|
773
|
OTHER
|
Inj, Beqvez, Per Tx Dose
|
23
|
20
|
—
|
—
|
$3,605,000.00
|
$4,109,700.00
|
$3,785,250.00
|
2024-10-01
|
|
00773
|
OTHER
|
Inj, Beqvez, Per Tx Dose
|
1
|
1
|
—
|
—
|
$3,496,850.00
|
$3,496,850.00
|
$3,496,850.00
|
2024-10-01
|
|
001
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
1
|
1
|
—
|
—
|
$178,990.51
|
$178,990.51
|
$178,990.51
|
2024-10-01
|
|
018
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
1
|
1
|
—
|
—
|
$147,693.56
|
$147,693.56
|
$147,693.56
|
2024-10-01
|
|
003
|
OTHER
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
1
|
1
|
—
|
—
|
$119,887.93
|
$119,887.93
|
$119,887.93
|
2024-10-01
|
|
222
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock…
|
3
|
1
|
—
|
—
|
$68,499.00
|
$102,063.00
|
$102,063.00
|
2024-10-01
|
|
223
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock…
|
3
|
1
|
—
|
—
|
$68,499.00
|
$102,063.00
|
$102,063.00
|
2024-10-01
|
|
225
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh…
|
3
|
1
|
—
|
—
|
$68,499.00
|
$102,063.00
|
$102,063.00
|
2024-10-01
|
|
224
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh…
|
3
|
1
|
—
|
—
|
$68,499.00
|
$102,063.00
|
$102,063.00
|
2024-10-01
|
|
227
|
MS_DRG
|
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc
|
3
|
1
|
—
|
—
|
$67,393.00
|
$100,416.00
|
$100,416.00
|
2024-10-01
|
|
226
|
MS_DRG
|
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc
|
3
|
1
|
—
|
—
|
$67,393.00
|
$100,416.00
|
$100,416.00
|
2024-10-01
|
|
004
|
OTHER
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
1
|
1
|
—
|
—
|
$84,296.07
|
$84,296.07
|
$84,296.07
|
2024-10-01
|
|
014
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
1
|
1
|
—
|
—
|
$78,325.54
|
$78,325.54
|
$78,325.54
|
2024-10-01
|
|
651
|
OTHER
|
Kidney Transplant With Hemodialysis Without Mcc
|
1
|
1
|
—
|
—
|
$76,277.63
|
$76,277.63
|
$76,277.63
|
2024-10-01
|
|
007
|
OTHER
|
Lung Transplant
|
1
|
1
|
—
|
—
|
$67,580.69
|
$67,580.69
|
$67,580.69
|
2024-10-01
|
|
002
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
1
|
1
|
—
|
—
|
$67,458.10
|
$67,458.10
|
$67,458.10
|
2024-10-01
|
|
955
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
1
|
1
|
—
|
—
|
$62,431.63
|
$62,431.63
|
$62,431.63
|
2024-10-01
|
|
020
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
1
|
1
|
—
|
—
|
$57,539.16
|
$57,539.16
|
$57,539.16
|
2024-10-01
|
|
246
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar…
|
3
|
1
|
—
|
—
|
$37,326.00
|
$55,615.00
|
$55,615.00
|
2024-10-01
|
|
247
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc
|
3
|
1
|
—
|
—
|
$37,326.00
|
$55,615.00
|
$55,615.00
|
2024-10-01
|
|
005
|
OTHER
|
Liver Transplant With Mcc Or Intestinal Transplant
|
1
|
1
|
—
|
—
|
$55,450.54
|
$55,450.54
|
$55,450.54
|
2024-10-01
|
|
453
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion With Mcc
|
1
|
1
|
—
|
—
|
$55,323.98
|
$55,323.98
|
$55,323.98
|
2024-10-01
|
|
B0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
7
|
7
|
—
|
—
|
$43,538.21
|
$57,143.90
|
$54,422.76
|
2024-10-01
|
|
B0505
|
OTHER
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
7
|
7
|
—
|
—
|
$43,091.05
|
$56,557.01
|
$53,863.82
|
2024-10-01
|
|
249
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc
|
3
|
1
|
—
|
—
|
$35,851.00
|
$53,419.00
|
$53,419.00
|
2024-10-01
|
|
248
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4…
|
3
|
1
|
—
|
—
|
$35,851.00
|
$53,419.00
|
$53,419.00
|
2024-10-01
|
|
B0106
|
OTHER
|
Stroke; M > 30.05 & M < 34.25
|
7
|
7
|
—
|
—
|
$41,521.01
|
$54,496.33
|
$51,901.27
|
2024-10-01
|
|
215
|
OTHER
|
Other Heart Assist System Implant
|
1
|
1
|
—
|
—
|
$51,453.49
|
$51,453.49
|
$51,453.49
|
2024-10-01
|
|
216
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
1
|
1
|
—
|
—
|
$49,806.62
|
$49,806.62
|
$49,806.62
|
2024-10-01
|
|
217
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
1
|
1
|
—
|
—
|
$49,529.65
|
$49,529.65
|
$49,529.65
|
2024-10-01
|
|
C0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
7
|
7
|
—
|
—
|
$38,718.09
|
$50,817.49
|
$48,397.61
|
2024-10-01
|
|
B0205
|
OTHER
|
Traumatic Brain Injury; M > 28.75 & M < 40.65
|
7
|
7
|
—
|
—
|
$37,693.78
|
$49,473.08
|
$47,117.22
|
2024-10-01
|
|
D0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
7
|
7
|
—
|
—
|
$37,585.20
|
$49,330.58
|
$46,981.50
|
2024-10-01
|
|
B0105
|
OTHER
|
Stroke; M > 34.25 & M < 38.85
|
7
|
7
|
—
|
—
|
$36,505.18
|
$47,913.04
|
$45,631.47
|
2024-10-01
|
|
021
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
1
|
1
|
—
|
—
|
$45,148.93
|
$45,148.93
|
$45,148.93
|
2024-10-01
|
|
C0106
|
OTHER
|
Stroke; M > 30.05 & M < 34.25
|
7
|
7
|
—
|
—
|
$36,009.45
|
$47,262.40
|
$45,011.81
|
2024-10-01
|
|
B1903
|
OTHER
|
Guillian Barre; M < 18.05
