Price Transparency Hospital negotiated rates

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

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Hospital

MEDICAL CITY ALLIANCE

Fort Worth, TX · CCN 670103 · Rates published

36,570 distinct procedures filed
37 distinct payers
1,607,123 rate rows
2026-03-01 last MRF observed
Data quality

1,586,291 of 1,607,123 rate rows are consumer-grade (98.7%)

20,832 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 11,192
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 5,587
template filing: same amount across many unrelated codes — excluded 3,758
placeholder amount (≤ $0.02) — excluded from medians 240
exceeds 10× this hospital's gross charge — excluded from medians 55
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/46-4027347_MEDICAL-CITY-ALLIANCE_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.medicalcityhealthcare.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 28cc5fc6e3d49a6f… · 686,454,019 bytes · first seen 2026-05-06

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,850,948.67 $4,850,948.67 $4,850,948.67 nat. median
$3,006,423
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 20 $5,291.79 $4,955,500.00 $4,535,408.75 nat. median
$9,966
outlier · 455.1×
00845
OTHER 		Inj, Atidarsagene Autotem 2 $4,369,850.00 $4,505,000.00 $4,437,425.00 nat. median
$4,505,000
1.0× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $4,271,819.03 $4,271,819.03 $4,271,819.03 nat. median
$2,469,189
1.7× median
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $3,847,800.00 $3,847,800.00 $3,847,800.00 nat. median
$2,448,600
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 20 $3,666,840.67 $4,790,847.10 $3,722,119.67 nat. median
$3,746,358
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,574,708.99 $3,685,267.00 $3,629,988.00 nat. median
$3,574,709
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 22 $6,223.86 $4,326,218.00 $3,377,777.90 nat. median
$13,041
outlier · 259.0×
908
OTHER 		Topi Adm Prad Zami Per Tr 20 $9,581.54 $4,336,566.00 $3,369,178.20 nat. median
$22,747
outlier · 148.1×
748
OTHER 		Inj, Lovotibeglogene Auto 22 $11,847.05 $4,228,260.40 $3,301,295.62 nat. median
$17,963
outlier · 183.8×
00908
OTHER 		Topi Adm Prad Zami Per Tr 2 $3,235,745.40 $3,335,820.00 $3,285,782.70 nat. median
$12,675
outlier · 259.2×
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,228,024.20 $3,327,860.00 $3,277,942.10 nat. median
$3,228,024
1.0× median
906
OTHER 		Inj Elivaldogene Autoteme 20 $8,466.42 $4,134,000.00 $3,211,800.00 nat. median
$20,756
outlier · 154.7×
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,154,932.76 $3,252,508.00 $3,203,720.38 nat. median
$3,187,420
1.0× median
00906
OTHER 		Inj Elivaldogene Autoteme 2 $3,084,600.00 $3,180,000.00 $3,132,300.00 nat. median
$21
outlier · 151392.0×
746
OTHER 		Inj, Betibeglogene Autote 22 $10,958.64 $3,821,959.70 $2,984,068.54 nat. median
$21,896
outlier · 136.3×
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,851,769.93 $2,939,969.00 $2,895,869.46 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 21 $2,455,110.00 $4,634,275.99 $2,627,815.71 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,511,311.57 $2,588,981.00 $2,550,146.29 nat. median
$2,457,321
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 2 $1,271,523.00 $4,067,128.80 $2,528,215.20 nat. median
$824,563
outlier · 3.1×
824
OTHER 		Inj, Exagamglogene Autote 22 $12,832.29 $4,174,280.00 $2,353,571.00 nat. median
$25,250
outlier · 93.2×
00824
OTHER 		Inj, Exagamglogene Autote 2 $2,262,040.00 $2,332,000.00 $2,297,020.00 nat. median
$2,332,000
1.0× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 2 $459,112.50 $2,937,060.00 $1,825,740.00 nat. median
$324,450
outlier · 5.6×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $536,573.93 $3,186,403.20 $1,597,833.00 nat. median
$675,122
outlier · 2.4×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $511,793.34 $2,874,615.36 $1,441,485.90 nat. median
$625,184
outlier · 2.3×
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 $500,948.74 $2,811,572.54 $1,409,872.86 nat. median
$674,188
outlier · 2.1×
C9301
HCPCS 		Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 1 $959,962.50 $1,544,287.50 $1,405,162.50 nat. median
$459,112
outlier · 3.1×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 $23.68 $2,643,227.20 $1,325,455.50 nat. median
$754,974
1.8× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $474,717.03 $2,555,975.04 $1,281,702.60 nat. median
$620,080
outlier · 2.1×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $6.22 $2,437,928.00 $1,222,507.50 nat. median
$634,511
1.9× median
2067
OTHER 		Afamitresgene Autoleucel 23 $766,766.90 $2,019,024.40 $801,444.80 nat. median
$786,032
