Hospital

LOS ROBLES HOSPITAL & MEDICAL CENTER

Thousand Oaks, CA · CCN 050549 · Rates published

Your selected procedure

You selected 29916 (CPT)

Arthroscopy, hip, surgical; with labral repair

This hospital’s price: $15,803 across 8 payers · range $5,745-$27,425

Source: https://core.secure.ehc.com/src/util/json-detail-price-list/95-2321136_los-robles-hospital-and-medical-center_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.

35,594 distinct procedures filed

39 distinct payers

796,955 rate rows

2026-07-17 last MRF observed

Data quality

726,836 of 796,955 rate rows are consumer-grade (91.2%)

70,119 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
template filing: same amount across many unrelated codes — excluded	26,750
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	20,442
per-diem day rate — not a per-procedure price	16,393
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	5,556
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	707
placeholder amount (≤ $0.02) — excluded from medians	123
percent-of-charges filed in the dollar field — excluded from medians	72
exceeds 10× this hospital's gross charge — excluded from medians	48
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings	28

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

Source MRF file	https://core.secure.ehc.com/src/util/json-detail-price-list/95-2321136_los-robles-hospital-and-medical-center_standardcharges.json
Found on page	https://losrobleshospital.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-12
Content fingerprint	1416f01f2c67f89b… · 491,487,451 bytes · first seen 2026-05-08

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	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	1	$3,884,946.48	$3,884,946.48	$3,884,946.48	nat. median $2,467,989 1.6× median
9138 OTHER	Inj, Hemgenix, Per Tx Dos	17	$3,636,171.00	$4,774,770.00	$3,709,629.00	nat. median $3,758,972 1.0× median
09138 OTHER	Inj, Hemgenix, Per Tx Dos	1	$3,672,900.00	$3,672,900.00	$3,672,900.00	nat. median $3,574,709 1.0× median
773 OTHER	Inj, Beqvez, Per Tx Dose	17	$3,568,950.00	$4,686,500.00	$3,641,050.00	nat. median $3,646,097 1.0× median
00773 OTHER	Inj, Beqvez, Per Tx Dose	1	$3,605,000.00	$3,605,000.00	$3,605,000.00	nat. median $3,496,850 1.0× median
00714 OTHER	Inj Delandistrogene Mox R	1	$3,325,455.00	$3,325,455.00	$3,325,455.00	nat. median $3,228,024 1.0× median
714 OTHER	Inj Delandistrogene Mox R	18	$8,469.42	$4,323,091.50	$3,325,455.00	nat. median $3,325,455 1.0× median
00748 OTHER	Inj, Lovotibeglogene Auto	1	$3,286,000.00	$3,286,000.00	$3,286,000.00	nat. median $3,187,420 1.0× median
748 OTHER	Inj, Lovotibeglogene Auto	18	$13,970.28	$4,271,800.00	$3,286,000.00	nat. median $3,252,508 1.0× median
00746 OTHER	Inj, Betibeglogene Autote	1	$2,968,000.00	$2,968,000.00	$2,968,000.00	nat. median $2,878,960 1.0× median
746 OTHER	Inj, Betibeglogene Autote	18	$12,408.39	$3,858,400.00	$2,968,000.00	nat. median $2,939,969 1.0× median
9141 OTHER	Inj Onase Abepar-xioi Tre	17	$2,364,727.86	$3,105,198.20	$2,412,500.14	nat. median $2,588,981 0.9× median
09141 OTHER	Inj Onase Abepar-xioi Tre	1	$2,388,614.00	$2,388,614.00	$2,388,614.00	nat. median $2,511,312 1.0× median
9194 OTHER	Tisagenlecleucel Car-pos	17	$523,900.97	$687,950.77	$534,484.83	nat. median $577,862 0.9× median
9498 OTHER	Ciltacabtagene Car-pos T	17	$521,852.17	$685,260.42	$532,394.64	nat. median $587,650 0.9× median
9422 OTHER	Idecabtagene Vicleucel Ca	17	$521,321.72	$684,563.88	$531,853.47	nat. median $563,449 0.9× median
