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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

METHODIST HOSPITAL STONE OAK

San Antonio, TX · CCN 670055 · Rates published

39,860 distinct procedures filed
58 distinct payers
1,920,935 rate rows
2026-07-17 last MRF observed
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.hcadam.com/api/public/content/e131399d17f645799531eb7f1f536aa2?download=true
Found on page https://sahealth.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 · 2026-09-21
Content fingerprint 015288a626f49185… · 908,263,007 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
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,897,200.00 $4,897,200.00 $4,897,200.00 nat. median
$2,968,000
1.6× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $3,884,946.48 $3,884,946.48 $3,884,946.48 nat. median
$2,455,111
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 20 $3,379,068.00 $4,003,461.00 $3,672,900.00 nat. median
$3,765,001
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,562,713.00 $3,672,900.00 $3,617,806.50 nat. median
$3,562,713
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 20 $3,316,600.00 $3,929,450.00 $3,605,000.00 nat. median
$3,677,100
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $3,496,850.00 $3,605,000.00 $3,550,925.00 nat. median
$3,496,850
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 23 $5,050.58 $4,655,637.00 $3,325,455.00 nat. median
$3,391,964
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 23 $8,330.92 $4,600,400.00 $3,286,000.00 nat. median
$3,351,720
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,225,691.35 $3,325,455.00 $3,275,573.17 nat. median
$3,225,691
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,187,420.00 $3,286,000.00 $3,236,710.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 23 $7,399.52 $4,600,400.00 $2,968,000.00 nat. median
$3,001,835
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,878,960.00 $2,968,000.00 $2,923,480.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 22 $2,197,524.88 $3,702,351.70 $2,400,557.07 nat. median
$2,508,045
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,316,955.58 $2,388,614.00 $2,352,784.79 nat. median
$2,316,956
1.0× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $492,271.12 $2,663,055.00 $1,653,409.80 nat. median
$599,737
outlier · 2.8×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $470,149.30 $2,402,476.50 $1,491,624.54 nat. median
$574,037
outlier · 2.6×
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 $459,839.17 $2,349,788.10 $1,458,911.92 nat. median
$579,571
outlier · 2.5×
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $435,956.80 $2,136,171.00 $1,326,283.56 nat. median
$513,770
outlier · 2.6×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 $25.48 $2,209,092.50 $863,696.72 nat. median
$621,313
1.4× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $6.70 $2,037,512.50 $807,075.90 nat. median
$562,501
1.4× median
9194
OTHER 		Tisagenlecleucel Car-pos 23 $486,857.47 $1,148,348.59 $535,437.38 nat. median
$555,653
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 23 $484,953.53 $1,143,857.78 $533,343.46 nat. median
$553,480
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 23 $484,460.59 $1,142,695.09 $532,801.33 nat. median
$552,917
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 23 $475,388.01 $1,121,295.64 $522,823.47 nat. median
$542,562
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $513,317.11 $529,192.90 $521,255.01 nat. median
$513,317
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $511,309.70 $527,123.40 $519,216.55 nat. median
$511,310
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $510,789.97 $526,587.60 $518,688.78 nat. median
$510,790
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $501,224.32 $516,726.10 $508,975.21 nat. median
$501,224
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 23 $450,299.52 $1,062,119.52 $495,231.58 nat. median
$513,929
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $474,772.32 $489,456.00 $482,114.16 nat. median
$474,772
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 23 $423,687.97 $999,350.97 $465,964.66 nat. median
$483,557
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $446,714.49 $460,530.40 $453,622.45 nat. median
$446,714
1.0× median
108937
CDM 		Tavr Heart Valve 29mm 21 $86,162.30 $523,128.25 $384,653.12 —
119940
