Price Transparencybeta Hospital negotiated rates

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

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Hospital

MEDICAL CITY PLANO

Plano, TX · CCN 450651 · Rates published

42,029 distinct procedures filed
60 distinct payers
2,265,716 rate rows
2026-07-31 last MRF observed
Data quality

2,195,767 of 2,265,716 rate rows are consumer-grade (96.9%)

69,949 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 24,475
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 19,768
per-diem day rate — not a per-procedure price 14,259
template filing: same amount across many unrelated codes — excluded 10,035
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 1,130
placeholder amount (≤ $0.02) — excluded from medians 236
exceeds 10× this hospital's gross charge — excluded from medians 40
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/62-1682203_MEDICAL-CITY-PLANO_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://medicalcityhealthcare.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-10-03
Content fingerprint 0e7b99a2e64a061a… · 993,104,970 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
$2,994,107
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 20 $5,373.81 $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 $6,320.33 $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 $9,730.05 $4,336,566.00 $3,385,857.30 nat. median
$30,519
outlier · 110.9×
748
OTHER 		Inj, Lovotibeglogene Auto 24 $12,030.68 $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 $8,597.64 $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 $11,128.50 $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 $13,031.19 $4,617,360.00 $2,425,280.00 nat. median
$2,285,360
1.1× median
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
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
$319,951
outlier · 5.7×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $536,573.93 $2,570,427.00 $1,565,413.20 nat. median
$646,415
outlier · 2.4×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $511,793.34 $2,318,912.10 $1,412,238.36 nat. median
$622,450
outlier · 2.3×
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×
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 $500,948.74 $2,268,056.34 $1,381,266.75 nat. median
$640,950
outlier · 2.2×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 $23.68 $2,132,254.50 $1,271,668.90 nat. median
$739,258
1.7× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $474,717.03 $2,061,869.40 $1,255,697.04 nat. median
$591,721
outlier · 2.1×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $6.22 $1,966,642.50 $1,172,898.50 nat. median
$608,239
1.9× median
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
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
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×
74
APR_DRG 		Allogeneic Bone Marrow Transplant 9 $326,736.31 $571,789.00 $352,875.00 nat. median
$170,082
outlier · 2.1×
5834
APR_DRG 		Neonate With Ecmo 8 $335,871.71 $419,839.64 $352,665.30 nat. median
$307,206
1.1× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 21 $314,036.10 $1,273,072.13 $336,467.25 nat. median
$359,454
0.9× median
286940
CDM 		Cage Spn 2.3x32.4x34.1mm 26 $113,159.57 $838,219.00 $335,287.60 nat. median
$335,288
1.0× 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
$51,570
outlier · 6.4×

Other procedures at this hospital

Browse this hospital's 42,029 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 — $5,373.81 $4,955,500.00 $4,535,408.75 2026-07-31
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 2026-07-31
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 — $6,320.33 $4,991,790.00 $3,460,974.40 2026-07-31
908 OTHER Topi Adm Prad Zami Per Tr 32 21 $57,740.35 — $9,730.05 $4,336,566.00 $3,385,857.30 2026-07-31
748 OTHER Inj, Lovotibeglogene Auto 42 24 $39,790.72 — $12,030.68 $4,878,762.00 $3,382,608.32 2026-07-31
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 — $8,597.64 $4,770,000.00 $3,275,400.00 2026-07-31
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 — $11,128.50 $4,409,953.50 $3,057,567.76 2026-07-31
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 — $13,031.19 $4,617,360.00 $2,425,280.00 2026-07-31
