Hospital

Wesley Rehabilitation Hospital, An Affiliate Of En

Wichita, KS · CCN 173027 · Rates published

33,346 distinct procedures filed

24 distinct payers

727,156 rate rows

2026-03-01 last MRF observed

Data quality

714,281 of 727,156 rate rows are consumer-grade (98.2%)

12,875 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	8,418
per-diem day rate — not a per-procedure price	4,157
template filing: same amount across many unrelated codes — excluded	165
placeholder amount (≤ $0.02) — excluded from medians	130
exceeds 10× this hospital's gross charge — excluded from medians	5

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

Source MRF file	https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1762545_WESLEY-MEDICAL-CENTER_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page	https://wesleymc.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-05-19
Content fingerprint	e380bced3154a829… · 380,095,325 bytes · first seen 2026-05-15

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
00845 OTHER	Inj, Atidarsagene Autotem	1	$4,505,000.00	$4,505,000.00	$4,505,000.00	nat. median $4,505,000 1.0× median
845 OTHER	Inj, Atidarsagene Autotem	7	$5,574.29	$4,730,250.00	$4,505,000.00	nat. median $9,966 outlier · 452.1×
J1413 HCPCS	Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose	1	$4,000,000.00	$4,000,000.00	$4,000,000.00	nat. median $3,325,455 1.2× median
09138 OTHER	Inj, Hemgenix, Per Tx Dos	1	$3,685,267.00	$3,685,267.00	$3,685,267.00	nat. median $3,574,709 1.0× median
9138 OTHER	Inj, Hemgenix, Per Tx Dos	6	$3,685,267.00	$3,869,530.35	$3,685,267.00	nat. median $3,746,358 1.0× median
J1414 HCPCS	Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose	5	$3,508,750.00	$3,508,750.00	$3,508,750.00	nat. median $3,710,000 0.9× median
J1411 HCPCS	Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose	5	$3,508,750.00	$3,508,750.00	$3,508,750.00	nat. median $3,710,000 0.9× median
00908 OTHER	Topi Adm Prad Zami Per Tr	1	$3,335,820.00	$3,335,820.00	$3,335,820.00	nat. median $12,675 outlier · 263.2×
908 OTHER	Topi Adm Prad Zami Per Tr	7	$10,093.05	$3,502,611.00	$3,335,820.00	nat. median $22,747 outlier · 146.6×
714 OTHER	Inj Delandistrogene Mox R	8	$6,556.12	$4,991,790.00	$3,327,860.00	nat. median $13,041 outlier · 255.2×
00714 OTHER	Inj Delandistrogene Mox R	1	$3,327,860.00	$3,327,860.00	$3,327,860.00	nat. median $3,228,024 1.0× median
748 OTHER	Inj, Lovotibeglogene Auto	8	$12,479.50	$4,878,762.00	$3,252,508.00	nat. median $17,963 outlier · 181.1×
00748 OTHER	Inj, Lovotibeglogene Auto	1	$3,252,508.00	$3,252,508.00	$3,252,508.00	nat. median $3,187,420 1.0× median
906 OTHER	Inj Elivaldogene Autoteme	8	$8,918.39	$4,770,000.00	$3,180,000.00	nat. median $20,756 outlier · 153.2×
00906 OTHER	Inj Elivaldogene Autoteme	1	$3,180,000.00	$3,180,000.00	$3,180,000.00	nat. median $21 outlier · 153697.4×
J3394 HCPCS	Injection, Lovotibeglogene Autotemcel, Per Treatment	5	$3,100,000.00	$3,100,000.00	$3,100,000.00	nat. median $3,286,000 0.9× median
J3393 HCPCS	Injection, Betibeglogene Autotemcel, Per Treatment	5	$2,800,000.00	$3,086,720.00	$3,012,520.00	nat. median $3,006,423 1.0× median
746 OTHER	Inj, Betibeglogene Autote	8	$11,543.67	$4,409,953.50	$2,939,969.00	nat. median $21,896 outlier · 134.3×
00746 OTHER	Inj, Betibeglogene Autote	1	$2,939,969.00	$2,939,969.00	$2,939,969.00	nat. median $2,878,960 1.0× median
9141 OTHER	Inj Onase Abepar-xioi Tre	7	$2,588,981.00	$3,883,471.50	$2,588,981.00	nat. median $2,588,981 1.0× median
09141 OTHER	Inj Onase Abepar-xioi Tre	1	$2,588,981.00	$2,588,981.00	$2,588,981.00	nat. median $2,457,321 1.1× median
00824 OTHER	Inj, Exagamglogene Autote	1	$2,332,000.00	$2,332,000.00	$2,332,000.00	nat. median $2,332,000 1.0× median
824 OTHER	Inj, Exagamglogene Autote	8	$13,517.35	$3,498,000.00	$2,332,000.00	nat. median $25,250 outlier · 92.4×
J3399 HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	5	$2,222,890.60	$2,397,684.95	$2,311,806.22	nat. median $2,469,189 0.9× median
J3392 HCPCS	Injection, Exagamglogene Autotemcel, Per Treatment	5	$2,205,500.00	$2,205,500.00	$2,205,500.00	nat. median $2,448,600 0.9× median
Q2058 HCPCS	Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,…	1	$1,057,350.00	$1,057,350.00	$1,057,350.00	nat. median $324,450 outlier · 3.3×
Q2057 HCPCS	Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure…	6	$770,620.00	$2,928,356.00	$801,444.80	nat. median $824,563 1.0× median
2067 OTHER	Afamitresgene Autoleucel	7	$770,620.00	$1,155,930.00	$770,620.00	nat. median $786,032 1.0× median
Q2056 HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	7	$553,169.00	$2,233,068.37	$596,464.31	nat. median $675,122 0.9× median
09498 OTHER	Ciltacabtagene Car-pos T	1	$587,649.60	$587,649.60	$587,649.60	nat. median $554,552 1.1× median
9498 OTHER	Ciltacabtagene Car-pos T	7	$587,649.60	$881,474.40	$587,649.60	nat. median $587,650 1.0× median
Q2042 HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	6	$566,531.30	$2,152,818.94	$586,359.90	nat. median $754,974 0.8× median
Q2054 HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	7	$516,442.00	$2,136,364.71	$570,634.26	nat. median $674,188 0.8× median
09194 OTHER	Tisagenlecleucel Car-pos	1	$566,531.30	$566,531.30	$566,531.30	nat. median $538,205 1.1× median
9194 OTHER	Tisagenlecleucel Car-pos	7	$566,531.30	$849,796.95	$566,531.30	nat. median $566,531 1.0× median
Q2055 HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	7	$527,622.00	$2,120,710.57	$566,452.96	nat. median $625,184 0.9× median
09413 OTHER	Lisocabtagene Car Pos T	1	$562,201.20	$562,201.20	$562,201.20	nat. median $534,091 1.1× median
9413 OTHER	Lisocabtagene Car Pos T	7	$562,201.20	$843,301.80	$562,201.20	nat. median $562,201 1.0× median
9422 OTHER	Idecabtagene Vicleucel Ca	7	$558,081.80	$837,122.70	$558,081.80	nat. median $558,082 1.0× median
09422 OTHER	Idecabtagene Vicleucel Ca	1	$558,081.80	$558,081.80	$558,081.80	nat. median $530,178 1.1× median
Q2041 HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	6	$502,841.00	$2,022,330.51	$550,818.97	nat. median $634,511 0.9× median
09035 OTHER	Axicabtagene Ciloleucel C	1	$532,192.20	$532,192.20	$532,192.20	nat. median $505,583 1.1× median
9035 OTHER	Axicabtagene Ciloleucel C	7	$532,192.20	$798,288.30	$532,192.20	nat. median $532,192 1.0× median
Q2053 HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	7	$463,155.00	$1,859,910.76	$496,791.96	nat. median $620,080 0.8× median
09391 OTHER	Brexucabtagene Car Pos T	1	$489,450.20	$489,450.20	$489,450.20	nat. median $464,978 1.1× median
9391 OTHER	Brexucabtagene Car Pos T	7	$489,450.20	$734,175.30	$489,450.20	nat. median $489,450 1.0× median
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	13	$8,060.00	$483,902.10	$322,601.40	nat. median $370,174 0.9× median
831 OTHER	Obecbtge Autol Up To 400	8	$3,817.03	$417,375.00	$278,250.00	nat. median $12,362 outlier · 22.5×
00831 OTHER	Obecbtge Autol Up To 400	1	$278,250.00	$278,250.00	$278,250.00	nat. median $278,250 1.0× median
J3403 HCPCS	Revakinagene Taroretcel-lwey, Per Implant	4	$265,000.00	$275,600.00	$274,275.00	nat. median $265,000 1.0× median

