Price Transparencybeta Hospital negotiated rates

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

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Hospital

RIVERSIDE COMMUNITY HOSPITAL

Riverside, CA · CCN 050022 · Rates published

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You selected 93306 (CPT)

ECHO2D COMP W CF DOP

This hospital’s price: $4,345 across 17 payers · range $177-$9,870

Source: https://core.secure.ehc.com/src/util/json-detail-price-list/33-0751869_riverside-community-hospital_standardcharges.json · observed 2024-10-01

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

34,588 distinct procedures filed
41 distinct payers
759,747 rate rows
2026-07-17 last MRF observed
Data quality

669,811 of 759,747 rate rows are consumer-grade (88.2%)

89,936 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
template filing: same amount across many unrelated codes — excluded 48,985
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 20,007
per-diem day rate — not a per-procedure price 13,123
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 6,211
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 1,278
percent-of-charges filed in the dollar field — excluded from medians 146
placeholder amount (≤ $0.02) — excluded from medians 115
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 41
exceeds 10× this hospital's gross charge — excluded from medians 30
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://core.secure.ehc.com/src/util/json-detail-price-list/33-0751869_riverside-community-hospital_standardcharges.json
Found on page https://riversidecommunityhospital.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-03
Content fingerprint b1a192f9229ceb61… · 481,764,662 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 $4,897,200.00 $4,897,200.00 $4,897,200.00 nat. median
$2,994,107
1.6× median
J3399
HCPCS 		$4,463,735.93 1 $3,884,946.48 $3,884,946.48 $3,884,946.48 nat. median
$2,467,386
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 21 $2,938,320.00 $4,407,480.00 $3,672,900.00 nat. median
$3,758,972
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 21 $2,884,000.00 $4,938,850.00 $3,605,000.00 nat. median
$3,672,053
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,489,255.00 $3,672,900.00 $3,581,077.50 nat. median
$3,574,709
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $3,424,750.00 $3,605,000.00 $3,514,875.00 nat. median
$3,496,850
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 23 $9,086.55 $4,555,873.35 $3,325,455.00 nat. median
$3,325,455
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 23 $14,988.25 $4,501,820.00 $3,286,000.00 nat. median
$3,252,508
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,159,182.25 $3,325,455.00 $3,242,318.62 nat. median
$3,228,024
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,121,700.00 $3,286,000.00 $3,203,850.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 23 $13,312.54 $4,066,160.00 $2,968,000.00 nat. median
$2,939,969
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,819,600.00 $2,968,000.00 $2,893,800.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 21 $1,910,891.20 $3,272,401.18 $2,388,614.00 nat. median
$2,588,981
0.9× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,269,183.30 $2,388,614.00 $2,328,898.65 nat. median
$2,511,312
0.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 21 $423,354.32 $724,994.27 $529,192.90 nat. median
$577,163
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 21 $421,698.72 $722,159.06 $527,123.40 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 21 $421,270.08 $721,425.01 $526,587.60 nat. median
$563,449
0.9× median
9413
OTHER 		Lisocabtagene Car Pos T 21 $413,380.88 $707,914.76 $516,726.10 nat. median
$562,201
0.9× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $502,733.26 $529,192.90 $515,963.08 nat. median
$549,535
0.9× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $500,767.23 $527,123.40 $513,945.32 nat. median
$570,020
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $500,258.22 $526,587.60 $513,422.91 nat. median
$541,339
0.9× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $490,889.79 $516,726.10 $503,807.94 nat. median
$545,335
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 21 $391,564.80 $670,554.72 $489,456.00 nat. median
$533,230
0.9× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $464,983.20 $489,456.00 $477,219.60 nat. median
$516,226
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 21 $368,424.32 $630,926.65 $460,530.40 nat. median
$492,768
0.9× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $437,503.88 $460,530.40 $449,017.14 nat. median
$474,767
0.9× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 24 $310,186.38 $712,057.00 $443,123.40 nat. median
$359,454
1.2× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 25 $8,580.00 $523,733.00 $331,200.90 nat. median
$249,036
1.3× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 2 $307,996.56 $342,218.40 $325,107.48 nat. median
$214,523
1.5× median
407910
CDM 		Valve Tavr 29mm 12 $48,718.60 $667,444.82 $316,670.90 nat. median
$233,280
1.4× median
407908
CDM 		Valve Tavr 23mm 12 $48,718.60 $667,444.82 $316,670.90 nat. median
$63
outlier · 4996.4×
407909
CDM 		Valve Tavr 26mm 12 $48,718.60 $667,444.82 $316,670.90 nat. median
$233,280
1.4× median
5834
APR_DRG 		Neonate With Ecmo 3 $309,665.00 $322,051.60 $309,665.00 nat. median
$307,206
1.0× median
382795
CDM 		Kit Aor Vlv 14fr 26mm 12 $46,569.30 $637,999.41 $302,700.45 nat. median
$185
outlier · 1638.0×
386756
CDM 		Valve Heart Trnscth 26mm 12 $46,569.30 $637,999.41 $302,700.45 nat. median
$416
outlier · 728.0×
384878
CDM 		Kit Aor Vlv 14fr 20mm 12 $46,569.30 $637,999.41 $302,700.45 nat. median
$302,700
1.0× median
386755
CDM 		Valve Heart Trnscth 23mm 12 $46,569.30 $637,999.41 $302,700.45 nat. median
$302,700
1.0× median
382796
CDM 		Kit Aor Vlv 14fr 29mm 12 $46,569.30 $637,999.41 $302,700.45 nat. median
$14,655
outlier · 20.7×
382794
CDM 		Kit Aor Vlv 14fr 23mm 12 $46,569.30 $637,999.41 $302,700.45 nat. median
$172
outlier · 1757.8×
386766
CDM 		Valve Heart Trnscth 20mm 12 $46,569.30 $637,999.41 $302,700.45 nat. median
$302,700
1.0× median
917537
CDM 		Valve Tavr Sz 26mm 12 $42,987.00 $588,921.90 $279,415.50 nat. median
$7
outlier · 42658.9×
917538
CDM 		Valve Tavr Size 34mm 12 $42,987.00 $588,921.90 $279,415.50 nat. median
$64,968
outlier · 4.3×
382590
CDM 		Valve Tavr 23mm 12 $42,987.00 $588,921.90 $279,415.50 nat. median
$7,086
outlier · 39.4×
382441
CDM 		Valve Tavr 26mm 12 $42,987.00 $588,921.90 $279,415.50 nat. median
$646
outlier · 432.3×
382386
CDM 		Valve Tavr 26mm 12 $42,987.00 $588,921.90 $279,415.50 nat. median
$279,416
1.0× median
386927
CDM 		Valve Aor Tavr 29mm 12 $42,987.00 $588,921.90 $279,415.50 nat. median
$279,416
1.0× median
917536
CDM 		Valve Tavr Sz 23mm 12 $42,987.00 $588,921.90 $279,415.50 nat. median
$144
outlier · 1942.1×
382568
CDM 		Valve Tavr 29mm 12 $42,987.00 $588,921.90 $279,415.50 nat. median
$10,487
outlier · 26.6×
387530
CDM 		Valve Aor Tavr 26mm 12 $42,987.00 $588,921.90 $279,415.50 nat. median
$279,416
1.0× median
387901
CDM 		Valve Tavor Aor 23mm 12 $42,987.00 $588,921.90 $279,415.50 nat. median
$66
outlier · 4250.3×