CDM 		Valve Tavr 26mm 21 $70,590.80 $428,587.00 $315,137.50 —
119939
CDM 		Valve Tavr 23mm 21 $70,590.80 $428,587.00 $315,137.50 —
119941
CDM 		Valve Tavr 29mm 21 $70,590.80 $428,587.00 $315,137.50 —
119938
CDM 		Valve Tavr 20mm 21 $70,590.80 $428,587.00 $315,137.50 —
775554
CDM 		Kit Aor Vlv 14fr 29mm 21 $67,476.50 $409,678.75 $301,234.38 nat. median
$11,226
outlier · 26.8×
100354
CDM 		Valve Heart Trnscth 26mm 21 $67,476.50 $409,678.75 $301,234.38 —
100352
CDM 		Valve Heart Trnscth 20mm 21 $67,476.50 $409,678.75 $301,234.38 nat. median
$1,471
outlier · 204.8×
100353
CDM 		Valve Heart Trnscth 23mm 21 $67,476.50 $409,678.75 $301,234.38 —
74
APR_DRG 		Allogeneic Bone Marrow Transplant 7 $253,775.00 $444,107.00 $296,917.00 nat. median
$149,836
2.0× median
134434
CDM 		Valve Tavr 29mm 21 $65,400.30 $397,073.25 $291,965.62 —
134662
CDM 		Valve Tavr 23mm 21 $65,400.30 $397,073.25 $291,965.62 —
134663
CDM 		Valve Tavr 31mm 21 $65,400.30 $397,073.25 $291,965.62 —
134664
CDM 		Valve Tavr 26mm 21 $65,400.30 $397,073.25 $291,965.62 —
246026
CDM 		Valve Triclip 1sgc 2cds 21 $62,286.00 $378,165.00 $278,062.50 —
111426
CDM 		Valve Tavr Sz 29mm 21 $62,286.00 $378,165.00 $278,062.50 —
111424
CDM 		Valve Tavr Sz 23mm 21 $62,286.00 $378,165.00 $278,062.50 —
111427
CDM 		Valve Tavr Size 34mm 21 $62,286.00 $378,165.00 $278,062.50 —

Other procedures at this hospital

Browse this hospital's 39,860 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 4 1 — — $4,897,200.00 $4,897,200.00 $4,897,200.00 2025-01-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 4 1 $4,463,735.93 — $3,884,946.48 $3,884,946.48 $3,884,946.48 2026-07-17
9138 OTHER Inj, Hemgenix, Per Tx Dos 41 20 — — $3,379,068.00 $4,003,461.00 $3,672,900.00 2025-01-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $3,562,713.00 $3,672,900.00 $3,617,806.50 2025-01-01
773 OTHER Inj, Beqvez, Per Tx Dose 41 20 $3,114.16 — $3,316,600.00 $3,929,450.00 $3,605,000.00 2026-07-17
00773 OTHER Inj, Beqvez, Per Tx Dose 2 2 — — $3,496,850.00 $3,605,000.00 $3,550,925.00 2025-01-01
714 OTHER Inj Delandistrogene Mox R 45 23 $13,511.58 — $5,050.58 $4,655,637.00 $3,325,455.00 2026-07-17
748 OTHER Inj, Lovotibeglogene Auto 45 23 $19,983.94 — $8,330.92 $4,600,400.00 $3,286,000.00 2026-07-17
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $3,225,691.35 $3,325,455.00 $3,275,573.17 2025-01-01
00748 OTHER Inj, Lovotibeglogene Auto 2 2 — — $3,187,420.00 $3,286,000.00 $3,236,710.00 2025-01-01
746 OTHER Inj, Betibeglogene Autote 47 23 $22,045.50 — $7,399.52 $4,600,400.00 $2,968,000.00 2026-07-17
00746 OTHER Inj, Betibeglogene Autote 2 2 — — $2,878,960.00 $2,968,000.00 $2,923,480.00 2025-01-01
9141 OTHER Inj Onase Abepar-xioi Tre 45 22 — — $2,197,524.88 $3,702,351.70 $2,400,557.07 2025-01-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $2,316,955.58 $2,388,614.00 $2,352,784.79 2025-01-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 13 4 $2,505,587.40 — $492,271.12 $2,663,055.00 $1,653,409.80 2026-07-17
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 13 4 $2,260,417.02 — $470,149.30 $2,402,476.50 $1,491,624.54 2026-07-17
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 13 4 $2,210,844.11 — $459,839.17 $2,349,788.10 $1,458,911.92 2026-07-17
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 13 4 $2,009,858.28 — $435,956.80 $2,136,171.00 $1,326,283.56 2026-07-17
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 15 4 $2,078,467.90 — $25.48 $2,209,092.50 $863,696.72 2026-07-17
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 15 4 $1,917,033.50 — $6.70 $2,037,512.50 $807,075.90 2026-07-17
9194 OTHER Tisagenlecleucel Car-pos 46 23 $889,558.93 — $486,857.47 $1,148,348.59 $535,437.38 2026-07-17
9498 OTHER Ciltacabtagene Car-pos T 46 23 $938,742.00 — $484,953.53 $1,143,857.78 $533,343.46 2026-07-17
9422 OTHER Idecabtagene Vicleucel Ca 46 23 $871,553.20 — $484,460.59 $1,142,695.09 $532,801.33 2026-07-17
9413 OTHER Lisocabtagene Car Pos T 46 23 $852,439.28 — $475,388.01 $1,121,295.64 $522,823.47 2026-07-17
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $513,317.11 $529,192.90 $521,255.01 2025-01-01
09498 OTHER Ciltacabtagene Car-pos T 2 2 — — $511,309.70 $527,123.40 $519,216.55 2025-01-01
09422 OTHER Idecabtagene Vicleucel Ca 2 2 — — $510,789.97 $526,587.60 $518,688.78 2025-01-01
09413 OTHER Lisocabtagene Car Pos T 2 2 — — $501,224.32 $516,726.10 $508,975.21 2025-01-01
9035 OTHER Axicabtagene Ciloleucel C 46 23 $828,854.15 — $450,299.52 $1,062,119.52 $495,231.58 2026-07-17
