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

SKY RIDGE MEDICAL CENTER

Lone Tree, CO · CCN 060112 · Rates published

35,820 distinct procedures filed
31 distinct payers
1,093,073 rate rows
2026-03-01 last MRF observed
Data quality

1,062,898 of 1,093,073 rate rows are consumer-grade (97.2%)

30,175 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 11,641
per-diem day rate — not a per-procedure price 9,333
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 6,864
template filing: same amount across many unrelated codes — excluded 1,691
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 439
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 101
placeholder amount (≤ $0.02) — excluded from medians 99
exceeds 10× this hospital's gross charge — excluded from medians 7
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-SKY-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 · 2026-09-21
Content fingerprint fcb3c55fe40446e3… · 615,196,326 bytes · first seen 2026-05-08

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,850,948.67 $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×
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×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $819,605.32 $1,762,948.71 $911,868.41 nat. median
$599,737
1.5× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $782,774.83 $1,674,245.19 $868,284.31 nat. median
$574,037
1.5× median
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
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 2 $332,753.88 $605,007.06 $605,007.06 nat. median
$207,733
outlier · 2.9×
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
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 18 $1,975.00 $484,444.00 $367,228.90 nat. median
$168,055
outlier · 2.2×
5834
APR_DRG 		Neonate With Ecmo 2 $285,455.19 $390,081.55 $337,768.37 nat. median
$390,362
0.9× median
5833
APR_DRG 		Neonate With Ecmo 2 $226,086.24 $342,642.39 $284,364.32 nat. median
$268,208
1.1× 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
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $234,151.17 $300,544.34 $267,347.76 nat. median
$286,698
0.9× median
897
OTHER 		Revakinagene, Per Implant 15 $262,350.00 $278,250.00 $265,000.00 nat. median
$269,427
1.0× median
C1825
HCPCS 		System Nrstm Gen Ipg 14 $57,610.28 $341,113.50 $246,359.75 nat. median
$35,000
outlier · 7.0×
24
APR_DRG 		Heart And/or Lung Transplant 2 $216,047.23 $267,232.31 $241,639.77 nat. median
$225,531
1.1× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 20 $1,975.00 $356,319.01 $238,523.60 nat. median
$186,516
1.3× median
1614
APR_DRG 		Implantable Heart Assist Systems 2 $223,876.33 $227,074.08 $225,475.20 nat. median
$202,242
1.1× median
581868
CDM 		Stent Eprsth 15cm 8mm 14 $49,063.17 $290,505.60 $209,809.60 —
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 $169,955.85 $241,870.40 $205,913.12 nat. median
$187,567
1.1× median
589193
CDM 		Kit Lo Prfl Comp Shth 7f 15 $66,279.60 $392,445.00 $202,109.17 nat. median
$49,536
outlier · 4.1×
863779
CDM 		Set Vntrc 17.4x13.8in 15 $66,279.60 $392,445.00 $202,109.17 nat. median
$39,168
outlier · 5.2×
573195
CDM 		Kit Cath Rt Heart 15 $66,279.60 $392,445.00 $202,109.17 nat. median
$38,919
outlier · 5.2×
886
OTHER 		Inj. Remestemcel-l-rknd/ 15 $199,652.31 $211,752.45 $201,669.00 nat. median
$203,660
1.0× median
5832
APR_DRG 		Neonate With Ecmo 2 $166,716.57 $235,856.24 $201,286.40 nat. median
$201,678
1.0× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 2 $157,878.35 $226,153.03 $192,015.69 nat. median
$173,018
1.1× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 20 $1,975.00 $346,590.07 $181,863.70 nat. median
$131,925