Other procedures at this hospital

Browse this hospital's 33,346 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

00845	OTHER	Inj, Atidarsagene Autotem	1	1	—	—	$4,505,000.00	$4,505,000.00	$4,505,000.00	2026-03-01
J1413	HCPCS	Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose	2	1	—	—	$4,000,000.00	$4,000,000.00	$4,000,000.00	2026-03-01
09138	OTHER	Inj, Hemgenix, Per Tx Dos	1	1	—	—	$3,685,267.00	$3,685,267.00	$3,685,267.00	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	1	1	—	—	$3,327,860.00	$3,327,860.00	$3,327,860.00	2026-03-01
00748	OTHER	Inj, Lovotibeglogene Auto	1	1	—	—	$3,252,508.00	$3,252,508.00	$3,252,508.00	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
00746	OTHER	Inj, Betibeglogene Autote	1	1	—	—	$2,939,969.00	$2,939,969.00	$2,939,969.00	2026-03-01
09141	OTHER	Inj Onase Abepar-xioi Tre	1	1	—	—	$2,588,981.00	$2,588,981.00	$2,588,981.00	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
Q2058	HCPCS	Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, …	1	1	—	—	$1,057,350.00	$1,057,350.00	$1,057,350.00	2026-03-01
09498	OTHER	Ciltacabtagene Car-pos T	1	1	—	—	$587,649.60	$587,649.60	$587,649.60	2026-03-01
09194	OTHER	Tisagenlecleucel Car-pos	1	1	—	—	$566,531.30	$566,531.30	$566,531.30	2026-03-01
09413	OTHER	Lisocabtagene Car Pos T	1	1	—	—	$562,201.20	$562,201.20	$562,201.20	2026-03-01
09422	OTHER	Idecabtagene Vicleucel Ca	1	1	—	—	$558,081.80	$558,081.80	$558,081.80	2026-03-01
09035	OTHER	Axicabtagene Ciloleucel C	1	1	—	—	$532,192.20	$532,192.20	$532,192.20	2026-03-01
09391	OTHER	Brexucabtagene Car Pos T	1	1	—	—	$489,450.20	$489,450.20	$489,450.20	2026-03-01
00831	OTHER	Obecbtge Autol Up To 400	1	1	—	—	$278,250.00	$278,250.00	$278,250.00	2026-03-01
00897	OTHER	Revakinagene, Per Implant	1	1	—	—	$265,000.00	$265,000.00	$265,000.00	2026-03-01
018	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$225,060.30	$225,060.30	$225,060.30	2026-03-01
A9543	HCPCS	Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil…	1	1	—	—	$215,933.29	$215,933.29	$215,933.29	2026-03-01
00886	OTHER	Inj. Remestemcel-l-rknd/	1	1	—	—	$201,669.00	$201,669.00	$201,669.00	2026-03-01
001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	1	1	—	—	$197,831.60	$197,831.60	$197,831.60	2026-03-01
A9699	HCPCS	Radiopharmaceutical, Therapeutic, Not Otherwise Classified	1	1	—	—	$177,441.49	$177,441.49	$177,441.49	2026-03-01
01907	OTHER	New Technology - Level 52	1	1	—	—	$141,035.50	$141,035.50	$141,035.50	2026-03-01
01908	OTHER	New Technology - Level 52	1	1	—	—	$141,035.50	$141,035.50	$141,035.50	2026-03-01
003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	1	1	—	—	$139,435.70	$139,435.70	$139,435.70	2026-03-01
01905	OTHER	New Technology - Level 51	1	1	—	—	$127,163.20	$127,163.20	$127,163.20	2026-03-01
01906	OTHER	New Technology - Level 51	1	1	—	—	$127,163.20	$127,163.20	$127,163.20	2026-03-01
01903	OTHER	New Technology - Level 50	1	1	—	—	$113,290.90	$113,290.90	$113,290.90	2026-03-01
01904	OTHER	New Technology - Level 50	1	1	—	—	$113,290.90	$113,290.90	$113,290.90	2026-03-01
004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	1	1	—	—	$108,888.30	$108,888.30	$108,888.30	2026-03-01
01902	OTHER	New Technology - Level 49	1	1	—	—	$99,418.61	$99,418.61	$99,418.61	2026-03-01
01901	OTHER	New Technology - Level 49	1	1	—	—	$99,418.61	$99,418.61	$99,418.61	2026-03-01
651	OTHER	Kidney Transplant With Hemodialysis Without Mcc	1	1	—	—	$97,586.36	$97,586.36	$97,586.36	2026-03-01
01585	OTHER	New Technology - Level 48	1	1	—	—	$87,858.36	$87,858.36	$87,858.36	2026-03-01
01599	OTHER	New Technology - Level 48	1	1	—	—	$87,858.36	$87,858.36	$87,858.36	2026-03-01
007	OTHER	Lung Transplant	1	1	—	—	$83,688.07	$83,688.07	$83,688.07	2026-03-01
01584	OTHER	New Technology - Level 47	1	1	—	—	$78,610.16	$78,610.16	$78,610.16	2026-03-01
01598	OTHER	New Technology - Level 47	1	1	—	—	$78,610.16	$78,610.16	$78,610.16	2026-03-01
002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	1	1	—	—	$74,172.33	$74,172.33	$74,172.33	2026-03-01
014	OTHER	Allogeneic Bone Marrow Transplant	1	1	—	—	$71,435.60	$71,435.60	$71,435.60	2026-03-01
005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	1	1	—	—	$70,683.16	$70,683.16	$70,683.16	2026-03-01
01597	OTHER	New Technology - Level 46	1	1	—	—	$69,361.96	$69,361.96	$69,361.96	2026-03-01
01583	OTHER	New Technology - Level 46	1	1	—	—	$69,361.96	$69,361.96	$69,361.96	2026-03-01
