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

METHODIST HOSPITAL STONE OAK

San Antonio, TX · CCN 670055 · Rates published

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You selected 27447 (CPT)

Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)

This hospital’s price: $13,926 across 19 payers · range $948-$37,872

Source: https://www.hcadam.com/api/public/content/e131399d17f645799531eb7f1f536aa2?download=true · observed 2025-01-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

39,864 distinct procedures filed
58 distinct payers
2,001,846 rate rows
2026-07-17 last MRF observed
Data quality

1,920,965 of 2,001,846 rate rows are consumer-grade (96.0%)

80,881 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
per-diem day rate — not a per-procedure price 30,226
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 26,505
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 14,420
template filing: same amount across many unrelated codes — excluded 6,299
percent-of-charges filed in the dollar field — excluded from medians 2,412
placeholder amount (≤ $0.02) — excluded from medians 479
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 433
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 75
exceeds 10× this hospital's gross charge — excluded from medians 32
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 not_modified · 2026-08-04
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
$2,997,086
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
$2,460,273
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
$3,758,972
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
$3,574,709
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
$3,646,097
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
$3,325,455
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 23 $8,330.92 $4,600,400.00 $3,286,000.00 nat. median
$3,252,508
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,225,691.35 $3,325,455.00 $3,275,573.17 nat. median
$3,228,024
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
$2,939,969
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
$2,588,981
0.9× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,316,955.58 $2,388,614.00 $2,352,784.79 nat. median
$2,511,312
0.9× 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
$631,793
outlier · 2.6×
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
$610,161
outlier · 2.4×
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
$624,417
outlier · 2.3×
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
$577,541
outlier · 2.3×
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
$691,418
1.2× 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
$588,565
1.4× median
9194
OTHER 		Tisagenlecleucel Car-pos 23 $486,857.47 $1,148,348.59 $535,437.38 nat. median
$576,820
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 23 $484,953.53 $1,143,857.78 $533,343.46 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 23 $484,460.59 $1,142,695.09 $532,801.33 nat. median
$560,872
0.9× median
9413
OTHER 		Lisocabtagene Car Pos T 23 $475,388.01 $1,121,295.64 $522,823.47 nat. median
$562,201
0.9× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $513,317.11 $529,192.90 $521,255.01 nat. median
$549,535
0.9× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $511,309.70 $527,123.40 $519,216.55 nat. median
$570,020
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $510,789.97 $526,587.60 $518,688.78 nat. median
$541,339
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $501,224.32 $516,726.10 $508,975.21 nat. median
$545,335
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 23 $450,299.52 $1,062,119.52 $495,231.58 nat. median
$533,230
0.9× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $474,772.32 $489,456.00 $482,114.16 nat. median
$516,226
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 23 $423,687.97 $999,350.97 $465,964.66 nat. median
$492,768
0.9× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $446,714.49 $460,530.40 $453,622.45 nat. median
$474,767
1.0× median
108937
CDM 		Tavr Heart Valve 29mm 21 $86,162.30 $523,128.25 $384,653.12 nat. median
$153,861
outlier · 2.5×
119940
CDM 		Valve Tavr 26mm 21 $70,590.80 $428,587.00 $315,137.50 nat. median
$70,591
outlier · 4.5×
119939
CDM 		Valve Tavr 23mm 21 $70,590.80 $428,587.00 $315,137.50 nat. median
$216
outlier · 1456.2×
119941
CDM 		Valve Tavr 29mm 21 $70,590.80 $428,587.00 $315,137.50 nat. median
$160,846
2.0× median
119938
CDM 		Valve Tavr 20mm 21 $70,590.80 $428,587.00 $315,137.50 nat. median
$28
outlier · 11319.6×
775554
CDM 		Kit Aor Vlv 14fr 29mm 21 $67,476.50 $409,678.75 $301,234.38 nat. median
$240,988
1.2× median
100354
CDM 		Valve Heart Trnscth 26mm 21 $67,476.50 $409,678.75 $301,234.38 nat. median
$2,160
outlier · 139.5×
100352
CDM 		Valve Heart Trnscth 20mm 21 $67,476.50 $409,678.75 $301,234.38 nat. median
$327
outlier · 920.3×
100353
CDM 		Valve Heart Trnscth 23mm 21 $67,476.50 $409,678.75 $301,234.38 nat. median
$2,160
outlier · 139.5×
74
APR_DRG 		Allogeneic Bone Marrow Transplant 7 $253,775.00 $444,107.00 $296,917.00 nat. median
$175,480
1.7× median
134434
CDM 		Valve Tavr 29mm 21 $65,400.30 $397,073.25 $291,965.62 nat. median
$239,178
1.2× median
134662
CDM 		Valve Tavr 23mm 21 $65,400.30 $397,073.25 $291,965.62 nat. median
$120,523
outlier · 2.4×
134663
CDM 		Valve Tavr 31mm 21 $65,400.30 $397,073.25 $291,965.62 nat. median
$14,202
outlier · 20.6×
134664
CDM 		Valve Tavr 26mm 21 $65,400.30 $397,073.25 $291,965.62 nat. median
$120,523
outlier · 2.4×
246026
CDM 		Valve Triclip 1sgc 2cds 21 $62,286.00 $378,165.00 $278,062.50 nat. median
$266,940
1.0× median
111426
CDM 		Valve Tavr Sz 29mm 21 $62,286.00 $378,165.00 $278,062.50 nat. median
$474
outlier · 587.0×
111424
CDM 		Valve Tavr Sz 23mm 21 $62,286.00 $378,165.00 $278,062.50 nat. median
$1,482
outlier · 187.6×
111427
CDM 		Valve Tavr Size 34mm 21 $62,286.00 $378,165.00 $278,062.50 nat. median
$6,387
outlier · 43.5×

Other procedures at this hospital

Browse this hospital's 39,864 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
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
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
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
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
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
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
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
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
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
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
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
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
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 65 28 — — $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
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
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
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
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
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
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
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
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
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
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
245660 CDM Stent 34mmx34mmx15cm 28 21 $261,008.00 $261,008.00 $36,541.12 $221,856.80 $163,130.00 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
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
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
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
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
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
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
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
1907 OTHER New Technology - Level 52 46 23 $282,491.32 — $129,845.30 $306,265.55 $142,801.60 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
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 16 4 $243,761.50 — $97,767.71 $257,170.92 $141,834.98 2026-07-17
01908 OTHER New Technology - Level 52 2 2 — — $136,902.11 $141,136.20 $139,019.15 2025-01-01
01907 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
1906 OTHER New Technology - Level 51 46 23 $254,705.38 — $117,073.68 $276,141.18 $128,755.60 2026-07-17
1905 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
01905 OTHER New Technology - Level 51 2 2 — — $123,436.38 $127,254.00 $125,345.19 2025-01-01
01906 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
1901 OTHER New Technology - Level 49 46 23 $199,133.50 — $91,530.40 $215,892.35 $100,663.54 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
773142 CDM Graft Evas 26x14.5m 14cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
654260 CDM Graft Evas 31x14.5m 13cm 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
659651 CDM Graft Evas 26x14.5m 12cm 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
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
773833 CDM Graft Evas 26x14.5m 18cm 28 21 $129,923.00 $129,923.00 $18,189.22 $110,434.55 $81,201.88 2025-01-01
652992 CDM Graft Evas 31x14.5m 15cm 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
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