1.4× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 $147,278.00 $214,354.80 $180,816.40 nat. median
$135,803
1.3× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 20 $1,975.00 $560,173.00 $180,799.80 nat. median
$145,435
1.2× median
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $150,848.58 $205,887.53 $178,368.05 nat. median
$173,134
1.0× median

Other procedures at this hospital

Browse this hospital's 35,820 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
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
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 6 4 — — $819,605.32 $1,762,948.71 $911,868.41 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 6 4 — — $782,774.83 $1,674,245.19 $868,284.31 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
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 3 2 — — $332,753.88 $605,007.06 $605,007.06 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
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 33 18 — — $1,975.00 $484,444.00 $367,228.90 2026-03-01
5834 APR_DRG Neonate With Ecmo 2 2 — — $285,455.19 $390,081.55 $337,768.37 2026-03-01
5833 APR_DRG Neonate With Ecmo 2 2 — — $226,086.24 $342,642.39 $284,364.32 2026-03-01
831 OTHER Obecbtge Autol Up To 400 21 15 — — $275,467.50 $292,162.50 $278,250.00 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $234,151.17 $300,544.34 $267,347.76 2026-03-01
897 OTHER Revakinagene, Per Implant 21 15 — — $262,350.00 $278,250.00 $265,000.00 2026-03-01
C1825 HCPCS System Nrstm Gen Ipg 21 14 $379,015.00 $379,015.00 $57,610.28 $341,113.50 $246,359.75 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 2 2 — — $216,047.23 $267,232.31 $241,639.77 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 41 20 — — $1,975.00 $356,319.01 $238,523.60 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 2 2 — — $223,876.33 $227,074.08 $225,475.20 2026-03-01
581868 CDM Stent Eprsth 15cm 8mm 21 14 $322,784.00 $322,784.00 $49,063.17 $290,505.60 $209,809.60 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $169,955.85 $241,870.40 $205,913.12 2026-03-01
589193 CDM Kit Lo Prfl Comp Shth 7f 34 15 $436,050.00 $436,050.00 $66,279.60 $392,445.00 $202,109.17 2026-03-01
573195 CDM Kit Cath Rt Heart 34 15 $436,050.00 $436,050.00 $66,279.60 $392,445.00 $202,109.17 2026-03-01
863779 CDM Set Vntrc 17.4x13.8in 34 15 $436,050.00 $436,050.00 $66,279.60 $392,445.00 $202,109.17 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 21 15 — — $199,652.31 $211,752.45 $201,669.00 2026-03-01
5832 APR_DRG Neonate With Ecmo 2 2 — — $166,716.57 $235,856.24 $201,286.40 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $157,878.35 $226,153.03 $192,015.69 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 30 20 — — $1,975.00 $346,590.07 $181,863.70 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $147,278.00 $214,354.80 $180,816.40 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 $180,799.80 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $150,848.58 $205,887.53 $178,368.05 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $147,710.57 $197,085.00 $172,397.79 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $147,467.52 $189,805.36 $168,636.44 2026-03-01
599964 CDM Ipg Dbs Rchrgbl Battery 21 14 $257,731.00 $257,731.00 $39,175.11 $231,957.90 $167,525.15 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $146,527.13 $184,979.66 $165,753.40 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $152,710.55 $175,247.53 $163,979.04 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $141,637.11 $185,485.48 $163,561.29 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $140,672.13 $186,317.79 $163,494.96 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 2 2 — — $155,337.18 $171,512.55 $163,424.86 2026-03-01