Other procedures at this hospital

Browse this hospital's 34,588 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
             
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 1 1 — — $4,897,200.00 $4,897,200.00 $4,897,200.00 2024-10-01
J3399 HCPCS $4,463,735.93 1 1 $4,463,735.93 — $3,884,946.48 $3,884,946.48 $3,884,946.48 2026-07-17
9138 OTHER Inj, Hemgenix, Per Tx Dos 24 21 — — $2,938,320.00 $4,407,480.00 $3,672,900.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 25 21 $5,328.32 — $2,884,000.00 $4,938,850.00 $3,605,000.00 2026-07-17
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $3,489,255.00 $3,672,900.00 $3,581,077.50 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 2 2 — — $3,424,750.00 $3,605,000.00 $3,514,875.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 27 23 $14,789.34 — $9,086.55 $4,555,873.35 $3,325,455.00 2026-07-17
748 OTHER Inj, Lovotibeglogene Auto 27 23 $21,289.87 — $14,988.25 $4,501,820.00 $3,286,000.00 2026-07-17
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $3,159,182.25 $3,325,455.00 $3,242,318.62 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 2 2 — — $3,121,700.00 $3,286,000.00 $3,203,850.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 27 23 $24,391.30 — $13,312.54 $4,066,160.00 $2,968,000.00 2026-07-17
00746 OTHER Inj, Betibeglogene Autote 2 2 — — $2,819,600.00 $2,968,000.00 $2,893,800.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 25 21 — — $1,910,891.20 $3,272,401.18 $2,388,614.00 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $2,269,183.30 $2,388,614.00 $2,328,898.65 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 25 21 $658,092.07 — $423,354.32 $724,994.27 $529,192.90 2026-07-17
9498 OTHER Ciltacabtagene Car-pos T 25 21 $694,477.50 — $421,698.72 $722,159.06 $527,123.40 2026-07-17
9422 OTHER Idecabtagene Vicleucel Ca 25 21 $644,771.50 — $421,270.08 $721,425.01 $526,587.60 2026-07-17
9413 OTHER Lisocabtagene Car Pos T 25 21 $630,631.10 — $413,380.88 $707,914.76 $516,726.10 2026-07-17
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $502,733.26 $529,192.90 $515,963.08 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 2 2 — — $500,767.23 $527,123.40 $513,945.32 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 2 2 — — $500,258.22 $526,587.60 $513,422.91 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 2 2 — — $490,889.79 $516,726.10 $503,807.94 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 25 21 $613,182.92 — $391,564.80 $670,554.72 $489,456.00 2026-07-17
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $464,983.20 $489,456.00 $477,219.60 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 25 21 $613,263.00 — $368,424.32 $630,926.65 $460,530.40 2026-07-17
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $437,503.88 $460,530.40 $449,017.14 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 32 24 — — $310,186.38 $712,057.00 $443,123.40 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 32 25 — — $8,580.00 $523,733.00 $331,200.90 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 2 $437,623.49 — $307,996.56 $342,218.40 $325,107.48 2026-07-17
407909 CDM Valve Tavr 26mm 18 12 $487,186.00 $487,186.00 $48,718.60 $667,444.82 $316,670.90 2024-10-01
407908 CDM Valve Tavr 23mm 18 12 $487,186.00 $487,186.00 $48,718.60 $667,444.82 $316,670.90 2024-10-01
407910 CDM Valve Tavr 29mm 18 12 $487,186.00 $487,186.00 $48,718.60 $667,444.82 $316,670.90 2024-10-01
5834 APR_DRG Neonate With Ecmo 3 3 — — $309,665.00 $322,051.60 $309,665.00 2024-10-01
382796 CDM Kit Aor Vlv 14fr 29mm 18 12 $465,693.00 $465,693.00 $46,569.30 $637,999.41 $302,700.45 2024-10-01
382795 CDM Kit Aor Vlv 14fr 26mm 18 12 $465,693.00 $465,693.00 $46,569.30 $637,999.41 $302,700.45 2024-10-01
386755 CDM Valve Heart Trnscth 23mm 18 12 $465,693.00 $465,693.00 $46,569.30 $637,999.41 $302,700.45 2024-10-01
384878 CDM Kit Aor Vlv 14fr 20mm 18 12 $465,693.00 $465,693.00 $46,569.30 $637,999.41 $302,700.45 2024-10-01
382794 CDM Kit Aor Vlv 14fr 23mm 18 12 $465,693.00 $465,693.00 $46,569.30 $637,999.41 $302,700.45 2024-10-01
386756 CDM Valve Heart Trnscth 26mm 18 12 $465,693.00 $465,693.00 $46,569.30 $637,999.41 $302,700.45 2024-10-01
386766 CDM Valve Heart Trnscth 20mm 18 12 $465,693.00 $465,693.00 $46,569.30 $637,999.41 $302,700.45 2024-10-01
