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 MOUNTAIN RIDGE

Thornton, CO · CCN 060065 · Rates published

26,908 distinct procedures filed
34 distinct payers
754,815 rate rows
2026-03-01 last MRF observed
Data quality

713,434 of 754,815 rate rows are consumer-grade (94.5%)

41,381 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
per-diem day rate — not a per-procedure price 20,455
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 18,603
template filing: same amount across many unrelated codes — excluded 1,691
exceeds 10× this hospital's gross charge — excluded from medians 533
placeholder amount (≤ $0.02) — excluded from medians 99
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-MOUNTAIN-RIDGE_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 Latest re-check couldn't be parsed — showing last good data · 2026-05-18
Content fingerprint 7f33aed7dcf26862… · 435,533,695 bytes · first seen 2026-05-17

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 $4,850,948.67 $4,850,948.67 $4,850,948.67 nat. median
$3,004,655
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 15 $4,459,950.00 $4,730,250.00 $4,505,000.00 nat. median
$9,966
outlier · 452.1×
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $3,847,800.00 $3,847,800.00 $3,847,800.00 nat. median
$2,448,600
1.6× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 3 $3,670,252.89 $4,271,819.03 $3,824,789.85 nat. median
$2,468,984
1.5× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 15 $3,648,414.33 $3,869,530.35 $3,685,267.00 nat. median
$3,746,358
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 15 $3,302,461.80 $3,502,611.00 $3,335,820.00 nat. median
$22,747
outlier · 146.6×
714
OTHER 		Inj Delandistrogene Mox R 15 $3,294,581.40 $3,494,253.00 $3,327,860.00 nat. median
$13,041
outlier · 255.2×
748
OTHER 		Inj, Lovotibeglogene Auto 15 $3,219,982.92 $3,415,133.40 $3,252,508.00 nat. median
$17,963
outlier · 181.1×
906
OTHER 		Inj Elivaldogene Autoteme 15 $3,148,200.00 $3,339,000.00 $3,180,000.00 nat. median
$20,756
outlier · 153.2×
746
OTHER 		Inj, Betibeglogene Autote 15 $2,910,569.31 $3,086,967.45 $2,939,969.00 nat. median
$21,896
outlier · 134.3×
9141
OTHER 		Inj Onase Abepar-xioi Tre 15 $2,563,091.19 $2,718,430.05 $2,588,981.00 nat. median
$2,588,981
1.0× median
824
OTHER 		Inj, Exagamglogene Autote 15 $2,308,680.00 $2,448,600.00 $2,332,000.00 nat. median
$25,250
outlier · 92.4×
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 2 $1,271,523.00 $2,311,860.00 $2,311,860.00 nat. median
$824,563
outlier · 2.8×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 5 $819,605.32 $1,762,948.71 $1,366,285.25 nat. median
$674,867
outlier · 2.0×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 5 $836,958.70 $1,699,593.90 $1,317,185.27 nat. median
$753,246
1.7× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 5 $765,607.90 $1,686,603.72 $1,307,117.89 nat. median
$673,137
1.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 5 $782,774.83 $1,674,245.19 $1,297,540.02 nat. median
$625,184
outlier · 2.1×
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 2 $459,112.50 $834,750.00 $834,750.00 nat. median
$324,450
outlier · 2.6×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $741,901.04 $1,596,576.72 $825,628.09 nat. median
$634,303
1.3× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $725,845.60 $1,468,350.60 $782,000.18 nat. median
$619,808
1.3× median
2067
OTHER 		Afamitresgene Autoleucel 15 $762,913.80 $809,151.00 $770,620.00 nat. median
$786,032
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 15 $581,773.10 $617,032.08 $587,649.60 nat. median
$587,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 15 $560,865.99 $594,857.87 $566,531.30 nat. median
$566,531
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 15 $556,579.19 $590,311.26 $562,201.20 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 15 $552,500.98 $585,985.89 $558,081.80 nat. median
$558,082
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 15 $526,870.28 $558,801.81 $532,192.20 nat. median
$532,192
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 15 $484,555.70 $513,922.71 $489,450.20 nat. median
$489,450
1.0× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 3 $332,753.88 $605,007.06 $468,880.47 nat. median
$209,753
outlier · 2.2×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 18 $1,975.00 $616,909.48 $345,988.90 nat. median
$370,174
0.9× median
833716
CDM 		Pump Cath Lv Impella 9fr 16 $101,072.40 $598,455.00 $334,137.38 nat. median
$17,844
outlier · 18.7×
581224