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $474,772.32 $489,456.00 $482,114.16 2025-01-01
9391 OTHER Brexucabtagene Car Pos T 46 23 $828,962.40 — $423,687.97 $999,350.97 $465,964.66 2026-07-17
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $446,714.49 $460,530.40 $453,622.45 2025-01-01
108937 CDM Tavr Heart Valve 29mm 28 21 $615,445.00 $615,445.00 $86,162.30 $523,128.25 $384,653.12 2025-01-01
119939 CDM Valve Tavr 23mm 28 21 $504,220.00 $504,220.00 $70,590.80 $428,587.00 $315,137.50 2025-01-01
119938 CDM Valve Tavr 20mm 28 21 $504,220.00 $504,220.00 $70,590.80 $428,587.00 $315,137.50 2025-01-01
119941 CDM Valve Tavr 29mm 28 21 $504,220.00 $504,220.00 $70,590.80 $428,587.00 $315,137.50 2025-01-01
119940 CDM Valve Tavr 26mm 28 21 $504,220.00 $504,220.00 $70,590.80 $428,587.00 $315,137.50 2025-01-01
775554 CDM Kit Aor Vlv 14fr 29mm 28 21 $481,975.00 $481,975.00 $67,476.50 $409,678.75 $301,234.38 2025-01-01
100353 CDM Valve Heart Trnscth 23mm 28 21 $481,975.00 $481,975.00 $67,476.50 $409,678.75 $301,234.38 2025-01-01
100352 CDM Valve Heart Trnscth 20mm 28 21 $481,975.00 $481,975.00 $67,476.50 $409,678.75 $301,234.38 2025-01-01
100354 CDM Valve Heart Trnscth 26mm 28 21 $481,975.00 $481,975.00 $67,476.50 $409,678.75 $301,234.38 2025-01-01
74 APR_DRG Allogeneic Bone Marrow Transplant 20 7 — — $253,775.00 $444,107.00 $296,917.00 2025-01-01
134663 CDM Valve Tavr 31mm 28 21 $467,145.00 $467,145.00 $65,400.30 $397,073.25 $291,965.62 2025-01-01
134664 CDM Valve Tavr 26mm 28 21 $467,145.00 $467,145.00 $65,400.30 $397,073.25 $291,965.62 2025-01-01
134434 CDM Valve Tavr 29mm 28 21 $467,145.00 $467,145.00 $65,400.30 $397,073.25 $291,965.62 2025-01-01
134662 CDM Valve Tavr 23mm 28 21 $467,145.00 $467,145.00 $65,400.30 $397,073.25 $291,965.62 2025-01-01
111427 CDM Valve Tavr Size 34mm 28 21 $444,900.00 $444,900.00 $62,286.00 $378,165.00 $278,062.50 2025-01-01
111425 CDM Valve Tavr Sz 26mm 28 21 $444,900.00 $444,900.00 $62,286.00 $378,165.00 $278,062.50 2025-01-01
246026 CDM Valve Triclip 1sgc 2cds 28 21 $444,900.00 $444,900.00 $62,286.00 $378,165.00 $278,062.50 2025-01-01
111426 CDM Valve Tavr Sz 29mm 28 21 $444,900.00 $444,900.00 $62,286.00 $378,165.00 $278,062.50 2025-01-01
111424 CDM Valve Tavr Sz 23mm 28 21 $444,900.00 $444,900.00 $62,286.00 $378,165.00 $278,062.50 2025-01-01
5834 APR_DRG Neonate With Ecmo 20 7 — — $260,870.00 $326,087.50 $273,913.50 2025-01-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 52 24 — — $3,938.00 $516,177.22 $271,829.37 2025-01-01
135679 CDM Stent Evas 22fr 16cm 28 21 $430,070.00 $430,070.00 $60,209.80 $365,559.50 $268,793.75 2025-01-01
24 APR_DRG Heart And/or Lung Transplant 20 7 — — $212,495.00 $371,867.00 $248,620.00 2025-01-01
C1823 HCPCS Generator Pulse Implnt 23 18 $359,805.00 $359,805.00 $50,372.70 $305,834.25 $241,069.35 2025-01-01
649089 CDM Valve Pulm 18mm 28 21 $378,165.00 $378,165.00 $52,943.10 $321,440.25 $236,353.12 2025-01-01
5833 APR_DRG Neonate With Ecmo 20 7 — — $220,895.00 $276,118.75 $231,939.75 2025-01-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 59 27 — — $137,695.00 $385,541.68 $203,169.03 2025-01-01
135188 CDM Implant Generator Pulse 28 21 $321,810.00 $321,810.00 $45,053.40 $273,538.50 $201,131.25 2025-01-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 2 $396,888.16 — $171,193.85 $176,488.50 $173,841.17 2026-07-17
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 20 7 — — $165,126.00 $206,407.50 $173,382.30 2025-01-01
1614 APR_DRG Implantable Heart Assist Systems 25 8 — — $160,349.00 $200,436.25 $173,177.52 2025-01-01
128000 CDM Graft Bn Fem Whole Left 28 21 $272,426.00 $272,426.00 $38,139.64 $231,562.10 $170,266.25 2025-01-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 63 28 — — $3,938.00 $342,628.40 $169,585.50 2025-01-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 18 5 $329,405.11 — $53,789.99 $350,107.09 $168,084.10 2026-07-17
105660 CDM Occluder Cardiac Lt 31mm 28 21 $266,940.00 $266,940.00 $37,371.60 $226,899.00 $166,837.50 2025-01-01
105654 CDM Occluder Cardiac Lt 16mm 28 21 $266,940.00 $266,940.00 $37,371.60 $226,899.00 $166,837.50 2025-01-01
105656 CDM Occluder Cardiac Lt 20mm 28 21 $266,940.00 $266,940.00 $37,371.60 $226,899.00 $166,837.50 2025-01-01
105658 CDM Occluder Cardiac Lt 25mm 28 21 $266,940.00 $266,940.00 $37,371.60 $226,899.00 $166,837.50 2025-01-01
