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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 GREEN OAKS HOSPITAL

Dallas, TX · CCN 454094 · Rates published

19,913 distinct procedures filed
50 distinct payers
264,617 rate rows
2026-07-17 last MRF observed
Data quality

232,127 of 264,617 rate rows are consumer-grade (87.7%)

32,490 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 16,033
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 14,898
per-diem day rate — not a per-procedure price 1,293
placeholder amount (≤ $0.02) — excluded from medians 254
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 9
exceeds 10× this hospital's gross charge — excluded from medians 3
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1797829_MEDICAL-CITY-GREEN-OAKS-HOSPITAL_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 · 2026-09-21
Content fingerprint b5707a70fae07476… · 143,071,012 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
845
OTHER 		Inj, Atidarsagene Autotem 13 $4,505,000.00 $4,955,500.00 $4,527,525.00 nat. median
$4,505,000
1.0× median
00845
OTHER 		Inj, Atidarsagene Autotem 1 $4,505,000.00 $4,505,000.00 $4,505,000.00 —
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 13 $3,685,267.00 $4,790,847.10 $3,703,693.33 nat. median
$3,765,001
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,685,267.00 $3,685,267.00 $3,685,267.00 nat. median
$3,562,713
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 15 $3,327,860.00 $4,326,218.00 $3,427,695.80 nat. median
$3,391,964
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 14 $3,335,820.00 $4,336,566.00 $3,369,178.20 nat. median
$8,800
outlier · 382.9×
748
OTHER 		Inj, Lovotibeglogene Auto 15 $3,252,508.00 $4,228,260.40 $3,350,083.24 nat. median
$3,351,720
1.0× median
00908
OTHER 		Topi Adm Prad Zami Per Tr 1 $3,335,820.00 $3,335,820.00 $3,335,820.00 —
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,327,860.00 $3,327,860.00 $3,327,860.00 nat. median
$3,225,691
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $3,252,508.00 $3,252,508.00 $3,252,508.00 nat. median
$3,187,420
1.0× median
906
OTHER 		Inj Elivaldogene Autoteme 14 $3,180,000.00 $4,134,000.00 $3,211,800.00 nat. median
$2,726
outlier · 1178.1×
00906
OTHER 		Inj Elivaldogene Autoteme 1 $3,180,000.00 $3,180,000.00 $3,180,000.00 —
746
OTHER 		Inj, Betibeglogene Autote 15 $2,939,969.00 $3,821,959.70 $3,028,168.07 nat. median
$3,001,835
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 1 $2,939,969.00 $2,939,969.00 $2,939,969.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 14 $2,588,981.00 $4,634,275.99 $2,614,870.81 nat. median
$2,508,045
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,588,981.00 $2,588,981.00 $2,588,981.00 nat. median
$2,316,956
1.1× median
824
OTHER 		Inj, Exagamglogene Autote 15 $2,332,000.00 $4,174,280.00 $2,378,640.00 nat. median
$28,063
outlier · 84.8×
00824
OTHER 		Inj, Exagamglogene Autote 1 $2,332,000.00 $2,332,000.00 $2,332,000.00 —
2067
OTHER 		Afamitresgene Autoleucel 17 $770,620.00 $2,019,024.40 $809,151.00 nat. median
$838,386
1.0× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 1 $629,434.09 $629,434.09 $629,434.09 nat. median
$131,925
outlier · 4.8×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 $551,617.09 $1,273,072.13 $609,957.05 nat. median
$168,055
outlier · 3.6×
9498
OTHER 		Ciltacabtagene Car-pos T 15 $587,649.60 $1,539,641.95 $605,279.09 nat. median
$553,480
1.1× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 2 $357,977.30 $826,172.60 $592,074.95 nat. median
$186,516
outlier · 3.2×
09498
OTHER 		Ciltacabtagene Car-pos T 1 $587,649.60 $587,649.60 $587,649.60 nat. median
$511,310
1.1× median
9194
OTHER 		Tisagenlecleucel Car-pos 15 $566,531.30 $1,484,312.01 $583,527.24 nat. median
$555,653
1.1× median
9413
OTHER 		Lisocabtagene Car Pos T 15 $562,201.20 $1,472,967.14 $579,067.24 nat. median
$542,562
1.1× median
9422
OTHER 		Idecabtagene Vicleucel Ca 15 $558,081.80 $1,462,174.32 $574,824.25 nat. median
$552,917
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $566,531.30 $566,531.30 $566,531.30 nat. median
$513,317
1.1× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $562,201.20 $562,201.20 $562,201.20 nat. median
$501,224
1.1× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $558,081.80 $558,081.80 $558,081.80 nat. median
$510,790
1.1× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 1 $553,169.00 $553,169.00 $553,169.00 nat. median
$599,737
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 16 $532,192.20 $1,394,343.56 $548,157.97 nat. median
$513,929
1.1× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $532,192.20 $532,192.20 $532,192.20 nat. median
