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

Global Rehabilitation Hospital

San Antonio, TX · CCN 673040 · Rates published

31,577 distinct procedures filed
54 distinct payers
1,775,596 rate rows
2026-03-01 last MRF observed
Data quality

1,696,164 of 1,775,596 rate rows are consumer-grade (95.5%)

79,432 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 37,399
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 36,712
template filing: same amount across many unrelated codes — excluded 4,864
placeholder amount (≤ $0.02) — excluded from medians 429
exceeds 10× this hospital's gross charge — excluded from medians 28
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/74-2730328_STONE-OAK-REHAB_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-05-18
Content fingerprint d2099ff528f44e83… · 801,109,023 bytes · first seen 2026-05-13

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 $5,455.45 $4,910,450.00 $4,588,793.00 nat. median
$9,966
outlier · 460.5×
00845
OTHER 		Inj, Atidarsagene Autotem 1 $4,505,000.00 $4,505,000.00 $4,505,000.00 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 19 $3,482,577.31 $4,016,941.03 $3,756,392.66 nat. median
$3,746,358
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,685,267.00 $3,685,267.00 $3,685,267.00 nat. median
$3,574,709
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 21 $9,877.87 $4,670,148.00 $3,400,201.33 nat. median
$22,747
outlier · 149.5×
714
OTHER 		Inj Delandistrogene Mox R 21 $6,416.35 $4,659,004.00 $3,392,087.70 nat. median
$13,041
outlier · 260.1×
00908
OTHER 		Topi Adm Prad Zami Per Tr 1 $3,335,820.00 $3,335,820.00 $3,335,820.00 nat. median
$12,675
outlier · 263.2×
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,327,860.00 $3,327,860.00 $3,327,860.00 nat. median
$3,228,024
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 21 $12,213.45 $4,553,511.20 $3,315,281.41 nat. median
$17,963
outlier · 184.6×
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $3,252,508.00 $3,252,508.00 $3,252,508.00 nat. median
$3,187,420
1.0× median
906
OTHER 		Inj Elivaldogene Autoteme 21 $8,728.26 $4,452,000.00 $3,241,374.00 nat. median
$20,756
outlier · 156.2×
00906
OTHER 		Inj Elivaldogene Autoteme 1 $3,180,000.00 $3,180,000.00 $3,180,000.00 nat. median
$21
outlier · 153697.4×
746
OTHER 		Inj, Betibeglogene Autote 22 $11,297.57 $4,733,350.09 $3,028,168.07 nat. median
$21,896
outlier · 138.3×
00746
OTHER 		Inj, Betibeglogene Autote 1 $2,939,969.00 $2,939,969.00 $2,939,969.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 21 $2,446,587.04 $4,168,259.41 $2,666,650.43 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,588,981.00 $2,588,981.00 $2,588,981.00 nat. median
$2,457,321
1.1× median
824
OTHER 		Inj, Exagamglogene Autote 22 $13,229.17 $3,754,520.00 $2,401,960.00 nat. median
$25,250
outlier · 95.1×
00824
OTHER 		Inj, Exagamglogene Autote 1 $2,332,000.00 $2,332,000.00 $2,332,000.00 nat. median
$2,332,000
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 2 $1,271,523.00 $2,865,310.56 $1,656,164.16 nat. median
$824,563
outlier · 2.0×
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 2 $459,112.50 $2,069,172.00 $1,195,992.00 nat. median
$324,450
outlier · 3.7×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 $578,771.00 $1,502,182.90 $1,040,476.95 nat. median
$754,974
1.4× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $553,169.00 $1,810,877.40 $972,594.00 nat. median
$675,122
1.4× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $502,841.00 $1,385,508.50 $944,174.75 nat. median
$634,511
1.5× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $516,442.00 $1,597,855.91 $927,632.05 nat. median
$674,188
1.4× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $527,622.00 $1,633,684.02 $920,834.85 nat. median
$625,184
1.5× median
C9301
HCPCS 		Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 1 $584,325.00 $1,087,957.50 $915,442.50 nat. median
$459,112
2.0× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $489,399.00 $1,452,596.28 $807,592.83 nat. median
$620,080
1.3× median
2067
OTHER 		Afamitresgene Autoleucel 21 $728,235.90 $1,240,698.20 $793,738.60 nat. median
$786,032
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 21 $555,328.87 $946,115.86 $605,279.09 nat. median
$587,650
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $587,649.60 $587,649.60 $587,649.60 nat. median
$554,552
1.1× median
9194
OTHER 		Tisagenlecleucel Car-pos 21 $535,372.08 $912,115.39 $583,527.24 nat. median
$566,531