105657 CDM Occluder Cardiac Lt 22mm 28 21 $266,940.00 $266,940.00 $37,371.60 $226,899.00 $166,837.50 2025-01-01
105661 CDM Occluder Cardiac Lt 34mm 28 21 $266,940.00 $266,940.00 $37,371.60 $226,899.00 $166,837.50 2025-01-01
105659 CDM Occluder Cardiac Lt 28mm 28 21 $266,940.00 $266,940.00 $37,371.60 $226,899.00 $166,837.50 2025-01-01
105655 CDM Occluder Cardiac Lt 18mm 28 21 $266,940.00 $266,940.00 $37,371.60 $226,899.00 $166,837.50 2025-01-01
245979 CDM Stnt Thorac 26x26mm 10cm 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 2025-01-01
245660 CDM Stent 34mmx34mmx15cm 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 2025-01-01
246542 CDM Stent Thor Act Cntrl 40x 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 2025-01-01
100838 CDM Stent Graft 15cm 31x31mm 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 2025-01-01
100834 CDM Stnt Thorac 28x28mm 10cm 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 2025-01-01
100837 CDM Stent 20fr 31x31mm 10cm 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 2025-01-01
100832 CDM Stent Graft 10cm 21x21mm 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 2025-01-01
100843 CDM Stent Graft 20cm 45x45mm 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 2025-01-01
100835 CDM Stent Graft 15cn 28x28mm 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 2025-01-01
245658 CDM Graft Evas 40x40x10cm 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 2025-01-01
119923 CDM Kit Cath Rt Heart 73 37 $421,480.00 $421,480.00 $25,288.80 $358,258.00 $158,476.48 2025-01-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 20 7 — — $150,222.00 $187,777.50 $157,733.10 2025-01-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 72 30 — — $3,938.00 $411,167.00 $154,707.11 2025-01-01
773520 CDM Implant Cust Cranial Lge 28 21 $244,122.00 $244,122.00 $34,177.08 $207,503.70 $152,576.25 2025-01-01
102883 CDM Implant Cust Cranial Xl 28 21 $238,019.00 $238,019.00 $33,322.66 $202,316.15 $148,761.88 2025-01-01
133751 CDM Coil Embl 6mm 2mm 28 21 $232,390.00 $232,390.00 $32,534.60 $197,531.50 $145,243.75 2025-01-01
C1820 HCPCS Ipg Nrstm 49.5x55.5x1.34 207 18 $205,706.00 $205,706.00 $27,032.04 $200,434.25 $144,814.50 2025-01-01
439515 CDM Cord Blood Acquisition 73 37 $384,659.63 $384,659.63 $23,079.58 $326,960.69 $144,632.02 2025-01-01
107794 CDM Cord Blood Acquisition 73 37 $384,659.63 $384,659.63 $23,079.58 $326,960.69 $144,632.02 2025-01-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 $509,683.47 — $141,260.13 $145,629.00 $143,444.57 2026-07-17
1908 OTHER New Technology - Level 52 46 23 $282,491.32 — $129,845.30 $306,265.55 $142,801.60 2026-07-17
1907 OTHER New Technology - Level 52 46 23 $282,491.32 — $129,845.30 $306,265.55 $142,801.60 2026-07-17
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 16 4 $243,761.50 — $97,767.71 $257,170.92 $141,834.98 2026-07-17
01907 OTHER New Technology - Level 52 2 2 — — $136,902.11 $141,136.20 $139,019.15 2025-01-01
01908 OTHER New Technology - Level 52 2 2 — — $136,902.11 $141,136.20 $139,019.15 2025-01-01
C1822 HCPCS Pulse Gen Imp 92 18 $227,160.00 $227,160.00 $23,851.80 $219,903.50 $137,873.50 2025-01-01
126332 CDM Kit Impl Crnl Cstm Lg 28 21 $210,657.00 $210,657.00 $29,491.98 $179,058.45 $131,660.62 2025-01-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 16 5 — — $61,600.24 $920,000.00 $131,376.00 2025-01-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 20 7 — — $122,865.00 $153,581.25 $129,008.25 2025-01-01
1905 OTHER New Technology - Level 51 46 23 $254,705.38 — $117,073.68 $276,141.18 $128,755.60 2026-07-17
1906 OTHER New Technology - Level 51 46 23 $254,705.38 — $117,073.68 $276,141.18 $128,755.60 2026-07-17
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 20 7 — — $121,776.00 $152,220.00 $127,864.80 2025-01-01
01906 OTHER New Technology - Level 51 2 2 — — $123,436.38 $127,254.00 $125,345.19 2025-01-01
01905 OTHER New Technology - Level 51 2 2 — — $123,436.38 $127,254.00 $125,345.19 2025-01-01
C1767 HCPCS Kit Impl Neurostim 368 18 $212,962.50 $212,962.50 $15,371.16 $296,226.70 $124,180.80 2025-01-01
119886 CDM Coil Embl 5.6mm 7mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
119884 CDM Device 17 Sng Sphr 5 .0 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
108762 CDM Coil Embl 4x3mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
112368 CDM Coil Embl 5mm 2mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
119883 CDM Coil Embol Neuro 4x2.6mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
