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

HCA HEALTHONE PRESBYTERIAN ST LUKES

Denver, CO · CCN 060014 · Rates published

33,838 distinct procedures filed
43 distinct payers
1,202,151 rate rows
2026-03-01 last MRF observed
Data quality

1,164,518 of 1,202,151 rate rows are consumer-grade (96.9%)

37,633 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 23,415
per-diem day rate — not a per-procedure price 12,394
template filing: same amount across many unrelated codes — excluded 1,691
placeholder amount (≤ $0.02) — excluded from medians 119
exceeds 10× this hospital's gross charge — excluded from medians 14
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/84-1321373_HCA-HEALTHONE-PRESBYTERIAN-ST-LUKES_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.healthonecares.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 406715aea8b38ec2… · 682,091,221 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 2 $4,850,948.67 $4,850,948.67 $4,850,948.67 nat. median
$3,004,655
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 18 $3,829,250.00 $4,730,250.00 $4,505,000.00 nat. median
$9,966
outlier · 452.1×
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 5 $3,670,252.89 $4,271,819.03 $4,271,819.03 nat. median
$2,468,984
1.7× median
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 3 $3,847,800.00 $3,847,800.00 $3,847,800.00 nat. median
$2,448,600
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 18 $3,132,476.95 $3,869,530.35 $3,685,267.00 nat. median
$3,746,358
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 18 $2,835,447.00 $3,502,611.00 $3,335,820.00 nat. median
$22,747
outlier · 146.6×
714
OTHER 		Inj Delandistrogene Mox R 18 $2,828,681.00 $3,494,253.00 $3,327,860.00 nat. median
$13,041
outlier · 255.2×
748
OTHER 		Inj, Lovotibeglogene Auto 18 $2,764,631.80 $3,415,133.40 $3,252,508.00 nat. median
$17,963
outlier · 181.1×
906
OTHER 		Inj Elivaldogene Autoteme 18 $2,703,000.00 $3,339,000.00 $3,180,000.00 nat. median
$20,756
outlier · 153.2×
746
OTHER 		Inj, Betibeglogene Autote 18 $2,498,973.65 $3,086,967.45 $2,939,969.00 nat. median
$21,896
outlier · 134.3×
9141
OTHER 		Inj Onase Abepar-xioi Tre 18 $2,200,633.85 $2,718,430.05 $2,588,981.00 nat. median
$2,588,981
1.0× median
Q2058
HCPCS 		Obecabtagene Inj 11 $459,112.50 $4,258,848.00 $2,339,140.00 nat. median
$324,450
outlier · 7.2×
824
OTHER 		Inj, Exagamglogene Autote 18 $1,982,200.00 $2,448,600.00 $2,332,000.00 nat. median
$25,250
outlier · 92.4×
Q2054
HCPCS 		Lisocabtagene 13 $765,607.90 $4,258,848.00 $2,093,127.00 nat. median
$673,137
outlier · 3.1×
Q2053
HCPCS 		Brexucabtagene 13 $725,845.60 $4,258,848.00 $2,093,127.00 nat. median
$619,808
outlier · 3.4×
Q2042
HCPCS 		Tisagenlecleucel Adult 13 $836,958.70 $4,258,848.00 $2,048,764.00 nat. median
$753,246
outlier · 2.7×
Q2056
HCPCS 		Ciltacabtagene 100 Mil 13 $819,605.32 $4,258,848.00 $2,048,764.00 nat. median
$674,867
outlier · 3.0×
Q2041
HCPCS 		Axicabtagene Adult 13 $741,901.04 $4,258,848.00 $2,048,764.00 nat. median
$634,303
outlier · 3.2×
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 2 $1,271,523.00 $1,271,523.00 $1,271,523.00 nat. median
$824,563
1.5× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $782,774.83 $920,834.85 $868,284.31 nat. median
$625,184
1.4× median
2067
OTHER 		Afamitresgene Autoleucel 18 $655,027.00 $809,151.00 $770,620.00 nat. median
$786,032
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 18 $499,502.16 $617,032.08 $587,649.60 nat. median
$587,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 18 $481,551.61 $594,857.87 $566,531.30 nat. median
$566,531
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 18 $477,871.02 $590,311.26 $562,201.20 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 18 $474,369.53 $585,985.89 $558,081.80 nat. median
$558,082
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 18 $452,363.37 $558,801.81 $532,192.20 nat. median
$532,192
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 18 $416,032.67 $513,922.71 $489,450.20 nat. median
$489,450
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 21 $1,975.00 $1,184,936.03 $358,468.40 nat. median
$370,174
1.0× median
30250X1
OTHER 		Transfusion Of Nonautologous Cord Blood Stem Cells Into Peripheral Artery, Open… 1 $352,277.00 $352,277.00 $352,277.00 nat. median
$275,325
1.3× median
30253X1
OTHER 		Transfusion Of Nonautologous Cord Blood Stem Cells Into Peripheral Artery, Percu… 1 $352,277.00 $352,277.00 $352,277.00 nat. median
$275,325
1.3× median
30263X1
OTHER 		Transfusion Of Nonautologous Cord Blood Stem Cells Into Central Artery, Percutan… 1 $352,277.00 $352,277.00 $352,277.00 nat. median
$275,325
1.3× median
30260X1
OTHER 		Transfusion Of Nonautologous Cord Blood Stem Cells Into Central Artery, Open App… 1 $352,277.00 $352,277.00 $352,277.00 nat. median