833716 CDM Pump Cath Lv Impella 9fr 34 15 $348,840.00 $348,840.00 $53,023.68 $313,956.00 $161,687.34 2026-03-01
987414 CDM Device Ventric Ast Tandm 34 15 $340,119.00 $340,119.00 $51,698.09 $306,107.10 $157,645.15 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
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $137,349.66 $173,879.40 $155,614.53 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $138,110.65 $164,450.82 $151,280.73 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 9 5 — — $102,561.22 $192,824.37 $149,438.89 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $140,292.35 $156,275.14 $148,283.74 2026-03-01
C1824 HCPCS Gen Pls Card Mod Sys 21 14 $227,194.00 $227,194.00 $34,533.49 $204,474.60 $147,676.10 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $97,228.31 $197,085.00 $147,156.65 2026-03-01
5831 APR_DRG Neonate With Ecmo 2 2 — — $144,073.44 $148,342.61 $146,208.02 2026-03-01
647588 CDM Prosthesis Tmj Bilat 21 14 $223,078.00 $223,078.00 $33,907.86 $200,770.20 $145,000.70 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $122,753.36 $161,568.68 $142,161.02 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
C1822 HCPCS Implant Pulse 8.5x15.5in 63 14 $205,751.00 $205,751.00 $28,451.36 $298,258.20 $140,385.00 2026-03-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 2 — — $77,046.96 $140,085.39 $140,085.39 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 2 2 — — $133,600.40 $144,998.05 $139,299.22 2026-03-01
647922 CDM Implant Crnl Bn Cstm 21 14 $211,166.00 $211,166.00 $32,097.23 $190,049.40 $137,257.90 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 2 2 — — $126,060.92 $137,709.89 $131,885.40 2026-03-01
842179 CDM Prosthesis Tmj Pt Cstm 21 14 $200,120.00 $200,120.00 $30,418.24 $180,108.00 $130,078.00 2026-03-01
A9543 HCPCS Y90 Ibritum Tiu Tx 40mci 36 15 $298,867.00 $298,867.00 $45,427.78 $268,980.30 $126,570.17 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
1611 APR_DRG Implantable Heart Assist Systems 2 2 — — $119,774.96 $130,823.35 $125,299.15 2026-03-01
64 APR_DRG Pancreas Transplant 2 2 — — $121,967.78 $126,246.35 $124,107.07 2026-03-01
774713 CDM Graft Evas 34x34x10cm 21 14 $190,591.00 $190,591.00 $28,969.83 $171,531.90 $123,884.15 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $109,463.50 $129,939.46 $119,701.48 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 $118,193.20 2026-03-01
872873 CDM Implant Crnl Peek 20 21 14 $179,578.00 $179,578.00 $27,295.86 $161,620.20 $116,725.70 2026-03-01
780834 CDM Stent Eprsth 37x37x10cm 21 14 $177,532.00 $177,532.00 $26,984.86 $159,778.80 $115,395.80 2026-03-01
558473 CDM Stent Thor 20f 26x21x10 21 14 $177,532.00 $177,532.00 $26,984.86 $159,778.80 $115,395.80 2026-03-01
864734 CDM Sensor Pa Cardiomems 21 14 $176,523.00 $176,523.00 $26,831.50 $158,870.70 $114,739.95 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $106,070.14 $118,758.01 $112,414.07 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
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 5 3 — — $103,412.00 $116,518.39 $111,810.57 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $86,393.57 $137,036.42 $111,715.00 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
7 MS_DRG Lung Transplant 38 18 — — $1,975.00 $161,290.67 $110,541.70 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $94,731.93 $123,515.26 $109,123.60 2026-03-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $98,203.42 $119,568.94 $108,886.18 2026-03-01
957978 CDM Ptca Stn W Ath Sgl Ri 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
