Hospital

FRISBIE MEMORIAL HOSPITAL

Rochester, NH · CCN 300014 · Rates published

23,810 distinct procedures filed

20 distinct payers

369,687 rate rows

2026-07-17 last MRF observed

Data quality

328,823 of 369,687 rate rows are consumer-grade (88.9%)

40,864 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	17,718
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	12,720
per-diem day rate — not a per-procedure price	6,342
template filing: same amount across many unrelated codes — excluded	3,044
placeholder amount (≤ $0.02) — excluded from medians	974
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	43
exceeds 10× this hospital's gross charge — excluded from medians	23

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

Source MRF file	https://core.secure.ehc.com/src/util/json-detail-price-list/84-2462186_frisbie-memorial-hospital_standardcharges.json
Found on page	https://frisbiehospital.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-03
Content fingerprint	f2c771816efbba90… · 246,453,248 bytes · first seen 2026-05-08

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code	Description	Payers	Min $	Max $	Avg median	vs national
845 OTHER	Inj, Atidarsagene Autotem	9	$6,016.87	$4,685,200.00	$4,505,000.00	nat. median $4,505,000 1.0× median
00845 OTHER	Inj, Atidarsagene Autotem	2	$4,369,850.00	$4,505,000.00	$4,437,425.00	—
9138 OTHER	Inj, Hemgenix, Per Tx Dos	8	$3,685,267.00	$3,832,677.68	$3,758,972.34	nat. median $3,765,001 1.0× median
09138 OTHER	Inj, Hemgenix, Per Tx Dos	2	$3,574,708.99	$3,685,267.00	$3,629,988.00	nat. median $3,562,713 1.0× median
908 OTHER	Topi Adm Prad Zami Per Tr	9	$10,894.39	$4,670,148.00	$3,369,178.20	nat. median $8,800 outlier · 382.9×
714 OTHER	Inj Delandistrogene Mox R	9	$7,076.64	$4,659,004.00	$3,361,138.60	nat. median $3,391,964 1.0× median
00908 OTHER	Topi Adm Prad Zami Per Tr	2	$3,235,745.40	$3,335,820.00	$3,285,782.70	—
748 OTHER	Inj, Lovotibeglogene Auto	9	$13,470.32	$4,553,511.20	$3,285,033.08	nat. median $3,351,720 1.0× median
00714 OTHER	Inj Delandistrogene Mox R	2	$3,228,024.20	$3,327,860.00	$3,277,942.10	nat. median $3,225,691 1.0× median
906 OTHER	Inj Elivaldogene Autoteme	9	$9,626.48	$4,452,000.00	$3,211,800.00	nat. median $2,726 outlier · 1178.1×
00748 OTHER	Inj, Lovotibeglogene Auto	2	$3,154,932.76	$3,252,508.00	$3,203,720.38	nat. median $3,187,420 1.0× median
00906 OTHER	Inj Elivaldogene Autoteme	2	$3,084,600.00	$3,180,000.00	$3,132,300.00	—
746 OTHER	Inj, Betibeglogene Autote	9	$12,460.19	$4,115,956.60	$2,969,368.69	nat. median $3,001,835 1.0× median
00746 OTHER	Inj, Betibeglogene Autote	2	$2,851,769.93	$2,939,969.00	$2,895,869.46	nat. median $2,878,960 1.0× median
9141 OTHER	Inj Onase Abepar-xioi Tre	9	$2,588,981.00	$4,615,635.33	$2,640,760.62	nat. median $2,508,045 1.1× median
09141 OTHER	Inj Onase Abepar-xioi Tre	2	$2,511,311.57	$2,588,981.00	$2,550,146.29	nat. median $2,316,956 1.1× median
824 OTHER	Inj, Exagamglogene Autote	10	$14,590.57	$4,157,489.60	$2,378,640.00	nat. median $28,063 outlier · 84.8×
00824 OTHER	Inj, Exagamglogene Autote	2	$2,262,040.00	$2,332,000.00	$2,297,020.00	—
2067 OTHER	Afamitresgene Autoleucel	9	$770,620.00	$1,373,861.34	$786,032.40	nat. median $838,386 0.9× median
9498 OTHER	Ciltacabtagene Car-pos T	9	$587,649.60	$1,047,661.71	$599,402.59	nat. median $553,480 1.1× median
09498 OTHER	Ciltacabtagene Car-pos T	2	$570,020.11	$587,649.60	$578,834.85	nat. median $511,310 1.1× median
9194 OTHER	Tisagenlecleucel Car-pos	9	$566,531.30	$1,010,012.00	$577,861.93	nat. median $555,653 1.0× median
9413 OTHER	Lisocabtagene Car Pos T	9	$562,201.20	$1,002,292.30	$573,445.22	nat. median $542,562 1.1× median
Q2042 HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	2	$561,407.87	$578,771.00	$570,089.44	nat. median $621,313 0.9× median
9422 OTHER	Idecabtagene Vicleucel Ca	9	$558,081.80	$994,948.23	$569,243.44	nat. median $552,917 1.0× median
09194 OTHER	Tisagenlecleucel Car-pos	2	$549,535.36	$566,531.30	$558,033.33	nat. median $513,317 1.1× median
09413 OTHER	Lisocabtagene Car Pos T	2	$545,335.16	$562,201.20	$553,768.18	nat. median $501,224 1.1× median
09422 OTHER	Idecabtagene Vicleucel Ca	2	$541,339.35	$558,081.80	$549,710.57	nat. median $510,790 1.1× median
Q2056 HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	2	$536,573.93	$553,169.00	$544,871.47	nat. median $599,737 0.9× median
9035 OTHER	Axicabtagene Ciloleucel C	9	$532,192.20	$948,792.25	$542,836.04	nat. median $513,929 1.1× median
09035 OTHER	Axicabtagene Ciloleucel C	2	$516,226.43	$532,192.20	$524,209.31	nat. median $474,772 1.1× median
Q2055 HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	2	$511,793.34	$527,622.00	$519,707.67	nat. median $574,037 0.9× median
Q2054 HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	2	$500,948.74	$516,442.00	$508,695.37	nat. median $579,571 0.9× median
9391 OTHER	Brexucabtagene Car Pos T	9	$489,450.20	$872,591.82	$499,239.20	nat. median $483,557 1.0× median
Q2041 HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	2	$487,755.77	$502,841.00	$495,298.39	nat. median $562,501 0.9× median
09391 OTHER	Brexucabtagene Car Pos T	2	$474,766.69	$489,450.20	$482,108.45	nat. median $446,714 1.1× median
Q2053 HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	2	$474,717.03	$489,399.00	$482,058.02	nat. median $513,770 0.9× median
J3403 HCPCS	Revakinagene Taroretcel-lwey, Per Implant	1	$332,575.00	$417,110.00	$417,110.00	nat. median $264,195 1.6× median
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	11	$23,535.00	$1,275,879.01	$352,870.43	nat. median $168,055 outlier · 2.1×
831 OTHER	Obecbtge Autol Up To 400	10	$4,120.09	$496,064.10	$283,815.00	nat. median $278,250 1.0× median
00831 OTHER	Obecbtge Autol Up To 400	2	$269,902.50	$278,250.00	$274,076.25	—
897 OTHER	Revakinagene, Per Implant	9	$265,000.00	$472,442.00	$270,300.00	nat. median $269,427 1.0× median
77425 CPT	Intraoperative Radiation Treatment Delivery, Electrons, Single Treatment Session…	1	$268,461.97	$268,461.97	$268,461.97	nat. median $7,458 outlier · 36.0×
1 MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	10	$203,126.17	$827,994.15	$266,888.41	nat. median $186,516 1.4× median
00897 OTHER	Revakinagene, Per Implant	2	$257,050.00	$265,000.00	$261,025.00	—
018 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	2	$242,929.13	$250,442.40	$246,685.77	nat. median $149,977 1.6× median
455 MS_DRG	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	1	$224,085.00	$257,697.00	$240,891.00	nat. median $2,106 outlier · 114.4×
453 MS_DRG	Combined Anterior And Posterior Spinal Fusion With Mcc	1	$224,085.00	$257,697.00	$240,891.00	nat. median $2,106 outlier · 114.4×
454 MS_DRG	Combined Anterior And Posterior Spinal Fusion With Cc	1	$224,085.00	$257,697.00	$240,891.00	nat. median $2,106 outlier · 114.4×
001 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	2	$213,538.61	$220,142.90	$216,840.76	nat. median $177,883 1.2× median