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	1	1	—	—	$66,242.25	$66,242.25	$66,242.25	2026-03-01
00717	OTHER	Instill Adstiladrin, Tx D	1	1	—	—	$64,274.79	$64,274.79	$64,274.79	2026-03-01
474	OTHER	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	1	1	—	—	$63,980.21	$63,980.21	$63,980.21	2026-03-01
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	1	1	—	—	$61,477.00	$61,477.00	$61,477.00	2026-03-01
01582	OTHER	New Technology - Level 45	1	1	—	—	$60,113.76	$60,113.76	$60,113.76	2026-03-01
01596	OTHER	New Technology - Level 45	1	1	—	—	$60,113.76	$60,113.76	$60,113.76	2026-03-01
05244	OTHER	Level 4 Blood Product Exc	1	1	—	—	$59,432.19	$59,432.19	$59,432.19	2026-03-01
429	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	1	1	—	—	$58,972.61	$58,972.61	$58,972.61	2026-03-01
020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	1	1	—	—	$58,293.30	$58,293.30	$58,293.30	2026-03-01
01643	OTHER	Y90 Ibritumomab, Rx	1	1	—	—	$56,824.55	$56,824.55	$56,824.55	2026-03-01
231	OTHER	Coronary Bypass With Ptca With Mcc	1	1	—	—	$55,177.99	$55,177.99	$55,177.99	2026-03-01
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	1	1	—	—	$54,999.91	$54,999.91	$54,999.91	2026-03-01
09273	OTHER	Sipuleucel-t Auto Cd54+	1	1	—	—	$54,404.11	$54,404.11	$54,404.11	2026-03-01
850	OTHER	Acute Leukemia With Other Procedures	1	1	—	—	$51,695.31	$51,695.31	$51,695.31	2026-03-01
01595	OTHER	New Technology - Level 44	1	1	—	—	$50,865.56	$50,865.56	$50,865.56	2026-03-01
01581	OTHER	New Technology - Level 44	1	1	—	—	$50,865.56	$50,865.56	$50,865.56	2026-03-01
2051	OTHER	Cath Renal Denerv Radiofr	1	1	—	—	$50,449.29	$50,449.29	$50,449.29	2026-03-01
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	1	1	—	—	$49,980.51	$49,980.51	$49,980.51	2026-03-01
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	1	1	—	—	$49,325.37	$49,325.37	$49,325.37	2026-03-01
447	OTHER	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	1	1	—	—	$47,966.14	$47,966.14	$47,966.14	2026-03-01
010	OTHER	Pancreas Transplant	1	1	—	—	$46,968.40	$46,968.40	$46,968.40	2026-03-01
019	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	1	1	—	—	$46,699.50	$46,699.50	$46,699.50	2026-03-01
64654	CPT	Initial Open Implantation Of Baroreflex Activation Therapy (bat) Modulation Syst…	1	1	—	—	$46,695.00	$46,695.00	$46,695.00	2026-03-01
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	1	1	—	—	$46,659.40	$46,659.40	$46,659.40	2026-03-01
956	OTHER	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	1	1	—	—	$45,625.69	$45,625.69	$45,625.69	2026-03-01
360	OTHER	Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc	1	1	—	—	$45,354.43	$45,354.43	$45,354.43	2026-03-01
011	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	1	1	—	—	$44,849.07	$44,849.07	$44,849.07	2026-03-01
01142	OTHER	Supprelin La Implant	1	1	—	—	$43,185.34	$43,185.34	$43,185.34	2026-03-01
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	1	1	—	—	$43,038.74	$43,038.74	$43,038.74	2026-03-01
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	1	1	—	—	$42,882.47	$42,882.47	$42,882.47	2026-03-01
01594	OTHER	New Technology - Level 43	1	1	—	—	$41,617.36	$41,617.36	$41,617.36	2026-03-01
01580	OTHER	New Technology - Level 43	1	1	—	—	$41,617.36	$41,617.36	$41,617.36	2026-03-01
834	OTHER	Acute Leukemia With Mcc	1	1	—	—	$40,805.01	$40,805.01	$40,805.01	2026-03-01
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	1	1	—	—	$40,411.10	$40,411.10	$40,411.10	2026-03-01
023	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	1	1	—	—	$40,326.78	$40,326.78	$40,326.78	2026-03-01
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	1	1	—	—	$40,066.73	$40,066.73	$40,066.73	2026-03-01
215	OTHER	Other Heart Assist System Implant	1	1	—	—	$39,995.38	$39,995.38	$39,995.38	2026-03-01
453	MS_DRG	Combined Anterior And Posterior Spinal Fusion With Mcc	3	2	—	—	$68,479.93	$71,363.30	$71,363.30	2026-03-01
222	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock…	3	2	—	—	$59,650.96	$62,162.58	$62,162.58	2026-03-01
224	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh…	3	2	—	—	$51,607.93	$53,780.90	$53,780.90	2026-03-01
226	MS_DRG	Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc	3	2	—	—	$47,785.02	$49,797.02	$49,797.02	2026-03-01
454	MS_DRG	Combined Anterior And Posterior Spinal Fusion With Cc	3	2	—	—	$45,672.50	$47,595.56	$47,595.56	2026-03-01
223	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock…	3	2	—	—	$45,287.26	$47,194.09	$47,194.09	2026-03-01