958000 CDM Prc D-el Cor Stnt Ath Lm 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957976 CDM Prc D-el Cor Stnt Ath Ri 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957974 CDM Prc D-el Cor Stnt Ath Lc 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957892 CDM Prc D-el Cor Stnt Ath Sl 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957975 CDM Prc D-el Cor Stnt Ath Rc 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957883 CDM Ptca Stent W Ath Sgl 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
958399 CDM Ptca Stn W Ath Sgl Rc 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
958397 CDM Ptca Stn W Ath Sgl Lc 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957973 CDM Prc D-el Cor Stnt Ath Ld 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
958398 CDM Ptca Stn W Ath Sgl Ld 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
957977 CDM Ptca Stn W Ath Sgl Lm 28 14 $193,706.70 $193,706.70 $29,443.42 $174,336.03 $108,185.20 2026-03-01
22 APR_DRG Heart And/or Lung Transplant 2 2 — — $99,145.98 $114,919.11 $107,032.54 2026-03-01
C1820 HCPCS Device Neurostimulator 357 14 $165,684.00 $165,684.00 $15,638.82 $255,348.00 $106,037.76 2026-03-01
605913 CDM Implant Bn Crnm Sphn 21 14 $162,435.00 $162,435.00 $24,690.12 $146,191.50 $105,582.75 2026-03-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $96,428.25 $114,461.64 $105,444.95 2026-03-01
889597 CDM Cnnla Prfsn 22fr 20d 34 15 $226,746.00 $226,746.00 $34,465.39 $204,071.40 $105,096.77 2026-03-01
872252 CDM Ped Flex 3.25mm X 30mm 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
869127 CDM Device Embl 5x30mm Pipel 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
894505 CDM Device Embl 3.25x16mm Pl 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
872255 CDM Ped Flex 4.50mm X 30mm 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
872254 CDM Ped Flex 4.25mm X 30mm 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
872257 CDM Ped Flex 4.75mm X 25mm 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
872248 CDM Device Embl 4.75x35mm Pl 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
872245 CDM Device Embl 3.5x35mm Pl 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
869593 CDM Device Embl 25x4mm Pline 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
872238 CDM Device Embl 20x2.5mm Pip 21 14 $157,931.00 $157,931.00 $24,005.51 $142,137.90 $102,655.15 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 34 18 — — $4,200.00 $210,000.00 $102,626.00 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $96,005.80 $103,331.49 $99,668.65 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 2 2 — — $87,662.37 $108,971.34 $98,316.85 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
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $72,493.90 $121,745.32 $97,119.61 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $92,455.46 $101,268.68 $96,862.07 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 41 20 — — $1,975.00 $306,157.00 $96,800.77 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 43 19 — — $1,975.00 $203,626.00 $96,690.40 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
566237 CDM Device Embl 5mm 35mm 21 14 $145,102.00 $145,102.00 $22,055.50 $130,591.80 $94,316.30 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 43 19 — — $1,975.00 $249,105.00 $94,163.65 2026-03-01
C2616 HCPCS Brachytx Ns Yttrium 90 27 13 $208,946.00 $208,946.00 $8,688.00 $188,051.40 $94,025.70 2026-03-01
843718 CDM Set Exfx Rgd Distrt 34 15 $202,328.00 $202,328.00 $30,753.86 $182,095.20 $93,779.03 2026-03-01
867880 CDM Device Embl 4.25x1mm Pln 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
867959 CDM Device Embl 4.75x20mm Pl 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
