Hospital

HCA FLORIDA ORANGE PARK HOSPITAL

Orange Park, FL · CCN 100226 · Rates published

Your selected procedure

You selected G0121 (HCPCS)

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

This hospital’s price: $2,324 across 6 payers · range $194-$4,651

Source: https://www.hcadam.com/api/public/content/32b081c08103459ea754d05492d4b3ca?download=true · observed 2026-03-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

35,286 distinct procedures filed

57 distinct payers

1,930,141 rate rows

2026-08-01 last MRF observed

Data quality

1,856,641 of 1,930,141 rate rows are consumer-grade (96.2%)

73,500 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 — reason	Rows
per-diem day rate — not a per-procedure price	19,607
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	16,963
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	16,741
exceeds 10× this hospital's gross charge — excluded from medians	11,133
template filing: same amount across many unrelated codes — excluded	7,554
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	1,067
placeholder amount (≤ $0.02) — excluded from medians	213
percent-of-charges filed in the dollar field — excluded from medians	165
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings	57

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/61-1269295_HCA-FLORIDA-ORANGE-PARK-HOSPITAL_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page	https://www.hcafloridahealthcare.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered via	CMS hospital list
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-10-11
Content fingerprint	c3a6bb09f5e33dd3… · 480,729,313 bytes · first seen 2026-06-08

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	$4,897,200.00	$4,897,200.00	nat. median $2,968,000 1.6× median
845 OTHER	Inj, Atidarsagene Autotem	16	$4,525.91	$4,910,450.00	$4,516,262.50	nat. median $4,505,000 1.0× median
00845 OTHER	Inj, Atidarsagene Autotem	1	$4,505,000.00	$4,505,000.00	$4,505,000.00	—
J3399 HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	1	$3,884,946.48	$4,271,819.03	$3,884,946.48	nat. median $2,455,111 1.6× 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
9138 OTHER	Inj, Hemgenix, Per Tx Dos	20	$2,938,320.00	$4,606,583.75	$3,703,693.33	nat. median $3,765,001 1.0× median
09138 OTHER	Inj, Hemgenix, Per Tx Dos	2	$3,672,900.00	$3,685,267.00	$3,672,900.00	nat. median $3,562,713 1.0× median
773 OTHER	Inj, Beqvez, Per Tx Dose	20	$2,884,000.00	$4,506,250.00	$3,623,025.00	nat. median $3,677,100 1.0× median
00773 OTHER	Inj, Beqvez, Per Tx Dose	2	$3,605,000.00	$3,605,000.00	$3,605,000.00	nat. median $3,496,850 1.0× median
908 OTHER	Topi Adm Prad Zami Per Tr	18	$9,211.17	$4,169,775.00	$3,352,499.10	nat. median $8,800 outlier · 381.0×
714 OTHER	Inj Delandistrogene Mox R	20	$5,015.74	$4,159,825.00	$3,342,082.27	nat. median $3,391,964 1.0× median
00908 OTHER	Topi Adm Prad Zami Per Tr	1	$3,335,820.00	$3,335,820.00	$3,335,820.00	—
00714 OTHER	Inj Delandistrogene Mox R	2	$3,325,455.00	$3,327,860.00	$3,325,455.00	nat. median $3,225,691 1.0× median
748 OTHER	Inj, Lovotibeglogene Auto	20	$8,273.46	$4,107,500.00	$3,302,430.00	nat. median $3,351,720 1.0× median
00748 OTHER	Inj, Lovotibeglogene Auto	2	$3,252,508.00	$3,286,000.00	$3,286,000.00	nat. median $3,187,420 1.0× median
906 OTHER	Inj Elivaldogene Autoteme	18	$6,035.96	$3,975,000.00	$3,195,900.00	nat. median $2,726 outlier · 1172.2×
00906 OTHER	Inj Elivaldogene Autoteme	1	$3,180,000.00	$3,180,000.00	$3,180,000.00	—
746 OTHER	Inj, Betibeglogene Autote	20	$7,348.47	$3,710,000.00	$2,982,840.00	nat. median $3,001,835 1.0× median
00746 OTHER	Inj, Betibeglogene Autote	2	$2,939,969.00	$2,968,000.00	$2,968,000.00	nat. median $2,878,960 1.0× median
9141 OTHER	Inj Onase Abepar-xioi Tre	20	$1,910,891.20	$3,236,226.25	$2,555,816.98	nat. median $2,508,045 1.0× median
09141 OTHER	Inj Onase Abepar-xioi Tre	2	$2,388,614.00	$2,588,981.00	$2,388,614.00	nat. median $2,316,956 1.0× median
824 OTHER	Inj, Exagamglogene Autote	18	$13,011.99	$2,915,000.00	$2,343,660.00	nat. median $28,063 outlier · 83.5×
00824 OTHER	Inj, Exagamglogene Autote	1	$2,332,000.00	$2,332,000.00	$2,332,000.00	—
Q2057 HCPCS	Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure…	1	$1,271,523.00	$1,271,523.00	$1,271,523.00	nat. median $813,967 1.6× median
2067 OTHER	Afamitresgene Autoleucel	19	$616,496.00	$963,275.00	$774,473.10	nat. median $838,386 0.9× median
Q2055 HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	3	$484,690.00	$920,834.85	$679,160.98	nat. median $574,037 1.2× median
Q2042 HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	4	$518,241.00	$934,776.65	$578,771.00	nat. median $621,313 0.9× median
9194 OTHER	Tisagenlecleucel Car-pos	20	$423,354.32	$708,164.13	$566,236.40	nat. median $555,653 1.0× median
9498 OTHER	Ciltacabtagene Car-pos T	20	$421,698.72	$734,562.00	$564,022.04	nat. median $553,480 1.0× median
9422 OTHER	Idecabtagene Vicleucel Ca	20	$421,270.08	$697,602.25	$558,081.80	nat. median $552,917 1.0× median
Q2056 HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	4	$507,496.00	$969,621.79	$553,169.00	nat. median $599,737 0.9× median
9413 OTHER	Lisocabtagene Car Pos T	20	$413,380.88	$702,751.50	$552,896.93	nat. median $542,562 1.0× median
09194 OTHER	Tisagenlecleucel Car-pos	2	$529,192.90	$566,531.30	$529,192.90	nat. median $513,317 1.0× median
09498 OTHER	Ciltacabtagene Car-pos T	2	$527,123.40	$587,649.60	$527,123.40	nat. median $511,310 1.0× median
09422 OTHER	Idecabtagene Vicleucel Ca	2	$526,587.60	$558,081.80	$526,587.60	nat. median $510,790 1.0× median
9035 OTHER	Axicabtagene Ciloleucel C	20	$391,564.80	$665,240.25	$523,717.92	nat. median $513,929 1.0× median
09413 OTHER	Lisocabtagene Car Pos T	2	$516,726.10	$562,201.20	$516,726.10	nat. median $501,224 1.0× median
Q2054 HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	4	$474,061.00	$927,632.05	$516,442.00	nat. median $579,571 0.9× median
Q2041 HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	4	$459,381.00	$878,117.20	$502,841.00	nat. median $562,501 0.9× median
09035 OTHER	Axicabtagene Ciloleucel C	2	$489,456.00	$532,192.20	$489,456.00	nat. median $474,772 1.0× median
9391 OTHER	Brexucabtagene Car Pos T	20	$368,424.32	$611,812.75	$489,450.20	nat. median $483,557 1.0× median
Q2053 HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	4	$449,440.00	$807,592.83	$489,399.00	nat. median $513,770 1.0× median
09391 OTHER	Brexucabtagene Car Pos T	2	$460,530.40	$489,450.20	$460,530.40	nat. median $446,714 1.0× median
Q2058 HCPCS	Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,…	1	$459,112.50	$459,112.50	$459,112.50	nat. median $286,598 1.6× median
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	28	$6,604.00	$501,070.50	$342,688.72	nat. median $168,055 outlier · 2.0×
J3402 HCPCS	Injection, Remestemcel-l-rknd, Per Therapeutic Dose	1	$332,753.88	$332,753.88	$332,753.88	nat. median $207,733 1.6× median
831 OTHER	Obecbtge Autol Up To 400	18	$2,783.91	$347,812.50	$279,641.25	nat. median $278,250 1.0× median
00831 OTHER	Obecbtge Autol Up To 400	1	$278,250.00	$278,250.00	$278,250.00	—
897 OTHER	Revakinagene, Per Implant	18	$212,000.00	$331,250.00	$266,325.00	nat. median $269,427 1.0× median
00897 OTHER	Revakinagene, Per Implant	1	$265,000.00	$265,000.00	$265,000.00	—