|
7
|
7
|
—
|
—
|
$35,878.02
|
$47,089.90
|
$44,847.52
|
2024-10-01
|
|
231
|
OTHER
|
Coronary Bypass With Ptca With Mcc
|
1
|
1
|
—
|
—
|
$44,710.16
|
$44,710.16
|
$44,710.16
|
2024-10-01
|
|
B0604
|
OTHER
|
Neurological; M < 25.85
|
7
|
7
|
—
|
—
|
$35,578.01
|
$46,696.14
|
$44,472.51
|
2024-10-01
|
|
019
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
1
|
1
|
—
|
—
|
$44,039.60
|
$44,039.60
|
$44,039.60
|
2024-10-01
|
|
956
|
OTHER
|
Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma
|
1
|
1
|
—
|
—
|
$43,339.76
|
$43,339.76
|
$43,339.76
|
2024-10-01
|
|
B0405
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5
|
7
|
7
|
—
|
—
|
$34,623.70
|
$45,443.61
|
$43,279.63
|
2024-10-01
|
|
957
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
1
|
1
|
—
|
—
|
$42,827.53
|
$42,827.53
|
$42,827.53
|
2024-10-01
|
|
A0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
7
|
7
|
—
|
—
|
$34,152.26
|
$44,824.84
|
$42,690.33
|
2024-10-01
|
|
A5104
|
OTHER
|
Expired, Not Orthopedic, Length Of Stay Is 16 Days
|
7
|
7
|
—
|
—
|
$34,049.40
|
$44,689.84
|
$42,561.75
|
2024-10-01
|
|
834
|
OTHER
|
Acute Leukemia With Mcc
|
1
|
1
|
—
|
—
|
$42,052.24
|
$42,052.24
|
$42,052.24
|
2024-10-01
|
|
C0505
|
OTHER
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
7
|
7
|
—
|
—
|
$33,523.68
|
$43,999.82
|
$41,904.59
|
2024-10-01
|
|
B0704
|
OTHER
|
Fracture Of Lower Extremity; M < 28.15
|
7
|
7
|
—
|
—
|
$33,247.95
|
$43,637.94
|
$41,559.94
|
2024-10-01
|
|
B2102
|
OTHER
|
Burns; M=12-45
|
7
|
7
|
—
|
—
|
$33,109.38
|
$43,456.06
|
$41,386.72
|
2024-10-01
|
|
845
|
OTHER
|
Inj, Atidarsagene Autotem
|
23
|
20
|
—
|
—
|
$4,764.90
|
$4,955,500.00
|
$4,595,100.00
|
2026-03-01
|
|
00845
|
OTHER
|
Inj, Atidarsagene Autotem
|
1
|
1
|
—
|
—
|
$4,369,850.00
|
$4,369,850.00
|
$4,369,850.00
|
2026-03-01
|
|
9138
|
OTHER
|
Inj, Hemgenix, Per Tx Dos
|
47
|
22
|
—
|
—
|
$3,672,900.00
|
$4,422,320.40
|
$3,856,545.00
|
2026-03-01
|
|
09138
|
OTHER
|
Inj, Hemgenix, Per Tx Dos
|
2
|
1
|
—
|
—
|
$3,562,713.00
|
$3,574,708.99
|
$3,568,711.00
|
2026-03-01
|
|
908
|
OTHER
|
Topi Adm Prad Zami Per Tr
|
26
|
23
|
—
|
—
|
$9,697.57
|
$4,836,939.00
|
$3,502,611.00
|
2026-03-01
|
|
714
|
OTHER
|
Inj Delandistrogene Mox R
|
50
|
24
|
—
|
—
|
$5,280.60
|
$4,825,397.00
|
$3,492,990.38
|
2026-03-01
|
|
748
|
OTHER
|
Inj, Lovotibeglogene Auto
|
50
|
24
|
—
|
—
|
$8,710.34
|
$4,764,700.00
|
$3,431,395.94
|
2026-03-01
|
|
906
|
OTHER
|
Inj Elivaldogene Autoteme
|
26
|
23
|
—
|
—
|
$6,354.69
|
$4,611,000.00
|
$3,339,000.00
|
2026-03-01
|
|
00908
|
OTHER
|
Topi Adm Prad Zami Per Tr
|
1
|
1
|
—
|
—
|
$3,235,745.40
|
$3,235,745.40
|
$3,235,745.40
|
2026-03-01
|
|
00714
|
OTHER
|
Inj Delandistrogene Mox R
|
2
|
1
|
—
|
—
|
$3,225,691.35
|
$3,228,024.20
|
$3,226,857.78
|
2026-03-01
|
|
00748
|
OTHER
|
Inj, Lovotibeglogene Auto
|
2
|
1
|
—
|
—
|
$3,154,932.76
|
$3,187,420.00
|
$3,171,176.38
|
2026-03-01
|
|
746
|
OTHER
|
Inj, Betibeglogene Autote
|
50
|
24
|
—
|
—
|
$7,736.51
|
$4,303,600.00
|
$3,101,667.29
|
2026-03-01
|
|
00906
|
OTHER
|
Inj Elivaldogene Autoteme
|
1
|
1
|
—
|
—
|
$3,084,600.00
|
$3,084,600.00
|
$3,084,600.00
|
2026-03-01
|
|
00746
|
OTHER
|
Inj, Betibeglogene Autote
|
2
|
1
|
—
|
—
|
$2,851,769.93
|
$2,878,960.00
|
$2,865,364.96
|
2026-03-01
|
|
9141
|
OTHER
|
Inj Onase Abepar-xioi Tre
|
49
|
23
|
—
|
—
|
$2,388,614.00
|
$3,754,022.45
|
$2,603,589.26
|
2026-03-01
|
|
824
|
OTHER
|
Inj, Exagamglogene Autote
|
26
|
23
|
—
|
—
|
$13,699.09
|
$3,381,400.00
|
$2,448,600.00
|
2026-03-01
|
|
09141
|
OTHER
|
Inj Onase Abepar-xioi Tre
|
2
|
1
|
—
|
—
|
$2,316,955.58
|
$2,511,311.57
|
$2,414,133.58
|
2026-03-01
|
|
00824
|
OTHER
|
Inj, Exagamglogene Autote
|
1
|
1
|
—
|
—
|
$2,262,040.00
|
$2,262,040.00
|
$2,262,040.00
|
2026-03-01
|
|
Q2057
|
HCPCS
|
Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure…
|
1
|
1
|
—
|
—
|
$1,656,833.00
|
$1,656,833.00
|
$1,656,833.00
|
2026-03-01
|
|
2067
|
OTHER
|
Afamitresgene Autoleucel
|
25
|
22
|
—
|
—
|
$770,620.00
|
$1,117,399.00
|
$809,151.00
|
2026-03-01
|
|
Q2058
|
HCPCS
|
Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, …
|
1
|
1
|
—
|
—
|
$598,237.50
|
$598,237.50
|
$598,237.50
|
2026-03-01
|
|
9498
|
OTHER
|
Ciltacabtagene Car-pos T
|
49
|
23
|
—
|
—
|
$527,123.40
|
$852,091.92
|
$587,649.60
|
2026-03-01
|
|
9194
|
OTHER
|
Tisagenlecleucel Car-pos
|
49
|
23
|
—
|
—
|
$529,192.90
|
$821,470.39
|
$576,820.26
|
2026-03-01
|
|
9422
|
OTHER
|
Idecabtagene Vicleucel Ca
|
49
|
23
|
—
|
—
|
$526,587.60
|
$809,218.61
|
$569,243.44
|
2026-03-01
|
|
9413
|
OTHER
|
Lisocabtagene Car Pos T
|
49
|
23
|
—
|
—
|
$516,726.10
|
$815,191.74
|
$563,231.45
|
2026-03-01
|
|
Q2042
|
HCPCS
|
Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…
|
11
|
3
|
—
|
—
|
$502,693.77
|
$1,218,042.30
|
$561,407.87
|
2026-03-01
|
|
09498
|
OTHER
|
Ciltacabtagene Car-pos T
|
2
|
1
|
—
|
—
|
$511,309.70
|
$570,020.11
|
$540,664.91
|
2026-03-01
|
|
Q2056
|
HCPCS
|
Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…
|
11
|
3
|
—
|
—
|
$492,271.12
|
$1,263,446.58
|
$536,573.93
|
2026-03-01
|
|
9035
|
OTHER
|
Axicabtagene Ciloleucel C
|
49
|
23
|
—
|
—
|
$489,456.00
|
$771,678.69
|
$533,507.04
|
2026-03-01
|
|
09194
|
OTHER
|
Tisagenlecleucel Car-pos
|
2
|
1
|
—
|
—
|
$513,317.11
|
$549,535.36
|
$531,426.23
|
2026-03-01
|
|
09422
|
OTHER
|
Idecabtagene Vicleucel Ca
|
2
|
1
|
—
|
—
|
$510,789.97
|
$541,339.35
|
$526,064.66
|
2026-03-01
|
|
09413
|
OTHER
|
Lisocabtagene Car Pos T
|
2
|
1
|
—
|
—
|
$501,224.32
|
$545,335.16
|
$523,279.74
|
2026-03-01
|
|
Q2055
|
HCPCS
|
Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…
|
7
|
3
|
—
|
—
|
$470,149.30
|
$1,199,875.72
|
$511,793.34
|
2026-03-01
|
|
Q2054
|
HCPCS
|
Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…
|
11
|
3
|
—
|
—
|
$459,839.17
|
$1,208,732.67
|
$500,948.74
|
2026-03-01
|
|
9391
|
OTHER
|
Brexucabtagene Car Pos T
|
49
|
23
|
—
|
—
|
$460,530.40
|
$709,702.79
|
$499,239.20
|
2026-03-01
|
|
09035
|
OTHER
|
Axicabtagene Ciloleucel C
|
2
|
1
|
—
|
—
|
$474,772.32
|
$516,226.43
|
$495,499.38
|
2026-03-01
|
|
Q2041
|
HCPCS
|
Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…
|
11
|
3
|
—
|
—
|
$445,599.57
|
$1,144,213.32
|
$487,755.77
|
2026-03-01
|
|
Q2053
|
HCPCS
|
Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…
|
11
|
3
|
—
|
—
|
$435,956.80
|
$1,052,317.93
|
$474,717.03
|
2026-03-01
|
|
09391
|
OTHER
|
Brexucabtagene Car Pos T
|
2
|
1
|
—
|
—
|
$446,714.49
|
$474,766.69
|
$460,740.59
|
2026-03-01
|
|
J3402
|
HCPCS
|
Injection, Remestemcel-l-rknd, Per Therapeutic Dose
|
1
|
1
|
—
|
—
|
$433,588.39
|
$433,588.39
|
$433,588.39
|
2026-03-01
|
|
831
|
OTHER
|
Obecbtge Autol Up To 400
|
26
|
23
|
—
|
—
|
$2,930.91
|
$403,462.50
|
$292,162.50
|
2026-03-01
|
|
18
|
MS_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
106
|
39
|
—
|
—
|
$6,771.00
|
$832,980.61
|
$288,849.89
|
2026-03-01
|
|
897
|
OTHER
|
Revakinagene, Per Implant
|
25
|
22
|
—
|
—
|
$265,000.00
|
$384,250.00
|
$278,250.00
|
2026-03-01
|
|
00831
|
OTHER
|
Obecbtge Autol Up To 400
|
1
|
1
|
—
|
—
|
$269,902.50
|
$269,902.50
|
$269,902.50
|
2026-03-01
|
|
00897
|
OTHER
|
Revakinagene, Per Implant
|
1
|
1
|
—
|
—
|
$257,050.00
|
$257,050.00
|
$257,050.00
|
2026-03-01
|
|
5834
|
APR_DRG
|
Neonate With Ecmo
|
31
|
13
|
—
|
—
|
$192,207.00
|
$312,391.65
|
$233,252.43
|
2026-03-01
|
|
886
|
OTHER
|
Inj. Remestemcel-l-rknd/
|
26
|
23
|
—
|
—
|
$5,526.79
|
$292,420.05
|
$211,752.45
|
2026-03-01
|
|
1
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
104
|
38
|
—
|
—
|
$9,780.00
|
$622,167.61
|
$204,528.84
|
2026-03-01
|
|
00886
|
OTHER
|
Inj. Remestemcel-l-rknd/
|
1
|
1
|
—
|
—
|
$195,618.93
|
$195,618.93
|
$195,618.93
|
2026-03-01
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
105
|
36
|
—
|
—
|
$8,000.00
|
$524,012.93
|
$163,537.97
|
2026-03-01
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
110
|
39
|
—
|
—
|
$8,000.00
|
$670,605.29
|
$157,199.18
|
2026-03-01
|
|
J7330
|
HCPCS
|
Autologous Cultured Chondrocytes, Implant
|
3
|
1
|
—
|
—
|
$156,515.70
|
$180,011.44
|
$156,515.70
|
2026-03-01
|
|
1908
|
OTHER
|
New Technology - Level 52
|
49
|
23
|
—
|
—
|
$147,339.90
|
$221,961.65
|
$156,180.29
|
2026-03-01
|
|
1907
|
OTHER
|
New Technology - Level 52
|
49
|
23
|
—
|
—
|
$147,339.90
|
$221,961.65
|
$156,180.29
|
2026-03-01
|
|
5884
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
31
|
13
|
—
|
—
|
$125,393.00
|
$191,333.91
|
$150,471.60
|
2026-03-01
|
|
01908
|
OTHER
|
New Technology - Level 52
|
2
|
1
|
—
|
—
|
$142,919.70
|
$148,484.69
|
$145,702.20
|
2026-03-01
|
|
01907
|
OTHER
|
New Technology - Level 52
|
2
|
1
|
—
|
—
|
$142,919.70
|
$148,484.69
|
$145,702.20
|
2026-03-01
|
|
5833
|
APR_DRG
|
Neonate With Ecmo
|
31
|
13
|
—
|
—
|
$124,517.00
|
$186,775.50
|
$142,333.94
|
2026-03-01
|
|
1905
|
OTHER
|
New Technology - Level 51
|
49
|
23
|
—
|
—
|
$132,847.50
|
$200,129.29
|
$140,818.35
|
2026-03-01
|
|
1906
|
OTHER
|
New Technology - Level 51
|
49
|
23
|
—
|
—
|
$132,847.50
|
$200,129.29
|
$140,818.35
|
2026-03-01
|
|
A9543
|
HCPCS
|
Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil…
|
3
|
1
|
—
|
—
|
$122,172.78
|
$140,774.65
|
$140,774.65
|
2026-03-01
|
|
24
|
APR_DRG
|
Heart And/or Lung Transplant
|
31
|
13
|
—
|
—
|
$111,047.00
|
$178,746.99
|
$133,464.42
|
2026-03-01
|
|
01906
|
OTHER
|
New Technology - Level 51
|
2
|
1
|
—
|
—
|
$128,862.07
|
$133,879.59
|
$131,370.83
|