00824 OTHER Inj, Exagamglogene Autote 2 2 — — $2,262,040.00 $2,332,000.00 $2,297,020.00 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
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 12 4 $2,630,635.20 — $536,573.93 $2,570,427.00 $1,565,413.20 2026-07-31
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 12 4 $2,373,228.96 — $511,793.34 $2,318,912.10 $1,412,238.36 2026-07-31
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
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 12 4 $2,321,181.98 — $500,948.74 $2,268,056.34 $1,381,266.75 2026-07-31
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 13 4 $2,182,199.20 — $23.68 $2,132,254.50 $1,271,668.90 2026-07-31
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 12 4 $2,110,165.44 — $474,717.03 $2,061,869.40 $1,255,697.04 2026-07-31
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 13 4 $2,012,708.00 — $6.22 $1,966,642.50 $1,172,898.50 2026-07-31
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 2026-07-31
9194 OTHER Tisagenlecleucel Car-pos 43 26 $1,039,331.61 — $563,698.64 $1,484,312.01 $594,857.87 2026-07-31
9413 OTHER Lisocabtagene Car Pos T 43 26 $995,962.22 — $559,390.19 $1,472,967.14 $590,311.26 2026-07-31
9422 OTHER Idecabtagene Vicleucel Ca 43 26 $1,018,294.30 — $555,291.39 $1,462,174.32 $585,985.89 2026-07-31
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 2026-07-31
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
9391 OTHER Brexucabtagene Car Pos T 43 26 $968,532.60 — $487,002.95 $1,282,359.52 $513,922.71 2026-07-31
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $474,766.69 $489,450.20 $482,108.45 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
74 APR_DRG Allogeneic Bone Marrow Transplant 30 9 — — $326,736.31 $571,789.00 $352,875.00 2026-03-01
5834 APR_DRG Neonate With Ecmo 21 8 — — $335,871.71 $419,839.64 $352,665.30 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 38 21 — — $314,036.10 $1,273,072.13 $336,467.25 2026-03-01
286940 CDM Cage Spn 2.3x32.4x34.1mm 45 26 $838,219.00 $838,219.00 $113,159.57 $838,219.00 $335,287.60 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
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 19 5 $345,844.92 — $55,306.59 $478,449.94 $307,485.36 2026-07-31
5833 APR_DRG Neonate With Ecmo 21 8 — — $284,403.82 $355,504.78 $298,624.01 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 30 9 — — $273,588.42 $478,780.00 $295,476.00 2026-03-01
831 OTHER Obecbtge Autol Up To 400 45 27 $33,546.40 — $3,679.75 $729,015.00 $292,162.50 2026-07-31
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 2026-07-31
897 OTHER Revakinagene, Per Implant 41 25 $23,901.95 — $263,675.00 $694,300.00 $278,250.00 2026-07-31
00831 OTHER Obecbtge Autol Up To 400 2 2 — — $269,902.50 $278,250.00 $274,076.25 2026-03-01
00897 OTHER Revakinagene, Per Implant 2 2 — — $257,050.00 $265,000.00 $261,025.00 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 58 27 — — $204,442.99 $916,157.34 $230,519.90 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 8 — — $212,601.28 $265,751.60 $223,231.34 2026-03-01
233190 CDM Implant Plvc Rt Custom 45 26 $556,327.00 $556,327.00 $75,104.15 $556,327.00 $222,530.80 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 $1,014,848.78 — $216,966.01 $223,676.30 $220,321.15 2026-07-31
1614 APR_DRG Implantable Heart Assist Systems 26 9 — — $206,450.43 $258,063.04 $219,869.48 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 45 27 $38,325.11 — $8,051.91 $528,372.78 $211,752.45 2026-07-31
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 21 8 — — $193,411.55 $241,764.44 $203,082.13 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 17 4 $227,599.37 — $126,372.49 $574,167.94 $202,348.70 2026-07-31
00886 OTHER Inj. Remestemcel-l-rknd/ 2 2 — — $195,618.93 $201,669.00 $198,643.96 2026-03-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 2 $484,340.00 — $190,716.55 $196,615.00 $193,665.77 2026-07-31
245162 CDM Stent Eprsth 12x37mm 40 24 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $193,562.62 2026-03-01
245763 CDM Stent Eprsth 34mm 15mm 40 24 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $193,562.62 2026-03-01
248063 CDM Kit Cath Rt Heart 65 35 $594,910.00 $594,910.00 $41,643.70 $594,910.00 $189,776.29 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 2026-07-31
