Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

PARKLAND MEDICAL CENTER

Derry, NH · CCN 300017 · Rates published

25,437 distinct procedures filed
27 distinct payers
913,490 rate rows
2026-07-15 last MRF observed
Data quality

850,240 of 913,490 rate rows are consumer-grade (93.1%)

63,250 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 28,606
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 18,460
per-diem day rate — not a per-procedure price 14,260
placeholder amount (≤ $0.02) — excluded from medians 1,620
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 228
exceeds 10× this hospital's gross charge — excluded from medians 76
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://core.secure.ehc.com/src/util/json-detail-price-list/02-0364103_parkland-medical-center_standardcharges.json
Found on page https://parklandmedicalcenter.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-10-22
Content fingerprint 668aa760f6e115e7… · 256,820,120 bytes · first seen 2026-05-06

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
J3391
HCPCS 		Injection, Atidarsagene Autotemcel, Per Treatment 1 $4,972,678.50 $4,972,678.50 $4,972,678.50 nat. median
$4,505,000
1.1× median
845
OTHER 		Inj, Atidarsagene Autotem 11 $6,016.87 $4,685,200.00 $4,550,050.00 nat. median
$17,146
outlier · 265.4×
J1413
HCPCS 		Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 1 $3,744,134.40 $4,680,249.60 $4,399,545.60 nat. median
$3,324,572
1.3× median
00845
OTHER 		Inj, Atidarsagene Autotem 2 $4,369,850.00 $4,414,900.00 $4,392,375.00 nat. median
$4,414,900
1.0× median
J1414
HCPCS 		Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose 1 $4,095,147.00 $4,504,983.00 $4,300,065.00 nat. median
$3,710,000
1.2× median
J1411
HCPCS 		Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 1 $4,095,147.00 $4,504,983.00 $4,300,065.00 nat. median
$3,703,693
1.2× median
J3394
HCPCS 		Injection, Lovotibeglogene Autotemcel, Per Treatment 1 $3,627,130.20 $4,533,991.80 $4,262,059.80 nat. median
$3,286,000
1.3× median
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $3,276,117.60 $4,095,218.40 $3,849,602.40 nat. median
$2,994,107
1.3× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 10 $2,948,213.60 $3,832,677.68 $3,758,972.34 nat. median
$3,758,972
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,574,708.99 $3,611,561.66 $3,593,135.33 nat. median
$3,574,709
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 11 $10,894.39 $3,469,252.80 $3,369,178.20 nat. median
$30,329
outlier · 111.1×
714
OTHER 		Inj Delandistrogene Mox R 11 $7,076.64 $3,460,974.40 $3,361,138.60 nat. median
$3,325,455
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 11 $13,470.32 $3,382,608.32 $3,285,033.08 nat. median
$3,252,508
1.0× median
00908
OTHER 		Topi Adm Prad Zami Per Tr 2 $3,235,745.40 $3,269,103.60 $3,252,424.50 nat. median
$14,694
outlier · 221.3×
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,228,024.20 $3,261,302.80 $3,244,663.50 nat. median
$3,228,024
1.0× median
906
OTHER 		Inj Elivaldogene Autoteme 11 $9,626.48 $3,307,200.00 $3,211,800.00 nat. median
$24,952
outlier · 128.7×
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,154,932.76 $3,187,457.84 $3,171,195.30 nat. median
$3,187,420
1.0× median
00906
OTHER 		Inj Elivaldogene Autoteme 2 $3,084,600.00 $3,116,400.00 $3,100,500.00 nat. median
$3,084,600
1.0× median
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $2,574,092.40 $3,217,671.60 $3,024,687.60 nat. median
$2,401,960
1.3× median
746
OTHER 		Inj, Betibeglogene Autote 11 $12,460.19 $3,057,567.76 $2,969,368.69 nat. median
$2,939,969
1.0× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $2,461,963.38 $3,077,507.88 $2,892,930.38 nat. median
$2,466,282
1.2× median
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,851,769.93 $2,881,169.62 $2,866,469.78 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 11 $2,071,184.80 $4,615,635.33 $2,640,760.62 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,511,311.57 $2,537,201.38 $2,524,256.47 nat. median
$2,511,312
1.0× median
824
OTHER 		Inj, Exagamglogene Autote 12 $14,590.57 $4,157,489.60 $2,378,640.00 nat. median
$2,262,040
1.1× median
00824
OTHER 		Inj, Exagamglogene Autote 2 $2,262,040.00 $2,285,360.00 $2,273,700.00 nat. median
$2,285,360
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 1 $883,978.20 $1,104,992.02 $1,038,718.70 nat. median
$809,217
1.3× median
2067
OTHER 		Afamitresgene Autoleucel 11 $616,496.00 $1,373,861.34 $786,032.40 nat. median
$789,886
1.0× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $536,573.93 $842,630.72 $707,823.91 nat. median
$646,415
1.1× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 $561,407.87 $812,349.23 $682,386.95 nat. median
$738,272
0.9× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $500,948.74 $806,140.36 $677,171.39 nat. median