$275,325
1.3× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 3 $332,753.88 $332,753.88 $332,753.88 nat. median
$209,753
1.6× median
5834
APR_DRG 		Neonate With Ecmo 2 $261,566.29 $390,081.55 $325,823.92 nat. median
$309,665
1.1× median
J7330
HCPCS 		Algrf Maci Fnl 1 Membran 20 $103,070.74 $610,287.30 $323,452.27 nat. median
$76,329
outlier · 4.2×
873686
CDM 		Kit Aor Vlv 14fr 29mm 18 $72,311.72 $428,161.50 $304,470.40 nat. median
$166,491
1.8× median
831
OTHER 		Obecbtge Autol Up To 400 18 $236,512.50 $292,162.50 $278,250.00 nat. median
$12,362
outlier · 22.5×
5833
APR_DRG 		Neonate With Ecmo 2 $207,165.75 $342,642.39 $274,904.07 nat. median
$244,017
1.1× median
C1825
HCPCS 		System Gen Neo2 18 $64,223.04 $380,268.00 $270,412.80 nat. median
$52,021
outlier · 5.2×
897
OTHER 		Revakinagene, Per Implant 18 $225,250.00 $278,250.00 $265,000.00 nat. median
$9,577
outlier · 27.7×
888466
CDM 		Allo Acq Unrel Dbl Cord 18 $82,088.85 $486,052.42 $258,417.88 nat. median
$258,418
1.0× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $214,555.75 $300,544.34 $257,550.05 nat. median
$246,434
1.0× median
30243X3
OTHER 		Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Per… 8 $2,740.00 $409,345.00 $257,220.75 nat. median
$270,000
1.0× median
30233X3
OTHER 		Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein,… 8 $2,740.00 $409,345.00 $257,220.75 nat. median
$270,000
1.0× median
30230X3
OTHER 		Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein,… 8 $2,740.00 $409,345.00 $257,220.75 nat. median
$270,000
1.0× median
30240X3
OTHER 		Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Ope… 8 $2,740.00 $409,345.00 $257,220.75 nat. median
$270,000
1.0× median
30240U3
OTHER 		Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 8 $2,740.00 $409,345.00 $250,002.50 nat. median
$247,431
1.0× median
30240Y3
OTHER 		Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein,… 8 $2,740.00 $409,345.00 $250,002.50 nat. median
$255,150
1.0× median
30230U3
OTHER 		Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 8 $2,740.00 $409,345.00 $250,002.50 nat. median
$250,002
1.0× median
30243G3
OTHER 		Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Percutaneous… 8 $2,740.00 $409,345.00 $250,002.50 nat. median
$255,150
1.0× median

Other procedures at this hospital

Browse this hospital's 33,838 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 3 2 — — $4,850,948.67 $4,850,948.67 $4,850,948.67 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 25 18 — — $3,829,250.00 $4,730,250.00 $4,505,000.00 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 9 5 — — $3,670,252.89 $4,271,819.03 $4,271,819.03 2026-03-01
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 6 3 — — $3,847,800.00 $3,847,800.00 $3,847,800.00 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 25 18 — — $3,132,476.95 $3,869,530.35 $3,685,267.00 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 25 18 — — $2,835,447.00 $3,502,611.00 $3,335,820.00 2026-03-01
714 OTHER Inj Delandistrogene Mox R 25 18 — — $2,828,681.00 $3,494,253.00 $3,327,860.00 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 25 18 — — $2,764,631.80 $3,415,133.40 $3,252,508.00 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 25 18 — — $2,703,000.00 $3,339,000.00 $3,180,000.00 2026-03-01
746 OTHER Inj, Betibeglogene Autote 25 18 — — $2,498,973.65 $3,086,967.45 $2,939,969.00 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 25 18 — — $2,200,633.85 $2,718,430.05 $2,588,981.00 2026-03-01
Q2058 HCPCS Obecabtagene Inj 25 11 — — $459,112.50 $4,258,848.00 $2,339,140.00 2026-03-01
824 OTHER Inj, Exagamglogene Autote 25 18 — — $1,982,200.00 $2,448,600.00 $2,332,000.00 2026-03-01
Q2053 HCPCS Brexucabtagene 28 13 — — $725,845.60 $4,258,848.00 $2,093,127.00 2026-03-01
Q2054 HCPCS Lisocabtagene 28 13 — — $765,607.90 $4,258,848.00 $2,093,127.00 2026-03-01
Q2041 HCPCS Axicabtagene Adult 31 13 — — $741,901.04 $4,258,848.00 $2,048,764.00 2026-03-01
Q2042 HCPCS Tisagenlecleucel Adult 31 13 — — $836,958.70 $4,258,848.00 $2,048,764.00 2026-03-01
Q2056 HCPCS Ciltacabtagene 100 Mil 31 13 — — $819,605.32 $4,258,848.00 $2,048,764.00 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 3 2 — — $1,271,523.00 $1,271,523.00 $1,271,523.00 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 6 4 — — $782,774.83 $920,834.85 $868,284.31 2026-03-01
2067 OTHER Afamitresgene Autoleucel 25 18 — — $655,027.00 $809,151.00 $770,620.00 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 25 18 — — $499,502.16 $617,032.08 $587,649.60 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 25 18 — — $481,551.61 $594,857.87 $566,531.30 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 25 18 — — $477,871.02 $590,311.26 $562,201.20 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 25 18 — — $474,369.53 $585,985.89 $558,081.80 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 25 18 — — $452,363.37 $558,801.81 $532,192.20 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 25 18 — — $416,032.67 $513,922.71 $489,450.20 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 36 21 — — $1,975.00 $1,184,936.03 $358,468.40 2026-03-01
