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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 DALLAS HOSPITAL

Dallas, TX · CCN 450647 · Rates published

40,956 distinct procedures filed
67 distinct payers
2,394,579 rate rows
2026-07-17 last MRF observed
Data quality

2,331,028 of 2,394,579 rate rows are consumer-grade (97.3%)

63,551 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 25,229
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 19,734
per-diem day rate — not a per-procedure price 13,877
template filing: same amount across many unrelated codes — excluded 2,992
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 1,132
placeholder amount (≤ $0.02) — excluded from medians 545
exceeds 10× this hospital's gross charge — excluded from medians 36
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 6
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1682198_MEDICAL-CITY-DALLAS_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 Latest re-check couldn't be parsed — showing last good data · 2026-10-12
Content fingerprint 6ac103cde294ec7e… · 1,050,715,330 bytes · first seen 2026-05-06

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
$2,994,107
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 20 $5,311.90 $4,955,500.00 $4,535,408.75 nat. median
$17,156
outlier · 264.4×
00845
OTHER 		Inj, Atidarsagene Autotem 2 $4,369,850.00 $4,505,000.00 $4,437,425.00 nat. median
$4,414,900
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
$2,467,386
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
$2,401,965
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 21 $3,666,840.67 $4,790,847.10 $3,740,546.00 nat. median
$3,758,972
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,574,708.99 $3,685,267.00 $3,629,988.00 nat. median
$3,574,709
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 24 $6,247.51 $4,991,790.00 $3,460,974.40 nat. median
$3,325,455
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 21 $9,617.95 $4,336,566.00 $3,385,857.30 nat. median
$30,519
outlier · 110.9×
748
OTHER 		Inj, Lovotibeglogene Auto 24 $11,892.06 $4,878,762.00 $3,382,608.32 nat. median
$3,252,508
1.0× median
00908
OTHER 		Topi Adm Prad Zami Per Tr 2 $3,235,745.40 $3,335,820.00 $3,285,782.70 nat. median
$14,890
outlier · 220.7×
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,228,024.20 $3,327,860.00 $3,277,942.10 nat. median
$3,228,024
1.0× median
906
OTHER 		Inj Elivaldogene Autoteme 22 $8,498.59 $4,770,000.00 $3,275,400.00 nat. median
$25,059
outlier · 130.7×
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,154,932.76 $3,252,508.00 $3,203,720.38 nat. median
$3,187,420
1.0× median
00906
OTHER 		Inj Elivaldogene Autoteme 2 $3,084,600.00 $3,180,000.00 $3,132,300.00 nat. median
$3,084,600
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 24 $11,000.28 $4,409,953.50 $3,057,567.76 nat. median
$2,939,969
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,851,769.93 $2,939,969.00 $2,895,869.46 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 24 $2,455,110.00 $4,919,063.90 $2,718,430.05 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,511,311.57 $2,588,981.00 $2,550,146.29 nat. median
$2,511,312
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
$813,967
outlier · 3.1×
824
OTHER 		Inj, Exagamglogene Autote 26 $12,881.06 $4,617,360.00 $2,425,280.00 nat. median
$2,285,360
1.1× median
Q2056
HCPCS 		Ciltacabtagene 100 Mil 19 $536,573.93 $4,937,864.25 $2,360,299.11 nat. median
$646,415
outlier · 3.7×
00824
OTHER 		Inj, Exagamglogene Autote 2 $2,262,040.00 $2,332,000.00 $2,297,020.00 nat. median
$2,285,360
1.0× median
Q2054
HCPCS 		Lisocabtagene 19 $500,948.74 $4,981,060.92 $2,249,511.38 nat. median
$640,950
outlier · 3.5×
Q2041
HCPCS 		Axicabtagene Adult 23 $6.22 $4,965,250.67 $2,148,599.38 nat. median
$608,239
outlier · 3.5×
Q2053
HCPCS 		Brexucabtagene 26 $474,717.03 $4,880,294.09 $2,121,146.50 nat. median
$591,721
outlier · 3.6×
Q2042
HCPCS 		Tisagenlecleucel Adult 26 $23.68 $4,817,860.09 $2,094,010.50 nat. median
$739,258
outlier · 2.8×
Q2058
HCPCS 		Obecabtagene Inj 34 $371,000.00 $4,717,000.00 $1,976,900.00 nat. median
$319,951
outlier · 6.2×
Q2055
HCPCS 		Idecabtagene 33 $416,855.60 $4,764,064.00 $1,845,479.29 nat. median
$622,450
outlier · 3.0×
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×
2067
OTHER 		Afamitresgene Autoleucel 27 $766,766.90 $2,019,024.40 $809,151.00 nat. median
$793,739
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 26 $565,868.90 $1,539,641.95 $617,032.08 nat. median
$587,650
1.1× median
9194
OTHER 		Tisagenlecleucel Car-pos 26 $563,698.64 $1,484,312.01 $594,857.87 nat. median
$577,163
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 26 $559,390.19 $1,472,967.14 $590,311.26 nat. median
$562,201
1.1× median
9422
OTHER 		Idecabtagene Vicleucel Ca 26 $555,291.39 $1,462,174.32 $585,985.89 nat. median
$563,449