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 22 $565,868.90 $1,539,641.95 $605,279.09 nat. median
$587,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 22 $563,698.64 $1,484,312.01 $591,726.20 nat. median
$566,531
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 22 $559,390.19 $1,472,967.14 $579,067.24 nat. median
$562,201
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $570,020.11 $587,649.60 $578,834.85 nat. median
$554,552
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 22 $555,291.39 $1,462,174.32 $574,824.25 nat. median
$558,082
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $549,535.36 $566,531.30 $558,033.33 nat. median
$538,205
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $545,335.16 $562,201.20 $553,768.18 nat. median
$534,091
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $541,339.35 $558,081.80 $549,710.57 nat. median
$530,178
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 22 $529,531.24 $1,394,343.56 $548,157.97 nat. median
$532,192
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $516,226.43 $532,192.20 $524,209.31 nat. median
$505,583
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 22 $487,002.95 $1,282,359.52 $504,133.71 nat. median
$489,450
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $474,766.69 $489,450.20 $482,108.45 nat. median
$464,978
1.0× median
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 5 $61,338.53 $1,100,800.00 $405,600.00 nat. median
$69,774
outlier · 5.8×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 28 $207,841.14 $842,426.46 $358,453.70 nat. median
$265,286
1.4× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 17 $318,346.14 $1,273,072.13 $341,085.15 nat. median
$370,174
0.9× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 $332,753.88 $332,753.88 $332,753.88 nat. median
$209,753
1.6× median
90288
CPT 		Botulism Immune Globulin, Human, For Intravenous Use 1 $294,713.96 $416,525.16 $329,245.80 nat. median
$55,037
outlier · 6.0×
Q2043
HCPCS 		Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 5 $55,306.59 $478,449.94 $310,609.58 nat. median
$66,682
outlier · 4.7×
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 4 $93,760.51 $582,739.61 $302,670.97 nat. median
$62,507
outlier · 4.8×

Other procedures at this hospital

Browse this hospital's 36,570 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 3 1 — — $4,850,948.67 $4,850,948.67 $4,850,948.67 2026-03-01
00845 OTHER Inj, Atidarsagene Autotem 2 2 — — $4,369,850.00 $4,505,000.00 $4,437,425.00 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 3 1 — — $4,271,819.03 $4,271,819.03 $4,271,819.03 2026-03-01
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 3 1 — — $3,847,800.00 $3,847,800.00 $3,847,800.00 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 31 20 — — $3,666,840.67 $4,790,847.10 $3,722,119.67 2026-03-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $3,574,708.99 $3,685,267.00 $3,629,988.00 2026-03-01
00908 OTHER Topi Adm Prad Zami Per Tr 2 2 — — $3,235,745.40 $3,335,820.00 $3,285,782.70 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $3,228,024.20 $3,327,860.00 $3,277,942.10 2026-03-01
00748 OTHER Inj, Lovotibeglogene Auto 2 2 — — $3,154,932.76 $3,252,508.00 $3,203,720.38 2026-03-01
00906 OTHER Inj Elivaldogene Autoteme 2 2 — — $3,084,600.00 $3,180,000.00 $3,132,300.00 2026-03-01
00746 OTHER Inj, Betibeglogene Autote 2 2 — — $2,851,769.93 $2,939,969.00 $2,895,869.46 2026-03-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $2,511,311.57 $2,588,981.00 $2,550,146.29 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 32 21 — — $2,455,110.00 $4,634,275.99 $2,627,815.71 2026-03-01
00824 OTHER Inj, Exagamglogene Autote 2 2 — — $2,262,040.00 $2,332,000.00 $2,297,020.00 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 9 2 — — $1,271,523.00 $4,067,128.80 $2,528,215.20 2026-03-01
C9301 HCPCS Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 6 1 — — $959,962.50 $1,544,287.50 $1,405,162.50 2026-03-01
2067 OTHER Afamitresgene Autoleucel 38 23 — — $766,766.90 $2,019,024.40 $801,444.80 2026-03-01
09498 OTHER Ciltacabtagene Car-pos T 2 2 — — $570,020.11 $587,649.60 $578,834.85 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 35 22 — — $565,868.90 $1,539,641.95 $605,279.09 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 35 22 — — $563,698.64 $1,484,312.01 $591,726.20 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 35 22 — — $559,390.19 $1,472,967.14 $579,067.24 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 35 22 — — $555,291.39 $1,462,174.32 $574,824.25 2026-03-01
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $549,535.36 $566,531.30 $558,033.33 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 2 2 — — $545,335.16 $562,201.20 $553,768.18 2026-03-01
