Hospital

ALASKA REGIONAL HOSPITAL

Anchorage, AK · CCN 020017 · Rates published

28,360 distinct procedures filed

22 distinct payers

1,148,935 rate rows

2026-09-01 last MRF observed

Data quality

1,084,260 of 1,148,935 rate rows are consumer-grade (94.4%)

64,675 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 — reason	Rows
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	32,210
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	24,179
per-diem day rate — not a per-procedure price	7,840
placeholder amount (≤ $0.02) — excluded from medians	288
template filing: same amount across many unrelated codes — excluded	134
exceeds 10× this hospital's gross charge — excluded from medians	18
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings	6

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/61-1000033_ALASKA-REGIONAL-HOSPITAL_standardcharges.json?si=dpx-pt-json-access-policy&spr=https&sv=2026-02-06&sr=c&sig=ks%2BgfAjyEHlZmeP2PYJ%2f9NpMuCoRStjTb2bhIy9Y6LM%3D
Found on page	https://www.alaskaregional.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-10-22
Content fingerprint	7dea06346fea618a… · 236,675,734 bytes · first seen 2026-09-21

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
845 OTHER	Inj, Atidarsagene Autotemc	4	$4,324,800.00	$4,595,100.00	$4,505,000.00	nat. median $17,157 outlier · 262.6×
9138 OTHER	Inj, Hemgenix, Per Tx Dose	5	$3,543,792.00	$4,614,312.50	$3,691,450.00	nat. median $3,758,972 1.0× median
908 OTHER	Topi Adm Prad Zami Per Tre	5	$3,154,351.68	$4,169,775.00	$3,335,820.00	nat. median $30,519 outlier · 109.3×
714 OTHER	Inj Delandistrogene Mox Ro	5	$3,184,221.12	$4,159,825.00	$3,327,860.00	nat. median $3,325,455 1.0× median
748 OTHER	Inj, Lovotibeglogene Autot	5	$3,105,891.84	$4,065,635.00	$3,252,508.00	nat. median $3,252,508 1.0× median
906 OTHER	Inj Elivaldogene Autotemec	5	$3,052,800.00	$3,975,000.00	$3,180,000.00	nat. median $25,088 outlier · 126.8×
746 OTHER	Inj, Betibeglogene Autotem	5	$2,813,049.60	$3,674,961.25	$2,939,969.00	nat. median $2,939,969 1.0× median
9141 OTHER	Inj Onase Abepar-xioi Trea	5	$2,572,836.48	$3,350,047.50	$2,680,038.00	nat. median $2,588,981 1.0× median
922 OTHER	Inj Onase Abepar-brve Trea	5	$2,557,658.88	$3,330,285.00	$2,664,228.00	nat. median $712 outlier · 3744.1×
824 OTHER	Inj, Exagamglogene Autotem	5	$2,208,870.72	$2,915,000.00	$2,332,000.00	nat. median $2,285,360 1.0× median
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	5	$362,616.86	$1,662,883.26	$937,005.57	nat. median $359,244 outlier · 2.6×
2067 OTHER	Afamitresgene Autoleucel	5	$770,620.00	$1,017,459.25	$813,967.40	nat. median $793,739 1.0× median
1 MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	5	$235,491.74	$1,079,144.34	$640,472.22	nat. median $248,541 outlier · 2.6×
9194 OTHER	Tisagenlecleucel Car-pos T	5	$566,531.30	$764,616.50	$611,693.20	nat. median $577,862 1.1× median
9498 OTHER	Ciltacabtagene Car-pos T	5	$564,458.69	$734,972.25	$587,977.80	nat. median $587,650 1.0× median
9413 OTHER	Lisocabtagene Car Pos T	5	$556,387.78	$724,463.25	$579,570.60	nat. median $562,201 1.0× median
9422 OTHER	Idecabtagene Vicleucel Car	5	$545,258.69	$709,972.25	$567,977.80	nat. median $563,449 1.0× median
9035 OTHER	Axicabtagene Ciloleucel Ca	5	$532,192.20	$703,126.13	$562,500.90	nat. median $533,230 1.1× median
9391 OTHER	Brexucabtagene Car Pos T	5	$489,450.20	$637,629.88	$510,103.90	nat. median $492,768 1.0× median
927 MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	6	$179,527.49	$822,165.05	$395,176.40	nat. median $198,115 2.0× median