30250X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Peripheral Artery, Open … 1 1 — — $352,277.00 $352,277.00 $352,277.00 2026-03-01
30260X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Central Artery, Open App… 1 1 — — $352,277.00 $352,277.00 $352,277.00 2026-03-01
30263X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Central Artery, Percutan… 1 1 — — $352,277.00 $352,277.00 $352,277.00 2026-03-01
30253X1 OTHER Transfusion Of Nonautologous Cord Blood Stem Cells Into Peripheral Artery, Percu… 1 1 — — $352,277.00 $352,277.00 $352,277.00 2026-03-01
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 6 3 — — $332,753.88 $332,753.88 $332,753.88 2026-03-01
5834 APR_DRG Neonate With Ecmo 2 2 — — $261,566.29 $390,081.55 $325,823.92 2026-03-01
J7330 HCPCS Algrf Maci Fnl 1 Membran 41 20 $678,097.00 $678,097.00 $103,070.74 $610,287.30 $323,452.27 2026-03-01
873686 CDM Kit Aor Vlv 14fr 29mm 26 18 $475,735.00 $475,735.00 $72,311.72 $428,161.50 $304,470.40 2026-03-01
831 OTHER Obecbtge Autol Up To 400 25 18 — — $236,512.50 $292,162.50 $278,250.00 2026-03-01
5833 APR_DRG Neonate With Ecmo 2 2 — — $207,165.75 $342,642.39 $274,904.07 2026-03-01
C1825 HCPCS System Gen Neo2 25 18 $422,520.00 $422,520.00 $64,223.04 $380,268.00 $270,412.80 2026-03-01
897 OTHER Revakinagene, Per Implant 25 18 — — $225,250.00 $278,250.00 $265,000.00 2026-03-01
888466 CDM Allo Acq Unrel Dbl Cord 38 18 $540,058.25 $540,058.25 $82,088.85 $486,052.42 $258,417.88 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $214,555.75 $300,544.34 $257,550.05 2026-03-01
30230X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein, … 16 8 — — $2,740.00 $409,345.00 $257,220.75 2026-03-01
30233X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein, … 16 8 — — $2,740.00 $409,345.00 $257,220.75 2026-03-01
30243X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Per… 16 8 — — $2,740.00 $409,345.00 $257,220.75 2026-03-01
30240X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Ope… 16 8 — — $2,740.00 $409,345.00 $257,220.75 2026-03-01
30230Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Peripheral Vei… 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30230U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30240Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein, … 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30243Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein, … 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30243G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Percutaneous … 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30233U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30230G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Peripheral Vein, Open Appro… 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30233Y3 OTHER Transfusion Of Allogeneic Unrelated Hamatopoietic Stem Cells Into Peripheral Vei… 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30243U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30240U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30240G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Open Approach… 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
30233G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Peripheral Vein, Percutaneo… 15 8 — — $2,740.00 $409,345.00 $250,002.50 2026-03-01
607048 CDM Stent Eprsth 22fr 31mm 26 18 $386,304.00 $386,304.00 $58,718.21 $347,673.60 $247,234.56 2026-03-01
871391 CDM Valve Pulm 18mm 26 18 $373,269.00 $373,269.00 $56,736.89 $335,942.10 $238,892.16 2026-03-01
871390 CDM Valve Pulm 16mm 26 18 $373,269.00 $373,269.00 $56,736.89 $335,942.10 $238,892.16 2026-03-01
779819 CDM Impl Fix 22x80-12mm 26 18 $369,689.00 $369,689.00 $56,192.73 $332,720.10 $236,600.96 2026-03-01
779818 CDM Impl Fix 21x80-12mm 26 18 $369,689.00 $369,689.00 $56,192.73 $332,720.10 $236,600.96 2026-03-01
779810 CDM Impl Fix 16x80-12mm 26 18 $369,689.00 $369,689.00 $56,192.73 $332,720.10 $236,600.96 2026-03-01
779811 CDM Impl Fix 17.5x80-12mm 26 18 $369,689.00 $369,689.00 $56,192.73 $332,720.10 $236,600.96 2026-03-01
779815 CDM Impl Fix 19.5x80-12mm 26 18 $369,689.00 $369,689.00 $56,192.73 $332,720.10 $236,600.96 2026-03-01
779814 CDM Impl Fixtre 18x80-12mm 26 18 $369,689.00 $369,689.00 $56,192.73 $332,720.10 $236,600.96 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 46 23 — — $1,975.00 $768,975.82 $232,973.10 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 2 2 — — $197,966.87 $267,232.31 $232,599.59 2026-03-01