Other procedures at this hospital

Browse this hospital's 23,810 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

90288	CPT	Botulism Immune Globulin, Human, For Intravenous Use	2	1	$2.17	—	$156,039.34	$156,039.34	$156,039.34	2026-07-17
429	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	2	2	$314.42	—	$63,654.79	$65,623.49	$64,639.14	2026-07-17
850	OTHER	Acute Leukemia With Other Procedures	2	2	$559.40	—	$55,799.70	$57,525.46	$56,662.58	2026-07-17
360	OTHER	Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc	2	2	$2,516.35	—	$48,955.38	$50,469.46	$49,712.42	2026-07-17
845	OTHER	Inj, Atidarsagene Autotem	11	9	$26,537.00	—	$6,016.87	$4,685,200.00	$4,505,000.00	2026-07-17
831	OTHER	Obecbtge Autol Up To 400	13	10	$26,537.00	—	$4,120.09	$496,064.10	$283,815.00	2026-07-17
897	OTHER	Revakinagene, Per Implant	11	9	$26,537.00	—	$265,000.00	$472,442.00	$270,300.00	2026-07-17
886	OTHER	Inj. Remestemcel-l-rknd/	13	10	$26,537.00	—	$9,015.43	$359,535.49	$205,702.38	2026-07-17
908	OTHER	Topi Adm Prad Zami Per Tr	12	9	$32,314.00	—	$10,894.39	$4,670,148.00	$3,369,178.20	2026-07-17
714	OTHER	Inj Delandistrogene Mox R	12	9	$32,314.00	—	$7,076.64	$4,659,004.00	$3,361,138.60	2026-07-17
748	OTHER	Inj, Lovotibeglogene Auto	12	9	$32,314.00	—	$13,470.32	$4,553,511.20	$3,285,033.08	2026-07-17
906	OTHER	Inj Elivaldogene Autoteme	12	9	$32,314.00	—	$9,626.48	$4,452,000.00	$3,211,800.00	2026-07-17
746	OTHER	Inj, Betibeglogene Autote	12	9	$32,314.00	—	$12,460.19	$4,115,956.60	$2,969,368.69	2026-07-17
824	OTHER	Inj, Exagamglogene Autote	13	10	$32,314.00	—	$14,590.57	$4,157,489.60	$2,378,640.00	2026-07-17
717	OTHER	Instill Adstiladrin, Tx D	13	10	$32,314.00	—	$13,357.03	$114,589.10	$65,560.29	2026-07-17
651	OTHER	Kidney Transplant With Hemodialysis Without Mcc	2	2	$40,260.01	—	$105,334.34	$108,592.10	$106,963.22	2026-07-17
956	OTHER	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	2	2	$43,189.08	—	$49,248.17	$50,771.31	$50,009.74	2026-07-17
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	2	2	$44,638.86	—	$71,501.60	$73,712.99	$72,607.30	2026-07-17
834	OTHER	Acute Leukemia With Mcc	2	2	$45,779.92	—	$44,044.75	$45,406.96	$44,725.85	2026-07-17
474	OTHER	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	2	2	$46,512.11	—	$69,059.97	$71,195.85	$70,127.91	2026-07-17
010	OTHER	Pancreas Transplant	2	2	$47,078.62	—	$50,697.49	$52,265.45	$51,481.47	2026-07-17
S2112	HCPCS	Arthroscopy, Knee, Surgical For Harvesting Of Cartilage (chondrocyte Cells)	2	1	$47,347.00	—	$44,397.00	$51,057.00	$47,727.00	2026-07-17
0715T	CPT	Percutaneous Transluminal Coronary Lithotripsy (list Separately In Addition To C…	2	1	$55,739.00	—	$52,267.00	$60,107.00	$56,187.00	2026-07-17
93592	CPT	Percutaneous Transcatheter Closure Of Paravalvular Leak; Each Additional Occlusi…	2	1	$55,739.00	—	$52,267.00	$60,107.00	$56,187.00	2026-07-17
92938	CPT	Percutaneous Transluminal Revascularization Of Or Through Coronary Artery Bypass…	2	1	$55,739.00	—	$52,267.00	$60,107.00	$56,187.00	2026-07-17
92934	CPT	Percutaneous Transluminal Coronary Atherectomy, With Intracoronary Stent, With C…	2	1	$55,739.00	—	$52,267.00	$60,107.00	$56,187.00	2026-07-17
92944	CPT	Percutaneous Transluminal Revascularization Of Chronic Total Occlusion, Coronary…	2	1	$55,739.00	—	$52,267.00	$60,107.00	$56,187.00	2026-07-17
92973	CPT	Percutaneous Transluminal Coronary Mechanical Aspiration Thrombectomy (List Sepa…	2	1	$55,739.00	—	$52,267.00	$60,107.00	$56,187.00	2026-07-17
92925	CPT	Percutaneous Transluminal Coronary Atherectomy, With Coronary Angioplasty When P…	2	1	$55,739.00	—	$52,267.00	$60,107.00	$56,187.00	2026-07-17
92929	CPT	Percutaneous Transcatheter Placement Of Intracoronary Stent(s), With Coronary An…	2	1	$55,739.00	—	$52,267.00	$60,107.00	$56,187.00	2026-07-17
92921	CPT	Percutaneous Transluminal Coronary Angioplasty; Each Additional Branch Of A Majo…	2	1	$55,739.00	—	$52,267.00	$60,107.00	$56,187.00	2026-07-17
92974	CPT	Transcatheter Placement Of Radiation Delivery Device For Subsequent Coronary Int…	2	1	$55,739.00	—	$52,267.00	$60,107.00	$56,187.00	2026-07-17
J9266	HCPCS	Injection, Pegaspargase, Per Single Dose Vial	12	4	$57,755.56	—	$26,258.38	$75,295.33	$44,739.47	2026-07-17
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	2	2	$61,127.13	—	$59,366.67	$61,202.75	$60,284.71	2026-07-17
63655	CPT	Laminectomy For Implantation Of Neurostimulator Electrodes, Plate/paddle, Epidur…	7	1	$61,778.44	—	$36,318.00	$66,787.00	$42,354.00	2026-07-17
22532	CPT	Arthrodesis, Lateral Extracavitary Technique, Including Minimal Discectomy To Pr…	9	2	$62,760.00	—	$67,500.00	$87,326.00	$78,719.00	2026-07-17
22612	CPT	Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Lumbar (w…	9	2	$62,760.00	—	$67,500.00	$87,326.00	$78,719.00	2026-07-17