3 MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	6	$178,476.77	$817,340.00	$392,857.23	nat. median $190,359 outlier · 2.1×
7 MS_DRG	Lung Transplant	5	$109,081.15	$498,686.30	$295,970.34	nat. median $117,977 outlier · 2.5×
831 OTHER	Obecbtge Autol Up To 400 M	5	$267,120.00	$347,812.50	$278,250.00	nat. median $24,155 outlier · 11.5×
14 MS_DRG	Allogeneic Bone Marrow Transplant	5	$101,262.82	$462,785.29	$274,663.09	nat. median $110,084 outlier · 2.5×
897 OTHER	Revakinagene, Per Implant	5	$251,116.51	$331,250.00	$265,000.00	nat. median $27,087 outlier · 9.8×
2 MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	5	$95,509.02	$436,364.95	$258,982.62	nat. median $103,938 outlier · 2.5×
4 MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	6	$116,638.85	$533,389.71	$256,375.56	nat. median $126,461 outlier · 2.0×
5 MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	5	$86,944.23	$397,036.73	$235,641.32	nat. median $94,943 outlier · 2.5×
426 MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	6	$92,904.28	$424,404.37	$203,991.39	nat. median $93,226 outlier · 2.2×
886 OTHER	Inj. Remestemcel-l-rknd/ T	5	$195,513.41	$254,574.75	$203,659.80	nat. median $201,669 1.0× median
212 MS_DRG	Concomitant Aortic And Mitral Valve Procedures	6	$91,670.67	$418,739.84	$201,268.72	nat. median $97,137 outlier · 2.1×
580090 CDM	Ins Icd Lead/generator	17	$83,413.20	$277,051.00	$187,679.71	nat. median $147,463 1.3× median
215 MS_DRG	Other Heart Assist System Implant	6	$83,979.72	$383,424.16	$184,294.11	nat. median $93,787 2.0× median
429 MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	6	$76,034.66	$346,941.68	$166,758.69	nat. median $77,936 outlier · 2.1×
1907 OTHER	New Technology - Level 52	5	$159,031.87	$207,072.75	$165,658.20	nat. median $155,855 1.1× median
1908 OTHER	New Technology - Level 52	5	$159,031.87	$207,072.75	$165,658.20	nat. median $155,612 1.1× median
10 MS_DRG	Pancreas Transplant	5	$60,655.27	$276,321.86	$163,997.04	nat. median $64,851 outlier · 2.5×
19 MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	5	$60,310.60	$274,739.18	$163,057.71	nat. median $66,623 outlier · 2.4×
850 MS_DRG	Acute Leukemia With Other Procedures	6	$73,098.66	$333,460.03	$160,278.69	nat. median $78,164 outlier · 2.1×
456 MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	6	$70,950.97	$323,598.13	$155,538.53	nat. median $77,487 outlier · 2.0×
304353 CDM	Ins/repl Sq Icd With Elec	17	$57,102.91	$260,964.17	$150,914.85	nat. median $91,466 1.6× median
591992 CDM	Rem/replace Icd Gen Mult	17	$56,836.53	$260,964.17	$150,210.83	nat. median $150,211 1.0× median
1905 OTHER	New Technology - Level 51	5	$143,389.44	$186,705.00	$149,364.00	nat. median $140,505 1.1× median
1906 OTHER	New Technology - Level 51	5	$143,389.44	$186,705.00	$149,364.00	nat. median $140,505 1.1× median
20 MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	6	$66,467.72	$303,011.75	$145,643.62	nat. median $74,298 2.0× median
957 MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Mcc	6	$64,380.40	$293,427.11	$141,036.73	nat. median $67,908 outlier · 2.1×
16 MS_DRG	Autologous Bone Marrow Transplant With Cc/mcc	5	$50,206.10	$228,340.89	$135,520.33	nat. median $53,841 outlier · 2.5×
427 MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	6	$61,015.03	$277,973.85	$133,609.07	nat. median $63,564 outlier · 2.1×
1904 OTHER	New Technology - Level 50	5	$127,747.01	$166,337.25	$133,069.80	nat. median $120,722 1.1× median
1903 OTHER	New Technology - Level 50	5	$127,747.01	$166,337.25	$133,069.80	nat. median $120,722 1.1× median