252517 CDM Implant Scapula Lt Cstm 45 26 $446,526.00 $446,526.00 $60,281.01 $446,526.00 $178,610.40 2026-03-01
204426 CDM Implant Ulna Custom 45 26 $446,526.00 $446,526.00 $60,281.01 $446,526.00 $178,610.40 2026-03-01
274539 CDM Stent Eprsth 22fr 31mm 45 26 $446,526.00 $446,526.00 $60,281.01 $446,526.00 $178,610.40 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 69 32 — — $154,974.08 $693,894.24 $174,306.22 2026-03-01
273673 CDM Stent Eprsth 15cm 8mm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
275821 CDM Stent Eprsth 28x8mm 20cm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
437822 CDM Valve Aor Tavr 23mm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
281843 CDM Stent Evas 22fr 16cm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
276980 CDM Stent Evas 22fr 16cm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
277447 CDM Stent Eprsth 8x40mm 15cm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
271026 CDM Stent Eprsth 28x8mm 15cm 45 26 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $173,210.40 2026-03-01
C1822 HCPCS Pulse Gen Imp 120 24 $383,990.00 $383,990.00 $47,019.82 $401,850.00 $171,643.53 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 58 28 — — $155,878.14 $697,990.55 $170,541.52 2026-03-01
C2624 HCPCS System Mntr 2x15mm 4.5cm 40 24 $375,060.00 $375,060.00 $50,633.10 $375,060.00 $167,651.82 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 21 8 — — $158,189.53 $197,736.91 $166,099.01 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 21 8 — — $156,787.69 $195,984.61 $164,627.07 2026-03-01
1908 OTHER New Technology - Level 52 46 27 $339,838.95 — $146,662.80 $392,862.71 $157,444.98 2026-07-31
1907 OTHER New Technology - Level 52 46 27 $339,838.95 — $146,662.80 $392,862.71 $157,444.98 2026-07-31
212276 CDM Graft Angio Min Dstl 4cm 45 26 $386,669.00 $386,669.00 $52,200.32 $386,669.00 $154,667.60 2026-03-01
442639 CDM Kit Impl Crnl Cstm Lg 45 26 $386,245.00 $386,245.00 $52,143.07 $386,245.00 $154,498.00 2026-03-01
880563 CDM Implant Cust Cranial Xl 45 26 $374,275.00 $374,275.00 $50,527.13 $374,275.00 $149,710.00 2026-03-01
475529 CDM Artery Cryo Aortoiliac 45 26 $373,285.00 $373,285.00 $50,393.47 $373,285.00 $149,314.00 2026-03-01
5832 APR_DRG Neonate With Ecmo 21 8 — — $141,711.93 $177,139.91 $148,797.53 2026-03-01
01908 OTHER New Technology - Level 52 2 2 — — $142,262.92 $146,662.80 $144,462.86 2026-03-01
01907 OTHER New Technology - Level 52 2 2 — — $142,262.92 $146,662.80 $144,462.86 2026-03-01
1906 OTHER New Technology - Level 51 46 27 $306,412.27 — $132,237.00 $354,220.59 $141,958.64 2026-07-31
1905 OTHER New Technology - Level 51 46 27 $306,412.27 — $132,237.00 $354,220.59 $141,958.64 2026-07-31
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 21 8 — — $134,564.75 $168,205.94 $141,292.99 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 2 $568,197.06 — $134,420.85 $138,578.20 $136,499.53 2026-07-31
207702 CDM Vsp Recon Maxillofacial 45 26 $337,284.00 $337,284.00 $45,533.34 $337,284.00 $134,913.60 2026-03-01
255241 CDM Kit Osteot Cstm N/impl 65 35 $416,321.00 $416,321.00 $29,142.47 $416,321.00 $132,806.40 2026-03-01
263482 CDM Device Clsr 27mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
263484 CDM Device Clsr 35mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
263480 CDM Device Clsr 20mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
263481 CDM Device Clsr 24mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
263483 CDM Device Clsr 31mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
263485 CDM Device Clsr 40mm 40 24 $294,440.00 $294,440.00 $39,749.40 $294,440.00 $131,614.68 2026-03-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 21 8 — — $125,047.72 $156,309.65 $131,300.11 2026-03-01
5831 APR_DRG Neonate With Ecmo 21 8 — — $124,780.17 $155,975.21 $131,019.18 2026-03-01
01906 OTHER New Technology - Level 51 2 2 — — $128,269.89 $132,237.00 $130,253.45 2026-03-01
01905 OTHER New Technology - Level 51 2 2 — — $128,269.89 $132,237.00 $130,253.45 2026-03-01
745290 CDM Stent Eprsth 34mm 15cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
872288 CDM Stent Eprsth 34mm 20cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
