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

DR DAN C TRIGG MEMORIAL HOSPITAL

Tucumcari, NM · CCN 321302 · Rates published

12,240 distinct procedures filed
9 distinct payers
78,448 rate rows
2026-04-01 last MRF observed
Data quality

61,468 of 78,448 rate rows are consumer-grade (78.4%)

16,980 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 16,520
template filing: same amount across many unrelated codes — excluded 444
placeholder amount (≤ $0.02) — excluded from medians 16
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://onbaseext.phs.org/PEL/DisplayDocument?ContentID=PEL_00954561
Found on page https://www.phs.org/tools-resources/patient/standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-16
Content fingerprint 9d798fbc7cd4a348… · 10,469,338 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
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 1 $4,402,595.74 $4,402,595.74 $4,402,595.74 nat. median
$2,469,189
1.8× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 1 $984,816.97 $2,630,033.35 $1,807,425.16 nat. median
$754,974
outlier · 2.4×
Q2056
HCPCS 		Ciltacabtagene Car-pos T 1 $989,817.28 $2,571,961.50 $1,780,889.39 nat. median
$675,122
outlier · 2.6×
Q2055
HCPCS 		Idecabtagene Vicleucel Car 1 $944,981.41 $2,387,877.90 $1,666,429.65 nat. median
$625,184
outlier · 2.7×
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 1 $924,257.25 $2,335,509.66 $1,629,883.46 nat. median
$674,188
outlier · 2.4×
Q2053
HCPCS 		Brexucabtagene Car Pos T 1 $875,952.00 $2,197,189.20 $1,536,570.60 nat. median
$620,080
outlier · 2.5×
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $875,952.00 $2,123,190.60 $1,499,571.30 nat. median
$634,511
outlier · 2.4×
18
MS_DRG 		Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 3 $140,433.54 $676,771.38 $618,974.09 nat. median
$370,174
1.7× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 3 $104,892.24 $505,492.24 $462,322.44 nat. median
$265,286
1.7× median
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 1 $441,114.19 $441,114.19 $441,114.19 nat. median
$111,989
outlier · 3.9×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 3 $88,344.18 $425,744.55 $389,385.33 nat. median
$206,368
1.9× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 3 $79,806.49 $384,600.08 $351,754.66 nat. median
$202,986
1.7× median
33276
HCPCS 		Insj Phrnc Nrv Stim Sys 1 $241,652.69 $241,652.69 $241,652.69 nat. median
$43,787
outlier · 5.5×
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 3 $52,617.05 $253,569.87 $231,914.62 nat. median
$133,176
1.7× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 3 $48,788.01 $235,117.14 $215,037.78 nat. median
$117,303
1.8× median
7
MS_DRG 		Lung Transplant 3 $48,665.12 $234,524.90 $214,496.12 nat. median
$122,708
1.7× median
L7180
HCPCS 		Electronic Elbow Sequential 1 $197,851.26 $197,851.26 $197,851.26 nat. median
$49,027
outlier · 4.0×
L7181
HCPCS 		Electronic Elbo Simultaneous 1 $196,243.70 $196,243.70 $196,243.70 nat. median
$50,598
outlier · 3.9×
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 3 $41,037.58 $197,766.59 $180,877.03 nat. median
$108,660
1.7× median
J9029
HCPCS 		Inj, Adstiladrin, Per Tx Dos 1 $28,440.00 $331,866.00 $180,153.00 nat. median
$69,774
outlier · 2.6×
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 3 $40,566.12 $195,494.54 $178,799.02 nat. median
$102,358
1.7× median
0571T
HCPCS 		Insj/rplcmt Icds Ss Eltrd 1 $176,344.84 $176,344.84 $176,344.84 nat. median
$32,221
outlier · 5.5×
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 3 $39,655.60 $191,106.59 $174,785.80 nat. median
$100,136
1.7× median
215
MS_DRG 		Other Heart Assist System Implant 3 $39,453.01 $190,130.29 $173,892.88 nat. median
$99,019
1.8× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 3 $39,033.69 $188,109.50 $172,044.67 nat. median
$98,905
1.7× median
33270
HCPCS 		Ins/rep Subq Defibrillator 1 $165,495.02 $165,495.02 $165,495.02 nat. median
$32,221
outlier · 5.1×
64582
HCPCS 		Opn Mpltj Hpglsl Nstm Ary Pg 1 $161,440.89 $161,440.89 $161,440.89 nat. median
$28,316
outlier · 5.7×
33287
HCPCS 		Rmv&rplcmt Phrnc Nrv Stim Pg 1 $159,043.67 $159,043.67 $159,043.67 nat. median
$29,718
outlier · 5.4×
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 $35,938.28 $173,192.25 $158,401.38 nat. median
$93,672
1.7× median
0266T
HCPCS 		Implt/rpl Crtd Sns Dev Total 1 $158,117.07 $158,117.07 $158,117.07 nat. median
$42,941
outlier · 3.7×
33289
HCPCS 		Tcat Impl Wrls P-art Prs Snr 1 $157,559.72 $157,559.72 $157,559.72 nat. median
$28,318
outlier · 5.6×
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 1 $152,549.00 $152,549.00 $152,549.00 nat. median
$87,411
1.7× median
850
MS_DRG 		Acute Leukemia With Other Procedures 3 $34,303.07 $165,311.89 $151,194.00 nat. median
$83,442
1.8× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 1 $122,955.60 $176,375.50 $149,665.55 nat. median
$66,682
outlier · 2.2×
C9760
HCPCS 		Non-blind Interatrial Shunt 1 $147,677.69 $147,677.69 $147,677.69 nat. median
$28,432
outlier · 5.2×
0424T
HCPCS 		Insj/rplc Nstim Apnea Compl 1 $143,531.45 $143,531.45 $143,531.45 nat. median
$24,752
outlier · 5.8×
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 3 $31,555.11 $152,069.06 $139,082.13 nat. median
$79,312
1.8× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 3 $31,537.24 $151,982.92 $139,003.35 nat. median
$81,118
1.7× median
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 3 $31,058.33 $149,674.98 $136,892.51 nat. median
$82,712
1.7× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 3 $30,017.46 $144,658.89 $132,304.81 nat. median
$77,576
1.7× median
222
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 $131,808.37 $131,808.37 $131,808.37 nat. median
$63,570
outlier · 2.1×
10
MS_DRG 		Pancreas Transplant 3 $29,690.12 $143,081.38 $130,862.02 nat. median
$68,882
1.9× median
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 3 $29,519.19 $142,257.63 $130,108.62 nat. median
$71,240
1.8× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 3 $29,106.20 $140,267.35 $128,288.31 nat. median
$73,807
1.7× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 $28,812.74 $138,853.15 $126,994.89 nat. median
$74,915
1.7× median
0614T
HCPCS 		Rmvl&rplcmt Ss Impl Dfb Pg 1 $123,725.66 $123,725.66 $123,725.66 nat. median
$23,514
outlier · 5.3×
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 3 $27,794.97 $133,948.34 $122,508.95 nat. median
$72,138
1.7× median
64568
HCPCS 		Inc For Vagus N Elect Impl 1 $122,459.74 $122,459.74 $122,459.74 nat. median
$27,541
outlier · 4.4×
224
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 $122,040.58 $122,040.58 $122,040.58 nat. median
$54,196
outlier · 2.3×
33230
HCPCS 		Insrt Pulse Gen W/dual Leads 1 $120,889.65 $120,889.65 $120,889.65 nat. median
$22,359
outlier · 5.4×

