Price Transparency 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

BELTON REGIONAL MEDICAL CENTER

Belton, MO · CCN 260214 · Rates published

24,235 distinct procedures filed
32 distinct payers
662,496 rate rows
2026-03-01 last MRF observed
Data quality

638,907 of 662,496 rate rows are consumer-grade (96.4%)

23,589 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
per-diem day rate — not a per-procedure price 11,691
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 11,428
template filing: same amount across many unrelated codes — excluded 244
placeholder amount (≤ $0.02) — excluded from medians 191
exceeds 10× this hospital's gross charge — excluded from medians 35
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/20-0851062_BELTON-REGIONAL-MEDICAL-CENTER_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-05-18
Content fingerprint b15925f062287e57… · 388,801,250 bytes · first seen 2026-05-13

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 9 $5,438.93 $4,820,350.00 $4,505,000.00 nat. median
$9,966
outlier · 452.1×
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $3,847,800.00 $3,847,800.00 $3,847,800.00 nat. median
$2,448,600
1.6× 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 9 $3,648,414.33 $3,943,235.69 $3,685,267.00 nat. median
$3,746,358
1.0× 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 9 $9,847.96 $3,569,327.40 $3,335,820.00 nat. median
$22,747
outlier · 146.6×
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
714
OTHER 		Inj Delandistrogene Mox R 9 $6,396.91 $3,560,810.20 $3,327,860.00 nat. median
$13,041
outlier · 255.2×
748
OTHER 		Inj, Lovotibeglogene Auto 9 $12,176.46 $3,480,183.56 $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 9 $8,701.83 $3,402,600.00 $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×
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 7 $2,968,000.00 $4,850,948.67 $3,086,720.00 nat. median
$3,006,423
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 9 $11,263.36 $3,145,766.83 $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 9 $2,563,091.19 $2,770,209.67 $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 9 $13,189.11 $2,495,240.00 $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… 7 $2,222,890.60 $4,271,819.03 $2,311,806.22 nat. median
$2,469,189
0.9× median
5834
APR_DRG 		Neonate With Ecmo 3 $867,972.57 $954,769.83 $867,972.57 nat. median
$309,665
outlier · 2.8×
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 7 $770,620.00 $1,271,523.00 $801,444.80 nat. median
$824,563
1.0× median
2067
OTHER 		Afamitresgene Autoleucel 9 $762,913.80 $824,563.40 $770,620.00 nat. median
$786,032
1.0× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 9 $553,169.00 $969,621.79 $611,155.55 nat. median
$675,122
0.9× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 9 $566,531.30 $934,776.65 $589,192.55 nat. median
$754,974
0.8× median
9498
OTHER 		Ciltacabtagene Car-pos T 9 $581,773.10 $628,785.07 $587,649.60 nat. median
$587,650
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $587,649.60 $587,649.60 $587,649.60 nat. median
$554,552
1.1× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 9 $516,442.00 $927,632.05 $584,689.29 nat. median
$674,188
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 9 $527,622.00 $920,834.85 $580,405.00 nat. median
$625,184
0.9× 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 9 $560,865.99 $606,188.49 $566,531.30 nat. median
$566,531
1.0× 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 9 $556,579.19 $601,555.28 $562,201.20 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 9 $552,500.98 $597,147.53 $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… 8 $502,841.00 $878,117.20 $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 9 $526,870.28 $569,445.65 $532,192.20 nat. median
$532,192
1.0× median
5833
APR_DRG 		Neonate With Ecmo 3 $524,059.51 $576,465.46 $524,059.51 nat. median
$244,017
outlier · 2.1×
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 8 $489,399.00 $807,592.83 $509,028.21 nat. median
$620,080
0.8× median
9391
OTHER 		Brexucabtagene Car Pos T 9 $484,555.70 $523,711.71 $489,450.20 nat. median
$489,450
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $489,450.20 $489,450.20 $489,450.20 nat. median
$464,978
1.1× 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
$324,450
1.4× median
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 $385,771.45 $424,348.60 $385,771.45 nat. median
$162,982
outlier · 2.4×
113
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 $378,804.38 $416,684.82 $378,804.38 nat. median
$60,845
outlier · 6.2×
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 $378,804.38 $416,684.82 $378,804.38 nat. median