867960 CDM Device Embl 5x16mm Pipln 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
867962 CDM Device Embl 5x25mm Pipln 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
867883 CDM Device Embl 3.75x18mm Pl 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
867963 CDM Device Embl 5x35mm Pipln 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
872237 CDM Device Embl 4.75x18mm Pl 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
868006 CDM Device Embl 20mm 4.5mm 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
872235 CDM Device Embl 4.5x16mm Pl 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
872236 CDM Device Embl 18x3.5mm Pip 21 14 $143,896.00 $143,896.00 $21,872.19 $129,506.40 $93,532.40 2026-03-01
C1882 HCPCS Crt-d Crd 5.37x8.08x0.99 399 14 $140,871.00 $140,871.00 $15,564.80 $147,044.70 $93,146.40 2026-03-01
868031 CDM Cannula Prfsn Dil Str Ti 34 15 $200,583.00 $200,583.00 $30,488.62 $180,524.70 $92,970.22 2026-03-01
867974 CDM Cannula W Dilatr 20d Ang 34 15 $200,583.00 $200,583.00 $30,488.62 $180,524.70 $92,970.22 2026-03-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $84,077.32 $101,808.06 $92,942.69 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 46 21 — — $1,975.00 $141,623.74 $92,914.71 2026-03-01
21 APR_DRG Heart And/or Lung Transplant 2 2 — — $84,994.56 $100,088.69 $92,541.62 2026-03-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $77,835.31 $105,620.11 $91,727.71 2026-03-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $86,314.72 $96,874.47 $91,594.60 2026-03-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 2 2 — — $79,787.70 $102,546.31 $91,167.01 2026-03-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $85,356.97 $96,556.86 $90,956.92 2026-03-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $82,118.42 $99,720.04 $90,919.23 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $89,282.74 $92,263.72 $90,773.23 2026-03-01
C1767 HCPCS Gen Nrstm 52x52x6.9mm 462 14 $167,725.50 $167,725.50 $13,788.53 $361,366.20 $89,921.39 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 10 5 — — $80,684.58 $163,212.33 $89,662.14 2026-03-01
953124 CDM Cth Plc/inj R&lhc/grafts 28 14 $160,304.65 $160,304.65 $24,366.31 $144,274.18 $89,530.15 2026-03-01
847625 CDM Implant Crnl Peek-optma 21 14 $137,388.00 $137,388.00 $20,882.98 $123,649.20 $89,302.20 2026-03-01
781500 CDM Implant Crnl 22.0mm 21 14 $136,673.00 $136,673.00 $20,774.30 $123,005.70 $88,837.45 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $83,470.40 $94,001.30 $88,735.85 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 38 18 — — $1,975.00 $136,091.96 $88,129.52 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
459 MS_DRG Spinal Fusion Except Cervical With Mcc 3 2 — — $83,684.44 $87,207.99 $87,207.99 2026-03-01
957953 CDM Ptca Cor Sgl Arty Ld 28 14 $156,006.95 $156,006.95 $23,713.06 $140,406.26 $87,129.89 2026-03-01
957954 CDM Ptca Cor Sgl Arty Rc 28 14 $156,006.95 $156,006.95 $23,713.06 $140,406.26 $87,129.89 2026-03-01
957971 CDM Ptca Cor W Ang Sgl Lm 28 14 $156,006.95 $156,006.95 $23,713.06 $140,406.26 $87,129.89 2026-03-01
957972 CDM Ptca Cor W Ang Sgl Ri 28 14 $156,006.95 $156,006.95 $23,713.06 $140,406.26 $87,129.89 2026-03-01
957952 CDM Ptca Cor Sgl Arty Lc 28 14 $156,006.95 $156,006.95 $23,713.06 $140,406.26 $87,129.89 2026-03-01
215 MS_DRG Other Heart Assist System Implant 35 21 — — $1,975.00 $342,540.00 $86,830.71 2026-03-01
906360 CDM Ins Uterin Tand/ov Cl Br 27 13 $134,626.00 $134,626.00 $20,463.15 $121,163.40 $86,160.64 2026-03-01
997676 CDM Graft Hemi Cndyl Mdl Lt 21 14 $132,447.00 $132,447.00 $20,131.94 $119,202.30 $86,090.55 2026-03-01
849531 CDM Graft Hemi Cndyl Mdl Rt 21 14 $132,447.00 $132,447.00 $20,131.94 $119,202.30 $86,090.55 2026-03-01