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 21 $531,280.13 $905,143.93 $579,067.24 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 21 $527,387.30 $898,511.70 $574,824.25 nat. median
$558,082
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $566,531.30 $566,531.30 $566,531.30 nat. median
$538,205
1.1× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $562,201.20 $562,201.20 $562,201.20 nat. median
$534,091
1.1× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $558,081.80 $558,081.80 $558,081.80 nat. median
$530,178
1.1× median
9035
OTHER 		Axicabtagene Ciloleucel C 21 $502,921.63 $856,829.44 $548,157.97 nat. median
$532,192
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $532,192.20 $532,192.20 $532,192.20 nat. median
$505,583
1.1× median
9391
OTHER 		Brexucabtagene Car Pos T 21 $462,530.44 $788,014.82 $504,133.71 nat. median
$489,450
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $489,450.20 $489,450.20 $489,450.20 nat. median
$464,978
1.1× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 24 $3,938.00 $614,750.34 $339,449.87 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
831
OTHER 		Obecbtge Autol Up To 400 22 $3,735.66 $447,982.50 $286,597.50 nat. median
$12,362
outlier · 23.2×
00831
OTHER 		Obecbtge Autol Up To 400 1 $278,250.00 $278,250.00 $278,250.00 nat. median
$278,250
1.0× median
74
APR_DRG 		Allogeneic Bone Marrow Transplant 8 $253,775.32 $444,107.00 $274,077.00 nat. median
$187,294
1.5× median
5834
APR_DRG 		Neonate With Ecmo 7 $260,870.76 $326,088.45 $273,914.30 nat. median
$309,665
0.9× median
897
OTHER 		Revakinagene, Per Implant 21 $250,425.00 $426,650.00 $272,950.00 nat. median
$9,577
outlier · 28.5×

Other procedures at this hospital

Browse this hospital's 31,577 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
L8614 HCPCS Processor Snd Dual Kt 408 47 $152,018.00 $152,018.00 $5,779.75 $335,718.55 $59,846.33 2026-03-01
107794 CDM Cord Blood Acquisition 69 33 $423,125.59 $423,125.59 $21,156.28 $359,656.75 $151,478.96 2026-03-01
439515 CDM Cord Blood Acquisition 69 33 $423,125.59 $423,125.59 $21,156.28 $359,656.75 $151,478.96 2026-03-01
107799 CDM Stemcell/bm Acquisition 69 33 $329,714.03 $329,714.03 $16,485.70 $280,256.93 $118,037.62 2026-03-01
439505 CDM Stemcell/bm Acquisition 69 33 $329,714.03 $329,714.03 $16,485.70 $280,256.93 $118,037.62 2026-03-01
107792 CDM Bone Marrow Acquisition 69 33 $329,714.03 $329,714.03 $16,485.70 $280,256.93 $118,037.62 2026-03-01
439525 CDM Donor Leuk Acquisition 69 33 $329,714.03 $329,714.03 $16,485.70 $280,256.93 $118,037.62 2026-03-01
439555 CDM Bone Marrow Acquisition 69 33 $329,714.03 $329,714.03 $16,485.70 $280,256.93 $118,037.62 2026-03-01
107796 CDM Donor Leuk Acquisition 69 33 $329,714.03 $329,714.03 $16,485.70 $280,256.93 $118,037.62 2026-03-01
131619 CDM Kit Lo Prfl Comp Shth 7f 69 33 $277,750.00 $277,750.00 $13,887.50 $236,087.50 $99,434.50 2026-03-01
112560 CDM Kit Cath Rt Heart 69 33 $277,750.00 $277,750.00 $13,887.50 $236,087.50 $99,434.50 2026-03-01
120324 CDM Cath Vasc Assist Strl 69 33 $277,750.00 $277,750.00 $13,887.50 $236,087.50 $99,434.50 2026-03-01
769638 CDM Set Vntrc 17.4x13.8in 69 33 $277,750.00 $277,750.00 $13,887.50 $236,087.50 $99,434.50 2026-03-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 84 33 — — $44,512.00 $174,002.00 $78,557.01 2026-03-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 84 33 — — $42,769.00 $138,203.96 $62,672.50 2026-03-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 84 33 — — $39,684.00 $115,427.91 $62,405.75 2026-03-01
215 MS_DRG Other Heart Assist System Implant 79 32 — — $3,938.00 $317,917.00 $81,035.85 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 83 32 — — $45,084.00 $149,495.12 $68,729.42 2026-03-01
A9543 HCPCS Y90 Ibritum Tiu Tx 40mci 69 31 $233,566.68 $233,566.68 $11,678.33 $213,233.06 $93,760.51 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 71 31 — — $3,938.00 $161,134.44 $87,081.07 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 69 31 — — $3,938.00 $154,803.69 $83,689.35 2026-03-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 73 31 — — $3,938.00 $204,740.00 $62,201.87 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 63 30 — — $3,938.00 $187,652.00 $84,811.28 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 63 30 — — $3,938.00 $149,410.00 $71,434.94 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 69 30 — — $3,938.00 $175,061.60 $68,515.87 2026-03-01