751780 CDM Stent Eprsth 45mm 15cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
871762 CDM Stent Eprsth 37mm 15cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
745289 CDM Stent Eprsth 15cm 28mm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
272724 CDM Stent Vasc 250mm 10mm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
754486 CDM Stent Eprsth 10cm 26mm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
747431 CDM Stent Eprsth 40mm 20cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
878283 CDM Stent Eprsth 31mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
877803 CDM Stent Eprsth 40mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
875236 CDM Stent Eprsth 37mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
875235 CDM Stent Eprsth 45mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
273109 CDM Stent Vasc 250mm 16mm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
853516 CDM Stent Eprsth 37mm 20cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
867229 CDM Stent Eprsth 28mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
745288 CDM Stent Eprsth 34mm 10cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
866977 CDM Stent Eprsth 31mm 15cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
853517 CDM Stent Eprsth 45mm 20cm 40 24 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $129,768.12 2026-03-01
466919 CDM Stent Graft 15cn 28x28mm 45 26 $320,623.00 $320,623.00 $43,284.11 $320,623.00 $128,249.20 2026-03-01
339477 CDM Graft Evas 40x40x10cm 45 26 $320,623.00 $320,623.00 $43,284.11 $320,623.00 $128,249.20 2026-03-01
875223 CDM Impl Crnl Lg 45 26 $319,642.00 $319,642.00 $43,151.67 $319,642.00 $127,856.80 2026-03-01
C1820 HCPCS Device Neurostimulator 480 24 $285,090.50 $285,090.50 $33,245.91 $316,033.00 $126,645.32 2026-03-01
244953 CDM Kit Cath Rt Heart 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
422506 CDM Kit Pmp Rt Hrt 22f 170cm 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
265596 CDM Kit Lo Prfl Comp Shth 7f 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
254667 CDM Cath Vasc Assist Strl 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
751731 CDM Pump Cath Lv Impella 9fr 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
866357 CDM Set Pump 21fr 5.0 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
862710 CDM Set Vntrc 17.4x13.8in 65 35 $396,544.00 $396,544.00 $27,758.08 $396,544.00 $126,497.54 2026-03-01
1903 OTHER New Technology - Level 50 46 27 $272,985.60 — $117,811.20 $315,578.48 $126,472.29 2026-07-31
1904 OTHER New Technology - Level 50 46 27 $272,985.60 — $117,811.20 $315,578.48 $126,472.29 2026-07-31
267810 CDM Cage Spnl 0d 12x14x20mm 45 26 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $126,313.20 2026-03-01
422111 CDM Implant Cust Cranial Lge 45 26 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $126,313.20 2026-03-01
864258 CDM Cage Brgd 20d 8x24x34 45 26 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $126,313.20 2026-03-01
864569 CDM Cage Brgd 20d 10x34x24 45 26 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $126,313.20 2026-03-01
473595 CDM Stent Thor 20f 26x21x10 45 26 $314,336.00 $314,336.00 $42,435.36 $314,336.00 $125,734.40 2026-03-01
467990 CDM Stent Graft 20cm 45x45mm 45 26 $314,336.00 $314,336.00 $42,435.36 $314,336.00 $125,734.40 2026-03-01
481638 CDM Graft Evas 34x34x10cm 45 26 $314,336.00 $314,336.00 $42,435.36 $314,336.00 $125,734.40 2026-03-01
469404 CDM Stent Graft 10cm 21x21mm 45 26 $314,336.00 $314,336.00 $42,435.36 $314,336.00 $125,734.40 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 30 9 — — $115,292.76 $201,762.00 $124,516.00 2026-03-01
468029 CDM Stent Eprsth 40x40x20cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
101241 CDM Graft Evas 45x45mm 10cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
467548 CDM Stent Eprsth 34x34x20cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
473613 CDM Stent Eprsth 37x37x20cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
459729 CDM Stent Eprsth 37x37x15cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
473088 CDM Stent 20fr 31x31mm 10cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
244589 CDM Stent Thor 31x26mm 10cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