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $570,020.11 $587,649.60 $578,834.85 nat. median
$570,020
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 26 $529,531.24 $1,394,343.56 $558,801.81 nat. median
$533,230
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $549,535.36 $566,531.30 $558,033.33 nat. median
$549,535
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $545,335.16 $562,201.20 $553,768.18 nat. median
$545,335
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $541,339.35 $558,081.80 $549,710.57 nat. median
$541,339
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $516,226.43 $532,192.20 $524,209.31 nat. median
$516,226
1.0× median
443630
CDM 		Kit Hrt Implant Lvas 30 $126,621.00 $1,151,100.00 $517,995.00 nat. median
$260
outlier · 1995.7×
9391
OTHER 		Brexucabtagene Car Pos T 26 $487,002.95 $1,282,359.52 $513,922.71 nat. median
$492,768
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $474,766.69 $489,450.20 $482,108.45 nat. median
$474,767
1.0× median
219919
CDM 		Device Vntrc Asst Strl 30 $117,625.20 $1,069,320.00 $481,194.00 nat. median
$9,238
outlier · 52.1×
867736
CDM 		Implant Hvas Ordr Set 30 $117,625.20 $1,069,320.00 $481,194.00 nat. median
$427,728
1.1× median
860906
CDM 		Kit Impl Lvas W/grafts 30 $115,500.00 $1,050,000.00 $472,500.00 nat. median
$420,000
1.1× median
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 5 $61,338.53 $888,000.00 $405,600.00 nat. median
$68,423
outlier · 5.9×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 22 $315,864.19 $1,273,072.13 $338,425.92 nat. median
$359,454
0.9× 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

Other procedures at this hospital

Browse this hospital's 40,956 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 3 1 — — $4,850,948.67 $4,850,948.67 $4,850,948.67 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 32 20 $23,739.10 — $5,311.90 $4,955,500.00 $4,535,408.75 2026-07-17
00845 OTHER Inj, Atidarsagene Autotem 2 2 — — $4,369,850.00 $4,505,000.00 $4,437,425.00 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 3 1 $4,463,735.93 — $4,271,819.03 $4,271,819.03 $4,271,819.03 2026-07-17
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 3 1 — — $3,847,800.00 $3,847,800.00 $3,847,800.00 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 32 21 — — $3,666,840.67 $4,790,847.10 $3,740,546.00 2026-03-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $3,574,708.99 $3,685,267.00 $3,629,988.00 2026-03-01
714 OTHER Inj Delandistrogene Mox R 42 24 $26,903.38 — $6,247.51 $4,991,790.00 $3,460,974.40 2026-07-17
908 OTHER Topi Adm Prad Zami Per Tr 32 21 $57,740.35 — $9,617.95 $4,336,566.00 $3,385,857.30 2026-07-17
748 OTHER Inj, Lovotibeglogene Auto 42 24 $39,790.72 — $11,892.06 $4,878,762.00 $3,382,608.32 2026-07-17
00908 OTHER Topi Adm Prad Zami Per Tr 2 2 — — $3,235,745.40 $3,335,820.00 $3,285,782.70 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $3,228,024.20 $3,327,860.00 $3,277,942.10 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 37 22 $50,196.06 — $8,498.59 $4,770,000.00 $3,275,400.00 2026-07-17
00748 OTHER Inj, Lovotibeglogene Auto 2 2 — — $3,154,932.76 $3,252,508.00 $3,203,720.38 2026-03-01
00906 OTHER Inj Elivaldogene Autoteme 2 2 — — $3,084,600.00 $3,180,000.00 $3,132,300.00 2026-03-01
746 OTHER Inj, Betibeglogene Autote 42 24 $43,895.58 — $11,000.28 $4,409,953.50 $3,057,567.76 2026-07-17
00746 OTHER Inj, Betibeglogene Autote 2 2 — — $2,851,769.93 $2,939,969.00 $2,895,869.46 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 39 24 — — $2,455,110.00 $4,919,063.90 $2,718,430.05 2026-03-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $2,511,311.57 $2,588,981.00 $2,550,146.29 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
824 OTHER Inj, Exagamglogene Autote 42 26 $64,304.75 — $12,881.06 $4,617,360.00 $2,425,280.00 2026-07-17
Q2056 HCPCS Ciltacabtagene 100 Mil 46 19 $2,348,119.80 — $536,573.93 $4,937,864.25 $2,360,299.11 2026-07-17
00824 OTHER Inj, Exagamglogene Autote 2 2 — — $2,262,040.00 $2,332,000.00 $2,297,020.00 2026-03-01
Q2054 HCPCS Lisocabtagene 47 19 $2,071,900.12 — $500,948.74 $4,981,060.92 $2,249,511.38 2026-07-17
Q2041 HCPCS Axicabtagene Adult 51 23 $1,796,554.50 — $6.22 $4,965,250.67 $2,148,599.38 2026-07-17
Q2053 HCPCS Brexucabtagene 56 26 $1,883,545.56 — $474,717.03 $4,880,294.09 $2,121,146.50 2026-07-17
Q2042 HCPCS Tisagenlecleucel Adult 56 26 $1,947,843.30 — $23.68 $4,817,860.09 $2,094,010.50 2026-07-17
Q2058 HCPCS Obecabtagene Inj 65 34 — — $371,000.00 $4,717,000.00 $1,976,900.00 2026-03-01
Q2055 HCPCS Idecabtagene 65 33 $2,118,357.54 — $416,855.60 $4,764,064.00 $1,845,479.29 2026-07-17
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
2067 OTHER Afamitresgene Autoleucel 46 27 — — $766,766.90 $2,019,024.40 $809,151.00 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 43 26 $1,096,795.50 — $565,868.90 $1,539,641.95 $617,032.08 2026-07-17