888258 CDM Allo Acq Unrltd Intrnl 38 18 $471,743.50 $471,743.50 $71,705.01 $424,569.15 $225,729.27 2026-03-01
887448 CDM Transcth Pulm Vlv Implnt 32 17 $450,432.00 $450,432.00 $68,465.66 $405,388.80 $222,963.84 2026-03-01
885915 CDM Imp Transcath Pulm Valve 32 17 $450,432.00 $450,432.00 $68,465.66 $405,388.80 $222,963.84 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 2 2 — — $205,140.78 $227,074.08 $216,107.43 2026-03-01
30240X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Central Vein, Open … 15 8 — — $135,000.00 $360,027.00 $206,269.00 2026-03-01
30243X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Central Vein, Percu… 15 8 — — $135,000.00 $360,027.00 $206,269.00 2026-03-01
30233X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Pe… 15 8 — — $135,000.00 $360,027.00 $206,269.00 2026-03-01
30230X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Op… 15 8 — — $135,000.00 $360,027.00 $206,269.00 2026-03-01
30230G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Open Approac… 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30230U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30243Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Central Vein, Pe… 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30233G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Percutaneous… 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30233U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30240U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30243G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Central Vein, Percutaneous Ap… 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30243U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30233Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Peripheral Vein,… 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30230Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Peripheral Vein,… 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30240Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Central Vein, Op… 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
30240G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Central Vein, Open Approach 14 8 — — $135,000.00 $360,027.00 $202,055.75 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 25 18 — — $171,418.65 $211,752.45 $201,669.00 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $155,732.75 $241,870.40 $198,801.58 2026-03-01
5832 APR_DRG Neonate With Ecmo 2 2 — — $152,764.55 $235,856.24 $194,310.39 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $144,665.98 $226,153.03 $185,409.51 2026-03-01
886343 CDM Liver Acquisition Dd 39 19 $384,412.25 $384,412.25 $58,430.66 $345,971.03 $184,517.88 2026-03-01
599964 CDM Ipg Dbs Rchrgbl Battery 26 18 $287,314.00 $287,314.00 $43,671.73 $258,582.60 $183,880.96 2026-03-01
773808 CDM Implnt Dent Pin 2 Med 26 18 $286,710.00 $286,710.00 $43,579.92 $258,039.00 $183,494.40 2026-03-01
30263X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Artery, Percutaneou… 22 8 — — $2,740.00 $409,345.00 $182,859.50 2026-03-01
30253X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Artery, Percutan… 22 8 — — $2,740.00 $409,345.00 $182,859.50 2026-03-01
30243X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Vein, Percutaneous … 22 8 — — $2,740.00 $409,345.00 $182,859.50 2026-03-01
30233X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Vein, Percutaneo… 22 8 — — $2,740.00 $409,345.00 $182,859.50 2026-03-01
30240X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Vein, Open Approach… 22 8 — — $2,740.00 $409,345.00 $182,859.50 2026-03-01
30250X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Artery, Open App… 22 8 — — $2,740.00 $409,345.00 $182,859.50 2026-03-01
30260X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Central Artery, Open Approa… 22 8 — — $2,740.00 $409,345.00 $182,859.50 2026-03-01
30230X0 OTHER Transfusion Of Autologous Cord Blood Stem Cells Into Peripheral Vein, Open Appro… 22 8 — — $2,740.00 $409,345.00 $182,859.50 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 33 22 — — $1,975.00 $585,857.72 $177,726.30 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 35 22 — — $1,975.00 $342,323.00 $176,689.00 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $134,952.74 $214,354.80 $174,653.77 2026-03-01
777583 CDM Implant Plvc Custom 26 18 $271,620.00 $271,620.00 $41,286.24 $244,458.00 $173,836.80 2026-03-01
970313 CDM Graft Art St Tis 6-32mm 26 18 $269,422.00 $269,422.00 $40,952.14 $242,479.80 $172,430.08 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $138,224.51 $205,887.53 $172,056.02 2026-03-01
