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

PROVIDENCE ST MARY MEDICAL CENTER

Apple Valley, CA · CCN 050300 · Rates published

14,453 distinct procedures filed
26 distinct payers
393,012 rate rows
2026-04-01 last MRF observed
Data quality

259,022 of 393,012 rate rows are consumer-grade (65.9%)

133,990 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 133,788
template filing: same amount across many unrelated codes — excluded 138
placeholder amount (≤ $0.02) — excluded from medians 64
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://pricetransparency.providence.org/socal/live/951914489_providence-st-mary-medical-center_standardcharges.json
Found on page https://www.providence.org/billing-support/pricing-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint ecd293ef18704a83… · 193,148,945 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
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 2 $3,691,450.00 $4,392,825.50 $3,912,937.00 nat. median
$3,710,000
1.1× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 2 $3,321,376.38 $3,952,437.89 $3,520,658.96 nat. median
$3,325,455
1.1× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 2 $3,245,381.39 $3,862,003.85 $3,440,104.27 nat. median
$3,286,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 2 $2,938,320.00 $3,496,600.80 $3,114,619.20 nat. median
$3,004,655
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 2 $2,587,087.26 $3,078,633.84 $2,742,312.49 nat. median
$2,468,984
1.1× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 2 $2,332,000.00 $2,775,080.00 $2,471,920.00 nat. median
$2,448,600
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 4 $770,620.00 $1,954,292.32 $1,286,935.40 nat. median
$824,563
1.6× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 4 $562,260.84 $1,425,893.48 $1,083,271.31 nat. median
$673,137
1.6× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 4 $588,494.81 $1,492,422.83 $944,811.41 nat. median
$674,867
1.4× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 4 $559,781.08 $1,419,604.82 $900,263.89 nat. median
$625,184
1.4× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 4 $531,849.12 $1,348,769.36 $857,004.01 nat. median
$634,303
1.4× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 4 $489,290.60 $1,240,840.96 $817,232.00 nat. median
$619,808
1.3× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 5 $1,310.00 $1,557,562.53 $690,953.41 nat. median
$753,246
0.9× median
C9301
HCPCS 		Obecabtagene Car Pos T 1 $598,237.50 $598,237.50 $598,237.50 nat. median
$459,112
1.3× median
18
MS_DRG 		Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 21 $431,992.01 $844,456.64 $431,992.01 nat. median
$370,174
1.2× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 21 $280,598.00 $655,248.49 $280,598.00 nat. median
$265,286
1.1× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 21 $213,949.83 $475,761.02 $213,949.83 nat. median
$206,474
1.0× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 21 $189,457.33 $429,616.66 $212,698.45 nat. median
$202,976
1.0× median
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 4 $11,158.00 $207,977.62 $146,434.64 nat. median
$87,428
1.7× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 21 $107,085.26 $268,342.16 $139,055.29 nat. median
$133,161
1.0× median
7
MS_DRG 		Lung Transplant 21 $130,054.88 $261,833.81 $130,054.88 nat. median
$122,708
1.1× median
J7330
HCPCS 		Cultured Chondrocytes Implnt 2 $88,948.40 $169,820.76 $129,384.58 nat. median
$76,329
1.7× median
222
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 4 $14,364.00 $190,502.12 $126,525.32 nat. median
$63,570
2.0× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 21 $120,743.88 $289,082.01 $120,743.88 nat. median
$117,357
1.0× median
224
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 4 $14,364.00 $166,547.69 $117,149.03 nat. median
$54,196
outlier · 2.2×
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 21 $113,891.70 $360,391.08 $113,891.70 nat. median
$108,660
1.0× median
209
MS_DRG 		Complex Aortic Arch Procedures 21 $113,761.87 $113,761.87 $113,761.87 nat. median
$98,047
1.2× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 21 $49,622.00 $196,907.34 $110,789.70 nat. median
$98,894
1.1× median
459
MS_DRG 		Spinal Fusion Except Cervical With Mcc 4 $11,158.00 $152,286.78 $109,598.76 nat. median
$65,393
1.7× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 21 $56,710.00 $204,637.78 $109,320.59 nat. median
$102,358
1.1× median
226
MS_DRG 		Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 4 $14,364.00 $149,572.14 $105,774.87 nat. median
$49,935
outlier · 2.1×
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 21 $103,691.84 $231,271.49 $103,691.84 nat. median
$100,136
1.0× median
