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

WELLSTAR WEST GEORGIA MEDICAL CENTER

Lagrange, GA · CCN 110016 · Rates published

46,855 distinct procedures filed
26 distinct payers
254,236 rate rows
2026-07-31 last MRF observed
Data quality

146,775 of 254,236 rate rows are consumer-grade (57.7%)

107,461 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 107,393
placeholder amount (≤ $0.02) — excluded from medians 50
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 10
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 8
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.wellstar.org/wellstar-west-georgia-medical-center_standard-charges
Found on page https://www.wellstar.org/financial-policy-and-privacy-info/hospital-pricing-transparency
Discovered viaCMS hospital list
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-08-17
Content fingerprint 44a89e4988b6ec44… · 56,166,456 bytes · first seen 2026-05-05

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
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 4 $0.03 $3,943,235.33 $3,685,266.67 nat. median
$3,710,000
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 4 $0.03 $3,548,614.97 $3,316,462.59 nat. median
$3,324,572
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 8 $0.03 $4,812,016.79 $2,577,866.14 nat. median
$2,460,273
1.0× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 9 $0.03 $1,159,783.35 $627,229.78 nat. median
$691,418
0.9× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 9 $0.03 $1,152,532.70 $596,290.47 nat. median
$624,417
1.0× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 8 $0.03 $1,109,103.13 $594,162.39 nat. median
$631,793
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 9 $0.03 $1,178,375.50 $590,757.01 nat. median
$610,161
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 9 $0.03 $1,120,267.47 $565,223.98 nat. median
$588,565
1.0× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 9 $0.03 $1,120,791.00 $518,662.89 nat. median
$577,541
0.9× median
18
MS_DRG 		Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 14 $313,068.58 $1,512,329.86 $433,599.98 nat. median
$370,165
1.2× median
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 2 $235,544.87 $355,377.59 $310,919.94 nat. median
$83,623
outlier · 3.7×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 14 $204,356.00 $1,129,585.31 $283,033.06 nat. median
$261,939
1.1× median
459
MS_DRG 		Spinal Fusion Except Cervical With Mcc 2 $176,293.17 $265,981.76 $232,707.51 nat. median
$62,767
outlier · 3.7×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 14 $156,497.48 $951,379.17 $216,749.01 nat. median
$205,166
1.1× median
454
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Cc 2 $162,577.37 $245,288.10 $214,602.62 nat. median
$57,648
outlier · 3.7×
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 15 $124,487.00 $859,436.74 $166,490.81 nat. median
$199,832
0.8× median
455
MS_DRG 		Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc 2 $122,421.45 $184,702.98 $161,596.69 nat. median
$46,399
outlier · 3.5×
7
MS_DRG 		Lung Transplant 14 $96,254.44 $524,075.06 $133,312.40 nat. median
$122,690
1.1× median
215
MS_DRG 		Other Heart Assist System Implant 15 $74,788.60 $424,869.80 $129,384.28 nat. median
$98,002
1.3× median
460
MS_DRG 		Spinal Fusion Except Cervical Without Mcc 2 $97,230.64 $146,696.42 $128,344.74 nat. median
$37,051
outlier · 3.5×
14
MS_DRG 		Allogeneic Bone Marrow Transplant 14 $89,568.42 $525,398.49 $124,052.26 nat. median
$114,305
1.1× median
A9543
HCPCS 		Y90 Ibritumomab, Rx 9 $56,824.55 $240,299.05 $118,734.79 nat. median
$63,643
1.9× median
J7330
HCPCS 		Cultured Chondrocytes Implnt 1 $117,940.04 $117,940.04 $117,940.04 nat. median
$75,807
1.6× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 14 $84,648.03 $441,934.05 $117,237.52 nat. median
$108,240
1.1× median
J9029
HCPCS 		Inj, Adstiladrin, Per Tx Dos 8 $63,342.28 $226,806.00 $114,360.00 nat. median
$69,291
1.7× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 14 $82,420.55 $420,354.09 $114,152.46 nat. median
$96,835
1.2× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 14 $81,365.62 $436,856.88 $112,691.38 nat. median
$100,978
1.1× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 14 $88,658.00 $566,633.43 $109,907.65 nat. median
$132,706
0.8× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 14 $77,323.74 $427,051.45 $107,093.38 nat. median
$99,646
1.1× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 9 $55,272.32 $196,075.84 $104,053.18 nat. median
$65,655
1.6× median
9236
OTHER 		Eculizumab Injection 1 $100,885.00 $100,885.00 $100,885.00 nat. median
$231
outlier · 436.0×