$117,173
outlier · 3.2×
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 3 $369,917.73 $406,909.50 $369,917.73 nat. median
$164,279
outlier · 2.3×
5832
APR_DRG 		Neonate With Ecmo 3 $328,858.95 $361,744.85 $328,858.95 nat. median
$156,126
outlier · 2.1×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 19 $127,712.10 $961,594.59 $327,318.65 nat. median
$370,174
0.9× median

Other procedures at this hospital

Browse this hospital's 24,235 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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
             
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 46 23 — — $38,485.44 $217,843.39 $75,157.89 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 46 23 — — $3,285.00 $207,999.00 $65,083.92 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 42 20 — — $15,163.00 $242,144.46 $83,303.60 2026-03-01
215 MS_DRG Other Heart Assist System Implant 41 23 — — $39,147.78 $334,366.00 $77,966.67 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 41 23 — — $34,894.86 $187,126.91 $65,522.52 2026-03-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 41 23 — — $3,285.00 $175,222.44 $61,498.41 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 36 19 — — $44,516.22 $252,047.04 $87,892.30 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 36 19 — — $45,771.18 $245,420.08 $84,813.85 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 36 19 — — $37,439.64 $200,625.77 $69,745.37 2026-03-01
850 MS_DRG Acute Leukemia With Other Procedures 35 19 — — $15,163.00 $192,829.75 $67,450.27 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 32 20 — — $81,258.66 $542,682.82 $211,142.55 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 32 21 — — $39,707.20 $232,726.63 $91,829.77 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 32 20 — — $32,872.98 $292,256.00 $88,911.53 2026-03-01
953034 CDM Revasc Fem/pop Stnt/ath 32 17 $165,093.77 $165,093.77 $21,462.19 $148,584.39 $62,983.27 2026-03-01
953038 CDM Revasc Tib Stnt/ath Init 32 17 $165,093.77 $165,093.77 $21,462.19 $148,584.39 $62,983.27 2026-03-01
952983 CDM Revasc Fem/pop Stnt/ath 32 17 $162,625.72 $162,625.72 $21,141.34 $146,363.15 $62,041.71 2026-03-01
952987 CDM Revasc Tib Stnt/ath Init 32 17 $162,625.72 $162,625.72 $21,141.34 $146,363.15 $62,041.71 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 31 19 — — $127,712.10 $961,594.59 $327,318.65 2026-03-01
7 MS_DRG Lung Transplant 30 21 — — $38,295.10 $250,780.62 $98,779.37 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 30 21 — — $30,508.08 $199,662.83 $79,102.39 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 29 21 — — $15,163.00 $413,452.43 $158,232.70 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 29 21 — — $57,937.32 $411,026.00 $157,317.00 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 29 21 — — $43,017.24 $268,232.36 $103,428.60 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 14 9 — — $5,438.93 $4,820,350.00 $4,505,000.00 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 14 9 — — $9,847.96 $3,569,327.40 $3,335,820.00 2026-03-01
714 OTHER Inj Delandistrogene Mox R 14 9 — — $6,396.91 $3,560,810.20 $3,327,860.00 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 14 9 — — $12,176.46 $3,480,183.56 $3,252,508.00 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 14 9 — — $8,701.83 $3,402,600.00 $3,180,000.00 2026-03-01
746 OTHER Inj, Betibeglogene Autote 14 9 — — $11,263.36 $3,145,766.83 $2,939,969.00 2026-03-01
824 OTHER Inj, Exagamglogene Autote 14 9 — — $13,189.11 $2,495,240.00 $2,332,000.00 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 14 9 — — $527,622.00 $920,834.85 $580,405.00 2026-03-01
831 OTHER Obecbtge Autol Up To 400 14 9 — — $3,724.34 $297,727.50 $278,250.00 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 14 9 — — $8,149.48 $215,785.83 $201,669.00 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 14 9 — — $109,253.43 $118,081.99 $110,357.00 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 14 9 — — $94,130.19 $101,736.67 $95,081.00 2026-03-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 14 9 — — $68,113.68 $73,617.82 $68,801.70 2026-03-01
717 OTHER Instill Adstiladrin, Tx D 14 9 — — $12,074.05 $68,774.03 $64,274.79 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 13 9 — — $3,648,414.33 $3,943,235.69 $3,685,267.00 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 13 9 — — $2,563,091.19 $2,770,209.67 $2,588,981.00 2026-03-01