CDM 		Cath Vasc Assist Strl 16 $101,072.40 $598,455.00 $334,137.38 nat. median
$58,252
outlier · 5.7×
589193
CDM 		Kit Lo Prfl Comp Shth 7f 16 $101,072.40 $598,455.00 $334,137.38 nat. median
$80,670
outlier · 4.1×
573195
CDM 		Kit Cath Rt Heart 16 $101,072.40 $598,455.00 $334,137.38 nat. median
$61,160
outlier · 5.5×
863779
CDM 		Set Vntrc 17.4x13.8in 16 $101,072.40 $598,455.00 $334,137.38 nat. median
$71,700
outlier · 4.7×
C1825
HCPCS 		System Nrstm Gen Ipg 16 $77,411.32 $458,356.50 $325,942.40 nat. median
$52,021
outlier · 6.3×
5834
APR_DRG 		Neonate With Ecmo 2 $252,178.74 $390,081.55 $321,130.15 nat. median
$309,665
1.0× median
831
OTHER 		Obecbtge Autol Up To 400 15 $275,467.50 $292,162.50 $278,250.00 nat. median
$12,362
outlier · 22.5×
5833
APR_DRG 		Neonate With Ecmo 2 $199,730.62 $342,642.39 $271,186.51 nat. median
$244,017
1.1× median
897
OTHER 		Revakinagene, Per Implant 15 $262,350.00 $278,250.00 $265,000.00 nat. median
$9,577
outlier · 27.7×
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $206,855.38 $300,544.34 $253,699.86 nat. median
$246,434
1.0× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 2 $138,148.31 $251,178.75 $251,178.75 nat. median
$76,329
outlier · 3.3×
C1604
HCPCS 		System Graft Stent Case 14 $55,293.80 $327,397.50 $234,634.88 nat. median
$28,350
outlier · 8.3×
24
APR_DRG 		Heart And/or Lung Transplant 2 $190,861.88 $267,232.31 $229,047.10 nat. median
$234,729
1.0× median
C1824
HCPCS 		Gen Pls Card Smart Mini 16 $49,485.88 $331,227.00 $227,895.50 nat. median
$37,950
outlier · 6.0×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 20 $1,975.00 $400,349.44 $225,436.20 nat. median
$265,286
0.8× median
C1735
HCPCS 		Catheter Renal 6fr 15 $64,686.34 $383,011.20 $224,699.90 nat. median
$26,064
outlier · 8.6×
1614
APR_DRG 		Implantable Heart Assist Systems 2 $197,778.32 $227,074.08 $212,426.20 nat. median
$207,730
1.0× median
886
OTHER 		Inj. Remestemcel-l-rknd/ 15 $199,652.31 $211,752.45 $201,669.00 nat. median
$17,985
outlier · 11.2×
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 $150,143.53 $241,870.40 $196,006.96 nat. median
$150,721
1.3× median
5832
APR_DRG 		Neonate With Ecmo 2 $147,281.87 $235,856.24 $191,569.05 nat. median
$156,126
1.2× median

Other procedures at this hospital

Browse this hospital's 26,908 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
             
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 1 1 — — $4,850,948.67 $4,850,948.67 $4,850,948.67 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 21 15 — — $4,459,950.00 $4,730,250.00 $4,505,000.00 2026-03-01
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 1 1 — — $3,847,800.00 $3,847,800.00 $3,847,800.00 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 4 3 — — $3,670,252.89 $4,271,819.03 $3,824,789.85 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 21 15 — — $3,648,414.33 $3,869,530.35 $3,685,267.00 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 21 15 — — $3,302,461.80 $3,502,611.00 $3,335,820.00 2026-03-01
714 OTHER Inj Delandistrogene Mox R 21 15 — — $3,294,581.40 $3,494,253.00 $3,327,860.00 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 21 15 — — $3,219,982.92 $3,415,133.40 $3,252,508.00 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 21 15 — — $3,148,200.00 $3,339,000.00 $3,180,000.00 2026-03-01
746 OTHER Inj, Betibeglogene Autote 21 15 — — $2,910,569.31 $3,086,967.45 $2,939,969.00 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 21 15 — — $2,563,091.19 $2,718,430.05 $2,588,981.00 2026-03-01
824 OTHER Inj, Exagamglogene Autote 21 15 — — $2,308,680.00 $2,448,600.00 $2,332,000.00 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 3 2 — — $1,271,523.00 $2,311,860.00 $2,311,860.00 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 9 5 — — $819,605.32 $1,762,948.71 $1,366,285.25 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 9 5 — — $836,958.70 $1,699,593.90 $1,317,185.27 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 9 5 — — $765,607.90 $1,686,603.72 $1,307,117.89 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 9 5 — — $782,774.83 $1,674,245.19 $1,297,540.02 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 3 2 — — $459,112.50 $834,750.00 $834,750.00 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 6 4 — — $741,901.04 $1,596,576.72 $825,628.09 2026-03-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 6 4 — — $725,845.60 $1,468,350.60 $782,000.18 2026-03-01