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 14 $67,994.29 $334,467.36 $94,172.09 nat. median
$81,124
1.2× median
90288
HCPCS 		Botulism Ig IV 1 $92,831.73 $92,831.73 $92,831.73 nat. median
$52,716
1.8× median
850
MS_DRG 		Acute Leukemia With Other Procedures 14 $65,483.54 $369,409.98 $90,694.71 nat. median
$81,364
1.1× median
209
MS_DRG 		Complex Aortic Arch Procedures 14 $84,554.80 $165,727.41 $88,782.54 nat. median
$96,134
0.9× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 14 $63,646.91 $339,624.73 $88,150.97 nat. median
$80,459
1.1× median
38240
HCPCS 		Transplt Allo Hct/donor 9 $6,760.00 $240,867.78 $85,726.04 nat. median
$13,835
outlier · 6.2×
J9226
HCPCS 		Supprelin La Implant 9 $45,020.65 $163,593.70 $84,778.60 nat. median
$55,200
1.5× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 14 $59,813.00 $323,258.29 $82,841.01 nat. median
$77,385
1.1× median
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 14 $58,028.01 $299,324.22 $80,368.79 nat. median
$71,485
1.1× median
276
MS_DRG 		Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 14 $46,458.17 $248,404.18 $78,978.89 nat. median
$58,419
1.4× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 15 $36,995.00 $387,019.64 $78,687.07 nat. median
$92,900
0.8× median
427
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 14 $55,150.07 $284,686.26 $76,382.85 nat. median
$66,640
1.1× median
10
MS_DRG 		Pancreas Transplant 14 $54,842.41 $319,733.15 $75,956.74 nat. median
$67,750
1.1× median
928
MS_DRG 		Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 14 $54,820.90 $267,834.56 $75,926.95 nat. median
$62,911
1.2× median
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 14 $54,547.66 $317,892.38 $75,548.51 nat. median
$69,153
1.1× median
463
MS_DRG 		Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective… 14 $44,255.79 $216,589.67 $75,234.84 nat. median
$51,984
1.4× median
870
MS_DRG 		Septicemia Or Severe Sepsis With Mv >96 Hours 15 $24,208.00 $278,983.48 $73,335.53 nat. median
$65,958
1.1× median
268
MS_DRG 		Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 14 $52,706.73 $267,381.39 $72,998.82 nat. median
$65,792
1.1× median
5465
OTHER 		Level 5 Neurostimulator And Related Procedures 2 $27,811.00 $117,048.00 $72,429.50 nat. median
$31,928
outlier · 2.3×

Other procedures at this hospital

Browse this hospital's 46,855 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
             
0266T OTHER Implt/rpl Crtd Sns Dev Total 1 1 — — $56,095.00 $56,095.00 $56,095.00 2026-04-01
0268T OTHER Implt/rpl Crtd Sns Dev Gen 1 1 — — $56,095.00 $56,095.00 $56,095.00 2026-04-01
0408T OTHER Insj/rplc Cardiac Modulj Sys 12 9 — — $9,000.00 $120,197.64 $53,435.06 2026-04-01
0409T OTHER Insj/rplc Car Modulj Pls Gn 12 9 — — $9,000.00 $85,177.52 $37,866.51 2026-04-01
0414T OTHER Rmvl & Rpl Car Modulj Pls Gn 12 9 — — $9,000.00 $85,177.52 $37,866.51 2026-04-01
0515T OTHER Insj Wcs Lv Compl Sys 12 9 — — $6,389.00 $85,177.52 $37,866.51 2026-04-01
0571T OTHER Insj/rplcmt Icds Ss Eltrd 12 9 — — $9,000.00 $120,197.64 $53,435.06 2026-04-01
0614T OTHER Rmvl&rplcmt Ss Impl Dfb Pg 12 9 — — $8,245.00 $85,177.52 $37,866.51 2026-04-01
0620T OTHER Evasc Ven Artlz Tibl/prnl Vn 12 9 — — $6,389.00 $168,667.55 $60,029.61 2026-04-01
0674T OTHER Laps Insj Nw/rpcmt Prm Isdss 12 9 — — $5,809.00 $118,163.65 $42,055.03 2026-04-01
0686T OTHER Histotripsy Mal Hepatcel Tis 11 8 — — $6,389.00 $131,186.29 $57,308.84 2026-04-01
0908T OTHER Opn Imp Int Nstm Sys Vgs Nrv 12 9 — — $4,714.00 $118,163.65 $42,055.03 2026-04-01
0909T OTHER Rplcmt Int Nstim Sys Vgs Nrv 12 9 — — $4,714.00 $118,163.65 $42,055.03 2026-04-01
0915T OTHER Insj Perm Ccm-d Sys Pg&eltrd 12 9 — — $9,000.00 $120,197.64 $53,435.06 2026-04-01
0916T OTHER Insj Perm Ccm-d Sys Pg Only 12 9 — — $5,809.00 $85,177.52 $37,866.51 2026-04-01
0923T OTHER Rmvl&rplcmt Perm Ccm-d Pg 12 9 — — $5,809.00 $85,177.52 $37,866.51 2026-04-01
0981T OTHER Tcat Impl Wrls Ivc Snr 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 22 14 — — $204,356.00 $1,129,585.31 $283,033.06 2026-04-01
10 MS_DRG Pancreas Transplant 22 14 — — $54,842.41 $319,733.15 $75,956.74 2026-04-01
1013T OTHER Lap Srg Imp/rpl Eso Nea&pg/r 10 8 — — $19,090.13 $74,289.02 $33,025.93 2026-04-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 26 14 — — $36,290.00 $216,385.14 $45,470.61 2026-04-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 22 14 — — $33,616.82 $164,562.75 $46,559.29 2026-04-01
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc 22 14 — — $24,048.56 $106,267.58 $33,307.26 2026-04-01
14 MS_DRG Allogeneic Bone Marrow Transplant 22 14 — — $89,568.42 $525,398.49 $124,052.26 2026-04-01