22630	CPT	Arthrodesis, Posterior Interbody Technique, Including Laminectomy And/or Discect…	9	2	$62,760.00	—	$67,500.00	$87,326.00	$78,719.00	2026-07-17
22586	CPT	Arthrodesis, Pre-sacral Interbody Technique, Including Disc Space Preparation, D…	9	2	$62,760.00	—	$67,500.00	$87,326.00	$78,719.00	2026-07-17
22610	CPT	Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Thoracic …	9	2	$62,760.00	—	$67,500.00	$87,326.00	$78,719.00	2026-07-17
22556	CPT	Arthrodesis, Anterior Interbody Technique, Including Minimal Discectomy To Prepa…	9	2	$62,760.00	—	$67,500.00	$87,326.00	$78,719.00	2026-07-17
22558	CPT	Arthrodesis, Anterior Interbody Technique, Including Minimal Discectomy To Prepa…	9	2	$62,760.00	—	$67,500.00	$87,326.00	$78,719.00	2026-07-17
22533	CPT	Arthrodesis, Lateral Extracavitary Technique, Including Minimal Discectomy To Pr…	9	2	$62,760.00	—	$67,500.00	$87,326.00	$78,719.00	2026-07-17
1142	OTHER	Supprelin La Implant	11	9	$64,291.79	—	$43,185.34	$76,990.82	$44,049.05	2026-07-17
023	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	2	2	$65,068.58	—	$43,528.56	$44,874.80	$44,201.68	2026-07-17
L7180	HCPCS	Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device…	13	10	$66,459.78	—	$44,699.06	$82,154.10	$47,003.13	2026-07-17
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	2	2	$66,647.79	—	$46,287.16	$47,718.72	$47,002.94	2026-07-17
L7181	HCPCS	Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi…	13	10	$69,450.93	—	$46,710.83	$85,851.63	$49,118.61	2026-07-17
5244	OTHER	Level 4 Blood Product Exc	11	9	$71,820.19	—	$67,163.09	$119,738.36	$68,506.35	2026-07-17
955	OTHER	Craniotomy For Multiple Significant Trauma	2	2	$76,473.81	—	$42,900.96	$44,227.79	$43,564.38	2026-07-17
J7330	HCPCS	Autologous Cultured Chondrocytes, Implant	10	2	$78,232.38	—	$87,563.86	$188,521.65	$109,821.13	2026-07-17
1594	OTHER	New Technology - Level 43	11	9	$78,776.08	—	$47,030.92	$83,846.72	$47,971.54	2026-07-17
1580	OTHER	New Technology - Level 43	11	9	$78,776.08	—	$47,030.92	$83,846.72	$47,971.54	2026-07-17
019	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	2	2	$80,999.11	—	$50,407.24	$51,966.23	$51,186.74	2026-07-17
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	2	2	$82,282.00	—	$43,247.86	$44,585.42	$43,916.64	2026-07-17
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	2	2	$84,131.41	—	$53,948.75	$55,617.27	$54,783.01	2026-07-17
9273	OTHER	Sipuleucel-t Auto Cd54+	11	9	$89,889.30	—	$54,404.11	$96,991.65	$55,492.19	2026-07-17
22634	CPT	Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Inter…	2	1	$94,140.00	—	$101,518.00	$101,518.00	$101,518.00	2026-07-17
22633	CPT	Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Inter…	9	2	$94,140.00	—	$67,500.00	$101,518.00	$78,719.00	2026-07-17
1595	OTHER	New Technology - Level 44	11	9	$96,281.68	—	$57,482.12	$102,479.12	$58,631.76	2026-07-17
1581	OTHER	New Technology - Level 44	11	9	$96,281.68	—	$57,482.12	$102,479.12	$58,631.76	2026-07-17
1643	OTHER	Y90 Ibritumomab, Rx	11	9	$100,453.63	—	$56,824.55	$101,306.81	$57,961.04	2026-07-17
J9226	HCPCS	Histrelin Implant (supprelin La), 50 Mg	12	4	$103,725.95	—	$43,855.64	$114,397.97	$67,973.73	2026-07-17
020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	2	2	$105,620.36	—	$62,921.53	$64,867.56	$63,894.54	2026-07-17
1596	OTHER	New Technology - Level 45	11	9	$113,787.28	—	$67,933.32	$121,111.52	$69,291.99	2026-07-17
1582	OTHER	New Technology - Level 45	11	9	$113,787.28	—	$67,933.32	$121,111.52	$69,291.99	2026-07-17
22802	CPT	Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 7 To 12 Vert…	9	2	$115,060.00	—	$67,500.00	$124,077.00	$78,719.00	2026-07-17
22804	CPT	Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 13 Or More V…	9	2	$115,060.00	—	$67,500.00	$124,077.00	$78,719.00	2026-07-17
22800	CPT	Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; Up To 6 Vert…	9	2	$115,060.00	—	$67,500.00	$124,077.00	$78,719.00	2026-07-17
22808	CPT	Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 2 To 3 Verteb…	9	2	$115,060.00	—	$67,500.00	$124,077.00	$78,719.00	2026-07-17
22810	CPT	Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 Verteb…	9	2	$115,060.00	—	$67,500.00	$124,077.00	$78,719.00	2026-07-17
22812	CPT	Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 8 Or More Ver…	9	2	$115,060.00	—	$67,500.00	$124,077.00	$78,719.00	2026-07-17
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	2	2	$120,692.00	—	$42,899.69	$44,226.48	$43,563.09	2026-07-17
56721	CDM	Sq Plmt Neurocver/spine	19	9	$125,941.00	$125,941.00	$10,377.54	$100,752.80	$50,376.40	2026-03-01
014	OTHER	Allogeneic Bone Marrow Transplant	2	2	$127,074.13	—	$77,107.29	$79,492.05	$78,299.67	2026-07-17
005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	2	2	$129,503.67	—	$76,295.11	$78,654.75	$77,474.93	2026-07-17