2067 OTHER Afamitresgene Autoleucel 21 15 — — $762,913.80 $809,151.00 $770,620.00 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 21 15 — — $581,773.10 $617,032.08 $587,649.60 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 21 15 — — $560,865.99 $594,857.87 $566,531.30 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 21 15 — — $556,579.19 $590,311.26 $562,201.20 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 21 15 — — $552,500.98 $585,985.89 $558,081.80 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 21 15 — — $526,870.28 $558,801.81 $532,192.20 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 21 15 — — $484,555.70 $513,922.71 $489,450.20 2026-03-01
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 6 3 — — $332,753.88 $605,007.06 $468,880.47 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 29 18 — — $1,975.00 $616,909.48 $345,988.90 2026-03-01
863779 CDM Set Vntrc 17.4x13.8in 32 16 $664,950.00 $664,950.00 $101,072.40 $598,455.00 $334,137.38 2026-03-01
833716 CDM Pump Cath Lv Impella 9fr 32 16 $664,950.00 $664,950.00 $101,072.40 $598,455.00 $334,137.38 2026-03-01
589193 CDM Kit Lo Prfl Comp Shth 7f 32 16 $664,950.00 $664,950.00 $101,072.40 $598,455.00 $334,137.38 2026-03-01
573195 CDM Kit Cath Rt Heart 32 16 $664,950.00 $664,950.00 $101,072.40 $598,455.00 $334,137.38 2026-03-01
581224 CDM Cath Vasc Assist Strl 32 16 $664,950.00 $664,950.00 $101,072.40 $598,455.00 $334,137.38 2026-03-01
C1825 HCPCS System Nrstm Gen Ipg 23 16 $509,285.00 $509,285.00 $77,411.32 $458,356.50 $325,942.40 2026-03-01
5834 APR_DRG Neonate With Ecmo 2 2 — — $252,178.74 $390,081.55 $321,130.15 2026-03-01
831 OTHER Obecbtge Autol Up To 400 21 15 — — $275,467.50 $292,162.50 $278,250.00 2026-03-01
5833 APR_DRG Neonate With Ecmo 2 2 — — $199,730.62 $342,642.39 $271,186.51 2026-03-01
897 OTHER Revakinagene, Per Implant 21 15 — — $262,350.00 $278,250.00 $265,000.00 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $206,855.38 $300,544.34 $253,699.86 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 3 2 — — $138,148.31 $251,178.75 $251,178.75 2026-03-01
C1604 HCPCS System Graft Stent Case 20 14 $363,775.00 $363,775.00 $55,293.80 $327,397.50 $234,634.88 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 2 2 — — $190,861.88 $267,232.31 $229,047.10 2026-03-01
C1824 HCPCS Gen Pls Card Smart Mini 46 16 $346,797.50 $346,797.50 $49,485.88 $331,227.00 $227,895.50 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 33 20 — — $1,975.00 $400,349.44 $225,436.20 2026-03-01
C1735 HCPCS Catheter Renal 6fr 29 15 $425,568.00 $425,568.00 $64,686.34 $383,011.20 $224,699.90 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 2 2 — — $197,778.32 $227,074.08 $212,426.20 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 21 15 — — $199,652.31 $211,752.45 $201,669.00 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $150,143.53 $241,870.40 $196,006.96 2026-03-01
5832 APR_DRG Neonate With Ecmo 2 2 — — $147,281.87 $235,856.24 $191,569.05 2026-03-01
C1772 HCPCS Pump Infs Pain 40ml 46 16 $280,436.50 $280,436.50 $40,024.79 $267,796.80 $184,324.70 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $139,473.95 $226,153.03 $182,813.49 2026-03-01
889597 CDM Can Prfsn 22fr Vsn 20d 32 16 $345,774.00 $345,774.00 $52,557.65 $311,196.60 $173,751.43 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 30 20 — — $1,975.00 $321,913.49 $172,365.20 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $130,109.31 $214,354.80 $172,232.05 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 32 20 — — $1,975.00 $560,173.00 $171,368.80 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $133,263.66 $205,887.53 $169,575.60 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $130,491.46 $197,085.00 $163,788.23 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $130,276.74 $189,805.36 $160,041.05 2026-03-01
1907 OTHER New Technology - Level 52 21 15 — — $155,885.20 $165,332.79 $157,459.80 2026-03-01
1908 OTHER New Technology - Level 52 21 15 — — $155,885.20 $165,332.79 $157,459.80 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $129,445.98 $184,979.66 $157,212.82 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $125,126.00 $185,485.48 $155,305.74 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $124,273.50 $186,317.79 $155,295.65 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $134,908.58 $175,247.53 $155,078.05 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 2 2 — — $151,518.76 $155,337.18 $153,427.97 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $121,338.35 $173,879.40 $147,608.88 2026-03-01
883402 CDM Ins/repl Subq Imp Icd Sy 29 15 $308,211.09 $308,211.09 $46,848.09 $277,389.98 $147,016.69 2026-03-01