$474,772
1.1× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 1 $527,622.00 $527,622.00 $527,622.00 nat. median
$574,037
0.9× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 1 $516,442.00 $516,442.00 $516,442.00 nat. median
$579,571
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 15 $489,450.20 $1,282,359.52 $504,133.71 nat. median
$483,557
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $489,450.20 $489,450.20 $489,450.20 nat. median
$446,714
1.1× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 1 $489,399.00 $489,399.00 $489,399.00 nat. median
$513,770
1.0× median
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 $405,245.30 $405,245.30 $405,245.30 nat. median
$65,477
outlier · 6.2×
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 3 $271,130.70 $625,740.12 $299,805.95 nat. median
$145,435
outlier · 2.1×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 2 $23.68 $578,771.00 $289,397.34 nat. median
$621,313
outlier · 0.5×
831
OTHER 		Obecbtge Autol Up To 400 16 $278,250.00 $729,015.00 $286,597.50 nat. median
$278,250
1.0× median
00831
OTHER 		Obecbtge Autol Up To 400 1 $278,250.00 $278,250.00 $278,250.00 —
7
MS_DRG 		Lung Transplant 2 $165,425.85 $381,784.85 $273,605.35 nat. median
$70,649
outlier · 3.9×
897
OTHER 		Revakinagene, Per Implant 16 $265,000.00 $694,300.00 $272,950.00 nat. median
$269,427
1.0× median
00897
OTHER 		Revakinagene, Per Implant 1 $265,000.00 $265,000.00 $265,000.00 —
14
MS_DRG 		Allogeneic Bone Marrow Transplant 2 $153,516.65 $354,299.71 $253,908.18 nat. median
$72,715
outlier · 3.5×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 2 $6.22 $502,841.00 $251,423.61 nat. median
$562,501
outlier · 0.4×
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 $144,752.41 $334,072.80 $239,412.60 nat. median
$65,418
outlier · 3.7×
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 1 $238,981.01 $238,981.01 $238,981.01 nat. median
$92,809
outlier · 2.6×

Other procedures at this hospital

Browse this hospital's 19,913 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
             
974 MS_DRG HIV With Major Related Condition With Mcc 3 3 — — $36,865.76 $85,082.17 $40,764.75 2026-03-01
J9216 HCPCS Injection, Interferon, Gamma 1-b, 3 Million Units 1 1 — — $40,938.48 $40,938.48 $40,938.48 2026-03-01
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 3 3 — — $37,047.15 $85,500.80 $40,965.32 2026-03-01
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 3 3 — — $37,070.15 $85,553.86 $40,990.75 2026-03-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 3 3 — — $37,201.72 $85,857.52 $41,136.24 2026-03-01
668 MS_DRG Transurethral Procedures With Mcc 3 3 — — $37,300.08 $86,084.52 $41,245.00 2026-03-01
A9600 HCPCS Strontium Sr-89 Chloride, Therapeutic, Per Millicurie 1 1 — — $41,417.99 $41,417.99 $41,417.99 2026-03-01
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 27 18 $62,773.00 — $39,525.60 $103,557.07 $41,501.88 2026-07-17
570 MS_DRG Skin Debridement With Mcc 3 3 — — $37,569.61 $86,706.57 $41,543.04 2026-03-01
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/mcc 3 3 — — $37,607.93 $86,795.01 $41,585.41 2026-03-01
472 MS_DRG Cervical Spinal Fusion With Cc 3 3 — — $37,633.48 $86,853.97 $41,613.66 2026-03-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 3 3 — — $38,020.53 $87,747.25 $42,041.65 2026-03-01
470 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without 4 3 — — $24,639.77 $60,000.00 $42,055.81 2026-03-01
D7949 HCPCS Reconstruct Midface W/graft 1 1 — — $42,501.35 $42,501.35 $42,501.35 2026-03-01
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 3 3 — — $38,536.60 $88,938.28 $42,612.30 2026-03-01
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 3 3 — — $38,578.76 $89,035.57 $42,658.91 2026-03-01
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 3 3 — — $38,583.87 $89,047.36 $42,664.56 2026-03-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 3 3 — — $38,746.10 $89,421.77 $42,843.95 2026-03-01
A9515 HCPCS Choline C-11, Diagnostic, Per Study Dose Up To 20 Millicuries 1 1 — — $42,922.20 $42,922.20 $42,922.20 2026-03-01
01142 OTHER Supprelin La Implant 1 1 — — $43,185.34 $43,185.34 $43,185.34 2026-03-01
263 MS_DRG Vein Ligation And Stripping 3 3 — — $39,055.23 $90,135.21 $43,185.78 2026-03-01
662 MS_DRG Minor Bladder Procedures With Mcc 3 3 — — $39,107.60 $90,256.08 $43,243.69 2026-03-01
01594 OTHER New Technology - Level 43 1 1 — — $43,277.88 $43,277.88 $43,277.88 2026-03-01
01580 OTHER New Technology - Level 43 1 1 — — $43,277.88 $43,277.88 $43,277.88 2026-03-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 3 3 — — $39,716.92 $91,662.33 $43,917.45 2026-03-01