9194 OTHER Tisagenlecleucel Car-pos 43 26 $1,039,331.61 — $563,698.64 $1,484,312.01 $594,857.87 2026-07-17
9413 OTHER Lisocabtagene Car Pos T 43 26 $995,962.22 — $559,390.19 $1,472,967.14 $590,311.26 2026-07-17
9422 OTHER Idecabtagene Vicleucel Ca 43 26 $1,018,294.30 — $555,291.39 $1,462,174.32 $585,985.89 2026-07-17
09498 OTHER Ciltacabtagene Car-pos T 2 2 — — $570,020.11 $587,649.60 $578,834.85 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 43 26 $968,406.12 — $529,531.24 $1,394,343.56 $558,801.81 2026-07-17
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $549,535.36 $566,531.30 $558,033.33 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 2 2 — — $545,335.16 $562,201.20 $553,768.18 2026-03-01
09422 OTHER Idecabtagene Vicleucel Ca 2 2 — — $541,339.35 $558,081.80 $549,710.57 2026-03-01
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $516,226.43 $532,192.20 $524,209.31 2026-03-01
443630 CDM Kit Hrt Implant Lvas 51 30 $1,151,100.00 $1,151,100.00 $126,621.00 $1,151,100.00 $517,995.00 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 43 26 $968,532.60 — $487,002.95 $1,282,359.52 $513,922.71 2026-07-17
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $474,766.69 $489,450.20 $482,108.45 2026-03-01
867736 CDM Implant Hvas Ordr Set 51 30 $1,069,320.00 $1,069,320.00 $117,625.20 $1,069,320.00 $481,194.00 2026-03-01
219919 CDM Device Vntrc Asst Strl 51 30 $1,069,320.00 $1,069,320.00 $117,625.20 $1,069,320.00 $481,194.00 2026-03-01
860906 CDM Kit Impl Lvas W/grafts 51 30 $1,050,000.00 $1,050,000.00 $115,500.00 $1,050,000.00 $472,500.00 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 18 5 — — $61,338.53 $888,000.00 $405,600.00 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 39 22 — — $315,864.19 $1,273,072.13 $338,425.92 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 6 1 — — $294,713.96 $416,525.16 $329,245.80 2026-03-01
5834 APR_DRG Neonate With Ecmo 26 11 — — $290,440.49 $368,579.30 $309,606.61 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 19 5 $308,703.12 — $55,306.59 $478,449.94 $307,485.36 2026-07-17
74 APR_DRG Allogeneic Bone Marrow Transplant 35 12 — — $282,540.77 $501,976.00 $301,185.59 2026-03-01
831 OTHER Obecbtge Autol Up To 400 45 27 $33,546.40 — $3,637.35 $729,015.00 $292,162.50 2026-07-17
30230G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Peripheral Vein, Open Appro… 9 3 $270,000.00 — $12,082.00 $363,283.00 $291,606.00 2026-07-17
30230U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 9 3 $270,000.00 — $12,082.00 $363,283.00 $291,606.00 2026-07-17
30233Y3 OTHER Transfusion Of Allogeneic Unrelated Hamatopoietic Stem Cells Into Peripheral Vei… 9 3 $270,000.00 — $12,082.00 $363,283.00 $291,606.00 2026-07-17
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 17 4 $385,945.21 — $93,760.51 $582,739.61 $289,037.14 2026-07-17
30243U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 10 3 $270,000.00 — $9,664.00 $363,283.00 $285,981.00 2026-07-17
30240Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein, … 10 3 $270,000.00 — $9,664.00 $363,283.00 $285,981.00 2026-07-17
30243Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein, … 10 3 $270,000.00 — $9,664.00 $363,283.00 $285,981.00 2026-07-17
30240G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Open Approach… 10 3 $270,000.00 — $9,664.00 $363,283.00 $285,981.00 2026-07-17
30243X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Per… 10 3 $270,000.00 — $12,082.00 $363,283.00 $285,981.00 2026-07-17
30240U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 10 3 $270,000.00 — $9,664.00 $363,283.00 $285,981.00 2026-07-17
30233G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Peripheral Vein, Percutaneo… 10 3 $270,000.00 — $9,664.00 $363,283.00 $285,981.00 2026-07-17
30230Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Peripheral Vei… 10 3 $270,000.00 — $9,664.00 $363,283.00 $285,981.00 2026-07-17
30233U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 10 3 $270,000.00 — $9,664.00 $363,283.00 $285,981.00 2026-07-17
30243G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Percutaneous … 10 3 $270,000.00 — $9,664.00 $363,283.00 $285,981.00 2026-07-17
30240X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Ope… 10 3 $270,000.00 — $12,082.00 $363,283.00 $285,981.00 2026-07-17
30233X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein, … 11 3 $270,000.00 — $9,664.00 $363,283.00 $280,356.00 2026-07-17
30230X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein, … 11 3 $270,000.00 — $9,664.00 $363,283.00 $280,356.00 2026-07-17
897 OTHER Revakinagene, Per Implant 41 25 $23,901.95 — $263,675.00 $694,300.00 $278,250.00 2026-07-17
00831 OTHER Obecbtge Autol Up To 400 2 2 — — $269,902.50 $278,250.00 $274,076.25 2026-03-01
867737 CDM Device Vntrc Asst Kit Pm 51 30 $606,158.00 $606,158.00 $66,677.38 $606,158.00 $272,771.10 2026-03-01
5833 APR_DRG Neonate With Ecmo 26 11 — — $245,934.33 $312,099.40 $262,163.50 2026-03-01