J9029
HCPCS 		Inj, Adstiladrin, Per Tx Dos 5 $64,282.30 $163,019.91 $102,137.73 nat. median
$69,774
1.5× median
454
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Cc 4 $11,158.00 $137,951.22 $101,071.86 nat. median
$62,372
1.6× median
215
MS_DRG 		Other Heart Assist System Implant 21 $14,364.00 $252,414.01 $100,161.39 nat. median
$99,019
1.0× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 21 $14,364.00 $385,211.90 $98,421.63 nat. median
$93,672
1.1× median
A9699
HCPCS 		Radiopharm Rx Agent Noc 1 $97,225.26 $97,225.26 $97,225.26 nat. median
$21,806
outlier · 4.5×
A9543
HCPCS 		Y90 Ibritumomab, Rx 5 $56,824.55 $144,107.06 $94,606.19 nat. median
$62,507
1.5× median
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 21 $49,622.00 $156,675.24 $90,699.57 nat. median
$82,711
1.1× median
C9150
HCPCS 		Xe129 Xenon, Diagnostic 1 $88,519.39 $88,519.39 $88,519.39 nat. median
$775
outlier · 114.2×
850
MS_DRG 		Acute Leukemia With Other Procedures 21 $87,203.08 $173,043.48 $87,203.08 nat. median
$83,470
1.0× median
223
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 4 $14,364.00 $140,530.13 $86,239.02 nat. median
$44,728
1.9× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 21 $4,246.26 $192,065.30 $84,910.03 nat. median
$79,312
1.1× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 21 $11,158.00 $194,506.22 $84,645.37 nat. median
$81,118
1.0× median
225
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 4 $14,364.00 $127,289.47 $83,578.49 nat. median
$48,704
1.7× median
227
MS_DRG 		Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 4 $14,364.00 $118,808.48 $82,967.07 nat. median
$39,020
outlier · 2.1×
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 21 $79,306.25 $233,461.30 $79,306.25 nat. median
$77,570
1.0× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 21 $14,364.00 $182,222.47 $77,403.70 nat. median
$74,915
1.0× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 21 $14,364.00 $225,874.08 $77,073.12 nat. median
$73,807
1.0× median
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 21 $12,257.00 $167,873.34 $76,820.45 nat. median
$72,135
1.1× median

Other procedures at this hospital

Browse this hospital's 14,453 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
0888T HCPCS Histotripsy Mal Renal Tissue 16 5 — — $1,310.00 $55,871.58 $24,785.30 2026-04-01
0956T HCPCS Prt Crn Ch Cr&tun Elt S-sclp 12 4 — — $14,105.00 $88,503.57 $35,945.85 2026-04-01
0960T HCPCS Rpl S-sclp Eltr Ra Rcvr&tlmt 12 4 — — $14,105.00 $88,503.57 $35,945.85 2026-04-01
0981T HCPCS Tcat Impl Wrls Ivc Snr 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 52 21 — — $280,598.00 $655,248.49 $280,598.00 2026-04-01
10 MS_DRG Pancreas Transplant 52 21 — — $69,405.57 $149,773.26 $72,384.16 2026-04-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 52 21 — — $55,190.31 $113,481.00 $55,190.31 2026-04-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 52 21 — — $42,825.23 $86,685.24 $42,825.23 2026-04-01
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc 52 21 — — $29,500.39 $61,543.15 $29,500.39 2026-04-01
14 MS_DRG Allogeneic Bone Marrow Transplant 52 21 — — $120,743.88 $289,082.01 $120,743.88 2026-04-01
140 MS_DRG Major Head And Neck Procedures With Mcc 56 21 — — $6,800.00 $90,049.13 $43,317.60 2026-04-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 54 21 — — $7,047.03 $67,047.08 $38,137.27 2026-04-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/Mcc 52 21 — — $59,940.19 $152,160.10 $59,940.19 2026-04-01
163 MS_DRG Major Chest Procedures With Mcc 60 21 — — $17,211.40 $208,158.39 $45,479.81 2026-04-01
164 MS_DRG Major Chest Procedures With Cc 54 21 — — $14,352.00 $59,703.98 $25,926.99 2026-04-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 56 21 — — $20,223.00 $85,766.79 $38,048.38 2026-04-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/Mcc 52 21 — — $54,972.59 $113,382.90 $54,972.59 2026-04-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 48 21 — — $30,445.18 $57,642.96 $30,445.18 2026-04-01
18 MS_DRG Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 52 21 — — $431,992.01 $844,456.64 $431,992.01 2026-04-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 52 21 — — $71,973.69 $150,705.50 $71,973.69 2026-04-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 52 21 — — $113,891.70 $360,391.08 $113,891.70 2026-04-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 52 21 — — $79,306.25 $233,461.30 $79,306.25 2026-04-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 70 21 — — $13,147.59 $129,542.62 $64,983.69 2026-04-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 74 21 — — $5,253.00 $57,511.91 $28,171.10 2026-04-01