09194 OTHER	Tisagenlecleucel Car-pos	1	$529,192.90	$529,192.90	$529,192.90	nat. median $549,535 1.0× median
Q2056 HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	5	$92,985.20	$837,683.55	$527,123.43	nat. median $646,415 0.8× median
09498 OTHER	Ciltacabtagene Car-pos T	1	$527,123.40	$527,123.40	$527,123.40	nat. median $570,020 0.9× median
09422 OTHER	Idecabtagene Vicleucel Ca	1	$526,587.60	$526,587.60	$526,587.60	nat. median $541,339 1.0× median
Q2055 HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	5	$106,631.80	$830,699.97	$526,587.59	nat. median $623,527 0.8× median
9413 OTHER	Lisocabtagene Car Pos T	17	$511,558.84	$671,743.93	$521,893.36	nat. median $562,201 0.9× median
Q2042 HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	6	$3,135.00	$863,696.72	$518,241.00	nat. median $739,658 0.7× median
09413 OTHER	Lisocabtagene Car Pos T	1	$516,726.10	$516,726.10	$516,726.10	nat. median $545,335 0.9× median
Q2054 HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	5	$104,247.00	$819,043.85	$516,726.08	nat. median $640,950 0.8× median
9035 OTHER	Axicabtagene Ciloleucel C	17	$484,561.44	$636,292.80	$494,350.56	nat. median $533,230 0.9× median
09035 OTHER	Axicabtagene Ciloleucel C	1	$489,456.00	$489,456.00	$489,456.00	nat. median $516,226 0.9× median
Q2041 HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	5	$98,876.80	$807,075.90	$489,455.96	nat. median $608,239 0.8× median
9391 OTHER	Brexucabtagene Car Pos T	17	$455,925.10	$598,689.52	$465,135.71	nat. median $492,768 0.9× median
Q2053 HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	5	$98,876.80	$741,576.00	$460,530.40	nat. median $592,235 0.8× median
09391 OTHER	Brexucabtagene Car Pos T	1	$460,530.40	$460,530.40	$460,530.40	nat. median $474,767 1.0× median
437378 CDM	Valve Tavr 29mm	10	$54,000.00	$540,000.00	$432,000.00	nat. median $10,348 outlier · 41.7×
437377 CDM	Valve Tavr 34mm	10	$54,000.00	$540,000.00	$432,000.00	nat. median $132,667 outlier · 3.3×
415481 CDM	Valve Aor Tavr 26mm	10	$54,000.00	$540,000.00	$432,000.00	nat. median $153,317 outlier · 2.8×
919614 CDM	Valve Mitral Sp 35l	10	$54,000.00	$540,000.00	$432,000.00	nat. median $432,000 1.0× median
437039 CDM	Valve Tavr 26mm	10	$54,000.00	$540,000.00	$432,000.00	nat. median $193,600 outlier · 2.2×
437579 CDM	Valve Tavr 23mm	10	$54,000.00	$540,000.00	$432,000.00	nat. median $126,434 outlier · 3.4×
630018 CDM	Valve Xt Sapien 26mm Ta	10	$53,750.00	$537,500.00	$430,000.00	nat. median $430,000 1.0× median
638867 CDM	Valve Hrt W/cert Sys 23a	10	$53,750.00	$537,500.00	$430,000.00	nat. median $3,082 outlier · 139.5×
635361 CDM	Valve Tavr 23mm	10	$53,750.00	$537,500.00	$430,000.00	nat. median $430,000 1.0× median
630019 CDM	Valve 29mm Sapien Xt	10	$53,750.00	$537,500.00	$430,000.00	nat. median $430,000 1.0× median
634405 CDM	Valve Tavr 34mm	10	$53,750.00	$537,500.00	$430,000.00	nat. median $430,000 1.0× median
627134 CDM	Valve Pulm 23mm Sapien	10	$53,750.00	$537,500.00	$430,000.00	nat. median $430,000 1.0× median
416528 CDM	Valve Aor With Intro 25mm	10	$53,750.00	$537,500.00	$430,000.00	nat. median $152,260 outlier · 2.8×
627135 CDM	Valve Pulm 26mm Sapien	10	$53,750.00	$537,500.00	$430,000.00	nat. median $430,000 1.0× median
407910 CDM	Valve Tavr 29mm	10	$53,750.00	$537,500.00	$430,000.00	nat. median $233,280 1.8× median
635645 CDM	Valve Heart W/cert 29a	10	$53,750.00	$537,500.00	$430,000.00	nat. median $430,000 1.0× median
634969 CDM	Valve Hrt W Cert Sys 26a	10	$53,750.00	$537,500.00	$430,000.00	nat. median $14,322 outlier · 30.0×
421038 CDM	Valve Tavr Sz 29mm	10	$53,750.00	$537,500.00	$430,000.00	nat. median $24,987 outlier · 17.2×