30250X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Peripheral Artery, Open … 2 1 — — $244,860.00 $278,250.00 $261,555.00 2026-03-01
30263X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Central Artery, Percutan… 2 1 — — $244,860.00 $278,250.00 $261,555.00 2026-03-01
30260X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Central Artery, Open App… 2 1 — — $244,860.00 $278,250.00 $261,555.00 2026-03-01
30253X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Peripheral Artery, Percu… 2 1 — — $244,860.00 $278,250.00 $261,555.00 2026-03-01
00897 OTHER Revakinagene, Per Implant 2 2 — — $257,050.00 $265,000.00 $261,025.00 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 35 12 — — $236,581.86 $420,323.00 $252,193.86 2026-03-01
02YA0Z2 OTHER Transplantation Of Heart, Zooplastic, Open Approach 8 4 $250,000.00 — $17,488.00 $304,500.00 $247,307.00 2026-07-17
30243X4 OTHER Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Central Vein, P… 1 1 — — $244,860.00 $244,860.00 $244,860.00 2026-03-01
30230X4 OTHER Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Peripheral Vein… 1 1 — — $244,860.00 $244,860.00 $244,860.00 2026-03-01
30233X4 OTHER Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Peripheral Vein… 1 1 — — $244,860.00 $244,860.00 $244,860.00 2026-03-01
30240X4 OTHER Transfusion Of Allogeneic Unspecified Cord Blood Stem Cells Into Central Vein, O… 1 1 — — $244,860.00 $244,860.00 $244,860.00 2026-03-01
02YA0Z0 OTHER Transplantation Of Heart, Allogeneic, Open Approach 7 4 $250,000.00 — $17,488.00 $304,500.00 $244,189.00 2026-07-17
02YA0Z1 OTHER Transplantation Of Heart, Syngeneic, Open Approach 7 4 $250,000.00 — $17,488.00 $304,500.00 $244,189.00 2026-07-17
30233X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Pe… 15 3 $192,000.00 — $12,082.00 $352,753.00 $236,778.00 2026-07-17
30240X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Central Vein, Open … 15 3 $192,000.00 — $12,082.00 $352,753.00 $236,778.00 2026-07-17
30230X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Op… 15 3 $192,000.00 — $12,082.00 $352,753.00 $236,778.00 2026-07-17
30243X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Central Vein, Percu… 15 3 $192,000.00 — $12,082.00 $352,753.00 $236,778.00 2026-07-17
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 62 30 — — $70,000.00 $842,426.46 $233,078.24 2026-03-01
30240Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Central Vein, Op… 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30233U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30230U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30243Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Central Vein, Pe… 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30243U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30230G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Open Approac… 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30233G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Percutaneous… 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30243G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Central Vein, Percutaneous Ap… 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30240G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Central Vein, Open Approach P… 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30230Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Peripheral Vein,… 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30240U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30233Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Peripheral Vein,… 13 3 $192,000.00 — $12,082.00 $352,753.00 $232,617.00 2026-07-17
30243X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Vein, Percutaneous … 20 3 $166,000.00 — $6,444.00 $363,283.00 $224,492.00 2026-07-17
30233X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Vein, Percutaneo… 20 3 $166,000.00 — $6,444.00 $363,283.00 $224,492.00 2026-07-17
30260X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Artery, Open Approa… 20 3 $166,000.00 — $6,444.00 $363,283.00 $224,492.00 2026-07-17
30250X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Artery, Open App… 20 3 $166,000.00 — $6,444.00 $363,283.00 $224,492.00 2026-07-17
30253X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Artery, Percutan… 20 3 $166,000.00 — $6,444.00 $363,283.00 $224,492.00 2026-07-17
30263X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Artery, Percutaneou… 20 3 $166,000.00 — $6,444.00 $363,283.00 $224,492.00 2026-07-17
30230X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Vein, Open Appro… 20 3 $166,000.00 — $6,444.00 $363,283.00 $224,492.00 2026-07-17
30240X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Vein, Open Approach… 20 3 $166,000.00 — $6,444.00 $363,283.00 $224,492.00 2026-07-17
235269 CDM Tavr Heart Valve 29mm 51 30 $488,870.00 $488,870.00 $53,775.70 $488,870.00 $219,991.50 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 $1,014,848.78 — $214,466.22 $221,099.20 $217,782.71 2026-07-17
