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

Seattle Cancer Care Alliance

Seattle, WA · CCN 500138 · Rates published

4,355 distinct procedures filed
14 distinct payers
61,778 rate rows
2026-04-01 last MRF observed
Data quality

11,084 of 61,778 rate rows are consumer-grade (17.9%)

50,694 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 50,674
placeholder amount (≤ $0.02) — excluded from medians 20
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.fredhutch.org/content/dam/www/patient-care/insurance-billing/price-transparency/911935159_fred-hutchinson-cancer-center_standardcharges.json
Found on page https://www.fredhutch.org/en/patient-care/patient-services/insurance-and-billing/patient-pricing-information.html
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-09-21
Content fingerprint 6cd66ddc39b417be… · 17,650,200 bytes · first seen 2026-05-08

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
J3391
HCPCS 		Inj, Atidarsagene Autotemcel 1 $10,586,750.00 $10,586,750.00 $10,586,750.00 nat. median
$4,505,000
outlier · 2.4×
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 1 $8,660,376.67 $8,660,376.67 $8,660,376.67 nat. median
$3,685,267
outlier · 2.3×
J3389
HCPCS 		Topi Adm Prad Zami Per Treat 1 $7,839,177.00 $7,839,177.00 $7,839,177.00 nat. median
$3,335,820
outlier · 2.4×
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 1 $7,820,470.37 $7,820,470.37 $7,820,470.37 nat. median
$3,325,455
outlier · 2.4×
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 1 $7,643,393.99 $7,643,393.99 $7,643,393.99 nat. median
$3,248,446
outlier · 2.4×
J3387
HCPCS 		Inj Elivaldogene Autotemecel 1 $7,473,000.00 $7,473,000.00 $7,473,000.00 nat. median
$3,180,000
outlier · 2.4×
J3393
HCPCS 		Inj, Betibeglogene Autotemce 1 $6,908,926.89 $6,908,926.89 $6,908,926.89 nat. median
$2,968,000
outlier · 2.3×
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 1 $6,084,105.89 $6,084,105.89 $6,084,105.89 nat. median
$2,455,111
outlier · 2.5×
J3392
HCPCS 		Inj, Exagamglogene Autotem 1 $5,480,200.00 $5,480,200.00 $5,480,200.00 nat. median
$2,332,000
outlier · 2.4×
Q2057
HCPCS 		Afamitresgene Autoleucel 1 $1,810,957.00 $1,810,957.00 $1,810,957.00 nat. median
$813,967
outlier · 2.2×
Q2056
HCPCS 		Ciltacabtagene Car-pos T 1 $1,380,976.49 $1,380,976.49 $1,380,976.49 nat. median
$599,737
outlier · 2.3×
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 1 $1,331,348.56 $1,331,348.56 $1,331,348.56 nat. median
$621,313
outlier · 2.1×
Q2054
HCPCS 		Lisocabtagene Maraleucel 70000000 Cells/ml IV Susp 1 $1,321,172.91 $1,321,172.91 $1,321,172.91 nat. median
$579,571
outlier · 2.3×
Q2055
HCPCS 		Idecabtagene Vicleucel Car 1 $1,311,492.07 $1,311,492.07 $1,311,492.07 nat. median
$574,037
outlier · 2.3×
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $1,250,651.76 $1,250,651.76 $1,250,651.76 nat. median
$562,501
outlier · 2.2×
Q2053
HCPCS 		Brexucabtagene Car Pos T 1 $1,150,207.97 $1,150,207.97 $1,150,207.97 nat. median
$513,770
outlier · 2.2×
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 1 $653,887.50 $653,887.50 $653,887.50 nat. median
$286,598
outlier · 2.3×
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 1 $473,922.20 $473,922.20 $473,922.20 nat. median
$207,733
outlier · 2.3×
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 12 — — $439,039.36 nat. median
$11,701
outlier · 37.5×
18
MS_DRG 		Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 12 — — $369,651.35 nat. median
$168,055
outlier · 2.2×
14
MS_DRG 		Allogeneic Bone Marrow Transplant 12 — — $253,691.22 nat. median
$72,715
outlier · 3.5×
372
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections With Cc 12 — — $249,436.37 nat. median
$7,653
outlier · 32.6×
840
MS_DRG 		Lymphoma And Non-acute Leukemia With Mcc 12 — — $218,656.74 nat. median
$22,339
outlier · 9.8×
97
MS_DRG 		Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 12 — — $218,445.08 nat. median
$24,748
outlier · 8.8×
J7330
HCPCS 		Cultured Chondrocytes Implnt 1 $196,756.69 $196,756.69 $196,756.69 nat. median
$92,809
outlier · 2.1×
J9029
HCPCS 		Inj, Adstiladrin, Per Tx Dos 1 $151,045.76 $151,045.76 $151,045.76 nat. median
$66,211
outlier · 2.3×
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 12 — — $144,394.94 nat. median