110044 CDM Coil Embol Neuro 7x3mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
119869 CDM Device Endo Sng 5x3mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
112416 CDM Coil Emb 7x5mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
111554 CDM Coil Emb Neuro 6x3mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
119870 CDM Coil Emb Neuro 7x4mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
119867 CDM Coil Embz .017 4.5mm 2mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
119868 CDM Coil Embl 4.5mm 3mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
119885 CDM Coil Emb Neuro 6x4.6mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
108761 CDM Coil Embol Neuro 4x2mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
107699 CDM Coil Emb Neuro 6x4mm 28 21 $197,759.00 $197,759.00 $27,686.26 $168,095.15 $123,599.38 2025-01-01
C1830 HCPCS Generator Nrstm 53x48mm 23 18 $182,990.00 $182,990.00 $25,618.60 $155,541.50 $122,603.30 2025-01-01
134379 CDM Putty Bngf Subst 20cc 28 21 $194,093.00 $194,093.00 $27,173.02 $164,979.05 $121,308.12 2025-01-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 2 $390,398.00 — $114,665.64 $118,212.00 $116,438.82 2026-07-17
5832 APR_DRG Neonate With Ecmo 20 7 — — $110,067.00 $137,583.75 $115,570.35 2025-01-01
113767 CDM Implant Cranial Med 28 21 $184,000.00 $184,000.00 $25,760.00 $156,400.00 $115,000.00 2025-01-01
1903 OTHER New Technology - Level 50 46 23 $226,919.44 — $104,302.06 $246,016.81 $114,709.59 2026-07-17
1904 OTHER New Technology - Level 50 46 23 $226,919.44 — $104,302.06 $246,016.81 $114,709.59 2026-07-17
127738 CDM Device Embl 4.5mm 20mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
136489 CDM Device Embl 5mm 16mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
108329 CDM Device Embl 4.5mm 12mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
129662 CDM Device Embl 4mm 14mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
135814 CDM Device Embl 3.75mm 10mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
110194 CDM Device Embl 4.25mm 14mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
129663 CDM Device Embl 3.75mm 12mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
126185 CDM Device Embl 3.25mm 12mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
129659 CDM Device Embl 4.75mm 16mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
108995 CDM Device Embl 3.75mm 16mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
127788 CDM Device Embl 4.5mm 16mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
127410 CDM Device Embl 5mm 35mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
125118 CDM Device Embl 3.5mm 12mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
111861 CDM Device Embl 4.75mm 20mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
106943 CDM Device Embl 2.5mm 16mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
108998 CDM Device Embl 4.50x25mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
128262 CDM Device Embl 4.5mm 14mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
129201 CDM Device Embl 4.25mm 25mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
109426 CDM Device Emb 5mm 14mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
129661 CDM Device Embl 3.75mm 14mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
119505 CDM Device Embl 4.25mm 12mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
127888 CDM Device Embl 4.75mm 14mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
108996 CDM Device Embl 4.25mm 18mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
128231 CDM Device Embl 5mm 25mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
128232 CDM Device Embl 5mm 12mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
127854 CDM Device Embl 4.75mm 12mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
111418 CDM Device Embl 4mm 12mm 28 21 $181,539.00 $181,539.00 $25,415.46 $154,308.15 $113,461.88 2025-01-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 18 5 $232,293.99 — $43,241.44 $245,072.58 $112,846.32 2026-07-17
439525 CDM Donor Leuk Acquisition 73 37 $299,740.03 $299,740.03 $17,984.40 $254,779.03 $112,702.25 2025-01-01
107799 CDM Stemcell/bm Acquisition 73 37 $299,740.03 $299,740.03 $17,984.40 $254,779.03 $112,702.25 2025-01-01
107792 CDM Bone Marrow Acquisition 73 37 $299,740.03 $299,740.03 $17,984.40 $254,779.03 $112,702.25 2025-01-01