2067 OTHER Afamitresgene Autoleucel 13 9 — — $762,913.80 $824,563.40 $770,620.00 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 13 9 — — $581,773.10 $628,785.07 $587,649.60 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 13 9 — — $560,865.99 $606,188.49 $566,531.30 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 13 9 — — $556,579.19 $601,555.28 $562,201.20 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 13 9 — — $552,500.98 $597,147.53 $558,081.80 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 13 9 — — $526,870.28 $569,445.65 $532,192.20 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 13 9 — — $484,555.70 $523,711.71 $489,450.20 2026-03-01
897 OTHER Revakinagene, Per Implant 13 9 — — $262,350.00 $283,550.00 $265,000.00 2026-03-01
1908 OTHER New Technology - Level 52 13 9 — — $148,013.32 $159,973.99 $149,508.40 2026-03-01
1907 OTHER New Technology - Level 52 13 9 — — $148,013.32 $159,973.99 $149,508.40 2026-03-01
1906 OTHER New Technology - Level 51 13 9 — — $133,454.67 $144,238.89 $134,802.70 2026-03-01
1905 OTHER New Technology - Level 51 13 9 — — $133,454.67 $144,238.89 $134,802.70 2026-03-01
1903 OTHER New Technology - Level 50 13 9 — — $118,896.03 $128,503.79 $120,097.00 2026-03-01
1904 OTHER New Technology - Level 50 13 9 — — $118,896.03 $128,503.79 $120,097.00 2026-03-01
1901 OTHER New Technology - Level 49 13 9 — — $104,337.39 $112,768.69 $105,391.30 2026-03-01
1902 OTHER New Technology - Level 49 13 9 — — $104,337.39 $112,768.69 $105,391.30 2026-03-01
1599 OTHER New Technology - Level 48 13 9 — — $92,205.22 $99,656.15 $93,136.59 2026-03-01
1585 OTHER New Technology - Level 48 13 9 — — $92,205.22 $99,656.15 $93,136.59 2026-03-01
1584 OTHER New Technology - Level 47 13 9 — — $82,499.46 $89,166.09 $83,332.79 2026-03-01
1598 OTHER New Technology - Level 47 13 9 — — $82,499.46 $89,166.09 $83,332.79 2026-03-01
1583 OTHER New Technology - Level 46 13 9 — — $72,793.70 $78,676.02 $73,528.99 2026-03-01
1597 OTHER New Technology - Level 46 13 9 — — $72,793.70 $78,676.02 $73,528.99 2026-03-01
1596 OTHER New Technology - Level 45 13 9 — — $63,087.94 $68,185.95 $63,725.19 2026-03-01
1582 OTHER New Technology - Level 45 13 9 — — $63,087.94 $68,185.95 $63,725.19 2026-03-01
5244 OTHER Level 4 Blood Product Exc 13 9 — — $62,372.64 $67,412.86 $63,002.67 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 11 9 — — $553,169.00 $969,621.79 $611,155.55 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 11 9 — — $566,531.30 $934,776.65 $589,192.55 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 11 9 — — $516,442.00 $927,632.05 $584,689.29 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 10 8 — — $502,841.00 $878,117.20 $550,818.97 2026-03-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 10 8 — — $489,399.00 $807,592.83 $509,028.21 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 10 8 — — $63,235.60 $106,053.40 $66,845.78 2026-03-01
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 9 7 — — $2,968,000.00 $4,850,948.67 $3,086,720.00 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 9 7 — — $2,222,890.60 $4,271,819.03 $2,311,806.22 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 9 7 — — $770,620.00 $1,271,523.00 $801,444.80 2026-03-01
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 7 6 — — $201,669.02 $332,753.88 $209,735.78 2026-03-01
J3403 HCPCS Revakinagene Taroretcel-lwey, Per Implant 6 6 — — $265,000.00 $275,600.00 $274,275.00 2026-03-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 5 4 — — $40,279.90 $71,363.30 $68,479.93 2026-03-01
5834 APR_DRG Neonate With Ecmo 3 3 — — $867,972.57 $954,769.83 $867,972.57 2026-03-01
5833 APR_DRG Neonate With Ecmo 3 3 — — $524,059.51 $576,465.46 $524,059.51 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 3 — — $385,771.45 $424,348.60 $385,771.45 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 3 — — $378,804.38 $416,684.82 $378,804.38 2026-03-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 3 — — $378,804.38 $416,684.82 $378,804.38 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 3 3 — — $369,917.73 $406,909.50 $369,917.73 2026-03-01
5832 APR_DRG Neonate With Ecmo 3 3 — — $328,858.95 $361,744.85 $328,858.95 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 3 3 — — $308,365.75 $339,202.33 $308,365.75 2026-03-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 3 — — $297,065.86 $326,772.45 $297,065.86 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 — — $278,343.38 $306,177.72 $278,343.38 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 — — $278,343.38 $306,177.72 $278,343.38 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 — — $278,343.38 $306,177.72 $278,343.38 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 3 3 — — $265,516.42 $292,068.06 $265,516.42 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 3 3 — — $252,157.21 $277,372.93 $252,157.21 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 3 3 — — $249,621.00 $274,583.10 $249,621.00 2026-03-01