$7,418
outlier · 19.5×
A9543
HCPCS 		Y90 Ibritumomab, Rx 1 $133,537.69 $133,537.69 $133,537.69 nat. median
$65,477
outlier · 2.0×
808
MS_DRG 		Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 12 — — $130,032.28 nat. median
$15,758
outlier · 8.3×
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 1 $127,849.66 $127,849.66 $127,849.66 nat. median
$63,499
outlier · 2.0×
A9699
HCPCS 		Radiopharm Rx Agent Noc 1 $109,733.56 $109,733.56 $109,733.56 nat. median
$7,098
outlier · 15.5×
16
MS_DRG 		Autologous Bone Marrow Transplant With Cc/Mcc 12 — — $102,359.53 nat. median
$38,932
outlier · 2.6×
J9226
HCPCS 		Supprelin La Implant 1 $101,485.55 $101,485.55 $101,485.55 nat. median
$57,036
1.8× median
391
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 12 — — $98,508.71 nat. median
$9,511
outlier · 10.4×
846
MS_DRG 		Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc 12 — — $80,375.85 nat. median
$16,550
outlier · 4.9×
999
MS_DRG 		Ungroupable 12 — — $78,094.39 nat. median
$2,024
outlier · 38.6×
837
MS_DRG 		Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 12 — — $75,124.86 nat. median
$32,992
outlier · 2.3×
J9266
HCPCS 		Pegaspargase Injection 1 $66,796.54 $66,796.54 $66,796.54 nat. median
$31,084
outlier · 2.1×
175
MS_DRG 		Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 12 — — $65,836.12 nat. median
$10,317
outlier · 6.4×
423
MS_DRG 		Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 12 — — $57,319.67 nat. median
$29,159
2.0× median
J9600
HCPCS 		Porfimer Sodium Injection 1 $56,936.79 $56,936.79 $56,936.79 nat. median
$26,416
outlier · 2.2×
25
MS_DRG 		Craniotomy And Endovascular Intracranial Procedures With Mcc 12 — — $56,269.68 nat. median
$32,531
1.7× median
809
MS_DRG 		Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 12 — — $56,211.00 nat. median
$9,154
outlier · 6.1×
206
MS_DRG 		Other Respiratory System Diagnoses Without Mcc 12 — — $55,921.54 nat. median
$6,811
outlier · 8.2×
542
MS_DRG 		Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 12 — — $54,035.84 nat. median
$12,976
outlier · 4.2×
5661
OTHER 		Therapeutic Nuclear Medicine 13 — — $51,267.57 nat. median
$249
outlier · 205.8×
202
MS_DRG 		Bronchitis And Asthma With Cc/Mcc 12 — — $51,108.03 nat. median
$7,228
outlier · 7.1×
315
MS_DRG 		Other Circulatory System Diagnoses With Cc 12 — — $45,978.24 nat. median
$7,244
outlier · 6.3×
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 12 — — $44,833.17 nat. median
$14,442
outlier · 3.1×
153
MS_DRG 		Otitis Media And Uri Without Mcc 12 — — $42,515.29 nat. median
$5,379
outlier · 7.9×

Other procedures at this hospital

Browse this hospital's 4,355 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
             
0016M OTHER Onc Bladder Mrna 209 Gen Alg 2 1 — — $4,798.24 $4,798.24 $4,798.24 2026-04-01
0017M OTHER Onc Dlbcl Mrna 20 Genes Alg 2 1 — — $3,451.54 $3,451.54 $3,451.54 2026-04-01
0018U OTHER Onc Thyr 10 Microrna Seq Alg 2 1 — — $4,127.87 $4,127.87 $4,127.87 2026-04-01
0019U OTHER Onc RNA Tiss Predict Alg 2 1 — — $5,053.12 $5,053.12 $5,053.12 2026-04-01
0026U OTHER Onc Thyr Dna&mrna 112 Genes 2 1 — — $4,950.00 $4,950.00 $4,950.00 2026-04-01
0036U OTHER Xome Tum & Nml Spec Seq Alys 2 1 — — $6,572.50 $6,572.50 $6,572.50 2026-04-01
0037U OTHER Trgt Gen Seq DNA 324 Genes 2 1 — — $4,812.50 $4,812.50 $4,812.50 2026-04-01
0045U OTHER Onc Brst Dux Carc Is 12 Gene 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
0047U OTHER Onc Prst8 Mrna 17 Gene Alg 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
0048U OTHER Onc Sld Org Neo DNA 468 Gene 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0050U OTHER Trgt Gen Seq DNA 194 Genes 2 1 — — $4,010.32 $4,010.32 $4,010.32 2026-04-01
0055U OTHER Card Hrt Trnspl 96 DNA Seq 2 1 — — $4,455.00 $4,455.00 $4,455.00 2026-04-01
0080U OTHER Onc Lng 5 Clin Rsk Factr Alg 2 1 — — $4,840.00 $4,840.00 $4,840.00 2026-04-01
0087U OTHER Crd Hrt Trnspl Mrna 1283 Gen 2 1 — — $4,344.20 $4,344.20 $4,344.20 2026-04-01
0088U OTHER Trnsplj Kdn Algrft Rej 1494 2 1 — — $4,344.20 $4,344.20 $4,344.20 2026-04-01
0092U OTHER Onc Lng 3 Prtn Bmrk Plsm Alg 2 1 — — $3,421.00 $3,421.00 $3,421.00 2026-04-01
0094U OTHER Genome Rapid Sequence Alys 2 1 — — $10,425.52 $10,425.52 $10,425.52 2026-04-01