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 3 3 — — $39,787.18 $91,824.47 $43,995.14 2026-03-01
665 MS_DRG Prostatectomy With Mcc 3 3 — — $39,870.21 $92,016.10 $44,086.95 2026-03-01
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 3 3 — — $40,137.19 $92,632.25 $44,382.16 2026-03-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 3 3 — — $40,231.71 $92,850.41 $44,486.69 2026-03-01
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 3 3 — — $40,250.87 $92,894.63 $44,507.88 2026-03-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 3 3 — — $40,365.84 $93,159.96 $44,635.00 2026-03-01
500 MS_DRG Soft Tissue Procedures With Mcc 3 3 — — $40,427.16 $93,301.47 $44,702.80 2026-03-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 3 3 — — $40,588.11 $93,672.93 $44,880.78 2026-03-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 3 3 — — $40,669.86 $93,861.61 $44,971.18 2026-03-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 3 3 — — $40,709.46 $93,953.00 $45,014.96 2026-03-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 3 3 — — $40,784.83 $94,126.94 $45,098.30 2026-03-01
1142 OTHER Supprelin La Implant 26 17 $70,797.51 — $43,185.34 $113,145.59 $45,344.61 2026-07-17
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 3 3 — — $41,009.65 $94,645.80 $45,346.90 2026-03-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 3 3 — — $41,222.98 $95,138.14 $45,582.79 2026-03-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 3 3 — — $41,265.13 $95,235.42 $45,629.40 2026-03-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 3 3 — — $41,322.61 $95,368.09 $45,692.96 2026-03-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 3 3 — — $41,368.60 $95,474.22 $45,743.81 2026-03-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 3 3 — — $41,551.27 $95,895.80 $45,945.80 2026-03-01
1580 OTHER New Technology - Level 43 26 17 $81,013.14 — $44,247.19 $115,927.64 $46,459.55 2026-07-17
1594 OTHER New Technology - Level 43 26 17 $81,013.14 — $44,247.19 $115,927.64 $46,459.55 2026-07-17
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 3 3 — — $42,048.18 $97,042.61 $46,495.26 2026-03-01
37 MS_DRG Extracranial Procedures With Mcc 3 3 — — $42,053.29 $97,054.40 $46,500.91 2026-03-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 3 3 — — $42,196.35 $97,384.59 $46,659.11 2026-03-01
264 MS_DRG Other Circulatory System O.r. Procedures 3 3 — — $42,672.82 $98,484.23 $47,185.97 2026-03-01
L8685 HCPCS $13,084.02 1 1 $14,868.20 — $47,650.80 $47,650.80 $47,650.80 2026-07-17
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 3 3 — — $43,522.30 $100,444.72 $48,125.29 2026-03-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 3 3 — — $43,579.78 $100,577.38 $48,188.85 2026-03-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 3 3 — — $43,794.38 $101,072.66 $48,426.15 2026-03-01
359 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc 3 3 — — $43,924.68 $101,373.37 $48,570.22 2026-03-01
A9572 HCPCS Indium In-111 Pentetreotide, Diagnostic, Per Study Dose, Up To 6 Millicuries 1 1 — — $48,725.28 $48,725.28 $48,725.28 2026-03-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 3 3 — — $44,129.06 $101,845.06 $48,796.22 2026-03-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 3 3 — — $44,343.66 $102,340.34 $49,033.53 2026-03-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 3 3 — — $44,548.05 $102,812.04 $49,259.53 2026-03-01
252 MS_DRG Other Vascular Procedures With Mcc 3 3 — — $44,559.54 $102,838.57 $49,272.24 2026-03-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 3 3 — — $44,956.82 $103,755.43 $49,711.53 2026-03-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 3 3 — — $45,428.18 $104,843.28 $50,232.74 2026-03-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 3 3 — — $45,465.22 $104,928.78 $50,273.70 2026-03-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 3 3 — — $45,508.65 $105,029.01 $50,321.73 2026-03-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 3 3 — — $45,546.97 $105,117.45 $50,364.10 2026-03-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 3 3 — — $45,614.68 $105,273.70 $50,438.96 2026-03-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 3 3 — — $45,660.66 $105,379.83 $50,489.81 2026-03-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 3 3 — — $45,766.69 $105,624.53 $50,607.05 2026-03-01
A9582 HCPCS Iodine I-123 Iobenguane, Diagnostic, Per Study Dose, Up To 15 Millicuries 1 1 — — $50,684.04 $50,684.04 $50,684.04 2026-03-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 3 3 — — $46,068.15 $106,320.28 $50,940.40 2026-03-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 3 3 — — $46,137.13 $106,479.48 $51,016.68 2026-03-01