011	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	2	2	$129,739.00	—	$48,409.90	$49,907.11	$49,158.51	2026-07-17
1597	OTHER	New Technology - Level 46	11	9	$131,292.88	—	$78,384.52	$139,743.92	$79,952.21	2026-07-17
1583	OTHER	New Technology - Level 46	11	9	$131,292.88	—	$78,384.52	$139,743.92	$79,952.21	2026-07-17
76844	CDM	Rmv Icd W Rplc Mult Ld	19	9	$131,348.00	$131,348.00	$10,823.08	$105,078.40	$52,539.20	2026-03-01
66661	CDM	Icd Ins/repl Ld/gen	19	9	$131,348.00	$131,348.00	$10,823.08	$105,078.40	$52,539.20	2026-03-01
84398	CDM	Ins/repl Subq Icd W/eval	19	9	$131,348.00	$131,348.00	$10,823.08	$105,078.40	$52,539.20	2026-03-01
76841	CDM	Ins Icd Gen W Mult Lead	19	9	$131,348.00	$131,348.00	$10,823.08	$105,078.40	$52,539.20	2026-03-01
Q2043	HCPCS	Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…	12	4	$135,141.34	—	$55,306.59	$144,116.49	$85,632.07	2026-07-17
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	2	2	$135,217.00	—	$41,736.79	$43,027.62	$42,382.21	2026-07-17
007	OTHER	Lung Transplant	2	2	$138,589.48	—	$90,332.55	$93,126.34	$91,729.45	2026-07-17
A9543	HCPCS	Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil…	10	2	$144,272.08	—	$85,097.42	$183,212.36	$106,727.76	2026-07-17
1584	OTHER	New Technology - Level 47	11	9	$148,798.48	—	$88,835.72	$158,376.32	$90,612.43	2026-07-17
1598	OTHER	New Technology - Level 47	11	9	$148,798.48	—	$88,835.72	$158,376.32	$90,612.43	2026-07-17
004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	2	2	$155,895.99	—	$117,533.54	$121,168.60	$119,351.07	2026-07-17
Q0480	HCPCS	Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only	13	10	$156,110.98	—	$104,995.71	$192,975.62	$110,407.86	2026-07-17
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	2	2	$163,705.00	—	$43,619.57	$44,968.63	$44,294.10	2026-07-17
1585	OTHER	New Technology - Level 48	11	9	$166,304.08	—	$99,286.92	$177,008.72	$101,272.66	2026-07-17
1599	OTHER	New Technology - Level 48	11	9	$166,304.08	—	$99,286.92	$177,008.72	$101,272.66	2026-07-17
85360	CDM	Cath Rh W Wirls Sens Plc	19	9	$179,641.00	$179,641.00	$14,802.42	$143,712.80	$71,856.40	2026-03-01
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	2	2	$181,146.00	—	$66,358.02	$68,410.33	$67,384.18	2026-07-17
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	2	2	$181,146.00	—	$50,363.96	$51,921.61	$51,142.79	2026-07-17
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	2	2	$181,146.00	—	$46,455.83	$47,892.61	$47,174.22	2026-07-17
1902	OTHER	New Technology - Level 49	11	9	$188,186.08	—	$112,350.90	$200,299.18	$114,597.92	2026-07-17
1901	OTHER	New Technology - Level 49	11	9	$188,186.08	—	$112,350.90	$200,299.18	$114,597.92	2026-07-17
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	2	2	$188,274.00	—	$53,241.59	$54,888.24	$54,064.91	2026-07-17
1904	OTHER	New Technology - Level 50	11	9	$214,444.48	—	$128,027.70	$228,247.78	$130,588.25	2026-07-17
1903	OTHER	New Technology - Level 50	11	9	$214,444.48	—	$128,027.70	$228,247.78	$130,588.25	2026-07-17
003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	2	2	$229,751.80	—	$150,506.27	$155,161.10	$152,833.68	2026-07-17
231	OTHER	Coronary Bypass With Ptca With Mcc	2	2	$233,640.00	—	$59,558.89	$61,400.92	$60,479.90	2026-07-17
232	OTHER	Coronary Bypass With Ptca Without Mcc	2	2	$233,640.00	—	$42,833.49	$44,158.24	$43,495.86	2026-07-17
1906	OTHER	New Technology - Level 51	11	9	$240,702.88	—	$143,704.50	$256,196.38	$146,578.59	2026-07-17
1905	OTHER	New Technology - Level 51	11	9	$240,702.88	—	$143,704.50	$256,196.38	$146,578.59	2026-07-17
215	OTHER	Other Heart Assist System Implant	2	2	$247,738.00	—	$43,170.84	$44,506.02	$43,838.43	2026-07-17
1907	OTHER	New Technology - Level 52	11	9	$266,961.28	—	$159,381.30	$284,144.98	$162,568.93	2026-07-17
1908	OTHER	New Technology - Level 52	11	9	$266,961.28	—	$159,381.30	$284,144.98	$162,568.93	2026-07-17
018	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	2	2	$410,356.46	—	$242,929.13	$250,442.40	$246,685.77	2026-07-17
001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	2	2	$706,915.00	—	$213,538.61	$220,142.90	$216,840.76	2026-07-17
002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	2	2	$706,915.00	—	$80,061.30	$82,537.42	$81,299.36	2026-07-17
9035	OTHER	Axicabtagene Ciloleucel C	11	9	$710,446.41	—	$532,192.20	$948,792.25	$542,836.04	2026-07-17
9391	OTHER	Brexucabtagene Car Pos T	11	9	$710,539.20	—	$489,450.20	$872,591.82	$499,239.20	2026-07-17
9413	OTHER	Lisocabtagene Car Pos T	11	9	$730,662.24	—	$562,201.20	$1,002,292.30	$573,445.22	2026-07-17
9422	OTHER	Idecabtagene Vicleucel Ca	11	9	$747,045.60	—	$558,081.80	$994,948.23	$569,243.44	2026-07-17
9194	OTHER	Tisagenlecleucel Car-pos	11	9	$762,479.08	—	$566,531.30	$1,010,012.00	$577,861.93	2026-07-17
9498	OTHER	Ciltacabtagene Car-pos T	11	9	$804,636.00	—	$587,649.60	$1,047,661.71	$599,402.59	2026-07-17