09422 OTHER Idecabtagene Vicleucel Ca 2 2 — — $541,339.35 $558,081.80 $549,710.57 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 12 4 — — $536,573.93 $3,186,403.20 $1,597,833.00 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 35 22 — — $529,531.24 $1,394,343.56 $548,157.97 2026-03-01
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $516,226.43 $532,192.20 $524,209.31 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 12 4 — — $511,793.34 $2,874,615.36 $1,441,485.90 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 12 4 — — $500,948.74 $2,811,572.54 $1,409,872.86 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 35 22 — — $487,002.95 $1,282,359.52 $504,133.71 2026-03-01
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $474,766.69 $489,450.20 $482,108.45 2026-03-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 12 4 — — $474,717.03 $2,555,975.04 $1,281,702.60 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 9 2 — — $459,112.50 $2,937,060.00 $1,825,740.00 2026-03-01
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 3 1 — — $332,753.88 $332,753.88 $332,753.88 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 30 17 — — $318,346.14 $1,273,072.13 $341,085.15 2026-03-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 6 1 — — $294,713.96 $416,525.16 $329,245.80 2026-03-01
5834 APR_DRG Neonate With Ecmo 22 8 — — $270,110.21 $337,637.76 $283,615.72 2026-03-01
00831 OTHER Obecbtge Autol Up To 400 2 2 — — $269,902.50 $278,250.00 $274,076.25 2026-03-01
897 OTHER Revakinagene, Per Implant 33 21 — — $263,675.00 $694,300.00 $272,950.00 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 31 9 — — $262,763.46 $459,836.00 $283,785.00 2026-03-01
00897 OTHER Revakinagene, Per Implant 2 2 — — $257,050.00 $265,000.00 $261,025.00 2026-03-01
5833 APR_DRG Neonate With Ecmo 22 8 — — $228,719.40 $285,899.25 $240,155.37 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 31 9 — — $220,021.59 $385,038.00 $237,623.00 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $213,654.33 $220,262.20 $216,958.27 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 67 28 — — $207,841.14 $842,426.46 $358,453.70 2026-03-01
00886 OTHER Inj. Remestemcel-l-rknd/ 2 2 — — $195,618.93 $201,669.00 $198,643.96 2026-03-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 2 — — $187,805.58 $193,614.00 $190,709.79 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 22 8 — — $170,975.33 $213,719.16 $179,524.10 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 27 9 — — $166,028.78 $207,535.98 $174,330.22 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 22 8 — — $155,542.82 $194,428.53 $163,319.96 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 64 27 — — $151,231.85 $638,050.74 $176,046.23 2026-03-01
1907 OTHER New Technology - Level 52 38 23 — — $145,692.90 $393,510.11 $156,202.49 2026-03-01
1908 OTHER New Technology - Level 52 38 23 — — $145,692.90 $393,510.11 $156,202.49 2026-03-01
01907 OTHER New Technology - Level 52 2 2 — — $141,322.11 $145,692.90 $143,507.51 2026-03-01
01908 OTHER New Technology - Level 52 2 2 — — $141,322.11 $145,692.90 $143,507.51 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 2 — — $132,369.21 $136,463.10 $134,416.15 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 17 4 — — $131,717.55 $574,167.94 $211,893.45 2026-03-01
1906 OTHER New Technology - Level 51 38 23 — — $131,362.50 $354,804.33 $140,838.36 2026-03-01
1905 OTHER New Technology - Level 51 38 23 — — $131,362.50 $354,804.33 $140,838.36 2026-03-01
01905 OTHER New Technology - Level 51 2 2 — — $127,421.63 $131,362.50 $129,392.07 2026-03-01
01906 OTHER New Technology - Level 51 2 2 — — $127,421.63 $131,362.50 $129,392.07 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 22 8 — — $127,217.05 $159,021.31 $133,577.90 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 22 8 — — $126,089.68 $157,612.10 $132,394.16 2026-03-01
1904 OTHER New Technology - Level 50 38 23 — — $117,032.10 $316,098.55 $125,474.24 2026-03-01
1903 OTHER New Technology - Level 50 38 23 — — $117,032.10 $316,098.55 $125,474.24 2026-03-01
5832 APR_DRG Neonate With Ecmo 22 8 — — $113,965.65 $142,457.06 $119,663.93 2026-03-01
01903 OTHER New Technology - Level 50 2 2 — — $113,521.14 $117,032.10 $115,276.62 2026-03-01
01904 OTHER New Technology - Level 50 2 2 — — $113,521.14 $117,032.10 $115,276.62 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 22 8 — — $108,217.85 $135,272.31 $113,628.74 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 41 24 — — $108,147.24 $629,884.36 $114,836.76 2026-03-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 2 — — $103,369.89 $106,566.90 $104,968.39 2026-03-01
1901 OTHER New Technology - Level 49 38 23 — — $102,701.70 $277,392.76 $110,110.11 2026-03-01