459	MS_DRG	Spinal Fusion Except Cervical With Mcc	3	2	—	—	$42,447.84	$44,235.12	$44,235.12	2026-03-01
225	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh…	3	2	—	—	$39,798.24	$41,473.95	$41,473.95	2026-03-01
J3403	HCPCS	Revakinagene Taroretcel-lwey, Per Implant	4	4	—	—	$265,000.00	$275,600.00	$274,275.00	2026-03-01
J1414	HCPCS	Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose	6	5	—	—	$3,508,750.00	$3,508,750.00	$3,508,750.00	2026-03-01
J1411	HCPCS	Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose	6	5	—	—	$3,508,750.00	$3,508,750.00	$3,508,750.00	2026-03-01
J3394	HCPCS	Injection, Lovotibeglogene Autotemcel, Per Treatment	6	5	—	—	$3,100,000.00	$3,100,000.00	$3,100,000.00	2026-03-01
J3393	HCPCS	Injection, Betibeglogene Autotemcel, Per Treatment	6	5	—	—	$2,800,000.00	$3,086,720.00	$3,012,520.00	2026-03-01
J3399	HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	6	5	—	—	$2,222,890.60	$2,397,684.95	$2,311,806.22	2026-03-01
J3392	HCPCS	Injection, Exagamglogene Autotemcel, Per Treatment	6	5	—	—	$2,205,500.00	$2,205,500.00	$2,205,500.00	2026-03-01
J3402	HCPCS	Injection, Remestemcel-l-rknd, Per Therapeutic Dose	5	5	—	—	$201,669.02	$766,342.28	$209,735.78	2026-03-01
9138	OTHER	Inj, Hemgenix, Per Tx Dos	11	6	—	—	$3,685,267.00	$3,869,530.35	$3,685,267.00	2026-03-01
Q2057	HCPCS	Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure…	7	6	—	—	$770,620.00	$2,928,356.00	$801,444.80	2026-03-01
Q2042	HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	6	6	—	—	$566,531.30	$2,152,818.94	$586,359.90	2026-03-01
Q2041	HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	6	6	—	—	$502,841.00	$2,022,330.51	$550,818.97	2026-03-01
845	OTHER	Inj, Atidarsagene Autotem	12	7	—	—	$5,574.29	$4,730,250.00	$4,505,000.00	2026-03-01
908	OTHER	Topi Adm Prad Zami Per Tr	12	7	—	—	$10,093.05	$3,502,611.00	$3,335,820.00	2026-03-01
9141	OTHER	Inj Onase Abepar-xioi Tre	13	7	—	—	$2,588,981.00	$3,883,471.50	$2,588,981.00	2026-03-01
2067	OTHER	Afamitresgene Autoleucel	13	7	—	—	$770,620.00	$1,155,930.00	$770,620.00	2026-03-01
Q2056	HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	8	7	—	—	$553,169.00	$2,233,068.37	$596,464.31	2026-03-01
9498	OTHER	Ciltacabtagene Car-pos T	13	7	—	—	$587,649.60	$881,474.40	$587,649.60	2026-03-01
Q2054	HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	8	7	—	—	$516,442.00	$2,136,364.71	$570,634.26	2026-03-01
9194	OTHER	Tisagenlecleucel Car-pos	13	7	—	—	$566,531.30	$849,796.95	$566,531.30	2026-03-01
Q2055	HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	8	7	—	—	$527,622.00	$2,120,710.57	$566,452.96	2026-03-01
9413	OTHER	Lisocabtagene Car Pos T	13	7	—	—	$562,201.20	$843,301.80	$562,201.20	2026-03-01
9422	OTHER	Idecabtagene Vicleucel Ca	13	7	—	—	$558,081.80	$837,122.70	$558,081.80	2026-03-01
9035	OTHER	Axicabtagene Ciloleucel C	13	7	—	—	$532,192.20	$798,288.30	$532,192.20	2026-03-01
Q2053	HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	8	7	—	—	$463,155.00	$1,859,910.76	$496,791.96	2026-03-01
9391	OTHER	Brexucabtagene Car Pos T	13	7	—	—	$489,450.20	$734,175.30	$489,450.20	2026-03-01
897	OTHER	Revakinagene, Per Implant	13	7	—	—	$265,000.00	$397,500.00	$265,000.00	2026-03-01
1907	OTHER	New Technology - Level 52	13	7	—	—	$137,549.30	$206,323.95	$137,549.30	2026-03-01
1908	OTHER	New Technology - Level 52	13	7	—	—	$137,549.30	$206,323.95	$137,549.30	2026-03-01
1906	OTHER	New Technology - Level 51	13	7	—	—	$124,020.00	$186,030.00	$124,020.00	2026-03-01
1905	OTHER	New Technology - Level 51	13	7	—	—	$124,020.00	$186,030.00	$124,020.00	2026-03-01
1903	OTHER	New Technology - Level 50	13	7	—	—	$110,490.60	$165,735.90	$110,490.60	2026-03-01
1904	OTHER	New Technology - Level 50	13	7	—	—	$110,490.60	$165,735.90	$110,490.60	2026-03-01
1902	OTHER	New Technology - Level 49	13	7	—	—	$96,961.15	$145,441.72	$96,961.15	2026-03-01
1901	OTHER	New Technology - Level 49	13	7	—	—	$96,961.15	$145,441.72	$96,961.15	2026-03-01
1599	OTHER	New Technology - Level 48	13	7	—	—	$85,686.65	$128,529.97	$85,686.65	2026-03-01
1585	OTHER	New Technology - Level 48	13	7	—	—	$85,686.65	$128,529.97	$85,686.65	2026-03-01
1598	OTHER	New Technology - Level 47	13	7	—	—	$76,667.05	$115,000.58	$76,667.05	2026-03-01
1584	OTHER	New Technology - Level 47	13	7	—	—	$76,667.05	$115,000.58	$76,667.05	2026-03-01
1583	OTHER	New Technology - Level 46	13	7	—	—	$67,647.45	$101,471.17	$67,647.45	2026-03-01
1597	OTHER	New Technology - Level 46	13	7	—	—	$67,647.45	$101,471.17	$67,647.45	2026-03-01