Other procedures at this hospital

Browse this hospital's 35,594 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

J3393	HCPCS	Injection, Betibeglogene Autotemcel, Per Treatment	2	1	—	—	$4,897,200.00	$4,897,200.00	$4,897,200.00	2024-10-01
J3399	HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	2	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	22	17	—	—	$3,636,171.00	$4,774,770.00	$3,709,629.00	2024-10-01
09138	OTHER	Inj, Hemgenix, Per Tx Dos	1	1	—	—	$3,672,900.00	$3,672,900.00	$3,672,900.00	2024-10-01
773	OTHER	Inj, Beqvez, Per Tx Dose	22	17	$4,966.91	—	$3,568,950.00	$4,686,500.00	$3,641,050.00	2026-07-17
00773	OTHER	Inj, Beqvez, Per Tx Dose	1	1	—	—	$3,605,000.00	$3,605,000.00	$3,605,000.00	2024-10-01
00714	OTHER	Inj Delandistrogene Mox R	1	1	—	—	$3,325,455.00	$3,325,455.00	$3,325,455.00	2024-10-01
714	OTHER	Inj Delandistrogene Mox R	23	18	$14,025.00	—	$8,469.42	$4,323,091.50	$3,325,455.00	2026-07-17
00748	OTHER	Inj, Lovotibeglogene Auto	1	1	—	—	$3,286,000.00	$3,286,000.00	$3,286,000.00	2024-10-01
748	OTHER	Inj, Lovotibeglogene Auto	23	18	$16,836.72	—	$13,970.28	$4,271,800.00	$3,286,000.00	2026-07-17
00746	OTHER	Inj, Betibeglogene Autote	1	1	—	—	$2,968,000.00	$2,968,000.00	$2,968,000.00	2024-10-01
746	OTHER	Inj, Betibeglogene Autote	23	18	$20,133.85	—	$12,408.39	$3,858,400.00	$2,968,000.00	2026-07-17
9141	OTHER	Inj Onase Abepar-xioi Tre	22	17	—	—	$2,364,727.86	$3,105,198.20	$2,412,500.14	2024-10-01
09141	OTHER	Inj Onase Abepar-xioi Tre	1	1	—	—	$2,388,614.00	$2,388,614.00	$2,388,614.00	2024-10-01
9194	OTHER	Tisagenlecleucel Car-pos	22	17	$544,627.92	—	$523,900.97	$687,950.77	$534,484.83	2026-07-17
9498	OTHER	Ciltacabtagene Car-pos T	22	17	$574,740.00	—	$521,852.17	$685,260.42	$532,394.64	2026-07-17
9422	OTHER	Idecabtagene Vicleucel Ca	22	17	$533,604.00	—	$521,321.72	$684,563.88	$531,853.47	2026-07-17
09194	OTHER	Tisagenlecleucel Car-pos	1	1	—	—	$529,192.90	$529,192.90	$529,192.90	2024-10-01
Q2056	HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	7	5	$813,285.00	—	$92,985.20	$837,683.55	$527,123.43	2026-07-17
09498	OTHER	Ciltacabtagene Car-pos T	1	1	—	—	$527,123.40	$527,123.40	$527,123.40	2024-10-01
09422	OTHER	Idecabtagene Vicleucel Ca	1	1	—	—	$526,587.60	$526,587.60	$526,587.60	2024-10-01
Q2055	HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	7	5	$733,705.50	—	$106,631.80	$830,699.97	$526,587.59	2026-07-17
9413	OTHER	Lisocabtagene Car Pos T	22	17	$521,901.60	—	$511,558.84	$671,743.93	$521,893.36	2026-07-17
Q2042	HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	9	6	$772,928.48	—	$3,135.00	$863,696.72	$518,241.00	2026-07-17
09413	OTHER	Lisocabtagene Car Pos T	1	1	—	—	$516,726.10	$516,726.10	$516,726.10	2024-10-01
Q2054	HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	7	5	$717,614.70	—	$104,247.00	$819,043.85	$516,726.08	2026-07-17
9035	OTHER	Axicabtagene Ciloleucel C	22	17	$507,461.72	—	$484,561.44	$636,292.80	$494,350.56	2026-07-17
09035	OTHER	Axicabtagene Ciloleucel C	1	1	—	—	$489,456.00	$489,456.00	$489,456.00	2024-10-01
Q2041	HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	7	5	$741,255.67	—	$98,876.80	$807,075.90	$489,455.96	2026-07-17
9391	OTHER	Brexucabtagene Car Pos T	22	17	$507,528.00	—	$455,925.10	$598,689.52	$465,135.71	2026-07-17
Q2053	HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	7	5	$740,441.46	—	$98,876.80	$741,576.00	$460,530.40	2026-07-17
09391	OTHER	Brexucabtagene Car Pos T	1	1	—	—	$460,530.40	$460,530.40	$460,530.40	2024-10-01
437378	CDM	Valve Tavr 29mm	14	10	$540,000.00	$540,000.00	$54,000.00	$540,000.00	$432,000.00	2024-10-01
437377	CDM	Valve Tavr 34mm	14	10	$540,000.00	$540,000.00	$54,000.00	$540,000.00	$432,000.00	2024-10-01
415481	CDM	Valve Aor Tavr 26mm	14	10	$540,000.00	$540,000.00	$54,000.00	$540,000.00	$432,000.00	2024-10-01
919614	CDM	Valve Mitral Sp 35l	14	10	$540,000.00	$540,000.00	$54,000.00	$540,000.00	$432,000.00	2024-10-01
437039	CDM	Valve Tavr 26mm	14	10	$540,000.00	$540,000.00	$54,000.00	$540,000.00	$432,000.00	2024-10-01
437579	CDM	Valve Tavr 23mm	14	10	$540,000.00	$540,000.00	$54,000.00	$540,000.00	$432,000.00	2024-10-01
630018	CDM	Valve Xt Sapien 26mm Ta	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
638867	CDM	Valve Hrt W/cert Sys 23a	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
635361	CDM	Valve Tavr 23mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
630019	CDM	Valve 29mm Sapien Xt	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
634405	CDM	Valve Tavr 34mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
627134	CDM	Valve Pulm 23mm Sapien	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
416528	CDM	Valve Aor With Intro 25mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
627135	CDM	Valve Pulm 26mm Sapien	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
407910	CDM	Valve Tavr 29mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