C1820 HCPCS Implant Nrstm Restore Ul 253 16 $223,381.00 $223,381.00 $29,046.14 $238,486.50 $145,197.65 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $122,010.62 $164,450.82 $143,230.72 2026-03-01
1905 OTHER New Technology - Level 51 21 15 — — $140,552.28 $149,070.60 $141,972.00 2026-03-01
1906 OTHER New Technology - Level 51 21 15 — — $140,552.28 $149,070.60 $141,972.00 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $85,894.07 $197,085.00 $141,489.54 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $123,938.00 $156,275.14 $140,106.57 2026-03-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 2 — — $77,046.96 $140,085.39 $140,085.39 2026-03-01
955646 CDM Rmv Icd W Rplc Dual Ld 29 15 $291,657.76 $291,657.76 $44,331.98 $262,491.98 $139,120.75 2026-03-01
5831 APR_DRG Neonate With Ecmo 2 2 — — $127,278.31 $148,342.61 $137,810.46 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $108,443.60 $161,568.68 $135,006.14 2026-03-01
606075 CDM Pack Cath Gd Vasc 100cm 32 16 $265,954.00 $265,954.00 $40,425.01 $239,358.60 $133,641.89 2026-03-01
606072 CDM Pack Cath Gd Vasc 100cm 32 16 $265,954.00 $265,954.00 $40,425.01 $239,358.60 $133,641.89 2026-03-01
606073 CDM Pack Cath Gd Vasc 100cm 32 16 $265,954.00 $265,954.00 $40,425.01 $239,358.60 $133,641.89 2026-03-01
606074 CDM Pack Cath Gd Vasc 100cm 32 16 $265,954.00 $265,954.00 $40,425.01 $239,358.60 $133,641.89 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 2 2 — — $118,026.15 $144,998.05 $131,512.10 2026-03-01
1904 OTHER New Technology - Level 50 21 15 — — $125,219.36 $132,808.41 $126,484.20 2026-03-01
1903 OTHER New Technology - Level 50 21 15 — — $125,219.36 $132,808.41 $126,484.20 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 2 2 — — $121,656.60 $126,060.92 $123,858.76 2026-03-01
839406 CDM Cement Bn Pmma Vert 23 16 $185,244.00 $185,244.00 $28,157.09 $166,719.60 $118,556.16 2026-03-01
1611 APR_DRG Implantable Heart Assist Systems 2 2 — — $115,572.84 $119,774.96 $117,673.90 2026-03-01
64 APR_DRG Pancreas Transplant 2 2 — — $107,749.59 $126,246.35 $116,997.97 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $96,702.97 $129,939.46 $113,321.21 2026-03-01
849531 CDM Graft Hemi Cndyl Mdl Rt 23 16 $176,315.00 $176,315.00 $26,799.88 $158,683.50 $112,841.60 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 33 20 — — $1,975.00 $239,323.00 $112,727.90 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 21 15 — — $111,218.58 $117,959.10 $112,342.00 2026-03-01
C1767 HCPCS Generator Nrstm 5 Ipg 184 16 $175,522.50 $175,522.50 $20,450.69 $412,521.30 $111,428.48 2026-03-01
1902 OTHER New Technology - Level 49 21 15 — — $109,886.44 $116,546.22 $110,996.40 2026-03-01
1901 OTHER New Technology - Level 49 21 15 — — $109,886.44 $116,546.22 $110,996.40 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 6 4 — — $93,760.51 $170,473.65 $110,197.09 2026-03-01
C1882 HCPCS Crtd Xt MRI Quad Df4 184 16 $165,236.00 $165,236.00 $23,561.67 $302,196.60 $109,453.08 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 6 4 — — $102,561.22 $192,824.37 $106,879.59 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $76,322.39 $137,036.42 $106,679.40 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $93,705.18 $118,758.01 $106,231.60 2026-03-01
7 MS_DRG Lung Transplant 30 18 — — $1,975.00 $185,006.56 $105,561.00 2026-03-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 5 3 — — $103,412.00 $108,222.49 $103,849.87 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $83,688.71 $123,515.26 $103,601.99 2026-03-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $86,755.51 $119,568.94 $103,162.23 2026-03-01
647599 CDM Cath Thrmb 150cm 32 16 $203,209.00 $203,209.00 $30,887.77 $182,888.10 $102,112.52 2026-03-01
22 APR_DRG Heart And/or Lung Transplant 2 2 — — $87,588.19 $114,919.11 $101,253.65 2026-03-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $85,187.29 $114,461.64 $99,824.46 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 30 18 — — $6,174.00 $210,000.00 $98,146.77 2026-03-01
1599 OTHER New Technology - Level 48 21 15 — — $97,109.01 $102,994.41 $98,089.91 2026-03-01