00845	OTHER	Inj, Atidarsagene Autotem	2	2	—	—	$4,369,850.00	$4,505,000.00	$4,437,425.00	2026-03-01
9138	OTHER	Inj, Hemgenix, Per Tx Dos	9	8	—	—	$3,685,267.00	$3,832,677.68	$3,758,972.34	2026-03-01
09138	OTHER	Inj, Hemgenix, Per Tx Dos	2	2	—	—	$3,574,708.99	$3,685,267.00	$3,629,988.00	2026-03-01
00908	OTHER	Topi Adm Prad Zami Per Tr	2	2	—	—	$3,235,745.40	$3,335,820.00	$3,285,782.70	2026-03-01
00714	OTHER	Inj Delandistrogene Mox R	2	2	—	—	$3,228,024.20	$3,327,860.00	$3,277,942.10	2026-03-01
00748	OTHER	Inj, Lovotibeglogene Auto	2	2	—	—	$3,154,932.76	$3,252,508.00	$3,203,720.38	2026-03-01
00906	OTHER	Inj Elivaldogene Autoteme	2	2	—	—	$3,084,600.00	$3,180,000.00	$3,132,300.00	2026-03-01
00746	OTHER	Inj, Betibeglogene Autote	2	2	—	—	$2,851,769.93	$2,939,969.00	$2,895,869.46	2026-03-01
9141	OTHER	Inj Onase Abepar-xioi Tre	11	9	—	—	$2,588,981.00	$4,615,635.33	$2,640,760.62	2026-03-01
09141	OTHER	Inj Onase Abepar-xioi Tre	2	2	—	—	$2,511,311.57	$2,588,981.00	$2,550,146.29	2026-03-01
00824	OTHER	Inj, Exagamglogene Autote	2	2	—	—	$2,262,040.00	$2,332,000.00	$2,297,020.00	2026-03-01
2067	OTHER	Afamitresgene Autoleucel	11	9	—	—	$770,620.00	$1,373,861.34	$786,032.40	2026-03-01
09498	OTHER	Ciltacabtagene Car-pos T	2	2	—	—	$570,020.11	$587,649.60	$578,834.85	2026-03-01
Q2042	HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	2	2	—	—	$561,407.87	$578,771.00	$570,089.44	2026-03-01
09194	OTHER	Tisagenlecleucel Car-pos	2	2	—	—	$549,535.36	$566,531.30	$558,033.33	2026-03-01
09413	OTHER	Lisocabtagene Car Pos T	2	2	—	—	$545,335.16	$562,201.20	$553,768.18	2026-03-01
09422	OTHER	Idecabtagene Vicleucel Ca	2	2	—	—	$541,339.35	$558,081.80	$549,710.57	2026-03-01
Q2056	HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	2	2	—	—	$536,573.93	$553,169.00	$544,871.47	2026-03-01
09035	OTHER	Axicabtagene Ciloleucel C	2	2	—	—	$516,226.43	$532,192.20	$524,209.31	2026-03-01
Q2055	HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	2	2	—	—	$511,793.34	$527,622.00	$519,707.67	2026-03-01
Q2054	HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	2	2	—	—	$500,948.74	$516,442.00	$508,695.37	2026-03-01
Q2041	HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	2	2	—	—	$487,755.77	$502,841.00	$495,298.39	2026-03-01
09391	OTHER	Brexucabtagene Car Pos T	2	2	—	—	$474,766.69	$489,450.20	$482,108.45	2026-03-01
Q2053	HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	2	2	—	—	$474,717.03	$489,399.00	$482,058.02	2026-03-01
J3403	HCPCS	Revakinagene Taroretcel-lwey, Per Implant	8	1	—	—	$332,575.00	$417,110.00	$417,110.00	2026-03-01
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	21	11	—	—	$23,535.00	$1,275,879.01	$352,870.43	2026-03-01
00831	OTHER	Obecbtge Autol Up To 400	2	2	—	—	$269,902.50	$278,250.00	$274,076.25	2026-03-01
77425	CPT	Intraoperative Radiation Treatment Delivery, Electrons, Single Treatment Session…	2	1	—	—	$268,461.97	$268,461.97	$268,461.97	2026-03-01
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	20	10	—	—	$203,126.17	$827,994.15	$266,888.41	2026-03-01
00897	OTHER	Revakinagene, Per Implant	2	2	—	—	$257,050.00	$265,000.00	$261,025.00	2026-03-01
453	MS_DRG	Combined Anterior And Posterior Spinal Fusion With Mcc	2	1	—	—	$224,085.00	$257,697.00	$240,891.00	2026-03-01
454	MS_DRG	Combined Anterior And Posterior Spinal Fusion With Cc	2	1	—	—	$224,085.00	$257,697.00	$240,891.00	2026-03-01
455	MS_DRG	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	2	1	—	—	$224,085.00	$257,697.00	$240,891.00	2026-03-01
00886	OTHER	Inj. Remestemcel-l-rknd/	2	2	—	—	$195,618.93	$201,669.00	$198,643.96	2026-03-01
927	MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	14	11	—	—	$31,017.00	$257,228.69	$171,742.00	2026-03-01
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	14	11	—	—	$87,866.00	$255,719.09	$170,742.20	2026-03-01
01908	OTHER	New Technology - Level 52	2	2	—	—	$154,564.36	$159,344.70	$156,954.53	2026-03-01
01907	OTHER	New Technology - Level 52	2	2	—	—	$154,564.36	$159,344.70	$156,954.53	2026-03-01
230	MS_DRG	Other Cardiothoracic Procedures Without Cc/mcc	2	1	—	—	$131,816.00	$151,589.00	$141,702.50	2026-03-01
01906	OTHER	New Technology - Level 51	2	2	—	—	$139,361.36	$143,671.50	$141,516.43	2026-03-01
01905	OTHER	New Technology - Level 51	2	2	—	—	$139,361.36	$143,671.50	$141,516.43	2026-03-01
01904	OTHER	New Technology - Level 50	2	2	—	—	$124,158.35	$127,998.30	$126,078.33	2026-03-01
01903	OTHER	New Technology - Level 50	2	2	—	—	$124,158.35	$127,998.30	$126,078.33	2026-03-01
215	MS_DRG	Other Heart Assist System Implant	21	11	—	—	$76,401.64	$273,456.00	$113,159.58	2026-03-01
4	MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	14	11	—	—	$101,894.10	$166,880.28	$113,022.43	2026-03-01
01902	OTHER	New Technology - Level 49	2	2	—	—	$108,955.35	$112,325.10	$110,640.23	2026-03-01