0108U OTHER Gi Barrett Esoph 9 Prtn Bmrk 2 1 — — $6,806.25 $6,806.25 $6,806.25 2026-04-01
0118U OTHER Trnsplj Don-drv Cll-fr DNA 2 1 — — $3,785.72 $3,785.72 $3,785.72 2026-04-01
0120U OTHER Onc B Cll Lymphm Mrna 58 Gen 2 1 — — $3,451.54 $3,451.54 $3,451.54 2026-04-01
0153U OTHER Onc Breast Mrna 101 Genes 2 1 — — $4,344.20 $4,344.20 $4,344.20 2026-04-01
0172U OTHER Onc Sld Tum Alys Brca1 Brca2 2 1 — — $4,166.25 $4,166.25 $4,166.25 2026-04-01
0211U OTHER Onc Pan-tum Dna&rna Gnrj Seq 2 1 — — $11,625.62 $11,625.62 $11,625.62 2026-04-01
0212U OTHER Rare Ds Gen DNA Alys Proband 2 1 — — $7,528.40 $7,528.40 $7,528.40 2026-04-01
0213U OTHER Rare Ds Gen DNA Alys Ea Comp 2 1 — — $3,726.18 $3,726.18 $3,726.18 2026-04-01
0214U OTHER Rare Ds Xom DNA Alys Proband 2 1 — — $7,183.83 $7,183.83 $7,183.83 2026-04-01
0215U OTHER Rare Ds Xom DNA Alys Ea Comp 2 1 — — $3,540.14 $3,540.14 $3,540.14 2026-04-01
0239U OTHER Trgt Gen Seq Alys Pnl 311+ 2 1 — — $4,812.50 $4,812.50 $4,812.50 2026-04-01
0242U OTHER Trgt Gen Seq Alys Pnl 55-74 2 1 — — $6,875.00 $6,875.00 $6,875.00 2026-04-01
0244U OTHER Onc Solid Orgn DNA 257 Genes 2 1 — — $4,812.50 $4,812.50 $4,812.50 2026-04-01
0248U OTHER Onc Brn Sphrd Cll 12 Rx Pnl 2 1 — — $4,171.56 $4,171.56 $4,171.56 2026-04-01
0250U OTHER Onc Sld Org Neo DNA 505 Gene 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0253U OTHER Rprdtve Med RNA Gen Prfl 238 2 1 — — $4,344.20 $4,344.20 $4,344.20 2026-04-01
0258U OTHER Ai Psor Mrna 50-100 Gen Alg 2 1 — — $5,053.12 $5,053.12 $5,053.12 2026-04-01
0261U OTHER Onc Clrct Ca Img Alys W/ai 2 1 — — $3,455.72 $3,455.72 $3,455.72 2026-04-01
0262U OTHER Onc Sld Tum Rt-pcr 7 Gen 2 1 — — $4,400.00 $4,400.00 $4,400.00 2026-04-01
0265U OTHER Rar Do Whl Gn&mtcdrl DNA Als 2 1 — — $7,529.22 $7,529.22 $7,529.22 2026-04-01
0266U OTHER Unxpl Cnst Hrtbl Do Gn Xprsn 2 1 — — $4,400.00 $4,400.00 $4,400.00 2026-04-01
0267U OTHER Rare Do Id Opt Gen Mapg&seq 2 1 — — $9,266.58 $9,266.58 $9,266.58 2026-04-01
0276U OTHER Hem Inh Thrombocytopenia 23 2 1 — — $3,366.77 $3,366.77 $3,366.77 2026-04-01
0287U OTHER Onc Thyr Dna&mrna 112 Genes 2 1 — — $4,950.00 $4,950.00 $4,950.00 2026-04-01
0288U OTHER Onc Lung Mrna Quan Pcr 11&3 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
0295U OTHER Onc Brst Dux Carc 7 Proteins 2 1 — — $7,473.12 $7,473.12 $7,473.12 2026-04-01
0297U OTHER Onc Pan Tum Whl Gen Seq DNA 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0298U OTHER Onc Pan Tum Whl Trns Seq RNA 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0300U OTHER Onc Pan Tum Whl Gen Seq&opt 2 1 — — $5,751.80 $5,751.80 $5,751.80 2026-04-01
0306U OTHER Onc Mrd Nxt-gnrj Alys 1st 2 1 — — $5,332.87 $5,332.87 $5,332.87 2026-04-01
0313U OTHER Onc Pncrs Dna&mrna Seq 74 2 1 — — $4,950.00 $4,950.00 $4,950.00 2026-04-01
0315U OTHER Onc Cutan Sq Cll Ca Mrna 40 2 1 — — $11,687.50 $11,687.50 $11,687.50 2026-04-01
0319U OTHER Neph RNA Pretrnspl Perph Bld 2 1 — — $3,643.75 $3,643.75 $3,643.75 2026-04-01
0320U OTHER Neph RNA Psttrnspl Perph Bld 2 1 — — $3,643.75 $3,643.75 $3,643.75 2026-04-01
0334U OTHER Onc Sld Orgn Tgsa DNA 84/+ 2 1 — — $4,812.50 $4,812.50 $4,812.50 2026-04-01
0335U OTHER Rare Ds Whl Gen Seq Fetal 2 1 — — $7,183.83 $7,183.83 $7,183.83 2026-04-01
0336U OTHER Rare Ds Whl Gen Seq Bld/slv 2 1 — — $3,540.14 $3,540.14 $3,540.14 2026-04-01
0337U OTHER Onc Plsm Cell Do&myeloma Id 2 1 — — $3,348.12 $3,348.12 $3,348.12 2026-04-01
0338U OTHER Onc Sld Tum Crcg Tum Cl Slct 2 1 — — $3,348.12 $3,348.12 $3,348.12 2026-04-01
0340U OTHER Onc Pan Ca Alys Mrd Plasma 2 1 — — $4,936.25 $4,936.25 $4,936.25 2026-04-01
0362U OTHER Onc Pap Thyr Ca RNA 82&10 2 1 — — $4,950.00 $4,950.00 $4,950.00 2026-04-01
0379U OTHER Tgsap Sl Or Neo Dna523&rna55 2 1 — — $4,521.70 $4,521.70 $4,521.70 2026-04-01
0388U OTHER Onc Nonsm Cll Lng Ca 37 Gen 2 1 — — $4,812.50 $4,812.50 $4,812.50 2026-04-01
0391U OTHER Onc Sld Tum Dna&rna 437 Gen 2 1 — — $4,950.00 $4,950.00 $4,950.00 2026-04-01
0409U OTHER Onc Sld Tum DNA 80 & RNA 36 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0417U OTHER Rare Ds Alys 335 Nuc Genes 2 1 — — $3,908.48 $3,908.48 $3,908.48 2026-04-01
0425U OTHER Genom Rpd Seq Alys Ea Cmprtr 2 1 — — $5,629.79 $5,629.79 $5,629.79 2026-04-01
0426U OTHER Genome Ultra-rapid Seq Alys 2 1 — — $10,425.52 $10,425.52 $10,425.52 2026-04-01