1585 OTHER New Technology - Level 48 21 15 — — $97,109.01 $102,994.41 $98,089.91 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 21 15 — — $94,130.19 $99,835.05 $95,081.00 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $84,814.08 $103,331.49 $94,072.79 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $77,443.28 $108,971.34 $93,207.31 2026-03-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $64,043.04 $121,745.32 $92,894.18 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 33 20 — — $1,975.00 $306,157.00 $92,690.48 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 35 19 — — $1,975.00 $203,626.00 $92,587.10 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $81,677.62 $101,268.68 $91,473.15 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 35 19 — — $1,975.00 $249,105.00 $90,220.41 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 10 5 — — $68,102.25 $163,212.33 $89,662.14 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 38 21 — — $1,975.00 $155,347.39 $89,050.58 2026-03-01
953034 CDM Revasc Fem/pop Stnt/ath 29 15 $184,676.01 $184,676.01 $28,070.75 $166,208.41 $88,090.46 2026-03-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $74,276.15 $101,808.06 $88,042.10 2026-03-01
1598 OTHER New Technology - Level 47 21 15 — — $86,887.07 $92,152.96 $87,764.72 2026-03-01
1584 OTHER New Technology - Level 47 21 15 — — $86,887.07 $92,152.96 $87,764.72 2026-03-01
21 APR_DRG Heart And/or Lung Transplant 2 2 — — $75,086.46 $100,088.69 $87,587.58 2026-03-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $68,761.79 $105,620.11 $87,190.95 2026-03-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $76,252.73 $96,874.47 $86,563.60 2026-03-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 2 2 — — $70,486.58 $102,546.31 $86,516.45 2026-03-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $72,545.60 $99,720.04 $86,132.82 2026-03-01
779383 CDM Implant Cranial Peek 23 16 $134,504.00 $134,504.00 $20,444.61 $121,053.60 $86,082.56 2026-03-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $75,406.63 $96,556.86 $85,981.74 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $78,874.75 $92,263.72 $85,569.24 2026-03-01
823482 CDM Implant Crnl Peek Cstm P 23 16 $133,307.00 $133,307.00 $20,262.66 $119,976.30 $85,316.48 2026-03-01
0819 RC — 1 1 — — $85,000.00 $85,000.00 $85,000.00 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 30 18 — — $1,975.00 $147,295.80 $84,568.48 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $73,739.98 $94,001.30 $83,870.64 2026-03-01
C1817 HCPCS Occluder Cv 30mm 92 16 $125,746.50 $125,746.50 $18,021.42 $127,332.00 $82,716.22 2026-03-01
215 MS_DRG Other Heart Assist System Implant 35 21 — — $1,975.00 $342,540.00 $81,757.24 2026-03-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 3 2 — — $77,726.25 $80,998.94 $80,998.94 2026-03-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 37 21 — — $1,975.00 $365,685.00 $80,371.90 2026-03-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 2 2 — — $67,560.96 $90,729.76 $79,145.36 2026-03-01
953038 CDM Revasc Tib Stnt/ath Init 29 15 $165,553.49 $165,553.49 $25,164.13 $148,998.14 $78,969.01 2026-03-01
122601 CDM Evas Rpr Ili With Aoi Gft 29 15 $165,119.24 $165,119.24 $25,098.12 $148,607.32 $78,761.88 2026-03-01
4404 APR_DRG Kidney Transplant 2 2 — — $71,687.35 $85,311.07 $78,499.21 2026-03-01
63 APR_DRG Pancreas Transplant 2 2 — — $75,763.86 $80,734.50 $78,249.18 2026-03-01
84 APR_DRG Autologous Bone Marrow Transplant 2 2 — — $63,295.99 $93,180.78 $78,238.38 2026-03-01
1597 OTHER New Technology - Level 46 21 15 — — $76,665.12 $81,311.50 $77,439.52 2026-03-01
1583 OTHER New Technology - Level 46 21 15 — — $76,665.12 $81,311.50 $77,439.52 2026-03-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 2 2 — — $67,986.07 $85,716.42 $76,851.24 2026-03-01
957988 CDM Prc D-e Cor Revsc Chrnlm 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957990 CDM Prc D-e Cor Revsc Chrnri 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957986 CDM Prc D-e Cor Revsc Chrnlc 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957987 CDM Prc D-e Cor Revsc Chrnld 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
958005 CDM Prc D-e Cor Revsc Ami Ri 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957993 CDM Prc D-el Cor Rvsc Cabglc 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
958000 CDM Prc D-el Cor Stnt Ath Lm 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957994 CDM Prc D-el Cor Rvsc Cabgld 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957981 CDM Prc D-e Cor Revsc Ami Lm 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957975 CDM Prc D-el Cor Stnt Ath Rc 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957892 CDM Prc D-el Cor Stnt Ath Sl 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957974 CDM Prc D-el Cor Stnt Ath Lc 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957894 CDM Prc D-el Cor Rvsc Cabg S 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957897 CDM Prc D-e Cor Revsc Chrn S 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957976 CDM Prc D-el Cor Stnt Ath Ri 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957890 CDM Perc Drug El Cor Stnt Sl 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957973 CDM Prc D-el Cor Stnt Ath Ld 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957996 CDM Prc D-el Cor Rvsc Cabgrc 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957995 CDM Prc D-el Cor Rvsc Cabglm 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