439555 CDM Bone Marrow Acquisition 73 37 $299,740.03 $299,740.03 $17,984.40 $254,779.03 $112,702.25 2025-01-01
439505 CDM Stemcell/bm Acquisition 73 37 $299,740.03 $299,740.03 $17,984.40 $254,779.03 $112,702.25 2025-01-01
107796 CDM Donor Leuk Acquisition 73 37 $299,740.03 $299,740.03 $17,984.40 $254,779.03 $112,702.25 2025-01-01
245550 CDM Coil Embl Endo 10mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
222298 CDM Coil Emboli Sph 27 9x7.6 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119874 CDM Coil Embl Endo 9mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
224208 CDM Sys Endo Sng Lyr 5mmx4mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119876 CDM Coil Emb Endo Sn Ly 10mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119887 CDM Coil Emb Endo Sn Ly Sphr 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
247707 CDM System Endo Sng Lyr 6mmx 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
224298 CDM System Endo Sng Lyr 5mmx 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119873 CDM Coil Embl 27x9x5mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
107700 CDM Coil Embl Endo 8mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119875 CDM Coil Emb Endo Sn Ly 9mmx 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119880 CDM Coil Embl Endo 11mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
220039 CDM Sys Endo Sgl Lyr 4x2.6mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119871 CDM Coil Embl Endo 8mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119881 CDM Coil Emb Endo Sn Ly 11mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
100400 CDM Coil Emb Endo 7mm 4mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
101630 CDM Coil Emb Endo Sn Ly 8mmx 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119877 CDM Coil Embl Endo 10mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
100399 CDM Coil Emb Endo 7mm 5mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
220040 CDM Sys Endo Sng Lyr 6x3mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119889 CDM Coil Emb Endo Sn Ly Sphr 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119888 CDM Coil Emb Endo Sn Ly Sphr 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119879 CDM Coil Embl Endo 11mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
100398 CDM Device Embl 3mm 4mm Web 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119882 CDM Coil Embl Endo 11mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119872 CDM Coil Embl 4mm 9mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
119878 CDM Coil Emb Endo Sn Ly 10mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
110045 CDM Coil Emb 3mm 8mm 28 21 $179,236.00 $179,236.00 $25,093.04 $152,350.60 $112,022.50 2025-01-01
01903 OTHER New Technology - Level 50 2 2 — — $109,970.65 $113,371.80 $111,671.23 2025-01-01
01904 OTHER New Technology - Level 50 2 2 — — $109,970.65 $113,371.80 $111,671.23 2025-01-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 20 7 — — $104,516.00 $130,645.00 $109,741.80 2025-01-01
105161 CDM Gft Evs 15f 20x14.5x12mm 28 21 $175,573.00 $175,573.00 $24,580.22 $149,237.05 $109,733.12 2025-01-01
104757 CDM Graft Endo Aaa 32x14mm 28 21 $175,573.00 $175,573.00 $24,580.22 $149,237.05 $109,733.12 2025-01-01
104593 CDM Graft Endo Aaa 36x14mm 28 21 $175,573.00 $175,573.00 $24,580.22 $149,237.05 $109,733.12 2025-01-01
108826 CDM Graft Evasc 20x12mmx12cm 28 21 $175,573.00 $175,573.00 $24,580.22 $149,237.05 $109,733.12 2025-01-01
105477 CDM Graft Endo Aaa 28.5x12mm 28 21 $175,573.00 $175,573.00 $24,580.22 $149,237.05 $109,733.12 2025-01-01
107409 CDM Stent Aaa Xcldr 12cm 28 21 $175,573.00 $175,573.00 $24,580.22 $149,237.05 $109,733.12 2025-01-01
106882 CDM Graft Endo Aaa 26x12mm 28 21 $175,573.00 $175,573.00 $24,580.22 $149,237.05 $109,733.12 2025-01-01
103969 CDM Stent Grft 23x12mm 12cm 28 21 $175,573.00 $175,573.00 $24,580.22 $149,237.05 $109,733.12 2025-01-01
220643 CDM Device Embl Pip2.75x12mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
103032 CDM Device Embl 4.25mmx12mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
223906 CDM Dev Embl Pipln 14x3.75mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
220756 CDM Device Embl Flx 4.5x14mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
119186 CDM Device Embl 5x20mm Pipln 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
247611 CDM Device Embl 25x4mm Pline 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