Other procedures at this hospital

Browse this hospital's 28,360 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

580090	CDM	Ins Icd Lead/generator	62	17	$297,904.30	$297,904.30	$83,413.20	$277,051.00	$187,679.71	2026-09-01
304353	CDM	Ins/repl Sq Icd With Elec	62	17	$203,938.98	$203,938.98	$57,102.91	$260,964.17	$150,914.85	2026-09-01
591992	CDM	Rem/replace Icd Gen Mult	62	17	$202,987.62	$202,987.62	$56,836.53	$260,964.17	$150,210.83	2026-09-01
591991	CDM	Rem/replace Icd Gen Sgl	62	17	$202,987.62	$202,987.62	$56,836.53	$188,778.49	$127,882.20	2026-09-01
591990	CDM	Rem/replace Icd Gen Dual	62	17	$202,987.62	$202,987.62	$56,836.53	$188,778.49	$127,882.20	2026-09-01
657088	CDM	Occluder Cv 25x18mm	30	16	$164,798.00	$164,798.00	$48,615.41	$153,262.14	$109,590.67	2026-03-01
657087	CDM	Occluder Cv 18x18mm	30	16	$164,798.00	$164,798.00	$48,615.41	$153,262.14	$109,590.67	2026-03-01
657089	CDM	Occluder Cv 35x18mm	30	16	$164,798.00	$164,798.00	$48,615.41	$153,262.14	$109,590.67	2026-03-01
660857	CDM	Device Embl 4.5mm 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660858	CDM	Device Embl 4.75mm 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660859	CDM	Device Embl 4.75mm 12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660801	CDM	Device Embl 3mm 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660466	CDM	Coil Emb Endo 7mm 4mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660842	CDM	Device Embl 4.25mm 12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660860	CDM	Device Embl 4.75mm 14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660864	CDM	Device Embl 4.75mm 25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660849	CDM	Device Embl 4.5mm 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660867	CDM	Device Embl 5mm 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660866	CDM	Device Embl 4.75mm 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659157	CDM	Coil Emb Endo 7mm 5.6mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660468	CDM	Coil Embol Neuro 4x2.6mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660845	CDM	Device Embl 4.25mm 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660847	CDM	Device Embl 4.25mm 30mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660831	CDM	Device Embl 3.75mm 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660463	CDM	Coil Emb Endo 5mm 3.6mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660832	CDM	Device Embl 4mm 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660833	CDM	Device Embl 4mm 12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660794	CDM	Device Embl 2.75mm 18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660834	CDM	Device Embl 4mm 14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660862	CDM	Device Embl 4.75mm 18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660335	CDM	Device Embl 4.5mm 16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659636	CDM	Coil Embl Endo 8mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660464	CDM	Coil Embl Endo 6mm 4mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660469	CDM	Coil Emb Neuro 6x4.6mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660804	CDM	Device Embl 3mm 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653254	CDM	Device Embl 16mm 2.5mm P	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660362	CDM	Device Embl Pl 4.75x14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659615	CDM	Valve Aortic 23mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657348	CDM	Kit Aor Tavr 26mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
650874	CDM	Stent Eprsth 45mm 10cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660462	CDM	Sys Endo Sng Lyr 5mmx4mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660802	CDM	Device Embl 3mm 25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660830	CDM	Device Embl 3.75mm 30mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660844	CDM	Device Embl 4.25mm 18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660838	CDM	Device Embl 4mm 25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659137	CDM	Valve Aor Tavr 29mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660465	CDM	Coil Emb Endo 6mm 4.6mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660796	CDM	Device Embl 3mm 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660848	CDM	Device Embl 4.25mm 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660836	CDM	Device Embl 4mm 18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660837	CDM	Device Embl 