140 MS_DRG Major Head And Neck Procedures With Mcc 22 14 — — $33,970.38 $169,599.82 $47,048.98 2026-04-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 22 14 — — $30,250.50 $132,411.38 $41,896.94 2026-04-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/Mcc 22 14 — — $45,906.68 $242,047.69 $63,580.76 2026-04-01
163 MS_DRG Major Chest Procedures With Mcc 26 14 — — $31,364.25 $184,835.33 $38,009.62 2026-04-01
164 MS_DRG Major Chest Procedures With Cc 23 14 — — $21,482.58 $111,958.00 $36,520.39 2026-04-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 27 14 — — $27,525.00 $154,440.50 $43,739.00 2026-04-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/Mcc 22 14 — — $42,339.56 $242,047.69 $58,640.29 2026-04-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 26 15 — — $23,365.00 $184,499.00 $42,465.94 2026-04-01
18 MS_DRG Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 22 14 — — $313,068.58 $1,512,329.86 $433,599.98 2026-04-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 22 14 — — $54,547.66 $317,892.38 $75,548.51 2026-04-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 22 14 — — $84,648.03 $441,934.05 $117,237.52 2026-04-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 22 14 — — $59,813.00 $323,258.29 $82,841.01 2026-04-01
2043 OTHER Orth/matrx/bn Fill Drug-elut 1 1 — — $36,483.00 $36,483.00 $36,483.00 2026-04-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 26 15 — — $38,711.50 $259,380.64 $52,995.28 2026-04-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 42 16 — — $19,403.00 $107,643.15 $49,936.12 2026-04-01
209 MS_DRG Complex Aortic Arch Procedures 15 14 — — $84,554.80 $165,727.41 $88,782.54 2026-04-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 22 14 — — $41,346.30 $221,666.84 $57,264.62 2026-04-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 22 14 — — $81,365.62 $436,856.88 $112,691.38 2026-04-01
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 15 14 — — $44,308.86 $86,845.37 $46,524.30 2026-04-01
215 MS_DRG Other Heart Assist System Implant 24 15 — — $74,788.60 $424,869.80 $129,384.28 2026-04-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 23 15 — — $36,995.00 $387,019.64 $78,687.07 2026-04-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 23 15 — — $36,995.00 $258,967.57 $54,074.18 2026-04-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 23 15 — — $36,995.00 $238,582.71 $54,074.18 2026-04-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 23 15 — — $36,995.00 $310,284.65 $62,538.11 2026-04-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 22 14 — — $26,168.46 $141,583.16 $36,243.32 2026-04-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 23 15 — — $36,995.00 $212,402.82 $44,539.81 2026-04-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 23 15 — — $36,995.00 $184,169.60 $42,294.53 2026-04-01
22558 HCPCS Lumbar Spine Fusion 12 9 — — $8,245.00 $103,904.54 $36,980.14 2026-04-01
22630 HCPCS Lumbar Spine Fusion 12 9 — — $8,245.00 $103,904.54 $36,980.14 2026-04-01
22633 HCPCS Lumbar Spine Fusion Combined 12 9 — — $8,245.00 $103,904.54 $39,796.89 2026-04-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 24 15 — — $36,995.00 $199,834.22 $41,582.43 2026-04-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 24 15 — — $25,300.00 $124,567.03 $32,390.58 2026-04-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 22 14 — — $44,476.68 $228,781.29 $61,600.21 2026-04-01
230 MS_DRG Other Cardiothoracic Procedures Without Cc/mcc 1 1 — — $36,995.00 $36,995.00 $36,995.00 2026-04-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 23 15 — — $36,995.00 $339,817.23 $68,305.54 2026-04-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 23 15 — — $36,995.00 $244,967.26 $50,139.96 2026-04-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 23 15 — — $36,995.00 $313,444.84 $62,284.11 2026-04-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 23 15 — — $36,995.00 $213,349.27 $45,536.60 2026-04-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 23 15 — — $36,995.00 $235,963.92 $48,651.30 2026-04-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 23 15 — — $33,421.75 $164,899.63 $36,995.00 2026-04-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 23 14 — — $37,339.00 $201,983.80 $41,385.21 2026-04-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 22 14 — — $31,435.96 $152,451.35 $43,538.81 2026-04-01
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 23 15 — — $23,824.09 $116,782.85 $40,500.95 2026-04-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 28 15 — — $17,812.00 $136,032.77 $45,462.51 2026-04-01
245 MS_DRG Aicd Generator Procedures 22 14 — — $36,101.04 $195,968.20 $49,999.94 2026-04-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 22 14 — — $35,988.45 $179,345.09 $49,844.00 2026-04-01