Other procedures at this hospital

Browse this hospital's 35,286 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

J3393	HCPCS	Injection, Betibeglogene Autotemcel, Per Treatment	3	1	—	—	$4,850,948.67	$4,897,200.00	$4,897,200.00	2026-03-01
845	OTHER	Inj, Atidarsagene Autotem	24	16	—	—	$4,525.91	$4,910,450.00	$4,516,262.50	2026-03-01
00845	OTHER	Inj, Atidarsagene Autotem	1	1	—	—	$4,505,000.00	$4,505,000.00	$4,505,000.00	2026-03-01
J3399	HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	3	1	—	—	$3,884,946.48	$4,271,819.03	$3,884,946.48	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
9138	OTHER	Inj, Hemgenix, Per Tx Dos	51	20	—	—	$2,938,320.00	$4,606,583.75	$3,703,693.33	2026-03-01
09138	OTHER	Inj, Hemgenix, Per Tx Dos	3	2	—	—	$3,672,900.00	$3,685,267.00	$3,672,900.00	2026-03-01
773	OTHER	Inj, Beqvez, Per Tx Dose	27	20	—	—	$2,884,000.00	$4,506,250.00	$3,623,025.00	2024-10-01
00773	OTHER	Inj, Beqvez, Per Tx Dose	2	2	—	—	$3,605,000.00	$3,605,000.00	$3,605,000.00	2024-10-01
908	OTHER	Topi Adm Prad Zami Per Tr	26	18	—	—	$9,211.17	$4,169,775.00	$3,352,499.10	2026-03-01
714	OTHER	Inj Delandistrogene Mox R	53	20	—	—	$5,015.74	$4,159,825.00	$3,342,082.27	2026-03-01
00908	OTHER	Topi Adm Prad Zami Per Tr	1	1	—	—	$3,335,820.00	$3,335,820.00	$3,335,820.00	2026-03-01
00714	OTHER	Inj Delandistrogene Mox R	3	2	—	—	$3,325,455.00	$3,327,860.00	$3,325,455.00	2026-03-01
748	OTHER	Inj, Lovotibeglogene Auto	53	20	—	—	$8,273.46	$4,107,500.00	$3,302,430.00	2026-03-01
00748	OTHER	Inj, Lovotibeglogene Auto	3	2	—	—	$3,252,508.00	$3,286,000.00	$3,286,000.00	2026-03-01
906	OTHER	Inj Elivaldogene Autoteme	26	18	—	—	$6,035.96	$3,975,000.00	$3,195,900.00	2026-03-01
00906	OTHER	Inj Elivaldogene Autoteme	1	1	—	—	$3,180,000.00	$3,180,000.00	$3,180,000.00	2026-03-01
746	OTHER	Inj, Betibeglogene Autote	53	20	—	—	$7,348.47	$3,710,000.00	$2,982,840.00	2026-03-01
00746	OTHER	Inj, Betibeglogene Autote	3	2	—	—	$2,939,969.00	$2,968,000.00	$2,968,000.00	2026-03-01
9141	OTHER	Inj Onase Abepar-xioi Tre	51	20	—	—	$1,910,891.20	$3,236,226.25	$2,555,816.98	2026-03-01
09141	OTHER	Inj Onase Abepar-xioi Tre	3	2	—	—	$2,388,614.00	$2,588,981.00	$2,388,614.00	2026-03-01
824	OTHER	Inj, Exagamglogene Autote	26	18	—	—	$13,011.99	$2,915,000.00	$2,343,660.00	2026-03-01
00824	OTHER	Inj, Exagamglogene Autote	1	1	—	—	$2,332,000.00	$2,332,000.00	$2,332,000.00	2026-03-01
Q2057	HCPCS	Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure…	1	1	—	—	$1,271,523.00	$1,271,523.00	$1,271,523.00	2026-03-01
2067	OTHER	Afamitresgene Autoleucel	25	19	—	—	$616,496.00	$963,275.00	$774,473.10	2026-03-01
Q2055	HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	6	3	—	—	$484,690.00	$920,834.85	$679,160.98	2026-03-01
Q2042	HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	9	4	—	—	$518,241.00	$934,776.65	$578,771.00	2026-03-01
9194	OTHER	Tisagenlecleucel Car-pos	51	20	—	—	$423,354.32	$708,164.13	$566,236.40	2026-03-01
9498	OTHER	Ciltacabtagene Car-pos T	51	20	—	—	$421,698.72	$734,562.00	$564,022.04	2026-03-01
9422	OTHER	Idecabtagene Vicleucel Ca	51	20	—	—	$421,270.08	$697,602.25	$558,081.80	2026-03-01
Q2056	HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	9	4	—	—	$507,496.00	$969,621.79	$553,169.00	2026-03-01
9413	OTHER	Lisocabtagene Car Pos T	51	20	—	—	$413,380.88	$702,751.50	$552,896.93	2026-03-01
09194	OTHER	Tisagenlecleucel Car-pos	3	2	—	—	$529,192.90	$566,531.30	$529,192.90	2026-03-01
09498	OTHER	Ciltacabtagene Car-pos T	3	2	—	—	$527,123.40	$587,649.60	$527,123.40	2026-03-01
09422	OTHER	Idecabtagene Vicleucel Ca	3	2	—	—	$526,587.60	$558,081.80	$526,587.60	2026-03-01
9035	OTHER	Axicabtagene Ciloleucel C	51	20	—	—	$391,564.80	$665,240.25	$523,717.92	2026-03-01
09413	OTHER	Lisocabtagene Car Pos T	3	2	—	—	$516,726.10	$562,201.20	$516,726.10	2026-03-01
Q2054	HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	9	4	—	—	$474,061.00	$927,632.05	$516,442.00	2026-03-01
Q2041	HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	9	4	—	—	$459,381.00	$878,117.20	$502,841.00	2026-03-01
09035	OTHER	Axicabtagene Ciloleucel C	3	2	—	—	$489,456.00	$532,192.20	$489,456.00	2026-03-01
9391	OTHER	Brexucabtagene Car Pos T	51	20	—	—	$368,424.32	$611,812.75	$489,450.20	2026-03-01
Q2053	HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	9	4	—	—	$449,440.00	$807,592.83	$489,399.00	2026-03-01
09391	OTHER	Brexucabtagene Car Pos T	3	2	—	—	$460,530.40	$489,450.20	$460,530.40	2026-03-01
Q2058	HCPCS	Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, …	1	1	—	—	$459,112.50	$459,112.50	$459,112.50	2026-03-01