850 MS_DRG Acute Leukemia With Other Procedures 63 30 — — $3,938.00 $123,276.64 $66,798.63 2026-03-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 69 30 — — $3,938.00 $150,610.09 $64,207.68 2026-03-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 63 30 — — $3,938.00 $127,235.00 $57,388.41 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 65 29 — — $3,938.00 $423,553.00 $167,239.90 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 65 29 — — $3,938.00 $207,196.00 $109,408.42 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 57 27 — — $3,938.00 $303,945.72 $162,049.34 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 60 26 — — $137,695.00 $398,948.24 $214,490.58 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 58 26 — — $79,284.65 $317,894.00 $87,180.22 2026-03-01
7 MS_DRG Lung Transplant 52 25 — — $3,938.00 $184,359.05 $99,523.72 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 49 24 — — $3,938.00 $614,750.34 $339,449.87 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 51 24 — — $86,048.79 $171,086.82 $92,413.09 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 54 24 — — $73,923.30 $146,780.28 $79,390.78 2026-03-01
746 OTHER Inj, Betibeglogene Autote 41 22 — — $11,297.57 $4,733,350.09 $3,028,168.07 2026-03-01
824 OTHER Inj, Exagamglogene Autote 41 22 — — $13,229.17 $3,754,520.00 $2,401,960.00 2026-03-01
831 OTHER Obecbtge Autol Up To 400 41 22 — — $3,735.66 $447,982.50 $286,597.50 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 41 22 — — $8,174.23 $324,687.09 $207,719.07 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 41 22 — — $105,359.94 $179,502.12 $114,836.76 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 47 22 — — $68,530.00 $153,080.41 $97,933.43 2026-03-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 41 22 — — $65,017.61 $110,770.74 $70,865.75 2026-03-01
717 OTHER Instill Adstiladrin, Tx D 41 22 — — $12,110.72 $103,482.41 $66,203.03 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 38 21 — — $9,877.87 $4,670,148.00 $3,400,201.33 2026-03-01
714 OTHER Inj Delandistrogene Mox R 38 21 — — $6,416.35 $4,659,004.00 $3,392,087.70 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 38 21 — — $12,213.45 $4,553,511.20 $3,315,281.41 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 38 21 — — $8,728.26 $4,452,000.00 $3,241,374.00 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 40 21 — — $2,446,587.04 $4,168,259.41 $2,666,650.43 2026-03-01
2067 OTHER Afamitresgene Autoleucel 40 21 — — $728,235.90 $1,240,698.20 $793,738.60 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 40 21 — — $555,328.87 $946,115.86 $605,279.09 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 40 21 — — $535,372.08 $912,115.39 $583,527.24 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 40 21 — — $531,280.13 $905,143.93 $579,067.24 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 40 21 — — $527,387.30 $898,511.70 $574,824.25 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 40 21 — — $502,921.63 $856,829.44 $548,157.97 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 40 21 — — $462,530.44 $788,014.82 $504,133.71 2026-03-01
897 OTHER Revakinagene, Per Implant 40 21 — — $250,425.00 $426,650.00 $272,950.00 2026-03-01
1908 OTHER New Technology - Level 52 40 21 — — $141,700.48 $241,415.64 $154,446.03 2026-03-01
1907 OTHER New Technology - Level 52 40 21 — — $141,700.48 $241,415.64 $154,446.03 2026-03-01
1905 OTHER New Technology - Level 51 40 21 — — $127,762.77 $217,669.91 $139,254.66 2026-03-01
1906 OTHER New Technology - Level 51 40 21 — — $127,762.77 $217,669.91 $139,254.66 2026-03-01
1903 OTHER New Technology - Level 50 40 21 — — $113,825.06 $193,924.18 $124,063.29 2026-03-01
1904 OTHER New Technology - Level 50 40 21 — — $113,825.06 $193,924.18 $124,063.29 2026-03-01
1902 OTHER New Technology - Level 49 40 21 — — $99,887.35 $170,178.45 $108,871.93 2026-03-01
1901 OTHER New Technology - Level 49 40 21 — — $99,887.35 $170,178.45 $108,871.93 2026-03-01
1585 OTHER New Technology - Level 48 40 21 — — $88,272.64 $150,390.42 $96,212.51 2026-03-01
1599 OTHER New Technology - Level 48 40 21 — — $88,272.64 $150,390.42 $96,212.51 2026-03-01
1584 OTHER New Technology - Level 47 40 21 — — $78,980.82 $134,559.92 $86,084.92 2026-03-01
1598 OTHER New Technology - Level 47 40 21 — — $78,980.82 $134,559.92 $86,084.92 2026-03-01
1583 OTHER New Technology - Level 46 40 21 — — $69,689.02 $118,729.43 $75,957.34 2026-03-01
1597 OTHER New Technology - Level 46 40 21 — — $69,689.02 $118,729.43 $75,957.34 2026-03-01
1582 OTHER New Technology - Level 45 40 21 — — $60,397.21 $102,898.95 $65,829.76 2026-03-01