265 MS_DRG Aicd Lead Procedures 3 3 — — $46,218.89 $106,668.15 $51,107.07 2026-03-01
332 MS_DRG Rectal Resection With Mcc 3 3 — — $46,250.82 $106,741.86 $51,142.39 2026-03-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 3 3 — — $46,314.69 $106,889.26 $51,213.01 2026-03-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 3 3 — — $46,350.46 $106,971.81 $51,252.56 2026-03-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 3 3 — — $46,901.02 $108,242.44 $51,861.35 2026-03-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 3 3 — — $46,920.18 $108,286.66 $51,882.54 2026-03-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 28 18 $78,774.15 — $49,600.80 $280,224.09 $52,080.84 2026-07-17
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 3 3 — — $47,337.89 $109,250.69 $52,344.43 2026-03-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 28 18 $79,419.45 — $50,007.20 $282,519.64 $52,507.56 2026-07-17
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 3 3 — — $47,606.14 $109,869.79 $52,641.05 2026-03-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 3 3 — — $47,740.27 $110,179.34 $52,789.36 2026-03-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 3 3 — — $47,745.38 $110,191.13 $52,795.01 2026-03-01
01595 OTHER New Technology - Level 44 1 1 — — $52,895.08 $52,895.08 $52,895.08 2026-03-01
01581 OTHER New Technology - Level 44 1 1 — — $52,895.08 $52,895.08 $52,895.08 2026-03-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 3 3 — — $47,859.07 $110,453.51 $52,920.72 2026-03-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 3 3 — — $48,068.56 $110,937.00 $53,152.38 2026-03-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 3 3 — — $49,043.22 $113,186.40 $54,230.11 2026-03-01
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $54,404.11 $54,404.11 $54,404.11 2026-03-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 3 3 — — $49,322.97 $113,832.04 $54,539.45 2026-03-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 3 3 — — $49,444.32 $114,112.11 $54,673.64 2026-03-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 3 3 — — $49,970.61 $115,326.72 $55,255.59 2026-03-01
9273 OTHER Sipuleucel-t Auto Cd54+ 22 15 $98,985.24 — $54,404.11 $142,538.77 $56,036.23 2026-07-17
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 3 3 — — $50,892.89 $117,455.25 $56,275.41 2026-03-01
1581 OTHER New Technology - Level 44 26 17 $99,015.86 — $54,079.79 $141,689.05 $56,783.78 2026-07-17
1595 OTHER New Technology - Level 44 26 17 $99,015.86 — $54,079.79 $141,689.05 $56,783.78 2026-07-17
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 3 3 — — $51,357.87 $118,528.36 $56,789.56 2026-03-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $56,824.55 $56,824.55 $56,824.55 2026-03-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 3 3 — — $52,699.14 $121,623.87 $58,272.69 2026-03-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 3 3 — — $53,050.42 $122,434.59 $58,661.12 2026-03-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 3 3 — — $53,300.79 $123,012.42 $58,937.97 2026-03-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 3 3 — — $53,507.73 $123,490.01 $59,166.80 2026-03-01
901 MS_DRG Wound Debridements For Injuries With Mcc 3 3 — — $53,607.37 $123,719.96 $59,276.97 2026-03-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 3 3 — — $53,671.24 $123,867.37 $59,347.60 2026-03-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 3 3 — — $53,828.36 $124,229.99 $59,521.34 2026-03-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 3 3 — — $53,855.18 $124,291.90 $59,551.00 2026-03-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 3 3 — — $53,947.16 $124,504.16 $59,652.70 2026-03-01
1643 OTHER Y90 Ibritumomab, Rx 26 17 $110,618.58 — $56,824.55 $148,880.32 $59,665.78 2026-07-17
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 3 3 — — $54,171.98 $125,023.02 $59,901.30 2026-03-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 4 3 — — $35,102.95 $98,225.00 $59,914.64 2026-03-01
140 MS_DRG Major Head And Neck Procedures With Mcc 3 3 — — $54,484.94 $125,745.31 $60,247.36 2026-03-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 3 3 — — $54,837.50 $126,558.98 $60,637.21 2026-03-01
935 MS_DRG Non-extensive Burns 1 1 — — $60,730.86 $60,730.86 $60,730.86 2026-03-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 3 3 — — $55,278.21 $127,576.08 $61,124.53 2026-03-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $61,803.51 $61,803.51 $61,803.51 2026-03-01
L8687 HCPCS $15,447.65 1 1 $17,554.15 — $62,014.14 $62,014.14 $62,014.14 2026-07-17
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 3 3 — — $56,113.63 $129,504.14 $62,048.30 2026-03-01