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 22 14 — — $25,915.31 $112,507.76 $35,892.71 2026-04-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 22 14 — — $25,679.37 $122,654.07 $35,565.93 2026-04-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 22 14 — — $26,709.20 $136,626.31 $36,992.24 2026-04-01
263 MS_DRG Vein Ligation And Stripping 22 14 — — $25,307.88 $107,554.92 $35,051.42 2026-04-01
264 MS_DRG Other Circulatory System O.r. Procedures 28 16 — — $26,213.00 $140,159.47 $47,296.22 2026-04-01
265 MS_DRG Aicd Lead Procedures 22 14 — — $29,329.68 $143,046.96 $40,621.61 2026-04-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 22 14 — — $47,331.66 $240,239.00 $65,554.35 2026-04-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 22 14 — — $37,523.87 $188,665.26 $51,970.56 2026-04-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 22 14 — — $52,706.73 $267,381.39 $72,998.82 2026-04-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 22 14 — — $33,668.46 $166,848.68 $46,630.82 2026-04-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 30 15 — — $13,834.00 $205,845.81 $48,634.63 2026-04-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 30 16 — — $30.00 $138,134.22 $40,006.78 2026-04-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 22 14 — — $32,967.80 $156,806.64 $45,660.40 2026-04-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 22 14 — — $26,988.17 $125,156.56 $37,378.61 2026-04-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 23 14 — — $50,703.00 $283,394.92 $58,333.77 2026-04-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 23 14 — — $46,458.17 $248,404.18 $78,978.89 2026-04-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 22 14 — — $36,503.36 $186,571.83 $50,557.15 2026-04-01
27702 HCPCS Reconstruct Ankle Joint 12 9 — — $8,245.00 $103,904.54 $36,980.14 2026-04-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 22 14 — — $43,299.83 $200,636.30 $59,970.26 2026-04-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 23 15 — — $29,245.05 $128,501.24 $38,537.00 2026-04-01
28 MS_DRG Spinal Procedures With Mcc 22 14 — — $46,470.36 $243,796.23 $64,361.45 2026-04-01
283 MS_DRG Acute Myocardial Infarction, Expired With Mcc 29 16 — — $17,587.01 $264,109.00 $34,470.54 2026-04-01
286 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc 41 16 — — $7,845.00 $88,762.18 $35,613.98 2026-04-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 22 14 — — $27,848.04 $134,609.08 $38,569.54 2026-04-01
294 MS_DRG Deep Vein Thrombophlebitis With Cc/Mcc 7 4 — — $32,638.81 $49,243.70 $37,861.07 2026-04-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 27 15 — — $124,487.00 $859,436.74 $166,490.81 2026-04-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 22 14 — — $35,513.69 $168,047.79 $49,186.46 2026-04-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 22 14 — — $51,334.10 $248,083.34 $71,097.73 2026-04-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 22 14 — — $35,387.47 $176,156.82 $49,011.64 2026-04-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 31 14 — — $20,743.00 $114,164.06 $36,995.00 2026-04-01
322 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc 43 17 — — $13,217.00 $72,552.15 $40,027.50 2026-04-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 25 15 — — $21,163.00 $170,810.96 $36,824.83 2026-04-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 22 14 — — $26,405.13 $114,777.65 $36,571.11 2026-04-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 30 16 — — $36,760.00 $203,676.18 $70,663.83 2026-04-01
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 28 16 — — $396.00 $97,376.52 $36,174.82 2026-04-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 31 14 — — $26,668.00 $337,834.00 $61,787.50 2026-04-01
330 MS_DRG Major Small And Large Bowel Procedures With Cc 44 16 — — $17,177.00 $137,094.00 $46,295.00 2026-04-01
331 MS_DRG Major Small And Large Bowel Procedures Without Cc/Mcc 38 16 — — $13,225.00 $69,304.00 $32,000.60 2026-04-01
332 MS_DRG Rectal Resection With Mcc 22 14 — — $29,347.61 $139,100.72 $40,646.44 2026-04-01
33230 HCPCS Insrt Pulse Gen W/dual Leads 12 9 — — $5,809.00 $85,177.52 $37,866.51 2026-04-01
33231 HCPCS Insrt Pulse Gen W/mult Leads 12 9 — — $5,809.00 $120,197.64 $53,435.06 2026-04-01
33240 HCPCS Insrt Pulse Gen W/singl Lead 13 10 — — $2,323.00 $85,177.52 $37,209.87 2026-04-01
33249 HCPCS Insj/rplcmt Defib W/lead(s) 12 9 — — $9,000.00 $120,197.64 $53,435.06 2026-04-01
33262 HCPCS Rmvl& Replc Pulse Gen 1 Lead 12 9 — — $5,809.00 $85,177.52 $37,866.51 2026-04-01
33263 HCPCS Rmvl & Rplcmt Dfb Gen 2 Lead 12 9 — — $5,809.00 $85,177.52 $37,866.51 2026-04-01