471570 CDM Stent Eprsth 40x40x15cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
483550 CDM Stnt Thorac 26x26mm 10cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
472852 CDM Stent 34mmx34mmx15cm 45 26 $310,929.00 $310,929.00 $41,975.42 $310,929.00 $124,371.60 2026-03-01
205234 CDM Cann W Dilator Strgt Tip 65 35 $383,380.00 $383,380.00 $26,836.60 $383,380.00 $122,298.22 2026-03-01
101317 CDM Stent Graft 15cm 31x31mm 45 26 $304,832.00 $304,832.00 $41,152.32 $304,832.00 $121,932.80 2026-03-01
205115 CDM Stnt Thorac 28x28mm 10cm 45 26 $304,832.00 $304,832.00 $41,152.32 $304,832.00 $121,932.80 2026-03-01
471891 CDM Graft Evas 45x45mm 15cm 45 26 $304,832.00 $304,832.00 $41,152.32 $304,832.00 $121,932.80 2026-03-01
472308 CDM Stent Eprsth 31x31x20cm 45 26 $304,832.00 $304,832.00 $41,152.32 $304,832.00 $121,932.80 2026-03-01
473093 CDM Stent Eprsth 37x37x10cm 45 26 $304,832.00 $304,832.00 $41,152.32 $304,832.00 $121,932.80 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 8 — — $114,074.89 $142,593.61 $119,778.63 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 8 — — $113,553.51 $141,941.89 $119,231.19 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 21 8 — — $113,259.87 $141,574.84 $118,922.86 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 21 8 — — $112,772.99 $140,966.24 $118,411.64 2026-03-01
C1882 HCPCS Crt-d Amplia Dtmb1qq 760 24 $258,325.00 $258,325.00 $13,517.28 $400,950.00 $118,081.39 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 21 8 — — $111,646.65 $139,558.31 $117,228.98 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 2026-07-31
C1767 HCPCS Device Ipg Sleep 51mm 520 24 $290,779.00 $290,779.00 $12,144.60 $446,526.00 $116,281.40 2026-03-01
235623 CDM Device Embl 4mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
247231 CDM Device Embl 2.5mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
218838 CDM Stent Aaa Xcldr 12cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
425738 CDM Device Embl 25mm 4.5mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233056 CDM Device Embl 4mm 35mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
235622 CDM Device Embl 4mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
228497 CDM Device Embl Flx 14x5mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
231698 CDM Device Embl 4.25mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
223314 CDM Device Embl 4x12mm Pline 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
277815 CDM Stent Vasc 350mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
231788 CDM Graft Endo Aaa 23x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233053 CDM Device Embl 3.75mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
211753 CDM Graft Endo Aaa 28.5x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233054 CDM Device Embl 4.75mm 25mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
244943 CDM Device Embl 4mm 10mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
247229 CDM Device Embl 10mm 2.5mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
261272 CDM Device Embl 4.25mm 10mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
220252 CDM Device Embl 14mm 2.5mm P 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
277448 CDM Stent Eprsth 4.3x40mm 6c 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
229410 CDM Device Emb 5mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
270082 CDM Device Embl 5.0x16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
251775 CDM Coil Emb Neuro 6x4mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
276858 CDM Coil Embol Neuro 4x2mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
234084 CDM Device Embl 4.75mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
258504 CDM Graft Vasc 36/28 199mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
234142 CDM Device Embl 3.5mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232561 CDM Device Embl 3.50x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233051 CDM Device Embl 4.25mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
240458 CDM Device Embl 4.75x30mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
270080 CDM Device Embl 4.00x2mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