30243Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Vein, Percutaneo… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30230C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30250Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Artery, Open … 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30243C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30233Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Vein, Percuta… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30253G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Artery, Percutaneous Appro… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30240Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Vein, Open Appro… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30263Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Artery, Percutan… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30233C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30230G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Vein, Open Approach 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30253Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Artery, Percu… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30250G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Artery, Open Approach 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30263G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Artery, Percutaneous Approach… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30260Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Central Artery, Open App… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30243G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Vein, Percutaneous Approach 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30230Y0 OTHER Transfusion Of Autologous Hematopoietic Stem Cells Into Peripheral Vein, Open Ap… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30240C0 OTHER Transfusion Of Autologous Hematopoietic Stem/Progenitor Cells, Genetically Modif… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30240G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Vein, Open Approach 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30260G0 OTHER Transfusion Of Autologous Bone Marrow Into Central Artery, Open Approach 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
30233G0 OTHER Transfusion Of Autologous Bone Marrow Into Peripheral Vein, Percutaneous Approac… 21 8 — — $2,740.00 $409,345.00 $170,719.00 2026-03-01
783358 CDM Stnt Thorac 26x26mm 10cm 26 18 $262,782.00 $262,782.00 $39,942.86 $236,503.80 $168,180.48 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $135,349.11 $197,085.00 $166,217.05 2026-03-01
968767 CDM Graft Bn Algrf Whl 26 18 $257,738.00 $257,738.00 $39,176.18 $231,964.20 $164,952.32 2026-03-01
774713 CDM Graft Evas 34x34x10cm 26 18 $257,629.00 $257,629.00 $39,159.61 $231,866.10 $164,882.56 2026-03-01
888467 CDM Liver Acqustn Living Dnr 39 19 $340,729.00 $340,729.00 $51,790.81 $306,656.10 $163,549.92 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $135,126.40 $189,805.36 $162,465.88 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $134,264.70 $184,979.66 $159,622.18 2026-03-01
C1822 HCPCS System Imp Ipg Neuro 50 18 $238,422.00 $238,422.00 $34,863.94 $222,728.40 $158,384.64 2026-03-01
943426 CDM Inst/rp Gen Sg/dl Icd 32 17 $319,678.25 $319,678.25 $48,591.09 $287,710.42 $158,240.73 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $129,783.91 $185,485.48 $157,634.70 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $128,899.68 $186,317.79 $157,608.73 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $139,930.65 $175,247.53 $157,589.09 2026-03-01
1908 OTHER New Technology - Level 52 25 18 — — $133,840.83 $165,332.79 $157,459.80 2026-03-01
1907 OTHER New Technology - Level 52 25 18 — — $133,840.83 $165,332.79 $157,459.80 2026-03-01
589193 CDM Kit Lo Prfl Comp Shth 7f 39 19 $327,450.00 $327,450.00 $49,772.40 $294,705.00 $157,176.00 2026-03-01
863779 CDM Set Vntrc 17.4x13.8in 39 19 $327,450.00 $327,450.00 $49,772.40 $294,705.00 $157,176.00 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 2 2 — — $155,337.18 $157,159.17 $156,248.17 2026-03-01
571375 CDM Kit Tibial Osteotomy 39 19 $323,128.00 $323,128.00 $49,115.46 $290,815.20 $155,101.44 2026-03-01
595978 CDM Implant Flap Cst Scmplx 26 18 $238,483.00 $238,483.00 $36,249.42 $214,634.70 $152,629.12 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $125,855.27 $173,879.40 $149,867.33 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $126,552.57 $164,450.82 $145,501.70 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $89,091.55 $197,085.00 $143,088.27 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $128,551.70 $156,275.14 $142,413.42 2026-03-01
1906 OTHER New Technology - Level 51 25 18 — — $120,676.20 $149,070.60 $141,972.00 2026-03-01
1905 OTHER New Technology - Level 51 25 18 — — $120,676.20 $149,070.60 $141,972.00 2026-03-01
986161 CDM Valve Aortic L5.6cm Od16 26 18 $221,590.00 $221,590.00 $33,681.68 $199,431.00 $141,817.60 2026-03-01