635645	CDM	Valve Heart W/cert 29a	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
634969	CDM	Valve Hrt W Cert Sys 26a	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
421038	CDM	Valve Tavr Sz 29mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
631357	CDM	Kit Aor Vlv 14fr 23mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
629967	CDM	Vlv Aor 26-29mm 0-43mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
407908	CDM	Valve Tavr 23mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
416529	CDM	Valve Aor With Intro 27mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
627348	CDM	Valve Hrt Sapien Xt 26mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
417189	CDM	Valve Tavi 27mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
630787	CDM	Valve Tavr 29mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
631358	CDM	Kit Aor Vlv 14fr 26mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
635891	CDM	Valve Aor Evolut R 34mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
629383	CDM	Valve Xt Sapien 23mm Ta	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
434124	CDM	System Trcsd 1clip 1cath	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
627349	CDM	Valve Hrt Sapien Xt 29mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
629964	CDM	Valve Aor 18-20mm 0-34mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
637992	CDM	Valve Aor 29mm Transcath	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
638026	CDM	Valve Aor 26mm Transcath	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
631158	CDM	Valve Transcth Aor 26mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
633886	CDM	Vavle Aor Enveor 29mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
415240	CDM	Valve Aor Tavr 34mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
627136	CDM	Valve Hrt Sapien 23mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
407909	CDM	Valve Tavr 26mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
421036	CDM	Valve Tavr Sz 23mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
C1822	HCPCS	Implant Pulse 8.5x15.5in	26	9	$517,042.00	$517,042.00	$143,612.09	$537,500.00	$430,000.00	2024-10-01
421039	CDM	Valve Tavr Size 34mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
416530	CDM	Valve Aor With Intro 23mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
627137	CDM	Valve Hrt Sapien 26mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
627347	CDM	Valve Hrt Sapien Xt 23mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
633884	CDM	Valve Aor Enveor 23mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
635363	CDM	Valve Tavr 29mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
415939	CDM	Valve Aor Tavr 23mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
411222	CDM	Stent Graft 30x36 100mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
635362	CDM	Valve Tavr 26mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
421037	CDM	Valve Tavr Sz 26mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
629969	CDM	Valve Aor 20-23mm 0-40m	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
415940	CDM	Valve Aor Tavr 29mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
419221	CDM	Valve Heart Trnscth 26mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
419448	CDM	Valve Heart Trnscth 23mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
629968	CDM	Valve Aor 23-26mm 0-43mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
631359	CDM	Kit Aor Vlv 14fr 29mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
634804	CDM	Kit Aor Vlv 14fr 20mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
633885	CDM	Vavle Aor Enveor 26mm	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
631120	CDM	Val Evlt Rtm Trnsct Aort	14	10	$537,500.00	$537,500.00	$53,750.00	$537,500.00	$430,000.00	2024-10-01
641422	CDM	Impl Crnl Ostmtch150-200	14	10	$520,159.00	$520,159.00	$52,015.90	$520,159.00	$416,127.20	2024-10-01
417201	CDM	Valve Tavr 25mm	14	10	$513,152.00	$513,152.00	$51,315.20	$513,152.00	$410,521.60	2024-10-01
409890	CDM	Transcth Aortic Vlv 25mm	14	10	$500,000.00	$500,000.00	$50,000.00	$500,000.00	$400,000.00	2024-10-01
409892	CDM	Transcth Aortic Vlv 27mm	14	10	$500,000.00	$500,000.00	$50,000.00	$500,000.00	$400,000.00	2024-10-01
633887	CDM	Valve Aor Med Clssc 31mm	14	10	$500,000.00	$500,000.00	$50,000.00	$500,000.00	$400,000.00	2024-10-01
409893	CDM	Transcth Aortic Vlv 29mm	14	10	$500,000.00	$500,000.00	$50,000.00	$500,000.00	$400,000.00	2024-10-01
409889	CDM	Transcth Aortic Vlv 23mm	14	10	$500,000.00	$500,000.00	$50,000.00	$500,000.00	$400,000.00	2024-10-01
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	32	25	—	—	$313,316.24	$587,467.95	$391,645.30	2024-10-01
418539	CDM	Stent Graft 10cm 21x21mm	14	10	$459,994.00	$459,994.00	$45,999.40	$459,994.00	$367,995.20	2024-10-01