01582 OTHER New Technology - Level 45 1 1 — — $62,512.28 $62,512.28 $62,512.28 2026-03-01
01596 OTHER New Technology - Level 45 1 1 — — $62,512.28 $62,512.28 $62,512.28 2026-03-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 3 3 — — $57,009.08 $131,570.75 $63,038.46 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 1 1 — — $63,235.60 $63,235.60 $63,235.60 2026-03-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 3 3 — — $57,233.91 $132,089.62 $63,287.06 2026-03-01
163 MS_DRG Major Chest Procedures With Mcc 3 3 — — $57,250.51 $132,127.95 $63,305.42 2026-03-01
799 MS_DRG Splenic Procedures With Mcc 3 3 — — $57,852.17 $133,516.50 $63,970.71 2026-03-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 3 3 — — $58,079.55 $134,041.26 $64,222.14 2026-03-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 3 3 — — $58,105.09 $134,100.22 $64,250.39 2026-03-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $64,274.79 $64,274.79 $64,274.79 2026-03-01
245 MS_DRG Aicd Generator Procedures 3 3 — — $58,280.10 $134,504.11 $64,443.90 2026-03-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 3 3 — — $58,566.24 $135,164.49 $64,760.30 2026-03-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 3 3 — — $58,715.69 $135,509.42 $64,925.56 2026-03-01
934 MS_DRG Full Thickness Burn Without Skin Graft Or Inhalation Injury 1 1 — — $65,170.70 $65,170.70 $65,170.70 2026-03-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 3 3 — — $58,996.72 $136,158.00 $65,236.31 2026-03-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 3 3 — — $59,754.22 $137,906.22 $66,073.93 2026-03-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 3 3 — — $59,933.05 $138,318.96 $66,271.68 2026-03-01
5244 OTHER Level 4 Blood Product Exc 26 17 $73,859.72 — $63,187.75 $165,551.90 $66,347.14 2026-07-17
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 3 3 — — $60,055.68 $138,601.97 $66,407.27 2026-03-01
1582 OTHER New Technology - Level 45 26 17 $117,018.58 — $63,912.39 $167,450.46 $67,108.01 2026-07-17
1596 OTHER New Technology - Level 45 26 17 $117,018.58 — $63,912.39 $167,450.46 $67,108.01 2026-07-17
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 3 3 — — $60,814.46 $140,353.14 $67,246.30 2026-03-01
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 2 2 $23,554.48 — $27,070.50 $107,510.88 $67,290.69 2026-07-17
717 OTHER Instill Adstiladrin, Tx D 26 17 $47,195.53 — $64,274.79 $168,399.95 $67,488.53 2026-07-17
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 3 3 — — $61,370.13 $141,635.57 $67,860.74 2026-03-01
471 MS_DRG Cervical Spinal Fusion With Mcc 3 3 — — $61,681.81 $142,354.90 $68,205.39 2026-03-01
652 MS_DRG Kidney Transplant 2 2 — — $41,253.63 $95,208.89 $68,231.26 2026-03-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 3 3 — — $62,607.93 $144,492.28 $69,229.45 2026-03-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 3 3 — — $62,869.80 $145,096.64 $69,519.01 2026-03-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 3 3 — — $63,085.68 $145,594.87 $69,757.73 2026-03-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 3 3 — — $63,198.09 $145,854.30 $69,882.02 2026-03-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 3 3 — — $63,709.05 $147,033.54 $70,447.02 2026-03-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 3 — — $64,383.51 $148,590.14 $71,192.82 2026-03-01
01583 OTHER New Technology - Level 46 1 1 — — $72,129.48 $72,129.48 $72,129.48 2026-03-01
01597 OTHER New Technology - Level 46 1 1 — — $72,129.48 $72,129.48 $72,129.48 2026-03-01
J7311 HCPCS Injection, Fluocinolone Acetonide, Intravitreal Implant (retisert), 0.01 Mg 2 2 $332.61 — $340.04 $144,007.56 $72,173.80 2026-07-17
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 27 18 — — $68,801.70 $180,260.45 $72,241.79 2026-03-01
653 MS_DRG Major Bladder Procedures With Mcc 3 3 — — $66,378.81 $153,195.07 $73,399.15 2026-03-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 3 3 — — $66,493.78 $153,460.40 $73,526.27 2026-03-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 3 3 — — $67,399.46 $155,550.60 $74,527.74 2026-03-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 3 3 — — $67,623.00 $156,066.52 $74,774.93 2026-03-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 3 3 — — $68,080.31 $157,121.94 $75,280.60 2026-03-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 3 — — $68,121.19 $157,216.28 $75,325.80 2026-03-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 4 3 — — $45,048.79 $103,967.69 $75,856.62 2026-03-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 3 3 — — $69,670.67 $160,792.32 $77,039.16 2026-03-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 3 3 — — $69,780.53 $161,045.86 $77,160.64 2026-03-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 3 3 — — $69,880.17 $161,275.81 $77,270.81 2026-03-01