4.00x2mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653257	CDM	Dev Embl 14x3.25mm Pipln	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659042	CDM	Graft Evas 45x45mm 10cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660467	CDM	Coil Emb Endo 7mm 5mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660800	CDM	Device Embl 3mm 18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660843	CDM	Device Emb 4.25mm 16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660841	CDM	Device Embl 4.25mm 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660856	CDM	Device Embl 4.5mm 30mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657733	CDM	Device Embl 10mm 4.75mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660865	CDM	Device Embl 4.75x30mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
654407	CDM	Device Embl 10mm 3.75mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659036	CDM	Stent Eprsth 37x37x10cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659616	CDM	Valve Aortic 25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659037	CDM	Stent Eprsth 37x37x15cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
238723	CDM	Device Clsr 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653253	CDM	Dev Embl 18x3.5mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659618	CDM	Valve Aortic 29mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660791	CDM	Device Embl 2.75mm 12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660808	CDM	Device Embl 3.25mm 16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660868	CDM	Device Embl 5mm 12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653261	CDM	Device Embl 4.25x14mm Pl	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660144	CDM	Coil Embl Endo 8mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660788	CDM	Device Embl 2.5mm 18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657750	CDM	Device Embl Pln 4.5x12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
658895	CDM	Device Clsr 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660177	CDM	Stent Eprsth 34x34x20cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660826	CDM	Device Embl 3.75x16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659035	CDM	Stent Graft 15cm 31x31mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
655143	CDM	Device Embl 30mm 4.75mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660827	CDM	Device Embl 3.75mm 18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659041	CDM	Stent 34mmx34mmx15cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659617	CDM	Valve Aortic 27mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660178	CDM	Stent Eprsth 37x37x20cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660829	CDM	Device Embl 3.75mm 25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
238720	CDM	Device Clsr 24mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660787	CDM	Device Embl 2.5mm 16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660789	CDM	Device Embl 2.5mm 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
649628	CDM	Stent Eprsth 31mm 10cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660129	CDM	Coil Emb 3mm 8mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660824	CDM	Device Embl 3.75mm 12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660828	CDM	Device Embl 3.75mm 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660790	CDM	Device Embl 2.75mm 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659225	CDM	Coil Embl Endo 4mm 3mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660211	CDM	System Imp 5mm 15mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660805	CDM	Device Embl 3.25mm 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659043	CDM	Graft Evas 45x45mm 15cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657919	CDM	Valve Heart Trnscth 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659226	CDM	Sys Endo Sgl Lyr 4x2.6mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653251	CDM	Device Embl 18mm 4.5mm P	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
647492	CDM	Stent Eprsth 34mm 20cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660220	CDM	Device Embl16x3.75mm Pip	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
650879	CDM	Stent Eprsth 40mm 20cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
656047	CDM	Dev Embl Ped 12x3.25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653252	CDM	Dev Embl 16x4.75mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660823	CDM	Device Embl 3.75mm 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660825	CDM	Device Embl 3.75mm 14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