886 OTHER Inj. Remestemcel-l-rknd/ 45 27 $38,325.11 — $7,959.14 $528,372.78 $211,752.45 2026-07-17
30263Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Artery, Percutan… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30250Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Artery, Open … 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30233G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Vein, Percutaneous Approac… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30243Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Vein, Percutaneo… 18 3 — — $6,444.00 $363,283.00 $207,095.00 2026-03-01
30240C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30253G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Artery, Percutaneous Appro… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30243C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30230Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Vein, Open Ap… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30253Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Artery, Percu… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30243G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Vein, Percutaneous Approach 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30250G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Artery, Open Approach 18 3 — — $6,444.00 $363,283.00 $207,095.00 2026-03-01
30260Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Artery, Open App… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30240G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Vein, Open Approach 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30233Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Vein, Percuta… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30240Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Vein, Open Appro… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30230G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Vein, Open Approach Pediat… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30230C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30260G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Artery, Open Approach 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30263G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Artery, Percutaneous Approach… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
30233C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 18 3 $166,000.00 — $6,444.00 $363,283.00 $207,095.00 2026-07-17
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 17 4 $227,599.37 — $106,519.41 $574,167.94 $202,348.70 2026-07-17
422844 CDM Valve Aor 23-26mm 0-43mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
868804 CDM Valve Xt Sapien 26mm Ta 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
868802 CDM Valve Hrt Sapien Xt 29mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
422838 CDM Vlv Aor 18-20mm 18f Evol 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
868799 CDM Valve Hrt Sapien Xt 23mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
437822 CDM Valve Aor Tavr 23mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
422841 CDM Valve Aor 29mm 23-27mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
868801 CDM Valve Hrt Sapien Xt 26mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
433568 CDM Valve Hrt W/cert Sys 23a 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
249246 CDM Valve Tavr 26mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
868803 CDM Valve Xt Sapien 23mm Ta 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
877269 CDM Valve Aor 23-26mm Coreva 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
433811 CDM Valve Hrt W/cert Sys 20a 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
422836 CDM Valve Sapien 26mm Stns 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
422846 CDM Valve Aor 26mm 20-23mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
427323 CDM Valve Aortic 34mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
872853 CDM Valve Pulm 16mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
422842 CDM Vlv Aor 31mm 26-29mm Cor 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
868805 CDM Valve 29mm Ascendra Aor 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
276829 CDM Stent Vasc 8x16mm 63cm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
237550 CDM Valve Aor/pulm 26mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
422843 CDM Valve Aor 18-20mm 0-34mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
422839 CDM Valve Aor 20-23mm 0-40m 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
433567 CDM Valve Hrt W Cert Sys 26a 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
216520 CDM Valve Plm Trnscth 25mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