J9029	HCPCS	Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose	8	7	—	—	$63,235.60	$244,244.20	$66,845.78	2026-03-01
1596	OTHER	New Technology - Level 45	13	7	—	—	$58,627.85	$87,941.77	$58,627.85	2026-03-01
1582	OTHER	New Technology - Level 45	13	7	—	—	$58,627.85	$87,941.77	$58,627.85	2026-03-01
5244	OTHER	Level 4 Blood Product Exc	13	7	—	—	$57,963.12	$86,944.68	$57,963.12	2026-03-01
1643	OTHER	Y90 Ibritumomab, Rx	13	7	—	—	$56,824.55	$85,236.83	$56,824.55	2026-03-01
Q2043	HCPCS	Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…	8	7	—	—	$54,404.11	$206,735.62	$56,798.68	2026-03-01
9273	OTHER	Sipuleucel-t Auto Cd54+	13	7	—	—	$54,404.11	$81,606.17	$54,404.11	2026-03-01
1595	OTHER	New Technology - Level 44	13	7	—	—	$49,608.25	$74,412.38	$49,608.25	2026-03-01
1581	OTHER	New Technology - Level 44	13	7	—	—	$49,608.25	$74,412.38	$49,608.25	2026-03-01
1142	OTHER	Supprelin La Implant	13	7	—	—	$43,185.34	$64,778.01	$43,185.34	2026-03-01
1580	OTHER	New Technology - Level 43	13	7	—	—	$40,588.65	$60,882.98	$40,588.65	2026-03-01
1594	OTHER	New Technology - Level 43	13	7	—	—	$40,588.65	$60,882.98	$40,588.65	2026-03-01
714	OTHER	Inj Delandistrogene Mox R	14	8	—	—	$6,556.12	$4,991,790.00	$3,327,860.00	2026-03-01
748	OTHER	Inj, Lovotibeglogene Auto	14	8	—	—	$12,479.50	$4,878,762.00	$3,252,508.00	2026-03-01
906	OTHER	Inj Elivaldogene Autoteme	14	8	—	—	$8,918.39	$4,770,000.00	$3,180,000.00	2026-03-01
746	OTHER	Inj, Betibeglogene Autote	14	8	—	—	$11,543.67	$4,409,953.50	$2,939,969.00	2026-03-01
824	OTHER	Inj, Exagamglogene Autote	14	8	—	—	$13,517.35	$3,498,000.00	$2,332,000.00	2026-03-01
831	OTHER	Obecbtge Autol Up To 400	14	8	—	—	$3,817.03	$417,375.00	$278,250.00	2026-03-01
886	OTHER	Inj. Remestemcel-l-rknd/	14	8	—	—	$8,352.30	$302,503.50	$201,669.00	2026-03-01
Q0480	HCPCS	Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only	14	8	—	—	$110,357.00	$165,535.50	$110,357.00	2026-03-01
K1007	HCPCS	Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin…	14	8	—	—	$95,081.00	$142,621.50	$95,081.00	2026-03-01
L8702	HCPCS	Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge…	14	8	—	—	$68,801.70	$103,202.55	$68,801.70	2026-03-01
717	OTHER	Instill Adstiladrin, Tx D	14	8	—	—	$12,374.54	$96,412.18	$64,274.79	2026-03-01
L7181	HCPCS	Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi…	14	8	—	—	$49,095.70	$73,643.55	$49,095.70	2026-03-01
L7180	HCPCS	Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device…	14	8	—	—	$44,240.40	$66,360.60	$44,240.40	2026-03-01
J7330	HCPCS	Algrf Maci Fnl 1 Membran	16	10	$248,613.00	$248,613.00	$37,540.56	$318,159.75	$113,243.22	2026-03-01
J9999	HCPCS	Carmustine Wafers 8/box	17	11	$280,642.29	$280,642.29	$40,412.49	$252,578.06	$89,805.53	2026-03-01
585068	CDM	Valve Tavr 20mm	16	11	$150,484.00	$150,484.00	$22,723.08	$135,435.60	$60,720.29	2026-03-01
585067	CDM	Valve Tavr 26mm	16	11	$150,484.00	$150,484.00	$22,723.08	$135,435.60	$60,720.29	2026-03-01
584925	CDM	Valve Tavr 23mm	16	11	$150,484.00	$150,484.00	$22,723.08	$135,435.60	$60,720.29	2026-03-01
585066	CDM	Valve Tavr 29mm	16	11	$150,484.00	$150,484.00	$22,723.08	$135,435.60	$60,720.29	2026-03-01
C1825	HCPCS	System Generator Ipg	16	11	$144,760.00	$144,760.00	$21,858.76	$130,284.00	$58,410.66	2026-03-01
775845	CDM	Valve Heart Trnscth 26mm	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
775844	CDM	Valve Heart Trnscth 23mm	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
784849	CDM	Valve Hrt W/cert Sys 23a	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
785937	CDM	Kit Vlv Aor 18fr 29mm	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
777386	CDM	Valve Aor With Intro 25mm	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
772861	CDM	Valve Aor 15f W/25mm Edg	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
772862	CDM	Valve Aor 15f W/23mm Edg	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
777390	CDM	Valve Aor With Intro 27mm	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
560361	CDM	Sys Valve Aor 26mm	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
155463	CDM	Valve 26mm Thv	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
772856	CDM	Valve Aor 15f W/27mm Edg	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
90294	CDM	Valve 23mm Thv	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
777384	CDM	Valve Aor With Intro 23mm	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