1902 OTHER New Technology - Level 49 38 23 — — $102,701.70 $277,392.76 $110,110.11 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 64 27 — — $102,616.99 $416,386.94 $116,259.29 2026-03-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 22 8 — — $100,564.19 $125,705.24 $105,592.40 2026-03-01
5831 APR_DRG Neonate With Ecmo 22 8 — — $100,349.03 $125,436.29 $105,366.48 2026-03-01
01902 OTHER New Technology - Level 49 2 2 — — $99,620.65 $102,701.70 $101,161.17 2026-03-01
01901 OTHER New Technology - Level 49 2 2 — — $99,620.65 $102,701.70 $101,161.17 2026-03-01
L5969 HCPCS Addition, Endoskeletal Ankle-foot Or Ankle System, Power Assist, Includes Any Ty… 1 1 — — $98,593.44 $98,593.44 $98,593.44 2026-03-01
7 MS_DRG Lung Transplant 51 27 — — $97,957.19 $381,784.85 $104,954.14 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 17 4 — — $93,760.51 $582,739.61 $302,670.97 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 31 9 — — $92,719.19 $162,259.00 $100,137.00 2026-03-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 2 2 — — $92,640.73 $95,505.91 $94,073.32 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 22 8 — — $91,739.76 $114,674.70 $96,326.75 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 22 8 — — $91,320.47 $114,150.59 $95,886.49 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 51 27 — — $91,160.94 $354,299.71 $97,672.44 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 22 8 — — $91,084.33 $113,855.41 $95,638.55 2026-03-01
1585 OTHER New Technology - Level 48 38 23 — — $90,759.68 $245,137.92 $97,306.65 2026-03-01
1599 OTHER New Technology - Level 48 38 23 — — $90,759.68 $245,137.92 $97,306.65 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 22 8 — — $90,692.77 $113,365.96 $95,227.41 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 22 8 — — $89,786.96 $112,233.70 $94,276.31 2026-03-01
01585 OTHER New Technology - Level 48 2 2 — — $88,036.89 $90,759.68 $89,398.29 2026-03-01
01599 OTHER New Technology - Level 48 2 2 — — $88,036.89 $90,759.68 $89,398.29 2026-03-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 22 8 — — $87,421.62 $109,277.02 $91,792.70 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 22 8 — — $86,638.51 $108,298.14 $90,970.44 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 27 9 — — $86,536.44 $108,170.55 $90,863.26 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 55 28 — — $86,159.42 $554,970.00 $96,709.56 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 22 8 — — $86,079.09 $107,598.86 $90,383.04 2026-03-01
1584 OTHER New Technology - Level 47 38 23 — — $81,206.08 $219,334.06 $87,063.90 2026-03-01
1598 OTHER New Technology - Level 47 38 23 — — $81,206.08 $219,334.06 $87,063.90 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 47 24 — — $80,850.00 $249,112.22 $97,933.43 2026-03-01
E0767 HCPCS Intrabuccal, Systemic Delivery Of Amplitude-modulated, Radiofrequency Electromag… 6 1 — — $80,266.41 $113,137.42 $103,199.67 2026-03-01
007 OTHER Lung Transplant 2 2 — — $79,446.81 $81,903.93 $80,675.37 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 31 9 — — $78,815.56 $137,927.00 $85,120.80 2026-03-01
01584 OTHER New Technology - Level 47 2 2 — — $78,769.90 $81,206.08 $79,987.99 2026-03-01
01598 OTHER New Technology - Level 47 2 2 — — $78,769.90 $81,206.08 $79,987.99 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 51 27 — — $78,714.37 $303,963.85 $84,336.83 2026-03-01
84 APR_DRG Autologous Bone Marrow Transplant 31 9 — — $78,499.76 $137,375.00 $84,779.70 2026-03-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 22 8 — — $77,104.95 $96,381.19 $80,960.20 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 27 9 — — $77,061.91 $96,327.39 $80,915.01 2026-03-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 1 — — $77,046.96 $77,046.96 $77,046.96 2026-03-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 22 8 — — $76,417.86 $95,522.32 $80,238.75 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 50 27 — — $75,983.00 $333,689.54 $92,212.13 2026-03-01
2464 APR_DRG Gastrointestinal Vascular Insufficiency 22 8 — — $74,728.58 $93,410.73 $78,465.01 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 22 8 — — $74,343.07 $92,928.84 $78,060.22 2026-03-01
64 APR_DRG Pancreas Transplant 31 9 — — $72,147.72 $126,259.00 $77,919.50 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 22 8 — — $72,142.03 $90,177.54 $75,749.13 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 22 8 — — $71,926.16 $89,907.70 $75,522.47 2026-03-01
1583 OTHER New Technology - Level 46 38 23 — — $71,652.48 $193,530.20 $76,821.14 2026-03-01
1597 OTHER New Technology - Level 46 38 23 — — $71,652.48 $193,530.20 $76,821.14 2026-03-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 2 — — $70,413.32 $72,591.05 $71,502.18 2026-03-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 22 8 — — $69,920.37 $87,400.46 $73,416.39 2026-03-01