238719	CDM	Device Clsr 27mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657983	CDM	System Endo Sng Lyr 5mmx	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660861	CDM	Device Embl 4.75mm 16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
647491	CDM	Stent Eprsth 34mm 15cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
565287	CDM	Coil Embl 6mm 2mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653259	CDM	Device Embl 14x3.5mm Pl	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660139	CDM	Coil Emb Neuro 6x4mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
649627	CDM	Stent Eprsth 31mm 15cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
655086	CDM	Device Embl 10mm 4mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
650875	CDM	Stent Eprsth 45mm 20cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660143	CDM	Coil Embl Endo 11mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653250	CDM	Dev Embl 16x5mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660140	CDM	Coil Embol Neuro 7x3mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660820	CDM	Device Embl 3.5mm 25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
661576	CDM	Coil Embl Endo 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
571922	CDM	Coil Emb Neuro 7mm 2mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660853	CDM	Device Embl 4.5mm 18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
658899	CDM	Device Clsr 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653262	CDM	Device Embl Flx 4.5x14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
661381	CDM	Graft Endo Aaa 26x12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659135	CDM	Valve Aor Tavr 23mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660795	CDM	Device Embl 2.75mm 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660276	CDM	Coil Emb Endo Sn Ly 11mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653246	CDM	Device Embl 16x4.25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
571284	CDM	Stent Vasc 500mm 14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
238721	CDM	Device Clsr 40mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657347	CDM	Kit Aor Tavr 23mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657920	CDM	Valve Heart Trnscth 23mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
661411	CDM	Graft Endo Aaa 28.5x12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
658465	CDM	Device Embl 4x35mm Pline	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659224	CDM	Coil Embl Endo 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660138	CDM	Coil Emb Neuro 6x3mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657346	CDM	Kit Aor Tavr 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
C1772	HCPCS	Pump Pain Infn 20ml	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
650878	CDM	Stent Eprsth 40mm 10cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
649625	CDM	Stent Eprsth 40mm 15cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660874	CDM	Device Embl 5mm 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660141	CDM	Coil Emb Neuro 7x4mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659034	CDM	Stent 20fr 31x31mm 10cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
655959	CDM	Sys Endo Sng Lyr 6x3mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660792	CDM	Device Embl 2.75mm 14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660793	CDM	Device Embl 2.75mm 16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653255	CDM	Dev Embl 16x2.75mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660810	CDM	Device Embl 3.25mm 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653248	CDM	Device Embl 5x18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660803	CDM	Device Embl 3mm 30mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660797	CDM	Device Embl 3mm 12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
649487	CDM	Stent Eprsth 37mm 15cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
643123	CDM	Stent Eprsth 45mm 15cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653258	CDM	Dev Embl 18x3.25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
C1822	HCPCS	Pulse Gen Imp	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