1597 OTHER New Technology - Level 46 26 17 $135,021.30 — $73,744.99 $193,211.87 $77,432.24 2026-07-17
1583 OTHER New Technology - Level 46 26 17 $135,021.30 — $73,744.99 $193,211.87 $77,432.24 2026-07-17
834 MS_DRG Acute Leukemia With Mcc 3 3 — — $70,127.98 $161,847.74 $77,544.84 2026-03-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 3 3 — — $70,550.80 $162,823.56 $78,012.38 2026-03-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 3 3 — — $71,102.64 $164,097.14 $78,622.57 2026-03-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 3 3 — — $71,815.43 $165,742.18 $79,410.75 2026-03-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 3 3 — — $72,805.41 $168,026.96 $80,505.44 2026-03-01
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 3 3 — — $72,899.94 $168,245.12 $80,609.96 2026-03-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 3 3 — — $73,198.85 $168,934.97 $80,940.49 2026-03-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 3 3 — — $73,668.94 $170,019.88 $81,460.29 2026-03-01
01598 OTHER New Technology - Level 47 1 1 — — $81,746.68 $81,746.68 $81,746.68 2026-03-01
01584 OTHER New Technology - Level 47 1 1 — — $81,746.68 $81,746.68 $81,746.68 2026-03-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 3 3 — — $74,916.96 $172,900.17 $82,840.30 2026-03-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 3 3 — — $74,965.50 $173,012.20 $82,893.97 2026-03-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 3 3 — — $76,172.64 $175,798.15 $84,228.79 2026-03-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 3 3 — — $76,728.31 $177,080.57 $84,843.22 2026-03-01
28 MS_DRG Spinal Procedures With Mcc 3 3 — — $76,750.02 $177,130.69 $84,867.24 2026-03-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 3 3 — — $77,443.65 $178,731.51 $85,634.22 2026-03-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 3 3 — — $78,193.49 $180,462.05 $86,463.36 2026-03-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 3 3 — — $78,284.18 $180,671.36 $86,563.65 2026-03-01
1584 OTHER New Technology - Level 47 26 17 $153,024.02 — $83,577.59 $218,973.29 $87,756.47 2026-07-17
1598 OTHER New Technology - Level 47 26 17 $153,024.02 — $83,577.59 $218,973.29 $87,756.47 2026-07-17
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 3 3 — — $82,196.86 $189,701.39 $90,890.14 2026-03-01
01585 OTHER New Technology - Level 48 1 1 — — $91,363.88 $91,363.88 $91,363.88 2026-03-01
01599 OTHER New Technology - Level 48 1 1 — — $91,363.88 $91,363.88 $91,363.88 2026-03-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 3 3 — — $83,687.58 $193,141.82 $92,538.53 2026-03-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 3 — — $83,992.88 $193,846.42 $92,876.11 2026-03-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 3 — — $83,992.88 $193,846.42 $92,876.11 2026-03-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 3 3 — — $85,350.76 $196,980.25 $94,377.60 2026-03-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 3 3 — — $85,413.35 $197,124.71 $94,446.81 2026-03-01
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc 1 1 — — $94,952.40 $94,952.40 $94,952.40 2026-03-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 3 3 — — $85,983.07 $198,439.56 $95,076.79 2026-03-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 3 3 — — $87,858.29 $202,767.37 $97,150.34 2026-03-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 3 3 — — $88,291.33 $203,766.78 $97,629.18 2026-03-01
6 MS_DRG Liver Transplant Without Mcc 2 2 — — $59,233.04 $136,703.40 $97,968.22 2026-03-01
1585 OTHER New Technology - Level 48 26 17 $171,026.74 — $93,410.20 $244,734.72 $98,080.71 2026-07-17
1599 OTHER New Technology - Level 48 26 17 $171,026.74 — $93,410.20 $244,734.72 $98,080.71 2026-07-17
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
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 27 18 — — $95,081.00 $249,112.22 $99,835.05 2026-03-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 3 3 — — $91,083.73 $210,211.32 $100,716.90 2026-03-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 3 3 — — $91,137.38 $210,335.14 $100,776.22 2026-03-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 3 3 — — $92,210.40 $212,811.55 $101,962.73 2026-03-01
01901 OTHER New Technology - Level 49 1 1 — — $103,385.40 $103,385.40 $103,385.40 2026-03-01
01902 OTHER New Technology - Level 49 1 1 — — $103,385.40 $103,385.40 $103,385.40 2026-03-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 3 3 — — $97,336.60 $224,642.27 $107,631.09 2026-03-01