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	98	28	—	—	$6,604.00	$501,070.50	$342,688.72	2026-03-01
J3402	HCPCS	Injection, Remestemcel-l-rknd, Per Therapeutic Dose	1	1	—	—	$332,753.88	$332,753.88	$332,753.88	2026-03-01
831	OTHER	Obecbtge Autol Up To 400	26	18	—	—	$2,783.91	$347,812.50	$279,641.25	2026-03-01
00831	OTHER	Obecbtge Autol Up To 400	1	1	—	—	$278,250.00	$278,250.00	$278,250.00	2026-03-01
897	OTHER	Revakinagene, Per Implant	24	18	—	—	$212,000.00	$331,250.00	$266,325.00	2026-03-01
00897	OTHER	Revakinagene, Per Implant	1	1	—	—	$265,000.00	$265,000.00	$265,000.00	2026-03-01
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	100	29	—	—	$8,700.00	$582,560.00	$257,590.10	2026-03-01
5834	APR_DRG	Neonate With Ecmo	33	14	—	—	$192,207.00	$312,391.65	$230,648.40	2026-03-01
886	OTHER	Inj. Remestemcel-l-rknd/	26	18	—	—	$5,249.58	$252,086.25	$202,677.34	2026-03-01
00886	OTHER	Inj. Remestemcel-l-rknd/	1	1	—	—	$201,669.00	$201,669.00	$201,669.00	2026-03-01
927	MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	101	27	—	—	$8,700.00	$385,940.53	$201,115.44	2026-03-01
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	102	28	—	—	$8,700.00	$547,971.96	$198,611.25	2026-03-01
001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	2	1	—	—	$170,012.99	$201,568.34	$185,790.66	2026-03-01
018	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	2	1	—	—	$140,285.74	$229,311.38	$184,798.56	2026-03-01
1907	OTHER	New Technology - Level 52	53	21	—	—	$117,871.92	$194,846.13	$155,876.90	2026-03-01
1908	OTHER	New Technology - Level 52	53	21	—	—	$117,871.92	$194,846.13	$155,876.90	2026-03-01
5884	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	33	14	—	—	$125,393.00	$191,333.91	$150,471.60	2026-03-01
01908	OTHER	New Technology - Level 52	3	2	—	—	$147,339.90	$153,077.00	$147,339.90	2026-03-01
01907	OTHER	New Technology - Level 52	3	2	—	—	$147,339.90	$153,077.00	$147,339.90	2026-03-01
5833	APR_DRG	Neonate With Ecmo	33	14	—	—	$118,611.62	$186,775.50	$142,333.94	2026-03-01
1905	OTHER	New Technology - Level 51	53	21	—	—	$106,278.00	$175,681.00	$140,544.80	2026-03-01
1906	OTHER	New Technology - Level 51	53	21	—	—	$106,278.00	$175,681.00	$140,544.80	2026-03-01
24	APR_DRG	Heart And/or Lung Transplant	33	14	—	—	$111,047.00	$178,746.99	$133,256.40	2026-03-01
01906	OTHER	New Technology - Level 51	3	2	—	—	$132,847.50	$138,020.20	$132,847.50	2026-03-01
01905	OTHER	New Technology - Level 51	3	2	—	—	$132,847.50	$138,020.20	$132,847.50	2026-03-01
4	MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	102	28	—	—	$8,700.00	$328,885.98	$129,916.91	2026-03-01
455	MS_DRG	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	2	1	—	—	$114,899.00	$143,622.00	$129,260.50	2024-10-01
003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	2	1	—	—	$113,874.68	$142,069.46	$127,972.07	2026-03-01
1903	OTHER	New Technology - Level 50	53	21	—	—	$94,684.08	$156,515.88	$125,212.70	2026-03-01
1904	OTHER	New Technology - Level 50	53	21	—	—	$94,684.08	$156,515.88	$125,212.70	2026-03-01
429019	CDM	Tavr Cardio Bypass Supp	47	18	$274,667.50	$274,667.50	$12,997.66	$274,667.50	$122,619.42	2026-03-01
7	MS_DRG	Lung Transplant	98	29	—	—	$8,700.00	$260,216.55	$120,860.41	2026-03-01
429868	CDM	Ins Perm Subq Defib	47	18	$269,914.98	$269,914.98	$12,772.76	$269,914.98	$120,497.76	2026-03-01
J7330	HCPCS	Autologous Cultured Chondrocytes, Implant	3	1	—	—	$120,116.70	$138,148.31	$120,116.70	2026-03-01
114	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	33	14	—	—	$97,644.00	$178,865.04	$119,243.36	2026-03-01
420812	CDM	Ins/rep Aicd Sngl/dual	47	18	$265,311.24	$265,311.24	$12,554.91	$265,311.24	$118,442.52	2026-03-01
01903	OTHER	New Technology - Level 50	3	2	—	—	$118,355.10	$122,963.60	$118,355.10	2026-03-01
01904	OTHER	New Technology - Level 50	3	2	—	—	$118,355.10	$122,963.60	$118,355.10	2026-03-01
425446	CDM	Rem/repl Aicd Sing Ld	47	18	$264,710.07	$264,710.07	$12,526.46	$264,710.07	$118,174.14	2026-03-01
425444	CDM	Insrt Aicd Only Dual Ld	47	18	$264,710.07	$264,710.07	$12,526.46	$264,710.07	$118,174.14	2026-03-01
425448	CDM	Rem/repl Aicd Mult Ld	47	18	$264,710.07	$264,710.07	$12,526.46	$264,710.07	$118,174.14	2026-03-01
425445	CDM	Insrt Aicd Only Mult Ld	47	18	$264,710.07	$264,710.07	$12,526.46	$264,710.07	$118,174.14	2026-03-01
425447	CDM	Rem/repl Aicd Dual Ld	47	18	$264,710.07	$264,710.07	$12,526.46	$264,710.07	$118,174.14	2026-03-01
14	MS_DRG	Allogeneic Bone Marrow Transplant	98	29	—	—	$6,604.00	$308,475.18	$117,500.48	2026-03-01