01901	OTHER	New Technology - Level 49	2	2	—	—	$108,955.35	$112,325.10	$110,640.23	2026-03-01
209	MS_DRG	Complex Aortic Arch Procedures	19	9	—	—	$89,677.38	$334,425.26	$110,405.84	2026-03-01
459	MS_DRG	Spinal Fusion Except Cervical With Mcc	2	1	—	—	$100,748.00	$115,862.00	$108,305.00	2026-03-01
2	MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	20	10	—	—	$79,470.20	$780,299.00	$107,919.53	2026-03-01
7	MS_DRG	Lung Transplant	20	10	—	—	$31,017.00	$382,626.61	$107,853.67	2026-03-01
A9699	HCPCS	Radiopharmaceutical, Therapeutic, Not Otherwise Classified	2	1	—	—	$105,673.38	$105,673.38	$105,673.38	2026-03-01
J9029	HCPCS	Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose	12	4	—	—	$61,338.53	$161,324.10	$101,168.52	2026-03-01
14	MS_DRG	Allogeneic Bone Marrow Transplant	20	10	—	—	$23,535.00	$355,080.87	$100,191.28	2026-03-01
01599	OTHER	New Technology - Level 48	2	2	—	—	$96,286.20	$99,264.12	$97,775.16	2026-03-01
01585	OTHER	New Technology - Level 48	2	2	—	—	$96,286.20	$99,264.12	$97,775.16	2026-03-01
K1007	HCPCS	Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin…	13	10	—	—	$92,228.57	$169,510.41	$96,982.62	2026-03-01
216	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	26	12	—	—	$66,135.00	$199,950.00	$94,319.75	2026-03-01
426	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	21	11	—	—	$75,589.61	$257,697.00	$93,600.00	2026-03-01
456	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	21	11	—	—	$61,072.56	$133,221.00	$93,600.00	2026-03-01
429	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	21	11	—	—	$60,145.14	$257,697.00	$93,600.00	2026-03-01
266	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	26	12	—	—	$43,200.65	$270,336.00	$91,592.00	2026-03-01
212	MS_DRG	Concomitant Aortic And Mitral Valve Procedures	26	12	—	—	$31,017.00	$321,286.16	$90,790.58	2026-03-01
01598	OTHER	New Technology - Level 47	2	2	—	—	$86,150.86	$88,815.32	$87,483.09	2026-03-01
01584	OTHER	New Technology - Level 47	2	2	—	—	$86,150.86	$88,815.32	$87,483.09	2026-03-01
5	MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	20	10	—	—	$31,017.00	$304,634.03	$86,158.46	2026-03-01
231	MS_DRG	Coronary Bypass With Ptca With Mcc	26	12	—	—	$60,789.00	$257,894.00	$80,282.99	2026-03-01
217	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	26	12	—	—	$46,568.49	$199,950.00	$79,092.78	2026-03-01
218	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	26	12	—	—	$42,902.82	$199,950.00	$79,092.78	2026-03-01
01583	OTHER	New Technology - Level 46	2	2	—	—	$76,015.52	$78,366.52	$77,191.02	2026-03-01
01597	OTHER	New Technology - Level 46	2	2	—	—	$76,015.52	$78,366.52	$77,191.02	2026-03-01
447	MS_DRG	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	21	11	—	—	$48,348.33	$115,862.00	$76,569.39	2026-03-01
460	MS_DRG	Spinal Fusion Except Cervical Without Mcc	2	1	—	—	$73,272.00	$73,272.00	$73,272.00	2026-03-01
850	MS_DRG	Acute Leukemia With Other Procedures	21	11	—	—	$31,017.00	$255,853.59	$71,884.45	2026-03-01
275	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	26	12	—	—	$50,961.11	$292,948.00	$70,683.18	2026-03-01
L8702	HCPCS	Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge…	13	10	—	—	$66,737.65	$122,659.67	$70,177.73	2026-03-01
267	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	26	12	—	—	$33,926.48	$206,162.00	$68,771.00	2026-03-01
457	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	21	11	—	—	$41,387.65	$133,221.00	$68,542.87	2026-03-01
219	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	26	12	—	—	$47,580.00	$180,699.00	$68,422.30	2026-03-01
427	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	21	11	—	—	$51,193.33	$257,697.00	$67,082.45	2026-03-01
01582	OTHER	New Technology - Level 45	2	2	—	—	$65,880.19	$67,917.72	$66,898.96	2026-03-01
01596	OTHER	New Technology - Level 45	2	2	—	—	$65,880.19	$67,917.72	$66,898.96	2026-03-01
233	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	26	12	—	—	$44,799.00	$207,819.00	$66,864.00	2026-03-01
B0404	HCPCS	Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5	2	2	—	—	$65,954.41	$67,273.50	$66,613.96	2026-03-01
430	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc	21	11	—	—	$39,448.43	$257,697.00	$66,353.31	2026-03-01
05244	OTHER	Level 4 Blood Product Exc	2	2	—	—	$65,133.23	$67,147.66	$66,140.45	2026-03-01
B0505	HCPCS	Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2	2	2	—	—	$64,868.50	$66,165.87	$65,517.18	2026-03-01
20	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	21	11	—	—	$31,017.00	$232,491.56	$65,448.92	2026-03-01
428	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	21	11	—	—	$39,701.57	$257,697.00	$64,732.37	2026-03-01
268	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	21	11	—	—	$48,081.50	$203,214.43	$63,916.32	2026-03-01
957	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Mcc	21	11	—	—	$31,017.00	$225,137.57	$63,423.11	2026-03-01