119185 CDM Device Embl 5x25mm Pipln 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
104621 CDM Device Embl 4x12mm Pline 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
246040 CDM Device Embl 4.75x35mm Pl 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
100450 CDM Device Embl Flx 14x5mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
246221 CDM Device Embl 14x3.5mm Pl 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
118012 CDM Device Embl 16x4.25mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
220568 CDM Dev Embl 10x2.75mm Pipln 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
222225 CDM Device Embl Pl 4.75x20mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
220567 CDM Dev Embl 14x3.25mm Pipln 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
119072 CDM Device Embl 3.75x18mm Pl 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
248520 CDM Dev Embl 20x4.25mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
119165 CDM Device Embl Pipln 16x3.5 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
100279 CDM Device Embl 30mm 4mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
245672 CDM Device Embl Pipln 14x4mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
101696 CDM Device Embl Pln 4.5x12mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
118662 CDM Device Embl 4.25x14mm Pl 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
218814 CDM Device Embl Piplin 4mmx2 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
118011 CDM Device Embl 16mm 4mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
223765 CDM Device Embl 3.5x10mm 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
245772 CDM Device Embl16x3.75mm Pip 28 21 $172,894.00 $172,894.00 $24,205.16 $146,959.90 $108,058.75 2025-01-01
L5969 HCPCS Addition, Endoskeletal Ankle-foot Or Ankle System, Power Assist, Includes Any Ty… 2 1 $100,565.67 — $106,097.82 $106,097.82 $106,097.82 2026-07-17
A9543 HCPCS Y90 Ibritum Tiu Tx 40mci 72 34 $218,286.62 $218,286.62 $13,097.20 $436,090.33 $105,642.96 2026-07-17
132142 CDM Graft Bn Femoral 28 21 $168,394.00 $168,394.00 $23,575.16 $143,134.90 $105,246.25 2025-01-01
73 APR_DRG Allogeneic Bone Marrow Transplant 20 7 — — $89,547.00 $156,708.00 $104,771.00 2025-01-01
106203 CDM Graft Endo Aaa 23x12mm 28 21 $167,049.00 $167,049.00 $23,386.86 $141,991.65 $104,405.62 2025-01-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 72 30 — — $3,938.00 $204,066.59 $102,181.24 2025-01-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 20 7 — — $97,124.00 $121,405.00 $101,980.20 2025-01-01
5831 APR_DRG Neonate With Ecmo 20 7 — — $96,916.00 $121,145.00 $101,761.80 2025-01-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 50 24 $642,484.33 — $92,000.00 $677,827.66 $101,180.00 2026-07-17
1902 OTHER New Technology - Level 49 46 23 $199,133.50 — $91,530.40 $215,892.35 $100,663.54 2026-07-17
1901 OTHER New Technology - Level 49 46 23 $199,133.50 — $91,530.40 $215,892.35 $100,663.54 2026-07-17
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 21 5 $153,523.29 — $37,032.96 $161,968.67 $99,500.82 2026-07-17
01901 OTHER New Technology - Level 49 2 2 — — $96,504.87 $99,489.56 $97,997.21 2025-01-01
01902 OTHER New Technology - Level 49 2 2 — — $96,504.87 $99,489.56 $97,997.21 2025-01-01
127999 CDM Graft Bn Ptla Left 28 21 $156,310.00 $156,310.00 $21,883.40 $132,863.50 $97,693.75 2025-01-01
127730 CDM Kit Pmp Rt Hrt 22f 170cm 73 37 $257,000.00 $257,000.00 $15,420.00 $218,450.00 $96,632.00 2025-01-01
769638 CDM Set Vntrc 17.4x13.8in 73 37 $257,000.00 $257,000.00 $15,420.00 $218,450.00 $96,632.00 2025-01-01
112560 CDM Kit Cath Rt Heart 73 37 $257,000.00 $257,000.00 $15,420.00 $218,450.00 $96,632.00 2025-01-01
120324 CDM Kit Cath Rt Heart 73 37 $257,000.00 $257,000.00 $15,420.00 $218,450.00 $96,632.00 2025-01-01
131619 CDM Kit Lo Prfl Comp Shth 7f 73 37 $257,000.00 $257,000.00 $15,420.00 $218,450.00 $96,632.00 2025-01-01
120101 CDM Graft Evas 26x12mm 12cm 28 21 $152,675.00 $152,675.00 $21,374.50 $129,773.75 $95,421.88 2025-01-01
686386 CDM Graft Evas 10cm 12mm 28 21 $152,675.00 $152,675.00 $21,374.50 $129,773.75 $95,421.88 2025-01-01
116161 CDM Graft Evas 10cm 14.5mm 28 21 $152,675.00 $152,675.00 $21,374.50 $129,773.75 $95,421.88 2025-01-01
14 MS_DRG Allogeneic Bone Marrow Transplant 56 26 — — $81,818.37 $179,325.12 $94,784.12 2025-01-01
7 MS_DRG Lung Transplant 57 27 — — $3,938.00 $183,904.56 $94,546.72 2025-01-01