5831 APR_DRG Neonate With Ecmo 3 3 — — $240,223.07 $264,245.38 $240,223.07 2026-03-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 3 3 — — $232,881.82 $256,170.00 $232,881.82 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 — — $227,797.15 $250,576.87 $227,797.15 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 3 3 — — $218,349.65 $240,184.62 $218,349.65 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 3 3 — — $199,540.23 $219,494.25 $199,540.23 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 3 3 — — $189,907.91 $208,898.70 $189,907.91 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $189,819.10 $208,801.01 $189,819.10 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 3 3 — — $186,797.89 $205,477.68 $186,797.89 2026-03-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $181,564.18 $199,720.60 $181,564.18 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 3 3 — — $176,011.02 $193,612.12 $176,011.02 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 3 3 — — $174,612.92 $192,074.21 $174,612.92 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 3 3 — — $174,612.92 $192,074.21 $174,612.92 2026-03-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 3 3 — — $174,612.92 $192,074.21 $174,612.92 2026-03-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $170,813.52 $187,894.87 $170,813.52 2026-03-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 3 3 — — $166,882.90 $183,571.19 $166,882.90 2026-03-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 3 3 — — $165,689.61 $182,258.57 $165,689.61 2026-03-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 3 3 — — $157,330.44 $173,063.48 $157,330.44 2026-03-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 3 — — $153,008.59 $168,309.45 $153,008.59 2026-03-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 3 3 — — $152,650.48 $167,915.53 $152,650.48 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 3 3 — — $150,036.80 $165,040.48 $150,036.80 2026-03-01
8634 APR_DRG Neonatal Aftercare 3 3 — — $145,642.81 $160,207.09 $145,642.81 2026-03-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $132,837.93 $146,121.72 $132,837.93 2026-03-01
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $132,430.76 $145,673.84 $132,430.76 2026-03-01
1611 APR_DRG Implantable Heart Assist Systems 3 3 — — $118,751.96 $130,627.16 $118,751.96 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 3 3 — — $118,751.96 $130,627.16 $118,751.96 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 3 3 — — $115,442.11 $126,986.32 $115,442.11 2026-03-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 3 3 — — $113,678.25 $125,046.08 $113,678.25 2026-03-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $110,868.13 $121,954.94 $110,868.13 2026-03-01
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 3 — — $105,546.28 $116,100.91 $105,546.28 2026-03-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 3 3 — — $104,514.13 $114,965.54 $104,514.13 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 3 3 — — $102,341.95 $112,576.15 $102,341.95 2026-03-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 3 3 — — $100,519.73 $110,571.70 $100,519.73 2026-03-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 3 3 — — $99,893.48 $109,882.83 $99,893.48 2026-03-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 3 3 — — $97,430.42 $107,173.46 $97,430.42 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 3 3 — — $95,992.79 $105,592.07 $95,992.79 2026-03-01
6021 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $92,795.84 $102,075.42 $92,795.84 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 3 3 — — $91,970.19 $101,167.21 $91,970.19 2026-03-01
5931 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 3 3 — — $91,742.36 $100,916.60 $91,742.36 2026-03-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 3 3 — — $88,707.01 $97,577.71 $88,707.01 2026-03-01
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 3 3 — — $88,707.01 $97,577.71 $88,707.01 2026-03-01
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 3 3 — — $88,263.06 $97,089.37 $88,263.06 2026-03-01
214 APR_DRG Open Craniotomy Except Trauma 3 3 — — $85,439.22 $93,983.14 $85,439.22 2026-03-01
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 3 3 — — $84,744.50 $93,218.95 $84,744.50 2026-03-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 3 3 — — $84,744.50 $93,218.95 $84,744.50 2026-03-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 3 3 — — $79,533.01 $87,486.31 $79,533.01 2026-03-01
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $78,337.77 $86,171.55 $78,337.77 2026-03-01