957896 CDM Prc D-e Cor Revsc Ami Sl 26 15 $117,889.38 $117,889.38 $17,919.19 $106,100.44 $75,449.20 2026-03-01
C1721 HCPCS Icd Defb Dlchmbr MRI Is1 184 16 $115,673.00 $115,673.00 $15,625.14 $118,863.00 $75,164.80 2026-03-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $64,490.37 $85,624.47 $75,057.42 2026-03-01
C1733 HCPCS Cath Ep Abl Pfa 31mm 64 16 $166,903.00 $166,903.00 $16,575.90 $202,278.60 $74,803.10 2026-03-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 3 2 — — $71,679.08 $74,697.14 $74,697.14 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 35 19 — — $1,975.00 $249,105.00 $74,222.95 2026-03-01
957964 CDM Perc Drug El Cor Stnt Lm 26 15 $115,745.93 $115,745.93 $17,593.38 $104,171.34 $74,077.40 2026-03-01
957989 CDM Prc D-e Cor Revsc Chrnrc 26 15 $115,745.93 $115,745.93 $17,593.38 $104,171.34 $74,077.40 2026-03-01
957965 CDM Perc Drug El Cor Stnt Rc 26 15 $115,745.93 $115,745.93 $17,593.38 $104,171.34 $74,077.40 2026-03-01
957979 CDM Prc D-e Cor Revsc Ami Lc 26 15 $115,745.93 $115,745.93 $17,593.38 $104,171.34 $74,077.40 2026-03-01
957980 CDM Prc D-e Cor Revsc Ami Ld 26 15 $115,745.93 $115,745.93 $17,593.38 $104,171.34 $74,077.40 2026-03-01
957982 CDM Prc D-e Cor Revsc Ami Rc 26 15 $115,745.93 $115,745.93 $17,593.38 $104,171.34 $74,077.40 2026-03-01
957963 CDM Perc Drug El Cor Stnt Ld 26 15 $115,745.93 $115,745.93 $17,593.38 $104,171.34 $74,077.40 2026-03-01
957966 CDM Perc Drug El Cor Stnt Ri 26 15 $115,745.93 $115,745.93 $17,593.38 $104,171.34 $74,077.40 2026-03-01
957997 CDM Prc D-el Cor Rvsc Cabgri 26 15 $115,745.93 $115,745.93 $17,593.38 $104,171.34 $74,077.40 2026-03-01
957962 CDM Perc Drug El Cor Stnt Lc 26 15 $115,745.93 $115,745.93 $17,593.38 $104,171.34 $74,077.40 2026-03-01
559437 CDM Model Skull Vis Asst 32 16 $146,529.00 $146,529.00 $22,272.41 $131,876.10 $73,630.82 2026-03-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $70,538.34 $76,451.17 $73,494.76 2026-03-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 2 2 — — $56,444.09 $89,622.37 $73,033.23 2026-03-01
899595 CDM Spacer Lg 25x32 8d 23 16 $114,005.00 $114,005.00 $17,328.76 $102,604.50 $72,963.20 2026-03-01
957952 CDM Ptca Cor Sgl Arty Lc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957953 CDM Ptca Cor Sgl Arty Ld 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958404 CDM Ptca Rvs Gft Stnt Sgl Ld 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958405 CDM Ptca Rvs Gft Stnt Sgl Rc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958397 CDM Ptca Stn W Ath Sgl Lc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958393 CDM Ptca Stnt W Ang Sgl Ld 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958398 CDM Ptca Stn W Ath Sgl Ld 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957985 CDM Rvsc Ami Stn Thrm Sgl Ri 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957885 CDM Ptca Rvsc Grft Stnt Sgl 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957991 CDM Rvsc Chr Stn Thrm Sgl Lm 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957999 CDM Ptca Rvs Gft Stnt Sgl Ri 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957883 CDM Ptca Stent W Ath Sgl 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958391 CDM Ptca Stnt W Ang Sgl Rc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957879 CDM Ptca Single Vessel 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957978 CDM Ptca Stn W Ath Sgl Ri 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958399 CDM Ptca Stn W Ath Sgl Rc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958412 CDM Rvsc Chr Stn Thrm Sgl Lc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958409 CDM Rvsc Ami Stn Thrm Sgl Lc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957954 CDM Ptca Cor Sgl Arty Rc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957977 CDM Ptca Stn W Ath Sgl Lm 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958403 CDM Ptca Rvs Gft Stnt Sgl Lc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958413 CDM Rvsc Chr Stn Thrm Sgl Ld 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957967 CDM Ptca Stnt W Ang Sgl Lm 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957984 CDM Rvsc Ami Stn Thrm Sgl Lm 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958414 CDM Rvsc Chr Stn Thrm Sgl Rc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957971 CDM Ptca Cor W Ang Sgl Lm 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957968 CDM Ptca Stnt W Ang Sgl Ri 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957888 CDM Rvsc Chr Stn Thrm Sgl 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957969 CDM Ptca Single Vessel Lm 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