0435U OTHER Onc Chemo Rx Cytox Csc 14 Rx 2 1 — — $4,171.56 $4,171.56 $4,171.56 2026-04-01
0444U OTHER Onc Sld Orgn Neo Tgsap 361 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0473U OTHER Onc Sld Tum Bld/slv 648 Gene 2 1 — — $6,187.50 $6,187.50 $6,187.50 2026-04-01
0485U OTHER Onc Sol Tum Cfdna&rna Ngs Gm 2 1 — — $5,018.04 $5,018.04 $5,018.04 2026-04-01
0487U OTHER Onc Sol Tum Cfcdna Tgsap 84 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0490U OTHER Onc Cutan/uveal Mlnma Cd146 2 1 — — $3,348.12 $3,348.12 $3,348.12 2026-04-01
0491U OTHER Onc Sol Tum Ctc Slct ER Prtn 2 1 — — $3,348.12 $3,348.12 $3,348.12 2026-04-01
0492U OTHER Onc Sol Tum Ctc Slctn Pd-l1 2 1 — — $3,348.12 $3,348.12 $3,348.12 2026-04-01
0493U OTHER Trnspl Med Quan Dd-cfdna Ngs 2 1 — — $3,785.72 $3,785.72 $3,785.72 2026-04-01
0497U OTHER Onc Prst8 Mrna Rt-pcr 6 Gene 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
0511U OTHER Onc Sol Tum 3dmicroenvir 36+ 2 1 — — $4,171.56 $4,171.56 $4,171.56 2026-04-01
0525U OTHER Onc Sphrd Cell Cul 11-rx Pnl 2 1 — — $4,171.56 $4,171.56 $4,171.56 2026-04-01
0530U OTHER Onc Pan-sol Tum Ctdna 77 Gen 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0532U OTHER Rare Ds Whlgen&mitochdrl DNA 2 1 — — $6,917.90 $6,917.90 $6,917.90 2026-04-01
0538U OTHER Onc Sol Tum Ngts Ffpe 600gen 2 1 — — $4,110.63 $4,110.63 $4,110.63 2026-04-01
0539U OTHER Onc Sol Tumor Cfctdna 152gen 2 1 — — $4,521.70 $4,521.70 $4,521.70 2026-04-01
0540U OTHER Trnsplj Med Quan Dd-cfdna 2 1 — — $3,785.72 $3,785.72 $3,785.72 2026-04-01
0543U OTHER Onc Sol Tum Ngs DNA 517 Gens 2 1 — — $4,110.63 $4,110.63 $4,110.63 2026-04-01
0560U OTHER Onc Mrd Gsa Cfdna Baseline 2 1 — — $5,332.87 $5,332.87 $5,332.87 2026-04-01
0567U OTHER Rare Ds Whl Gen Seq Srs&lrs 2 1 — — $6,917.90 $6,917.90 $6,917.90 2026-04-01
0571U OTHER Onc Sol Tum Dna80&rna10g Ngs 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0576U OTHER Trnsplj Med Lar Quan Ddcfdna 2 1 — — $4,455.00 $4,455.00 $4,455.00 2026-04-01
0578U OTHER Onc Cutan Mln RNA Qpcr 10gen 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
0582U OTHER Rare Ds Rpd Whlgen DNA Vrnts 2 1 — — $10,425.52 $10,425.52 $10,425.52 2026-04-01
0583U OTHER Rare Ds Rpd Whlgen Cmptr DNA 2 1 — — $5,212.76 $5,212.76 $5,212.76 2026-04-01
0585U OTHER Tgsap So Neo Cfdna 521 Genes 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0586U OTHER Onc Mrna Gen Xprsn 216 Genes 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
0592U OTHER Onc Hl Neo DNA Tgs 417 Genes 2 1 — — $4,014.45 $4,014.45 $4,014.45 2026-04-01
14 MS_DRG Allogeneic Bone Marrow Transplant 40 12 — — — — $253,691.22 2026-04-01
153 MS_DRG Otitis Media And Uri Without Mcc 40 12 — — — — $42,515.29 2026-04-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/Mcc 40 12 — — — — $102,359.53 2026-04-01
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 40 12 — — — — $65,836.12 2026-04-01
177 MS_DRG Respiratory Infections And Inflammations With Mcc 40 12 — — — — $439,039.36 2026-04-01
178 MS_DRG Respiratory Infections And Inflammations With Cc 40 12 — — — — $144,394.94 2026-04-01
18 MS_DRG Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 40 12 — — — — $369,651.35 2026-04-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 40 12 — — — — $12,225.04 2026-04-01
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 40 12 — — — — $41,809.65 2026-04-01
202 MS_DRG Bronchitis And Asthma With Cc/Mcc 40 12 — — — — $51,108.03 2026-04-01
206 MS_DRG Other Respiratory System Diagnoses Without Mcc 40 12 — — — — $55,921.54 2026-04-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 40 12 — — — — $56,269.68 2026-04-01
315 MS_DRG Other Circulatory System Diagnoses With Cc 40 12 — — — — $45,978.24 2026-04-01
371 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 40 12 — — — — $30,498.94 2026-04-01
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 40 12 — — — — $249,436.37 2026-04-01
375 MS_DRG Digestive Malignancy With Cc 40 12 — — — — $18,602.82 2026-04-01
389 MS_DRG Gastrointestinal Obstruction With Cc 40 12 — — — — $11,674.55 2026-04-01
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 40 12 — — — — $98,508.71 2026-04-01
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 40 12 — — — — $28,641.53 2026-04-01