2026-03-01
|
|
01905
|
OTHER
|
New Technology - Level 51
|
2
|
1
|
—
|
—
|
$128,862.07
|
$133,879.59
|
$131,370.83
|
2026-03-01
|
|
114
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
31
|
13
|
—
|
—
|
$97,644.00
|
$178,865.04
|
$131,167.70
|
2026-03-01
|
|
1904
|
OTHER
|
New Technology - Level 50
|
49
|
23
|
—
|
—
|
$118,355.10
|
$178,297.22
|
$125,456.41
|
2026-03-01
|
|
1903
|
OTHER
|
New Technology - Level 50
|
49
|
23
|
—
|
—
|
$118,355.10
|
$178,297.22
|
$125,456.41
|
2026-03-01
|
|
01904
|
OTHER
|
New Technology - Level 50
|
2
|
1
|
—
|
—
|
$114,804.45
|
$119,274.69
|
$117,039.57
|
2026-03-01
|
|
01903
|
OTHER
|
New Technology - Level 50
|
2
|
1
|
—
|
—
|
$114,804.45
|
$119,274.69
|
$117,039.57
|
2026-03-01
|
|
Q2043
|
HCPCS
|
Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…
|
5
|
2
|
—
|
—
|
$53,789.99
|
$119,352.48
|
$116,968.84
|
2026-03-01
|
|
Q0480
|
HCPCS
|
Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only
|
51
|
24
|
—
|
—
|
$96,999.90
|
$161,679.35
|
$111,503.00
|
2026-03-01
|
|
1901
|
OTHER
|
New Technology - Level 49
|
49
|
23
|
—
|
—
|
$103,862.70
|
$156,465.00
|
$110,094.46
|
2026-03-01
|
|
1902
|
OTHER
|
New Technology - Level 49
|
49
|
23
|
—
|
—
|
$103,862.70
|
$156,465.00
|
$110,094.46
|
2026-03-01
|
|
5832
|
APR_DRG
|
Neonate With Ecmo
|
31
|
13
|
—
|
—
|
$95,607.00
|
$143,410.50
|
$109,286.16
|
2026-03-01
|
|
1614
|
APR_DRG
|
Implantable Heart Assist Systems
|
31
|
13
|
—
|
—
|
$93,372.41
|
$142,750.50
|
$106,711.32
|
2026-03-01
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
109
|
38
|
—
|
—
|
$8,000.00
|
$402,488.98
|
$103,120.09
|
2026-03-01
|
|
01902
|
OTHER
|
New Technology - Level 49
|
2
|
1
|
—
|
—
|
$100,746.82
|
$104,669.69
|
$102,708.26
|
2026-03-01
|
|
01901
|
OTHER
|
New Technology - Level 49
|
2
|
1
|
—
|
—
|
$100,746.82
|
$104,669.69
|
$102,708.26
|
2026-03-01
|
|
8414
|
APR_DRG
|
Extensive Third Degree Burns With Skin Graft
|
31
|
13
|
—
|
—
|
$83,057.18
|
$135,325.50
|
$101,043.04
|
2026-03-01
|
|
6304
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
31
|
13
|
—
|
—
|
$81,396.21
|
$137,205.00
|
$100,776.26
|
2026-03-01
|
|
A9699
|
HCPCS
|
Radiopharmaceutical, Therapeutic, Not Otherwise Classified
|
3
|
1
|
—
|
—
|
$100,053.67
|
$100,394.53
|
$100,053.67
|
2026-03-01
|
|
6094
|
APR_DRG
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
31
|
13
|
—
|
—
|
$82,446.00
|
$133,307.22
|
$99,536.06
|
2026-03-01
|
|
5883
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
31
|
13
|
—
|
—
|
$81,552.00
|
$127,428.00
|
$97,862.40
|
2026-03-01
|
|
94
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
31
|
13
|
—
|
—
|
$75,232.00
|
$130,764.62
|
$97,637.58
|
2026-03-01
|
|
1585
|
OTHER
|
New Technology - Level 48
|
49
|
23
|
—
|
—
|
$91,785.68
|
$138,271.42
|
$97,292.82
|
2026-03-01
|
|
1599
|
OTHER
|
New Technology - Level 48
|
49
|
23
|
—
|
—
|
$91,785.68
|
$138,271.42
|
$97,292.82
|
2026-03-01
|
|
6314
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
31
|
13
|
—
|
—
|
$80,942.00
|
$128,217.69
|
$97,130.40
|
2026-03-01
|
|
K1007
|
HCPCS
|
Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin…
|
51
|
24
|
—
|
—
|
$88,300.94
|
$137,867.45
|
$96,982.62
|
2026-03-01
|
|
5914
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
31
|
13
|
—
|
—
|
$79,657.00
|
$125,467.54
|
$95,588.40
|
2026-03-01
|
|
7
|
MS_DRG
|
Lung Transplant
|
102
|
38
|
—
|
—
|
$9,780.00
|
$318,451.68
|
$95,375.03
|
2026-03-01
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
102
|
38
|
—
|
—
|
$6,771.00
|
$377,510.35
|
$94,669.18
|
2026-03-01
|
|
01585
|
OTHER
|
New Technology - Level 48
|
2
|
1
|
—
|
—
|
$89,032.11
|
$92,498.81
|
$90,765.46
|
2026-03-01
|
|
01599
|
OTHER
|
New Technology - Level 48
|
2
|
1
|
—
|
—
|
$89,032.11
|
$92,498.81
|
$90,765.46
|
2026-03-01
|
|
5831
|
APR_DRG
|
Neonate With Ecmo
|
31
|
13
|
—
|
—
|
$69,493.00
|
$122,622.00
|
$90,340.90
|
2026-03-01
|
|
5934
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
31
|
13
|
—
|
—
|
$73,863.00
|
$110,794.50
|
$88,248.00
|
2026-03-01
|
|
1598
|
OTHER
|
New Technology - Level 47
|
49
|
23
|
—
|
—
|
$82,124.09
|
$123,716.61
|
$87,051.54
|
2026-03-01
|
|
1584
|
OTHER
|
New Technology - Level 47
|
49
|
23
|
—
|
—
|
$82,124.09
|
$123,716.61
|
$87,051.54
|
2026-03-01
|
|
5882
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
31
|
13
|
—
|
—
|
$71,560.00
|
$109,192.05
|
$85,872.00
|
2026-03-01
|
|
113
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
31
|
13
|
—
|
—
|
$56,946.00
|
$133,113.71
|
$85,419.00
|
2026-03-01
|
|
74
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
31
|
13
|
—
|
—
|
$73,667.54
|
$113,416.50
|
$84,684.32
|
2026-03-01
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
104
|
38
|