646595	CDM	Valve Heart Trnscth 20mm	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
294902	CDM	Kit Aor Vlv 14fr 29mm	16	11	$143,845.00	$143,845.00	$21,720.60	$129,460.50	$58,041.46	2026-03-01
647828	CDM	Stent Eprsth 26x8mm 15cm	16	11	$141,632.00	$141,632.00	$21,386.43	$127,468.80	$57,148.51	2026-03-01
598386	CDM	Valve Tavr 34mm	16	11	$139,419.00	$139,419.00	$21,052.27	$125,477.10	$56,255.57	2026-03-01
43729	CDM	Valve Tavr 29mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
43696	CDM	Valve Tavr 29mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
780879	CDM	Valve Aor Tavr 23mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
780882	CDM	Valve Aor Tavr 34mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
43697	CDM	Valve Tavr 34mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
79123	CDM	Valve Aor 18-20mm 0-34mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
43730	CDM	Valve Tavr 23mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
43695	CDM	Valve Tavr 26mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
780880	CDM	Valve Aor Tavr 26mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
43728	CDM	Valve Tavr 26mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
575013	CDM	Valve Tavr Sz 23mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
575012	CDM	Valve Tavr Sz 26mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
575010	CDM	Valve Tavr Size 34mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
575011	CDM	Valve Tavr Sz 29mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
780881	CDM	Valve Aor Tavr 29mm	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
43727	CDM	Valve Aor 23mm Evolutpro	16	11	$132,780.00	$132,780.00	$20,049.78	$119,502.00	$53,576.73	2026-03-01
595991	CDM	Valve Tavr 29mm	16	11	$130,284.00	$130,284.00	$19,672.88	$117,255.60	$52,569.60	2026-03-01
596518	CDM	Valve Tavr 26mm	16	11	$130,284.00	$130,284.00	$19,672.88	$117,255.60	$52,569.60	2026-03-01
598801	CDM	Valve Tavr 23mm	16	11	$130,284.00	$130,284.00	$19,672.88	$117,255.60	$52,569.60	2026-03-01
790	MS_DRG	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	19	11	—	—	$4,689.00	$76,410.00	$45,424.16	2026-03-01
646538	CDM	System Trcsd 1clip 1cath	16	11	$112,200.00	$112,200.00	$16,942.20	$100,980.00	$45,272.70	2026-03-01
J1246	HCPCS	Dinutuximab 17.5 Mg Inj	17	11	$126,550.06	$126,550.06	$18,223.21	$113,895.05	$40,496.02	2026-03-01
90288	CPT	Botulism Ig Human IV	18	12	$380,701.20	$380,701.20	$57,485.88	$342,631.08	$128,867.35	2026-03-01
J9118	HCPCS	Calasparg 3750 Units Inj	19	12	$192,916.05	$192,916.05	$76.53	$173,624.45	$57,874.82	2026-03-01
J7504	HCPCS	Lym Ig Equine 250mg Inj	19	12	$162,107.09	$162,107.09	$4,376.29	$145,896.38	$48,632.13	2026-03-01
63708	CDM	Tips Placement Init	21	12	$154,525.00	$154,525.00	$22,251.60	$139,072.50	$46,357.50	2026-03-01
27928	CDM	Cas Without Protect Device	21	12	$146,306.00	$146,306.00	$21,068.06	$131,675.40	$43,891.80	2026-03-01
38463	CDM	Cas W/protect Device	21	12	$146,306.00	$146,306.00	$21,068.06	$131,675.40	$43,891.80	2026-03-01
38464	CDM	Cas Without Protect Device	21	12	$146,306.00	$146,306.00	$21,068.06	$131,675.40	$43,891.80	2026-03-01
27929	CDM	Cas W/protect Device	21	12	$146,306.00	$146,306.00	$21,068.06	$131,675.40	$43,891.80	2026-03-01
69251	CDM	Extcran Vertebral Stent	21	12	$139,955.00	$139,955.00	$20,153.52	$125,959.50	$41,986.50	2026-03-01
898580	CDM	Trnscth Plc Vrt Stnt Ini	21	12	$135,000.00	$135,000.00	$19,440.00	$121,500.00	$40,500.00	2026-03-01
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	23	13	—	—	$8,060.00	$483,902.10	$322,601.40	2026-03-01
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	22	13	—	—	$22,960.96	$81,434.52	$54,289.68	2026-03-01
J2326	HCPCS	Nusinersen 12 Mg Inj	21	14	$946,770.00	$946,770.00	$1,183.65	$852,093.00	$178,939.53	2026-03-01
578762	CDM	Kit Cath Rt Heart	25	14	$530,704.00	$530,704.00	$76,421.38	$477,633.60	$125,246.14	2026-03-01
212	MS_DRG	Concomitant Aortic And Mitral Valve Procedures	24	14	—	—	$8,022.00	$123,184.95	$82,123.30	2026-03-01
589193	CDM	Kit Lo Prfl Comp Shth 7f	25	14	$323,600.00	$323,600.00	$46,598.40	$291,240.00	$76,369.60	2026-03-01
581224	CDM	Cath Vasc Assist Strl	25	14	$323,600.00	$323,600.00	$46,598.40	$291,240.00	$76,369.60	2026-03-01
766441	CDM	Set Pump 21fr 5.0	25	14	$323,600.00	$323,600.00	$46,598.40	$291,240.00	$76,369.60	2026-03-01
706309	CDM	Set Vntrc 17.4x13.8in	25	14	$323,600.00	$323,600.00	$46,598.40	$291,240.00	$76,369.60	2026-03-01