01597 OTHER New Technology - Level 46 2 2 — — $69,502.91 $71,652.48 $70,577.70 2026-03-01
01583 OTHER New Technology - Level 46 2 2 — — $69,502.91 $71,652.48 $70,577.70 2026-03-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $68,413.82 $68,413.82 $68,413.82 2026-03-01
014 OTHER Allogeneic Bone Marrow Transplant 2 2 — — $67,815.28 $69,912.66 $68,863.97 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 27 9 — — $67,223.57 $84,029.46 $70,584.75 2026-03-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 2 2 — — $67,100.98 $69,176.27 $68,138.62 2026-03-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 40 24 — — $66,737.65 $180,260.45 $70,865.75 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 22 8 — — $66,120.39 $82,650.49 $69,426.41 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 22 8 — — $65,583.73 $81,979.66 $68,862.92 2026-03-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 2 2 — — $62,885.13 $64,830.03 $63,857.58 2026-03-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 22 8 — — $62,788.78 $78,485.98 $65,928.22 2026-03-01
00717 OTHER Instill Adstiladrin, Tx D 2 2 — — $62,346.55 $64,274.79 $63,310.67 2026-03-01
72 APR_DRG Allogeneic Bone Marrow Transplant 31 9 — — $62,296.93 $109,020.00 $67,280.70 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 27 9 — — $62,206.25 $77,757.81 $65,316.56 2026-03-01
1582 OTHER New Technology - Level 45 38 23 — — $62,098.88 $167,726.35 $66,578.40 2026-03-01
1596 OTHER New Technology - Level 45 38 23 — — $62,098.88 $167,726.35 $66,578.40 2026-03-01
L8687 HCPCS Implantable Neurostimulator Pulse Generator, Dual Array, Rechargeable, Includes … 1 1 — — $62,014.14 $62,014.14 $62,014.14 2026-03-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 22 8 — — $61,494.97 $76,868.71 $64,569.72 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 18 5 — — $61,338.53 $1,100,800.00 $405,600.00 2026-03-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 65 28 — — $60,790.61 $236,544.00 $67,752.32 2026-03-01
474 OTHER Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 2 2 — — $60,737.73 $62,616.22 $61,676.98 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 58 28 — — $60,607.00 $471,244.47 $89,887.74 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 58 28 — — $60,607.00 $385,232.48 $74,176.18 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 65 28 — — $60,607.00 $359,312.58 $72,086.86 2026-03-01
8634 APR_DRG Neonatal Aftercare 22 8 — — $60,541.15 $75,676.44 $63,568.21 2026-03-01
01596 OTHER New Technology - Level 45 2 2 — — $60,235.91 $62,098.88 $61,167.40 2026-03-01
01582 OTHER New Technology - Level 45 2 2 — — $60,235.91 $62,098.88 $61,167.40 2026-03-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 22 8 — — $59,959.69 $74,949.61 $62,957.67 2026-03-01
05244 OTHER Level 4 Blood Product Exc 2 2 — — $59,552.96 $61,394.80 $60,473.88 2026-03-01
0936T CPT Photobiomodulation Therapy Of Retina, Single Session 6 1 — — $59,084.21 $64,941.69 $62,867.93 2026-03-01
1611 APR_DRG Implantable Heart Assist Systems 27 9 — — $58,996.98 $73,746.23 $61,946.83 2026-03-01
4404 APR_DRG Kidney Transplant 31 9 — — $58,851.17 $102,990.00 $63,559.30 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 22 8 — — $58,582.30 $73,227.88 $61,511.42 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 22 8 — — $58,562.39 $73,202.99 $61,490.51 2026-03-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 2 — — $58,361.39 $60,166.38 $59,263.88 2026-03-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 22 8 — — $57,051.29 $71,314.11 $59,903.85 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 22 8 — — $57,051.29 $71,314.11 $59,903.85 2026-03-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 22 8 — — $56,889.47 $71,111.84 $59,733.94 2026-03-01
1643 OTHER Y90 Ibritumomab, Rx 38 23 — — $56,540.43 $148,880.32 $59,097.54 2026-03-01
5244 OTHER Level 4 Blood Product Exc 38 23 — — $56,502.21 $165,824.67 $65,823.54 2026-03-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 58 28 — — $56,060.47 $308,652.90 $60,397.31 2026-03-01
429 OTHER Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 2 2 — — $55,983.92 $57,715.38 $56,849.65 2026-03-01
10 MS_DRG Pancreas Transplant 50 26 — — $55,862.38 $211,546.81 $59,852.55 2026-03-01
4414 APR_DRG Major Bladder Procedures 22 8 — — $55,694.53 $69,618.16 $58,479.26 2026-03-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 51 27 — — $55,562.77 $210,335.14 $59,531.53 2026-03-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 71 29 — — $55,453.00 $335,921.79 $83,271.06 2026-03-01