$640,950
1.1× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $511,793.34 $800,233.39 $672,209.45 nat. median
$622,245
1.1× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 3 $487,755.77 $763,110.45 $641,025.55 nat. median
$608,101
1.1× median
9498
OTHER 		Ciltacabtagene Car-pos T 11 $470,119.68 $1,047,661.71 $599,402.59 nat. median
$587,650
1.0× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $474,717.03 $701,822.64 $589,542.76 nat. median
$591,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 11 $453,225.04 $1,010,012.00 $577,861.93 nat. median
$577,003
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 11 $449,760.96 $1,002,292.30 $573,445.22 nat. median
$562,201
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $570,020.11 $575,896.61 $572,958.36 nat. median
$570,020
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 11 $446,465.44 $994,948.23 $569,243.44 nat. median
$562,826
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $549,535.36 $555,200.67 $552,368.02 nat. median
$549,535
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $545,335.16 $550,957.18 $548,146.17 nat. median
$545,335
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $541,339.35 $546,920.16 $544,129.76 nat. median
$541,339
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 11 $425,753.76 $948,792.25 $542,836.04 nat. median
$533,230
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $516,226.43 $521,548.36 $518,887.40 nat. median
$516,226
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 11 $391,560.16 $872,591.82 $499,239.20 nat. median
$492,768
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $474,766.69 $479,661.20 $477,213.95 nat. median
$474,767
1.0× median
J3403
HCPCS 		Revakinagene Taroretcel-lwey, Per Implant 2 $303,981.50 $494,516.50 $379,983.50 nat. median
$265,000
1.4× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 1 $307,136.03 $383,926.72 $360,900.22 nat. median
$319,951
1.1× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 14 $22,485.00 $1,204,234.43 $334,374.20 nat. median
$359,358
0.9× median
831
OTHER 		Obecbtge Autol Up To 400 12 $4,120.09 $496,064.10 $283,815.00 nat. median
$23,568
outlier · 12.0×

Other procedures at this hospital

Browse this hospital's 25,437 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J3391 HCPCS Injection, Atidarsagene Autotemcel, Per Treatment 2 1 — — $4,972,678.50 $4,972,678.50 $4,972,678.50 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 24 11 $24,316.00 — $6,016.87 $4,685,200.00 $4,550,050.00 2026-07-15
J1413 HCPCS Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 8 1 — — $3,744,134.40 $4,680,249.60 $4,399,545.60 2026-03-01
00845 OTHER Inj, Atidarsagene Autotem 4 2 — — $4,369,850.00 $4,414,900.00 $4,392,375.00 2026-03-01
J1411 HCPCS Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 4 1 — — $4,095,147.00 $4,504,983.00 $4,300,065.00 2026-03-01
J1414 HCPCS Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose 4 1 — — $4,095,147.00 $4,504,983.00 $4,300,065.00 2026-03-01
J3394 HCPCS Injection, Lovotibeglogene Autotemcel, Per Treatment 8 1 — — $3,627,130.20 $4,533,991.80 $4,262,059.80 2026-03-01
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 8 1 — — $3,276,117.60 $4,095,218.40 $3,849,602.40 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 20 10 — — $2,948,213.60 $3,832,677.68 $3,758,972.34 2026-03-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 4 2 — — $3,574,708.99 $3,611,561.66 $3,593,135.33 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 24 11 $32,314.00 — $10,894.39 $3,469,252.80 $3,369,178.20 2026-07-15
714 OTHER Inj Delandistrogene Mox R 24 11 $32,314.00 — $7,076.64 $3,460,974.40 $3,361,138.60 2026-07-15
748 OTHER Inj, Lovotibeglogene Auto 24 11 $32,314.00 — $13,470.32 $3,382,608.32 $3,285,033.08 2026-07-15
00908 OTHER Topi Adm Prad Zami Per Tr 4 2 — — $3,235,745.40 $3,269,103.60 $3,252,424.50 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 4 2 — — $3,228,024.20 $3,261,302.80 $3,244,663.50 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 24 11 $32,314.00 — $9,626.48 $3,307,200.00 $3,211,800.00 2026-07-15
00748 OTHER Inj, Lovotibeglogene Auto 4 2 — — $3,154,932.76 $3,187,457.84 $3,171,195.30 2026-03-01
00906 OTHER Inj Elivaldogene Autoteme 4 2 — — $3,084,600.00 $3,116,400.00 $3,100,500.00 2026-03-01
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 8 1 — — $2,574,092.40 $3,217,671.60 $3,024,687.60 2026-03-01
746 OTHER Inj, Betibeglogene Autote 24 11 $32,314.00 — $12,460.19 $3,057,567.76 $2,969,368.69 2026-07-15
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 8 1 $2,759,219.00 — $2,461,963.38 $3,077,507.88 $2,892,930.38 2026-07-15
00746 OTHER Inj, Betibeglogene Autote 4 2 — — $2,851,769.93 $2,881,169.62 $2,866,469.78 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 22 11 — — $2,071,184.80 $4,615,635.33 $2,640,760.62 2026-03-01