209 MS_DRG Complex Aortic Arch Procedures 42 21 — — $113,761.87 $113,761.87 $113,761.87 2026-04-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 52 21 — — $53,589.37 $170,379.86 $53,589.37 2026-04-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 50 21 — — $56,710.00 $204,637.78 $109,320.59 2026-04-01
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 42 21 — — $57,715.05 $57,715.05 $57,715.05 2026-04-01
215 MS_DRG Other Heart Assist System Implant 58 21 — — $14,364.00 $252,414.01 $100,161.39 2026-04-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 64 21 — — $14,364.00 $385,211.90 $98,421.63 2026-04-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 60 21 — — $14,364.00 $146,880.12 $66,387.88 2026-04-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 58 21 — — $14,364.00 $116,349.47 $66,387.88 2026-04-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 58 21 — — $14,364.00 $182,222.47 $77,403.70 2026-04-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 52 21 — — $32,452.59 $109,933.87 $32,452.59 2026-04-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 60 21 — — $14,364.00 $122,156.54 $53,978.87 2026-04-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 58 21 — — $14,364.00 $102,982.13 $51,056.63 2026-04-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 14 4 — — $14,364.00 $190,502.12 $126,525.32 2026-04-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 14 4 — — $14,364.00 $140,530.13 $86,239.02 2026-04-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 14 4 — — $14,364.00 $166,547.69 $117,149.03 2026-04-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 14 4 — — $14,364.00 $127,289.47 $83,578.49 2026-04-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 14 4 — — $14,364.00 $149,572.14 $105,774.87 2026-04-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 14 4 — — $14,364.00 $118,808.48 $82,967.07 2026-04-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 62 21 — — $14,364.00 $140,602.52 $50,129.82 2026-04-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 60 21 — — $14,364.00 $90,216.54 $32,173.95 2026-04-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 52 21 — — $57,948.75 $128,092.55 $57,948.75 2026-04-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 66 21 — — $4,246.26 $192,065.30 $84,910.03 2026-04-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 58 21 — — $14,364.00 $133,431.34 $61,267.48 2026-04-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 80 21 — — $14,364.00 $225,874.08 $77,073.12 2026-04-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 82 21 — — $11,235.00 $120,290.22 $55,276.19 2026-04-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 64 21 — — $9,502.81 $136,415.18 $59,329.97 2026-04-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 64 21 — — $14,364.00 $92,315.86 $42,553.58 2026-04-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 62 21 — — $22,469.48 $108,782.41 $49,873.15 2026-04-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 52 21 — — $39,788.14 $88,961.02 $39,788.14 2026-04-01
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 58 21 — — $5,253.00 $63,113.12 $29,187.79 2026-04-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 74 21 — — $6,800.00 $84,210.40 $32,606.39 2026-04-01
245 MS_DRG Aicd Generator Procedures 58 21 — — $14,364.00 $122,475.51 $46,284.77 2026-04-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 14 4 — — $14,364.00 $70,709.59 $49,498.99 2026-04-01
247 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 14 4 — — $14,364.00 $44,977.06 $31,554.49 2026-04-01
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 14 4 — — $14,364.00 $71,799.97 $49,736.95 2026-04-01
249 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc 14 4 — — $14,364.00 $42,513.52 $30,020.97 2026-04-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 52 21 — — $46,127.98 $101,611.24 $46,127.98 2026-04-01
252 MS_DRG Other Vascular Procedures With Mcc 68 21 — — $763.42 $75,120.88 $35,557.59 2026-04-01
253 MS_DRG Other Vascular Procedures With Cc 58 21 — — $14,364.00 $60,032.00 $26,642.07 2026-04-01
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 54 21 — — $27,658.76 $57,527.75 $27,658.76 2026-04-01
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 60 21 — — $14,364.00 $72,419.81 $32,100.04 2026-04-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 54 21 — — $4,984.80 $69,178.08 $31,771.47 2026-04-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 54 21 — — $33,205.62 $81,081.77 $33,205.62 2026-04-01
263 MS_DRG Vein Ligation And Stripping 62 21 — — $786.57 $52,150.50 $31,254.13 2026-04-01
264 MS_DRG Other Circulatory System O.r. Procedures 66 21 — — $12,913.08 $73,471.73 $34,082.49 2026-04-01