—
|
—
|
$9,780.00
|
$431,934.66
|
$83,567.08
|
2026-03-01
|
|
209
|
MS_DRG
|
Complex Aortic Arch Procedures
|
59
|
37
|
—
|
—
|
$10,132.00
|
$378,738.37
|
$83,426.73
|
2026-03-01
|
|
212
|
MS_DRG
|
Concomitant Aortic And Mitral Valve Procedures
|
114
|
41
|
—
|
—
|
$8,000.00
|
$360,398.39
|
$83,339.05
|
2026-03-01
|
|
01598
|
OTHER
|
New Technology - Level 47
|
2
|
1
|
—
|
—
|
$79,660.37
|
$82,762.15
|
$81,211.26
|
2026-03-01
|
|
01584
|
OTHER
|
New Technology - Level 47
|
2
|
1
|
—
|
—
|
$79,660.37
|
$82,762.15
|
$81,211.26
|
2026-03-01
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
116
|
41
|
—
|
—
|
$10,799.00
|
$389,750.38
|
$81,186.97
|
2026-03-01
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
114
|
41
|
—
|
—
|
$10,799.00
|
$350,517.36
|
$80,436.82
|
2026-03-01
|
|
44
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
31
|
13
|
—
|
—
|
$66,782.00
|
$100,494.24
|
$80,138.40
|
2026-03-01
|
|
14
|
APR_DRG
|
Liver Transplant And/or Intestinal Transplant
|
31
|
13
|
—
|
—
|
$67,242.00
|
$100,863.00
|
$79,595.47
|
2026-03-01
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
102
|
38
|
—
|
—
|
$9,780.00
|
$383,703.98
|
$78,230.06
|
2026-03-01
|
|
1613
|
APR_DRG
|
Implantable Heart Assist Systems
|
31
|
13
|
—
|
—
|
$64,392.00
|
$104,446.96
|
$77,987.07
|
2026-03-01
|
|
1583
|
OTHER
|
New Technology - Level 46
|
49
|
23
|
—
|
—
|
$72,462.48
|
$109,161.80
|
$76,810.23
|
2026-03-01
|
|
1597
|
OTHER
|
New Technology - Level 46
|
49
|
23
|
—
|
—
|
$72,462.48
|
$109,161.80
|
$76,810.23
|
2026-03-01
|
|
459
|
MS_DRG
|
Spinal Fusion Except Cervical With Mcc
|
5
|
2
|
—
|
—
|
$11,430.00
|
$75,435.00
|
$75,435.00
|
2026-03-01
|
|
23
|
APR_DRG
|
Heart And/or Lung Transplant
|
31
|
13
|
—
|
—
|
$62,352.00
|
$97,366.79
|
$74,822.40
|
2026-03-01
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
116
|
41
|
—
|
—
|
$10,799.00
|
$244,770.56
|
$74,774.95
|
2026-03-01
|
|
5881
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
31
|
13
|
—
|
—
|
$61,338.00
|
$93,593.57
|
$73,605.60
|
2026-03-01
|
|
112
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
31
|
13
|
—
|
—
|
$48,895.00
|
$105,823.65
|
$73,342.50
|
2026-03-01
|
|
01597
|
OTHER
|
New Technology - Level 46
|
2
|
1
|
—
|
—
|
$70,288.61
|
$73,025.48
|
$71,657.04
|
2026-03-01
|
|
01583
|
OTHER
|
New Technology - Level 46
|
2
|
1
|
—
|
—
|
$70,288.61
|
$73,025.48
|
$71,657.04
|
2026-03-01
|
|
5913
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
31
|
13
|
—
|
—
|
$59,125.00
|
$94,624.20
|
$70,950.00
|
2026-03-01
|
|
L8702
|
HCPCS
|
Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge…
|
51
|
24
|
—
|
—
|
$63,895.55
|
$99,762.46
|
$70,177.73
|
2026-03-01
|
|
6034
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
31
|
13
|
—
|
—
|
$42,546.04
|
$102,481.50
|
$68,321.00
|
2026-03-01
|
|
850
|
MS_DRG
|
Acute Leukemia With Other Procedures
|
114
|
41
|
—
|
—
|
$8,000.00
|
$308,239.39
|
$67,227.93
|
2026-03-01
|
|
717
|
OTHER
|
Instill Adstiladrin, Tx D
|
50
|
24
|
—
|
—
|
$12,654.78
|
$93,198.45
|
$66,839.29
|
2026-03-01
|
|
1596
|
OTHER
|
New Technology - Level 45
|
49
|
23
|
—
|
—
|
$62,800.88
|
$94,606.99
|
$66,568.93
|
2026-03-01
|
|
1582
|
OTHER
|
New Technology - Level 45
|
49
|
23
|
—
|
—
|
$62,800.88
|
$94,606.99
|
$66,568.93
|
2026-03-01
|
|
6024
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
31
|
13
|
—
|
—
|
$54,849.00
|
$83,100.26
|
$65,818.80
|
2026-03-01
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
114
|
41
|
—
|
—
|
$10,799.00
|
$279,084.82
|
$65,755.42
|
2026-03-01
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
114
|
41
|
—
|
—
|
$10,799.00
|
$246,574.11
|
$65,652.43
|
2026-03-01
|
|
1643
|
OTHER
|
Y90 Ibritumomab, Rx
|
49
|
23
|
—
|
—
|
$56,824.55
|
$94,941.04
|
$65,476.58
|
2026-03-01
|
|
5891
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational
|
31
|
13
|
—
|
—
|
$48,983.00
|
$89,188.07
|
$65,404.58
|
2026-03-01
|
|
5893
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational
|
31
|
13
|
—
|
—
|
$46,525.00
|
$89,188.07
|
$65,404.58
|
2026-03-01
|
|
5892
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational
|
31
|
13
|
—
|
—
|
$47,538.00
|
$89,188.07
|
$65,404.58
|
2026-03-01
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
135
|
46
|
—
|
—
|
$10,799.00
|
$187,062.91
|
$64,974.58
|
2026-03-01
|
|
5244
|
OTHER
|
Level 4 Blood Product Exc
|
49
|
23
|
—
|
—
|
$50,304.25
|
$93,534.34
|
$64,506.44
|
2026-03-01
|
|
460
|
MS_DRG
|
Spinal Fusion Except Cervical Without Mcc
|
5
|
2
|
—
|
—
|
$11,430.00
|
$62,710.00
|
$62,710.00
|
2026-03-01
|
|
1604
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
31
|
13
|
—
|
—
|
$53,600.81
|
$83,284.50
|
$62,185.76
|
2026-03-01
|
|
01582
|
OTHER
|