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 1 1 — — $107,964.43 $107,964.43 $107,964.43 2026-03-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 3 3 — — $97,659.78 $225,388.14 $107,988.45 2026-03-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 3 — — $98,082.60 $226,363.96 $108,455.99 2026-03-01
1901 OTHER New Technology - Level 49 26 17 $193,530.14 — $105,700.90 $276,936.36 $110,985.94 2026-07-17
1902 OTHER New Technology - Level 49 26 17 $193,530.14 — $105,700.90 $276,936.36 $110,985.94 2026-07-17
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 3 3 — — $100,516.05 $231,980.09 $111,146.80 2026-03-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 2 2 — — $69,392.20 $160,149.64 $114,770.92 2026-03-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 1 1 — — $114,804.91 $114,804.91 $114,804.91 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 28 18 $177,067.59 — $111,492.00 $629,884.36 $117,066.60 2026-07-17
01904 OTHER New Technology - Level 50 1 1 — — $117,811.20 $117,811.20 $117,811.20 2026-03-01
01903 OTHER New Technology - Level 50 1 1 — — $117,811.20 $117,811.20 $117,811.20 2026-03-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 2 2 — — $71,593.16 $165,229.21 $118,411.18 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 3 3 — — $107,345.03 $247,740.64 $118,698.02 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 3 3 — — $107,683.54 $248,521.88 $119,072.34 2026-03-01
J7310 HCPCS Ganciclovir, 4.5 Mg, Long-acting Implant 1 1 — — $121,326.75 $121,326.75 $121,326.75 2026-03-01
850 MS_DRG Acute Leukemia With Other Procedures 3 3 — — $110,616.45 $255,290.72 $122,315.44 2026-03-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 2 2 — — $75,745.99 $174,813.49 $125,279.74 2026-03-01
1904 OTHER New Technology - Level 50 26 17 $220,534.22 — $120,449.80 $315,578.48 $126,472.29 2026-07-17
1903 OTHER New Technology - Level 50 26 17 $220,534.22 — $120,449.80 $315,578.48 $126,472.29 2026-07-17
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 3 3 — — $115,088.63 $265,612.02 $127,260.60 2026-03-01
01906 OTHER New Technology - Level 51 1 1 — — $132,237.00 $132,237.00 $132,237.00 2026-03-01
01905 OTHER New Technology - Level 51 1 1 — — $132,237.00 $132,237.00 $132,237.00 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 2 2 $42,302.58 — $45,212.00 $227,738.40 $136,475.20 2026-07-17
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 3 — — $124,965.49 $288,406.73 $138,182.05 2026-03-01
215 MS_DRG Other Heart Assist System Implant 3 3 — — $127,190.72 $293,542.32 $140,642.63 2026-03-01
1906 OTHER New Technology - Level 51 26 17 $247,538.30 — $135,198.70 $354,220.59 $141,958.64 2026-07-17
1905 OTHER New Technology - Level 51 26 17 $247,538.30 — $135,198.70 $354,220.59 $141,958.64 2026-07-17
01908 OTHER New Technology - Level 52 1 1 — — $146,662.80 $146,662.80 $146,662.80 2026-03-01
01907 OTHER New Technology - Level 52 1 1 — — $146,662.80 $146,662.80 $146,662.80 2026-03-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 1 1 — — $150,512.49 $150,512.49 $150,512.49 2026-03-01
10 MS_DRG Pancreas Transplant 2 2 — — $91,662.39 $211,546.81 $151,604.60 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 3 3 — — $138,905.75 $320,579.34 $153,596.66 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 3 3 — — $140,784.81 $324,916.00 $155,674.45 2026-03-01
1907 OTHER New Technology - Level 52 26 17 $274,542.38 — $149,947.60 $392,862.71 $157,444.98 2026-07-17
1908 OTHER New Technology - Level 52 26 17 $274,542.38 — $149,947.60 $392,862.71 $157,444.98 2026-07-17
209 MS_DRG Complex Aortic Arch Procedures 3 3 — — $144,586.35 $333,689.54 $159,878.05 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 2 2 $55,114.75 — $57,017.10 $310,609.58 $183,813.34 2026-07-17
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 3 3 — — $176,937.78 $408,353.12 $195,651.02 2026-03-01
00886 OTHER Inj. Remestemcel-l-rknd/ 1 1 — — $201,669.00 $201,669.00 $201,669.00 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 23 16 $16,885.05 — $201,669.00 $528,372.78 $207,719.07 2026-07-17
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 1 1 — — $211,458.37 $211,458.37 $211,458.37 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 2 2 — — $131,706.33 $303,963.85 $217,835.09 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 1 1 — — $238,981.01 $238,981.01 $238,981.01 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 2 — — $144,752.41 $334,072.80 $239,412.60 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 2 2 — — $6.22 $502,841.00 $251,423.61 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 2 2 — — $153,516.65 $354,299.71 $253,908.18 2026-03-01
00897 OTHER Revakinagene, Per Implant 1 1 — — $265,000.00 $265,000.00 $265,000.00 2026-03-01