1596 OTHER New Technology - Level 45 40 21 — — $60,397.21 $102,898.95 $65,829.76 2026-03-01
5244 OTHER Level 4 Blood Product Exc 40 21 — — $59,712.42 $101,732.28 $65,083.38 2026-03-01
1643 OTHER Y90 Ibritumomab, Rx 40 21 — — $53,699.20 $91,487.53 $58,529.29 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 37 20 — — $5,455.45 $4,910,450.00 $4,588,793.00 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 36 19 — — $3,482,577.31 $4,016,941.03 $3,756,392.66 2026-03-01
135188 CDM Implant Generator Pulse 30 18 $395,794.00 $395,794.00 $55,411.16 $336,424.90 $184,835.80 2026-03-01
773520 CDM Implant Cust Cranial Lge 30 18 $321,691.00 $321,691.00 $45,036.74 $273,437.35 $150,229.70 2026-03-01
105655 CDM Occluder Cardiac Lt 18mm 30 18 $288,360.00 $288,360.00 $40,370.40 $245,106.00 $134,664.12 2026-03-01
105654 CDM Occluder Cardiac Lt 16mm 30 18 $288,360.00 $288,360.00 $40,370.40 $245,106.00 $134,664.12 2026-03-01
105660 CDM Occluder Cardiac Lt 31mm 30 18 $288,360.00 $288,360.00 $40,370.40 $245,106.00 $134,664.12 2026-03-01
105658 CDM Occluder Cardiac Lt 25mm 30 18 $288,360.00 $288,360.00 $40,370.40 $245,106.00 $134,664.12 2026-03-01
105659 CDM Occluder Cardiac Lt 28mm 30 18 $288,360.00 $288,360.00 $40,370.40 $245,106.00 $134,664.12 2026-03-01
105656 CDM Occluder Cardiac Lt 20mm 30 18 $288,360.00 $288,360.00 $40,370.40 $245,106.00 $134,664.12 2026-03-01
105661 CDM Occluder Cardiac Lt 34mm 30 18 $288,360.00 $288,360.00 $40,370.40 $245,106.00 $134,664.12 2026-03-01
105657 CDM Occluder Cardiac Lt 22mm 30 18 $288,360.00 $288,360.00 $40,370.40 $245,106.00 $134,664.12 2026-03-01
246542 CDM Stent Eprsth 40x40x15cm 30 18 $281,952.00 $281,952.00 $39,473.28 $239,659.20 $131,671.58 2026-03-01
100837 CDM Stent 20fr 31x31mm 10cm 30 18 $281,952.00 $281,952.00 $39,473.28 $239,659.20 $131,671.58 2026-03-01
245658 CDM Graft Evas 40x40x10cm 30 18 $281,952.00 $281,952.00 $39,473.28 $239,659.20 $131,671.58 2026-03-01
245979 CDM Stnt Thorac 26x26mm 10cm 30 18 $281,952.00 $281,952.00 $39,473.28 $239,659.20 $131,671.58 2026-03-01
100843 CDM Stent Graft 20cm 45x45mm 30 18 $281,952.00 $281,952.00 $39,473.28 $239,659.20 $131,671.58 2026-03-01
138669 CDM Genrator Imp Pulse 7 30 18 $281,580.00 $281,580.00 $39,421.20 $239,343.00 $131,497.86 2026-03-01
126332 CDM Kit Impl Crnl Cstm Lg 30 18 $277,593.00 $277,593.00 $38,863.02 $235,954.05 $129,635.93 2026-03-01
137424 CDM Coil Emb Neuro 7mm 2mm 30 18 $260,597.00 $260,597.00 $36,483.58 $221,507.45 $121,698.80 2026-03-01
111554 CDM Coil Emb Neuro 6x3mm 30 18 $260,597.00 $260,597.00 $36,483.58 $221,507.45 $121,698.80 2026-03-01
133751 CDM Coil Embl 6mm 2mm 30 18 $251,038.00 $251,038.00 $35,145.32 $213,382.30 $117,234.74 2026-03-01
113767 CDM Implant Cranial Med 30 18 $242,466.00 $242,466.00 $33,945.24 $206,096.10 $113,231.62 2026-03-01
106943 CDM Device Embl 2.5mm 16mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
108329 CDM Device Embl 4.5mm 12mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
126185 CDM Device Embl 3.25x12mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
129661 CDM Device Embl 3.75mm 14mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
127788 CDM Device Embl 4.50x16mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
119505 CDM Device Embl 4.25mm 12mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
129659 CDM Device Embl 4.75mm 16mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
129662 CDM Device Embl 4mm 14mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
129663 CDM Device Embl 3.75mm 12mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
111861 CDM Device Embl 4.75mm 20mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
108998 CDM Device Embl 4.50x25mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
111418 CDM Device Embl 4mm 12mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
125118 CDM Device Embl 3.50x12mm 30 18 $239,223.00 $239,223.00 $33,491.22 $203,339.55 $111,717.14 2026-03-01
140189 CDM Implant Crnl Peek Lg 30 18 $238,103.00 $238,103.00 $33,334.42 $202,387.55 $111,194.10 2026-03-01
119871 CDM Coil Embl Endo 8mm 30 18 $236,188.00 $236,188.00 $33,066.32 $200,759.80 $110,299.79 2026-03-01
107700 CDM Coil Embl Endo 8mm 30 18 $236,188.00 $236,188.00 $33,066.32 $200,759.80 $110,299.79 2026-03-01
110194 CDM Device Embl 4.25mm 14mm 30 18 $228,913.00 $228,913.00 $32,047.82 $194,576.05 $106,902.37 2026-03-01
134379 CDM Putty Bngf Subst 20cc 30 18 $209,760.00 $209,760.00 $29,366.40 $178,296.00 $97,957.92 2026-03-01
106203 CDM Graft Endo Aaa 23x12mm 30 18 $194,403.00 $194,403.00 $27,216.42 $165,242.55 $90,786.20 2026-03-01