1902	OTHER	New Technology - Level 49	53	21	—	—	$83,090.16	$137,350.75	$109,880.60	2026-03-01
1901	OTHER	New Technology - Level 49	53	21	—	—	$83,090.16	$137,350.75	$109,880.60	2026-03-01
5832	APR_DRG	Neonate With Ecmo	33	14	—	—	$91,071.80	$143,410.50	$109,286.16	2026-03-01
A9543	HCPCS	Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil…	3	1	—	—	$93,760.51	$108,036.36	$108,036.36	2026-03-01
209	MS_DRG	Complex Aortic Arch Procedures	52	28	—	—	$9,013.00	$309,478.63	$107,494.81	2026-03-01
Q0480	HCPCS	Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only	55	21	—	—	$79,999.92	$139,378.75	$106,999.89	2026-03-01
1614	APR_DRG	Implantable Heart Assist Systems	33	14	—	—	$88,926.10	$142,750.50	$106,711.32	2026-03-01
2	MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	100	29	—	—	$8,700.00	$352,946.94	$105,661.29	2026-03-01
01902	OTHER	New Technology - Level 49	3	2	—	—	$103,862.70	$107,906.90	$103,862.70	2026-03-01
01901	OTHER	New Technology - Level 49	3	2	—	—	$103,862.70	$107,906.90	$103,862.70	2026-03-01
212	MS_DRG	Concomitant Aortic And Mitral Valve Procedures	106	30	—	—	$8,700.00	$294,492.48	$103,088.81	2026-03-01
429021	CDM	Tavr/tavi Transaortic	47	18	$229,309.92	$229,309.92	$10,851.27	$229,309.92	$102,370.50	2026-03-01
428992	CDM	Tavr/tavi/trans Exposure	47	18	$229,309.92	$229,309.92	$10,851.27	$229,309.92	$102,370.50	2026-03-01
426	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	106	30	—	—	$10,799.00	$286,418.39	$100,623.55	2026-03-01
6304	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	33	14	—	—	$77,520.20	$137,205.00	$100,617.00	2026-03-01
8414	APR_DRG	Extensive Third Degree Burns With Skin Graft	33	14	—	—	$79,102.08	$135,325.50	$99,238.70	2026-03-01
6094	APR_DRG	Neonate Birth Weight 1500-2499 Grams With Major Procedure	33	14	—	—	$82,446.00	$133,307.22	$98,935.20	2026-03-01
420809	CDM	Ins/rep Aicd Sngl/dual	47	18	$220,591.12	$220,591.12	$10,438.69	$220,591.12	$98,478.18	2026-03-01
5	MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	98	29	—	—	$8,700.00	$313,536.18	$98,084.84	2026-03-01
5883	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	33	14	—	—	$81,552.00	$127,428.00	$97,862.40	2026-03-01
215	MS_DRG	Other Heart Assist System Implant	106	30	—	—	$10,799.00	$318,476.88	$97,766.02	2026-03-01
6314	APR_DRG	Neonate Birth Weight > 2499 Grams With Other Major Procedure	33	14	—	—	$80,942.00	$128,217.69	$97,130.40	2026-03-01
1585	OTHER	New Technology - Level 48	53	21	—	—	$73,428.54	$121,379.76	$97,103.81	2026-03-01
1599	OTHER	New Technology - Level 48	53	21	—	—	$73,428.54	$121,379.76	$97,103.81	2026-03-01
5914	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	33	14	—	—	$79,657.00	$125,467.54	$95,588.40	2026-03-01
004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	2	1	—	—	$80,068.05	$110,944.95	$95,506.50	2026-03-01
K1007	HCPCS	Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin…	55	21	—	—	$72,825.52	$118,851.25	$95,081.00	2026-03-01
216	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	102	28	—	—	$57,011.00	$238,995.00	$94,463.73	2026-03-01
429917	CDM	Ins Icd Gen W/sngl Lead	47	18	$210,073.65	$210,073.65	$9,940.99	$210,073.65	$93,782.88	2026-03-01
454	MS_DRG	Combined Anterior And Posterior Spinal Fusion With Cc	2	1	—	—	$81,685.00	$102,106.00	$91,895.50	2024-10-01
959463	CDM	Pump Heart 21fr 85mm	82	23	$381,095.00	$381,095.00	$15,000.00	$381,095.00	$91,843.90	2026-03-01
969170	CDM	Kit Cath Rt Heart	82	23	$381,095.00	$381,095.00	$15,000.00	$381,095.00	$91,843.90	2026-03-01
01585	OTHER	New Technology - Level 48	3	2	—	—	$91,785.68	$95,359.60	$91,785.68	2026-03-01
01599	OTHER	New Technology - Level 48	3	2	—	—	$91,785.68	$95,359.60	$91,785.68	2026-03-01
459	MS_DRG	Spinal Fusion Except Cervical With Mcc	2	1	—	—	$80,518.00	$100,647.00	$90,582.50	2024-10-01
94	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	33	14	—	—	$75,232.00	$130,764.62	$90,278.40	2026-03-01
5934	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	33	14	—	—	$73,540.00	$110,794.50	$88,248.00	2026-03-01
1584	OTHER	New Technology - Level 47	53	21	—	—	$65,699.27	$108,603.01	$86,882.41	2026-03-01
1598	OTHER	New Technology - Level 47	53	21	—	—	$65,699.27	$108,603.01	$86,882.41	2026-03-01
429018	CDM	Tavr/tavi Op Axl Art Apr	47	18	$194,031.94	$194,031.94	$9,181.87	$194,031.94	$86,621.40	2026-03-01
428541	CDM	Tavr Pros Valve Faa	47	18	$194,031.94	$194,031.94	$9,181.87	$194,031.94	$86,621.40	2026-03-01
429020	CDM	Tavr/tavi Opn Ili Art	47	18	$194,031.94	$194,031.94	$9,181.87	$194,031.94	$86,621.40	2026-03-01