639569	CDM	Cage Spn Latmap 4 Nuvamp	14	10	$446,207.00	$446,207.00	$44,620.70	$446,207.00	$356,965.60	2024-10-01
439062	CDM	Valve Aor 35mm	14	10	$437,760.00	$437,760.00	$43,776.00	$437,760.00	$350,208.00	2024-10-01
439061	CDM	Valve Aor 29mm	14	10	$437,760.00	$437,760.00	$43,776.00	$437,760.00	$350,208.00	2024-10-01
632235	CDM	Valve Portico Tavi 27mm	14	10	$432,100.00	$432,100.00	$43,210.00	$432,100.00	$345,680.00	2024-10-01
632189	CDM	Valve Hrt Prtco Tavi23mm	14	10	$432,100.00	$432,100.00	$43,210.00	$432,100.00	$345,680.00	2024-10-01
632236	CDM	Valve Portico Tavi 29mm	14	10	$432,100.00	$432,100.00	$43,210.00	$432,100.00	$345,680.00	2024-10-01
632190	CDM	Valve Hrt Prtco Tavi25mm	14	10	$432,100.00	$432,100.00	$43,210.00	$432,100.00	$345,680.00	2024-10-01
421075	CDM	Stnt Thorac 28x28mm 10cm	14	10	$428,032.00	$428,032.00	$42,803.20	$428,032.00	$342,425.60	2024-10-01
420742	CDM	Graft Evas 34x34x10cm	14	10	$428,032.00	$428,032.00	$42,803.20	$428,032.00	$342,425.60	2024-10-01
421076	CDM	Stent 20fr 31x31mm 10cm	14	10	$428,032.00	$428,032.00	$42,803.20	$428,032.00	$342,425.60	2024-10-01
421074	CDM	Stnt Thorac 26x26mm 10cm	14	10	$428,032.00	$428,032.00	$42,803.20	$428,032.00	$342,425.60	2024-10-01
919923	CDM	Stent 34mmx34mmx15cm	14	10	$428,032.00	$428,032.00	$42,803.20	$428,032.00	$342,425.60	2024-10-01
419935	CDM	Device Embl 4.5mm 30mm	14	10	$418,176.00	$418,176.00	$41,817.60	$418,176.00	$334,540.80	2024-10-01
633335	CDM	Device Embl 5x30mm	14	10	$404,586.00	$404,586.00	$40,458.60	$404,586.00	$323,668.80	2024-10-01
632614	CDM	Device Embl 5x25mm Pipln	14	10	$404,586.00	$404,586.00	$40,458.60	$404,586.00	$323,668.80	2024-10-01
632273	CDM	Dev Embl Ped 3.50x30mm	14	10	$404,586.00	$404,586.00	$40,458.60	$404,586.00	$323,668.80	2024-10-01
C1820	HCPCS	Generator Nrstm Prcsn Sp	182	9	$406,167.00	$406,167.00	$4,924.21	$480,903.00	$313,632.00	2024-10-01
632211	CDM	Dev Embl Pipeln 14x3mm	14	10	$383,808.00	$383,808.00	$38,380.80	$383,808.00	$307,046.40	2024-10-01
C1882	HCPCS	Aicd Lumx 340 Hft 359657	260	9	$389,764.50	$389,764.50	$33,788.68	$465,664.00	$307,032.00	2024-10-01
419937	CDM	Device Embl 5mm 16mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419936	CDM	Device Embl 4.75mm 16mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
434062	CDM	Device Embl 4.75x30mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420488	CDM	Device Embl 4.25mm 20mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419932	CDM	Device Embl 3.25mm 20mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
413300	CDM	Device Embl 3.5mm 25mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420921	CDM	Device Embl 4.5mm 35mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420490	CDM	Device Embl 4.5mm 16mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
421096	CDM	Device Embl 3.25mm 16mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419938	CDM	Device Embl 5mm 20mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420831	CDM	Device Embl 2.5mm 14mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
914694	CDM	Device Emb 4.25mm 16mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420493	CDM	Device Embl 5mm 25mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
914699	CDM	Device Embl 4.75mm 14mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419939	CDM	Device Embl 5mm 30mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420489	CDM	Device Embl 4.5mm 12mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
434061	CDM	Device Embl 4.50x25mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
914693	CDM	Device Embl 4.25mm 12mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
913449	CDM	Device Embl 5mm 35mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419957	CDM	Device Embl 3.75mm 18mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419933	CDM	Device Embl 3.5mm 20mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420482	CDM	Device Embl 3.75mm 16mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420544	CDM	Device Embl 4mm 25mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
439930	CDM	Device Embl 3.5mm 10mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420492	CDM	Device Emb 5mm 14mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
919704	CDM	Device Embl 5mm 18mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419930	CDM	Device Embl 3mm 14mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420481	CDM	Device Embl 3.5mm 16mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419934	CDM	Device Embl 3.75mm 14mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
914700	CDM	Device Embl 4.75mm 20mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420483	CDM	Device Embl 4mm 14mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420486	CDM	Device Embl 4mm 20mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419931	CDM	Device Embl 3mm 20mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419902	CDM	Device Embl 3mm 16mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