105477 CDM Graft Endo Aaa 28.5x12mm 30 18 $194,403.00 $194,403.00 $27,216.42 $165,242.55 $90,786.20 2026-03-01
104757 CDM Graft Endo Aaa 32x14mm 30 18 $189,661.00 $189,661.00 $26,552.54 $161,211.85 $88,571.68 2026-03-01
104593 CDM Graft Endo Aaa 36x14mm 30 18 $189,661.00 $189,661.00 $26,552.54 $161,211.85 $88,571.68 2026-03-01
103969 CDM Stent Grft 23x12mm 12cm 30 18 $189,661.00 $189,661.00 $26,552.54 $161,211.85 $88,571.68 2026-03-01
108826 CDM Graft Evasc 20x12mmx12cm 30 18 $189,661.00 $189,661.00 $26,552.54 $161,211.85 $88,571.68 2026-03-01
106882 CDM Graft Endo Aaa 26x12mm 30 18 $189,661.00 $189,661.00 $26,552.54 $161,211.85 $88,571.68 2026-03-01
138861 CDM Graft Bn Fem Condyle 30 18 $187,448.00 $187,448.00 $26,242.72 $159,330.80 $87,538.21 2026-03-01
133086 CDM Pump Pain Infn 148gm 30 18 $186,040.00 $186,040.00 $26,045.60 $158,134.00 $86,880.68 2026-03-01
132142 CDM Graft Bn Femoral 30 18 $181,987.00 $181,987.00 $25,478.18 $154,688.95 $84,987.93 2026-03-01
140074 CDM Cage Spn 12d 14x14x6mm 30 18 $175,260.00 $175,260.00 $24,536.40 $148,971.00 $81,846.42 2026-03-01
750702 CDM Graft Evas 23x14.5m 12cm 30 18 $169,043.00 $169,043.00 $23,666.02 $143,686.55 $78,943.08 2026-03-01
773648 CDM Graft Evas 23x14.5m 16cm 30 18 $169,043.00 $169,043.00 $23,666.02 $143,686.55 $78,943.08 2026-03-01
659651 CDM Graft Evas 26x14.5m 12cm 30 18 $169,043.00 $169,043.00 $23,666.02 $143,686.55 $78,943.08 2026-03-01
116161 CDM Graft Evas 10cm 14.5mm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
687969 CDM Graft Evas 26x12mm 14cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
773647 CDM Graft Evas 23x12mm 18cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
114560 CDM Graft Evas 26x12mm 18cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
687931 CDM Graft Evas 28.5x12m 16cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
773238 CDM Graft Evas 23x12mm 12cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
686592 CDM Graft Evas 26x12mm 16cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
773729 CDM Graft Evas 23x12mm 16cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
773841 CDM Graft Evas 26x14.5m 16cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
773142 CDM Graft Evas 26x14.5m 14cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
686386 CDM Graft Evas 10cm 12mm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
773833 CDM Graft Evas 26x14.5m 18cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
774298 CDM Graft Evas 14.5mm 16cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
654260 CDM Graft Evas 31x14.5m 13cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
659212 CDM Graft Evas 23x14.5m14cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
120101 CDM Graft Evas 26x12mm 12cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
654298 CDM Graft Evas 35x14.5m 14cm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
687302 CDM Graft Evas 10cm 10mm 30 18 $164,926.00 $164,926.00 $23,089.64 $140,187.10 $77,020.44 2026-03-01
112284 CDM Graft Hemi Cndyl Mdl Lt 30 18 $160,930.00 $160,930.00 $22,530.20 $136,790.50 $75,154.31 2026-03-01
116804 CDM Occluder Cv 35x18mm 30 18 $160,120.00 $160,120.00 $22,416.80 $136,102.00 $74,776.04 2026-03-01
116803 CDM Occluder Cv 18x18mm 30 18 $160,120.00 $160,120.00 $22,416.80 $136,102.00 $74,776.04 2026-03-01
116805 CDM Occluder Cv 25x18mm 30 18 $160,120.00 $160,120.00 $22,416.80 $136,102.00 $74,776.04 2026-03-01
133738 CDM Graft Bn Sub 12.5cc 30 18 $146,243.00 $146,243.00 $20,474.02 $124,306.55 $68,295.48 2026-03-01
132128 CDM Allograft Tibia Rt 30 18 $122,304.00 $122,304.00 $17,122.56 $103,958.40 $57,115.97 2026-03-01
129071 CDM Device Clsr 27mm 27 17 $272,340.00 $272,340.00 $38,127.60 $231,489.00 $149,787.00 2026-03-01
129073 CDM Device Clsr 35mm 27 17 $272,340.00 $272,340.00 $38,127.60 $231,489.00 $149,787.00 2026-03-01
129070 CDM Device Clsr 24mm 27 17 $272,340.00 $272,340.00 $38,127.60 $231,489.00 $149,787.00 2026-03-01
129072 CDM Device Clsr 31mm 27 17 $272,340.00 $272,340.00 $38,127.60 $231,489.00 $149,787.00 2026-03-01
129069 CDM Device Clsr 20mm 27 17 $272,340.00 $272,340.00 $38,127.60 $231,489.00 $149,787.00 2026-03-01
129074 CDM Device Clsr 40mm 27 17 $272,340.00 $272,340.00 $38,127.60 $231,489.00 $149,787.00 2026-03-01
C1822 HCPCS Pulse Gen Imp 108 17 $299,340.00 $299,340.00 $31,430.70 $289,777.75 $149,187.73 2026-03-01
C1820 HCPCS Generator Impl Pls 5 216 17 $271,485.00 $271,485.00 $35,621.46 $250,127.80 $148,024.08 2026-03-01