778209 CDM Valve Aor Crvlv 9-17mm 26 18 $221,590.00 $221,590.00 $33,681.68 $199,431.00 $141,817.60 2026-03-01
778207 CDM Valve Aor Cndt 23mm 26 18 $221,532.00 $221,532.00 $33,672.86 $199,378.80 $141,780.48 2026-03-01
606857 CDM Valve Aor With Cndt 24mm 26 18 $221,532.00 $221,532.00 $33,672.86 $199,378.80 $141,780.48 2026-03-01
5831 APR_DRG Neonate With Ecmo 2 2 — — $132,016.36 $148,342.61 $140,179.48 2026-03-01
833810 CDM Stent Eprsth 21mm 10cm 25 18 $218,107.00 $218,107.00 $33,152.26 $196,296.30 $139,588.48 2026-03-01
835876 CDM Stent Eprsth 28mm 10cm 25 18 $218,107.00 $218,107.00 $33,152.26 $196,296.30 $139,588.48 2026-03-01
951597 CDM Allo Acq Nmdp Stem Cell 38 18 $291,569.25 $291,569.25 $44,318.53 $262,412.33 $139,515.89 2026-03-01
951528 CDM Kidney Acquisition Dd 39 19 $289,463.50 $289,463.50 $43,998.45 $260,517.15 $138,942.48 2026-03-01
955646 CDM Rmv Icd W Rplc Dual Ld 32 17 $279,514.50 $279,514.50 $42,486.20 $251,563.05 $138,359.67 2026-03-01
955645 CDM Rmv Icd W Rplc Sgl Ld 32 17 $279,514.50 $279,514.50 $42,486.20 $251,563.05 $138,359.67 2026-03-01
955647 CDM Rmv Icd W Rplc Mult Ld 32 17 $279,514.50 $279,514.50 $42,486.20 $251,563.05 $138,359.67 2026-03-01
819686 CDM Stent Eprsth 31mm 10cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
822625 CDM Stent Eprsth 45mm 15cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
835884 CDM Stent Eprsth 45mm 10cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
822623 CDM Stent Eprsth 37mm 20cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
819684 CDM Stent Eprsth 15cm 28mm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
835885 CDM Stent Eprsth 45mm 20cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
835881 CDM Stent Eprsth 37mm 10cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
835880 CDM Stent Eprsth 34mm 20cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
835878 CDM Stent Eprsth 34mm 10cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
819681 CDM Stent Eprsth 31mm 15cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
822624 CDM Stent Eprsth 40mm 20cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
835883 CDM Stent Eprsth 40mm 15cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
835882 CDM Stent Eprsth 40mm 10cm 25 18 $215,911.00 $215,911.00 $32,818.47 $194,319.90 $138,183.04 2026-03-01
778208 CDM Valve Aortic 6-30mm 26 18 $214,154.00 $214,154.00 $32,551.41 $192,738.60 $137,058.56 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $112,480.50 $161,568.68 $137,024.59 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 2 2 — — $122,419.77 $144,998.05 $133,708.91 2026-03-01
C1767 HCPCS Kit Impl Neurostim 625 18 $213,614.00 $213,614.00 $15,505.37 $488,473.20 $132,888.96 2026-03-01
595979 CDM Cage Ankle Cstm Sz M 26 18 $205,888.00 $205,888.00 $31,294.98 $185,299.20 $131,768.32 2026-03-01
951596 CDM Allo Acq Nmdp Cord Bld 38 18 $270,029.75 $270,029.75 $41,044.52 $243,026.77 $129,209.24 2026-03-01
794446 CDM Visc Infrarn Abd 4+ Prst 32 17 $258,343.25 $258,343.25 $39,268.17 $232,508.92 $127,879.91 2026-03-01
794442 CDM Endovasc Visc Aor 4 Grft 32 17 $258,343.25 $258,343.25 $39,268.17 $232,508.92 $127,879.91 2026-03-01
1904 OTHER New Technology - Level 50 25 18 — — $107,511.57 $132,808.41 $126,484.20 2026-03-01
1903 OTHER New Technology - Level 50 25 18 — — $107,511.57 $132,808.41 $126,484.20 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 2 2 — — $126,060.92 $126,185.36 $126,123.14 2026-03-01
833716 CDM Set Pump Asst 2.5in 39 19 $261,960.00 $261,960.00 $39,817.92 $235,764.00 $125,740.80 2026-03-01
583512 CDM Implant Crnl Small 26 18 $196,183.00 $196,183.00 $29,819.82 $176,564.70 $125,557.12 2026-03-01
C1820 HCPCS Generator Ipg Nrstm 350 18 $198,283.00 $198,283.00 $22,569.87 $235,323.90 $125,205.99 2026-03-01
584411 CDM Graft Stnt 21f 40/36x145 25 18 $192,549.00 $192,549.00 $29,267.45 $173,294.10 $123,231.36 2026-03-01
794445 CDM Visc Infraren Abd 3 Prst 32 17 $247,111.50 $247,111.50 $37,560.95 $222,400.35 $122,320.20 2026-03-01
794441 CDM Endovasc Visc Aor 3 Grft 32 17 $247,111.50 $247,111.50 $37,560.95 $222,400.35 $122,320.20 2026-03-01
951527 CDM Kidney Acquisition Live 39 19 $254,466.50 $254,466.50 $38,678.91 $229,019.85 $122,143.92 2026-03-01
1611 APR_DRG Implantable Heart Assist Systems 2 2 — — $119,774.96 $119,875.13 $119,825.05 2026-03-01
64 APR_DRG Pancreas Transplant 2 2 — — $111,760.66 $126,246.35 $119,003.51 2026-03-01
794440 CDM Endovasc Visc Aor 2 Grft 32 17 $235,879.00 $235,879.00 $35,853.61 $212,291.10 $116,760.10 2026-03-01
794444 CDM Visc Infraren Abd 2 Prst 32 17 $235,879.00 $235,879.00 $35,853.61 $212,291.10 $116,760.10 2026-03-01
955644 CDM Ins Icd Gen W Mult Lead 32 17 $234,570.00 $234,570.00 $35,654.64 $211,113.00 $116,112.15 2026-03-01