381711 CDM Val Evlt Rtm Trnsct Aort 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
382442 CDM Valve Tavr 29mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
386927 CDM Valve Aor Tavr 29mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
382441 CDM Valve Tavr 26mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
387536 CDM Valve Aor Tavr 34mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
382386 CDM Valve Tavr 26mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
382568 CDM Valve Tavr 29mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
382398 CDM Valve Tavr 34mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
387901 CDM Valve Tavor Aor 23mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
917537 CDM Valve Tavr Sz 26mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
387530 CDM Valve Aor Tavr 26mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
917538 CDM Valve Tavr Size 34mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
917536 CDM Valve Tavr Sz 23mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
382590 CDM Valve Tavr 23mm 18 12 $429,870.00 $429,870.00 $42,987.00 $588,921.90 $279,415.50 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 31 24 — — $8,580.00 $509,433.00 $279,089.80 2024-10-01
5833 APR_DRG Neonate With Ecmo 3 3 — — $269,678.00 $280,465.12 $269,678.00 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 $566,836.02 — $254,142.54 $282,380.60 $268,261.57 2026-07-17
920215 CDM Kit Cath Rt Heart 29 19 $599,953.00 $599,953.00 $59,995.30 $821,935.61 $263,979.32 2024-10-01
413134 CDM Valve Tavr 20mm 18 12 $393,652.00 $393,652.00 $39,365.20 $539,303.24 $255,873.80 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 36 26 — — $7,041.00 $443,752.00 $252,203.90 2024-10-01
437579 CDM Valve Tavr 23mm 18 12 $364,707.00 $364,707.00 $36,470.70 $499,648.59 $237,059.55 2024-10-01
437039 CDM Valve Tavr 26mm 18 12 $364,707.00 $364,707.00 $36,470.70 $499,648.59 $237,059.55 2024-10-01
437377 CDM Valve Tavr 34mm 18 12 $364,707.00 $364,707.00 $36,470.70 $499,648.59 $237,059.55 2024-10-01
437378 CDM Valve Tavr 29mm 18 12 $364,707.00 $364,707.00 $36,470.70 $499,648.59 $237,059.55 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 — — $230,970.00 $240,208.80 $230,970.00 2024-10-01
916616 CDM Valve Tavr Sz 29mm 18 12 $347,340.00 $347,340.00 $34,734.00 $475,855.80 $225,771.00 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 2 $443,752.00 — $206,296.20 $229,218.00 $217,757.10 2026-07-17
1614 APR_DRG Implantable Heart Assist Systems 3 3 — — $213,037.00 $221,558.48 $213,037.00 2024-10-01
24 APR_DRG Heart And/or Lung Transplant 3 3 — — $206,386.00 $214,641.44 $206,386.00 2024-10-01
C2616 HCPCS Brachytx Ns Yttrium 90 30 8 $262,203.00 $262,203.00 $24,592.00 $239,240.70 $201,906.02 2026-07-17
1907 OTHER New Technology - Level 52 25 21 $256,775.61 — $159,984.00 $273,972.60 $199,980.00 2026-07-17
1908 OTHER New Technology - Level 52 25 21 $256,775.61 — $159,984.00 $273,972.60 $199,980.00 2026-07-17
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 3 2 $103,458.96 — $120,116.70 $199,409.63 $199,409.63 2026-07-17
01908 OTHER New Technology - Level 52 2 2 — — $189,981.00 $199,980.00 $194,980.50 2024-10-01
01907 OTHER New Technology - Level 52 2 2 — — $189,981.00 $199,980.00 $194,980.50 2024-10-01
C1822 HCPCS Pulse Gen Imp 44 8 $273,282.00 $273,282.00 $68,593.86 $285,838.20 $189,879.20 2024-10-01
1906 OTHER New Technology - Level 51 25 21 $231,519.08 — $144,247.92 $247,024.56 $180,309.90 2026-07-17
1905 OTHER New Technology - Level 51 25 21 $231,519.08 — $144,247.92 $247,024.56 $180,309.90 2026-07-17
384515 CDM Cath Pmp Impella 5.0 9f 29 19 $409,724.00 $409,724.00 $40,972.40 $561,321.88 $180,278.56 2024-10-01
01905 OTHER New Technology - Level 51 2 2 — — $171,294.40 $180,309.90 $175,802.15 2024-10-01
01906 OTHER New Technology - Level 51 2 2 — — $171,294.40 $180,309.90 $175,802.15 2024-10-01
386526 CDM Stent Gft Thor Act 37x37 18 12 $267,284.00 $267,284.00 $26,728.40 $366,179.08 $173,734.60 2024-10-01
5832 APR_DRG Neonate With Ecmo 3 3 — — $169,230.00 $175,999.20 $169,230.00 2024-10-01
410562 CDM Stent Gft 31x31mm 20cm 18 12 $259,988.00 $259,988.00 $25,998.80 $356,183.56 $168,992.20 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 36 26 — — $7,041.00 $301,751.00 $166,582.10 2024-10-01