09141 OTHER Inj Onase Abepar-xioi Tre 4 2 — — $2,511,311.57 $2,537,201.38 $2,524,256.47 2026-03-01
824 OTHER Inj, Exagamglogene Autote 26 12 $32,314.00 — $14,590.57 $4,157,489.60 $2,378,640.00 2026-07-15
00824 OTHER Inj, Exagamglogene Autote 4 2 — — $2,262,040.00 $2,285,360.00 $2,273,700.00 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 8 1 — — $883,978.20 $1,104,992.02 $1,038,718.70 2026-03-01
2067 OTHER Afamitresgene Autoleucel 22 11 — — $616,496.00 $1,373,861.34 $786,032.40 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 12 3 — — $536,573.93 $842,630.72 $707,823.91 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 12 3 — — $561,407.87 $812,349.23 $682,386.95 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 12 3 — — $500,948.74 $806,140.36 $677,171.39 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 12 3 — — $511,793.34 $800,233.39 $672,209.45 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 12 3 — — $487,755.77 $763,110.45 $641,025.55 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 22 11 $804,636.00 — $470,119.68 $1,047,661.71 $599,402.59 2026-07-15
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 12 3 — — $474,717.03 $701,822.64 $589,542.76 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 22 11 $762,479.08 — $453,225.04 $1,010,012.00 $577,861.93 2026-07-15
9413 OTHER Lisocabtagene Car Pos T 22 11 $730,662.24 — $449,760.96 $1,002,292.30 $573,445.22 2026-07-15
09498 OTHER Ciltacabtagene Car-pos T 4 2 — — $570,020.11 $575,896.61 $572,958.36 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 22 11 $747,045.60 — $446,465.44 $994,948.23 $569,243.44 2026-07-15
09194 OTHER Tisagenlecleucel Car-pos 4 2 — — $549,535.36 $555,200.67 $552,368.02 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 4 2 — — $545,335.16 $550,957.18 $548,146.17 2026-03-01
09422 OTHER Idecabtagene Vicleucel Ca 4 2 — — $541,339.35 $546,920.16 $544,129.76 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 22 11 $710,446.41 — $425,753.76 $948,792.25 $542,836.04 2026-07-15
09035 OTHER Axicabtagene Ciloleucel C 4 2 — — $516,226.43 $521,548.36 $518,887.40 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 22 11 $710,539.20 — $391,560.16 $872,591.82 $499,239.20 2026-07-15
09391 OTHER Brexucabtagene Car Pos T 4 2 — — $474,766.69 $479,661.20 $477,213.95 2026-03-01
J3403 HCPCS Revakinagene Taroretcel-lwey, Per Implant 20 2 — — $303,981.50 $494,516.50 $379,983.50 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 8 1 — — $307,136.03 $383,926.72 $360,900.22 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 40 14 — — $22,485.00 $1,204,234.43 $334,374.20 2026-03-01
831 OTHER Obecbtge Autol Up To 400 26 12 $24,316.00 — $4,120.09 $496,064.10 $283,815.00 2026-07-15
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 8 1 — — $231,334.53 $289,173.21 $271,829.68 2026-03-01
00831 OTHER Obecbtge Autol Up To 400 4 2 — — $269,902.50 $272,685.00 $271,293.75 2026-03-01
897 OTHER Revakinagene, Per Implant 22 11 $24,316.00 — $212,000.00 $472,442.00 $270,300.00 2026-07-15
00897 OTHER Revakinagene, Per Implant 4 2 — — $257,050.00 $259,700.00 $258,375.00 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 2 $410,356.46 — $242,929.13 $245,433.55 $244,181.34 2026-07-15
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 38 13 — — $173,596.32 $781,499.70 $221,335.31 2026-03-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 4 2 $571,681.00 — $213,538.61 $215,740.04 $214,639.33 2026-07-15
886 OTHER Inj. Remestemcel-l-rknd/ 26 12 $24,316.00 — $9,015.43 $359,535.49 $205,702.38 2026-07-15
76839 CDM Ins Icd Gen W Dual Lead 48 14 $347,866.75 $347,866.75 $10,749.08 $347,866.75 $204,963.09 2026-03-01
66661 CDM Icd Ins/repl Ld/gen 48 14 $342,137.75 $342,137.75 $10,572.06 $342,137.75 $201,587.56 2026-03-01
00886 OTHER Inj. Remestemcel-l-rknd/ 4 2 — — $195,618.93 $197,635.62 $196,627.27 2026-03-01
77425 CPT Intraoperative Radiation Treatment Delivery, Electrons, Single Treatment Session… 4 1 — — $171,653.17 $171,653.17 $171,653.17 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 30 14 — — $31,098.00 $257,228.69 $167,758.54 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 30 14 — — $65,362.00 $255,719.09 $164,351.50 2026-03-01
1908 OTHER New Technology - Level 52 22 11 $266,961.28 — $128,668.96 $286,738.78 $164,052.92 2026-07-15
1907 OTHER New Technology - Level 52 22 11 $266,961.28 — $128,668.96 $286,738.78 $164,052.92 2026-07-15
01907 OTHER New Technology - Level 52 4 2 — — $161,105.65 $162,766.53 $161,936.09 2026-03-01
01908 OTHER New Technology - Level 52 4 2 — — $161,105.65 $162,766.53 $161,936.09 2026-03-01
76842 CDM Rmv Icd W Rplc Sgl Ld 48 14 $266,284.00 $266,284.00 $8,228.18 $266,284.00 $156,894.53 2026-03-01