897 OTHER Revakinagene, Per Implant 23 16 $10,530.58 — $265,000.00 $694,300.00 $272,950.00 2026-07-17
7 MS_DRG Lung Transplant 2 2 — — $165,425.85 $381,784.85 $273,605.35 2026-03-01
00831 OTHER Obecbtge Autol Up To 400 1 1 — — $278,250.00 $278,250.00 $278,250.00 2026-03-01
831 OTHER Obecbtge Autol Up To 400 23 16 $29,403.50 — $278,250.00 $729,015.00 $286,597.50 2026-07-17
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 2 2 — — $23.68 $578,771.00 $289,397.34 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 3 3 — — $271,130.70 $625,740.12 $299,805.95 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 1 — — $405,245.30 $405,245.30 $405,245.30 2026-03-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 1 1 — — $489,399.00 $489,399.00 $489,399.00 2026-03-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $489,450.20 $489,450.20 $489,450.20 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 22 15 $782,439.00 — $489,450.20 $1,282,359.52 $504,133.71 2026-07-17
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 1 1 — — $516,442.00 $516,442.00 $516,442.00 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 1 1 — — $527,622.00 $527,622.00 $527,622.00 2026-03-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $532,192.20 $532,192.20 $532,192.20 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 23 16 $782,336.82 — $532,192.20 $1,394,343.56 $548,157.97 2026-07-17
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 1 1 — — $553,169.00 $553,169.00 $553,169.00 2026-03-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $558,081.80 $558,081.80 $558,081.80 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $562,201.20 $562,201.20 $562,201.20 2026-03-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $566,531.30 $566,531.30 $566,531.30 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 22 15 $822,639.50 — $558,081.80 $1,462,174.32 $574,824.25 2026-07-17
9413 OTHER Lisocabtagene Car Pos T 22 15 $804,598.30 — $562,201.20 $1,472,967.14 $579,067.24 2026-07-17
9194 OTHER Tisagenlecleucel Car-pos 22 15 $839,634.71 — $566,531.30 $1,484,312.01 $583,527.24 2026-07-17
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $587,649.60 $587,649.60 $587,649.60 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 2 2 — — $357,977.30 $826,172.60 $592,074.95 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 22 15 $886,057.50 — $587,649.60 $1,539,641.95 $605,279.09 2026-07-17
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 3 — — $551,617.09 $1,273,072.13 $609,957.05 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 1 1 — — $629,434.09 $629,434.09 $629,434.09 2026-03-01
2067 OTHER Afamitresgene Autoleucel 26 17 — — $770,620.00 $2,019,024.40 $809,151.00 2026-03-01
00824 OTHER Inj, Exagamglogene Autote 1 1 — — $2,332,000.00 $2,332,000.00 $2,332,000.00 2026-03-01
824 OTHER Inj, Exagamglogene Autote 20 15 $61,973.29 — $2,332,000.00 $4,174,280.00 $2,378,640.00 2026-07-17
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,588,981.00 $2,588,981.00 $2,588,981.00 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 19 14 — — $2,588,981.00 $4,634,275.99 $2,614,870.81 2026-03-01
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,939,969.00 $2,939,969.00 $2,939,969.00 2026-03-01
746 OTHER Inj, Betibeglogene Autote 22 15 $42,239.03 — $2,939,969.00 $3,821,959.70 $3,028,168.07 2026-07-17
00906 OTHER Inj Elivaldogene Autoteme 1 1 — — $3,180,000.00 $3,180,000.00 $3,180,000.00 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 19 14 $47,279.40 — $3,180,000.00 $4,134,000.00 $3,211,800.00 2026-07-17
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,252,508.00 $3,252,508.00 $3,252,508.00 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,327,860.00 $3,327,860.00 $3,327,860.00 2026-03-01
00908 OTHER Topi Adm Prad Zami Per Tr 1 1 — — $3,335,820.00 $3,335,820.00 $3,335,820.00 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 22 15 $35,321.94 — $3,252,508.00 $4,228,260.40 $3,350,083.24 2026-07-17
908 OTHER Topi Adm Prad Zami Per Tr 19 14 $53,743.03 — $3,335,820.00 $4,336,566.00 $3,369,178.20 2026-07-17
714 OTHER Inj Delandistrogene Mox R 22 15 $24,344.78 — $3,327,860.00 $4,326,218.00 $3,427,695.80 2026-07-17
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,685,267.00 $3,685,267.00 $3,685,267.00 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 18 13 — — $3,685,267.00 $4,790,847.10 $3,703,693.33 2026-03-01
00845 OTHER Inj, Atidarsagene Autotem 1 1 — — $4,505,000.00 $4,505,000.00 $4,505,000.00 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 18 13 $22,250.52 — $4,505,000.00 $4,955,500.00 $4,527,525.00 2026-07-17
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