388209 CDM Graft Evas 40x40x10cm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
386548 CDM Graft Stnt 15cm 37mm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
389786 CDM Stent 34mmx34mmx15cm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
388207 CDM Graft Evas 45x45mm 10cm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
388208 CDM Stent 20fr 31x31mm 10cm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
389502 CDM Stent Thor Act Cntrl 40x 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
388206 CDM Stnt Thorac 28x28mm 10cm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
391084 CDM Stent Graft 15cm 31x31mm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
390966 CDM Stent Graft 15cn 28x28mm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
388196 CDM Graft Evas 34x34x10cm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
919754 CDM Graft Evas 45x45mm 15cm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
388205 CDM Stnt Thorac 26x26mm 10cm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
388204 CDM Stent Graft 10cm 21x21mm 18 12 $252,191.00 $252,191.00 $25,219.10 $345,501.67 $163,924.15 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 3 3 — — $161,433.00 $167,890.32 $161,433.00 2024-10-01
920793 CDM Kit Cath Rt Heart 29 19 $365,825.00 $365,825.00 $36,582.50 $501,180.25 $160,963.00 2024-10-01
184495 CDM Cath Iab Vasc Impela 2.5 29 19 $365,825.00 $365,825.00 $36,582.50 $501,180.25 $160,963.00 2024-10-01
1903 OTHER New Technology - Level 50 25 21 $206,262.54 — $128,511.84 $220,076.53 $160,639.80 2026-07-17
1904 OTHER New Technology - Level 50 25 21 $206,262.54 — $128,511.84 $220,076.53 $160,639.80 2026-07-17
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 3 — — $160,319.00 $166,731.76 $160,319.00 2024-10-01
C1820 HCPCS Nrstm Impl 1.9inx.6in 143 8 $234,875.00 $234,875.00 $45,679.63 $348,324.30 $159,621.35 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 3 3 — — $156,990.00 $163,269.60 $156,990.00 2024-10-01
01904 OTHER New Technology - Level 50 2 2 — — $152,607.81 $160,639.80 $156,623.80 2024-10-01
01903 OTHER New Technology - Level 50 2 2 — — $152,607.81 $160,639.80 $156,623.80 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 32 24 — — $102,651.00 $231,786.30 $154,524.20 2024-10-01
7 MS_DRG Lung Transplant 32 25 — — $8,580.00 $237,072.00 $154,137.20 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 2 $301,751.00 — $145,051.83 $161,168.70 $153,110.27 2026-07-17
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 3 3 — — $153,007.00 $159,127.28 $153,007.00 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 3 3 — — $151,837.00 $157,910.48 $151,837.00 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 3 3 — — $150,323.00 $156,335.92 $150,323.00 2024-10-01
J9999 HCPCS Carmustine Wafers 8/box 11 8 $199,050.00 $199,050.00 $29,857.50 $179,145.00 $149,287.50 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 — — $148,138.00 $154,063.52 $148,138.00 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 3 3 — — $147,676.00 $153,583.04 $147,676.00 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 3 — — $145,988.00 $151,827.52 $145,988.00 2024-10-01
385054 CDM Graft Evas Alpha 142x34m 18 12 $222,100.00 $222,100.00 $22,210.00 $304,277.00 $144,365.00 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 — — $144,198.00 $149,965.92 $144,198.00 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 2 2 $161,604.60 — $134,778.06 $149,753.40 $142,265.73 2026-07-17
1901 OTHER New Technology - Level 49 25 21 $181,006.01 — $112,775.76 $193,128.49 $140,969.70 2026-07-17
1902 OTHER New Technology - Level 49 25 21 $181,006.01 — $112,775.76 $193,128.49 $140,969.70 2026-07-17
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 7 7 $733,705.50 — $96,938.00 $830,699.97 $140,560.10 2026-07-17
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 2 2 $100,000.00 — $131,254.11 $145,837.90 $138,546.01 2026-07-17
389616 CDM Device Embl 3.5mm 12mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
435062 CDM Device Embl 3mm 14mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
916665 CDM Device Embl 2.5mm 14mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