76843 CDM Rmv Icd W Rplc Dual Ld 48 14 $266,284.00 $266,284.00 $8,228.18 $266,284.00 $156,894.53 2026-03-01
76844 CDM Rmv Icd W Rplc Mult Ld 48 14 $266,284.00 $266,284.00 $8,228.18 $266,284.00 $156,894.53 2026-03-01
76841 CDM Ins Icd Gen W Mult Lead 48 14 $266,284.00 $266,284.00 $8,228.18 $266,284.00 $156,894.53 2026-03-01
66659 CDM Ins Icd Gen Exst Sgl Ld 48 14 $266,284.00 $266,284.00 $8,228.18 $266,284.00 $156,894.53 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 4 2 $229,751.80 — $150,506.27 $152,057.88 $151,282.08 2026-07-15
1905 OTHER New Technology - Level 51 22 11 $240,702.88 — $116,013.04 $258,535.06 $147,916.63 2026-07-15
1906 OTHER New Technology - Level 51 22 11 $240,702.88 — $116,013.04 $258,535.06 $147,916.63 2026-07-15
01906 OTHER New Technology - Level 51 4 2 — — $145,259.25 $146,756.76 $146,008.01 2026-03-01
01905 OTHER New Technology - Level 51 4 2 — — $145,259.25 $146,756.76 $146,008.01 2026-03-01
1903 OTHER New Technology - Level 50 22 11 $214,444.48 — $103,357.12 $230,331.34 $131,780.33 2026-07-15
1904 OTHER New Technology - Level 50 22 11 $214,444.48 — $103,357.12 $230,331.34 $131,780.33 2026-07-15
01904 OTHER New Technology - Level 50 4 2 — — $129,412.84 $130,746.99 $130,079.92 2026-03-01
01903 OTHER New Technology - Level 50 4 2 — — $129,412.84 $130,746.99 $130,079.92 2026-03-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 4 2 $155,895.99 — $117,533.54 $118,745.23 $118,139.38 2026-07-15
1902 OTHER New Technology - Level 49 22 11 $188,186.08 — $90,701.20 $202,127.62 $115,644.03 2026-07-15
1901 OTHER New Technology - Level 49 22 11 $188,186.08 — $90,701.20 $202,127.62 $115,644.03 2026-07-15
01902 OTHER New Technology - Level 49 4 2 — — $113,566.44 $114,737.22 $114,151.83 2026-03-01
01901 OTHER New Technology - Level 49 4 2 — — $113,566.44 $114,737.22 $114,151.83 2026-03-01
230 MS_DRG Other Cardiothoracic Procedures Without Cc/mcc 4 1 — — $98,055.00 $122,912.00 $110,483.50 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 26 12 $156,110.98 — $86,594.40 $192,975.62 $110,407.86 2026-07-15
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 4 1 — — $110,221.04 $110,221.04 $110,221.04 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 30 14 — — $85,803.60 $166,880.28 $107,254.50 2026-03-01
74727 CDM Revasc Fem/pop Stnt/ath 48 14 $181,943.25 $181,943.25 $5,622.05 $181,943.25 $107,200.96 2026-03-01
74731 CDM Revasc Tib Stnt/ath Init 48 14 $181,943.25 $181,943.25 $5,622.05 $181,943.25 $107,200.96 2026-03-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 4 2 $40,260.01 — $105,334.34 $106,420.26 $105,877.30 2026-07-15
85360 CDM Cath Rh W Wirls Sens Plc 48 14 $179,434.25 $179,434.25 $5,544.52 $179,434.25 $105,722.66 2026-03-01
22634 CPT Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Inter… 4 1 $94,140.00 — $104,095.00 $104,095.00 $104,095.00 2026-07-15
88556 CDM Ins/rplc Card Mod W Elec 48 14 $176,053.25 $176,053.25 $5,440.05 $176,053.25 $103,730.57 2026-03-01
1599 OTHER New Technology - Level 48 22 11 $166,304.08 — $80,154.56 $178,624.44 $102,197.06 2026-07-15
1585 OTHER New Technology - Level 48 22 11 $166,304.08 — $80,154.56 $178,624.44 $102,197.06 2026-07-15
01599 OTHER New Technology - Level 48 4 2 — — $100,361.05 $101,395.70 $100,878.38 2026-03-01
01585 OTHER New Technology - Level 48 4 2 — — $100,361.05 $101,395.70 $100,878.38 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 24 3 $146,743.29 — $79,336.69 $191,096.93 $100,834.61 2026-07-15
7 MS_DRG Lung Transplant 38 13 — — $31,098.00 $361,140.93 $100,276.30 2026-03-01
74678 CDM Revasc Fem/pop Stnt/ath 48 14 $168,466.50 $168,466.50 $5,205.61 $168,466.50 $99,260.46 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 24 3 $79,572.42 — $36,598.84 $196,634.70 $98,259.91 2026-07-15
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 26 12 — — $76,064.80 $169,510.41 $96,982.62 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 38 13 — — $22,485.00 $335,141.98 $94,918.47 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 28 5 — — $61,338.53 $168,266.70 $92,163.62 2026-03-01
1584 OTHER New Technology - Level 47 22 11 $148,798.48 — $71,717.30 $159,821.99 $91,439.55 2026-07-15
1598 OTHER New Technology - Level 47 22 11 $148,798.48 — $71,717.30 $159,821.99 $91,439.55 2026-07-15
007 OTHER Lung Transplant 4 2 $138,589.48 — $90,332.55 $91,263.81 $90,798.18 2026-07-15
209 MS_DRG Complex Aortic Arch Procedures 34 11 — — $70,115.22 $315,646.24 $90,273.35 2026-03-01
01598 OTHER New Technology - Level 47 4 2 — — $89,796.83 $90,722.57 $90,259.70 2026-03-01
01584 OTHER New Technology - Level 47 4 2 — — $89,796.83 $90,722.57 $90,259.70 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 38 13 — — $70,195.75 $632,683.00 $89,499.58 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 40 14 — — $68,271.72 $208,947.00 $87,046.44 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 48 15 — — $31,098.00 $303,244.94 $85,042.62 2026-03-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 12 2 $5.64 — $67,569.93 $162,754.51 $84,463.88 2026-07-15
