perfusion Device, Hemostas… 7 1 — — $4,729.65 $123,407.40 $117,877.36 2026-03-01
C9301 HCPCS Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 6 1 — — $959,962.50 $1,544,287.50 $1,405,162.50 2026-03-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 6 1 — — $294,713.96 $416,525.16 $329,245.80 2026-03-01
0936T CPT Photobiomodulation Therapy Of Retina, Single Session 6 1 — — $112,310.93 $123,407.40 $119,478.16 2026-03-01
E0767 HCPCS Intrabuccal, Systemic Delivery Of Amplitude-modulated, Radiofrequency Electromag… 6 1 — — $80,266.41 $113,137.42 $103,199.67 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
00845 OTHER Inj, Atidarsagene Autotem 1 1 — — $4,369,850.00 $4,369,850.00 $4,369,850.00 2026-03-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,574,708.99 $3,574,708.99 $3,574,708.99 2026-03-01
00908 OTHER Topi Adm Prad Zami Per Tr 1 1 — — $3,235,745.40 $3,235,745.40 $3,235,745.40 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,228,024.20 $3,228,024.20 $3,228,024.20 2026-03-01
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,154,932.76 $3,154,932.76 $3,154,932.76 2026-03-01
00906 OTHER Inj Elivaldogene Autoteme 1 1 — — $3,084,600.00 $3,084,600.00 $3,084,600.00 2026-03-01
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,851,769.93 $2,851,769.93 $2,851,769.93 2026-03-01
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,511,311.57 $2,511,311.57 $2,511,311.57 2026-03-01
00824 OTHER Inj, Exagamglogene Autote 1 1 — — $2,262,040.00 $2,262,040.00 $2,262,040.00 2026-03-01
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $570,020.11 $570,020.11 $570,020.11 2026-03-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $549,535.36 $549,535.36 $549,535.36 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $545,335.16 $545,335.16 $545,335.16 2026-03-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $541,339.35 $541,339.35 $541,339.35 2026-03-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $516,226.43 $516,226.43 $516,226.43 2026-03-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $474,766.69 $474,766.69 $474,766.69 2026-03-01
00831 OTHER Obecbtge Autol Up To 400 1 1 — — $269,902.50 $269,902.50 $269,902.50 2026-03-01
00897 OTHER Revakinagene, Per Implant 1 1 — — $257,050.00 $257,050.00 $257,050.00 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $239,784.29 $239,784.29 $239,784.29 2026-03-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $210,774.21 $210,774.21 $210,774.21 2026-03-01
00886 OTHER Inj. Remestemcel-l-rknd/ 1 1 — — $195,618.93 $195,618.93 $195,618.93 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $148,557.92 $148,557.92 $148,557.92 2026-03-01
01907 OTHER New Technology - Level 52 1 1 — — $142,262.92 $142,262.92 $142,262.92 2026-03-01
01908 OTHER New Technology - Level 52 1 1 — — $142,262.92 $142,262.92 $142,262.92 2026-03-01
01906 OTHER New Technology - Level 51 1 1 — — $128,269.89 $128,269.89 $128,269.89 2026-03-01
01905 OTHER New Technology - Level 51 1 1 — — $128,269.89 $128,269.89 $128,269.89 2026-03-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $116,012.00 $116,012.00 $116,012.00 2026-03-01
01903 OTHER New Technology - Level 50 1 1 — — $114,276.86 $114,276.86 $114,276.86 2026-03-01
01904 OTHER New Technology - Level 50 1 1 — — $114,276.86 $114,276.86 $114,276.86 2026-03-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $103,970.71 $103,970.71 $103,970.71 2026-03-01
01902 OTHER New Technology - Level 49 1 1 — — $100,283.84 $100,283.84 $100,283.84 2026-03-01
01901 OTHER New Technology - Level 49 1 1 — — $100,283.84 $100,283.84 $100,283.84 2026-03-01
L5969 HCPCS Addition, Endoskeletal Ankle-foot Or Ankle System, Power Assist, Includes Any Ty… 1 1 — — $98,593.44 $98,593.44 $98,593.44 2026-03-01
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