661283	CDM	Valve Aortic L5.6cm Od16	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660852	CDM	Device Embl 4.50x16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660819	CDM	Device Embl 3.5mm 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659614	CDM	Valve Aortic 21mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660806	CDM	Device Embl 3.25x12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653260	CDM	Dev Embl Pipln 14x3.75mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660835	CDM	Device Embl 4mm 16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660854	CDM	Device Embl 4.5mm 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653256	CDM	Dev Embl 16x3mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
658897	CDM	Device Clsr 27mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657349	CDM	Kit Aor Vlv 14fr 29mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
565334	CDM	Pump Pain Infn 148gm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660784	CDM	Device Embl 10mm 2.5mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659136	CDM	Valve Aor Tavr 26mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660785	CDM	Device Embl 2.5mm 12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
656607	CDM	Device Embl Pln 12x4.75	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660799	CDM	Device Embl 3mm 16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660839	CDM	Device Embl 4mm 30mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660840	CDM	Device Embl 4mm 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660798	CDM	Device Embl 3mm 14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660873	CDM	Device Embl 5.0x.0mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
661380	CDM	Graft Endo Aaa 23x12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660816	CDM	Device Embl 3.5mm 14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660815	CDM	Device Embl 3.50x12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660870	CDM	Device Embl 5mm 18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660817	CDM	Device Embl 3.5mm 16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660521	CDM	Coil Emb Endo 6mm 5mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660850	CDM	Device Embl 4.5mm 12mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660871	CDM	Device Embl 5.0x20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657732	CDM	Device Embl 12mm 3.75mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660135	CDM	Coil Embol Neuro 4x2mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660786	CDM	Device Embl 2.5mm 14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660765	CDM	Device Embl 5.0x16mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653249	CDM	Dev Embl 20x4.25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653245	CDM	Device Embl Pipln 14x4mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660696	CDM	Device Embl 4.25mm 14mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660813	CDM	Device Embl 3.25mm 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660872	CDM	Device Embl 5mm 25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
238722	CDM	Device Clsr 31mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659979	CDM	Device Endo Sng 5x3mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660132	CDM	Coil Embl Endo 9mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660520	CDM	Coil Emb Endo Sn Ly 7mmx	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660142	CDM	Coil Emb 7x5mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
640521	CDM	Kit Implant Crnmxf Med	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660855	CDM	Device Embl 4.50x25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
238741	CDM	Device Clsr 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653247	CDM	Device Embl 18mm 4.25mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659138	CDM	Valve Aor Tavr 34mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
655446	CDM	Stent Eprsth 15cm 28mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
658545	CDM	Coil Embl Endo 11mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
643124	CDM	Stent Eprsth 37mm 10cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660134	CDM	Coil Embl 4.5mm 3mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660814	CDM	Device Embl 3.5mm 10mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
655970	CDM	Device Embl Flx 14x5mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
649626	CDM	Stent Eprsth 34mm 10cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659756	CDM	Device Embl 14mm 2.5mm P	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