1583 OTHER New Technology - Level 46 22 11 $131,292.88 — $63,280.02 $141,019.52 $80,682.02 2026-07-15
1597 OTHER New Technology - Level 46 22 11 $131,292.88 — $63,280.02 $141,019.52 $80,682.02 2026-07-15
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 4 2 $571,681.00 — $80,061.30 $80,886.67 $80,473.99 2026-07-15
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 38 13 — — $31,098.00 $287,527.88 $79,836.53 2026-03-01
01597 OTHER New Technology - Level 46 4 2 — — $79,232.56 $80,049.39 $79,640.98 2026-03-01
01583 OTHER New Technology - Level 46 4 2 — — $79,232.56 $80,049.39 $79,640.98 2026-03-01
215 MS_DRG Other Heart Assist System Implant 40 14 — — $61,679.44 $221,723.00 $79,026.79 2026-03-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 48 15 — — $60,600.35 $162,123.00 $78,873.73 2026-03-01
22810 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 Verteb… 20 3 $115,060.00 — $26,605.10 $127,227.00 $78,187.50 2026-07-15
22812 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 8 Or More Ver… 20 3 $115,060.00 — $26,605.10 $127,227.00 $78,187.50 2026-07-15
22804 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 13 Or More V… 20 3 $115,060.00 — $26,605.10 $127,227.00 $78,187.50 2026-07-15
22808 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 2 To 3 Verteb… 20 3 $115,060.00 — $26,605.10 $127,227.00 $78,187.50 2026-07-15
22800 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; Up To 6 Vert… 20 3 $115,060.00 — $26,605.10 $127,227.00 $78,187.50 2026-07-15
22802 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 7 To 12 Vert… 20 3 $115,060.00 — $26,605.10 $127,227.00 $78,187.50 2026-07-15
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 28 5 $137,456.16 — $55,306.59 $150,318.56 $78,010.05 2026-07-15
014 OTHER Allogeneic Bone Marrow Transplant 4 2 $127,074.13 — $77,107.29 $77,902.21 $77,504.75 2026-07-15
89245 CDM Perc Mch Thrm Per W Stnt 48 14 $131,143.50 $131,143.50 $4,052.33 $131,143.50 $77,269.75 2026-03-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 4 2 $129,503.67 — $76,295.11 $77,081.65 $76,688.38 2026-07-15
88557 CDM Ins/rplc Card Mod Plsgen 48 14 $125,239.75 $125,239.75 $3,869.91 $125,239.75 $73,791.26 2026-03-01
88562 CDM Rmv/rplc Crd Mod With Pgen 48 14 $125,239.75 $125,239.75 $3,869.91 $125,239.75 $73,791.26 2026-03-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 4 2 $44,638.86 — $71,501.60 $72,238.73 $71,870.17 2026-07-15
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 40 14 — — $55,810.70 $208,947.00 $71,507.46 2026-03-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 26 12 — — $55,041.36 $122,659.67 $70,177.73 2026-03-01
1582 OTHER New Technology - Level 45 22 11 $113,787.28 — $54,842.74 $122,217.06 $69,924.50 2026-07-15
1596 OTHER New Technology - Level 45 22 11 $113,787.28 — $54,842.74 $122,217.06 $69,924.50 2026-07-15
76834 CDM Insrt Pm Gen Exst Mlt Ld 48 14 $118,334.00 $118,334.00 $3,656.52 $118,334.00 $69,722.39 2026-03-01
474 OTHER Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 4 2 $46,512.11 — $69,059.97 $69,771.93 $69,415.95 2026-07-15
5244 OTHER Level 4 Blood Product Exc 22 11 $71,820.19 — $54,220.93 $120,831.34 $69,131.68 2026-07-15
01596 OTHER New Technology - Level 45 4 2 — — $68,668.29 $69,376.21 $69,022.25 2026-03-01
01582 OTHER New Technology - Level 45 4 2 — — $68,668.29 $69,376.21 $69,022.25 2026-03-01
44097 CDM Insrt/repl Gen Dual Chmb 48 14 $116,295.00 $116,295.00 $3,593.52 $116,295.00 $68,521.01 2026-03-01
85331 CDM Insrt Perm Pcmkr Ldless 48 14 $115,897.00 $115,897.00 $3,581.22 $115,897.00 $68,286.51 2026-03-01
05244 OTHER Level 4 Blood Product Exc 4 2 — — $67,889.72 $68,589.61 $68,239.67 2026-03-01
850 MS_DRG Acute Leukemia With Other Procedures 40 14 — — $31,098.00 $241,486.61 $67,707.97 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 48 15 — — $52,219.70 $235,083.78 $67,559.23 2026-03-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 4 2 $146,492.00 — $66,358.02 $67,042.12 $66,700.07 2026-07-15
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 40 14 — — $52,055.54 $133,571.00 $66,696.17 2026-03-01
44094 CDM Ppi Dual/atrial & Vent 48 14 $112,698.75 $112,698.75 $3,482.39 $112,698.75 $66,402.10 2026-03-01
44057 CDM Ppi Ins Card Ven Sys Ld 48 14 $112,698.75 $112,698.75 $3,482.39 $112,698.75 $66,402.10 2026-03-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 48 15 — — $40,731.23 $162,123.00 $65,958.80 2026-03-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 48 15 — — $40,731.23 $162,123.00 $65,958.80 2026-03-01
717 OTHER Instill Adstiladrin, Tx D 26 12 $32,314.00 — $13,357.03 $114,589.10 $65,560.29 2026-07-15