C1767 HCPCS Kit Impl Neurostim 459 17 $281,879.00 $281,879.00 $20,255.34 $390,352.30 $132,777.60 2026-03-01
C1830 HCPCS Generator Nrstm 53x48mm 27 17 $241,135.00 $241,135.00 $33,758.90 $204,964.75 $132,624.25 2026-03-01
C1772 HCPCS Pump Infs Pain 20ml 54 17 $175,338.50 $175,338.50 $23,049.18 $158,134.00 $91,785.18 2026-03-01
C2622 HCPCS Prosthesis Penl 27 13mm 27 17 $143,900.00 $143,900.00 $20,146.00 $122,315.00 $79,145.00 2026-03-01
C1882 HCPCS Crt-d Crd 5.37x8.08x0.99 270 17 $145,243.50 $145,243.50 $14,009.80 $173,915.10 $76,307.27 2026-03-01
126705 CDM Implant Crnl Peek Sm 27 17 $134,337.00 $134,337.00 $18,807.18 $114,186.45 $73,885.35 2026-03-01
C1815 HCPCS Cuff Urth Sphncr Ab 5cm 54 17 $127,235.00 $127,235.00 $17,417.12 $110,552.70 $68,424.40 2026-03-01
C1813 HCPCS Prosth Penl Pump Ps 15cm 486 17 $151,297.50 $151,297.50 $1,541.12 $183,362.85 $64,334.52 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 26 8 — — $253,775.32 $444,107.00 $274,077.00 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 26 8 — — $212,495.48 $371,867.00 $229,495.00 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 26 8 — — $160,349.56 $200,436.95 $170,772.52 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 26 8 — — $89,547.62 $156,708.00 $96,711.40 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 26 8 — — $83,576.35 $104,470.44 $89,008.83 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 26 8 — — $76,119.58 $133,209.00 $82,209.10 2026-03-01
84 APR_DRG Autologous Bone Marrow Transplant 26 8 — — $75,814.57 $132,676.00 $81,879.70 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 26 8 — — $74,425.92 $93,032.40 $79,263.61 2026-03-01
64 APR_DRG Pancreas Transplant 26 8 — — $69,679.82 $121,940.00 $75,254.20 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 26 8 — — $64,924.11 $81,155.14 $69,144.16 2026-03-01
72 APR_DRG Allogeneic Bone Marrow Transplant 26 8 — — $60,165.99 $105,290.00 $64,979.30 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 26 8 — — $60,078.40 $75,098.00 $63,983.51 2026-03-01
4404 APR_DRG Kidney Transplant 26 8 — — $56,838.09 $99,466.70 $61,385.10 2026-03-01
1611 APR_DRG Implantable Heart Assist Systems 26 8 — — $56,978.91 $71,223.64 $60,682.53 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 26 8 — — $52,337.58 $91,590.80 $56,524.60 2026-03-01
5834 APR_DRG Neonate With Ecmo 21 7 — — $260,870.76 $326,088.45 $273,914.30 2026-03-01
5833 APR_DRG Neonate With Ecmo 21 7 — — $220,895.77 $276,119.71 $231,940.56 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 7 — — $165,126.91 $206,408.64 $173,383.26 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 21 7 — — $150,222.29 $187,777.86 $157,733.40 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 21 7 — — $122,865.43 $153,581.79 $129,008.70 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 21 7 — — $121,776.62 $152,220.77 $127,865.45 2026-03-01
5832 APR_DRG Neonate With Ecmo 21 7 — — $110,067.32 $137,584.15 $115,570.69 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 21 7 — — $104,516.13 $130,645.16 $109,741.94 2026-03-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 21 7 — — $97,124.26 $121,405.32 $101,980.47 2026-03-01
5831 APR_DRG Neonate With Ecmo 21 7 — — $96,916.46 $121,145.58 $101,762.28 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 7 — — $88,601.69 $110,752.11 $93,031.77 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 7 — — $88,196.74 $110,245.93 $92,606.58 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 21 7 — — $87,968.67 $109,960.84 $92,367.10 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 21 7 — — $87,590.51 $109,488.14 $91,970.04 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 21 7 — — $86,715.69 $108,394.61 $91,051.47 2026-03-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 21 7 — — $84,431.26 $105,539.07 $88,652.82 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 21 7 — — $83,674.93 $104,593.66 $87,858.68 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 21 7 — — $83,134.65 $103,918.31 $87,291.38 2026-03-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 21 7 — — $74,467.48 $93,084.35 $78,190.85 2026-03-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 21 7 — — $73,803.89 $92,254.86 $77,494.08 2026-03-01