777585 CDM Implant Custom Made Devi 26 18 $181,080.00 $181,080.00 $27,524.16 $162,972.00 $115,891.20 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 36 22 — — $1,975.00 $494,413.70 $115,643.80 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $100,302.82 $129,939.46 $115,121.14 2026-03-01
798749 CDM Graft Endo Aaa 26x12mm 26 18 $177,633.00 $177,633.00 $27,000.22 $159,869.70 $113,685.12 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 25 18 — — $95,490.70 $117,959.10 $112,342.00 2026-03-01
794439 CDM Endovasc Visc Aor 1 Grft 32 17 $224,646.50 $224,646.50 $34,146.27 $202,181.85 $111,200.02 2026-03-01
794443 CDM Visc Infraren Abd 1 Prst 32 17 $224,646.50 $224,646.50 $34,146.27 $202,181.85 $111,200.02 2026-03-01
1902 OTHER New Technology - Level 49 25 18 — — $94,346.94 $116,546.22 $110,996.40 2026-03-01
1901 OTHER New Technology - Level 49 25 18 — — $94,346.94 $116,546.22 $110,996.40 2026-03-01
986163 CDM Valve Pulmonary Sm 26 18 $171,766.00 $171,766.00 $26,108.43 $154,589.40 $109,930.24 2026-03-01
533815 CDM Valve Pulm Med 17-21mm 26 18 $170,731.00 $170,731.00 $25,951.11 $153,657.90 $109,267.84 2026-03-01
L8614 HCPCS Implant Coclr Hires 90k 639 31 $206,377.00 $206,377.00 $2,844.22 $389,883.60 $109,023.20 2026-03-01
7 MS_DRG Lung Transplant 43 21 — — $1,975.00 $355,353.49 $108,183.10 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $79,163.55 $137,036.42 $108,099.99 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $97,193.43 $118,758.01 $107,975.72 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 6 4 — — $102,561.22 $106,879.59 $106,053.40 2026-03-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 5 3 — — $103,412.00 $109,731.32 $105,297.73 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $86,804.09 $123,515.26 $105,159.67 2026-03-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $89,985.06 $119,568.94 $104,777.00 2026-03-01
606835 CDM Kit Bn Ostomy Long 39 19 $216,406.00 $216,406.00 $32,893.71 $194,765.40 $103,874.88 2026-03-01
22 APR_DRG Heart And/or Lung Transplant 2 2 — — $90,848.74 $114,919.11 $102,883.93 2026-03-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $88,358.45 $114,461.64 $101,410.04 2026-03-01
589435 CDM Cage Bn Strl 2.5-5cm 26 18 $158,083.00 $158,083.00 $24,028.62 $142,274.70 $101,173.12 2026-03-01
951595 CDM Allo Acq Peri Stem Cell 38 18 $211,282.00 $211,282.00 $32,114.86 $190,153.80 $101,098.43 2026-03-01
779804 CDM Impl Abutment Prost 26 18 $157,794.00 $157,794.00 $23,984.69 $142,014.60 $100,988.16 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 42 23 — — $3,000.00 $329,771.18 $100,464.90 2026-03-01
563373 CDM Valve Algrt Pulm Artery 26 18 $156,924.00 $156,924.00 $23,852.45 $141,231.60 $100,431.36 2026-03-01
986164 CDM Valve Aortic =16mm 26 18 $156,065.00 $156,065.00 $23,721.88 $140,458.50 $99,881.60 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 6 4 — — $93,760.51 $110,197.09 $99,752.60 2026-03-01
997676 CDM Graft Hemi Cndyl Mdl Lt 26 18 $155,211.00 $155,211.00 $23,592.07 $139,689.90 $99,335.04 2026-03-01
967441 CDM Graft Bn Fem Medial Left 26 18 $155,211.00 $155,211.00 $23,592.07 $139,689.90 $99,335.04 2026-03-01
849531 CDM Graft Hemi Cndyl Rt Mdl 26 18 $155,211.00 $155,211.00 $23,592.07 $139,689.90 $99,335.04 2026-03-01
879797 CDM Graft Evas 10cm 14.5mm 26 18 $154,461.00 $154,461.00 $23,478.07 $139,014.90 $98,855.04 2026-03-01
879796 CDM Graft Evas 10cm 12mm 26 18 $154,461.00 $154,461.00 $23,478.07 $139,014.90 $98,855.04 2026-03-01
875000 CDM Applier Int Clip 86cm 26 18 $153,881.00 $153,881.00 $23,389.91 $138,492.90 $98,483.84 2026-03-01
C9293 HCPCS Glucarpidase 1000 U Inj 40 20 $234,171.75 $234,171.75 $740.34 $210,754.58 $98,235.05 2026-03-01
1599 OTHER New Technology - Level 48 25 18 — — $83,376.42 $102,994.41 $98,089.91 2026-03-01
1585 OTHER New Technology - Level 48 25 18 — — $83,376.42 $102,994.41 $98,089.91 2026-03-01
574166 CDM Valve Pm 27mm 4.6cm 26 18 $152,170.00 $152,170.00 $23,129.84 $136,953.00 $97,388.80 2026-03-01
898769 CDM Evas Rpr Prosthesis Addl 32 17 $196,700.25 $196,700.25 $29,898.44 $177,030.23 $97,366.62 2026-03-01
898767 CDM Evas Rpr Delayd Ext Addl 32 17 $196,700.25 $196,700.25 $29,898.44 $177,030.23 $97,366.62 2026-03-01
997677 CDM Graft Bn Fem Hemi Cndyl 26 18 $151,953.00 $151,953.00 $23,096.86 $136,757.70 $97,249.92 2026-03-01
975598 CDM Graft Bn Hemi Condrl Rt 26 18 $151,953.00 $151,953.00 $23,096.86 $136,757.70 $97,249.92 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $87,971.36 $103,331.49 $95,651.43 2026-03-01
862140 CDM Graft Mdl Condyle Prt Lt 26 18 $148,960.00 $148,960.00 $22,641.92 $134,064.00 $95,334.40 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 25 18 — — $80,818.85 $99,835.05 $95,081.00 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 46 23 — — $1,975.00 $310,944.59 $94,784.90 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 46 22 — — $1,975.00 $310,587.87 $94,677.28 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $80,326.17 $108,971.34 $94,648.76 2026-03-01