112284 CDM Graft Hemi Cndyl Mdl Lt 28 21 $148,910.00 $148,910.00 $20,847.40 $126,573.50 $93,068.75 2025-01-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 20 7 — — $88,601.00 $110,751.25 $93,031.05 2025-01-01
C1772 HCPCS Pump Infs Pain 40ml 46 18 $133,059.00 $133,059.00 $17,491.32 $120,003.00 $92,735.25 2025-01-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 51 24 $127,050.00 — $83,749.35 $197,539.22 $92,725.09 2026-07-17
116805 CDM Occluder Cv 25x18mm 28 21 $148,226.00 $148,226.00 $20,751.64 $125,992.10 $92,641.25 2025-01-01
116803 CDM Occluder Cv 18x18mm 28 21 $148,226.00 $148,226.00 $20,751.64 $125,992.10 $92,641.25 2025-01-01
116804 CDM Occluder Cv 35x18mm 28 21 $148,226.00 $148,226.00 $20,751.64 $125,992.10 $92,641.25 2025-01-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 20 7 — — $88,196.00 $110,245.00 $92,605.80 2025-01-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 20 7 — — $87,968.00 $109,960.00 $92,366.40 2025-01-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 20 7 — — $87,590.00 $109,487.50 $91,969.50 2025-01-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 20 7 — — $86,715.00 $108,393.75 $91,050.75 2025-01-01
1613 APR_DRG Implantable Heart Assist Systems 25 8 — — $83,576.00 $104,470.00 $90,262.46 2025-01-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 20 7 — — $76,119.00 $133,209.00 $89,059.90 2025-01-01
1585 OTHER New Technology - Level 48 46 23 $175,978.55 — $80,887.38 $190,788.70 $88,958.53 2026-07-17
1599 OTHER New Technology - Level 48 46 23 $175,978.55 — $80,887.38 $190,788.70 $88,958.53 2026-07-17
84 APR_DRG Autologous Bone Marrow Transplant 20 7 — — $75,814.00 $132,676.00 $88,703.10 2025-01-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 20 7 — — $84,431.00 $105,538.75 $88,652.55 2025-01-01
133086 CDM Pump Pain Infn 148gm 28 21 $141,180.00 $141,180.00 $19,765.20 $120,003.00 $88,237.50 2025-01-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 20 7 — — $83,674.00 $104,592.50 $87,857.70 2025-01-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 20 7 — — $83,134.00 $103,917.50 $87,290.70 2025-01-01
01599 OTHER New Technology - Level 48 2 2 — — $85,283.43 $87,921.06 $86,602.24 2025-01-01
01585 OTHER New Technology - Level 48 2 2 — — $85,283.43 $87,921.06 $86,602.24 2025-01-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 3 1 — — $76,953.90 $104,228.70 $86,207.85 2025-01-01
245933 CDM Implant Crnfcl Sm 28 21 $131,874.00 $131,874.00 $18,462.36 $112,092.90 $82,421.25 2025-01-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 2 $187,986.97 — $80,624.20 $83,117.73 $81,870.96 2026-07-17
64 APR_DRG Pancreas Transplant 20 7 — — $69,679.00 $121,940.00 $81,525.40 2025-01-01
658517 CDM Graft Evas 35x14.5m 16cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
685420 CDM Graft Evas 35x14.5m 18cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
773729 CDM Graft Evas 23x12mm 16cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
687969 CDM Graft Evas 26x12mm 14cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
684643 CDM Graft Evas 14.5mm 18cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
685501 CDM Graft Evas 23x14.5m 18cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
654298 CDM Graft Evas 35x14.5m 14cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
750702 CDM Graft Evas 23x14.5m 12cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
774342 CDM Graft Evas 28.5x12m 18cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
773238 CDM Graft Evas 23x12mm 12cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
685065 CDM Graft Evas 14.5mm 14cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
687302 CDM Graft Evas 10cm 10mm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
773647 CDM Graft Evas 23x12mm 18cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
685859 CDM Graft Evas 14.5mm 12cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
774298 CDM Graft Evas 14.5mm 16cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
686592 CDM Graft Evas 26x12mm 16cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
659212 CDM Graft Evas 23x14.5m14cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
687931 CDM Graft Evas 28.5x12m 16cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
773648 CDM Graft Evas 23x14.5m 16cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
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