6213 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 3 3 — — $78,014.00 $85,815.40 $78,014.00 2026-03-01
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $77,793.25 $85,572.58 $77,793.25 2026-03-01
6092 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 3 — — $75,859.21 $83,445.13 $75,859.21 2026-03-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 3 3 — — $75,687.15 $83,255.87 $75,687.15 2026-03-01
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 3 3 — — $75,293.83 $82,823.21 $75,293.83 2026-03-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 3 3 — — $75,161.96 $82,678.16 $75,161.96 2026-03-01
8514 APR_DRG Gender Related Procedures 3 3 — — $75,148.25 $82,663.08 $75,148.25 2026-03-01
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 3 3 — — $74,436.10 $81,879.71 $74,436.10 2026-03-01
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition… 3 3 — — $73,751.02 $81,126.12 $73,751.02 2026-03-01
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 3 3 — — $73,157.44 $80,473.18 $73,157.44 2026-03-01
2994 APR_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 3 3 — — $72,327.52 $79,560.27 $72,327.52 2026-03-01
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 3 3 — — $71,846.41 $79,031.05 $71,846.41 2026-03-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 3 3 — — $71,186.25 $78,304.88 $71,186.25 2026-03-01
1784 APR_DRG External Heart Assist Devices 3 3 — — $70,654.57 $77,720.03 $70,654.57 2026-03-01
7524 APR_DRG Personality Disorders 3 3 — — $69,054.90 $75,960.39 $69,054.90 2026-03-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 3 3 — — $68,639.66 $75,503.63 $68,639.66 2026-03-01
6091 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 3 — — $68,119.37 $74,931.31 $68,119.37 2026-03-01
8633 APR_DRG Neonatal Aftercare 3 3 — — $67,420.32 $74,162.35 $67,420.32 2026-03-01
6224 APR_DRG Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $67,318.53 $74,050.38 $67,318.53 2026-03-01
6223 APR_DRG Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $67,318.53 $74,050.38 $67,318.53 2026-03-01
6333 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 3 3 — — $67,206.93 $73,927.62 $67,206.93 2026-03-01
6143 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition… 3 3 — — $67,040.14 $73,744.15 $67,040.14 2026-03-01
4284 APR_DRG Genetic Disorders 3 3 — — $66,910.14 $73,601.15 $66,910.14 2026-03-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 3 3 — — $66,780.57 $73,458.63 $66,780.57 2026-03-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 3 3 — — $66,364.32 $73,000.75 $66,364.32 2026-03-01
6071 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $66,273.63 $72,900.99 $66,273.63 2026-03-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 3 3 — — $65,236.03 $71,759.63 $65,236.03 2026-03-01
1834 APR_DRG Percutaneous Structural Cardiac Procedures 3 3 — — $63,962.73 $70,359.00 $63,962.73 2026-03-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 3 3 — — $63,130.22 $69,443.24 $63,130.22 2026-03-01
6904 APR_DRG Acute Leukemia 3 3 — — $62,985.93 $69,284.52 $62,985.93 2026-03-01
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 3 3 — — $62,801.69 $69,081.86 $62,801.69 2026-03-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 3 3 — — $62,668.51 $68,935.36 $62,668.51 2026-03-01
6954 APR_DRG Chemotherapy For Acute Leukemia 3 3 — — $62,471.57 $68,718.73 $62,471.57 2026-03-01
6122 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 3 3 — — $62,459.52 $68,705.47 $62,459.52 2026-03-01
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 3 3 — — $62,401.59 $68,641.75 $62,401.59 2026-03-01
6082 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 3 3 — — $61,713.87 $67,885.26 $61,713.87 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
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 1 1 — — $3,847,800.00 $3,847,800.00 $3,847,800.00 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
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
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
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 — — $219,595.20 $219,595.20 $219,595.20 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 — — $193,027.70 $193,027.70 $193,027.70 2026-03-01
01907 OTHER New Technology - Level 52 1 1 — — $143,460.30 $143,460.30 $143,460.30 2026-03-01
01908 OTHER New Technology - Level 52 1 1 — — $143,460.30 $143,460.30 $143,460.30 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 1 1 — — $138,148.31 $138,148.31 $138,148.31 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $136,049.80 $136,049.80 $136,049.80 2026-03-01
01906 OTHER New Technology - Level 51 1 1 — — $129,349.50 $129,349.50 $129,349.50 2026-03-01
01905 OTHER New Technology - Level 51 1 1 — — $129,349.50 $129,349.50 $129,349.50 2026-03-01