265 MS_DRG Aicd Lead Procedures 54 21 — — $36,854.92 $76,071.00 $36,854.92 2026-04-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 54 21 — — $56,710.00 $160,552.86 $61,924.63 2026-04-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 54 21 — — $48,266.22 $126,703.56 $48,266.22 2026-04-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 54 21 — — $56,710.00 $157,326.96 $69,409.99 2026-04-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 54 21 — — $42,897.14 $97,604.88 $42,897.14 2026-04-01
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc 52 21 — — $25,916.01 $56,821.94 $25,916.01 2026-04-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 68 21 — — $19,563.98 $117,218.16 $53,414.59 2026-04-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 58 21 — — $25,103.44 $80,638.38 $36,236.72 2026-04-01
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/Mcc 62 21 — — $14,364.00 $60,826.03 $26,216.62 2026-04-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 54 21 — — $41,921.39 $86,805.14 $41,921.39 2026-04-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 56 21 — — $2,197.89 $74,322.32 $33,594.12 2026-04-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 60 21 — — $17,180.10 $132,751.27 $71,931.74 2026-04-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 58 21 — — $21,220.14 $116,360.48 $60,708.20 2026-04-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 60 21 — — $7,459.81 $105,397.48 $46,845.05 2026-04-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 48 21 — — $56,309.86 $93,984.48 $56,309.86 2026-04-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 48 21 — — $36,737.07 $60,194.10 $36,737.07 2026-04-01
28 MS_DRG Spinal Procedures With Mcc 52 21 — — $60,725.18 $131,660.04 $60,725.18 2026-04-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 52 21 — — $27,746.65 $60,649.58 $27,746.65 2026-04-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 56 21 — — $26,617.14 $74,539.49 $34,791.58 2026-04-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 54 21 — — $189,457.33 $429,616.66 $212,698.45 2026-04-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 52 21 — — $45,466.83 $98,769.91 $45,466.83 2026-04-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 52 21 — — $1,751.00 $116,210.20 $67,498.45 2026-04-01
318 MS_DRG Percutaneous Coronary Atherectomy Without Intraluminal Device 42 21 — — $24,910.30 $24,910.30 $24,910.30 2026-04-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 58 21 — — $14,364.00 $97,632.03 $45,291.05 2026-04-01
320 MS_DRG Other Endovascular Cardiac Valve Procedures Without Mcc 58 21 — — $14,364.00 $56,710.00 $24,741.52 2026-04-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 82 22 — — $6,541.36 $70,709.59 $27,892.46 2026-04-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 58 21 — — $12,091.07 $80,013.33 $43,937.80 2026-04-01
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 64 21 — — $6,131.40 $69,964.93 $32,188.93 2026-04-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 48 21 — — $32,782.17 $53,765.53 $32,782.17 2026-04-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 58 21 — — $11,116.91 $121,654.33 $50,529.31 2026-04-01
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 54 21 — — $12,257.00 $59,034.37 $25,130.02 2026-04-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 76 21 — — $12,435.25 $141,954.76 $46,625.34 2026-04-01
330 MS_DRG Major Small And Large Bowel Procedures With Cc 76 21 — — $10,506.00 $57,437.26 $24,660.63 2026-04-01
332 MS_DRG Rectal Resection With Mcc 52 21 — — $36,879.89 $94,100.73 $36,879.89 2026-04-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 62 21 — — $20,293.49 $88,008.63 $36,382.53 2026-04-01
338 MS_DRG Appendectomy With Complicated Principal Diagnosis With Mcc 10 3 — — $38,710.52 $63,314.45 $49,905.01 2026-04-01
339 MS_DRG Appendectomy With Complicated Principal Diagnosis With Cc 10 3 — — $23,729.04 $38,344.29 $30,591.12 2026-04-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 56 21 — — $38,144.29 $89,913.40 $39,376.67 2026-04-01
341 MS_DRG Appendectomy Without Complicated Principal Diagnosis With Mcc 10 3 — — $32,918.15 $52,397.08 $42,437.57 2026-04-01
342 MS_DRG Appendectomy Without Complicated Principal Diagnosis With Cc 10 3 — — $21,176.03 $32,419.59 $27,299.82 2026-04-01
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 56 21 — — $17,000.00 $63,361.96 $26,514.24 2026-04-01
350 MS_DRG Inguinal And Femoral Hernia Procedures With Mcc 56 21 — — $22,356.00 $55,478.19 $25,606.41 2026-04-01
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 54 21 — — $1,751.00 $68,053.76 $29,702.13 2026-04-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 62 21 — — $24,514.00 $97,080.05 $44,590.96 2026-04-01
359 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc 46 21 — — $28,764.27 $35,061.23 $35,061.23 2026-04-01