656269	CDM	Device Embl 4x12mm Pline	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657921	CDM	Valve Heart Trnscth 26mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
658898	CDM	Device Clsr 31mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
657304	CDM	Stent Eprsth 21mm 10cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
658896	CDM	Device Clsr 24mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660821	CDM	Device Embl 3.5mm 30mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
659033	CDM	Graft Evas 34x34x10cm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660136	CDM	Coil Embl 4x3mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660822	CDM	Device Embl 3.5mm 35mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660137	CDM	Coil Embl 5mm 2mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
660863	CDM	Device Embl 4.75mm 20mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
653244	CDM	Device Embl Pipln 4x18mm	56	16	$166,640.00	$166,640.00	$49,158.80	$154,975.20	$109,149.20	2026-09-01
J9226	HCPCS	Supprelin La 50 Mg Imp	54	15	$195,572.62	$195,572.62	$57,693.92	$181,882.54	$123,210.75	2026-09-01
583916	CDM	Valve Aortic 19mm	26	15	$166,640.00	$166,640.00	$49,158.80	$145,976.64	$109,149.20	2026-09-01
583920	CDM	Valve Aortic 27mm	26	15	$166,640.00	$166,640.00	$49,158.80	$145,976.64	$109,149.20	2026-09-01
583917	CDM	Valve Aortic 21mm	26	15	$166,640.00	$166,640.00	$49,158.80	$145,976.64	$109,149.20	2026-09-01
583918	CDM	Valve Aortic 23mm	26	15	$166,640.00	$166,640.00	$49,158.80	$145,976.64	$109,149.20	2026-09-01
577593	CDM	Coil Embl Endo 11mm	26	15	$166,640.00	$166,640.00	$49,158.80	$145,976.64	$109,149.20	2026-09-01
583919	CDM	Valve Aortic 25mm	26	15	$166,640.00	$166,640.00	$49,158.80	$145,976.64	$109,149.20	2026-09-01
587533	CDM	Implant Cust Cranial Lge	26	15	$166,640.00	$166,640.00	$49,158.80	$145,976.64	$109,149.20	2026-09-01
429639	CDM	Implant Cranial Peek	26	15	$166,640.00	$166,640.00	$49,158.80	$145,976.64	$109,149.20	2026-09-01
927	MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	18	6	—	—	$179,527.49	$822,165.05	$395,176.40	2026-09-01
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	18	6	—	—	$178,476.77	$817,340.00	$392,857.23	2026-09-01
4	MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	18	6	—	—	$116,638.85	$533,389.71	$256,375.56	2026-09-01
426	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	18	6	—	—	$92,904.28	$424,404.37	$203,991.39	2026-09-01
212	MS_DRG	Concomitant Aortic And Mitral Valve Procedures	18	6	—	—	$91,670.67	$418,739.84	$201,268.72	2026-09-01
215	MS_DRG	Other Heart Assist System Implant	18	6	—	—	$83,979.72	$383,424.16	$184,294.11	2026-09-01
429	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	18	6	—	—	$76,034.66	$346,941.68	$166,758.69	2026-09-01
850	MS_DRG	Acute Leukemia With Other Procedures	18	6	—	—	$73,098.66	$333,460.03	$160,278.69	2026-09-01
456	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	18	6	—	—	$70,950.97	$323,598.13	$155,538.53	2026-09-01
20	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	18	6	—	—	$66,467.72	$303,011.75	$145,643.62	2026-09-01
957	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Mcc	18	6	—	—	$64,380.40	$293,427.11	$141,036.73	2026-09-01
427	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	18	6	—	—	$61,015.03	$277,973.85	$133,609.07	2026-09-01
928	MS_DRG	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	18	6	—	—	$60,630.11	$276,206.33	$132,759.50	2026-09-01
275	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	18	6	—	—	$60,275.38	$274,577.44	$131,976.57	2026-09-01
870	MS_DRG	Septicemia Or Severe Sepsis With Mv >96 Hours	18	6	—	—	$58,442.16	$266,159.59	$127,930.51	2026-09-01
268	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	18	6	—	—	$58,157.87	$264,854.17	$127,303.05	2026-09-01
955	MS_DRG	Craniotomy For Multiple Significant Trauma	18	6	—	—	$56,926.78	$259,201.20	$124,585.93	2026-09-01
317	MS_DRG	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	18	6	—	—	$56,552.76	$257,483.74	$123,760.43	2026-09-01
447	MS_DRG	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	18	6	—	—	$56,511.66	$257,295.05	$123,669.73	2026-09-01
573	MS_DRG	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	18	6	—	—	$55,419.78	$252,281.31	$121,259.86	2026-09-01
207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	18	6	—	—	$54,441.12	$247,787.43	$119,099.86	2026-09-01
266	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	18	6	—	—	$51,872.44	$235,992.43	$113,430.56	2026-09-01
969	MS_DRG	HIV With Extensive O.r. Procedures With Mcc	18	6	—	—	$51,812.89	$235,719.02	$113,299.14	2026-09-01