New Technology - Level 45
|
2
|
1
|
—
|
—
|
$60,916.85
|
$63,288.81
|
$62,102.83
|
2026-03-01
|
|
01596
|
OTHER
|
New Technology - Level 45
|
2
|
1
|
—
|
—
|
$60,916.85
|
$63,288.81
|
$62,102.83
|
2026-03-01
|
|
00717
|
OTHER
|
Instill Adstiladrin, Tx D
|
2
|
1
|
—
|
—
|
$61,454.13
|
$62,346.55
|
$61,900.34
|
2026-03-01
|
|
J9029
|
HCPCS
|
Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose
|
11
|
3
|
—
|
—
|
$61,338.53
|
$138,190.80
|
$61,600.24
|
2026-03-01
|
|
1612
|
APR_DRG
|
Implantable Heart Assist Systems
|
31
|
13
|
—
|
—
|
$51,688.00
|
$77,532.00
|
$61,481.88
|
2026-03-01
|
|
5933
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
31
|
13
|
—
|
—
|
$51,226.00
|
$80,695.10
|
$61,471.20
|
2026-03-01
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
114
|
41
|
—
|
—
|
$10,799.00
|
$241,605.15
|
$61,409.69
|
2026-03-01
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
133
|
45
|
—
|
—
|
$10,799.00
|
$212,102.59
|
$61,032.68
|
2026-03-01
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
135
|
46
|
—
|
—
|
$10,799.00
|
$207,284.20
|
$60,769.58
|
2026-03-01
|
|
5912
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
31
|
13
|
—
|
—
|
$44,835.00
|
$81,160.27
|
$59,517.54
|
2026-03-01
|
|
01643
|
OTHER
|
Y90 Ibritumomab, Rx
|
2
|
1
|
—
|
—
|
$55,119.81
|
$63,512.28
|
$59,316.04
|
2026-03-01
|
|
1611
|
APR_DRG
|
Implantable Heart Assist Systems
|
31
|
13
|
—
|
—
|
$49,247.00
|
$76,852.35
|
$59,096.40
|
2026-03-01
|
|
9273
|
OTHER
|
Sipuleucel-t Auto Cd54+
|
49
|
23
|
—
|
—
|
$54,404.11
|
$79,772.08
|
$57,668.36
|
2026-03-01
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
123
|
44
|
—
|
—
|
$9,780.00
|
$193,448.08
|
$57,611.27
|
2026-03-01
|
|
19
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
123
|
44
|
—
|
—
|
$9,780.00
|
$195,412.24
|
$57,279.59
|
2026-03-01
|
|
B0404
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
10
|
10
|
—
|
—
|
$45,247.39
|
$59,387.20
|
$56,559.24
|
2026-03-01
|
|
1595
|
OTHER
|
New Technology - Level 44
|
49
|
23
|
—
|
—
|
$53,139.28
|
$80,052.18
|
$56,327.64
|
2026-03-01
|
|
1581
|
OTHER
|
New Technology - Level 44
|
49
|
23
|
—
|
—
|
$53,139.28
|
$80,052.18
|
$56,327.64
|
2026-03-01
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
124
|
46
|
—
|
—
|
$10,799.00
|
$235,424.90
|
$55,910.85
|
2026-03-01
|
|
05244
|
OTHER
|
Level 4 Blood Product Exc
|
2
|
1
|
—
|
—
|
$48,795.12
|
$62,571.25
|
$55,683.18
|
2026-03-01
|
|
B0505
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
10
|
10
|
—
|
—
|
$44,502.41
|
$58,409.41
|
$55,628.01
|
2026-03-01
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
113
|
41
|
—
|
—
|
$8,000.00
|
$165,976.60
|
$55,612.87
|
2026-03-01
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
124
|
44
|
—
|
—
|
$10,799.00
|
$217,816.51
|
$55,400.04
|
2026-03-01
|
|
22
|
APR_DRG
|
Heart And/or Lung Transplant
|
31
|
13
|
—
|
—
|
$45,376.00
|
$73,729.74
|
$55,051.54
|
2026-03-01
|
|
64
|
APR_DRG
|
Pancreas Transplant
|
31
|
13
|
—
|
—
|
$45,492.54
|
$72,558.00
|
$54,176.64
|
2026-03-01
|
|
C2616
|
HCPCS
|
Brachytherapy Source, Non-stranded, Yttrium-90, Per Source
|
3
|
1
|
—
|
—
|
$40,208.00
|
$56,373.00
|
$53,804.00
|
2026-03-01
|
|
8424
|
APR_DRG
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
31
|
13
|
—
|
—
|
$46,203.00
|
$69,304.50
|
$53,142.85
|
2026-03-01
|
|
09273
|
OTHER
|
Sipuleucel-t Auto Cd54+
|
2
|
1
|
—
|
—
|
$52,771.99
|
$53,364.77
|
$53,068.38
|
2026-03-01
|
|
01581
|
OTHER
|
New Technology - Level 44
|
2
|
1
|
—
|
—
|
$51,545.10
|
$53,552.15
|
$52,548.62
|
2026-03-01
|
|
01595
|
OTHER
|
New Technology - Level 44
|
2
|
1
|
—
|
—
|
$51,545.10
|
$53,552.15
|
$52,548.62
|
2026-03-01
|
|
8514
|
APR_DRG
|
Gender Related Procedures
|
31
|
13
|
—
|
—
|
$42,908.27
|
$70,353.00
|
$52,530.24
|
2026-03-01
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
135
|
46
|
—
|
—
|
$10,799.00
|
$115,135.00
|
$52,514.29
|
2026-03-01
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
135
|
46
|
—
|
—
|
$8,000.00
|
$147,521.39
|
$52,349.04
|
2026-03-01
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
134
|
46
|
—
|
—
|
$10,799.00
|
$205,711.67
|
$52,321.26
|
2026-03-01
|
|
54
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
31
|
13
|
—
|
—
|
$43,560.00
|
$70,007.73
|
$52,272.44
|
2026-03-01
|
|
43
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
31
|
13
|
—
|
—
|
$41,876.00
|
$69,298.37
|
$51,742.78
|
2026-03-01
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
116
|
41
|
—
|
—
|
$10,799.00
|
$244,770.56
|
$51,314.96
|
2026-03-01
|
|
6303
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
31
|
13
|
—
|
—
|
$43,677.00
|
$65,515.50
|
$51,276.94
|
2026-03-01
|
|
L7181
|
HCPCS
|
Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi…