360 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc 48 21 — — $3,502.00 $24,831.41 $24,831.41 2026-04-01
37 MS_DRG Extracranial Procedures With Mcc 54 21 — — $15,759.00 $74,080.26 $33,598.11 2026-04-01
37271 HCPCS Revsc Evsc Fpvt Athrc Sf 1st 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
37273 HCPCS Revsc Evsc Fpvt Athrc Cplx 1 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
37275 HCPCS Rvsc Evsc Fpvt St Athrc Sf 1 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
37277 HCPCS Rvsc Evsc Fpvt St Athr Cpx 1 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
37284 HCPCS Revsc Evasc Tpvt St Sf 1st 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
37286 HCPCS Revsc Evasc Tpvt St Cplx 1st 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
37288 HCPCS Revsc Evsc Tpvt Athrc Sf 1st 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
37290 HCPCS Revsc Evsc Tpvt Athrc Cplx 1 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
37292 HCPCS Rvsc Evsc Tpvt St Athrc Sf 1 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
37294 HCPCS Rvsc Evsc Tpvt St Athr Cpx 1 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 54 21 — — $107,085.26 $268,342.16 $139,055.29 2026-04-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 54 21 — — $37,349.06 $89,533.35 $39,281.79 2026-04-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 56 21 — — $34,655.20 $122,622.38 $40,872.75 2026-04-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 52 21 — — $55,354.09 $129,635.37 $55,354.09 2026-04-01
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 52 21 — — $29,684.16 $65,083.49 $29,684.16 2026-04-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 54 21 — — $35,154.62 $84,821.19 $36,329.60 2026-04-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 54 21 — — $21,265.00 $84,886.79 $33,709.97 2026-04-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 56 21 — — $21,265.00 $82,016.06 $36,299.64 2026-04-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 58 21 — — $4,059.12 $79,495.97 $34,746.64 2026-04-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 56 22 — — $49.60 $94,537.34 $42,196.04 2026-04-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 52 21 — — $49,622.00 $196,907.34 $110,789.70 2026-04-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 56 21 — — $48,213.82 $199,118.86 $72,812.61 2026-04-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 54 21 — — $40,588.00 $103,420.69 $56,867.15 2026-04-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 50 21 — — $49,622.00 $156,675.24 $90,699.57 2026-04-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 50 21 — — $49,622.00 $102,761.30 $58,316.28 2026-04-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 56 21 — — $25,500.00 $125,945.10 $67,449.52 2026-04-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 62 21 — — $32,060.32 $189,205.86 $43,072.91 2026-04-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 52 21 — — $48,261.78 $96,742.26 $53,946.91 2026-04-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 52 21 — — $30,394.13 $57,969.84 $32,981.91 2026-04-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 14 4 — — $11,158.00 $207,977.62 $146,434.64 2026-04-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 14 4 — — $11,158.00 $137,951.22 $101,071.86 2026-04-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc 14 4 — — $11,158.00 $108,382.00 $76,107.54 2026-04-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 60 21 — — $11,158.00 $194,506.22 $84,645.37 2026-04-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 58 21 — — $11,158.00 $147,088.24 $60,273.76 2026-04-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 60 21 — — $3,502.00 $113,503.62 $42,391.79 2026-04-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 14 4 — — $11,158.00 $152,286.78 $109,598.76 2026-04-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 14 4 — — $11,158.00 $88,965.54 $60,446.80 2026-04-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 60 21 — — $1,751.00 $137,455.80 $55,878.42 2026-04-01
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 60 21 — — $5,436.89 $71,128.09 $27,285.25 2026-04-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 60 21 — — $3,502.00 $121,376.08 $57,641.15 2026-04-01
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 54 21 — — $8,755.00 $67,289.14 $31,826.40 2026-04-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 58 21 — — $5,253.00 $120,914.59 $52,706.50 2026-04-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 56 21 — — $28,355.00 $80,900.80 $35,940.10 2026-04-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/Mcc 54 21 — — $28,164.11 $63,432.09 $28,164.11 2026-04-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 60 21 — — $5,244.72 $69,775.30 $31,012.44 2026-04-01