28	MS_DRG	Spinal Procedures With Mcc	18	6	—	—	$50,865.25	$231,367.62	$111,207.62	2026-09-01
276	MS_DRG	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	18	6	—	—	$50,851.00	$231,302.15	$111,176.16	2026-09-01
457	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	18	6	—	—	$50,486.20	$229,627.05	$110,371.02	2026-09-01
9138	OTHER	Inj, Hemgenix, Per Tx Dose	10	5	—	—	$3,543,792.00	$4,614,312.50	$3,691,450.00	2026-09-01
908	OTHER	Topi Adm Prad Zami Per Tre	10	5	$69,244.41	—	$3,154,351.68	$4,169,775.00	$3,335,820.00	2026-09-01
714	OTHER	Inj Delandistrogene Mox Ro	10	5	$32,263.55	—	$3,184,221.12	$4,159,825.00	$3,327,860.00	2026-09-01
748	OTHER	Inj, Lovotibeglogene Autot	10	5	$47,718.54	—	$3,105,891.84	$4,065,635.00	$3,252,508.00	2026-09-01
906	OTHER	Inj Elivaldogene Autotemec	10	5	$60,197.01	—	$3,052,800.00	$3,975,000.00	$3,180,000.00	2026-09-01
746	OTHER	Inj, Betibeglogene Autotem	10	5	$52,641.24	—	$2,813,049.60	$3,674,961.25	$2,939,969.00	2026-09-01
9141	OTHER	Inj Onase Abepar-xioi Trea	10	5	—	—	$2,572,836.48	$3,350,047.50	$2,680,038.00	2026-09-01
922	OTHER	Inj Onase Abepar-brve Trea	6	5	$52,385.34	—	$2,557,658.88	$3,330,285.00	$2,664,228.00	2026-09-01
824	OTHER	Inj, Exagamglogene Autotem	10	5	$77,116.69	—	$2,208,870.72	$2,915,000.00	$2,332,000.00	2026-09-01
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	16	5	—	—	$362,616.86	$1,662,883.26	$937,005.57	2026-09-01
2067	OTHER	Afamitresgene Autoleucel	10	5	—	—	$770,620.00	$1,017,459.25	$813,967.40	2026-09-01
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	16	5	—	—	$235,491.74	$1,079,144.34	$640,472.22	2026-09-01
9194	OTHER	Tisagenlecleucel Car-pos T	10	5	$567,320.75	—	$566,531.30	$764,616.50	$611,693.20	2026-09-01
9498	OTHER	Ciltacabtagene Car-pos T	10	5	$598,687.50	—	$564,458.69	$734,972.25	$587,977.80	2026-09-01
9413	OTHER	Lisocabtagene Car Pos T	10	5	$543,647.50	—	$556,387.78	$724,463.25	$579,570.60	2026-09-01
9422	OTHER	Idecabtagene Vicleucel Car	10	5	$555,837.50	—	$545,258.69	$709,972.25	$567,977.80	2026-09-01
9035	OTHER	Axicabtagene Ciloleucel Ca	10	5	$528,605.96	—	$532,192.20	$703,126.13	$562,500.90	2026-09-01
9391	OTHER	Brexucabtagene Car Pos T	10	5	$528,675.00	—	$489,450.20	$637,629.88	$510,103.90	2026-09-01
7	MS_DRG	Lung Transplant	16	5	—	—	$109,081.15	$498,686.30	$295,970.34	2026-09-01
831	OTHER	Obecbtge Autol Up To 400 M	10	5	$40,230.11	—	$267,120.00	$347,812.50	$278,250.00	2026-09-01
14	MS_DRG	Allogeneic Bone Marrow Transplant	16	5	—	—	$101,262.82	$462,785.29	$274,663.09	2026-09-01
897	OTHER	Revakinagene, Per Implant	10	5	$28,664.12	—	$251,116.51	$331,250.00	$265,000.00	2026-09-01
2	MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	16	5	—	—	$95,509.02	$436,364.95	$258,982.62	2026-09-01
5	MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	16	5	—	—	$86,944.23	$397,036.73	$235,641.32	2026-09-01
886	OTHER	Inj. Remestemcel-l-rknd/ T	10	5	$45,960.92	—	$195,513.41	$254,574.75	$203,659.80	2026-09-01
1907	OTHER	New Technology - Level 52	10	5	$395,198.75	—	$159,031.87	$207,072.75	$165,658.20	2026-09-01
1908	OTHER	New Technology - Level 52	10	5	$395,198.75	—	$159,031.87	$207,072.75	$165,658.20	2026-09-01
10	MS_DRG	Pancreas Transplant	16	5	—	—	$60,655.27	$276,321.86	$163,997.04	2026-09-01
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	16	5	—	—	$60,310.60	$274,739.18	$163,057.71	2026-09-01
1905	OTHER	New Technology - Level 51	10	5	$356,326.88	—	$143,389.44	$186,705.00	$149,364.00	2026-09-01
1906	OTHER	New Technology - Level 51	10	5	$356,326.88	—	$143,389.44	$186,705.00	$149,364.00	2026-09-01
16	MS_DRG	Autologous Bone Marrow Transplant With Cc/mcc	16	5	—	—	$50,206.10	$228,340.89	$135,520.33	2026-09-01
1904	OTHER	New Technology - Level 50	10	5	$317,454.99	—	$127,747.01	$166,337.25	$133,069.80	2026-09-01
1903	OTHER	New Technology - Level 50	10	5	$317,454.99	—	$127,747.01	$166,337.25	$133,069.80	2026-09-01
8	MS_DRG	Simultaneous Pancreas And Kidney Transplant	16	5	—	—	$47,479.76	$215,821.94	$128,090.33	2026-09-01
17	MS_DRG	Autologous Bone Marrow Transplant Without Cc/mcc	16	5	—	—	$46,034.82	$209,187.01	$124,152.50	2026-09-01
924	OTHER	Inj Zopapogene Per Ther Do	6	5	—	—	$117,024.00	$152,375.00	$121,900.00	2026-09-01
1901	OTHER	New Technology - Level 49	10	5	$278,583.12	—	$112,104.58	$145,969.50	$116,775.60	2026-09-01
1902	OTHER	New Technology - Level 49	10	5	$278,583.12	—	$112,104.58	$145,969.50	$116,775.60	2026-09-01
845	OTHER	Inj, Atidarsagene Autotemc	8	4	$28,468.83	—	$4,324,800.00	$4,595,100.00	$4,505,000.00	2026-09-01

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