958392 CDM Ptca Stnt W Ang Sgl Lc 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957887 CDM Rvsc Ami Stn Thrm Sgl 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957881 CDM Ptca Stent W Angio Sgl 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957972 CDM Ptca Cor W Ang Sgl Ri 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957992 CDM Rvsc Chr Stn Thrm Sgl Ri 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
957998 CDM Ptca Rvs Gft Stnt Sgl Lm 26 15 $113,734.94 $113,734.94 $17,287.71 $102,361.45 $72,790.36 2026-03-01
875000 CDM Applier Int Clip 86cm 23 16 $113,707.00 $113,707.00 $17,283.46 $102,336.30 $72,772.48 2026-03-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $67,117.51 $77,870.66 $72,494.08 2026-03-01
C1722 HCPCS Icd Crd 5.37x7.36x.99 138 16 $115,971.50 $115,971.50 $12,152.55 $118,863.00 $71,779.87 2026-03-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 2 2 — — $60,259.70 $83,281.64 $71,770.67 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 10 5 — — $51,183.44 $129,556.02 $71,625.25 2026-03-01
958385 CDM Ptca Single Vessel Lc 26 15 $111,667.04 $111,667.04 $16,973.39 $100,500.34 $71,466.91 2026-03-01
958386 CDM Ptca Single Vessel Ld 26 15 $111,667.04 $111,667.04 $16,973.39 $100,500.34 $71,466.91 2026-03-01
958387 CDM Ptca Single Vessel Rc 26 15 $111,667.04 $111,667.04 $16,973.39 $100,500.34 $71,466.91 2026-03-01
957970 CDM Ptca Single Vessel Ri 26 15 $111,667.04 $111,667.04 $16,973.39 $100,500.34 $71,466.91 2026-03-01
958410 CDM Rvsc Ami Stn Thrm Sgl Ld 26 15 $111,667.04 $111,667.04 $16,973.39 $100,500.34 $71,466.91 2026-03-01
958411 CDM Rvsc Ami Stn Thrm Sgl Rc 26 15 $111,667.04 $111,667.04 $16,973.39 $100,500.34 $71,466.91 2026-03-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 2 2 — — $52,956.16 $89,972.97 $71,464.57 2026-03-01
850 MS_DRG Acute Leukemia With Other Procedures 35 19 — — $1,975.00 $123,709.62 $71,438.73 2026-03-01
1784 APR_DRG External Heart Assist Devices 2 2 — — $66,669.53 $75,623.86 $71,146.70 2026-03-01
953042 CDM Revasc Tib Stnt/ath Add 29 15 $149,049.70 $149,049.70 $22,655.55 $134,144.73 $71,096.71 2026-03-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $40,612.90 $100,572.04 $70,592.47 2026-03-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 2 2 — — $60,372.97 $79,986.33 $70,179.65 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 35 21 — — $1,975.00 $250,636.00 $69,612.82 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 35 21 — — $1,975.00 $298,034.00 $69,402.07 2026-03-01
898769 CDM Evas Rpr Prosthesis Addl 29 15 $144,921.62 $144,921.62 $22,028.09 $130,429.46 $69,127.61 2026-03-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 21 15 — — $68,113.68 $72,241.79 $68,801.70 2026-03-01
953119 CDM Cth Plc/inj Cr Art W Rhc 26 15 $107,470.12 $107,470.12 $16,335.46 $96,723.11 $68,780.88 2026-03-01
894635 CDM Cage Spn 50x22x12mm 23 16 $107,181.00 $107,181.00 $16,291.51 $96,462.90 $68,595.84 2026-03-01
878578 CDM Cage Spn 50x22x12mm 23 16 $107,181.00 $107,181.00 $16,291.51 $96,462.90 $68,595.84 2026-03-01
892442 CDM Perc Mch Thrm Ang Periph 29 15 $143,707.17 $143,707.17 $21,843.49 $129,336.45 $68,548.32 2026-03-01
953033 CDM Revasc Fem/pop W Stntplc 29 15 $143,440.49 $143,440.49 $21,802.95 $129,096.44 $68,421.11 2026-03-01
792872 CDM Ev Revsc Fem/pop W Grft 29 15 $143,440.49 $143,440.49 $21,802.95 $129,096.44 $68,421.11 2026-03-01
62 APR_DRG Pancreas Transplant 2 2 — — $65,770.39 $70,524.24 $68,147.32 2026-03-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $58,183.59 $77,832.42 $68,008.01 2026-03-01
898771 CDM Evas Rpr Iliac Nonrupt 29 15 $140,793.34 $140,793.34 $21,400.59 $126,714.01 $67,158.42 2026-03-01
898776 CDM Evas Rpr Infrn Ao Rupt 29 15 $140,793.34 $140,793.34 $21,400.59 $126,714.01 $67,158.42 2026-03-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $52,772.12 $81,511.10 $67,141.61 2026-03-01