432907	CDM	Tmvi W/prosth Valve	45	17	$194,031.94	$194,031.94	$9,181.87	$194,031.94	$86,621.40	2026-03-01
429022	CDM	Tavr/tavi Perc Fem Aprch	47	18	$194,031.94	$194,031.94	$9,181.87	$194,031.94	$86,621.40	2026-03-01
651	OTHER	Kidney Transplant With Hemodialysis Without Mcc	2	1	—	—	$72,451.80	$99,429.58	$85,940.69	2026-03-01
5882	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	33	14	—	—	$71,560.00	$109,192.05	$85,872.00	2026-03-01
113	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	33	14	—	—	$56,946.00	$133,113.71	$85,419.00	2026-03-01
74	APR_DRG	Allogeneic Bone Marrow Transplant	33	14	—	—	$70,159.56	$113,416.50	$84,191.47	2026-03-01
5831	APR_DRG	Neonate With Ecmo	33	14	—	—	$69,493.00	$122,622.00	$83,391.60	2026-03-01
850	MS_DRG	Acute Leukemia With Other Procedures	106	30	—	—	$8,700.00	$251,871.77	$83,086.21	2026-03-01
01584	OTHER	New Technology - Level 47	3	2	—	—	$82,124.09	$85,321.80	$82,124.09	2026-03-01
01598	OTHER	New Technology - Level 47	3	2	—	—	$82,124.09	$85,321.80	$82,124.09	2026-03-01
231	MS_DRG	Coronary Bypass With Ptca With Mcc	100	28	—	—	$15,603.00	$201,483.20	$81,973.24	2026-03-01
429	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	106	30	—	—	$10,799.00	$228,048.69	$81,814.42	2026-03-01
44	APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	33	14	—	—	$66,782.00	$100,494.24	$80,138.40	2026-03-01
14	APR_DRG	Liver Transplant And/or Intestinal Transplant	33	14	—	—	$66,329.56	$100,863.00	$79,595.47	2026-03-01
456	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	95	28	—	—	$15,603.00	$204,884.00	$79,491.95	2026-03-01
1613	APR_DRG	Implantable Heart Assist Systems	33	14	—	—	$64,392.00	$104,446.96	$77,270.40	2026-03-01
A9699	HCPCS	Radiopharmaceutical, Therapeutic, Not Otherwise Classified	3	1	—	—	$76,785.37	$77,046.96	$76,785.37	2026-03-01
1583	OTHER	New Technology - Level 46	53	21	—	—	$57,969.98	$95,826.26	$76,661.01	2026-03-01
1597	OTHER	New Technology - Level 46	53	21	—	—	$57,969.98	$95,826.26	$76,661.01	2026-03-01
C1823	HCPCS	Generator Pulse N-rechg	15	9	$95,580.00	$95,580.00	$12,425.40	$95,580.00	$76,464.00	2024-10-01
233	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	102	28	—	—	$51,800.00	$169,378.22	$75,735.07	2026-03-01
20	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	102	30	—	—	$10,799.00	$197,802.00	$74,924.96	2026-03-01
219	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	98	28	—	—	$52,805.03	$1,197,400.00	$74,876.95	2026-03-01
23	APR_DRG	Heart And/or Lung Transplant	33	14	—	—	$62,352.00	$97,366.79	$74,822.40	2026-03-01
007	OTHER	Lung Transplant	2	1	—	—	$64,191.07	$85,268.81	$74,729.94	2026-03-01
5881	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	33	14	—	—	$61,338.00	$93,593.57	$73,605.60	2026-03-01
014	OTHER	Allogeneic Bone Marrow Transplant	2	1	—	—	$72,784.91	$74,396.99	$73,590.95	2026-03-01
Q2043	HCPCS	Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…	6	3	—	—	$55,453.60	$91,596.09	$73,391.94	2026-03-01
01597	OTHER	New Technology - Level 46	3	2	—	—	$72,462.48	$75,284.00	$72,462.48	2026-03-01
01583	OTHER	New Technology - Level 46	3	2	—	—	$72,462.48	$75,284.00	$72,462.48	2026-03-01
5913	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	33	14	—	—	$59,125.00	$94,624.20	$70,950.00	2026-03-01
112	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	33	14	—	—	$48,895.00	$105,823.65	$70,549.10	2026-03-01
957	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Mcc	106	30	—	—	$8,700.00	$135,624.52	$70,120.90	2026-03-01
10	MS_DRG	Pancreas Transplant	98	29	—	—	$8,700.00	$158,072.30	$69,862.54	2026-03-01
002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	2	1	—	—	$64,074.62	$75,573.33	$69,823.98	2026-03-01
C2642	HCPCS	Brachytx Strnd Cesium131	180	10	$104,749.50	$104,749.50	$9,687.60	$168,480.00	$69,650.10	2026-03-01
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	99	29	—	—	$8,700.00	$159,677.28	$69,647.20	2026-03-01
275	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	101	28	—	—	$12,541.00	$192,372.84	$69,083.91	2026-03-01
L8702	HCPCS	Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge…	55	21	—	—	$52,697.36	$86,002.13	$68,801.70	2026-03-01
427	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	104	30	—	—	$10,799.00	$178,123.00	$68,544.30	2026-03-01
6034	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	33	14	—	—	$40,520.04	$102,481.50	$68,321.00	2026-03-01
932522	CDM	Kit Aor Vlv 14fr 29mm	38	13	$105,300.00	$105,300.00	$5,580.90	$105,300.00	$67,392.00	2026-03-01
932521	CDM	Kit Vlv Aor 14fr 26mm	38	13	$105,300.00	$105,300.00	$5,580.90	$105,300.00	$67,392.00	2026-03-01