215 MS_DRG Other Heart Assist System Implant 71 29 — — $55,453.00 $567,817.00 $82,352.75 2026-03-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 71 29 — — $55,453.00 $276,270.00 $75,926.30 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 71 29 — — $55,453.00 $289,465.91 $72,965.04 2026-03-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 70 28 — — $55,453.00 $262,520.88 $66,241.83 2026-03-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 63 28 — — $55,418.82 $329,192.00 $61,765.35 2026-03-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 59 28 — — $55,378.67 $229,061.81 $63,321.96 2026-03-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 2 2 — — $55,339.02 $57,050.54 $56,194.78 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 19 5 — — $55,306.59 $478,449.94 $310,609.58 2026-03-01
01643 OTHER Y90 Ibritumomab, Rx 2 2 — — $55,119.81 $56,824.55 $55,972.18 2026-03-01
J7310 HCPCS Ganciclovir, 4.5 Mg, Long-acting Implant 14 3 — — $54,979.20 $145,041.92 $102,675.84 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 31 9 — — $54,191.25 $94,834.70 $58,526.60 2026-03-01
9273 OTHER Sipuleucel-t Auto Cd54+ 35 22 — — $54,132.09 $142,538.77 $56,036.23 2026-03-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 66 29 — — $53,581.91 $294,489.00 $59,718.08 2026-03-01
83 APR_DRG Autologous Bone Marrow Transplant 31 9 — — $53,059.97 $92,854.90 $57,304.80 2026-03-01
437822 CDM Valve Aor Tavr 23mm 27 11 $392,040.00 $392,040.00 $52,925.40 $392,040.00 $115,651.80 2026-03-01
09273 OTHER Sipuleucel-t Auto Cd54+ 2 2 — — $52,771.99 $54,404.11 $53,588.05 2026-03-01
1595 OTHER New Technology - Level 44 38 23 — — $52,545.28 $141,922.49 $56,335.65 2026-03-01
1581 OTHER New Technology - Level 44 38 23 — — $52,545.28 $141,922.49 $56,335.65 2026-03-01
231 OTHER Coronary Bypass With Ptca With Mcc 2 2 — — $52,381.60 $54,001.65 $53,191.62 2026-03-01
275 OTHER Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 2 2 — — $52,212.54 $53,827.36 $53,019.95 2026-03-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 58 28 — — $52,189.49 $229,601.04 $56,031.66 2026-03-01
1784 APR_DRG External Heart Assist Devices 22 8 — — $52,164.12 $65,205.15 $54,772.33 2026-03-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 71 29 — — $51,380.52 $308,347.00 $65,670.40 2026-03-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 71 29 — — $51,380.52 $304,994.00 $65,670.40 2026-03-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 22 8 — — $51,371.05 $64,213.81 $53,939.60 2026-03-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 22 8 — — $51,312.02 $64,140.02 $53,877.62 2026-03-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 27 9 — — $51,085.12 $63,856.40 $53,639.38 2026-03-01
6904 APR_DRG Acute Leukemia 22 8 — — $50,626.35 $63,282.94 $53,157.67 2026-03-01
850516 CDM Device Vntrc Asst 2 Lvas 27 11 $373,750.00 $373,750.00 $50,456.25 $373,750.00 $110,256.25 2026-03-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 59 28 — — $50,338.13 $202,343.60 $56,380.01 2026-03-01
434 APR_DRG Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies 22 8 — — $50,316.23 $62,895.29 $52,832.04 2026-03-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 22 8 — — $50,259.69 $62,824.61 $52,772.67 2026-03-01
258384 CDM Cage Spn 12d 34x28x13mm 27 11 $363,440.00 $363,440.00 $49,064.40 $363,440.00 $107,214.80 2026-03-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 70 28 — — $48,129.38 $422,445.00 $58,484.03 2026-03-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 79 32 — — $47,650.68 $208,177.56 $81,187.00 2026-03-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 63 28 — — $47,243.29 $206,254.63 $52,653.56 2026-03-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 65 28 — — $45,113.01 $254,970.23 $52,300.87 2026-03-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 79 32 — — $44,763.27 $201,515.99 $66,796.41 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 19 5 — — $43,855.64 $389,632.46 $194,769.81 2026-03-01
C1822 HCPCS Pulse Gen Imp 22 9 $313,880.00 $313,880.00 $42,373.80 $313,880.00 $100,127.72 2026-03-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 71 29 — — $42,341.46 $276,270.00 $57,612.00 2026-03-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 74 32 — — $41,930.43 $222,011.00 $69,705.20 2026-03-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 71 29 — — $40,212.83 $261,868.00 $57,367.56 2026-03-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 17 4 — — $39,976.89 $203,447.46 $120,275.16 2026-03-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 79 32 — — $39,537.71 $169,883.82 $67,522.12 2026-03-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 70 28 — — $38,757.22 $187,578.19 $52,069.61 2026-03-01
C2624 HCPCS Sensor Artery Impl Systm 22 9 $282,240.00 $282,240.00 $38,102.40 $282,240.00 $90,034.56 2026-03-01
245 MS_DRG Aicd Generator Procedures 74 32 — — $36,736.88 $137,150.31 $60,273.87 2026-03-01