876617 CDM Kit Aor Vlv 14fr 29mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
225803 CDM Valve Aor 26mm Evolutpro 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
877267 CDM Val Evlt Rtm Trnsct Aort 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
467879 CDM Valve Aor 23mm Sapien 3 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
872854 CDM Valve Pulm 18mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
422845 CDM Vlv Aor 26-29mm 0-43mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
216519 CDM Valve Plm Trnscth 22mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
249245 CDM Valve Tavr 23mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
225801 CDM Valve Aor 23mm Evolutpro 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
433810 CDM Valve Heart W/cert 29a 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
877268 CDM Valve Transcth Aor 26mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
270499 CDM Valve Tavr 29mm 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
237603 CDM Valve Aor 29mm Evolutpro 51 30 $447,320.00 $447,320.00 $49,205.20 $447,320.00 $201,294.00 2026-03-01
870432 CDM Valve Hrt Trncath 20mm 51 30 $447,250.00 $447,250.00 $49,197.50 $447,250.00 $201,262.50 2026-03-01
863553 CDM Valve Aor 23x18mm 51 30 $447,250.00 $447,250.00 $49,197.50 $447,250.00 $201,262.50 2026-03-01
863855 CDM Valve Aor Sapien 29mm 51 30 $447,250.00 $447,250.00 $49,197.50 $447,250.00 $201,262.50 2026-03-01
863528 CDM Valve Aor Sapien 3 26mm 51 30 $447,250.00 $447,250.00 $49,197.50 $447,250.00 $201,262.50 2026-03-01
00886 OTHER Inj. Remestemcel-l-rknd/ 2 2 — — $195,618.93 $201,669.00 $198,643.96 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 26 11 — — $183,844.06 $233,304.65 $195,975.91 2026-03-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 2 $484,340.00 — $188,519.31 $194,349.80 $191,434.55 2026-07-17
1614 APR_DRG Implantable Heart Assist Systems 31 12 — — $178,525.19 $226,554.81 $190,306.04 2026-03-01
220761 CDM Impl Custom Cp7a1034 51 30 $417,955.00 $417,955.00 $45,975.05 $417,955.00 $188,079.75 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 19 5 $216,892.20 — $43,855.64 $389,632.46 $185,582.55 2026-07-17
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 26 11 — — $167,250.00 $212,246.19 $178,286.80 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 81 33 — — $156,089.68 $638,050.74 $177,157.00 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 63 29 — — $12,500.00 $641,817.38 $168,555.87 2026-03-01
236543 CDM Allo Dbl Cord Donor Acq 71 39 $500,776.79 $500,776.79 $35,054.38 $500,776.79 $167,760.22 2026-03-01
234428 CDM Allo Dbl Cord Donor Acq 71 39 $500,776.79 $500,776.79 $35,054.38 $500,776.79 $167,760.22 2026-03-01
459729 CDM Graft Stnt 15cm 37mm 51 30 $360,395.00 $360,395.00 $39,643.45 $360,395.00 $162,177.75 2026-03-01
468694 CDM Stent Thor 40x40mm 20cm 51 30 $360,395.00 $360,395.00 $39,643.45 $360,395.00 $162,177.75 2026-03-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc Pediatric 8 1 — — $76,103.85 $193,257.15 $160,080.84 2026-03-01
1908 OTHER New Technology - Level 52 46 27 $339,838.95 — $146,662.80 $392,862.71 $157,444.98 2026-07-17
1907 OTHER New Technology - Level 52 46 27 $339,838.95 — $146,662.80 $392,862.71 $157,444.98 2026-07-17
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 6 1 — — $120,606.76 $161,786.86 $147,159.85 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 26 11 — — $136,792.24 $173,594.21 $145,819.14 2026-03-01
876436 CDM Pins Implt Ear Fx Flx28 51 30 $323,459.00 $323,459.00 $35,580.49 $323,459.00 $145,556.55 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 26 11 — — $135,580.01 $172,055.85 $144,526.91 2026-03-01
01907 OTHER New Technology - Level 52 2 2 — — $142,262.92 $146,662.80 $144,462.86 2026-03-01
01908 OTHER New Technology - Level 52 2 2 — — $142,262.92 $146,662.80 $144,462.86 2026-03-01
1905 OTHER New Technology - Level 51 46 27 $306,412.27 — $132,237.00 $354,220.59 $141,958.64 2026-07-17
1906 OTHER New Technology - Level 51 46 27 $306,412.27 — $132,237.00 $354,220.59 $141,958.64 2026-07-17
712139 CDM Graft Art St Tis 6-32mm 51 30 $312,438.00 $312,438.00 $34,368.18 $312,438.00 $140,597.10 2026-03-01
241762 CDM Liver Acquisition 71 39 $412,561.51 $412,561.51 $28,879.31 $412,561.51 $138,208.11 2026-03-01
C1882 HCPCS Crt Defib Card 71x51x12 1,334 28 $276,939.00 $276,939.00 $22,347.93 $460,000.00 $138,151.44 2026-03-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 6 1 — — $111,669.08 $149,747.89 $136,254.42 2026-03-01
C1822 HCPCS Pulse Gen Imp 184 28 $293,673.00 $293,673.00 $27,060.00 $349,410.00 $135,300.00 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 2 $568,197.06 — $132,872.15 $136,981.60 $134,926.88 2026-07-17
5832 APR_DRG Neonate With Ecmo 26 11 — — $122,543.46 $155,512.00 $130,630.08 2026-03-01
01905 OTHER New Technology - Level 51 2 2 — — $128,269.89 $132,237.00 $130,253.45 2026-03-01
