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

29,159 distinct procedures filed
35 distinct payers
757,066 rate rows
2026-07-17 last MRF observed
Data quality

713,090 of 757,066 rate rows are consumer-grade (94.2%)

43,976 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 12,379
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 8,572
template filing: same amount across many unrelated codes — excluded 1,691
exceeds 10× this hospital's gross charge — excluded from medians 533
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 200
placeholder amount (≤ $0.02) — excluded from medians 99
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 47
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 not_modified · 2026-08-11
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
$2,968,000
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 15 $4,459,950.00 $4,730,250.00 $4,505,000.00 nat. median
$4,505,000
1.0× median
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $3,847,800.00 $3,847,800.00 $3,847,800.00 nat. median
$2,332,000
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
$2,455,111
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 15 $3,648,414.33 $3,869,530.35 $3,685,267.00 nat. median
$3,765,001
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
$8,800
outlier · 379.1×
714
OTHER 		Inj Delandistrogene Mox R 15 $3,294,581.40 $3,494,253.00 $3,327,860.00 nat. median
$3,391,964
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 15 $3,219,982.92 $3,415,133.40 $3,252,508.00 nat. median
$3,351,720
1.0× median
906
OTHER 		Inj Elivaldogene Autoteme 15 $3,148,200.00 $3,339,000.00 $3,180,000.00 nat. median
$2,726
outlier · 1166.4×
746
OTHER 		Inj, Betibeglogene Autote 15 $2,910,569.31 $3,086,967.45 $2,939,969.00 nat. median
$3,001,835
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 15 $2,563,091.19 $2,718,430.05 $2,588,981.00 nat. median
$2,508,045
1.0× median
824
OTHER 		Inj, Exagamglogene Autote 15 $2,308,680.00 $2,448,600.00 $2,332,000.00 nat. median
$28,063
outlier · 83.1×
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
$813,967
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
$599,737
outlier · 2.3×
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
$621,313
outlier · 2.1×
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
$579,571
outlier · 2.3×
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
$574,037
outlier · 2.3×
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
$286,598
outlier · 2.9×
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
$562,501
1.5× 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
$513,770
1.5× median
2067
OTHER 		Afamitresgene Autoleucel 15 $762,913.80 $809,151.00 $770,620.00 nat. median
$838,386
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 15 $581,773.10 $617,032.08 $587,649.60 nat. median
$553,480
1.1× median
9194
OTHER 		Tisagenlecleucel Car-pos 15 $560,865.99 $594,857.87 $566,531.30 nat. median
$555,653
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 15 $556,579.19 $590,311.26 $562,201.20 nat. median
$542,562
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 15 $552,500.98 $585,985.89 $558,081.80 nat. median
$552,917
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 15 $526,870.28 $558,801.81 $532,192.20 nat. median
$513,929
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 15 $484,555.70 $513,922.71 $489,450.20 nat. median
$483,557
1.0× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 3 $332,753.88 $605,007.06 $468,880.47 nat. median
$207,733
outlier · 2.3×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 18 $1,975.00 $616,909.48 $345,988.90 nat. median
$168,055
outlier · 2.1×
833716
CDM 		Pump Cath Lv Impella 9fr 16 $101,072.40 $598,455.00 $334,137.38 nat. median
$19,400
outlier · 17.2×
581224
CDM 		Cath Vasc Assist Strl 16 $101,072.40 $598,455.00 $334,137.38 —
589193
CDM 		Kit Lo Prfl Comp Shth 7f 16 $101,072.40 $598,455.00 $334,137.38 nat. median
$49,536
outlier · 6.7×
573195
CDM 		Kit Cath Rt Heart 16 $101,072.40 $598,455.00 $334,137.38 nat. median
$38,919
outlier · 8.6×
863779
CDM 		Set Vntrc 17.4x13.8in 16 $101,072.40 $598,455.00 $334,137.38 nat. median
$39,168
outlier · 8.5×
C1825
HCPCS 		System Nrstm Gen Ipg 16 $77,411.32 $458,356.50 $325,942.40 nat. median
$35,000
outlier · 9.3×
5834
APR_DRG 		Neonate With Ecmo 2 $252,178.74 $390,081.55 $321,130.15 nat. median
$390,362
0.8× median
831
OTHER 		Obecbtge Autol Up To 400 15 $275,467.50 $292,162.50 $278,250.00 nat. median
$278,250
1.0× median
5833
APR_DRG 		Neonate With Ecmo 2 $199,730.62 $342,642.39 $271,186.51 nat. median
$268,208
1.0× median
897
OTHER 		Revakinagene, Per Implant 15 $262,350.00 $278,250.00 $265,000.00 nat. median
$269,427
1.0× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $206,855.38 $300,544.34 $253,699.86 nat. median
$286,698
0.9× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 2 $138,148.31 $251,178.75 $251,178.75 nat. median
$92,809
outlier · 2.7×
C1604
HCPCS 		System Graft Stent Case 14 $55,293.80 $327,397.50 $234,634.88 nat. median
$17,652
outlier · 13.3×
24
APR_DRG 		Heart And/or Lung Transplant 2 $190,861.88 $267,232.31 $229,047.10 nat. median
$225,531
1.0× median
C1824
HCPCS 		Gen Pls Card Smart Mini 16 $49,485.88 $331,227.00 $227,895.50 nat. median
$32,119
outlier · 7.1×
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
$186,516
1.2× median
C1735
HCPCS 		Catheter Renal 6fr 15 $64,686.34 $383,011.20 $224,699.90 nat. median
$4,620
outlier · 48.6×
1614
APR_DRG 		Implantable Heart Assist Systems 2 $197,778.32 $227,074.08 $212,426.20 nat. median
$202,242
1.1× median
886
OTHER 		Inj. Remestemcel-l-rknd/ 15 $199,652.31 $211,752.45 $201,669.00 nat. median
$203,660
1.0× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 $150,143.53 $241,870.40 $196,006.96 nat. median
$187,567
1.0× median
5832
APR_DRG 		Neonate With Ecmo 2 $147,281.87 $235,856.24 $191,569.05 nat. median
$201,678
0.9× median

Other procedures at this hospital

Browse this hospital's 29,159 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 1 1 — — $4,850,948.67 $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
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
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
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
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
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
1908 OTHER New Technology - Level 52 21 15 — — $155,885.20 $165,332.79 $157,459.80 2026-03-01
1907 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
1906 OTHER New Technology - Level 51 21 15 — — $140,552.28 $149,070.60 $141,972.00 2026-03-01
1905 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
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
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
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
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
23 APR_DRG Heart And/or Lung Transplant 2 2 — — $118,026.15 $144,998.05 $131,512.10 2026-03-01
1903 OTHER New Technology - Level 50 21 15 — — $125,219.36 $132,808.41 $126,484.20 2026-03-01
1904 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… 32 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
1584 OTHER New Technology - Level 47 21 15 — — $86,887.07 $92,152.96 $87,764.72 2026-03-01
1598 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
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 20 — — $71,442.00 $365,685.00 $81,175.62 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
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
1583 OTHER New Technology - Level 46 21 15 — — $76,665.12 $81,311.50 $77,439.52 2026-03-01
1597 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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 34 20 — — $51,548.84 $250,636.00 $69,612.82 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 34 20 — — $24,600.00 $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
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
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
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… 34 20 — — $53,754.00 $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 34 20 — — $61,154.38 $445,189.00 $63,412.71 2026-03-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 38 21 — — $1,975.00 $108,857.89 $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
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
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
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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