916574	CDM	Device Embl 3mm 10mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
915600	CDM	Device Embl 4.5mm 14mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
916573	CDM	Device Embl 4.25mm 14mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420491	CDM	Device Embl 4.5mm 20mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
422346	CDM	Device Embl 4.5mm 18mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
914689	CDM	Device Embl 3mm 12mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
430707	CDM	Device Embl 2.5mm 16mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419956	CDM	Device Embl 3.5mm 14mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420273	CDM	Device Embl 10mm 2.5mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
419929	CDM	Device Embl 2.5mm 12mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420484	CDM	Device Embl 4mm 16mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420563	CDM	Device Embl 3.5mm 18mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
412999	CDM	Device Embl 2.75mm 12mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420485	CDM	Device Embl 4mm 18mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
420487	CDM	Device Embl 4mm 30mm	14	10	$375,967.00	$375,967.00	$37,596.70	$375,967.00	$300,773.60	2024-10-01
629875	CDM	Dev Embol Piplne 20x4.5	14	10	$371,654.00	$371,654.00	$37,165.40	$371,654.00	$297,323.20	2024-10-01
415922	CDM	Implant Crnl Ossdsgncstm	14	10	$366,558.00	$366,558.00	$36,655.80	$366,558.00	$293,246.40	2024-10-01
418551	CDM	Valve Aortic 29mm	14	10	$365,904.00	$365,904.00	$36,590.40	$365,904.00	$292,723.20	2024-10-01
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	34	26	—	—	$8,580.00	$438,864.60	$292,576.40	2024-10-01
001	OTHER	$950.00	1	1	$361,237.48	—	$287,078.20	$287,078.20	$287,078.20	2026-07-17
415616	CDM	Device Embl Pl 4.75x14mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
417170	CDM	Device Embl Pln 30x4.25	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
637218	CDM	Dev Embl 16x5mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642476	CDM	Dev Embl 16x4.75mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
633762	CDM	Device Embl 5x35mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642475	CDM	Device Embl Flx 18x5mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
643292	CDM	Device Embl 4.25x14mm Pl	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642477	CDM	Device Embl 5x20mm Pipln	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
634607	CDM	Device Embl Pln 4.5x12mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
629316	CDM	Dev Emb Pipeln 2.50x16mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642435	CDM	Device Embl 16x4.25mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642472	CDM	Device Embl 30x4.75mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642573	CDM	Device Embl Flx 4.5x14mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
640008	CDM	Device Embl Pipln 16x3.5	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
636512	CDM	Dev Embl Ped 2.75x18mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
638547	CDM	Device Embl 18mm 4.5mm P	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642129	CDM	Dev Embl Ppln 35x4.5mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
640276	CDM	Dev Embl Pipln 14x2.75mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
641892	CDM	Device Embl 30mm 4.5mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
632411	CDM	Device Embl 25x4mm Pline	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
636635	CDM	Device Embl 20mm 2.5mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642574	CDM	Device Emb 20mm 3mm Pip	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
633431	CDM	Device Embl Pl 4.75x20mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
640780	CDM	Dev Embl Pipln 14x3.75mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
419232	CDM	Device Embl 25mm 3.5mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
635567	CDM	Device Embl Pipln 4x18mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
634902	CDM	Device Embl Piplin 4mmx2	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
635176	CDM	Device Embl Pipln 14x4mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
632607	CDM	Device Embl 12mm 3.75mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
638030	CDM	Device Embl 18x4.75mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642473	CDM	Device Embl Flx 18x3mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
635414	CDM	Device Embl16x3.75mm Pip	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
632210	CDM	Device Embl 14x3.5mm Pl	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
641247	CDM	Device Embl 4.5mm 16mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