|
51
|
24
|
—
|
—
|
$46,068.21
|
$71,927.83
|
$50,597.51
|
2026-03-01
|
|
J9600
|
HCPCS
|
Injection, Porfimer Sodium, 75 Mg
|
3
|
1
|
—
|
—
|
$50,561.89
|
$52,091.10
|
$50,561.89
|
2026-03-01
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
116
|
41
|
—
|
—
|
$10,799.00
|
$244,770.56
|
$50,457.09
|
2026-03-01
|
|
6074
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
31
|
13
|
—
|
—
|
$42,035.00
|
$64,236.87
|
$50,442.00
|
2026-03-01
|
|
B0106
|
HCPCS
|
Stroke; M > 30.05 & M < 34.25
|
10
|
10
|
—
|
—
|
$40,347.31
|
$52,955.85
|
$50,434.14
|
2026-03-01
|
|
5932
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
31
|
13
|
—
|
—
|
$41,957.00
|
$64,905.25
|
$50,348.40
|
2026-03-01
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
113
|
41
|
—
|
—
|
$8,000.00
|
$234,133.31
|
$50,326.28
|
2026-03-01
|
|
21
|
APR_DRG
|
Heart And/or Lung Transplant
|
31
|
13
|
—
|
—
|
$41,730.00
|
$65,165.07
|
$50,076.00
|
2026-03-01
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
133
|
46
|
—
|
—
|
$6,000.00
|
$79,140.11
|
$49,945.44
|
2026-03-01
|
|
317
|
MS_DRG
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
124
|
46
|
—
|
—
|
$9,780.00
|
$207,003.13
|
$49,181.85
|
2026-03-01
|
|
B1903
|
HCPCS
|
Guillian Barre; M < 18.05
|
10
|
10
|
—
|
—
|
$39,310.32
|
$51,594.79
|
$49,137.90
|
2026-03-01
|
|
73
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
31
|
13
|
—
|
—
|
$36,953.00
|
$66,933.09
|
$49,084.27
|
2026-03-01
|
|
93
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
31
|
13
|
—
|
—
|
$32,422.00
|
$87,882.00
|
$48,633.00
|
2026-03-01
|
|
B0205
|
HCPCS
|
Traumatic Brain Injury; M > 28.75 & M < 40.65
|
10
|
10
|
—
|
—
|
$38,813.19
|
$50,942.31
|
$48,516.48
|
2026-03-01
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
134
|
46
|
—
|
—
|
$10,799.00
|
$153,128.50
|
$48,339.54
|
2026-03-01
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
116
|
41
|
—
|
—
|
$10,799.00
|
$300,881.31
|
$47,827.26
|
2026-03-01
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
114
|
41
|
—
|
—
|
$10,799.00
|
$246,574.11
|
$47,670.71
|
2026-03-01
|
|
573
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
135
|
46
|
—
|
—
|
$8,000.00
|
$136,019.64
|
$47,612.05
|
2026-03-01
|
|
976232
|
CDM
|
Kit Aor Vlv 14fr 29mm
|
13
|
7
|
$94,445.00
|
$94,445.00
|
$4,533.36
|
$86,889.40
|
$47,222.50
|
2026-03-01
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
124
|
44
|
—
|
—
|
$6,000.00
|
$142,865.03
|
$47,203.99
|
2026-03-01
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
135
|
46
|
—
|
—
|
$10,799.00
|
$170,584.18
|
$46,647.88
|
2026-03-01
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
135
|
46
|
—
|
—
|
$8,000.00
|
$150,835.50
|
$46,611.45
|
2026-03-01
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
135
|
46
|
—
|
—
|
$10,799.00
|
$134,281.24
|
$46,455.80
|
2026-03-01
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
135
|
46
|
—
|
—
|
$10,799.00
|
$169,777.77
|
$46,447.44
|
2026-03-01
|
|
1142
|
OTHER
|
Supprelin La Implant
|
49
|
23
|
—
|
—
|
$43,185.34
|
$65,757.80
|
$46,257.21
|
2026-03-01
|
|
C0404
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
10
|
10
|
—
|
—
|
$36,984.20
|
$48,541.77
|
$46,230.25
|
2026-03-01
|
|
6023
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
31
|
13
|
—
|
—
|
$38,906.00
|
$58,359.00
|
$46,158.30
|
2026-03-01
|
|
1580
|
OTHER
|
New Technology - Level 43
|
49
|
23
|
—
|
—
|
$43,477.68
|
$65,497.37
|
$46,086.34
|
2026-03-01
|
|
1594
|
OTHER
|
New Technology - Level 43
|
49
|
23
|
—
|
—
|
$43,477.68
|
$65,497.37
|
$46,086.34
|
2026-03-01
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/mcc
|
111
|
44
|
—
|
—
|
$6,771.00
|
$377,510.35
|
$45,419.59
|
2026-03-01
|
|
0294T
|
CPT
|
HInsertion Of Left Atrial Hemodynamic Monitor; Pressure Sensor Lead At Time Of I…
|
7
|
2
|
—
|
—
|
$19,926.00
|
$52,079.00
|
$45,326.00
|
2026-03-01
|
|
B2102
|
HCPCS
|
Burns; M=12-45
|
10
|
10
|
—
|
—
|
$36,253.47
|
$47,582.67
|
$45,316.83
|
2026-03-01
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
135
|
46
|
—
|
—
|
$10,799.00
|
$135,553.57
|
$45,231.67
|
2026-03-01
|
|
D0404
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
10
|
10
|
—
|
—
|
$36,011.31
|
$47,264.84
|
$45,014.14
|
2026-03-01
|
|
B0405
|
HCPCS
|
Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5
|
10
|
10
|
—
|
—
|
$35,840.38
|
$47,040.50
|
$44,800.47
|
2026-03-01
|
|
C0106
|
HCPCS
|
Stroke; M > 30.05 & M < 34.25
|
10
|
10
|
—
|
—
|
$35,828.98
|
$47,025.54
|
$44,786.23
|
2026-03-01
|
|
B0105
|
HCPCS
|
Stroke; M > 34.25 & M < 38.85
|
10
|
10
|
—
|
—
|
$35,819.01
|
$47,012.45
|
$44,773.76
|
2026-03-01
|
|
23
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
135
|
46
|
—
|
—