409932 CDM Device Embl 4.25mm 18mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
390924 CDM Device Embl 4.5mm 16mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
913621 CDM Device Embl 4mm 12mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
914693 CDM Device Embl 4.25mm 12mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
916573 CDM Device Embl 4.25mm 14mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
914704 CDM Device Embl 5mm 25mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
390230 CDM Device Embl 4mm 18mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
390925 CDM Device Embl 5mm 20mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
437359 CDM Device Embl 3.75mm 18mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
391031 CDM Device Embl 3.75mm 14mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
408845 CDM Device Emb 5mm 14mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
916574 CDM Device Embl 3mm 10mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
913620 CDM Device Embl 4mm 20mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
434061 CDM Device Embl 4.50x25mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
916380 CDM Device Embl 4mm 14mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
914699 CDM Device Embl 4.75mm 14mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
914701 CDM Device Embl 5mm 12mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
407954 CDM Device Embl 3.5mm 20mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
913449 CDM Device Embl 5mm 35mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
913448 CDM Device Embl 3.25mm 16mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
918337 CDM Device Embl 2.5mm 12mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
429813 CDM Device Embl 2.75mm 16mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
914692 CDM Device Embl 4mm 16mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
438140 CDM Device Embl 4.5mm 18mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
391032 CDM Device Embl 3.75mm 16mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
390210 CDM Device Embl 2.75mm 12mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
919704 CDM Device Embl 5mm 18mm 18 12 $212,496.00 $212,496.00 $21,249.60 $291,119.52 $138,122.40 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 3 3 — — $137,512.00 $143,012.48 $137,512.00 2024-10-01
01901 OTHER New Technology - Level 49 2 2 — — $133,921.21 $140,969.70 $137,445.46 2024-10-01
01902 OTHER New Technology - Level 49 2 2 — — $133,921.21 $140,969.70 $137,445.46 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 7 7 $717,614.70 — $94,770.00 $819,043.85 $137,416.50 2026-07-17
5831 APR_DRG Neonate With Ecmo 3 3 — — $137,045.00 $142,526.80 $137,045.00 2024-10-01
686002 CDM Liver Acqist-cadvr Dnr 29 19 $308,000.00 $308,000.00 $30,800.00 $421,960.00 $135,520.00 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 3 3 — — $134,969.00 $140,367.76 $134,969.00 2024-10-01
74 APR_DRG Allogeneic Bone Marrow Transplant 3 3 — — $133,615.00 $138,959.60 $133,615.00 2024-10-01
389785 CDM Device Embl 14x3.5mm Pl 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
386746 CDM Device Embl 4x35mm Pline 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
389465 CDM Device Embl 12mm 3mm 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
387659 CDM Device Anrsm Dvrsn 5x12 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
384510 CDM Device Embl Pipln 14x4mm 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
384275 CDM Device Embl Pln 30x4.25 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
388603 CDM Device Embl16x3.75mm Pip 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
387658 CDM Dev Embl 16x4.75mm 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
383234 CDM Device Embl 5x35mm 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
383304 CDM Device Embl Pl 4.75x14mm 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
387987 CDM Dev Embl Pipln 14x3.75mm 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
386038 CDM Device Embl 5x25mm Pipln 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
387791 CDM Device Embl 14mm 2.5mm P 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