418 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Cc 40 12 — — — — $42,472.08 2026-04-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 40 12 — — — — $57,319.67 2026-04-01
5072 OTHER Level 2 Excision/ Biopsy/ Incision And Drainage 46 13 — — — — $5,870.45 2026-04-01
5073 OTHER Level 3 Excision/ Biopsy/ Incision And Drainage 46 13 — — — — $8,320.94 2026-04-01
5111 OTHER Level 1 Musculoskeletal Procedures 46 13 — — — — $9,620.93 2026-04-01
5114 OTHER Level 4 Musculoskeletal Procedures 46 13 — — — — $13,737.47 2026-04-01
5153 OTHER Level 3 Airway Endoscopy 46 13 — — — — $5,782.51 2026-04-01
5154 OTHER Level 4 Airway Endoscopy 46 13 — — — — $9,258.92 2026-04-01
5183 OTHER Level 3 Vascular Procedures 46 13 — — — — $7,780.18 2026-04-01
5184 OTHER Level 4 Vascular Procedures 46 13 — — — — $18,715.42 2026-04-01
5242 OTHER Level 2 Blood Product Exchange And Related Services 46 13 — — — — $14,242.01 2026-04-01
5243 OTHER Level 3 Blood Product Exchange And Related Services 46 13 — — — — $13,395.42 2026-04-01
5244 OTHER Level 4 Blood Product Exchange And Related Services 46 13 — — — — $30,389.87 2026-04-01
5301 OTHER Level 1 Upper Gi Procedures 46 13 — — — — $3,584.30 2026-04-01
5302 OTHER Level 2 Upper Gi Procedures 46 13 — — — — $4,629.45 2026-04-01
5312 OTHER Level 2 Lower Gi Procedures 46 13 — — — — $4,089.85 2026-04-01
5313 OTHER Level 3 Lower Gi Procedures 46 13 — — — — $16,184.84 2026-04-01
5375 OTHER Level 5 Urology And Related Services 46 13 — — — — $12,485.42 2026-04-01
5415 OTHER Level 5 Gynecologic Procedures 46 13 — — — — $18,268.11 2026-04-01
542 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 40 12 — — — — $54,035.84 2026-04-01
5442 OTHER Level 2 Nerve Injections 46 13 — — — — $4,236.24 2026-04-01
5443 OTHER Level 3 Nerve Injections 46 13 — — — — $4,686.55 2026-04-01
5524 OTHER Level 4 Imaging Without Contrast 46 13 — — — — $8,627.65 2026-04-01
5571 OTHER Level 1 Imaging With Contrast 46 13 — — — — $4,124.80 2026-04-01
5572 OTHER Level 2 Imaging With Contrast 46 13 — — — — $3,935.47 2026-04-01
5591 OTHER Level 1 Nuclear Medicine And Related Services 46 13 — — — — $3,612.27 2026-04-01
5592 OTHER Level 2 Nuclear Medicine And Related Services 46 13 — — — — $3,351.66 2026-04-01
5593 OTHER Level 3 Nuclear Medicine And Related Services 46 13 — — — — $4,920.15 2026-04-01
5594 OTHER Level 4 Nuclear Medicine And Related Services 46 13 — — — — $6,290.97 2026-04-01
5613 OTHER Level 3 Therapeutic Radiation Treatment Preparation 46 13 — — — — $10,499.70 2026-04-01
5624 OTHER Level 4 Radiation Therapy 46 13 — — — — $4,756.80 2026-04-01
5625 OTHER Level 5 Radiation Therapy 46 13 — — — — $4,730.67 2026-04-01
5626 OTHER Level 6 Radiation Therapy 46 13 — — — — $5,632.97 2026-04-01
563 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 40 12 — — — — $27,210.03 2026-04-01
5661 OTHER Therapeutic Nuclear Medicine 46 13 — — — — $51,267.57 2026-04-01
5673 OTHER Level 3 Pathology 46 13 — — — — $3,367.80 2026-04-01
5674 OTHER Level 4 Pathology 46 13 — — — — $4,629.97 2026-04-01
5694 OTHER Level 4 Drug Administration 46 13 — — — — $6,899.16 2026-04-01
602 MS_DRG Cellulitis With Mcc 40 12 — — — — $16,325.07 2026-04-01
75 MS_DRG Viral Meningitis With Cc/Mcc 40 12 — — — — $29,987.40 2026-04-01
808 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 40 12 — — — — $130,032.28 2026-04-01
809 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 40 12 — — — — $56,211.00 2026-04-01
811 MS_DRG Red Blood Cell Disorders With Mcc 40 12 — — — — $18,822.16 2026-04-01
812 MS_DRG Red Blood Cell Disorders Without Mcc 40 12 — — — — $11,346.52 2026-04-01
814 MS_DRG Reticuloendothelial And Immunity Disorders With Mcc 40 12 — — — — $28,899.65 2026-04-01
81412 HCPCS Ashkenazi Jewish Assoc Dis 2 1 — — $3,366.77 $3,366.77 $3,366.77 2026-04-01
81415 HCPCS Hc Exome Seq Analysis 4 1 $27,000.19 $24,300.17 $6,572.50 $6,572.50 $6,572.50 2026-04-01
81416 HCPCS Hc Exome Seq Compare 4 1 $66,049.98 $59,444.98 $16,500.00 $16,500.00 $16,500.00 2026-04-01
81419 HCPCS Epilepsy Gen Seq Alys Panel 2 1 — — $3,366.77 $3,366.77 $3,366.77 2026-04-01
81425 HCPCS Hc Genome Seq Analysis 4 1 $48,855.78 $43,970.20 $6,917.90 $6,917.90 $6,917.90 2026-04-01
81426 HCPCS Hc Genome Seq Compare 4 1 $30,655.00 $27,589.50 $3,726.18 $3,726.18 $3,726.18 2026-04-01