429 OTHER Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 4 2 $314.42 — $63,654.79 $64,311.02 $63,982.90 2026-07-15
78407 CDM Perc Drug El Cor Stnt Ad 48 14 $108,068.25 $108,068.25 $3,339.31 $108,068.25 $63,673.81 2026-03-01
78543 CDM Perc Drug El Cor Stnt Lc 48 14 $107,779.50 $107,779.50 $3,330.39 $107,779.50 $63,503.68 2026-03-01
78408 CDM Prc D-el Cor Stnt Ath Sl 44 13 $107,085.75 $107,085.75 $3,308.95 $107,085.75 $63,405.47 2026-03-01
78420 CDM Prc D-e Cor Revsc Chrn A 44 13 $107,085.75 $107,085.75 $3,308.95 $107,085.75 $63,405.47 2026-03-01
78418 CDM Prc D-e Cor Revsc Ami Sl 44 13 $107,085.75 $107,085.75 $3,308.95 $107,085.75 $63,405.47 2026-03-01
78419 CDM Prc D-e Cor Revsc Chrn S 44 13 $107,085.75 $107,085.75 $3,308.95 $107,085.75 $63,405.47 2026-03-01
78417 CDM Prc D-el Cor Rvsc Cabg A 44 13 $107,085.75 $107,085.75 $3,308.95 $107,085.75 $63,405.47 2026-03-01
78406 CDM Perc Drug El Cor Stnt Sl 44 13 $107,085.75 $107,085.75 $3,308.95 $107,085.75 $63,405.47 2026-03-01
78581 CDM Prc D-el Cor Rvsc Cabglc 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78409 CDM Prc D-el Cor Stnt Ath Ad 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78556 CDM Prc D-el Cor Stnt Ath Ld 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78557 CDM Prc D-el Cor Stnt Ath Lc 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78559 CDM Prc D-el Cor Stnt Ath Rc 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78582 CDM Prc D-el Cor Rvsc Cabgld 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78561 CDM Prc D-el Cor Stnt Ath Ri 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78583 CDM Prc D-el Cor Rvsc Cabglm 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
79101 CDM P D-el Cor Stn Ath Ad Rc 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
79098 CDM P D-el Cor Stn Ath Ad Ld 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
79096 CDM P D-el Cor Stn Ath Ad Lc 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78589 CDM Prc D-el Cor Stnt Ath Lm 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
79088 CDM Perc Drug El Cor Stnt Ri 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78584 CDM Prc D-el Cor Rvsc Cabgrc 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78585 CDM Prc D-el Cor Rvsc Cabgri 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
78410 CDM Prc D-el Cor Rvsc Cabg S 44 13 $107,085.00 $107,085.00 $3,308.93 $107,085.00 $63,405.03 2026-03-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 4 2 $105,620.36 — $62,921.53 $63,570.21 $63,245.87 2026-07-15
00717 OTHER Instill Adstiladrin, Tx D 4 2 — — $62,346.55 $62,989.29 $62,667.92 2026-03-01
78529 CDM Ptca Cor Sgl Arty Rc 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78530 CDM Ptca Cor Ea Add Bch Ld 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78544 CDM Perc Drug El Cor Stnt Ld 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78545 CDM Perc Drug El Cor Stnt Lm 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78547 CDM Perc Drug El Cor Stnt Rc 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78531 CDM Ptca Cor Ea Add Bch Rc 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78390 CDM Ptca Cor Ea Add Bch Lc 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78528 CDM Ptca Cor Sgl Arty Ld 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78548 CDM Perc Drug El Cor Stnt Ri 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78554 CDM Ptca Cor W Ang Sgl Lm 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78555 CDM Ptca Cor W Ang Sgl Ri 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
78389 CDM Ptca Cor Sgl Arty Lc 44 13 $105,820.00 $105,820.00 $3,269.84 $105,820.00 $62,656.02 2026-03-01
22532 CPT Arthrodesis, Lateral Extracavitary Technique, Including Minimal Discectomy To Pr… 20 3 $62,760.00 — $11,152.90 $86,736.00 $62,550.00 2026-07-15
22558 CPT Arthrodesis, Anterior Interbody Technique, Including Minimal Discectomy To Prepa… 20 3 $62,760.00 — $11,152.90 $86,736.00 $62,550.00 2026-07-15
22533 CPT Arthrodesis, Lateral Extracavitary Technique, Including Minimal Discectomy To Pr… 20 3 $62,760.00 — $11,152.90 $86,736.00 $62,550.00 2026-07-15
22633 CPT Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Inter… 20 3 $94,140.00 — $26,605.10 $104,095.00 $62,550.00 2026-07-15
22610 CPT Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Thoracic … 20 3 $62,760.00 — $11,152.90 $86,736.00 $62,550.00 2026-07-15
22556 CPT Arthrodesis, Anterior Interbody Technique, Including Minimal Discectomy To Prepa… 20 3 $62,760.00 — $11,152.90 $86,736.00 $62,550.00 2026-07-15
22586 CPT Arthrodesis, Pre-sacral Interbody Technique, Including Disc Space Preparation, D… 20 3 $62,760.00 — $26,605.10 $86,736.00 $62,550.00 2026-07-15
22612 CPT Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Lumbar (w… 20 3 $62,760.00 — $11,152.90 $86,736.00 $62,550.00 2026-07-15