33264 HCPCS Rmvl & Rplcmt Dfb Gen Mlt Ld 12 9 — — $5,809.00 $120,197.64 $53,435.06 2026-04-01
33270 HCPCS Ins/rep Subq Defibrillator 12 9 — — $5,809.00 $120,197.64 $53,435.06 2026-04-01
33274 HCPCS Tcat Insj/rpl Perm Ldls Pm 12 9 — — $6,389.00 $73,758.96 $32,790.28 2026-04-01
33276 HCPCS Insj Phrnc Nrv Stim Sys 12 9 — — $5,809.00 $168,667.55 $71,900.78 2026-04-01
33287 HCPCS Rmv&rplcmt Phrnc Nrv Stim Pg 12 9 — — $5,809.00 $118,163.65 $52,530.83 2026-04-01
33289 HCPCS Tcat Impl Wrls P-art Prs Snr 12 9 — — $9,000.00 $109,837.41 $48,829.32 2026-04-01
336 MS_DRG Peritoneal Adhesiolysis With Cc 33 16 — — $15,209.00 $84,715.69 $34,232.86 2026-04-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 22 14 — — $31,140.49 $155,944.40 $43,129.57 2026-04-01
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 24 14 — — $22,309.00 $117,617.01 $33,507.88 2026-04-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 31 15 — — $30,440.00 $171,059.60 $59,304.08 2026-04-01
36906 HCPCS Thrmbc/nfs Dialysis Circuit 12 9 — — $9,000.00 $70,197.49 $31,207.00 2026-04-01
37 MS_DRG Extracranial Procedures With Mcc 22 14 — — $26,991.04 $133,173.35 $37,382.59 2026-04-01
37227 HCPCS Fem/popl Revasc Stnt & Ather 2 2 — — $6,389.00 $56,095.00 $31,242.00 2026-04-01
37231 HCPCS Hc Pta 1St Tib/Peroneal With Stent Plus Atherectomy 2 2 — — $6,389.00 $56,095.00 $31,242.00 2026-04-01
37271 HCPCS Revsc Evsc Fpvt Athrc Sf 1st 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
37273 HCPCS Revsc Evsc Fpvt Athrc Cplx 1 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
37275 HCPCS Rvsc Evsc Fpvt St Athrc Sf 1 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
37277 HCPCS Rvsc Evsc Fpvt St Athr Cpx 1 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
37284 HCPCS Revsc Evasc Tpvt St Sf 1st 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
37286 HCPCS Revsc Evasc Tpvt St Cplx 1st 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
37288 HCPCS Revsc Evsc Tpvt Athrc Sf 1st 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
37290 HCPCS Revsc Evsc Tpvt Athrc Cplx 1 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
37292 HCPCS Rvsc Evsc Tpvt St Athrc Sf 1 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
37294 HCPCS Rvsc Evsc Tpvt St Athr Cpx 1 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
38240 HCPCS Transplt Allo Hct/donor 12 9 — — $6,760.00 $240,867.78 $85,726.04 2026-04-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 25 14 — — $88,658.00 $566,633.43 $109,907.65 2026-04-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 26 16 — — $27,090.00 $201,127.00 $53,755.18 2026-04-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 22 14 — — $32,214.79 $157,576.64 $44,617.49 2026-04-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 22 14 — — $42,613.51 $217,700.55 $59,019.71 2026-04-01
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 22 14 — — $24,180.52 $112,620.05 $33,490.02 2026-04-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 22 14 — — $28,952.45 $140,408.11 $40,099.14 2026-04-01
41 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe… 25 15 — — $10,011.00 $90,578.89 $32,554.46 2026-04-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 22 14 — — $27,071.36 $109,740.59 $37,493.83 2026-04-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 23 15 — — $28,930.94 $140,508.37 $49,182.60 2026-04-01
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 32 17 — — $16,916.00 $95,307.16 $36,994.88 2026-04-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 22 14 — — $27,815.77 $141,535.04 $38,524.84 2026-04-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 23 14 — — $24,972.00 $163,106.98 $35,486.56 2026-04-01
424 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Cc 23 14 — — $19,072.23 $91,561.44 $32,422.79 2026-04-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 22 14 — — $82,420.55 $420,354.09 $114,152.46 2026-04-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 22 14 — — $55,150.07 $284,686.26 $76,382.85 2026-04-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 22 14 — — $43,700.00 $220,780.54 $60,524.50 2026-04-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 22 14 — — $67,994.29 $334,467.36 $94,172.09 2026-04-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 22 14 — — $44,740.59 $219,372.89 $61,965.71 2026-04-01