81427 HCPCS Hc Genome Seq Reeval 4 1 $14,371.43 $12,934.29 $3,214.27 $3,214.27 $3,214.27 2026-04-01
81440 HCPCS Mitochondrial Gene 2 1 — — $4,570.50 $4,570.50 $4,570.50 2026-04-01
81441 HCPCS Ibmfs Seq Alys Pnl 30 Genes 2 1 — — $3,366.77 $3,366.77 $3,366.77 2026-04-01
81443 HCPCS Hc Imd: Full Gene Panel 4 1 $7,454.25 $6,708.82 $3,366.77 $3,366.77 $3,366.77 2026-04-01
81455 HCPCS Targeted Genomic Seq Analys 4 1 $11,053.59 $9,948.23 $4,014.45 $4,014.45 $4,014.45 2026-04-01
81456 HCPCS Tgsap So/hl 51/< RNA Alys 4 1 $4,182.88 $3,764.59 $4,014.45 $4,014.45 $4,014.45 2026-04-01
81459 HCPCS So Neo Gsap Dna/dna&rna 4 1 $7,809.50 $7,028.55 $4,110.63 $4,110.63 $4,110.63 2026-04-01
81464 HCPCS So Gsap Cll Fr Mcrstl Ins 2 1 — — $4,521.70 $4,521.70 $4,521.70 2026-04-01
815 MS_DRG Reticuloendothelial And Immunity Disorders With Cc 40 12 — — — — $25,642.72 2026-04-01
81518 HCPCS Onc Brst Mrna 11 Genes 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
81519 HCPCS Oncology Breast Mrna 4 1 $14,958.50 $13,462.65 $5,325.38 $5,325.38 $5,325.38 2026-04-01
81520 HCPCS Onc Breast Mrna 58 Genes 2 1 — — $3,451.54 $3,451.54 $3,451.54 2026-04-01
81521 HCPCS Onc Breast Mrna 70 Genes 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
81522 HCPCS Onc Breast Mrna 12 Genes 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
81523 HCPCS Onc Brst Mrna 70 Cnt 31 Gene 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
81525 HCPCS Oncology Colon Mrna 2 1 — — $4,284.50 $4,284.50 $4,284.50 2026-04-01
81529 HCPCS Onc Cutan Mlnma Mrna 31 Gene 2 1 — — $9,890.38 $9,890.38 $9,890.38 2026-04-01
81538 HCPCS Oncology Lung 2 1 — — $3,947.62 $3,947.62 $3,947.62 2026-04-01
81540 HCPCS Oncology Tum Unknown Origin 2 1 — — $5,156.25 $5,156.25 $5,156.25 2026-04-01
81541 HCPCS Onc Prostate Mrna 46 Genes 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
81542 HCPCS Onc Prostate Mrna 22 Cnt Gen 2 1 — — $5,325.38 $5,325.38 $5,325.38 2026-04-01
81546 HCPCS Onc Thyr Mrna 10,196 Gen Alg 2 1 — — $4,950.00 $4,950.00 $4,950.00 2026-04-01
81552 HCPCS Onc Uveal Mlnma Mrna 15 Gene 2 1 — — $10,692.00 $10,692.00 $10,692.00 2026-04-01
81554 HCPCS Pulm Ds Ipf Mrna 190 Gen Alg 2 1 — — $7,438.20 $7,438.20 $7,438.20 2026-04-01
81558 HCPCS Trnspl Rej Kdn Mrna Qpcr 139 2 1 — — $4,455.00 $4,455.00 $4,455.00 2026-04-01
81595 HCPCS Cardiology Hrt Trnspl Mrna 2 1 — — $4,455.00 $4,455.00 $4,455.00 2026-04-01
824 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Cc 40 12 — — — — $37,531.17 2026-04-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 40 12 — — — — $75,124.86 2026-04-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 40 12 — — — — $218,656.74 2026-04-01
841 MS_DRG Lymphoma And Non-acute Leukemia With Cc 40 12 — — — — $39,386.81 2026-04-01
842 MS_DRG Lymphoma And Non-acute Leukemia Without Cc/Mcc 40 12 — — — — $25,126.26 2026-04-01
846 MS_DRG Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc 40 12 — — — — $80,375.85 2026-04-01
847 MS_DRG Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc 40 12 — — — — $31,027.91 2026-04-01
848 MS_DRG Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc 40 12 — — — — $10,290.99 2026-04-01
864 MS_DRG Fever And Inflammatory Conditions 40 12 — — — — $11,723.79 2026-04-01
865 MS_DRG Viral Illness With Mcc 40 12 — — — — $28,916.84 2026-04-01
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 40 12 — — — — $44,833.17 2026-04-01
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 40 12 — — — — $18,970.35 2026-04-01
90291 HCPCS Cmv Ig IV 2 1 — — $5,102.95 $5,102.95 $5,102.95 2026-04-01
90396 HCPCS Varicella-zoster Ig IM 2 1 — — $5,553.97 $5,553.97 $5,553.97 2026-04-01
919 MS_DRG Complications Of Treatment With Mcc 40 12 — — — — $20,689.72 2026-04-01
948 MS_DRG Signs And Symptoms Without Mcc 40 12 — — — — $8,379.39 2026-04-01
9511 OTHER Cryoprecipitate Each Unit 46 13 — — — — $6,252.44 2026-04-01
9521 OTHER Platelets Leukoreduced Irrad 46 13 — — — — $6,958.65 2026-04-01
9525 OTHER Platelets, Hla-m, L/r, Unit 46 13 — — — — $5,065.04 2026-04-01
9530 OTHER Plate Pheres Leukoredu Irrad 46 13 — — — — $3,759.07 2026-04-01
9536 OTHER Platelets Pheresis Path Redu 46 13 — — — — $3,865.00 2026-04-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 40 12 — — — — $218,445.08 2026-04-01