2464 APR_DRG Gastrointestinal Vascular Insufficiency 21 7 — — $72,172.40 $90,215.50 $75,781.02 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 21 7 — — $71,800.07 $89,750.09 $75,390.07 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 21 7 — — $69,674.33 $87,092.91 $73,158.05 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 21 7 — — $69,465.84 $86,832.30 $72,939.13 2026-03-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 21 7 — — $67,528.66 $84,410.83 $70,905.09 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 21 7 — — $63,858.66 $79,823.33 $67,051.59 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 21 7 — — $63,340.36 $79,175.45 $66,507.38 2026-03-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 21 7 — — $60,641.01 $75,801.26 $63,673.06 2026-03-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 21 7 — — $59,391.46 $74,239.32 $62,361.03 2026-03-01
8634 APR_DRG Neonatal Aftercare 21 7 — — $58,470.27 $73,087.84 $61,393.78 2026-03-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 21 7 — — $57,908.69 $72,385.86 $60,804.12 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 21 7 — — $56,578.43 $70,723.04 $59,407.35 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 21 7 — — $56,559.19 $70,698.99 $59,387.15 2026-03-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 21 7 — — $55,099.78 $68,874.73 $57,854.77 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 21 7 — — $55,099.78 $68,874.73 $57,854.77 2026-03-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 21 7 — — $54,943.50 $68,679.38 $57,690.68 2026-03-01
4414 APR_DRG Major Bladder Procedures 21 7 — — $53,789.43 $67,236.79 $56,478.90 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 16 4 — — $578,771.00 $1,502,182.90 $1,040,476.95 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 16 4 — — $502,841.00 $1,385,508.50 $944,174.75 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 15 4 — — $63,235.60 $625,600.00 $109,800.00 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 15 4 — — $57,017.10 $238,072.82 $102,381.13 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 15 4 — — $45,212.00 $143,688.67 $83,375.51 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 11 3 — — $553,169.00 $1,810,877.40 $972,594.00 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 11 3 — — $516,442.00 $1,597,855.91 $927,632.05 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 11 3 — — $527,622.00 $1,633,684.02 $920,834.85 2026-03-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 11 3 — — $489,399.00 $1,452,596.28 $807,592.83 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 14 3 — — $80,175.90 $149,279.89 $131,526.65 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 10 2 — — $1,271,523.00 $2,865,310.56 $1,656,164.16 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 10 2 — — $459,112.50 $2,069,172.00 $1,195,992.00 2026-03-01
C2616 HCPCS Brachytherapy Source, Non-stranded, Yttrium-90, Per Source 10 2 — — $13,952.00 $165,104.57 $95,883.71 2026-03-01
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 4 1 — — $4,850,948.67 $4,850,948.67 $4,850,948.67 2026-03-01
00845 OTHER Inj, Atidarsagene Autotem 1 1 — — $4,505,000.00 $4,505,000.00 $4,505,000.00 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 4 1 — — $4,271,819.03 $4,271,819.03 $4,271,819.03 2026-03-01
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 4 1 — — $3,847,800.00 $3,847,800.00 $3,847,800.00 2026-03-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,685,267.00 $3,685,267.00 $3,685,267.00 2026-03-01
00908 OTHER Topi Adm Prad Zami Per Tr 1 1 — — $3,335,820.00 $3,335,820.00 $3,335,820.00 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,327,860.00 $3,327,860.00 $3,327,860.00 2026-03-01
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,252,508.00 $3,252,508.00 $3,252,508.00 2026-03-01
00906 OTHER Inj Elivaldogene Autoteme 1 1 — — $3,180,000.00 $3,180,000.00 $3,180,000.00 2026-03-01
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,939,969.00 $2,939,969.00 $2,939,969.00 2026-03-01
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,588,981.00 $2,588,981.00 $2,588,981.00 2026-03-01
00824 OTHER Inj, Exagamglogene Autote 1 1 — — $2,332,000.00 $2,332,000.00 $2,332,000.00 2026-03-01
C9301 HCPCS Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 6 1 — — $584,325.00 $1,087,957.50 $915,442.50 2026-03-01
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $587,649.60 $587,649.60 $587,649.60 2026-03-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $566,531.30 $566,531.30 $566,531.30 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $562,201.20 $562,201.20 $562,201.20 2026-03-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $558,081.80 $558,081.80 $558,081.80 2026-03-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $532,192.20 $532,192.20 $532,192.20 2026-03-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $489,450.20 $489,450.20 $489,450.20 2026-03-01