471 MS_DRG Cervical Spinal Fusion With Mcc 62 21 — — $11,158.00 $113,490.05 $48,944.35 2026-04-01
472 MS_DRG Cervical Spinal Fusion With Cc 66 21 — — $492.39 $69,069.49 $30,142.57 2026-04-01
473 MS_DRG Cervical Spinal Fusion Without Cc/Mcc 64 21 — — $7,004.00 $61,769.64 $25,101.06 2026-04-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 54 21 — — $17,014.54 $92,134.88 $43,593.24 2026-04-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 54 21 — — $33,902.10 $75,939.79 $35,221.02 2026-04-01
478 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Cc 56 21 — — $24,547.60 $53,317.79 $25,279.83 2026-04-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 82 21 — — $11,158.00 $219,414.02 $29,805.00 2026-04-01
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 62 21 — — $11,158.00 $53,982.88 $28,402.81 2026-04-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 60 21 — — $9,383.88 $77,086.73 $32,948.95 2026-04-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 66 21 — — $7,004.00 $78,457.62 $37,388.23 2026-04-01
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 64 21 — — $10,506.00 $52,600.67 $26,047.84 2026-04-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 58 21 — — $11,158.00 $82,212.87 $36,929.82 2026-04-01
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 58 21 — — $11,158.00 $58,462.03 $30,848.66 2026-04-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 52 21 — — $103,691.84 $231,271.49 $103,691.84 2026-04-01
500 MS_DRG Soft Tissue Procedures With Mcc 56 21 — — $14,008.00 $71,347.53 $32,326.75 2026-04-01
503 MS_DRG Foot Procedures With Mcc 58 21 — — $11,158.00 $59,466.45 $28,594.56 2026-04-01
509 MS_DRG Arthroscopy 16 5 — — $11,158.00 $37,864.70 $28,690.58 2026-04-01
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 58 21 — — $11,158.00 $61,773.90 $30,885.61 2026-04-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 60 21 — — $11,158.00 $70,965.21 $32,547.47 2026-04-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 60 21 — — $5,273.56 $81,084.03 $38,044.39 2026-04-01
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 68 21 — — $12,257.00 $69,300.23 $29,384.54 2026-04-01
5213 OTHER Level 3 Electrophysiologic Procedures 16 6 — — $17,190.00 $36,939.89 $30,609.67 2026-04-01
5231 OTHER Level 1 Icd And Similar Procedures 16 6 — — $27,457.35 $28,964.02 $28,520.13 2026-04-01
5232 OTHER Level 2 Icd And Similar Procedures 20 7 — — $1,016.14 $49,428.80 $40,737.44 2026-04-01
5378 OTHER Level 8 Urology And Related Services 6 2 — — $605.97 $43,578.32 $25,166.74 2026-04-01
545 MS_DRG Connective Tissue Disorders With Mcc 56 21 — — $21,920.70 $56,543.69 $25,504.54 2026-04-01
5464 OTHER Level 4 Neurostimulator And Related Procedures 6 2 — — $312.66 $26,812.26 $26,604.30 2026-04-01
5465 OTHER Level 5 Neurostimulator And Related Procedures 6 3 — — $37,798.35 $42,169.33 $37,945.35 2026-04-01
570 MS_DRG Skin Debridement With Mcc 56 21 — — $29,817.50 $64,162.78 $30,092.63 2026-04-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 54 21 — — $38,522.00 $125,264.80 $66,149.19 2026-04-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 52 21 — — $35,388.81 $73,442.32 $35,388.81 2026-04-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 54 21 — — $40,273.00 $114,469.58 $49,668.42 2026-04-01
577 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 54 21 — — $14,008.00 $57,627.28 $27,192.36 2026-04-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 56 21 — — $17,510.00 $66,232.69 $33,062.80 2026-04-01
6 MS_DRG Liver Transplant Without Mcc 52 21 — — $47,029.82 $106,135.64 $47,029.82 2026-04-01
61 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 64 21 — — $3,502.00 $65,336.86 $28,255.00 2026-04-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 60 21 — — $750.00 $90,234.63 $35,548.60 2026-04-01
619 MS_DRG O.r. Procedures For Obesity With Mcc 52 21 — — $29,556.32 $69,248.20 $29,556.32 2026-04-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 54 21 — — $33,447.74 $81,728.76 $36,265.68 2026-04-01
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 52 21 — — $30,881.61 $64,273.63 $30,881.61 2026-04-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 54 21 — — $37,592.81 $83,658.42 $37,939.52 2026-04-01
64656 HCPCS Revj/rplcmt Bat Mod Sys Pg 8 3 — — $39,688.16 $100,649.17 $44,649.18 2026-04-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 54 21 — — $7,004.00 $102,095.35 $47,672.99 2026-04-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 52 21 — — $37,729.79 $83,556.62 $37,729.79 2026-04-01
652 MS_DRG Kidney Transplant 52 21 — — $32,972.92 $71,980.94 $32,972.92 2026-04-01
653 MS_DRG Major Bladder Procedures With Mcc 52 21 — — $52,616.62 $123,271.80 $52,616.62 2026-04-01