999 MS_DRG Ungroupable 40 12 — — — — $78,094.39 2026-04-01
A2034 HCPCS Found Drs Solo, Per Sq Cm 2 1 — — $3,615.29 $3,615.29 $3,615.29 2026-04-01
A4642 HCPCS In111 Satumomab 2 1 — — $3,939.52 $3,939.52 $3,939.52 2026-04-01
A9507 HCPCS In111 Capromab 2 1 — — $4,066.18 $4,066.18 $4,066.18 2026-04-01
A9515 HCPCS Choline C-11 2 1 — — $5,913.61 $5,913.61 $5,913.61 2026-04-01
A9542 HCPCS In111 Ibritumomab, Dx 2 1 — — $9,660.03 $9,660.03 $9,660.03 2026-04-01
A9543 HCPCS Y90 Ibritumomab, Rx 2 1 — — $133,537.69 $133,537.69 $133,537.69 2026-04-01
A9553 HCPCS Cr51 Chromate 2 1 — — $4,507.21 $4,507.21 $4,507.21 2026-04-01
A9571 HCPCS Indium In-111 Auto Platelet 2 1 — — $11,273.82 $11,273.82 $11,273.82 2026-04-01
A9572 HCPCS Indium In-111 Pentetreotide 2 1 — — $4,702.21 $4,702.21 $4,702.21 2026-04-01
A9582 HCPCS Iodine I-123 Iobenguane 2 1 — — $5,446.13 $5,446.13 $5,446.13 2026-04-01
A9584 HCPCS Iodine I-123 Ioflupane 2 1 — — $3,261.19 $3,261.19 $3,261.19 2026-04-01
A9586 HCPCS Florbetapir F18 2 1 — — $4,290.25 $4,290.25 $4,290.25 2026-04-01
A9589 HCPCS Insti Hexaminolevulinate Hcl 2 1 — — $3,348.21 $3,348.21 $3,348.21 2026-04-01
A9600 HCPCS Sr89 Strontium 2 1 — — $9,743.90 $9,743.90 $9,743.90 2026-04-01
A9604 HCPCS Sm 153 Lexidronam 2 1 — — $7,425.53 $7,425.53 $7,425.53 2026-04-01
A9699 HCPCS Radiopharm Rx Agent Noc 2 1 — — $109,733.56 $109,733.56 $109,733.56 2026-04-01
J0202 HCPCS Injection, Alemtuzumab 2 1 — — $5,750.69 $5,750.69 $5,750.69 2026-04-01
J0225 HCPCS Inj, Vutrisiran, 1 Mg 2 1 — — $11,772.47 $11,772.47 $11,772.47 2026-04-01
J0480 HCPCS Basiliximab 2 1 — — $11,235.51 $11,235.51 $11,235.51 2026-04-01
J0578 HCPCS Inj Brixadi, More Than 7 Day 2 1 — — $3,948.49 $3,948.49 $3,948.49 2026-04-01
J0600 HCPCS Edetate Calcium Disodium Inj 2 1 — — $14,592.75 $14,592.75 $14,592.75 2026-04-01
J0630 HCPCS Calcitonin Salmon Injection 4 1 $9,172.90 $8,255.61 $3,368.02 $3,368.02 $3,368.02 2026-04-01
J0801 HCPCS Inj. Acthar Gel To 40 Units 2 1 — — $9,805.45 $9,805.45 $9,805.45 2026-04-01
J0802 HCPCS Inj. (ani), Up To 40 Units 2 1 — — $8,346.59 $8,346.59 $8,346.59 2026-04-01
J0840 HCPCS Crotalidae Poly Immune Fab 2 1 — — $4,292.32 $4,292.32 $4,292.32 2026-04-01
J0841 HCPCS Inj Crotalidae IM F(ab')2 Eq 2 1 — — $11,574.13 $11,574.13 $11,574.13 2026-04-01
J0850 HCPCS Cytomegalovirus Imm IV /vial 2 1 — — $4,249.58 $4,249.58 $4,249.58 2026-04-01
J1162 HCPCS Digoxin Immune Fab (ovine) 2 1 — — $12,142.43 $12,142.43 $12,142.43 2026-04-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 2 1 — — $8,660,376.67 $8,660,376.67 $8,660,376.67 2026-04-01
J1412 HCPCS Inj Roctavian Ml 2x10^13vc G 2 1 — — $29,501.22 $29,501.22 $29,501.22 2026-04-01
J1413 HCPCS Inj Delandistrogene Mox Rokl 2 1 — — $7,820,470.37 $7,820,470.37 $7,820,470.37 2026-04-01
J1826 HCPCS Interferon Beta-1a Inj 2 1 — — $7,940.16 $7,940.16 $7,940.16 2026-04-01
J1950 HCPCS Leuprolide Acetate (3 Month) 11.25 Mg IM Kit 4 1 $8,759.30 $7,883.37 $4,145.09 $4,145.09 $4,145.09 2026-04-01
J2507 HCPCS Pegloticase Injection 2 1 — — $8,856.70 $8,856.70 $8,856.70 2026-04-01
J2787 HCPCS Riboflavin 5?phos Opth<=3ml 2 1 — — $6,429.60 $6,429.60 $6,429.60 2026-04-01
J2993 HCPCS Reteplase Injection 2 1 — — $6,825.76 $6,825.76 $6,825.76 2026-04-01
J3240 HCPCS Thyrotropin Injection 4 1 $5,490.24 $4,941.21 $4,995.25 $4,995.25 $4,995.25 2026-04-01
J3316 HCPCS Inj., Triptorelin Xr 3.75 Mg 2 1 — — $8,847.73 $8,847.73 $8,847.73 2026-04-01
J3387 HCPCS Inj Elivaldogene Autotemecel 2 1 — — $7,473,000.00 $7,473,000.00 $7,473,000.00 2026-04-01
J3389 HCPCS Topi Adm Prad Zami Per Treat 2 1 — — $7,839,177.00 $7,839,177.00 $7,839,177.00 2026-04-01
J3391 HCPCS Inj, Atidarsagene Autotemcel 2 1 — — $10,586,750.00 $10,586,750.00 $10,586,750.00 2026-04-01
J3392 HCPCS Inj, Exagamglogene Autotem 2 1 — — $5,480,200.00 $5,480,200.00 $5,480,200.00 2026-04-01
J3393 HCPCS Inj, Betibeglogene Autotemce 2 1 — — $6,908,926.89 $6,908,926.89 $6,908,926.89 2026-04-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 2 1 — — $7,643,393.99 $7,643,393.99 $7,643,393.99 2026-04-01
J3398 HCPCS Inj Luxturna 1 Billion Vec G 2 1 — — $7,112.98 $7,112.98 $7,112.98 2026-04-01
J3399 HCPCS Inj Onase Abepar-xioi Treat 2 1 — — $6,084,105.89 $6,084,105.89 $6,084,105.89 2026-04-01