386040 CDM Device Embl Pl 4.75x20mm 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
385836 CDM Device Embl Piplin 4mmx2 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
383395 CDM Device Embl 25mm 4.5mm 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
386041 CDM Device Embl 18x4.75mm 18 12 $202,377.00 $202,377.00 $20,237.70 $277,256.49 $131,545.05 2024-10-01
23 APR_DRG Heart And/or Lung Transplant 3 3 — — $130,623.00 $135,847.92 $130,623.00 2024-10-01
409376 CDM Valve Aortic 25mm 18 12 $200,606.00 $200,606.00 $20,060.60 $274,830.22 $130,393.90 2024-10-01
917246 CDM Valve Aortic 27mm 18 12 $200,606.00 $200,606.00 $20,060.60 $274,830.22 $130,393.90 2024-10-01
388947 CDM Valve Aortic 29mm 18 12 $200,606.00 $200,606.00 $20,060.60 $274,830.22 $130,393.90 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 7 7 $740,441.46 — $89,888.00 $741,576.00 $130,337.60 2026-07-17
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 7 7 $741,255.67 — $89,888.00 $807,075.90 $130,337.60 2026-07-17
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 32 25 — — $8,580.00 $278,466.00 $130,117.40 2024-10-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 3 3 — — $129,535.00 $134,716.40 $129,535.00 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 3 3 — — $129,460.00 $134,638.40 $129,460.00 2024-10-01
353214 CDM Pump Cath Lv Impella 9fr 29 19 $292,660.00 $292,660.00 $29,266.00 $400,944.20 $128,770.40 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 9 7 — — $22,989.00 $171,264.00 $128,679.87 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 32 25 — — $8,580.00 $208,165.00 $128,632.70 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 32 25 — — $8,580.00 $200,034.00 $125,765.40 2024-10-01
215 MS_DRG Other Heart Assist System Implant 40 28 — — $7,041.00 $197,421.00 $125,127.50 2024-10-01
1599 OTHER New Technology - Level 48 25 21 $159,958.90 — $99,662.40 $170,671.86 $124,578.00 2026-07-17
1585 OTHER New Technology - Level 48 25 21 $159,958.90 — $99,662.40 $170,671.86 $124,578.00 2026-07-17
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 28 21 — — $8,580.00 $185,710.50 $123,807.00 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 3 3 — — $123,134.00 $128,059.36 $123,134.00 2024-10-01
007 OTHER Lung Transplant 2 2 $175,272.19 — $116,288.91 $129,209.90 $122,749.40 2026-07-17
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 7 7 $813,285.00 — $84,532.00 $837,683.55 $122,571.40 2026-07-17
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 2 $270,355.00 — $116,078.04 $128,975.60 $122,526.82 2026-07-17
435041 CDM Kit Lo Prfl Comp Shth 7f 29 19 $277,130.00 $277,130.00 $27,713.00 $379,668.10 $121,937.20 2024-10-01
01599 OTHER New Technology - Level 48 2 2 — — $118,349.10 $124,578.00 $121,463.55 2024-10-01
01585 OTHER New Technology - Level 48 2 2 — — $118,349.10 $124,578.00 $121,463.55 2024-10-01
410069 CDM System Imp 5mm 15mm 18 12 $180,868.00 $180,868.00 $18,086.80 $247,789.16 $117,564.20 2024-10-01
C1767 HCPCS Device Ipg Sleep 51mm 143 8 $233,117.00 $233,117.00 $36,074.14 $262,971.90 $115,665.30 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 41 28 — — $41,522.00 $187,574.00 $114,059.30 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 3 3 — — $113,900.00 $118,456.00 $113,900.00 2024-10-01
916377 CDM Gft Evs 15f 20x14.5x12mm 18 12 $174,886.00 $174,886.00 $17,488.60 $239,593.82 $113,675.90 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 2 2 $110,028.00 — $107,428.77 $119,365.30 $113,397.04 2026-07-17
23564 CDM Xpand-r Lg 25x30 8 Deg 3 18 12 $171,517.00 $171,517.00 $17,151.70 $234,978.29 $111,486.05 2024-10-01
1598 OTHER New Technology - Level 47 25 21 $143,121.21 — $89,171.68 $152,706.50 $111,464.60 2026-07-17
1584 OTHER New Technology - Level 47 25 21 $143,121.21 — $89,171.68 $152,706.50 $111,464.60 2026-07-17
390085 CDM Graft Endo Aaa 28.5x12mm 18 12 $169,641.00 $169,641.00 $16,964.10 $232,408.17 $110,266.65 2024-10-01
391091 CDM Graft Endo Aaa 26x12mm 18 12 $169,641.00 $169,641.00 $16,964.10 $232,408.17 $110,266.65 2024-10-01
913391 CDM Graft Endo Aaa 23x12mm 18 12 $169,641.00 $169,641.00 $16,964.10 $232,408.17 $110,266.65 2024-10-01
389282 CDM Graft Endo Aaa 36x14mm 18 12 $169,641.00 $169,641.00 $16,964.10 $232,408.17 $110,266.65 2024-10-01