654 MS_DRG Major Bladder Procedures With Cc 54 21 — — $9,144.51 $65,608.32 $28,676.45 2026-04-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 52 21 — — $32,516.51 $74,238.62 $32,516.51 2026-04-01
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 54 21 — — $25,857.10 $60,283.11 $26,095.78 2026-04-01
662 MS_DRG Minor Bladder Procedures With Mcc 54 21 — — $31,295.08 $66,277.94 $31,295.08 2026-04-01
665 MS_DRG Prostatectomy With Mcc 56 21 — — $31,891.31 $68,696.23 $31,891.31 2026-04-01
668 MS_DRG Transurethral Procedures With Mcc 54 21 — — $29,881.90 $110,243.76 $29,881.90 2026-04-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 64 21 — — $14,008.00 $78,713.34 $42,681.42 2026-04-01
7 MS_DRG Lung Transplant 52 21 — — $130,054.88 $261,833.81 $130,054.88 2026-04-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 58 21 — — $9,898.00 $96,329.00 $36,418.48 2026-04-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 58 21 — — $9,898.00 $86,454.50 $36,501.38 2026-04-01
749 MS_DRG Other Female Reproductive System O.r. Procedures With Cc/Mcc 52 21 — — $26,362.43 $61,246.80 $26,362.43 2026-04-01
77 MS_DRG Hypertensive Encephalopathy With Mcc 12 4 — — $12,897.00 $34,654.64 $27,298.93 2026-04-01
783 MS_DRG Cesarean Section With Sterilization With Mcc 54 21 — — $11,437.00 $42,364.22 $25,238.88 2026-04-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 64 21 — — $1,794.03 $534,810.06 $60,078.01 2026-04-01
791 MS_DRG Prematurity With Major Problems 56 21 — — $7,047.03 $93,852.00 $41,257.25 2026-04-01
792 MS_DRG Prematurity Without Major Problems 64 21 — — $43.03 $52,829.16 $25,179.96 2026-04-01
793 MS_DRG Full Term Neonate With Major Problems 64 21 — — $8,798.03 $89,938.29 $42,361.83 2026-04-01
799 MS_DRG Splenic Procedures With Mcc 54 21 — — $12,257.00 $116,365.31 $45,950.21 2026-04-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 52 21 — — $56,693.37 $122,765.07 $56,693.37 2026-04-01
800 MS_DRG Splenic Procedures With Cc 52 21 — — $28,777.32 $66,766.57 $28,777.32 2026-04-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 52 21 — — $40,509.21 $83,898.21 $40,509.21 2026-04-01
81211 HCPCS Brca1&2 Seq & Com Dup/del 4 1 — — $26,426.08 $31,711.29 $29,068.69 2026-04-01
81280 HCPCS Long Qt Synd Gene Full Seq 4 1 — — $33,730.02 $40,476.02 $37,103.02 2026-04-01
81436 HCPCS Hereditary Colon Ca Dsordrs 4 1 — — $25,503.56 $30,604.28 $28,053.92 2026-04-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 52 21 — — $59,292.02 $128,658.10 $59,292.02 2026-04-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 52 21 — — $46,508.49 $101,733.40 $46,508.49 2026-04-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 52 21 — — $47,437.29 $113,942.49 $47,437.29 2026-04-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 52 21 — — $32,278.81 $72,519.35 $32,278.81 2026-04-01
834 MS_DRG Acute Leukemia With Mcc 54 21 — — $38,825.47 $136,865.36 $55,547.84 2026-04-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 52 21 — — $48,700.66 $128,925.04 $48,700.66 2026-04-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 56 21 — — $10,506.00 $72,745.57 $33,026.85 2026-04-01
846 MS_DRG Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc 52 21 — — $26,611.11 $60,398.48 $26,611.11 2026-04-01
849 MS_DRG Radiotherapy 52 21 — — $27,779.61 $56,272.23 $27,779.61 2026-04-01
850 MS_DRG Acute Leukemia With Other Procedures 48 21 — — $87,203.08 $173,043.48 $87,203.08 2026-04-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 92 21 — — $3,470.25 $118,191.23 $50,041.94 2026-04-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 58 21 — — $12,257.00 $102,832.83 $46,147.95 2026-04-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 86 22 — — $17,452.69 $191,724.36 $69,748.56 2026-04-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 52 21 — — $39,318.75 $73,817.71 $39,318.75 2026-04-01
901 MS_DRG Wound Debridements For Injuries With Mcc 54 21 — — $42,631.48 $582,499.54 $42,631.48 2026-04-01
904 MS_DRG Skin Grafts For Injuries With Cc/Mcc 54 21 — — $10,506.00 $84,185.51 $37,403.21 2026-04-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 60 21 — — $12,257.00 $177,867.56 $39,063.08 2026-04-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 52 21 — — $213,949.83 $475,761.02 $213,949.83 2026-04-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 52 21 — — $72,354.20 $147,635.70 $72,354.20 2026-04-01
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc 52 21 — — $32,886.03 $68,067.34 $32,886.03 2026-04-01
92930 HCPCS Prq Tcat Plmt Ntrac St 2+les 8 3 — — $23,577.55 $59,792.66 $26,524.74 2026-04-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 52 21 — — $39,611.37 $81,281.39 $39,611.37 2026-04-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 52 21 — — $36,957.79 $76,602.62 $36,957.79 2026-04-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 52 21 — — $35,868.19 $82,187.99 $35,868.19 2026-04-01