776975 CDM Rotapro Console Kit Assy 39 19 $196,470.00 $196,470.00 $29,863.44 $176,823.00 $94,305.60 2026-03-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $66,427.10 $121,745.32 $94,086.21 2026-03-01
565377 CDM Graft Endo Aaa 32x14mm 26 18 $146,494.00 $146,494.00 $22,267.09 $131,844.60 $93,756.16 2026-03-01
566572 CDM Gft Evs 15f 20x14.5x12mm 26 18 $146,494.00 $146,494.00 $22,267.09 $131,844.60 $93,756.16 2026-03-01
796086 CDM Graft Endo Aaa 23x12mm 26 18 $146,494.00 $146,494.00 $22,267.09 $131,844.60 $93,756.16 2026-03-01
890951 CDM Graft Bn Cndyl Plg Latrl 26 18 $146,234.00 $146,234.00 $22,227.57 $131,610.60 $93,589.76 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $84,718.14 $101,268.68 $92,993.41 2026-03-01
789349 CDM Cath Rh W Wirls Sens Plc 32 17 $187,598.50 $187,598.50 $28,514.97 $168,838.65 $92,861.26 2026-03-01
898775 CDM Evas Rpr Ao/il Nonrupt 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
898774 CDM Evas Rpr Ao/il Rupt Uni 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
117332 CDM Evas Rpr Iliac Nonrupt E 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
898776 CDM Evas Rpr Infrn Ao Rupt 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
898777 CDM Evas Rpr Infr Ao Nonrupt 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
898768 CDM Evas Rpr Delayd Ext Intl 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
124161 CDM Evas Stnt Coa Without Sb 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
898771 CDM Evas Rpr Iliac Nonrupt 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
898773 CDM Evas Rpr Ao/il Nonrup Bi 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
118176 CDM Evas St Rpr Ac Maj Brnch 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
898772 CDM Evas Rpr Ao/il Rupt Bi 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
898770 CDM Evas Rpr Iliac Art Rupt 32 17 $187,332.75 $187,332.75 $28,474.58 $168,599.48 $92,729.71 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 46 22 — — $1,975.00 $249,105.00 $92,213.55 2026-03-01
791553 CDM Perq Acc/cls Fem Art Uni 32 17 $185,971.25 $185,971.25 $28,267.63 $167,374.13 $92,055.77 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 49 24 — — $1,975.00 $298,385.30 $90,995.76 2026-03-01
C1882 HCPCS Crt-d Crd 5.37x8.08x0.99 375 18 $141,783.00 $141,783.00 $19,557.99 $154,247.40 $90,741.12 2026-03-01
982184 CDM Graft Bn Fem Whole Left 26 18 $140,881.00 $140,881.00 $21,413.91 $126,792.90 $90,163.84 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 10 5 — — $80,684.58 $137,213.42 $89,766.78 2026-03-01
0811 RC — 6 2 — — $45,000.00 $178,009.00 $89,629.50 2026-03-01
0812 RC — 6 2 — — $45,000.00 $178,009.00 $89,629.50 2026-03-01
0813 RC — 6 2 — — $45,000.00 $178,009.00 $89,629.50 2026-03-01
0810 RC — 6 2 — — $45,000.00 $178,009.00 $89,629.50 2026-03-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $77,041.14 $101,808.06 $89,424.60 2026-03-01
868552 CDM Prcssor Xtrn Dl Coclr IM 39 19 $185,992.00 $185,992.00 $28,270.78 $167,392.80 $89,276.16 2026-03-01
21 APR_DRG Heart And/or Lung Transplant 2 2 — — $77,881.62 $100,088.69 $88,985.15 2026-03-01
587421 CDM Implant Abutment Custm 26 18 $138,828.00 $138,828.00 $21,101.86 $124,945.20 $88,849.92 2026-03-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $71,321.49 $105,620.11 $88,470.80 2026-03-01
953021 CDM Revasc Tib Stnt/ath Init 32 17 $178,679.25 $178,679.25 $27,159.25 $160,811.33 $88,446.23 2026-03-01
953038 CDM Revasc Tib Stnt/ath Init 32 17 $178,679.25 $178,679.25 $27,159.25 $160,811.33 $88,446.23 2026-03-01
953034 CDM Revasc Fem/pop Stnt/ath 32 17 $178,679.25 $178,679.25 $27,159.25 $160,811.33 $88,446.23 2026-03-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $79,091.29 $96,874.47 $87,982.88 2026-03-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 2 2 — — $73,110.50 $102,546.31 $87,828.40 2026-03-01
1598 OTHER New Technology - Level 47 25 18 — — $74,600.01 $92,152.96 $87,764.72 2026-03-01
1584 OTHER New Technology - Level 47 25 18 — — $74,600.01 $92,152.96 $87,764.72 2026-03-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $75,246.17 $99,720.04 $87,483.10 2026-03-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $78,213.70 $96,556.86 $87,385.28 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 58 25 — — $1,975.00 $400,495.00 $87,193.21 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $81,810.93 $92,263.72 $87,037.32 2026-03-01
C2616 HCPCS Brachytx Ns Yttrium 90 33 18 $181,080.00 $181,080.00 $8,688.00 $162,972.00 $86,918.40 2026-03-01
594774 CDM Pump Pain Infn 148gm 26 18 $135,050.00 $135,050.00 $20,527.60 $121,545.00 $86,432.00 2026-03-01
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