635415	CDM	Device Embl 25mm 3.75mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
417255	CDM	Device Embl 20mm 3.75mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
638451	CDM	Dev Embl Ped 12x3.25mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642575	CDM	Device Embl Flx 14x5mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
635177	CDM	Device Embl 16mm 4mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
635566	CDM	Device Embl 3.75x18mm Pl	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
418997	CDM	Device Embl Ped25x4.75mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
642572	CDM	Device Embl 14mm 2.5mm P	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
638589	CDM	Device Embl 4.25mmx12mm	14	10	$358,064.00	$358,064.00	$35,806.40	$358,064.00	$286,451.20	2024-10-01
628092	CDM	Dev Embl Mesh 18 4.5	14	10	$347,609.00	$347,609.00	$34,760.90	$347,609.00	$278,087.20	2024-10-01
628093	CDM	Dev Embl Sys Mesh 20x4.5	14	10	$347,609.00	$347,609.00	$34,760.90	$347,609.00	$278,087.20	2024-10-01
627917	CDM	Dev Emb Pipeln 5x18mm	14	10	$347,609.00	$347,609.00	$34,760.90	$347,609.00	$278,087.20	2024-10-01
90288	CPT	Botulism Ig Human IV	12	9	$340,877.97	$340,877.97	$51,131.70	$340,877.97	$272,702.38	2024-10-01
917246	CDM	Valve Aortic 27mm	14	10	$340,480.00	$340,480.00	$34,048.00	$340,480.00	$272,384.00	2024-10-01
420317	CDM	Valve Aortic 25mm	14	10	$340,480.00	$340,480.00	$34,048.00	$340,480.00	$272,384.00	2024-10-01
409666	CDM	Valve Aortic 23mm	14	10	$340,480.00	$340,480.00	$34,048.00	$340,480.00	$272,384.00	2024-10-01
919964	CDM	Valve Aortic 21mm	14	10	$340,480.00	$340,480.00	$34,048.00	$340,480.00	$272,384.00	2024-10-01
914529	CDM	Coil Emolization 1x1mm	14	10	$338,592.00	$338,592.00	$33,859.20	$338,592.00	$270,873.60	2024-10-01
639568	CDM	Cage Spn Latmap 3 Nuvamp	14	10	$338,003.00	$338,003.00	$33,800.30	$338,003.00	$270,402.40	2024-10-01
417518	CDM	System Imp 5mm 15mm	14	10	$329,902.00	$329,902.00	$32,990.20	$329,902.00	$263,921.60	2024-10-01
C1767	HCPCS	Generator Nrstm 5 Ipg	78	9	$341,741.50	$341,741.50	$71,843.93	$430,219.00	$261,360.00	2024-10-01
J9999	HCPCS	Carmustine Wafers 8/box	12	9	$317,209.50	$317,209.50	$47,581.43	$317,209.50	$253,767.60	2024-10-01
927	MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	32	25	—	—	$8,580.00	$384,542.00	$246,449.90	2024-10-01
631416	CDM	Graft Condyle Rt Medial	14	10	$299,258.00	$299,258.00	$29,925.80	$299,258.00	$239,406.40	2024-10-01
626500	CDM	Graft Bn Hemi Condrl Rt	14	10	$298,604.00	$298,604.00	$29,860.40	$298,604.00	$238,883.20	2024-10-01
627399	CDM	Graft Bn Fem Hemi Cndyl	14	10	$298,604.00	$298,604.00	$29,860.40	$298,604.00	$238,883.20	2024-10-01
C1721	HCPCS	Aicd Protcta 2ch D334drm	234	9	$297,464.00	$297,464.00	$53,614.79	$466,349.00	$237,271.02	2024-10-01
018	OTHER	$950.00	1	1	$467,896.31	—	$236,881.80	$236,881.80	$236,881.80	2026-07-17
638830	CDM	Algraft Tis 3-7mm 91cm	14	10	$296,095.00	$296,095.00	$29,609.50	$296,095.00	$236,876.00	2024-10-01
434394	CDM	Pump Pain Infn 20ml	14	10	$292,384.00	$292,384.00	$29,238.40	$292,384.00	$233,907.20	2024-10-01
638659	CDM	Implant Cranial Peek	14	10	$291,029.00	$291,029.00	$29,102.90	$291,029.00	$232,823.20	2024-10-01
918878	CDM	Graft Endo Aaa 26x12mm	14	10	$287,925.00	$287,925.00	$28,792.50	$287,925.00	$230,340.00	2024-10-01
420736	CDM	Graft Endo Aaa 28.5x12mm	14	10	$287,925.00	$287,925.00	$28,792.50	$287,925.00	$230,340.00	2024-10-01
411669	CDM	Graft Endo Aaa 36x14mm	14	10	$287,925.00	$287,925.00	$28,792.50	$287,925.00	$230,340.00	2024-10-01
914107	CDM	Graft Endo Aaa 32x14mm	14	10	$287,925.00	$287,925.00	$28,792.50	$287,925.00	$230,340.00	2024-10-01
913391	CDM	Graft Endo Aaa 23x12mm	14	10	$287,925.00	$287,925.00	$28,792.50	$287,925.00	$230,340.00	2024-10-01
C1722	HCPCS	Crt-d Hf-t Df1 360d	169	9	$284,055.00	$284,055.00	$53,614.79	$507,437.00	$229,542.30	2024-10-01
639708	CDM	Implant Crnl Pk Ptspc	14	10	$280,989.00	$280,989.00	$28,098.90	$280,989.00	$224,791.20	2024-10-01
420892	CDM	Pump Heart 21fr 85mm	25	16	$540,000.00	$540,000.00	$54,000.00	$540,000.00	$223,074.00	2024-10-01
920215	CDM	Kit Cath Rt Heart	25	16	$540,000.00	$540,000.00	$54,000.00	$540,000.00	$223,074.00	2024-10-01
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	37	27	—	—	$7,763.00	$528,616.00	$222,651.70	2024-10-01
636824	CDM	Implant Cranial Peek	14	10	$276,227.00	$276,227.00	$27,622.70	$276,227.00	$220,981.60	2024-10-01
635080	CDM	Implant Cranial Peek	14	10	$275,738.00	$275,738.00	$27,573.80	$275,738.00	$220,590.40	2024-10-01
C1772	HCPCS	Pump Infs Pain 20ml	26	9	$265,281.00	$265,281.00	$74,829.63	$271,815.00	$217,452.00	2024-10-01
639053	CDM	Graft Evas 31x14.5m 13cm	14	10	$269,071.00	$269,071.00	$26,907.10	$269,071.00	$215,256.80	2024-10-01
416054	CDM	Graft Evas 26x14.5m 12cm	14	10	$269,071.00	$269,071.00	$26,907.10	$269,071.00	$215,256.80	2024-10-01
425292	CDM	Graft Evas 10cm 10mm	14	10	$269,071.00	$269,071.00	$26,907.10	$269,071.00	$215,256.80	2024-10-01