578953 CDM Graft Bn Ptla Left 21 14 $131,908.00 $131,908.00 $20,050.02 $118,717.20 $85,740.20 2026-03-01
566572 CDM Gft Evs 15f 20x14.5x12mm 21 14 $131,410.00 $131,410.00 $19,974.32 $118,269.00 $85,416.50 2026-03-01
565377 CDM Graft Endo Aaa 32x14mm 21 14 $131,410.00 $131,410.00 $19,974.32 $118,269.00 $85,416.50 2026-03-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 20 — — $71,442.00 $365,685.00 $85,322.10 2026-03-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 2 2 — — $67,560.96 $102,702.09 $85,131.52 2026-03-01
0819 RC — 1 1 — — $85,000.00 $85,000.00 $85,000.00 2026-03-01
780616 CDM Graft Bn Ptla Lt Ostchnd 21 14 $130,755.00 $130,755.00 $19,874.76 $117,679.50 $84,990.75 2026-03-01
589611 CDM Kit Impl Gel18g 20cm 21 14 $129,565.00 $129,565.00 $19,693.88 $116,608.50 $84,217.25 2026-03-01
796086 CDM Graft Endo Aaa 23x12mm 21 14 $128,205.00 $128,205.00 $19,487.16 $115,384.50 $83,333.25 2026-03-01
63 APR_DRG Pancreas Transplant 2 2 — — $80,734.50 $85,761.34 $83,247.92 2026-03-01
4404 APR_DRG Kidney Transplant 2 2 — — $81,146.92 $85,311.07 $83,228.99 2026-03-01
C1823 HCPCS Generator Pulse Implnt 42 14 $186,800.50 $186,800.50 $14,814.07 $248,526.00 $82,841.93 2026-03-01
819738 CDM Implnt Crnl Peek Ptspc S 21 14 $127,301.00 $127,301.00 $19,349.75 $114,570.90 $82,745.65 2026-03-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 2 2 — — $67,986.07 $97,027.20 $82,506.64 2026-03-01
84 APR_DRG Autologous Bone Marrow Transplant 2 2 — — $71,648.27 $93,180.78 $82,414.52 2026-03-01
875055 CDM Probe Sz1 Neuroblate Sys 34 15 $177,281.00 $177,281.00 $26,946.71 $159,552.90 $82,169.74 2026-03-01
875050 CDM Probe Sz00 Neuroblate Sy 34 15 $177,281.00 $177,281.00 $26,946.71 $159,552.90 $82,169.74 2026-03-01
875052 CDM Probe Lsr 3.3mm 133mm 34 15 $177,281.00 $177,281.00 $26,946.71 $159,552.90 $82,169.74 2026-03-01
953123 CDM Cth Plc/inj R&lhc/l Vent 28 14 $145,549.80 $145,549.80 $22,123.57 $130,994.82 $81,289.56 2026-03-01
C1840 HCPCS Telescope Impt Wa2.7x St 21 14 $124,684.00 $124,684.00 $18,951.97 $112,215.60 $81,044.60 2026-03-01
606069 CDM Pack Cath Gd Vasc 80cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606066 CDM Pack Cath Gd Vasc 115cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606067 CDM Pack Cath Gd Vasc 115cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606073 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606061 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606070 CDM Pack Cath Gd Vasc 80cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606072 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606062 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606071 CDM Pack Cath Gd Vasc 80cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606074 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606065 CDM Pack Cath Gd Vasc 115cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
606060 CDM Pack Cath Gd Vasc 100cm 34 15 $174,403.00 $174,403.00 $26,509.26 $156,962.70 $80,835.79 2026-03-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 3 2 — — $77,173.70 $80,423.12 $80,423.12 2026-03-01
798749 CDM Graft Endo Aaa 26x12mm 21 14 $122,406.00 $122,406.00 $18,605.71 $110,165.40 $79,563.90 2026-03-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $73,000.26 $85,624.47 $79,312.36 2026-03-01
594774 CDM Pump Pain Infn 148gm 21 14 $121,144.00 $121,144.00 $18,413.89 $109,029.60 $78,743.60 2026-03-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $76,451.17 $79,846.29 $78,148.73 2026-03-01
796249 CDM Graft Endo Aaa 28.5x12mm 21 14 $119,420.00 $119,420.00 $18,151.84 $107,478.00 $77,623.00 2026-03-01
562607 CDM Graft Endo Aaa 36x14mm 21 14 $119,420.00 $119,420.00 $18,151.84 $107,478.00 $77,623.00 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