835976	CDM	Kit Pmp Rt Hrt 22f 170cm	25	14	$323,600.00	$323,600.00	$46,598.40	$291,240.00	$76,369.60	2026-03-01
573195	CDM	Kit Cath Rt Heart	25	14	$323,600.00	$323,600.00	$46,598.40	$291,240.00	$76,369.60	2026-03-01
790455	CDM	Tandem Lung Kit Size 29	25	14	$278,296.00	$278,296.00	$40,074.62	$250,466.40	$65,677.86	2026-03-01
558756	CDM	Kit Pmp Oxyg Extrcpl 29f	25	14	$278,296.00	$278,296.00	$40,074.62	$250,466.40	$65,677.86	2026-03-01
558757	CDM	Kit Pmp Oxyg Extrcpl 31f	25	14	$278,296.00	$278,296.00	$40,074.62	$250,466.40	$65,677.86	2026-03-01
850	MS_DRG	Acute Leukemia With Other Procedures	24	14	—	—	$8,022.00	$143,246.42	$65,639.72	2026-03-01
961030	CDM	Set Pump Asst 2.5in	25	14	$258,880.00	$258,880.00	$37,278.72	$232,992.00	$61,095.68	2026-03-01
562681	CDM	Kit Bld Pump Cann 29fr	25	14	$252,408.00	$252,408.00	$36,346.75	$227,167.20	$59,568.29	2026-03-01
44326	CDM	Kit Bl Pmp Cann 29fr	25	14	$252,408.00	$252,408.00	$36,346.75	$227,167.20	$59,568.29	2026-03-01
558209	CDM	Kit Bld Pmp Cann 31fr	25	14	$252,408.00	$252,408.00	$36,346.75	$227,167.20	$59,568.29	2026-03-01
C9293	HCPCS	Glucarpidase 1000 U Inj	21	14	$287,240.05	$287,240.05	$384.80	$258,516.05	$54,288.37	2026-03-01
317	MS_DRG	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	24	14	—	—	$29,194.88	$76,431.62	$50,954.41	2026-03-01
44182	CDM	Kit Bld Cann 17fr 24fr	25	14	$213,576.00	$213,576.00	$30,754.94	$192,218.40	$50,403.94	2026-03-01
574855	CDM	Kit Bld Cann 17fr 24fr	25	14	$213,576.00	$213,576.00	$30,754.94	$192,218.40	$50,403.94	2026-03-01
C1735	HCPCS	Catheter Renal 6fr	25	14	$207,104.00	$207,104.00	$29,822.98	$186,393.60	$48,876.54	2026-03-01
576202	CDM	Cannula Systm W Circuit	25	14	$187,688.00	$187,688.00	$27,027.07	$168,919.20	$44,294.37	2026-03-01
561694	CDM	Cannula W Dltr Buble Trp	25	14	$187,688.00	$187,688.00	$27,027.07	$168,919.20	$44,294.37	2026-03-01
606418	CDM	Dressing Wnd 20x40cm	25	14	$186,394.00	$186,394.00	$26,840.74	$167,754.60	$43,988.98	2026-03-01
278	MS_DRG	Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures	24	14	—	—	$14,399.00	$63,923.79	$42,615.86	2026-03-01
7	MS_DRG	Lung Transplant	25	15	—	—	$41,701.44	$146,363.99	$97,575.99	2026-03-01
209	MS_DRG	Complex Aortic Arch Procedures	27	15	—	—	$14,703.00	$128,149.89	$85,433.26	2026-03-01
426	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	27	15	—	—	$17,649.00	$147,871.21	$83,218.18	2026-03-01
5	MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	25	15	—	—	$33,221.76	$117,551.57	$77,928.34	2026-03-01
J7181	HCPCS	Tretten 3125 U Inj	22	15	$386,597.75	$386,597.75	$17.34	$347,937.97	$73,066.97	2026-03-01
J9226	HCPCS	Supprelin La 50 Mg Imp	22	15	$333,406.68	$333,406.68	$43,185.34	$300,066.01	$70,848.92	2026-03-01
429	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	27	15	—	—	$17,649.00	$117,658.33	$68,245.56	2026-03-01
427	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	27	15	—	—	$17,649.00	$104,214.42	$54,914.90	2026-03-01
10	MS_DRG	Pancreas Transplant	25	15	—	—	$23,115.84	$81,893.38	$54,595.59	2026-03-01
447	MS_DRG	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	27	15	—	—	$22,214.00	$76,741.00	$50,917.94	2026-03-01
430	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc	27	15	—	—	$17,649.00	$70,267.13	$44,111.18	2026-03-01
213	MS_DRG	Endovascular Abdominal Aorta With Iliac Branch Procedures	27	15	—	—	$14,703.00	$65,494.67	$43,663.11	2026-03-01
428	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	27	15	—	—	$17,649.00	$83,291.11	$43,031.19	2026-03-01
8	MS_DRG	Simultaneous Pancreas And Kidney Transplant	25	15	—	—	$18,043.52	$64,352.52	$42,901.68	2026-03-01
J9269	HCPCS	Tagraxf-erzs 1000mcg Inj	22	15	$224,279.18	$224,279.18	$338.53	$201,851.26	$42,388.77	2026-03-01
450	MS_DRG	Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically	27	15	—	—	$22,214.00	$61,282.21	$40,854.81	2026-03-01
927	MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	27	16	—	—	$8,022.00	$240,150.90	$160,100.60	2026-03-01
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	27	16	—	—	$64,352.64	$295,257.00	$159,168.00	2026-03-01
4	MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	27	16	—	—	$47,780.48	$195,003.00	$104,283.80	2026-03-01
14	MS_DRG	Allogeneic Bone Marrow Transplant	28	16	—	—	$8,060.00	$135,955.14	$90,636.76	2026-03-01
20	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	27	16	—	—	$34,886.72	$101,184.12	$60,747.14	2026-03-01