639307	CDM	Graft Evas 23x12mm 18cm	14	10	$269,071.00	$269,071.00	$26,907.10	$269,071.00	$215,256.80	2024-10-01
418819	CDM	Graft Evas 35x14.5m 16cm	14	10	$269,071.00	$269,071.00	$26,907.10	$269,071.00	$215,256.80	2024-10-01
420916	CDM	Graft Evas 14.5mm 12cm	14	10	$269,071.00	$269,071.00	$26,907.10	$269,071.00	$215,256.80	2024-10-01
635925	CDM	Implant Cranial Peek	14	10	$265,270.00	$265,270.00	$26,527.00	$265,270.00	$212,216.00	2024-10-01
417202	CDM	Valve Ng Tav 29mm	25	16	$513,152.00	$513,152.00	$51,315.20	$513,152.00	$211,983.09	2024-10-01
439745	CDM	Impl Crnl Ostmtch 20-100	14	10	$263,908.00	$263,908.00	$26,390.80	$263,908.00	$211,126.40	2024-10-01
419845	CDM	Valve Ng Tav 35mm	25	16	$510,720.00	$510,720.00	$51,072.00	$510,720.00	$210,978.43	2024-10-01
621151	CDM	Graft Evas 16cm 25.5mm	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
642808	CDM	Graft Evs 18cm 26x14.5mm	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
639933	CDM	Graft Excluder 16cm 28.5	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
623178	CDM	Graft Evas 14cm 23x14.5m	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
626014	CDM	Graft Evas 14cm 26mm	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
642150	CDM	Graft Excldr 12x23x15.5	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
416989	CDM	Graft Evas 26x14.5m 14cm	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
415522	CDM	Graft Evas 12cm 23x12mm	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
415906	CDM	Graft Evas 23x14.5m14cm	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
625136	CDM	Graft Evas 18cm 23mm	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
418386	CDM	Graft Evas 14.5mm 14cm	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
624905	CDM	Stent Aaa Exldr C3 23x12	14	10	$261,230.00	$261,230.00	$26,123.00	$261,230.00	$208,984.00	2024-10-01
614432	CDM	Gft Bif 28-16x145mm 20fr	14	10	$260,707.00	$260,707.00	$26,070.70	$260,707.00	$208,565.60	2024-10-01
620734	CDM	Gft Bif 25-16x124mm 18fr	14	10	$260,707.00	$260,707.00	$26,070.70	$260,707.00	$208,565.60	2024-10-01
416671	CDM	Implant Bn Cranial Peek	14	10	$260,482.00	$260,482.00	$26,048.20	$260,482.00	$208,385.60	2024-10-01
634156	CDM	Impl Crnl Peek-optmacstm	14	10	$252,976.00	$252,976.00	$25,297.60	$252,976.00	$202,380.80	2024-10-01
1907	OTHER	New Technology - Level 52	22	17	$275,595.24	—	$197,980.20	$259,974.00	$201,979.80	2026-07-17
1908	OTHER	New Technology - Level 52	22	17	$275,595.24	—	$197,980.20	$259,974.00	$201,979.80	2026-07-17
01907	OTHER	New Technology - Level 52	1	1	—	—	$199,980.00	$199,980.00	$199,980.00	2024-10-01
01908	OTHER	New Technology - Level 52	1	1	—	—	$199,980.00	$199,980.00	$199,980.00	2024-10-01
641098	CDM	Valve Aortic 29mm	14	10	$248,853.00	$248,853.00	$24,885.30	$248,853.00	$199,082.40	2024-10-01
640344	CDM	Grft Evas Xcld10cm14.5mm	14	10	$243,079.00	$243,079.00	$24,307.90	$243,079.00	$194,463.20	2024-10-01
643061	CDM	Occluder Cv 25x18mm	14	10	$243,079.00	$243,079.00	$24,307.90	$243,079.00	$194,463.20	2024-10-01
416139	CDM	Graft Evas 10cm 12mm	14	10	$243,079.00	$243,079.00	$24,307.90	$243,079.00	$194,463.20	2024-10-01
639815	CDM	Graft Evas 17cm 31x14.5	14	10	$243,079.00	$243,079.00	$24,307.90	$243,079.00	$194,463.20	2024-10-01
640343	CDM	Graft Evas 14cm 35mm 14.	14	10	$243,079.00	$243,079.00	$24,307.90	$243,079.00	$194,463.20	2024-10-01
614475	CDM	Gft Bif 36-16x145mm 20fr	14	10	$242,592.00	$242,592.00	$24,259.20	$242,592.00	$194,073.60	2024-10-01
620610	CDM	Gft Bif 23-16x124mm 18fr	14	10	$242,592.00	$242,592.00	$24,259.20	$242,592.00	$194,073.60	2024-10-01
620672	CDM	Gft Bif 23-13x124mm 18fr	14	10	$242,592.00	$242,592.00	$24,259.20	$242,592.00	$194,073.60	2024-10-01
621555	CDM	Gft Bif 23-13x145mm 18fr	14	10	$242,592.00	$242,592.00	$24,259.20	$242,592.00	$194,073.60	2024-10-01
614358	CDM	Gft Bif 25-13x166mm 18fr	14	10	$242,592.00	$242,592.00	$24,259.20	$242,592.00	$194,073.60	2024-10-01
619599	CDM	Gft Bif 32-16x145mm 20fr	14	10	$242,592.00	$242,592.00	$24,259.20	$242,592.00	$194,073.60	2024-10-01
619982	CDM	Gft Bif 23-16x166mm 18fr	14	10	$242,592.00	$242,592.00	$24,259.20	$242,592.00	$194,073.60	2024-10-01
619464	CDM	Gft Bif 28-13x166mm 20fr	14	10	$242,592.00	$242,592.00	$24,259.20	$242,592.00	$194,073.60	2024-10-01
635725	CDM	Implant Cranial Plate	14	10	$240,581.00	$240,581.00	$24,058.10	$240,581.00	$192,464.80	2024-10-01
003	OTHER	$950.00	1	1	$528,616.00	—	$192,285.00	$192,285.00	$192,285.00	2026-07-17
422402	CDM	Valve Aortic Xl	14	10	$238,336.00	$238,336.00	$23,833.60	$238,336.00	$190,668.80	2024-10-01
422400	CDM	Valve Aortic Sm	14	10	$238,336.00	$238,336.00	$23,833.60	$238,336.00	$190,668.80	2024-10-01
632707	CDM	Valve Aortic Lg 23-25mm	14	10	$238,336.00	$238,336.00	$23,833.60	$238,336.00	$190,668.80	2024-10-01

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