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 52 21 — — $26,478.28 $56,735.98 $26,478.28 2026-04-01
9512 OTHER Rbc Leukocytes Reduced 4 2 — — $2,178.07 $127,351.26 $64,764.66 2026-04-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 52 21 — — $67,943.88 $142,247.14 $67,943.88 2026-04-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 56 21 — — $38,301.06 $225,061.18 $38,301.06 2026-04-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 54 21 — — $12,257.00 $167,873.34 $76,820.45 2026-04-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 54 21 — — $42,804.26 $95,134.56 $42,804.26 2026-04-01
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/Mcc 52 21 — — $30,122.59 $61,853.07 $30,122.59 2026-04-01
96 MS_DRG Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc 52 21 — — $26,478.28 $52,743.19 $26,478.28 2026-04-01
963 MS_DRG Other Multiple Significant Trauma With Mcc 54 21 — — $25,427.65 $61,626.85 $28,022.30 2026-04-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 52 21 — — $61,853.72 $130,922.56 $61,853.72 2026-04-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 54 21 — — $15,358.78 $84,891.32 $36,791.00 2026-04-01
970 MS_DRG HIV With Extensive O.r. Procedures Without Mcc 54 21 — — $26,216.40 $66,624.05 $27,059.54 2026-04-01
974 MS_DRG HIV With Major Related Condition With Mcc 56 21 — — $16,552.92 $60,755.91 $29,542.34 2026-04-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 62 21 — — $12,257.00 $104,237.65 $47,577.11 2026-04-01
982 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 58 21 — — $14,008.00 $57,487.03 $25,272.84 2026-04-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 58 21 — — $24,514.00 $73,795.23 $34,959.36 2026-04-01
A9543 HCPCS Y90 Ibritumomab, Rx 16 5 — — $56,824.55 $144,107.06 $94,606.19 2026-04-01
A9545 HCPCS I-131 Tositumomab, Rx, Per Dose 4 1 — — $36,090.09 $36,090.09 $36,090.09 2026-04-01
A9699 HCPCS Radiopharm Rx Agent Noc 4 1 — — $97,225.26 $97,225.26 $97,225.26 2026-04-01
C8007 HCPCS Opn Mplnt Hpgls Ns Ary Ps Gn 8 3 — — $39,688.16 $100,649.17 $44,649.18 2026-04-01
C8011 HCPCS Opn Mplnt Hpgls Ns Ary Rec 8 3 — — $39,688.16 $100,649.17 $44,649.18 2026-04-01
C9150 HCPCS Xe129 Xenon, Diagnostic 4 1 — — $88,519.39 $88,519.39 $88,519.39 2026-04-01
C9301 HCPCS Obecabtagene Car Pos T 4 1 — — $598,237.50 $598,237.50 $598,237.50 2026-04-01
C9760 HCPCS Non-blind Interatrial Shunt 16 5 — — $14,105.00 $87,797.28 $28,518.69 2026-04-01
G0419 HCPCS Sat Biopsy Prostate: >60 4 1 — — $24,183.47 $29,020.16 $26,601.82 2026-04-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 6 2 — — $3,691,450.00 $4,392,825.50 $3,912,937.00 2026-04-01
J1413 HCPCS Inj Delandistrogene Mox Rokl 6 2 — — $3,321,376.38 $3,952,437.89 $3,520,658.96 2026-04-01
J3392 HCPCS Inj, Exagamglogene Autotem 6 2 — — $2,332,000.00 $2,775,080.00 $2,471,920.00 2026-04-01
J3393 HCPCS Inj, Betibeglogene Autotemce 6 2 — — $2,938,320.00 $3,496,600.80 $3,114,619.20 2026-04-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 6 2 — — $3,245,381.39 $3,862,003.85 $3,440,104.27 2026-04-01
J3399 HCPCS Inj Onase Abepar-xioi Treat 6 2 — — $2,587,087.26 $3,078,633.84 $2,742,312.49 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 8 2 — — $88,948.40 $169,820.76 $129,384.58 2026-04-01
J9029 HCPCS Inj, Adstiladrin, Per Tx Dos 18 5 — — $64,282.30 $163,019.91 $102,137.73 2026-04-01
J9226 HCPCS Supprelin La Implant 20 6 — — $24,825.15 $104,415.81 $56,701.10 2026-04-01
J9266 HCPCS Pegaspargase Injection 20 6 — — $2,131.43 $72,083.41 $39,002.90 2026-04-01
J9600 HCPCS Porfimer Sodium Injection 8 2 — — $4,464.78 $52,091.10 $28,277.94 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 12 4 — — $531,849.12 $1,348,769.36 $857,004.01 2026-04-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 16 5 — — $1,310.00 $1,557,562.53 $690,953.41 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 18 6 — — $52,771.21 $142,698.67 $66,960.34 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 12 4 — — $489,290.60 $1,240,840.96 $817,232.00 2026-04-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 14 4 — — $562,260.84 $1,425,893.48 $1,083,271.31 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 12 4 — — $559,781.08 $1,419,604.82 $900,263.89 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 12 4 — — $588,494.81 $1,492,422.83 $944,811.41 2026-04-01
Q2057 HCPCS Afamitresgene Autoleucel 12 4 — — $770,620.00 $1,954,292.32 $1,286,935.40 2026-04-01
S3865 HCPCS Comp Genet Test Hyp Cardiomy 2 1 — — $29,130.86 $29,130.86 $29,130.86 2026-04-01
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