962844	CDM	Valve Heart Trnscth 20mm	38	13	$105,300.00	$105,300.00	$5,580.90	$105,300.00	$67,392.00	2026-03-01
955702	CDM	Valve Heart Trnscth 26mm	38	13	$105,300.00	$105,300.00	$5,580.90	$105,300.00	$67,392.00	2026-03-01
934198	CDM	Kit Aor Vlv 14fr 20mm	38	13	$105,300.00	$105,300.00	$5,580.90	$105,300.00	$67,392.00	2026-03-01
955592	CDM	Valve Heart Trnscth 23mm	38	13	$105,300.00	$105,300.00	$5,580.90	$105,300.00	$67,392.00	2026-03-01
957486	CDM	Valve Heart Trnscth 20mm	38	13	$105,300.00	$105,300.00	$5,580.90	$105,300.00	$67,392.00	2026-03-01
932520	CDM	Valve 23mm Thv	38	13	$105,300.00	$105,300.00	$5,580.90	$105,300.00	$67,392.00	2026-03-01
939201	CDM	Valve Hrt W Cert Sys 26a	38	13	$105,300.00	$105,300.00	$5,580.90	$105,300.00	$67,392.00	2026-03-01
1582	OTHER	New Technology - Level 45	53	21	—	—	$50,240.70	$83,049.51	$66,439.61	2026-03-01
1596	OTHER	New Technology - Level 45	53	21	—	—	$50,240.70	$83,049.51	$66,439.61	2026-03-01
974863	CDM	System Trcsd 1clip 1cath	38	13	$103,680.00	$103,680.00	$5,495.04	$103,680.00	$66,355.20	2026-03-01
268	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	102	28	—	—	$34,816.95	$128,933.00	$65,886.67	2026-03-01
6024	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	33	14	—	—	$54,849.00	$83,100.26	$65,818.80	2026-03-01
217	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	102	28	—	—	$44,071.75	$200,009.46	$65,614.95	2026-03-01
01643	OTHER	Y90 Ibritumomab, Rx	3	2	—	—	$56,824.55	$65,476.58	$65,476.58	2026-03-01
1643	OTHER	Y90 Ibritumomab, Rx	53	21	—	—	$45,459.64	$81,845.73	$65,476.58	2026-03-01
975909	CDM	Valve Tavr 34mm	38	13	$102,060.00	$102,060.00	$5,409.18	$102,060.00	$65,318.40	2026-03-01
975910	CDM	Valve Tavr 29mm	38	13	$102,060.00	$102,060.00	$5,409.18	$102,060.00	$65,318.40	2026-03-01
975895	CDM	Valve Tavr 26mm	38	13	$102,060.00	$102,060.00	$5,409.18	$102,060.00	$65,318.40	2026-03-01
717	OTHER	Instill Adstiladrin, Tx D	53	20	—	—	$12,020.06	$80,343.49	$64,274.79	2026-03-01
447	MS_DRG	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	99	28	—	—	$18,165.00	$168,142.00	$64,218.20	2026-03-01
218	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	102	28	—	—	$40,602.61	$200,009.46	$64,095.73	2026-03-01
955	MS_DRG	Craniotomy For Multiple Significant Trauma	106	30	—	—	$8,700.00	$191,317.44	$64,039.76	2026-03-01
870	MS_DRG	Septicemia Or Severe Sepsis With Mv >96 Hours	104	30	—	—	$9,000.00	$82,136.80	$64,039.72	2026-03-01
J9029	HCPCS	Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose	9	4	—	—	$63,235.60	$106,053.40	$63,505.40	2026-03-01
00717	OTHER	Instill Adstiladrin, Tx D	3	2	—	—	$63,354.77	$64,274.79	$63,354.77	2026-03-01
01596	OTHER	New Technology - Level 45	3	2	—	—	$62,800.88	$65,246.20	$62,800.88	2026-03-01
01582	OTHER	New Technology - Level 45	3	2	—	—	$62,800.88	$65,246.20	$62,800.88	2026-03-01
489919	CDM	Set Pump 21fr 5.0	82	23	$260,260.00	$260,260.00	$12,772.79	$260,260.00	$62,722.66	2026-03-01
005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	2	1	—	—	$52,669.33	$72,018.27	$62,343.80	2026-03-01
936627	CDM	Valve Tavr 29mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
936578	CDM	Valve Tavr 34mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
936628	CDM	Valve Tavr 26mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
966993	CDM	Valve Tavr Sz 23mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
966991	CDM	Valve Tavr Sz 29mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
966990	CDM	Valve Tavr Size 34mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
966992	CDM	Valve Tavr Sz 26mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
939547	CDM	Valve Tavr 23mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
939549	CDM	Valve Tavr 29mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
936629	CDM	Valve Tavr 23mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
939548	CDM	Valve Tavr 26mm	38	13	$97,200.00	$97,200.00	$5,151.60	$97,200.00	$62,208.00	2026-03-01
928	MS_DRG	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	101	27	—	—	$8,700.00	$116,143.35	$62,151.63	2026-03-01
1612	APR_DRG	Implantable Heart Assist Systems	33	14	—	—	$51,234.90	$77,532.00	$61,481.88	2026-03-01
5933	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	33	14	—	—	$51,226.00	$80,695.10	$61,471.20	2026-03-01
1604	APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	33	14	—	—	$51,048.39	$83,284.50	$61,258.07	2026-03-01
432992	CDM	Transcath W Wir Sens Pa	47	18	$136,883.17	$136,883.17	$6,477.51	$136,883.17	$61,108.56	2026-03-01