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 4 1 — — $332,753.88 $332,753.88 $332,753.88 2026-03-01
00831 OTHER Obecbtge Autol Up To 400 1 1 — — $278,250.00 $278,250.00 $278,250.00 2026-03-01
00897 OTHER Revakinagene, Per Implant 1 1 — — $265,000.00 $265,000.00 $265,000.00 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $220,262.20 $220,262.20 $220,262.20 2026-03-01
00886 OTHER Inj. Remestemcel-l-rknd/ 1 1 — — $201,669.00 $201,669.00 $201,669.00 2026-03-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $193,614.00 $193,614.00 $193,614.00 2026-03-01
01908 OTHER New Technology - Level 52 1 1 — — $143,194.90 $143,194.90 $143,194.90 2026-03-01
01907 OTHER New Technology - Level 52 1 1 — — $143,194.90 $143,194.90 $143,194.90 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $136,463.10 $136,463.10 $136,463.10 2026-03-01
01906 OTHER New Technology - Level 51 1 1 — — $129,110.20 $129,110.20 $129,110.20 2026-03-01
01905 OTHER New Technology - Level 51 1 1 — — $129,110.20 $129,110.20 $129,110.20 2026-03-01
01903 OTHER New Technology - Level 50 1 1 — — $115,025.50 $115,025.50 $115,025.50 2026-03-01
01904 OTHER New Technology - Level 50 1 1 — — $115,025.50 $115,025.50 $115,025.50 2026-03-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $106,566.90 $106,566.90 $106,566.90 2026-03-01
01901 OTHER New Technology - Level 49 1 1 — — $100,940.80 $100,940.80 $100,940.80 2026-03-01
01902 OTHER New Technology - Level 49 1 1 — — $100,940.80 $100,940.80 $100,940.80 2026-03-01
E0767 HCPCS Intrabuccal, Systemic Delivery Of Amplitude-modulated, Radiofrequency Electromag… 6 1 — — $68,035.34 $119,252.95 $100,141.90 2026-03-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $95,505.91 $95,505.91 $95,505.91 2026-03-01
01599 OTHER New Technology - Level 48 1 1 — — $89,203.57 $89,203.57 $89,203.57 2026-03-01
01585 OTHER New Technology - Level 48 1 1 — — $89,203.57 $89,203.57 $89,203.57 2026-03-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 4 1 — — $81,824.40 $108,125.10 $89,130.15 2026-03-01
007 OTHER Lung Transplant 1 1 — — $81,903.93 $81,903.93 $81,903.93 2026-03-01
01584 OTHER New Technology - Level 47 1 1 — — $79,813.77 $79,813.77 $79,813.77 2026-03-01
01598 OTHER New Technology - Level 47 1 1 — — $79,813.77 $79,813.77 $79,813.77 2026-03-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 4 1 — — $78,560.00 $78,560.00 $78,560.00 2026-03-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 4 1 — — $78,560.00 $78,560.00 $78,560.00 2026-03-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 4 1 — — $77,046.96 $77,046.96 $77,046.96 2026-03-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 4 1 — — $73,323.00 $73,323.00 $73,323.00 2026-03-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 4 1 — — $73,323.00 $73,323.00 $73,323.00 2026-03-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 4 1 — — $73,323.00 $73,323.00 $73,323.00 2026-03-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $72,591.05 $72,591.05 $72,591.05 2026-03-01
01597 OTHER New Technology - Level 46 1 1 — — $70,423.97 $70,423.97 $70,423.97 2026-03-01
01583 OTHER New Technology - Level 46 1 1 — — $70,423.97 $70,423.97 $70,423.97 2026-03-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $69,912.66 $69,912.66 $69,912.66 2026-03-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $69,176.27 $69,176.27 $69,176.27 2026-03-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $64,830.03 $64,830.03 $64,830.03 2026-03-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $64,274.79 $64,274.79 $64,274.79 2026-03-01
474 OTHER Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 1 1 — — $62,616.22 $62,616.22 $62,616.22 2026-03-01
01582 OTHER New Technology - Level 45 1 1 — — $61,034.17 $61,034.17 $61,034.17 2026-03-01
01596 OTHER New Technology - Level 45 1 1 — — $61,034.17 $61,034.17 $61,034.17 2026-03-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $60,342.16 $60,342.16 $60,342.16 2026-03-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $60,166.38 $60,166.38 $60,166.38 2026-03-01
429 OTHER Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 1 1 — — $57,715.38 $57,715.38 $57,715.38 2026-03-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $57,050.54 $57,050.54 $57,050.54 2026-03-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $56,824.55 $56,824.55 $56,824.55 2026-03-01
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