22630 CPT Arthrodesis, Posterior Interbody Technique, Including Laminectomy And/or Discect… 20 3 $62,760.00 — $12,033.90 $86,736.00 $62,550.00 2026-07-15
76837 CDM Rmv Ppm W Rplc Dual Ld 48 14 $105,245.50 $105,245.50 $3,252.09 $105,245.50 $62,010.65 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 28 5 $105,502.66 — $43,855.64 $119,321.09 $61,923.46 2026-07-15
74729 CDM Revasc Tib W Ath Init 48 14 $105,054.75 $105,054.75 $3,246.19 $105,054.75 $61,898.26 2026-03-01
74725 CDM Revasc Fem/pop W Stntplc 48 14 $105,054.75 $105,054.75 $3,246.19 $105,054.75 $61,898.26 2026-03-01
74684 CDM Revasc Tib Ath Ea Add 48 14 $105,054.75 $105,054.75 $3,246.19 $105,054.75 $61,898.26 2026-03-01
74730 CDM Revasc Tib W Stntplc Ini 48 14 $105,054.75 $105,054.75 $3,246.19 $105,054.75 $61,898.26 2026-03-01
74724 CDM Revasc Fem/pop W Atherct 48 14 $105,054.75 $105,054.75 $3,246.19 $105,054.75 $61,898.26 2026-03-01
74733 CDM Revasc Tib Ath Ea Add 48 14 $105,054.75 $105,054.75 $3,246.19 $105,054.75 $61,898.26 2026-03-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 48 15 — — $37,962.87 $225,922.00 $61,593.04 2026-03-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 48 15 — — $47,563.85 $149,282.00 $61,535.72 2026-03-01
J3357 HCPCS Ustekinumab 90 Mg Sq 70 16 $146,276.50 $146,276.50 $178.81 $146,276.50 $61,436.13 2026-07-15
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 40 14 — — $31,098.00 $219,436.44 $60,929.90 2026-03-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 48 15 — — $47,358.81 $168,504.00 $60,678.48 2026-03-01
44096 CDM Insrt Pm Gen Exst Sgl Ld 48 14 $102,754.25 $102,754.25 $3,175.11 $102,754.25 $60,542.80 2026-03-01
356979 CDM Graft St Tis 10mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
415174 CDM Graft Nrv 2-3mm 30mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
562965 CDM Spacer Spn 22d 26x10x9mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
469319 CDM Disc Intvrtb 19x5x15mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
463043 CDM Disc Intvrtb 15x5x13mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
472677 CDM Disc Spnl 13x17x5mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
491260 CDM Cement Bn Ca Phs Ha 15cc 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
479866 CDM Wedge Bn Grft 10x20x22mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
606426 CDM Disc Spn Large 5mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
599863 CDM Graft Bn Cbm 6cc 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
604671 CDM Spacer 10x30mm 7-14mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
877100 CDM Graft Bn Putty 5cc 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
467345 CDM Disc Intvrtb 15x15mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
546261 CDM Disc Cerv 6x15x12.5mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
476771 CDM Patella Ligament Pre 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
479264 CDM Cage 1l+ 14x45mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
533038 CDM Allograft Fiber 15cc 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
492954 CDM Graft Bn Mtrx Frmbl Lrg 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
466788 CDM Spacer Spn 31x10x9-13mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
610429 CDM Cage Spn 15d 7x14mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
555129 CDM Spacer Spn 12x14mm 16mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
547041 CDM Interbody Spn 18x20-25mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
391149 CDM Pump Contrl Urn Ab Sys 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
469277 CDM Disc Intvrtb 15x7x15mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
481422 CDM Disc Intvrtb 17x6x13mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
546711 CDM Disc Cerv 6x15x15mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
555128 CDM Spacer Spn 12x14mm 12mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
481126 CDM Cage 1l+ Nd 14mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
389364 CDM Graft Bn Lg 8cc 1x2in 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
612623 CDM Spacer Spn 8d 10x9x30mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
463555 CDM Disc Intvrtb 17mm 5mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
465323 CDM Disc Intvrtb 15x6x13mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
461920 CDM Disc Intvrtb 17x6x15mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
367402 CDM Graft Bn Med 5.6cc 1x2in 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
612624 CDM Spacer Spnl 10mm 26mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
367403 CDM Graft Bn Sm 2.8cc 1x2in 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