957	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Mcc	27	16	—	—	$17,036.80	$86,852.74	$57,901.83	2026-03-01
928	MS_DRG	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	27	16	—	—	$8,022.00	$81,859.89	$54,573.26	2026-03-01
275	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	30	16	—	—	$14,703.00	$89,931.00	$54,258.42	2026-03-01
955	MS_DRG	Craniotomy For Multiple Significant Trauma	27	16	—	—	$15,023.36	$84,497.00	$51,286.37	2026-03-01
573	MS_DRG	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	27	16	—	—	$8,022.00	$74,923.26	$49,948.84	2026-03-01
969	MS_DRG	HIV With Extensive O.r. Procedures With Mcc	27	16	—	—	$8,022.00	$70,121.33	$46,747.55	2026-03-01
276	MS_DRG	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	30	16	—	—	$14,703.00	$90,956.00	$45,893.82	2026-03-01
16	MS_DRG	Autologous Bone Marrow Transplant With Cc/mcc	28	16	—	—	$8,060.00	$67,982.16	$45,321.44	2026-03-01
820	MS_DRG	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	27	16	—	—	$8,022.00	$67,257.57	$44,838.38	2026-03-01
23	MS_DRG	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	27	16	—	—	$24,277.44	$65,755.92	$43,837.28	2026-03-01
463	MS_DRG	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective	27	16	—	—	$22,677.00	$65,412.04	$43,608.03	2026-03-01
461	MS_DRG	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	27	16	—	—	$25,477.76	$63,441.48	$42,294.32	2026-03-01
405	MS_DRG	Pancreas, Liver And Shunt Procedures With Mcc	27	16	—	—	$8,022.00	$62,855.33	$41,903.55	2026-03-01
11	MS_DRG	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	27	16	—	—	$8,022.00	$62,672.22	$41,781.48	2026-03-01
17	MS_DRG	Autologous Bone Marrow Transplant Without Cc/mcc	28	16	—	—	$8,060.00	$62,428.83	$41,619.22	2026-03-01
21	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	27	16	—	—	$23,464.32	$79,876.00	$40,868.14	2026-03-01
466	MS_DRG	Revision Of Hip Or Knee Replacement With Mcc	27	16	—	—	$24,006.40	$59,895.57	$39,930.38	2026-03-01
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	32	17	—	—	$14,703.00	$314,657.40	$209,771.60	2026-03-01
2	MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	32	17	—	—	$14,703.00	$310,089.00	$85,530.02	2026-03-01
215	MS_DRG	Other Heart Assist System Implant	33	17	—	—	$14,703.00	$172,228.00	$75,297.20	2026-03-01
216	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	33	17	—	—	$14,703.00	$111,000.90	$74,000.60	2026-03-01
231	MS_DRG	Coronary Bypass With Ptca With Mcc	33	17	—	—	$14,703.00	$95,896.17	$63,930.78	2026-03-01
456	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	30	17	—	—	$22,214.00	$110,046.20	$63,733.53	2026-03-01
219	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	33	17	—	—	$14,703.00	$87,504.76	$58,336.51	2026-03-01
233	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	33	17	—	—	$14,703.00	$87,135.21	$58,090.14	2026-03-01
870	MS_DRG	Septicemia Or Severe Sepsis With Mv >96 Hours	30	17	—	—	$5,335.00	$78,947.02	$52,631.35	2026-03-01
268	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	33	17	—	—	$14,703.00	$78,568.53	$52,379.02	2026-03-01
217	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	33	17	—	—	$14,703.00	$108,378.00	$50,126.73	2026-03-01
218	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	33	17	—	—	$14,703.00	$108,378.00	$50,126.73	2026-03-01
207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	30	17	—	—	$5,335.00	$73,620.35	$49,080.23	2026-03-01
266	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	33	17	—	—	$14,703.00	$103,977.00	$46,800.39	2026-03-01
232	MS_DRG	Coronary Bypass With Ptca Without Mcc	33	17	—	—	$14,703.00	$80,175.00	$46,310.63	2026-03-01
28	MS_DRG	Spinal Procedures With Mcc	30	17	—	—	$22,214.00	$68,859.71	$45,906.47	2026-03-01
457	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	30	17	—	—	$22,214.00	$94,398.00	$45,570.04	2026-03-01
235	MS_DRG	Coronary Bypass Without Cardiac Catheterization With Mcc	33	17	—	—	$14,703.00	$67,299.99	$44,866.66	2026-03-01
834	MS_DRG	Acute Leukemia With Mcc	30	17	—	—	$5,335.00	$63,071.92	$42,047.95	2026-03-01
234	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	33	17	—	—	$14,703.00	$62,768.24	$41,845.49	2026-03-01
220	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	33	17	—	—	$14,703.00	$61,317.94	$40,878.63	2026-03-01
270	MS_DRG	Other Major Cardiovascular Procedures With Mcc	33	17	—	—	$14,703.00	$60,687.13	$40,458.09	2026-03-01

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