914107 CDM Graft Endo Aaa 32x14mm 18 12 $169,641.00 $169,641.00 $16,964.10 $232,408.17 $110,266.65 2024-10-01
C1772 HCPCS Pump Infs Pain 20ml 11 8 $146,243.00 $146,243.00 $42,264.23 $131,618.70 $109,682.25 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $109,563.00 $113,945.52 $109,563.00 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 28 21 — — $8,580.00 $163,364.85 $108,909.90 2024-10-01
01598 OTHER New Technology - Level 47 2 2 — — $105,891.37 $111,464.60 $108,677.99 2024-10-01
01584 OTHER New Technology - Level 47 2 2 — — $105,891.37 $111,464.60 $108,677.99 2024-10-01
387172 CDM Cage Spn 0d 13x16x0-24mm 18 12 $164,927.00 $164,927.00 $16,492.70 $225,949.99 $107,202.55 2024-10-01
C1882 HCPCS Crt-d Crd 5.37x8.08x0.99 286 8 $163,667.00 $163,667.00 $26,486.56 $276,135.30 $106,422.12 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 2 2 $156,458.44 — $99,010.08 $110,011.20 $104,510.64 2026-07-17
64 APR_DRG Pancreas Transplant 3 3 — — $103,208.00 $107,336.32 $103,208.00 2024-10-01
746038 CDM Tavr Car Pul By Percut 22 15 $231,221.50 $231,221.50 $23,122.15 $316,773.46 $102,893.57 2024-10-01
746044 CDM Tavr Car Pul By Central 22 15 $231,221.50 $231,221.50 $23,122.15 $316,773.46 $102,893.57 2024-10-01
746042 CDM Tavr Car Pul By Open 22 15 $231,221.50 $231,221.50 $23,122.15 $316,773.46 $102,893.57 2024-10-01
21706 CDM Spacer Spn -6d 23x49x21 18 12 $157,435.00 $157,435.00 $15,743.50 $215,685.95 $102,332.75 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 3 3 — — $102,271.00 $106,361.84 $102,271.00 2024-10-01
746070 CDM Tmvr Perc Initial Device 22 15 $227,017.50 $227,017.50 $22,701.75 $311,013.97 $101,022.79 2024-10-01
463270 CDM Ins/repl Sq Icd With Elec 22 15 $226,797.00 $226,797.00 $22,679.70 $310,711.89 $100,924.66 2024-10-01
386234 CDM Implant Lt Frnt Prtl Tmp 18 12 $155,106.00 $155,106.00 $15,510.60 $212,495.22 $100,818.90 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 2 2 $162,769.11 — $95,416.11 $106,017.90 $100,717.01 2026-07-17
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 2 2 $139,067.44 — $95,198.31 $105,775.90 $100,487.10 2026-07-17
231 MS_DRG Coronary Bypass With Ptca With Mcc 41 28 — — $41,522.00 $156,842.00 $100,256.30 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 40 28 — — $21,616.00 $162,914.00 $100,200.00 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 27 23 $134,738.64 — $79,999.92 $136,999.86 $99,999.90 2026-07-17
24158 CDM Cage Spn Xpnd Peek38x46 18 12 $152,780.00 $152,780.00 $15,278.00 $209,308.60 $99,307.00 2024-10-01
746034 CDM Tavr/tavi Trans Exposr 22 15 $223,091.25 $223,091.25 $22,309.13 $305,635.01 $99,275.60 2024-10-01
382785 CDM Graft Evas 26x14.5m 16cm 18 12 $152,078.00 $152,078.00 $15,207.80 $208,346.86 $98,850.70 2024-10-01
381689 CDM Graft Evas 14.5mm 12cm 18 12 $152,078.00 $152,078.00 $15,207.80 $208,346.86 $98,850.70 2024-10-01
359722 CDM Graft Evas 14.5mm 14cm 18 12 $152,078.00 $152,078.00 $15,207.80 $208,346.86 $98,850.70 2024-10-01
386277 CDM Graft Evas 10cm 10mm 18 12 $152,078.00 $152,078.00 $15,207.80 $208,346.86 $98,850.70 2024-10-01
380545 CDM Graft Evas 26x14.5m 12cm 18 12 $152,078.00 $152,078.00 $15,207.80 $208,346.86 $98,850.70 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 28 21 — — $8,580.00 $148,037.88 $98,691.92 2024-10-01
746030 CDM Tavr/tavi Trans Aortic 22 15 $221,206.00 $221,206.00 $22,120.60 $303,052.22 $98,436.67 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 3 3 — — $98,416.00 $102,352.64 $98,416.00 2024-10-01
1583 OTHER New Technology - Level 46 25 21 $126,283.52 — $78,680.93 $134,741.09 $98,351.16 2026-07-17
1597 OTHER New Technology - Level 46 25 21 $126,283.52 — $78,680.93 $134,741.09 $98,351.16 2026-07-17
385037 CDM Graft Bn Fem Cndyl Algrf 18 12 $150,145.00 $150,145.00 $15,014.50 $205,698.65 $97,594.25 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 3 3 — — $97,139.00 $101,024.56 $97,139.00 2024-10-01
916139 CDM Cage Spnl12x14x36mm 18 12 $148,435.00 $148,435.00 $14,843.50 $203,355.95 $96,482.75 2024-10-01
388102 CDM Cage Spnl 13x16x18-21mm 18 12 $148,435.00 $148,435.00 $14,843.50 $203,355.95 $96,482.75 2024-10-01
354234 CDM Graft Evas 35x14.5m 18cm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
355545 CDM Graft Evas 31x14.5m 17cm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