01906 OTHER New Technology - Level 51 2 2 — — $128,269.89 $132,237.00 $130,253.45 2026-03-01
743854 CDM Gft Evas 28x116mm 51 30 $288,477.00 $288,477.00 $31,732.47 $288,477.00 $129,814.65 2026-03-01
446781 CDM Kit Bld Pmp 31fr Cann 71 39 $384,635.00 $384,635.00 $26,924.45 $384,635.00 $128,852.73 2026-03-01
1904 OTHER New Technology - Level 50 46 27 $272,985.60 — $117,811.20 $315,578.48 $126,472.29 2026-07-17
1903 OTHER New Technology - Level 50 46 27 $272,985.60 — $117,811.20 $315,578.48 $126,472.29 2026-07-17
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 26 11 — — $116,363.03 $147,668.83 $124,041.81 2026-03-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc Pediatric 6 1 — — $100,826.98 $135,174.40 $123,025.30 2026-03-01
203790 CDM Valve Aortic L5.6cm Od16 51 30 $268,261.00 $268,261.00 $29,508.71 $268,261.00 $120,717.45 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 49 28 $599,885.67 — $108,147.24 $629,884.36 $117,066.60 2026-07-17
02HA3QZ OTHER Insertion Of Implantable Heart Assist System Into Heart, Percutaneous Approach 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02HA4QZ OTHER Insertion Of Implantable Heart Assist System Into Heart, Percutaneous Endoscopic… 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02HA3RS OTHER Insertion Of Biventricular External Heart Assist System Into Heart, Percutaneous… 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02HA0QZ OTHER Insertion Of Implantable Heart Assist System Into Heart, Open Approach 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02HA0RS OTHER Insertion Of Biventricular External Heart Assist System Into Heart, Open Approac… 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02HA4RZ OTHER Insertion Of External Heart Assist System Into Heart, Percutaneous Endoscopic Ap… 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02WA3QZ OTHER Revision Of Implantable Heart Assist System In Heart, Percutaneous Approach 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02WA3RZ OTHER Revision Of External Heart Assist System In Heart, Percutaneous Approach 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02WA0QZ OTHER Revision Of Implantable Heart Assist System In Heart, Open Approach 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02HA0RZ OTHER Insertion Of External Heart Assist System Into Heart, Open Approach 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02WA4QZ OTHER Revision Of Implantable Heart Assist System In Heart, Percutaneous Endoscopic Ap… 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02WA4RZ OTHER Revision Of External Heart Assist System In Heart, Percutaneous Endoscopic Appro… 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02HA4RS OTHER Insertion Of Biventricular External Heart Assist System Into Heart, Percutaneous… 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
02WA0RZ OTHER Revision Of External Heart Assist System In Heart, Open Approach 1 1 $105,000.00 — $116,595.00 $116,595.00 $116,595.00 2026-07-17
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 81 33 — — $102,650.68 $416,386.94 $116,505.38 2026-03-01
286017 CDM Implant Crnl Bn Cstm 51 30 $258,375.00 $258,375.00 $28,421.25 $258,375.00 $116,268.75 2026-03-01
01903 OTHER New Technology - Level 50 2 2 — — $114,276.86 $117,811.20 $116,044.03 2026-03-01
01904 OTHER New Technology - Level 50 2 2 — — $114,276.86 $117,811.20 $116,044.03 2026-03-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc Pediatric 8 1 — — $55,140.13 $140,095.59 $115,984.64 2026-03-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 26 11 — — $108,133.31 $137,225.01 $115,269.01 2026-03-01
5831 APR_DRG Neonate With Ecmo 26 11 — — $107,901.95 $136,931.41 $115,022.39 2026-03-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 17 4 $143,344.23 — $39,976.89 $203,447.46 $114,857.36 2026-07-17
477565 CDM Valve Pulm Med 17-21mm 51 30 $253,012.00 $253,012.00 $27,831.32 $253,012.00 $113,855.40 2026-03-01
108820 CDM Implt Eye Orbtl .59mg 51 30 $252,082.00 $252,082.00 $27,729.02 $252,082.00 $113,436.90 2026-03-01
33289 CPT Cath Rt W/sensor 104 36 $226,633.53 $236,832.04 $948.00 $247,030.55 $111,107.09 2026-07-17
1902 OTHER New Technology - Level 49 46 27 $239,558.93 — $103,385.40 $276,936.36 $110,985.94 2026-07-17
1901 OTHER New Technology - Level 49 46 27 $239,558.93 — $103,385.40 $276,936.36 $110,985.94 2026-07-17
C1722 HCPCS Defib Card 30j 50x75mm 782 28 $210,220.00 $210,220.00 $18,820.23 $393,343.00 $110,466.95 2026-03-01
877388 CDM Prosthesis Tmj Pt Cstm 51 30 $244,860.00 $244,860.00 $26,934.60 $244,860.00 $110,187.00 2026-03-01
C1721 HCPCS Defib Card Thk15mm 1,104 28 $209,622.00 $209,622.00 $19,827.39 $358,800.00 $108,186.26 2026-03-01
C9293 HCPCS Glucarpidase 1000 U Inj 61 30 $318,838.15 $318,838.15 $740.34 $318,838.15 $106,810.78 2026-03-01