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 2 1 — — $473,922.20 $473,922.20 $473,922.20 2026-04-01
J7294 HCPCS Seg Acet And Eth Estr Yearly 2 1 — — $6,825.95 $6,825.95 $6,825.95 2026-04-01
J7296 HCPCS Levonorgestrel 19.5 Mg Iu IUD 4 1 $3,741.06 $3,366.95 $3,588.29 $3,588.29 $3,588.29 2026-04-01
J7298 HCPCS Mirena, 52 Mg 4 1 $3,741.06 $3,366.95 $3,588.29 $3,588.29 $3,588.29 2026-04-01
J7299 HCPCS Intraut Copp Cont (miudella) 2 1 — — $3,211.98 $3,211.98 $3,211.98 2026-04-01
J7300 HCPCS Paragard Intrauterine Copper Iu IUD 4 1 $3,508.12 $3,157.31 $3,346.40 $3,346.40 $3,346.40 2026-04-01
J7307 HCPCS Etonogestrel Implant System 2 1 — — $3,596.51 $3,596.51 $3,596.51 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 2 1 — — $196,756.69 $196,756.69 $196,756.69 2026-04-01
J7352 HCPCS Afamelanotide Implant, 1 Mg 2 1 — — $6,917.04 $6,917.04 $6,917.04 2026-04-01
J7504 HCPCS Lymphocyte Immune Globulin 2 1 — — $12,473.64 $12,473.64 $12,473.64 2026-04-01
J9015 HCPCS Aldesleukin Injection 2 1 — — $7,846.34 $7,846.34 $7,846.34 2026-04-01
J9026 HCPCS Tarlatamab-dlle 10 Mg IV Solr 4 1 $33,365.00 $30,028.50 $3,681.49 $3,681.49 $3,681.49 2026-04-01
J9029 HCPCS Inj, Adstiladrin, Per Tx Dos 2 1 — — $151,045.76 $151,045.76 $151,045.76 2026-04-01
J9200 HCPCS Floxuridine Injection 4 1 $11,456.80 $10,311.12 $9,999.06 $9,999.06 $9,999.06 2026-04-01
J9216 HCPCS Interferon Gamma 1-b Inj 2 1 — — $23,856.21 $23,856.21 $23,856.21 2026-04-01
J9225 HCPCS Vantas Implant 2 1 — — $11,067.40 $11,067.40 $11,067.40 2026-04-01
J9226 HCPCS Supprelin La Implant 2 1 — — $101,485.55 $101,485.55 $101,485.55 2026-04-01
J9229 HCPCS Inotuzumab Ozogamicin 0.9 Mg IV Solr 4 1 $43,139.81 $38,825.83 $6,619.41 $6,619.41 $6,619.41 2026-04-01
J9266 HCPCS Pegaspargase Injection 4 1 $54,632.27 $49,169.04 $66,796.54 $66,796.54 $66,796.54 2026-04-01
J9268 HCPCS Pentostatin Injection 4 1 $9,293.92 $8,364.53 $5,962.19 $5,962.19 $5,962.19 2026-04-01
J9286 HCPCS Inj Glofitamab Gxbm, 2.5 Mg 4 1 $25,879.38 $23,291.44 $6,682.44 $6,682.44 $6,682.44 2026-04-01
J9600 HCPCS Porfimer Sodium Injection 2 1 — — $56,936.79 $56,936.79 $56,936.79 2026-04-01
Q0224 HCPCS Pemivibart 500 Mg/4ml IV Soln 4 1 $2,412.17 $2,170.95 $17,011.65 $17,011.65 $17,011.65 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 4 1 $1,007,160.00 $906,444.00 $1,250,651.76 $1,250,651.76 $1,250,651.76 2026-04-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 4 1 $913,882.08 $822,493.87 $1,331,348.56 $1,331,348.56 $1,331,348.56 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 4 1 $132,717.30 $119,445.57 $127,849.66 $127,849.66 $127,849.66 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 4 1 $924,000.00 $831,600.00 $1,150,207.97 $1,150,207.97 $1,150,207.97 2026-04-01
Q2054 HCPCS Lisocabtagene Maraleucel 70000000 Cells/ml IV Susp 4 1 $1,062,700.80 $956,430.72 $1,321,172.91 $1,321,172.91 $1,321,172.91 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 2 1 — — $1,311,492.07 $1,311,492.07 $1,311,492.07 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 4 1 $1,110,620.88 $999,558.79 $1,380,976.49 $1,380,976.49 $1,380,976.49 2026-04-01
Q2057 HCPCS Afamitresgene Autoleucel 2 1 — — $1,810,957.00 $1,810,957.00 $1,810,957.00 2026-04-01
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 2 1 — — $653,887.50 $653,887.50 $653,887.50 2026-04-01
Q4113 HCPCS Graftjacket Xpress 2 1 — — $4,694.13 $4,694.13 $4,694.13 2026-04-01
Q4114 HCPCS Integra Flowable Wound Matri 2 1 — — $6,651.72 $6,651.72 $6,651.72 2026-04-01
Q4162 HCPCS Amnio Bio And Woundex Flow 2 1 — — $6,031.67 $6,031.67 $6,031.67 2026-04-01
Q4174 HCPCS Palingen Or Promatrx 2 1 — — $3,387.53 $3,387.53 $3,387.53 2026-04-01
Q4246 HCPCS Coretext Or Protext, Per Cc 2 1 — — $7,567.00 $7,567.00 $7,567.00 2026-04-01
Q4310 HCPCS Procenta, Per 100 Mg 2 1 — — $13,959.71 $13,959.71 $13,959.71 2026-04-01
Q9982 HCPCS Flutemetamol F18 Diagnostic 2 1 — — $4,568.42 $4,568.42 $4,568.42 2026-04-01
Q9983 HCPCS Florbetaben F18 Diagnostic 2 1 — — $3,723.97 $3,723.97 $3,723.97 2026-04-01
Q9991 HCPCS Buprenorph Xr 100 Mg Or Less 4 1 $4,324.68 $3,892.21 $4,696.55 $4,696.55 $4,696.55 2026-04-01
Q9992 HCPCS Buprenorphine Xr Over 100 Mg 4 1 $4,324.68 $3,892.21 $4,696.55 $4,696.55 $4,696.55 2026-04-01
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