266	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	106	30	—	—	$10,799.00	$245,859.26	$60,320.35	2026-03-01
317	MS_DRG	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	106	30	—	—	$8,700.00	$169,148.55	$60,241.76	2026-03-01
207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	106	30	—	—	$6,604.00	$86,829.99	$60,234.34	2026-03-01
429	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	1	1	—	—	$60,086.51	$60,086.51	$60,086.51	2026-03-01
935485	CDM	Strattice Tm 40x25cm	19	12	$76,361.00	$76,361.00	$4,047.13	$76,361.00	$59,561.58	2024-10-01
5893	APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational	33	14	—	—	$46,525.00	$89,188.07	$59,458.71	2026-03-01
5892	APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational	33	14	—	—	$47,538.00	$89,188.07	$59,458.71	2026-03-01
5891	APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational	33	14	—	—	$48,983.00	$89,188.07	$59,458.71	2026-03-01
232	MS_DRG	Coronary Bypass With Ptca Without Mcc	106	30	—	—	$10,799.00	$201,483.20	$59,120.79	2026-03-01
1611	APR_DRG	Implantable Heart Assist Systems	33	14	—	—	$49,247.00	$76,852.35	$59,096.40	2026-03-01
969	MS_DRG	HIV With Extensive O.r. Procedures With Mcc	106	30	—	—	$8,700.00	$123,252.27	$58,697.19	2026-03-01
276	MS_DRG	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	104	30	—	—	$10,799.00	$1,197,400.00	$58,024.38	2026-03-01
235	MS_DRG	Coronary Bypass Without Cardiac Catheterization With Mcc	106	30	—	—	$10,799.00	$139,389.52	$57,825.30	2026-03-01
422893	CDM	Cth Plc/inj R&lhc/grafts	45	17	$128,253.72	$128,253.72	$6,293.93	$128,253.72	$57,714.17	2026-03-01
573	MS_DRG	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	103	30	—	—	$11,000.00	$77,974.15	$57,415.72	2026-03-01
28	MS_DRG	Spinal Procedures With Mcc	102	30	—	—	$10,799.00	$122,629.00	$57,361.03	2026-03-01
020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	2	1	—	—	$54,653.19	$59,394.36	$57,023.78	2026-03-01
457	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	101	30	—	—	$10,799.00	$138,730.57	$56,943.38	2026-03-01
790	MS_DRG	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	73	23	—	—	$33,409.00	$70,952.84	$56,762.27	2026-03-01
461	MS_DRG	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	106	30	—	—	$10,799.00	$106,913.00	$56,657.23	2026-03-01
16	MS_DRG	Autologous Bone Marrow Transplant With Cc/mcc	98	29	—	—	$6,604.00	$308,475.18	$56,634.76	2026-03-01
1595	OTHER	New Technology - Level 44	53	21	—	—	$42,511.42	$70,272.76	$56,218.21	2026-03-01
1581	OTHER	New Technology - Level 44	53	21	—	—	$42,511.42	$70,272.76	$56,218.21	2026-03-01
499252	CDM	Set Vntrc 17.4x13.8in	82	23	$232,375.00	$232,375.00	$11,404.27	$232,375.00	$56,002.38	2026-03-01
974168	CDM	Kit Lo Prfl Comp Shth 7f	82	23	$232,375.00	$232,375.00	$11,404.27	$232,375.00	$56,002.38	2026-03-01
974595	CDM	Cath Vasc Assist Strl	82	23	$232,375.00	$232,375.00	$11,404.27	$232,375.00	$56,002.38	2026-03-01
967009	CDM	Kit Cath Rt Heart	82	23	$232,375.00	$232,375.00	$11,404.27	$232,375.00	$56,002.38	2026-03-01
9273	OTHER	Sipuleucel-t Auto Cd54+	51	20	—	—	$43,523.29	$68,769.04	$55,290.31	2026-03-01
213	MS_DRG	Endovascular Abdominal Aorta With Iliac Branch Procedures	52	28	—	—	$11,098.00	$156,038.06	$55,121.83	2026-03-01
23	MS_DRG	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	102	30	—	—	$10,799.00	$121,887.90	$55,066.25	2026-03-01
09273	OTHER	Sipuleucel-t Auto Cd54+	3	2	—	—	$54,404.11	$55,015.23	$55,015.23	2026-03-01
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	2	1	—	—	$47,308.48	$62,638.21	$54,973.35	2026-03-01
430	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc	104	30	—	—	$10,799.00	$148,770.00	$54,919.51	2026-03-01
B0404	HCPCS	Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5	8	2	—	—	$51,548.80	$58,456.31	$54,894.09	2026-03-01
5244	OTHER	Level 4 Blood Product Exc	53	21	—	—	$40,243.40	$82,107.89	$54,831.63	2026-03-01
422892	CDM	Cth Plc/inj R&lhc/l Vent	45	17	$121,653.79	$121,653.79	$5,970.05	$121,653.79	$54,744.21	2026-03-01
22	APR_DRG	Heart And/or Lung Transplant	33	14	—	—	$45,376.00	$73,729.74	$54,451.20	2026-03-01
820	MS_DRG	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	106	30	—	—	$8,700.00	$92,541.73	$54,360.61	2026-03-01
B0505	HCPCS	Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2	8	2	—	—	$51,019.38	$57,493.85	$54,160.01	2026-03-01
5912	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	33	14	—	—	$44,835.00	$81,160.27	$54,106.85	2026-03-01
17	MS_DRG	Autologous Bone Marrow Transplant Without Cc/mcc	98	29	—	—	$6,604.00	$308,475.18	$54,096.91	2026-03-01