432 MS_DRG Cirrhosis And Alcoholic Hepatitis With Mcc 37 17 — — $15,761.00 $83,827.00 $34,293.41 2026-04-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 22 14 — — $51,298.96 $268,865.24 $71,049.06 2026-04-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 22 14 — — $33,794.67 $163,752.65 $46,805.62 2026-04-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 22 14 — — $41,603.04 $206,523.57 $57,620.21 2026-04-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 22 14 — — $26,548.56 $123,752.92 $36,769.76 2026-04-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 5 2 — — $235,544.87 $355,377.59 $310,919.94 2026-04-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 5 2 — — $162,577.37 $245,288.10 $214,602.62 2026-04-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc 5 2 — — $122,421.45 $184,702.98 $161,596.69 2026-04-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 22 14 — — $63,646.91 $339,624.73 $88,150.97 2026-04-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 22 14 — — $46,146.21 $230,156.86 $63,912.50 2026-04-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 22 14 — — $33,305.58 $173,157.04 $46,128.23 2026-04-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 5 2 — — $176,293.17 $265,981.76 $232,707.51 2026-04-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 5 2 — — $97,230.64 $146,696.42 $128,344.74 2026-04-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 22 14 — — $42,990.02 $246,106.22 $59,541.18 2026-04-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 23 14 — — $44,255.79 $216,589.67 $75,234.84 2026-04-01
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 25 15 — — $9,709.00 $118,250.65 $40,864.00 2026-04-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 24 14 — — $24,922.00 $204,301.81 $43,562.20 2026-04-01
471 MS_DRG Cervical Spinal Fusion With Mcc 22 14 — — $38,010.82 $194,785.13 $52,644.99 2026-04-01
472 MS_DRG Cervical Spinal Fusion With Cc 22 14 — — $24,509.69 $116,181.29 $33,945.92 2026-04-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 23 14 — — $32,023.00 $179,842.38 $36,560.09 2026-04-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 22 14 — — $28,156.41 $137,909.64 $38,996.63 2026-04-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 30 16 — — $16,161.00 $117,945.86 $31,948.50 2026-04-01
481 MS_DRG Hip And Femur Procedures Except Major Joint With Cc 40 16 — — $250.00 $83,211.79 $35,056.59 2026-04-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 22 14 — — $26,524.89 $129,279.25 $36,736.97 2026-04-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 29 15 — — $24,114.50 $142,409.30 $31,792.52 2026-04-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 22 14 — — $29,383.46 $141,178.11 $40,696.09 2026-04-01
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 23 14 — — $25,016.72 $101,250.57 $37,296.00 2026-04-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 22 14 — — $77,323.74 $427,051.45 $107,093.38 2026-04-01
509 MS_DRG Arthroscopy 7 4 — — $46,689.53 $70,442.68 $54,159.92 2026-04-01
5116 OTHER Level 6 Musculoskeletal Procedures 13 8 — — $18,171.00 $71,641.00 $40,629.75 2026-04-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 22 14 — — $26,236.59 $124,009.59 $36,337.68 2026-04-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 23 14 — — $162.00 $143,724.72 $32,296.68 2026-04-01
5213 OTHER Level 3 Electrophysiologic Procedures 7 4 — — $23,654.00 $39,246.00 $37,430.75 2026-04-01
5232 OTHER Level 2 Icd And Similar Procedures 15 9 — — $40.00 $118,329.00 $71,352.50 2026-04-01
5378 OTHER Level 8 Urology And Related Services 12 8 — — $15,690.00 $77,162.00 $39,682.88 2026-04-01
5463 OTHER Level 3 Neurostimulator And Related Procedures 1 1 — — $60,805.00 $60,805.00 $60,805.00 2025-08-01
5464 OTHER Level 4 Neurostimulator And Related Procedures 9 5 — — $16,709.00 $97,771.00 $37,603.00 2026-04-01
5465 OTHER Level 5 Neurostimulator And Related Procedures 2 2 — — $27,811.00 $117,048.00 $72,429.50 2026-04-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 22 14 — — $50,365.22 $246,952.41 $69,755.83 2026-04-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 22 14 — — $28,276.90 $138,948.33 $39,163.51 2026-04-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 22 14 — — $38,530.76 $216,357.07 $53,365.10 2026-04-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 24 14 — — $26,606.65 $130,702.95 $33,614.50 2026-04-01
6 MS_DRG Liver Transplant Without Mcc 22 14 — — $36,636.04 $194,460.29 $50,740.91 2026-04-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 24 14 — — $19,516.00 $154,997.95 $39,322.42 2026-04-01
61885 HCPCS Insrt/redo Neurostim 1 Array 14 10 — — $1,694.00 $118,163.65 $42,055.03 2026-04-01
61886 HCPCS Implant Neurostim Arrays 14 10 — — $1,937.00 $118,163.65 $42,055.03 2026-04-01
61891 HCPCS Rev/rplcmt Sk-mnt Crnl Nstm 12 9 — — $5,809.00 $118,163.65 $42,055.03 2026-04-01
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 24 14 — — $25,040.38 $114,974.16 $37,828.32 2026-04-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 24 15 — — $28,234.00 $158,262.42 $32,216.11 2026-04-01