248168 CDM Graft Bn Fem Whole Left 27 11 $269,787.00 $269,787.00 $36,421.25 $269,787.00 $79,587.16 2026-03-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 58 28 — — $36,089.00 $285,691.85 $55,993.39 2026-03-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 74 32 — — $34,269.24 $183,055.00 $57,625.12 2026-03-01
258440 CDM Cage Spn 7dg 14x16x7mm 27 11 $240,408.00 $240,408.00 $32,455.08 $240,408.00 $70,920.36 2026-03-01
258441 CDM Cage Spn 7dg 14x16x8mm 27 11 $240,408.00 $240,408.00 $32,455.08 $240,408.00 $70,920.36 2026-03-01
422506 CDM Kit Pmp Rt Hrt 22f 170cm 45 18 $460,620.00 $460,620.00 $32,243.40 $460,620.00 $118,839.96 2026-03-01
862710 CDM Set Vntrc 17.4x13.8in 45 18 $460,620.00 $460,620.00 $32,243.40 $460,620.00 $118,839.96 2026-03-01
265596 CDM Kit Lo Prfl Comp Shth 7f 45 18 $460,620.00 $460,620.00 $32,243.40 $460,620.00 $118,839.96 2026-03-01
422734 CDM Graft Evas 10cm 12mm 27 11 $238,464.00 $238,464.00 $32,192.64 $238,464.00 $70,346.88 2026-03-01
446494 CDM Graft Bn Cartiform 25x20 27 11 $238,464.00 $238,464.00 $32,192.64 $238,464.00 $70,346.88 2026-03-01
423117 CDM Graft Evas 10cm 14.5mm 27 11 $238,464.00 $238,464.00 $32,192.64 $238,464.00 $70,346.88 2026-03-01
271184 CDM Graft Bn Sub 12.5cc 27 11 $238,464.00 $238,464.00 $32,192.64 $238,464.00 $70,346.88 2026-03-01
444727 CDM Occluder Cv 35x18mm 27 11 $238,381.00 $238,381.00 $32,181.44 $238,381.00 $70,322.40 2026-03-01
442513 CDM Occluder Cv 25x18mm 27 11 $238,381.00 $238,381.00 $32,181.44 $238,381.00 $70,322.40 2026-03-01
730191 CDM Device Ast Vent 00551042 27 11 $225,000.00 $225,000.00 $30,375.00 $225,000.00 $66,375.00 2026-03-01
211753 CDM Graft Endo Aaa 28.5x12mm 27 11 $208,980.00 $208,980.00 $28,212.30 $208,980.00 $61,649.10 2026-03-01
879051 CDM Graft Evas 28.5x12m 16cm 27 11 $208,980.00 $208,980.00 $28,212.30 $208,980.00 $61,649.10 2026-03-01
216719 CDM Graft Endo Aaa 26x12mm 27 11 $208,980.00 $208,980.00 $28,212.30 $208,980.00 $61,649.10 2026-03-01
100505 CDM Cage Tlif 30x10x11mm 27 11 $206,624.00 $206,624.00 $27,894.24 $206,624.00 $60,954.08 2026-03-01
476763 CDM Cage Spnl 30x10x12mm 5d 27 11 $206,624.00 $206,624.00 $27,894.24 $206,624.00 $60,954.08 2026-03-01
222739 CDM Cage Spn 5d 10x13x30mm 27 11 $206,624.00 $206,624.00 $27,894.24 $206,624.00 $60,954.08 2026-03-01
465179 CDM Cage Spnl 24mmx10mmx13mm 27 11 $204,220.00 $204,220.00 $27,569.70 $204,220.00 $60,244.90 2026-03-01
257394 CDM Spacer Spn 12mm 27 11 $201,936.00 $201,936.00 $27,261.36 $201,936.00 $59,571.12 2026-03-01
747440 CDM Graft Nrv 4-5mm 70mm 27 11 $199,196.00 $199,196.00 $26,891.46 $199,196.00 $58,762.82 2026-03-01
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 19 5 — — $26,258.38 $243,082.56 $92,862.31 2026-03-01
257996 CDM Cage Spn 4.5x12x6 7mm 3d 27 11 $192,320.00 $192,320.00 $25,963.20 $192,320.00 $56,734.40 2026-03-01
0915T CPT Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 9 2 — — $25,963.00 $90,413.66 $73,421.02 2026-03-01
751731 CDM Set Pump Asst 2.5in 45 18 $368,400.00 $368,400.00 $25,788.00 $368,400.00 $95,047.20 2026-03-01
481326 CDM Graft Hemi Cndyl Mdl Lt 27 11 $176,796.00 $176,796.00 $23,867.46 $176,796.00 $52,154.82 2026-03-01
719583 CDM Graft Hemi Cndyl Mdl Rt 27 11 $176,796.00 $176,796.00 $23,867.46 $176,796.00 $52,154.82 2026-03-01
422126 CDM Graft Bn Hemi Condrl Rt 27 11 $176,796.00 $176,796.00 $23,867.46 $176,796.00 $52,154.82 2026-03-01
747118 CDM Graft Bn Fem Hemi Cndyl 27 11 $176,796.00 $176,796.00 $23,867.46 $176,796.00 $52,154.82 2026-03-01
281817 CDM Kit Cstm Maxilla 45 18 $257,364.00 $257,364.00 $18,015.48 $257,364.00 $66,399.91 2026-03-01
C2616 HCPCS Brachytherapy Source, Non-stranded, Yttrium-90, Per Source 10 2 — — $17,424.00 $88,363.42 $59,820.49 2026-03-01
824 OTHER Inj, Exagamglogene Autote 34 22 — — $12,832.29 $4,174,280.00 $2,353,571.00 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 36 22 — — $11,847.05 $4,228,260.40 $3,301,295.62 2026-03-01
717 OTHER Instill Adstiladrin, Tx D 40 24 — — $11,747.40 $168,399.95 $66,203.03 2026-03-01
746 OTHER Inj, Betibeglogene Autote 36 22 — — $10,958.64 $3,821,959.70 $2,984,068.54 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 53 23 — — $10,500.00 $641,817.38 $170,564.52 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 63 28 — — $10,500.00 $326,886.32 $88,738.82 2026-03-01
850 MS_DRG Acute Leukemia With Other Procedures 58 28 — — $10,500.00 $262,963.04 $71,441.73 2026-03-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 53 23 — — $10,500.00 $215,618.53 $59,829.12 2026-03-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 65 28 — — $10,500.00 $196,941.64 $54,976.47 2026-03-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 65 28 — — $10,500.00 $184,012.40 $52,108.77 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 31 20 — — $9,581.54 $4,336,566.00 $3,369,178.20 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 31 20 — — $8,466.42 $4,134,000.00 $3,211,800.00 2026-03-01