00717	OTHER	Instill Adstiladrin, Tx D	2	2	—	—	$62,346.55	$64,274.79	$63,310.67	2026-03-01
232	MS_DRG	Coronary Bypass With Ptca Without Mcc	26	12	—	—	$44,050.91	$257,894.00	$63,247.73	2026-03-01
220	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	26	12	—	—	$38,195.05	$180,699.00	$62,875.35	2026-03-01
450	MS_DRG	Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically	21	11	—	—	$37,137.82	$115,862.00	$61,465.91	2026-03-01
270	MS_DRG	Other Major Cardiovascular Procedures With Mcc	21	11	—	—	$37,015.94	$100,353.00	$60,870.47	2026-03-01
10	MS_DRG	Pancreas Transplant	20	10	—	—	$31,017.00	$212,013.23	$60,394.10	2026-03-01
207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	21	11	—	—	$46,642.78	$190,119.65	$59,797.67	2026-03-01
221	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	26	12	—	—	$33,118.05	$180,699.00	$59,478.40	2026-03-01
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	21	11	—	—	$31,017.00	$210,798.89	$59,473.24	2026-03-01
B0106	HCPCS	Stroke; M > 30.05 & M < 34.25	2	2	—	—	$58,811.86	$59,988.10	$59,399.98	2026-03-01
928	MS_DRG	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	14	11	—	—	$31,017.00	$86,415.97	$58,611.12	2026-03-01
B1903	HCPCS	Guillian Barre; M < 18.05	2	2	—	—	$57,300.30	$58,446.30	$57,873.30	2026-03-01
870	MS_DRG	Septicemia Or Severe Sepsis With Mv >96 Hours	21	11	—	—	$23,535.00	$204,216.04	$57,659.87	2026-03-01
B0205	HCPCS	Traumatic Brain Injury; M > 28.75 & M < 40.65	2	2	—	—	$56,575.66	$57,707.17	$57,141.42	2026-03-01
01581	OTHER	New Technology - Level 44	2	2	—	—	$55,744.85	$57,468.92	$56,606.88	2026-03-01
01595	OTHER	New Technology - Level 44	2	2	—	—	$55,744.85	$57,468.92	$56,606.88	2026-03-01
234	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	26	12	—	—	$38,365.24	$185,332.00	$56,565.45	2026-03-01
955	MS_DRG	Craniotomy For Multiple Significant Trauma	21	11	—	—	$31,017.00	$198,877.08	$56,189.15	2026-03-01
01643	OTHER	Y90 Ibritumomab, Rx	2	2	—	—	$55,119.81	$56,824.55	$55,972.18	2026-03-01
317	MS_DRG	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	21	11	—	—	$31,017.00	$197,559.33	$55,826.15	2026-03-01
213	MS_DRG	Endovascular Abdominal Aorta With Iliac Branch Procedures	19	9	—	—	$45,882.73	$168,616.07	$55,666.24	2026-03-01
573	MS_DRG	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	21	11	—	—	$31,017.00	$193,567.66	$54,726.56	2026-03-01
C0404	HCPCS	Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5	2	2	—	—	$53,909.66	$54,987.85	$54,448.76	2026-03-01
09273	OTHER	Sipuleucel-t Auto Cd54+	2	2	—	—	$52,771.99	$54,404.11	$53,588.05	2026-03-01
B2102	HCPCS	Burns; M=12-45	2	2	—	—	$52,844.51	$53,901.40	$53,372.96	2026-03-01
D0404	HCPCS	Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5	2	2	—	—	$52,491.53	$53,541.36	$53,016.44	2026-03-01
B0405	HCPCS	Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5	2	2	—	—	$52,242.37	$53,287.22	$52,764.79	2026-03-01
C0106	HCPCS	Stroke; M > 30.05 & M < 34.25	2	2	—	—	$52,225.76	$53,270.28	$52,748.02	2026-03-01
B0105	HCPCS	Stroke; M > 34.25 & M < 38.85	2	2	—	—	$52,211.23	$53,255.45	$52,733.34	2026-03-01
447	OTHER	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	2	2	—	—	$51,774.46	$53,375.73	$52,575.10	2026-03-01
B0604	HCPCS	Neurological; M < 25.85	2	2	—	—	$50,865.77	$51,883.09	$51,374.43	2026-03-01
461	MS_DRG	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	21	11	—	—	$44,255.72	$163,182.56	$51,325.24	2026-03-01
969	MS_DRG	HIV With Extensive O.r. Procedures With Mcc	21	11	—	—	$31,017.00	$180,859.93	$51,225.97	2026-03-01
405	MS_DRG	Pancreas, Liver And Shunt Procedures With Mcc	21	11	—	—	$39,147.71	$161,631.39	$50,837.36	2026-03-01
11	MS_DRG	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	21	11	—	—	$38,911.16	$161,146.84	$50,684.95	2026-03-01
C0505	HCPCS	Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2	2	2	—	—	$49,850.45	$50,847.46	$50,348.96	2026-03-01
28	MS_DRG	Spinal Procedures With Mcc	21	11	—	—	$31,017.00	$177,521.23	$50,306.26	2026-03-01
276	MS_DRG	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	26	12	—	—	$30,104.00	$177,471.00	$50,292.43	2026-03-01
16	MS_DRG	Autologous Bone Marrow Transplant With Cc/mcc	20	10	—	—	$23,535.00	$175,198.92	$50,153.46	2026-03-01
277	MS_DRG	Cardiac Defibrillator Implant Without Mcc	26	12	—	—	$33,550.03	$234,563.00	$50,055.30	2026-03-01
236	MS_DRG	Coronary Bypass Without Cardiac Catheterization Without Mcc	26	12	—	—	$29,652.86	$150,753.00	$49,594.01	2026-03-01
B1004	HCPCS	Amputation, Lower Extremity; M=39-45	2	2	—	—	$49,071.83	$50,053.26	$49,562.54	2026-03-01
448	MS_DRG	Multiple Level Spinal Fusion Except Cervical Without Mcc	21	11	—	—	$29,446.60	$109,157.00	$49,302.69	2026-03-01
235	MS_DRG	Coronary Bypass Without Cardiac Catheterization With Mcc	26	12	—	—	$33,823.00	$151,589.00	$49,207.62	2026-03-01