358775 CDM Graft Evas 16cm 26mm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
358313 CDM Graft Evas 26x14.5m 14cm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
383189 CDM Graft Evas 14.5mm 16cm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
385918 CDM Graft Evas 23x14.5m 12cm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
358311 CDM Graft Evas 31x14.5m 15cm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
380095 CDM Graft Evas 16cm 23mm 14. 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
639049 CDM Graft Evas 31x14.5m 13cm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
384284 CDM Stent Gft Ilic 14cm 23mm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
386312 CDM Graft Evas 12cm 23x12mm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
355893 CDM Graft Evas 12cm 26mm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
357620 CDM Stent Aaa Exldr 18x28.5 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
387628 CDM Graft Evas 26x12mm 14cm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
355892 CDM Graft Evas 14cm 26mm 18 12 $147,647.00 $147,647.00 $14,764.70 $202,276.39 $95,970.55 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 — — $95,908.00 $99,744.32 $95,908.00 2024-10-01
01583 OTHER New Technology - Level 46 2 2 — — $93,433.60 $98,351.16 $95,892.38 2024-10-01
01597 OTHER New Technology - Level 46 2 2 — — $93,433.60 $98,351.16 $95,892.38 2024-10-01
358431 CDM Graft Evas 23x14.5m14cm 18 12 $147,518.00 $147,518.00 $14,751.80 $202,099.66 $95,886.70 2024-10-01
383469 CDM Graft Evas 10cm 14.5mm 18 12 $147,518.00 $147,518.00 $14,751.80 $202,099.66 $95,886.70 2024-10-01
358432 CDM Graft Evas 35x14.5m 14cm 18 12 $147,518.00 $147,518.00 $14,751.80 $202,099.66 $95,886.70 2024-10-01
350081 CDM Gft Bif 32-16x124mm 20fr 18 12 $147,351.00 $147,351.00 $14,735.10 $201,870.87 $95,778.15 2024-10-01
350005 CDM Gft Bif 23-16x145mm 18fr 18 12 $147,351.00 $147,351.00 $14,735.10 $201,870.87 $95,778.15 2024-10-01
352322 CDM Gft Bif 25-16x124mm 18fr 18 12 $147,351.00 $147,351.00 $14,735.10 $201,870.87 $95,778.15 2024-10-01
385367 CDM Cage Spn 10x12x33.5mm 18 12 $147,300.00 $147,300.00 $14,730.00 $201,801.00 $95,745.00 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 41 28 — — $7,041.00 $163,359.00 $95,414.16 2024-10-01
10 MS_DRG Pancreas Transplant 34 26 — — $8,580.00 $141,574.99 $94,383.33 2024-10-01
22 APR_DRG Heart And/or Lung Transplant 3 3 — — $94,013.00 $97,773.52 $94,013.00 2024-10-01
391245 CDM Cage Spnl C 30-45x20mm 18 12 $144,600.00 $144,600.00 $14,460.00 $198,102.00 $93,990.00 2024-10-01
390861 CDM Cage Spnl 13mm D Cntrpc 18 12 $144,600.00 $144,600.00 $14,460.00 $198,102.00 $93,990.00 2024-10-01
391331 CDM Cage Spnl Cntrpc 13mm 18 12 $144,600.00 $144,600.00 $14,460.00 $198,102.00 $93,990.00 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 32 25 — — $8,580.00 $154,490.00 $93,845.05 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 9 7 $772,928.48 — $763.00 $863,696.72 $93,695.80 2026-07-17
174232 CDM Graft Evas Tlnt 170x32mm 18 12 $144,027.00 $144,027.00 $14,402.70 $197,316.99 $93,617.55 2024-10-01
215 OTHER Other Heart Assist System Implant 2 2 $159,809.50 — $88,538.19 $98,375.77 $93,456.98 2026-07-17
459 MS_DRG Spinal Fusion Except Cervical With Mcc 9 7 — — $22,989.00 $128,182.00 $93,233.45 2024-10-01
354856 CDM Graft Evas 16cm 26mm 18 12 $143,219.00 $143,219.00 $14,321.90 $196,210.03 $93,092.35 2024-10-01
386405 CDM Occluder Cv 25x18mm 18 12 $143,219.00 $143,219.00 $14,321.90 $196,210.03 $93,092.35 2024-10-01
354418 CDM Graft Evas 14cm 28.5mm 18 12 $143,219.00 $143,219.00 $14,321.90 $196,210.03 $93,092.35 2024-10-01
386272 CDM Occluder Cv 35x18mm 18 12 $143,219.00 $143,219.00 $14,321.90 $196,210.03 $93,092.35 2024-10-01
385434 CDM Graft Evas 10cm 12mm 18 12 $143,219.00 $143,219.00 $14,321.90 $196,210.03 $93,092.35 2024-10-01
352375 CDM Gft Bif 32-20x145mm 20fr 18 12 $142,932.00 $142,932.00 $14,293.20 $195,816.84 $92,905.80 2024-10-01
351178 CDM Gft Bif 25-13x124mm 18fr 18 12 $142,932.00 $142,932.00 $14,293.20 $195,816.84 $92,905.80 2024-10-01
175059 CDM Gft Bif 25-13x166mm 18fr 18 12 $142,932.00 $142,932.00 $14,293.20 $195,816.84 $92,905.80 2024-10-01
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