270479 CDM Device Embl 4.50x25mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
242042 CDM Stent Grft 23x12mm 12cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
248655 CDM Device Embl 5mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
284916 CDM Stent Vasc 250mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
270083 CDM Device Embl 5mm 25mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233052 CDM Device Embl 4.5mm 35mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232591 CDM System Imp 5mm 15mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
231696 CDM Device Embl 4.75mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
244942 CDM Device Embl 4.25mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
223010 CDM Coil Embl Endo 9mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
234048 CDM Device Embl 4mm 30mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
254564 CDM Device Embl 3mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
244389 CDM Device Embl 3.5mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
463852 CDM Device Embl Pln 4.5x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233049 CDM Device Embl 5.0x20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232510 CDM Device Embl 4mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
216750 CDM Graft Endo Aaa 36x14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
279418 CDM Device Embl 4mm 25mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
267263 CDM Device Embl 4.50x16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
857807 CDM Graft Evas 35x14.5m 14cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
248261 CDM Device Embl 3.5mm 10mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
221145 CDM Graft Evasc 20x12mmx12cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232511 CDM Device Embl 3.75mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
258797 CDM Valve Aortic 27mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
235825 CDM Device Embl 3mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
230328 CDM Device Embl 3.5mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
274124 CDM Device Embl 400mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
216719 CDM Graft Endo Aaa 26x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
250130 CDM Device Embl 3.75x16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
204057 CDM Valve Aortic 27mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
216652 CDM Graft Endo Aaa 32x14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
480921 CDM Coil Emb Endo Sn Ly 7mmx 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
230329 CDM Device Embl 3.25mm 14mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232560 CDM Device Embl 3.75mm 10mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
231983 CDM Device Embl 4.5mm 20mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
240461 CDM Device Embl 5mm 35mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
232314 CDM Device Embl 3mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
276815 CDM Coil Emb Neuro 7mm 2mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233599 CDM Device Embl 3.25mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
235860 CDM Device Embl 3mm 10mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
174251 CDM Device Embl 10mm 5mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
870971 CDM Graft Evas 26x12mm 16cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
252222 CDM Device Embl 2.75mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
222589 CDM Gft Evs 15f 20x14.5x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
472784 CDM Device Embl 18mm 2.5mm P 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
254326 CDM Device Embl 4.5mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
254671 CDM Device Embl 4.75mm 16mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
240704 CDM Coil Emb Neuro 6x3mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
279420 CDM Device Embl 4.75mm 12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
233300 CDM Device Embl 3.25x12mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
250131 CDM Device Embl 3.5mm 18mm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