63685 HCPCS Insrt/redo Spine N Generator 14 10 — — $1,694.00 $118,163.65 $42,055.03 2026-04-01
637 MS_DRG Diabetes With Mcc 48 16 — — $10,203.00 $60,030.00 $32,912.00 2026-04-01
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 41 16 — — $14,488.00 $79,770.87 $32,936.64 2026-04-01
64568 HCPCS Inc For Vagus N Elect Impl 12 9 — — $4,714.00 $168,667.55 $71,900.78 2026-04-01
64582 HCPCS Opn Mpltj Hpglsl Nstm Ary Pg 12 9 — — $4,714.00 $118,163.65 $52,530.83 2026-04-01
64656 HCPCS Revj/rplcmt Bat Mod Sys Pg 10 8 — — $30,364.64 $118,163.65 $52,530.83 2026-04-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 22 14 — — $37,097.88 $184,759.13 $51,380.57 2026-04-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 22 14 — — $29,957.90 $139,249.11 $41,491.69 2026-04-01
652 MS_DRG Kidney Transplant 22 14 — — $26,542.10 $123,167.40 $36,760.81 2026-04-01
653 MS_DRG Major Bladder Procedures With Mcc 24 15 — — $39,008.00 $223,547.72 $49,002.07 2026-04-01
654 MS_DRG Major Bladder Procedures With Cc 23 15 — — $23,456.91 $172,395.00 $39,876.75 2026-04-01
662 MS_DRG Minor Bladder Procedures With Mcc 22 14 — — $25,337.28 $125,100.42 $35,092.13 2026-04-01
668 MS_DRG Transurethral Procedures With Mcc 26 16 — — $24,322.51 $116,947.27 $43,902.13 2026-04-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 35 16 — — $30,526.00 $168,035.76 $62,000.07 2026-04-01
674 MS_DRG Other Kidney And Urinary Tract Procedures With Cc 34 16 — — $272.00 $126,108.00 $36,376.12 2026-04-01
69930 HCPCS Implant Cochlear Device 14 10 — — $3,721.00 $126,260.43 $44,936.71 2026-04-01
7 MS_DRG Lung Transplant 22 14 — — $96,254.44 $524,075.06 $133,312.40 2026-04-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 22 14 — — $29,016.28 $157,901.48 $40,187.55 2026-04-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 22 14 — — $29,075.80 $159,641.99 $40,269.99 2026-04-01
77 MS_DRG Hypertensive Encephalopathy With Mcc 8 4 — — $13,219.00 $62,008.80 $45,520.90 2026-04-01
78 MS_DRG Hypertensive Encephalopathy With Cc 8 5 — — $26,522.52 $40,015.77 $32,787.58 2026-04-01
783 MS_DRG Cesarean Section With Sterilization With Mcc 31 16 — — $6,277.00 $88,431.00 $35,680.38 2026-04-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 36 17 — — $3,291.00 $238,418.28 $57,357.75 2026-04-01
791 MS_DRG Prematurity With Major Problems 33 15 — — $7,613.00 $162,826.25 $34,765.25 2026-04-01
793 MS_DRG Full Term Neonate With Major Problems 31 15 — — $3,723.00 $167,257.74 $34,948.26 2026-04-01
799 MS_DRG Splenic Procedures With Mcc 22 14 — — $35,860.79 $190,674.47 $49,667.19 2026-04-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 22 14 — — $43,575.21 $218,197.84 $60,351.67 2026-04-01
800 MS_DRG Splenic Procedures With Cc 22 14 — — $23,529.34 $116,847.01 $32,588.13 2026-04-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 22 14 — — $31,953.74 $143,756.80 $44,255.93 2026-04-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 22 14 — — $45,441.25 $233,481.48 $62,936.13 2026-04-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 24 14 — — $16,116.00 $187,654.64 $38,800.00 2026-04-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 22 14 — — $36,928.64 $191,504.62 $51,146.17 2026-04-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 22 14 — — $26,043.68 $123,664.69 $36,070.50 2026-04-01
834 MS_DRG Acute Leukemia With Mcc 23 15 — — $41,369.00 $221,650.80 $45,745.32 2026-04-01
835 MS_DRG Acute Leukemia With Cc 23 14 — — $18,340.02 $85,654.12 $31,178.03 2026-04-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 22 14 — — $37,835.83 $200,792.71 $52,402.62 2026-04-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 25 15 — — $23,547.00 $127,907.70 $45,187.41 2026-04-01
849 MS_DRG Radiotherapy 22 14 — — $22,812.90 $107,113.77 $31,595.86 2026-04-01
850 MS_DRG Acute Leukemia With Other Procedures 22 14 — — $65,483.54 $369,409.98 $90,694.71 2026-04-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 51 17 — — $120.00 $222,424.00 $71,778.09 2026-04-01
854 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Cc 44 17 — — $12,802.00 $80,135.81 $35,699.00 2026-04-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 28 15 — — $250.00 $180,921.18 $49,863.86 2026-04-01
857 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Cc 27 16 — — $18,739.47 $87,382.61 $32,981.47 2026-04-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 36 15 — — $24,208.00 $278,983.48 $73,335.53 2026-04-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 23 14 — — $31,098.89 $157,584.66 $50,901.00 2026-04-01
901 MS_DRG Wound Debridements For Injuries With Mcc 22 14 — — $33,477.69 $177,668.74 $46,366.60 2026-04-01