|
$10,799.00
|
$149,165.79
|
$44,720.41
|
2026-03-01
|
|
3034
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
31
|
13
|
—
|
—
|
$35,847.83
|
$59,817.00
|
$44,383.03
|
2026-03-01
|
|
430
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
134
|
46
|
—
|
—
|
$10,799.00
|
$167,844.55
|
$44,382.50
|
2026-03-01
|
|
213
|
MS_DRG
|
Endovascular Abdominal Aorta With Iliac Branch Procedures
|
70
|
40
|
—
|
—
|
$10,132.00
|
$190,958.58
|
$44,331.61
|
2026-03-01
|
|
17
|
MS_DRG
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
111
|
44
|
—
|
—
|
$6,771.00
|
$377,510.35
|
$44,049.61
|
2026-03-01
|
|
J9226
|
HCPCS
|
Histrelin Implant (supprelin La), 50 Mg
|
11
|
3
|
—
|
—
|
$43,241.44
|
$94,940.24
|
$43,855.64
|
2026-03-01
|
|
428
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
134
|
46
|
—
|
—
|
$10,799.00
|
$168,921.56
|
$43,759.60
|
2026-03-01
|
|
B0604
|
HCPCS
|
Neurological; M < 25.85
|
10
|
10
|
—
|
—
|
$34,895.97
|
$45,800.96
|
$43,619.97
|
2026-03-01
|
|
986887
|
CDM
|
Valve Tavr 34mm
|
13
|
7
|
$87,180.00
|
$87,180.00
|
$4,184.64
|
$80,205.60
|
$43,590.00
|
2026-03-01
|
|
912730
|
CDM
|
Valve Aor Tavr 29mm
|
13
|
7
|
$87,180.00
|
$87,180.00
|
$4,184.64
|
$80,205.60
|
$43,590.00
|
2026-03-01
|
|
976660
|
CDM
|
Valve Tavr 23mm
|
13
|
7
|
$87,180.00
|
$87,180.00
|
$4,184.64
|
$80,205.60
|
$43,590.00
|
2026-03-01
|
|
912731
|
CDM
|
Valve Aor Tavr 34mm
|
13
|
7
|
$87,180.00
|
$87,180.00
|
$4,184.64
|
$80,205.60
|
$43,590.00
|
2026-03-01
|
|
912729
|
CDM
|
Valve Aor Tavr 26mm
|
13
|
7
|
$87,180.00
|
$87,180.00
|
$4,184.64
|
$80,205.60
|
$43,590.00
|
2026-03-01
|
|
976663
|
CDM
|
Valve Tavr 26mm
|
13
|
7
|
$87,180.00
|
$87,180.00
|
$4,184.64
|
$80,205.60
|
$43,590.00
|
2026-03-01
|
|
976664
|
CDM
|
Valve Tavr 29mm
|
13
|
7
|
$87,180.00
|
$87,180.00
|
$4,184.64
|
$80,205.60
|
$43,590.00
|
2026-03-01
|
|
220
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
133
|
45
|
—
|
—
|
$10,799.00
|
$212,102.59
|
$43,545.01
|
2026-03-01
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
135
|
46
|
—
|
—
|
$10,799.00
|
$157,929.23
|
$43,421.49
|
2026-03-01
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
105
|
40
|
—
|
—
|
$11,098.00
|
$59,755.00
|
$43,377.87
|
2026-03-01
|
|
01580
|
OTHER
|
New Technology - Level 43
|
2
|
1
|
—
|
—
|
$42,173.35
|
$43,815.48
|
$42,994.42
|
2026-03-01
|
|
01594
|
OTHER
|
New Technology - Level 43
|
2
|
1
|
—
|
—
|
$42,173.35
|
$43,815.48
|
$42,994.42
|
2026-03-01
|
|
01142
|
OTHER
|
Supprelin La Implant
|
2
|
1
|
—
|
—
|
$41,889.78
|
$43,989.70
|
$42,939.74
|
2026-03-01
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
135
|
46
|
—
|
—
|
$8,000.00
|
$128,599.95
|
$42,911.37
|
2026-03-01
|
|
C0505
|
HCPCS
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
10
|
10
|
—
|
—
|
$34,199.42
|
$44,886.74
|
$42,749.28
|
2026-03-01
|
|
8
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant
|
123
|
44
|
—
|
—
|
$9,780.00
|
$195,412.24
|
$42,524.43
|
2026-03-01
|
|
1624
|
APR_DRG
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
31
|
13
|
—
|
—
|
$36,021.77
|
$56,856.00
|
$42,452.48
|
2026-03-01
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
114
|
41
|
—
|
—
|
$10,799.00
|
$241,605.15
|
$42,337.62
|
2026-03-01
|
|
278
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures
|
135
|
46
|
—
|
—
|
$10,799.00
|
$149,249.44
|
$42,233.08
|
2026-03-01
|
|
0207
|
RC
|
—
|
27
|
12
|
—
|
—
|
$8,000.00
|
$44,347.50
|
$42,172.50
|
2026-03-01
|
|
B1004
|
HCPCS
|
Amputation, Lower Extremity; M=39-45
|
10
|
10
|
—
|
—
|
$33,665.25
|
$44,185.65
|
$42,081.57
|
2026-03-01
|
|
8634
|
APR_DRG
|
Neonatal Aftercare
|
31
|
13
|
—
|
—
|
$35,009.00
|
$52,513.50
|
$41,802.50
|
2026-03-01
|
|
B1504
|
HCPCS
|
Pulmonary; M < 29.15
|
10
|
10
|
—
|
—
|
$33,367.55
|
$43,794.90
|
$41,709.43
|
2026-03-01
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective
|
135
|
46
|
—
|
—
|
$9,780.00
|
$119,296.06
|
$41,597.07
|
2026-03-01
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
135
|
46
|
—
|
—
|
$8,000.00
|
$149,246.10
|
$41,506.96
|
2026-03-01
|
|
0923T
|
CPT
|
Removal And Replacement Of Permanent Cardiac Contractility Modulation-defibrilla…
|
1
|
1
|
—
|
—
|
$41,326.00
|
$41,326.00
|
$41,326.00
|
2026-03-01
|
|
0915T
|
CPT
|
Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co…
|
1
|
1
|
—
|
—
|
$41,326.00
|
$41,326.00
|
$41,326.00
|
2026-03-01
|
|
0916T
|
CPT
|
Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co…
|
1
|
1
|
—
|
—
|
$41,326.00
|
$41,326.00
|
$41,326.00
|
2026-03-01
|
|
84
|
APR_DRG
|
Autologous Bone Marrow Transplant
|
31
|
13
|
—
|
—
|
$32,765.10
|
$56,214.00
|
$41,223.60
|
2026-03-01
|
|
0208
|
RC
|
—
|
49
|
20
|
—
|
—
|
$6,000.00
|
$41,922.50
|
$41,172.50
|
2026-03-01
|