864475 CDM Valve Aor Crdgft 22mm Lg 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
858902 CDM Graft Evas 31x14.5m 13cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
870016 CDM Graft Evas 23x14.5m 16cm 45 26 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $116,123.60 2026-03-01
433365 CDM Occluder Cv 18x18mm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
737806 CDM Grft Xcldr Aaa 31/14/15 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
433364 CDM Occluder Cv 35x18mm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
857566 CDM Graft Evas 31x14.5m 15cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
433363 CDM Occluder Cv 25x18mm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
879077 CDM Graft Evas 26x12mm 18cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
872483 CDM Graft Evas 26x12mm 14cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
870014 CDM Graft Evas 23x12mm 16cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
870031 CDM Graft Evas 26x14.5m 18cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
870013 CDM Graft Evas 14.5mm 18cm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
866807 CDM Graft Evas 18cm 23mm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
869126 CDM Graft Evas 16cm 26mm 45 26 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $116,062.00 2026-03-01
01904 OTHER New Technology - Level 50 2 2 — — $114,276.86 $117,811.20 $116,044.03 2026-03-01
01903 OTHER New Technology - Level 50 2 2 — — $114,276.86 $117,811.20 $116,044.03 2026-03-01
282543 CDM Guide Prnt 3d Bn Hrvt 65 35 $361,629.00 $361,629.00 $25,314.03 $361,629.00 $115,359.65 2026-03-01
C1772 HCPCS Pump Pain Infn 20ml 80 24 $257,884.00 $257,884.00 $34,642.08 $259,160.00 $115,270.32 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 70 32 — — $101,773.13 $452,829.97 $114,989.07 2026-03-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 17 4 $143,344.23 — $39,976.89 $203,447.46 $114,857.36 2026-07-31
1613 APR_DRG Implantable Heart Assist Systems 26 9 — — $107,604.75 $134,505.94 $114,598.99 2026-03-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 21 8 — — $108,705.44 $135,881.80 $114,140.71 2026-03-01
715751 CDM Spacer Peek 12d D30mmxw3 45 26 $285,231.00 $285,231.00 $38,506.18 $285,231.00 $114,092.40 2026-03-01
447250 CDM Cage Spn 5d 9x8x23mm 45 26 $284,502.00 $284,502.00 $38,407.77 $284,502.00 $113,800.80 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 21 8 — — $107,731.67 $134,664.59 $113,118.25 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 8 — — $107,036.06 $133,795.08 $112,387.86 2026-03-01
480949 CDM Cage Spn Cncrd 9x7x23 45 26 $278,927.00 $278,927.00 $37,655.14 $278,927.00 $111,570.80 2026-03-01
1901 OTHER New Technology - Level 49 46 27 $239,558.93 — $103,385.40 $276,936.36 $110,985.94 2026-07-31
1902 OTHER New Technology - Level 49 46 27 $239,558.93 — $103,385.40 $276,936.36 $110,985.94 2026-07-31
426806 CDM Device Embl 25mm 3.75mm 45 26 $276,473.00 $276,473.00 $37,323.86 $276,473.00 $110,589.20 2026-03-01
423709 CDM Device Embl 5x30mm 45 26 $276,473.00 $276,473.00 $37,323.86 $276,473.00 $110,589.20 2026-03-01
245865 CDM Dressing Wnd 20x40cm 60 33 $337,284.00 $337,284.00 $23,609.88 $337,284.00 $110,291.87 2026-03-01
207698 CDM Kit Implant Crnmxf Med 45 26 $274,294.00 $274,294.00 $37,029.69 $274,294.00 $109,717.60 2026-03-01
216456 CDM Cannula Dual 31fr 51cm 65 35 $343,720.00 $343,720.00 $24,060.40 $343,720.00 $109,646.68 2026-03-01
240399 CDM Cannula Introd 29fx46cm 65 35 $343,720.00 $343,720.00 $24,060.40 $343,720.00 $109,646.68 2026-03-01
877253 CDM Cannula Prfsn Str Dil Cr 65 35 $343,720.00 $343,720.00 $24,060.40 $343,720.00 $109,646.68 2026-03-01
875506 CDM Can Prfsn 22fr Vsn 20d 65 35 $343,720.00 $343,720.00 $24,060.40 $343,720.00 $109,646.68 2026-03-01
480948 CDM Cage Spn 5d 9x8x23mm 45 26 $273,458.00 $273,458.00 $36,916.83 $273,458.00 $109,383.20 2026-03-01
270458 CDM Cage Spn 18mm 24mm 45 26 $270,009.00 $270,009.00 $36,451.21 $270,009.00 $108,003.60 2026-03-01
265452 CDM Cage Spnl Exp 18mm 45 26 $270,009.00 $270,009.00 $36,451.21 $270,009.00 $108,003.60 2026-03-01
100901 CDM Coil Emb Endo 6mm 4.6mm 45 26 $267,007.00 $267,007.00 $36,045.94 $267,007.00 $106,802.80 2026-03-01
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