90288 HCPCS Botulism Ig IV 2 1 — — $92,831.73 $92,831.73 $92,831.73 2026-04-01
904 MS_DRG Skin Grafts For Injuries With Cc/Mcc 22 14 — — $29,723.39 $154,837.53 $41,166.90 2026-04-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 32 17 — — $8,279.00 $159,754.28 $55,802.12 2026-04-01
9236 OTHER Eculizumab Injection 1 1 — — $100,885.00 $100,885.00 $100,885.00 2025-08-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 22 14 — — $156,497.48 $951,379.17 $216,749.01 2026-04-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 22 14 — — $54,820.90 $267,834.56 $75,926.95 2026-04-01
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc 22 14 — — $26,479.71 $127,538.74 $36,674.40 2026-04-01
92930 HCPCS Prq Tcat Plmt Ntrac St 2+les 10 8 — — $18,038.73 $70,197.49 $31,207.00 2026-04-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 22 14 — — $31,309.02 $173,517.98 $43,362.99 2026-04-01
93580 HCPCS Transcath Closure Of Asd 12 9 — — $9,842.00 $70,197.49 $31,207.00 2026-04-01
93581 HCPCS Transcath Closure Of Vsd 12 9 — — $9,842.00 $70,197.49 $31,207.00 2026-04-01
93582 HCPCS Perq Transcath Closure Pda 12 9 — — $9,842.00 $70,197.49 $31,207.00 2026-04-01
93590 HCPCS Perq Transcath Cls Mitral 12 9 — — $9,842.00 $70,197.49 $31,207.00 2026-04-01
93591 HCPCS Perq Transcath Cls Aortic 12 9 — — $9,842.00 $70,197.49 $31,207.00 2026-04-01
93653 HCPCS Ep & Ablate Supravent Arrhyt 12 9 — — $9,000.00 $100,089.92 $38,963.68 2026-04-01
93654 HCPCS Ep & Ablate Ventric Tachy 12 9 — — $9,000.00 $100,089.92 $38,963.68 2026-04-01
93656 HCPCS Tx Atrial Fib Pulm Vein Isol 12 9 — — $9,000.00 $100,089.92 $38,963.68 2026-04-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 22 14 — — $29,403.54 $127,282.08 $40,723.90 2026-04-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 23 14 — — $28,621.13 $146,315.43 $48,655.92 2026-04-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 22 14 — — $51,653.95 $273,826.10 $71,540.73 2026-04-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 25 15 — — $20,939.00 $153,285.51 $32,493.89 2026-04-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 22 14 — — $58,028.01 $299,324.22 $80,368.79 2026-04-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 22 14 — — $33,601.76 $164,807.39 $46,538.43 2026-04-01
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/Mcc 22 14 — — $24,495.35 $106,022.94 $33,926.06 2026-04-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 22 14 — — $47,280.75 $253,613.69 $65,483.84 2026-04-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 25 15 — — $26,596.00 $143,764.82 $49,782.43 2026-04-01
974 MS_DRG HIV With Major Related Condition With Mcc 24 14 — — $17,666.00 $119,750.54 $33,348.97 2026-04-01
98 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Cc 23 15 — — $19,839.59 $86,989.59 $33,727.30 2026-04-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 30 16 — — $11,378.00 $190,666.45 $64,060.24 2026-04-01
A9543 HCPCS Y90 Ibritumomab, Rx 16 9 — — $56,824.55 $240,299.05 $118,734.79 2026-04-01
C9760 HCPCS Non-blind Interatrial Shunt 12 9 — — $5,063.00 $103,075.34 $45,823.17 2026-04-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 7 4 — — $0.03 $3,943,235.33 $3,685,266.67 2026-04-01
J1413 HCPCS Inj Delandistrogene Mox Rokl 7 4 — — $0.03 $3,548,614.97 $3,316,462.59 2026-04-01
J3399 HCPCS Inj Onase Abepar-xioi Treat 11 8 — — $0.03 $4,812,016.79 $2,577,866.14 2026-04-01
J7310 HCPCS Ganciclovir Long Act Implant 2 1 — — $32,325.76 $32,325.76 $32,325.76 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 2 1 — — $117,940.04 $117,940.04 $117,940.04 2026-04-01
J9029 HCPCS Inj, Adstiladrin, Per Tx Dos 13 8 — — $63,342.28 $226,806.00 $114,360.00 2026-04-01
J9226 HCPCS Supprelin La Implant 14 9 — — $45,020.65 $163,593.70 $84,778.60 2026-04-01
J9266 HCPCS Pegaspargase Injection 14 9 — — $28,424.06 $94,617.96 $51,596.43 2026-04-01
J9600 HCPCS Porfimer Sodium Injection 16 9 — — $24,228.42 $94,284.62 $45,342.71 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 12 9 — — $0.03 $1,120,267.47 $565,223.98 2026-04-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 12 9 — — $0.03 $1,159,783.35 $627,229.78 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 14 9 — — $55,272.32 $196,075.84 $104,053.18 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 12 9 — — $0.03 $1,120,791.00 $518,662.89 2026-04-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 12 9 — — $0.03 $1,152,532.70 $596,290.47 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 12 9 — — $0.03 $1,178,375.50 $590,757.01 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 11 8 — — $0.03 $1,109,103.13 $594,162.39 2026-04-01
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