01904 OTHER New Technology - Level 50 1 1 — — $115,238.70 $115,238.70 $115,238.70 2026-03-01
01903 OTHER New Technology - Level 50 1 1 — — $115,238.70 $115,238.70 $115,238.70 2026-03-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $106,244.10 $106,244.10 $106,244.10 2026-03-01
01902 OTHER New Technology - Level 49 1 1 — — $101,127.90 $101,127.90 $101,127.90 2026-03-01
01901 OTHER New Technology - Level 49 1 1 — — $101,127.90 $101,127.90 $101,127.90 2026-03-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $95,216.69 $95,216.69 $95,216.69 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 1 — — $93,760.51 $93,760.51 $93,760.51 2026-03-01
01599 OTHER New Technology - Level 48 1 1 — — $89,368.87 $89,368.87 $89,368.87 2026-03-01
01585 OTHER New Technology - Level 48 1 1 — — $89,368.87 $89,368.87 $89,368.87 2026-03-01
007 OTHER Lung Transplant 1 1 — — $81,655.89 $81,655.89 $81,655.89 2026-03-01
01584 OTHER New Technology - Level 47 1 1 — — $79,961.67 $79,961.67 $79,961.67 2026-03-01
01598 OTHER New Technology - Level 47 1 1 — — $79,961.67 $79,961.67 $79,961.67 2026-03-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 1 — — $77,046.96 $77,046.96 $77,046.96 2026-03-01
2Y45X5Z OTHER Packing Of Urethra Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W46X5Z OTHER Packing Of Right Inguinal Region Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W49X5Z OTHER Packing Of Left Upper Extremity Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3NXYZ OTHER Immobilization Of Right Upper Leg Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W1VX7Z OTHER Compression Of Left Toe Using Intermittent Pressure Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4PX5Z OTHER Packing Of Left Upper Leg Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4RX5Z OTHER Packing Of Left Lower Leg Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3NX3Z OTHER Immobilization Of Right Upper Leg Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4NX5Z OTHER Packing Of Right Upper Leg Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3UXYZ OTHER Immobilization Of Right Toe Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3KXYZ OTHER Immobilization Of Left Finger Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4CX5Z OTHER Packing Of Right Lower Arm Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3JX3Z OTHER Immobilization Of Right Finger Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3AX3Z OTHER Immobilization Of Right Upper Arm Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3FX3Z OTHER Immobilization Of Left Hand Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4EX5Z OTHER Packing Of Right Hand Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3DX3Z OTHER Immobilization Of Left Lower Arm Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
0NH005Z OTHER Insertion Of External Fixation Device Into Skull, Open Approach 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3PX3Z OTHER Immobilization Of Left Upper Leg Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W45X5Z OTHER Packing Of Back Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3TXYZ OTHER Immobilization Of Left Foot Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4MX5Z OTHER Packing Of Left Lower Extremity Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3BX3Z OTHER Immobilization Of Left Upper Arm Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3DXYZ OTHER Immobilization Of Left Lower Arm Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3JXYZ OTHER Immobilization Of Right Finger Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4KX5Z OTHER Packing Of Left Finger Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4VX5Z OTHER Packing Of Left Toe Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3MXYZ OTHER Immobilization Of Left Lower Extremity Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3SXYZ OTHER Immobilization Of Right Foot Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3QX3Z OTHER Immobilization Of Right Lower Leg Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3RX3Z OTHER Immobilization Of Left Lower Leg Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4GX5Z OTHER Packing Of Right Thumb Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3AXYZ OTHER Immobilization Of Right Upper Arm Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3BXYZ OTHER Immobilization Of Left Upper Arm Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3MX3Z OTHER Immobilization Of Left Lower Extremity Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W48X5Z OTHER Packing Of Right Upper Extremity Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4JX5Z OTHER Packing Of Right Finger Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3RXYZ OTHER Immobilization Of Left Lower Leg Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3VX3Z OTHER Immobilization Of Left Toe Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4BX5Z OTHER Packing Of Left Upper Arm Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