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 2 2 — — $60,259.70 $94,271.14 $77,265.42 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 43 19 — — $1,975.00 $249,105.00 $77,084.34 2026-03-01
890951 CDM Graft Bn Cndyl Plg Latrl 21 14 $118,395.00 $118,395.00 $17,996.04 $106,555.50 $76,956.75 2026-03-01
547138 CDM Graft Bn Fem Condyl Rt 21 14 $118,395.00 $118,395.00 $17,996.04 $106,555.50 $76,956.75 2026-03-01
773643 CDM Graft Bn Fem Cndyl Algrf 21 14 $118,395.00 $118,395.00 $17,996.04 $106,555.50 $76,956.75 2026-03-01
895716 CDM Graft Bn Fem Condyl Lt 21 14 $118,395.00 $118,395.00 $17,996.04 $106,555.50 $76,956.75 2026-03-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $75,974.06 $77,870.66 $76,922.36 2026-03-01
475890 CDM Graft Bn Lt Mdl Fem Hemi 21 14 $118,172.00 $118,172.00 $17,962.14 $106,354.80 $76,811.80 2026-03-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 2 2 — — $63,892.23 $89,622.37 $76,757.30 2026-03-01
943426 CDM Inst/rp Gen Sg/dl Icd 27 13 $118,146.53 $118,146.53 $17,958.27 $106,331.88 $75,613.78 2026-03-01
1784 APR_DRG External Heart Assist Devices 2 2 — — $75,466.97 $75,623.86 $75,545.42 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 13 6 — — $51,183.44 $129,556.02 $75,026.04 2026-03-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 2 2 — — $59,944.04 $89,972.97 $74,958.51 2026-03-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 2 2 — — $68,339.54 $79,986.33 $74,162.93 2026-03-01
850 MS_DRG Acute Leukemia With Other Procedures 43 19 — — $1,975.00 $95,133.27 $74,111.84 2026-03-01
879797 CDM Graft Evas 10cm 14.5mm 21 14 $113,624.00 $113,624.00 $17,270.85 $102,261.60 $73,855.60 2026-03-01
844420 CDM Graft Evas 31x14.5m 13cm 21 14 $113,624.00 $113,624.00 $17,270.85 $102,261.60 $73,855.60 2026-03-01
865761 CDM Graft Evas 26x14.5m 12cm 21 14 $113,624.00 $113,624.00 $17,270.85 $102,261.60 $73,855.60 2026-03-01
879796 CDM Graft Evas 10cm 12mm 21 14 $113,624.00 $113,624.00 $17,270.85 $102,261.60 $73,855.60 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 $73,376.20 2026-03-01
978221 CDM Defib Card Fortify .5m/s 21 14 $112,857.00 $112,857.00 $17,154.26 $101,571.30 $73,357.05 2026-03-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $45,972.01 $100,572.04 $73,272.02 2026-03-01
C1772 HCPCS Defib Card 40j Unify 84 14 $112,687.00 $112,687.00 $13,167.00 $139,771.80 $72,961.00 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 34 20 — — $51,548.84 $250,636.00 $72,884.07 2026-03-01
62 APR_DRG Pancreas Transplant 2 2 — — $70,524.24 $74,449.18 $72,486.71 2026-03-01
862138 CDM Graft Evas 23x14.5m14cm 21 14 $111,485.00 $111,485.00 $16,945.72 $100,336.50 $72,465.25 2026-03-01
867110 CDM Graft Evas 14.5mm 12cm 21 14 $111,485.00 $111,485.00 $16,945.72 $100,336.50 $72,465.25 2026-03-01
875058 CDM Probe Sz3 Neuroblate Sys 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
563822 CDM Probe Lsr Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875078 CDM Sz #000 Neuroblat Fulfre 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875059 CDM Probe Sz3 Sdefr 3.3 Ldp 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875080 CDM Probe 175mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875062 CDM Probe Sz5 Neuroblate Sys 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875088 CDM Probe 238mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875084 CDM Probe 196mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875053 CDM Probe Sz1 Neuroblate Sys 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875090 CDM Probe 259mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875086 CDM Probe 217mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875060 CDM Probe Sz4 Neuroblate Sys 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875063 CDM Probe Sz5 Sdefr 3.3 Ldp 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875061 CDM Probe Sz4 Sdefr 3.3 Ldp 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875056 CDM Probe Sz2 Neuroblate Sys 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