875223 CDM Impl Crnl Lg 51 30 $237,136.00 $237,136.00 $26,084.96 $237,136.00 $106,711.20 2026-03-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc Pediatric 8 1 — — $50,633.65 $128,626.89 $106,505.48 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 35 12 — — $99,697.85 $177,128.00 $106,276.89 2026-03-01
866357 CDM Set Pump 21fr 5.0 71 39 $316,960.00 $316,960.00 $22,187.20 $316,960.00 $106,181.60 2026-03-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 2 $385,544.94 — $103,762.65 $106,971.80 $105,367.23 2026-07-17
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 26 11 — — $98,644.71 $125,183.64 $105,154.26 2026-03-01
719336 CDM Gft Prox Main 46x46 51 30 $232,928.00 $232,928.00 $25,622.08 $232,928.00 $104,817.60 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 26 11 — — $98,193.85 $124,611.49 $104,673.65 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 26 11 — — $97,939.93 $124,289.25 $104,402.97 2026-03-01
270502 CDM Prothesis Cstm Cranial 51 30 $231,226.00 $231,226.00 $25,434.86 $231,226.00 $104,051.70 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 26 11 — — $97,518.90 $123,754.95 $103,954.16 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
7 MS_DRG Lung Transplant 46 28 — — $96,316.11 $381,784.85 $103,195.83 2026-03-01
738282 CDM Stnt Talent 38x38x199m 51 30 $228,894.00 $228,894.00 $25,178.34 $228,894.00 $103,002.30 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 26 11 — — $96,544.92 $122,518.94 $102,915.91 2026-03-01
231601 CDM Custom Tmj Implant 51 30 $226,973.00 $226,973.00 $24,967.03 $226,973.00 $102,137.85 2026-03-01
483228 CDM Imp Coch Ultra Mid-sc 51 30 $226,515.00 $226,515.00 $24,916.65 $226,515.00 $101,931.75 2026-03-01
C1820 HCPCS Device Neurostimulator 736 28 $202,394.00 $202,394.00 $19,219.64 $318,320.00 $101,842.95 2026-03-01
01902 OTHER New Technology - Level 49 2 2 — — $100,283.84 $103,385.40 $101,834.62 2026-03-01
01901 OTHER New Technology - Level 49 2 2 — — $100,283.84 $103,385.40 $101,834.62 2026-03-01
864568 CDM Valve Pricrd Bln 23mm 51 30 $223,625.00 $223,625.00 $24,598.75 $223,625.00 $100,631.25 2026-03-01
422506 CDM Kit Pmp Rt Hrt 22f 170cm 71 39 $300,000.00 $300,000.00 $21,000.00 $300,000.00 $100,500.00 2026-03-01
862710 CDM Set Vntrc 17.4x13.8in 71 39 $300,000.00 $300,000.00 $21,000.00 $300,000.00 $100,500.00 2026-03-01
868832 CDM Cage Spnl Brgde 10x24x34 51 30 $223,024.00 $223,024.00 $24,532.64 $223,024.00 $100,360.80 2026-03-01
868833 CDM Cage Spnl Brgde 8x24x34 51 30 $223,024.00 $223,024.00 $24,532.64 $223,024.00 $100,360.80 2026-03-01
868899 CDM Cage Spnl Brgd 6x24x34 51 30 $223,024.00 $223,024.00 $24,532.64 $223,024.00 $100,360.80 2026-03-01
864569 CDM Cage Brgd 20d 10x34x24 51 30 $223,024.00 $223,024.00 $24,532.64 $223,024.00 $100,360.80 2026-03-01
864258 CDM Cage Brgd 20d 8x24x34 51 30 $223,024.00 $223,024.00 $24,532.64 $223,024.00 $100,360.80 2026-03-01
864259 CDM Cage Brgd 30d 8x24x34 51 30 $223,024.00 $223,024.00 $24,532.64 $223,024.00 $100,360.80 2026-03-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 6 1 — — $82,204.96 $110,251.62 $100,303.41 2026-03-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 26 11 — — $94,001.54 $119,291.30 $100,204.69 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 55 28 $107,800.00 — $80,850.00 $249,112.22 $99,835.05 2026-07-17
720463 CDM Stnt Graft Evas 116x28x2 51 30 $221,836.00 $221,836.00 $24,401.96 $221,836.00 $99,826.20 2026-03-01
719337 CDM Stent Thorac Distl Main 51 30 $221,836.00 $221,836.00 $24,401.96 $221,836.00 $99,826.20 2026-03-01
719338 CDM Stent Thorac Distl Main 51 30 $221,836.00 $221,836.00 $24,401.96 $221,836.00 $99,826.20 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 26 11 — — $93,159.49 $118,222.70 $99,307.07 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 31 12 — — $93,049.74 $118,083.43 $99,190.08 2026-03-01
446783 CDM Kit Tandemlife 24frx60cm 71 39 $295,185.00 $295,185.00 $20,662.95 $295,185.00 $98,886.98 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 26 11 — — $92,557.97 $117,459.35 $98,665.85 2026-03-01
L5969 HCPCS $93,897.86 1 1 $93,897.86 — $98,593.44 $98,593.44 $98,593.44 2026-07-17
1585 OTHER New Technology - Level 48 46 27 $211,703.37 — $91,363.88 $244,734.72 $98,080.71 2026-07-17
1599 OTHER New Technology - Level 48 46 27 $211,703.37 — $91,363.88 $244,734.72 $98,080.71 2026-07-17
741888 CDM Valve Pulm Large 22+mm 51 30 $217,406.00 $217,406.00 $23,914.66 $217,406.00 $97,832.70 2026-03-01
745537 CDM Valve Aortic =16mm 51 30 $217,406.00 $217,406.00 $23,914.66 $217,406.00 $97,832.70 2026-03-01
859350 CDM Valve Aor 17-21mm 51 30 $217,406.00 $217,406.00 $23,914.66 $217,406.00 $97,832.70 2026-03-01
851240 CDM Graft Vlv Aor 23mm 51 30 $217,406.00 $217,406.00 $23,914.66 $217,406.00 $97,832.70 2026-03-01
870031 CDM Graft Evs 18cm 26x14.5mm 51 30 $217,292.00 $217,292.00 $23,902.12 $217,292.00 $97,781.40 2026-03-01
737806 CDM Grft Xcldr Aaa 31/14/15 51 30 $217,292.00 $217,292.00 $23,902.12 $217,292.00 $97,781.40 2026-03-01
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