0NH045Z OTHER Insertion Of External Fixation Device Into Skull, Percutaneous Endoscopic Approa… 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3FXYZ OTHER Immobilization Of Left Hand Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4TX5Z OTHER Packing Of Left Foot Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3GXYZ OTHER Immobilization Of Right Thumb Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3QXYZ OTHER Immobilization Of Right Lower Leg Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W40X5Z OTHER Packing Of Head Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4SX5Z OTHER Packing Of Right Foot Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3SX3Z OTHER Immobilization Of Right Foot Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W44X5Z OTHER Packing Of Chest Wall Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3HXYZ OTHER Immobilization Of Left Thumb Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3TX3Z OTHER Immobilization Of Left Foot Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W10X7Z OTHER Compression Of Head Using Intermittent Pressure Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4AX5Z OTHER Packing Of Right Upper Arm Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3KX3Z OTHER Immobilization Of Left Finger Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4LX5Z OTHER Packing Of Right Lower Extremity Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3LX3Z OTHER Immobilization Of Right Lower Extremity Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3CXYZ OTHER Immobilization Of Right Lower Arm Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3VXYZ OTHER Immobilization Of Left Toe Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3LXYZ OTHER Immobilization Of Right Lower Extremity Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W47X5Z OTHER Packing Of Left Inguinal Region Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3CX3Z OTHER Immobilization Of Right Lower Arm Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3HX3Z OTHER Immobilization Of Left Thumb Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4HX5Z OTHER Packing Of Left Thumb Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W30X3Z OTHER Immobilization Of Head Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3UX3Z OTHER Immobilization Of Right Toe Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4DX5Z OTHER Packing Of Left Lower Arm Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4FX5Z OTHER Packing Of Left Hand Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2Y40X5Z OTHER Packing Of Mouth And Pharynx Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3GX3Z OTHER Immobilization Of Right Thumb Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W4QX5Z OTHER Packing Of Right Lower Leg Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W19X7Z OTHER Compression Of Left Upper Extremity Using Intermittent Pressure Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W43X5Z OTHER Packing Of Abdominal Wall Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W39XYZ OTHER Immobilization Of Left Upper Extremity Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3EX3Z OTHER Immobilization Of Right Hand Using Brace 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3EXYZ OTHER Immobilization Of Right Hand Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W42X5Z OTHER Packing Of Neck Using Packing Material 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
2W3PXYZ OTHER Immobilization Of Left Upper Leg Using Other Device 1 1 — — $72,905.50 $72,905.50 $72,905.50 2026-03-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $72,371.22 $72,371.22 $72,371.22 2026-03-01
01597 OTHER New Technology - Level 46 1 1 — — $70,554.47 $70,554.47 $70,554.47 2026-03-01
01583 OTHER New Technology - Level 46 1 1 — — $70,554.47 $70,554.47 $70,554.47 2026-03-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $69,700.95 $69,700.95 $69,700.95 2026-03-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $68,966.78 $68,966.78 $68,966.78 2026-03-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $64,633.70 $64,633.70 $64,633.70 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 — — $62,426.60 $62,426.60 $62,426.60 2026-03-01
01596 OTHER New Technology - Level 45 1 1 — — $61,147.27 $61,147.27 $61,147.27 2026-03-01
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