875074 CDM Probe 154mm Neuroblate 34 15 $156,333.00 $156,333.00 $23,762.62 $140,699.70 $72,460.35 2026-03-01
865762 CDM Graft Evas 23x12mm 16cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872020 CDM Graft Evas 23x14.5m 18cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872008 CDM Graft Evas 26x12mm 14cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
862822 CDM Graft Evas 35x14.5m 14cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872021 CDM Graft Evas 26x14.5m 18cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872023 CDM Graft Evas 14.5mm 18cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872010 CDM Graft Evas 26x14.5m 14cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872013 CDM Graft Evas 35x14.5m 18cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
872005 CDM Graft Evas 23x14.5m 12cm 21 14 $110,857.00 $110,857.00 $16,850.26 $99,771.30 $72,057.05 2026-03-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $65,861.25 $77,832.42 $71,846.83 2026-03-01
999395 CDM Nrstm Impl 60mm Fsn Spn 21 14 $109,458.00 $109,458.00 $16,637.62 $98,512.20 $71,147.70 2026-03-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $68,082.75 $73,338.55 $70,710.65 2026-03-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $63,303.40 $77,952.72 $70,628.06 2026-03-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $59,735.71 $81,511.10 $70,623.40 2026-03-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $69,476.69 $71,540.93 $70,508.81 2026-03-01
864322 CDM Graft Evas 18cm 26x12mm 21 14 $108,236.00 $108,236.00 $16,451.87 $97,412.40 $70,353.40 2026-03-01
8634 APR_DRG Neonatal Aftercare 2 2 — — $62,637.89 $77,892.95 $70,265.42 2026-03-01
72 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $65,291.24 $74,627.94 $69,959.59 2026-03-01
895204 CDM Graft Evas 10cm 10mm 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
872016 CDM Graft Evas 26x14.5m 16cm 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
784085 CDM Graft Bn Trochlea Lt Ost 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
872019 CDM Graft Evas 18cm 23mm 12m 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
778160 CDM Graft Bn Ptla Rt 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
866765 CDM Stent Aaa 31x14.5 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
851481 CDM Graft Evas 16cm 35mm 14. 21 14 $107,627.00 $107,627.00 $16,359.30 $96,864.30 $69,957.55 2026-03-01
588855 CDM Implant Crnl Custm 21 14 $106,525.00 $106,525.00 $16,191.80 $95,872.50 $69,241.25 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
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $66,004.48 $71,576.31 $68,790.39 2026-03-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $65,407.69 $71,654.06 $68,530.88 2026-03-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 2 2 — — $61,230.20 $75,601.25 $68,415.73 2026-03-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 2 2 — — $65,515.48 $70,086.42 $67,800.95 2026-03-01
872014 CDM Graft Evas 23x14.5m 16cm 21 14 $103,846.00 $103,846.00 $15,784.59 $93,461.40 $67,499.90 2026-03-01
872011 CDM Graft Evas 14.5mm 14cm 21 14 $103,846.00 $103,846.00 $15,784.59 $93,461.40 $67,499.90 2026-03-01
866168 CDM Graft Evas 31x14.5m 17cm 21 14 $103,846.00 $103,846.00 $15,784.59 $93,461.40 $67,499.90 2026-03-01
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