953028 CDM Revasc Iliac W Stnt Init 29 15 $140,748.71 $140,748.71 $21,393.80 $126,673.84 $67,137.13 2026-03-01
1582 OTHER New Technology - Level 45 21 15 — — $66,443.17 $70,470.03 $67,114.31 2026-03-01
1596 OTHER New Technology - Level 45 21 15 — — $66,443.17 $70,470.03 $67,114.31 2026-03-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $55,923.91 $77,952.72 $66,938.32 2026-03-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $60,146.11 $73,338.55 $66,742.33 2026-03-01
8634 APR_DRG Neonatal Aftercare 2 2 — — $55,335.98 $77,892.95 $66,614.46 2026-03-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $61,377.57 $71,540.93 $66,459.25 2026-03-01
5244 OTHER Level 4 Blood Product Exc 21 15 — — $65,689.84 $69,671.04 $66,353.37 2026-03-01
898774 CDM Evas Rpr Ao/il Rupt Uni 29 15 $138,728.60 $138,728.60 $21,086.75 $124,855.74 $66,173.54 2026-03-01
898773 CDM Evas Rpr Ao/il Nonrup Bi 29 15 $138,728.60 $138,728.60 $21,086.75 $124,855.74 $66,173.54 2026-03-01
898772 CDM Evas Rpr Ao/il Rupt Bi 29 15 $138,728.60 $138,728.60 $21,086.75 $124,855.74 $66,173.54 2026-03-01
72 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $57,680.01 $74,627.94 $66,153.98 2026-03-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 36 21 — — $1,975.00 $214,777.00 $65,150.61 2026-03-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $58,310.12 $71,576.31 $64,943.21 2026-03-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 2 2 — — $54,092.39 $75,601.25 $64,846.82 2026-03-01
886631 CDM Plc Urtr Stnt Sep Cth Bi 29 15 $135,746.12 $135,746.12 $20,633.41 $122,171.51 $64,750.90 2026-03-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $57,782.91 $71,654.06 $64,718.49 2026-03-01
791553 CDM Perq Acc/cls Fem Art Uni 29 15 $134,899.38 $134,899.38 $20,504.71 $121,409.44 $64,347.00 2026-03-01
717 OTHER Instill Adstiladrin, Tx D 21 15 — — $63,632.04 $67,488.53 $64,274.79 2026-03-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 2 2 — — $57,878.12 $70,086.42 $63,982.27 2026-03-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $51,185.35 $76,109.59 $63,647.47 2026-03-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 35 21 — — $1,975.00 $293,057.00 $63,635.64 2026-03-01
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $53,974.80 $72,993.23 $63,484.01 2026-03-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 35 21 — — $1,975.00 $445,189.00 $63,372.41 2026-03-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 39 21 — — $1,975.00 $1,108,073.72 $63,171.21 2026-03-01
953037 CDM Revasc Tib W Stntplc Ini 29 15 $132,329.00 $132,329.00 $20,114.01 $119,096.10 $63,120.93 2026-03-01
88557 CDM Ins/rplc Card Mod Plsgen 29 15 $132,187.84 $132,187.84 $20,092.55 $118,969.06 $63,053.60 2026-03-01
88556 CDM Ins/rplc Card Mod W Elec 29 15 $132,187.84 $132,187.84 $20,092.55 $118,969.06 $63,053.60 2026-03-01
C1761 HCPCS Cath Corn 3.5mm 12mm 32 16 $125,011.00 $125,011.00 $19,001.67 $112,509.90 $62,818.03 2026-03-01
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $57,095.29 $68,386.29 $62,740.79 2026-03-01
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 2 2 — — $51,411.57 $73,898.87 $62,655.22 2026-03-01
776941 CDM Graft Drms Ptch 16x20cm 23 16 $96,529.00 $96,529.00 $14,672.41 $86,876.10 $61,778.56 2026-03-01
953036 CDM Revasc Tib W Ath Init 29 15 $129,503.18 $129,503.18 $19,684.48 $116,552.86 $61,773.02 2026-03-01
575210 CDM Kit Cath Throm 8fr 100cm 32 16 $122,351.00 $122,351.00 $18,597.35 $110,115.90 $61,481.38 2026-03-01
892447 CDM Perc Mch Thrm Per W Stnt 29 15 $128,849.69 $128,849.69 $19,585.15 $115,964.72 $61,461.30 2026-03-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 2 2 — — $49,121.22 $73,506.43 $61,313.82 2026-03-01
953032 CDM Revasc Fem/pop W Atherct 29 15 $128,116.53 $128,116.53 $19,473.71 $115,304.88 $61,111.58 2026-03-01
124829 CDM Ul Proc Vasc Surg 29 15 $128,116.53 $128,116.53 $19,473.71 $115,304.88 $61,111.58 2026-03-01
7404 APR_DRG Mental Illness Diagnosis With O.r. Procedure 2 2 — — $47,098.63 $74,797.91 $60,948.27 2026-03-01
793673 CDM Cage Peek Fonft 14x35-45 23 16 $94,966.00 $94,966.00 $14,434.83 $85,469.40 $60,778.24 2026-03-01
1834 APR_DRG Percutaneous Structural Cardiac Procedures 2 2 — — $56,892.07 $64,279.18 $60,585.62 2026-03-01
12 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $59,119.16 $61,457.01 $60,288.09 2026-03-01
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $46,027.58 $74,403.48 $60,215.53 2026-03-01
873186 CDM Elctrod Esurg 25cm 6.4fr 32 16 $119,691.00 $119,691.00 $18,193.03 $107,721.90 $60,144.73 2026-03-01
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