478681 CDM Disc Intvrtb 15x7x13mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
491363 CDM Graft Nrv 1-2mm 15mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
608814 CDM Impl Disc Spn Ht 4 Sz2 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
609758 CDM Cage Spn Xl 19x16x5mm 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
455513 CDM System Impl Spn Stblzn 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
567634 CDM Spacer Tissue Shldr Med 40 12 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $60,099.40 2026-03-01
82167 CDM Transcth Stnt Plc In Vn 48 14 $101,918.50 $101,918.50 $3,149.28 $101,918.50 $60,050.38 2026-03-01
82161 CDM Transcth Stnt Plc Ia 48 14 $101,918.50 $101,918.50 $3,149.28 $101,918.50 $60,050.38 2026-03-01
570417 CDM Cage Spn 15d 7x10x22mm 40 12 $99,770.00 $99,770.00 $3,082.89 $99,770.00 $59,961.77 2026-03-01
231 OTHER Coronary Bypass With Ptca With Mcc 4 2 $188,944.00 — $59,558.89 $60,172.90 $59,865.90 2026-07-15
275 OTHER Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 4 2 $59,904.59 — $59,366.67 $59,978.69 $59,672.68 2026-07-15
474131 CDM Mold Spcr Shd8x46x18x53 48 14 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $59,209.40 2026-03-01
1581 OTHER New Technology - Level 44 22 11 $96,281.68 — $46,405.46 $103,414.58 $59,166.97 2026-07-15
1595 OTHER New Technology - Level 44 22 11 $96,281.68 — $46,405.46 $103,414.58 $59,166.97 2026-07-15
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 40 14 — — $31,098.00 $212,495.39 $59,002.61 2026-03-01
773195 CDM Cap Bn Shldr 39mm 40 12 $97,925.00 $97,925.00 $3,025.88 $97,925.00 $58,852.93 2026-03-01
563612 CDM Needle Electrode Emg/nmj 48 14 $99,220.00 $99,220.00 $3,065.90 $99,220.00 $58,748.16 2026-03-01
01595 OTHER New Technology - Level 44 4 2 — — $58,104.01 $58,703.02 $58,403.51 2026-03-01
01581 OTHER New Technology - Level 44 4 2 — — $58,104.01 $58,703.02 $58,403.51 2026-03-01
565243 CDM Module Positioning Ptp 48 14 $98,522.00 $98,522.00 $3,044.33 $98,522.00 $58,334.88 2026-03-01
1643 OTHER Y90 Ibritumomab, Rx 22 11 $100,453.63 — $45,459.64 $101,306.81 $57,961.04 2026-07-15
74676 CDM Revasc Fem/pop W Atherct 48 14 $97,272.75 $97,272.75 $3,005.73 $97,272.75 $57,313.10 2026-03-01
74677 CDM Revasc Fem/pop W Stntplc 48 14 $97,272.75 $97,272.75 $3,005.73 $97,272.75 $57,313.10 2026-03-01
74680 CDM Revasc Tib W Ath Init 48 14 $97,227.75 $97,227.75 $3,004.34 $97,227.75 $57,286.59 2026-03-01
74681 CDM Revasc Tib W Stntplc Ini 48 14 $97,227.75 $97,227.75 $3,004.34 $97,227.75 $57,286.59 2026-03-01
74682 CDM Revasc Tib Stnt/ath Init 48 14 $97,227.75 $97,227.75 $3,004.34 $97,227.75 $57,286.59 2026-03-01
C1733 HCPCS Cath Abl Prtl Vn 35mm 58 15 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $57,199.43 2026-03-01
C1759 HCPCS Cath Dx US Intrcar 10f 58 15 $99,999.00 $99,999.00 $3,089.97 $99,999.00 $57,199.43 2026-03-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 48 15 — — $44,169.84 $237,529.00 $57,144.73 2026-03-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 40 14 — — $44,716.20 $208,947.00 $57,013.15 2026-03-01
C1886 HCPCS Probe Rf Ablat 17ga 15mm 58 15 $99,354.00 $99,354.00 $3,070.04 $99,354.00 $56,830.49 2026-03-01
10 MS_DRG Pancreas Transplant 38 13 — — $31,098.00 $200,108.03 $56,674.33 2026-03-01
93592 CPT Percutaneous Transcatheter Closure Of Paravalvular Leak; Each Additional Occlusi… 4 1 $55,739.00 — $51,627.00 $61,633.00 $56,630.00 2026-07-15
92974 CPT Transcatheter Placement Of Radiation Delivery Device For Subsequent Coronary Int… 4 1 $55,739.00 — $51,627.00 $61,633.00 $56,630.00 2026-07-15
92934 CPT Percutaneous Transluminal Coronary Atherectomy, With Intracoronary Stent, With C… 4 1 $55,739.00 — $51,627.00 $61,633.00 $56,630.00 2026-07-15
92938 CPT Percutaneous Transluminal Revascularization Of Or Through Coronary Artery Bypass… 4 1 $55,739.00 — $51,627.00 $61,633.00 $56,630.00 2026-07-15
92929 CPT Percutaneous Transcatheter Placement Of Intracoronary Stent(s), With Coronary An… 4 1 $55,739.00 — $51,627.00 $61,633.00 $56,630.00 2026-07-15
92925 CPT Percutaneous Transluminal Coronary Atherectomy, With Coronary Angioplasty When P… 4 1 $55,739.00 — $51,627.00 $61,633.00 $56,630.00 2026-07-15
92944 CPT Percutaneous Transluminal Revascularization Of Chronic Total Occlusion, Coronary… 4 1 $55,739.00 — $51,627.00 $61,633.00 $56,630.00 2026-07-15
92973 CPT Percutaneous Transluminal Coronary Mechanical Aspiration Thrombectomy (List Sepa… 4 1 $55,739.00 — $51,627.00 $61,633.00 $56,630.00 2026-07-15
92921 CPT Percutaneous Transluminal Coronary Angioplasty; Each Additional Branch Of A Majo… 4 1 $55,739.00 — $51,627.00 $61,633.00 $56,630.00 2026-07-15
0715T CPT Percutaneous Transluminal Coronary Lithotripsy (list Separately In Addition To C… 4 1 $55,739.00 — $51,627.00 $61,633.00 $56,630.00 2026-07-15
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