820	MS_DRG	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	21	11	—	—	$31,017.00	$173,281.38	$49,138.31	2026-03-01
B1504	HCPCS	Pulmonary; M < 29.15	2	2	—	—	$48,637.88	$49,610.63	$49,124.25	2026-03-01
790	MS_DRG	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	11	9	—	—	$42,873.25	$68,323.91	$48,802.79	2026-03-01
458	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	21	11	—	—	$31,137.73	$133,221.00	$48,540.81	2026-03-01
B0704	HCPCS	Fracture Of Lower Extremity; M < 28.15	2	2	—	—	$47,630.86	$48,583.48	$48,107.17	2026-03-01
B1304	HCPCS	Rheumatoid, Other Arthritis; M=12-35	2	2	—	—	$47,572.72	$48,524.18	$48,048.45	2026-03-01
23	MS_DRG	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	21	11	—	—	$31,017.00	$169,307.44	$48,043.61	2026-03-01
A0404	HCPCS	Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5	2	2	—	—	$47,500.05	$48,450.05	$47,975.05	2026-03-01
463	MS_DRG	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective	21	11	—	—	$31,017.00	$168,397.43	$47,792.93	2026-03-01
D0106	HCPCS	Stroke; M > 30.05 & M < 34.25	2	2	—	—	$47,317.33	$48,263.68	$47,790.51	2026-03-01
8	MS_DRG	Simultaneous Pancreas And Kidney Transplant	20	10	—	—	$31,017.00	$165,593.51	$47,481.51	2026-03-01
B0904	HCPCS	Other Orthopedic; M < 24.15	2	2	—	—	$46,679.90	$47,613.50	$47,146.70	2026-03-01
402	MS_DRG	Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical	21	11	—	—	$28,336.01	$257,697.00	$46,841.68	2026-03-01
D0505	HCPCS	Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2	2	2	—	—	$46,376.76	$47,304.29	$46,840.53	2026-03-01
C0105	HCPCS	Stroke; M > 34.25 & M < 38.85	2	2	—	—	$46,364.30	$47,291.59	$46,827.94	2026-03-01
278	MS_DRG	Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures	21	11	—	—	$31,017.00	$164,458.95	$46,707.99	2026-03-01
B2005	HCPCS	Miscellaneous; M=12-32 And A Tm81	2	2	—	—	$45,924.12	$46,842.60	$46,383.36	2026-03-01
01580	OTHER	New Technology - Level 43	2	2	—	—	$45,609.52	$47,020.12	$46,314.82	2026-03-01
01594	OTHER	New Technology - Level 43	2	2	—	—	$45,609.52	$47,020.12	$46,314.82	2026-03-01
77523	CPT	Proton Treatment Delivery; Intermediate	2	1	—	—	$46,190.89	$46,190.89	$46,190.89	2026-03-01
77525	CPT	Proton Treatment Delivery; Complex	2	1	—	—	$46,190.89	$46,190.89	$46,190.89	2026-03-01
77522	CPT	Proton Treatment Delivery; Simple, With Compensation	2	1	—	—	$46,190.89	$46,190.89	$46,190.89	2026-03-01
B0504	HCPCS	Nontraumatic Spinal Cord Injury; M > 29.25 & M < 3	2	2	—	—	$45,656.28	$46,569.40	$46,112.84	2026-03-01
834	MS_DRG	Acute Leukemia With Mcc	21	11	—	—	$23,535.00	$162,204.59	$46,086.99	2026-03-01
17	MS_DRG	Autologous Bone Marrow Transplant Without Cc/mcc	20	10	—	—	$23,535.00	$160,502.74	$46,065.42	2026-03-01
B1704	HCPCS	Major Multiple Trauma,no Brain Or Spinal Cord Inju	2	2	—	—	$45,581.53	$46,493.16	$46,037.35	2026-03-01
228	MS_DRG	Other Cardiothoracic Procedures With Mcc	21	11	—	—	$35,934.92	$151,589.00	$45,976.19	2026-03-01
A5104	HCPCS	Expired, Not Orthopedic, Length Of Stay Is 16 Days	2	2	—	—	$45,432.03	$46,340.67	$45,886.35	2026-03-01
C0205	HCPCS	Traumatic Brain Injury; M > 28.75 & M < 40.65	2	2	—	—	$44,983.55	$45,883.22	$45,433.39	2026-03-01
B0304	HCPCS	Nontraumatic Brain Injury; M < 26.15	2	2	—	—	$44,921.26	$45,819.68	$45,370.47	2026-03-01
A0106	HCPCS	Stroke; M > 30.05 & M < 34.25	2	2	—	—	$44,881.81	$45,779.44	$45,330.62	2026-03-01
B1404	HCPCS	Cardiac; M < 31.15	2	2	—	—	$44,574.51	$45,466.00	$45,020.26	2026-03-01
B1204	HCPCS	Osteoarthritis; M=39-47	2	2	—	—	$44,568.28	$45,459.65	$45,013.96	2026-03-01
C2102	HCPCS	Burns; M=12-45	2	2	—	—	$44,427.09	$45,315.63	$44,871.36	2026-03-01
B0204	HCPCS	Traumatic Brain Injury; M > 40.65 & M < 44.25	2	2	—	—	$44,099.03	$44,981.01	$44,540.02	2026-03-01
21	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	21	11	—	—	$31,017.00	$156,410.61	$44,490.92	2026-03-01
B2004	HCPCS	Miscellaneous; M < 27.85	2	2	—	—	$43,874.79	$44,752.29	$44,313.54	2026-03-01
B0805	HCPCS	Replacement Of Lower Extremity Joint; M > 22.05 &	2	2	—	—	$43,415.92	$44,284.24	$43,850.08	2026-03-01
B1203	HCPCS	Osteoarthritis; M < 30.75	2	2	—	—	$43,291.34	$44,157.17	$43,724.25	2026-03-01
653	MS_DRG	Major Bladder Procedures With Mcc	21	11	—	—	$31,017.00	$153,532.83	$43,698.19	2026-03-01
B1804	HCPCS	Major Multiple Trauma With Brain Or Spinal Code In	2	2	—	—	$42,907.22	$43,765.37	$43,336.29	2026-03-01
A0505	HCPCS	Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2	2	2	—	—	$42,739.04	$43,593.82	$43,166.43	2026-03-01
C0405	HCPCS	Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5	2	2	—	—	$42,701.67	$43,555.70	$43,128.68	2026-03-01
01142	OTHER	Supprelin La Implant	2	2	—	—	$41,889.78	$43,185.34	$42,537.56	2026-03-01
D0105	HCPCS	Stroke; M > 34.25 & M < 38.85	2	2	—	—	$42,006.10	$42,846.22	$42,426.16	2026-03-01

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