0901T CPT Placement Of Bone Marrow Sampling Port, Including Imaging Guidance When Performe… 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0969T CPT Removal Of Epicranial Neurostimulator System 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0943T CPT Cystourethroscopy, Flexible; With Removal Of Prostatic Urethral Scaffold 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0968T CPT Insertion Or Replacement Of Epicranial Neurostimulator System, Including Electro… 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0955T CPT Totally Implantable Active Middle Ear Hearing Implant; Removal, Including Remova… 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0908T CPT Open Implantation Of Integrated Neurostimulation System, Vagus Nerve, Including … 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0954T CPT Totally Implantable Active Middle Ear Hearing Implant; Replacement Of Sound Proc… 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0953T CPT Totally Implantable Active Middle Ear Hearing Implant; Revision Or Replacement, … 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0941T CPT Cystourethroscopy, Flexible; With Insertion And Expansion Of Prostatic Urethral … 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0935T CPT Cystourethroscopy With Renal Pelvic Sympathetic Denervation, Radiofrequency Abla… 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0909T CPT Replacement Of Integrated Neurostimulation System, Vagus Nerve, Including Analys… 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0951T CPT Totally Implantable Active Middle Ear Hearing Implant; Initial Placement, Includ… 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0952T CPT Totally Implantable Active Middle Ear Hearing Implant; Revision Or Replacement, … 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0910T CPT Removal Of Integrated Neurostimulation System, Vagus Nerve 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0942T CPT Cystourethroscopy, Flexible; With Removal And Replacement Of Prostatic Urethral … 9 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 37 23 — — $7,929.01 $528,372.78 $205,702.38 2026-03-01
C1722 HCPCS Aicd .99cm 5.37x7.79cm 330 9 $182,585.00 $182,585.00 $7,779.24 $330,807.00 $53,862.57 2026-03-01
C1772 HCPCS Pump Inf Isomd Cnst Flow 66 9 $236,115.00 $236,115.00 $7,494.26 $238,464.00 $62,334.36 2026-03-01
714 OTHER Inj Delandistrogene Mox R 36 22 — — $6,223.86 $4,326,218.00 $3,377,777.90 2026-03-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 65 28 — — $5,441.00 $207,775.62 $57,791.36 2026-03-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 65 28 — — $5,441.00 $193,433.52 $54,064.98 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 32 20 — — $5,291.79 $4,955,500.00 $4,535,408.75 2026-03-01
0895T CPT Connection Of Liver Allograft To Normothermic Machine Perfusion Device, Hemostas… 7 1 — — $5,238.99 $64,941.69 $62,031.14 2026-03-01
0896T CPT Connection Of Liver Allograft To Normothermic Machine Perfusion Device, Hemostas… 7 1 — — $5,238.99 $64,941.69 $62,031.14 2026-03-01
0872T CPT Replacement Of Indwelling Bladder And Peritoneal Catheters, Including Tunneling … 10 2 — — $5,238.99 $64,941.69 $59,084.21 2026-03-01
0894T CPT Cannulation Of The Liver Allograft In Preparation For Connection To The Normothe… 10 2 — — $5,238.99 $64,941.69 $59,084.21 2026-03-01
0870T CPT Implantation Of Subcutaneous Peritoneal Ascites Pump System, Percutaneous, Inclu… 10 2 — — $5,238.99 $64,941.69 $59,084.21 2026-03-01
0871T CPT Replacement Of A Subcutaneous Peritoneal Ascites Pump, Including Reconnection Be… 10 2 — — $5,238.99 $64,941.69 $59,084.21 2026-03-01
0874T CPT Removal Of A Peritoneal Ascites Pump System, Including Implanted Peritoneal Asci… 10 2 — — $5,238.99 $64,941.69 $59,084.21 2026-03-01
0873T CPT Revision Of A Subcutaneously Implanted Peritoneal Ascites Pump System, Any Compo… 10 2 — — $5,238.99 $64,941.69 $59,084.21 2026-03-01
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 17 4 — — $5,213.67 $142,036.23 $84,120.07 2026-03-01
831 OTHER Obecbtge Autol Up To 400 37 23 — — $3,623.59 $729,015.00 $283,815.00 2026-03-01
C1820 HCPCS Kit Generator Ipg 396 9 $236,051.50 $236,051.50 $2,816.64 $418,164.00 $72,017.11 2026-03-01
27445 CPT Arthroplasty, Knee, Hinge Prosthesis (eg, Walldius Type) 19 7 — — $1,874.49 $70,440.00 $55,684.00 2026-03-01
C1767 HCPCS Generator Nrstm 5 Ipg 286 9 $238,029.00 $238,029.00 $375.03 $331,058.00 $70,457.82 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 13 4 — — $23.68 $2,643,227.20 $1,325,455.50 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 13 4 — — $6.22 $2,437,928.00 $1,222,507.50 2026-03-01
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