428	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	104	30	—	—	$10,799.00	$148,770.00	$53,791.59	2026-03-01
234	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	106	30	—	—	$10,799.00	$129,048.77	$53,701.96	2026-03-01
220	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	102	30	—	—	$10,799.00	$1,197,400.00	$53,335.70	2026-03-01
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	2	1	—	—	$39,030.78	$67,493.46	$53,262.12	2026-03-01
64	APR_DRG	Pancreas Transplant	33	14	—	—	$43,326.23	$72,558.00	$53,209.20	2026-03-01
8424	APR_DRG	Burns With Skin Graft Except Extensive Third Degree Burns	33	14	—	—	$44,285.71	$69,304.50	$53,142.85	2026-03-01
01581	OTHER	New Technology - Level 44	3	2	—	—	$53,139.28	$55,208.40	$53,139.28	2026-03-01
01595	OTHER	New Technology - Level 44	3	2	—	—	$53,139.28	$55,208.40	$53,139.28	2026-03-01
412777	CDM	Robotic Or First 60 Min	45	17	$118,822.70	$118,822.70	$5,622.86	$118,822.70	$53,045.85	2026-03-01
453	OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	1	1	—	—	$52,549.11	$52,549.11	$52,549.11	2024-10-01
54	APR_DRG	Tracheostomy With Mv >96 Hours Without Extensive Procedure	33	14	—	—	$43,560.00	$70,007.73	$52,272.00	2026-03-01
8	MS_DRG	Simultaneous Pancreas And Kidney Transplant	98	29	—	—	$8,700.00	$159,677.28	$52,214.01	2026-03-01
21	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	102	30	—	—	$10,799.00	$197,422.91	$51,727.65	2026-03-01
428551	CDM	Robotic Or First 60 Min	47	18	$115,590.59	$115,590.59	$5,469.91	$115,590.59	$51,602.94	2026-03-01
8514	APR_DRG	Gender Related Procedures	33	14	—	—	$40,865.02	$70,353.00	$51,592.20	2026-03-01
834	MS_DRG	Acute Leukemia With Mcc	106	30	—	—	$6,604.00	$65,713.71	$51,421.68	2026-03-01
450	MS_DRG	Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically	103	30	—	—	$10,799.00	$129,553.00	$51,345.24	2026-03-01
6303	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	33	14	—	—	$42,730.78	$65,515.50	$51,276.94	2026-03-01
460	MS_DRG	Spinal Fusion Except Cervical Without Mcc	2	1	—	—	$45,570.00	$56,963.00	$51,266.50	2024-10-01
B0106	HCPCS	Stroke; M > 30.05 & M < 34.25	8	2	—	—	$49,029.19	$52,265.34	$51,161.29	2026-03-01
270	MS_DRG	Other Major Cardiovascular Procedures With Mcc	106	30	—	—	$10,799.00	$101,183.00	$51,103.26	2026-03-01
405	MS_DRG	Pancreas, Liver And Shunt Procedures With Mcc	104	30	—	—	$10,799.00	$121,953.52	$51,071.75	2026-03-01
278	MS_DRG	Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures	106	30	—	—	$10,799.00	$121,956.26	$50,627.35	2026-03-01
463	MS_DRG	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective	106	30	—	—	$8,700.00	$124,284.00	$50,529.68	2026-03-01
11	MS_DRG	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	106	30	—	—	$8,700.00	$89,298.97	$50,483.29	2026-03-01
6074	APR_DRG	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	33	14	—	—	$42,035.00	$64,236.87	$50,442.00	2026-03-01
653	MS_DRG	Major Bladder Procedures With Mcc	105	30	—	—	$9,013.00	$91,478.13	$50,357.60	2026-03-01
5932	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	33	14	—	—	$41,957.00	$64,905.25	$50,348.40	2026-03-01
05244	OTHER	Level 4 Blood Product Exc	3	2	—	—	$50,304.25	$64,506.44	$50,304.25	2026-03-01
43	APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	33	14	—	—	$41,876.00	$69,298.37	$50,251.20	2026-03-01
228	MS_DRG	Other Cardiothoracic Procedures With Mcc	106	30	—	—	$10,799.00	$176,730.00	$50,111.82	2026-03-01
21	APR_DRG	Heart And/or Lung Transplant	33	14	—	—	$41,730.00	$65,165.07	$50,076.00	2026-03-01
955	OTHER	Craniotomy For Multiple Significant Trauma	2	1	—	—	$40,496.08	$59,300.26	$49,898.17	2026-03-01
L7181	HCPCS	Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi…	55	21	—	—	$37,994.40	$62,006.75	$49,605.40	2026-03-01
466	MS_DRG	Revision Of Hip Or Knee Replacement With Mcc	106	30	—	—	$10,799.00	$109,455.00	$49,397.34	2026-03-01
231	OTHER	Coronary Bypass With Ptca With Mcc	2	1	—	—	$42,467.64	$56,220.22	$49,343.93	2026-03-01
221	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	102	30	—	—	$10,799.00	$1,197,400.00	$49,161.99	2026-03-01
447	OTHER	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	1	1	—	—	$48,872.15	$48,872.15	$48,872.15	2026-03-01
C1822	HCPCS	Pulse Gen Imp	34	13	$62,626.00	$62,626.00	$3,319.18	$62,626.00	$48,848.28	2026-03-01
93	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	33	14	—	—	$32,422.00	$87,882.00	$48,633.00	2026-03-01
434785	CDM	Right Vad Venous Access	47	18	$108,560.39	$108,560.39	$5,137.23	$108,560.39	$48,464.46	2026-03-01

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