Other procedures at this hospital

Browse this hospital's 12,240 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
             
J3399 HCPCS Inj Onase Abepar-xioi Treat 4 1 — — $4,402,595.74 $4,402,595.74 $4,402,595.74 2026-04-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 8 1 — — $984,816.97 $2,630,033.35 $1,807,425.16 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 8 1 — — $989,817.28 $2,571,961.50 $1,780,889.39 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 8 1 — — $944,981.41 $2,387,877.90 $1,666,429.65 2026-04-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 8 1 — — $924,257.25 $2,335,509.66 $1,629,883.46 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 8 1 — — $875,952.00 $2,197,189.20 $1,536,570.60 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 8 1 — — $875,952.00 $2,123,190.60 $1,499,571.30 2026-04-01
18 MS_DRG Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 12 3 — — $140,433.54 $676,771.38 $618,974.09 2026-04-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 12 3 — — $104,892.24 $505,492.24 $462,322.44 2026-04-01
Q0480 HCPCS Driver Pneumatic Vad, Rep 4 1 — — $441,114.19 $441,114.19 $441,114.19 2026-04-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 12 3 — — $88,344.18 $425,744.55 $389,385.33 2026-04-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 12 3 — — $79,806.49 $384,600.08 $351,754.66 2026-04-01
33276 HCPCS Insj Phrnc Nrv Stim Sys 4 1 — — $241,652.69 $241,652.69 $241,652.69 2026-04-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 12 3 — — $52,617.05 $253,569.87 $231,914.62 2026-04-01
14 MS_DRG Allogeneic Bone Marrow Transplant 12 3 — — $48,788.01 $235,117.14 $215,037.78 2026-04-01
7 MS_DRG Lung Transplant 12 3 — — $48,665.12 $234,524.90 $214,496.12 2026-04-01
L7180 HCPCS Electronic Elbow Sequential 4 1 — — $197,851.26 $197,851.26 $197,851.26 2026-04-01
L7181 HCPCS Electronic Elbo Simultaneous 4 1 — — $196,243.70 $196,243.70 $196,243.70 2026-04-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 12 3 — — $41,037.58 $197,766.59 $180,877.03 2026-04-01
J9029 HCPCS Inj, Adstiladrin, Per Tx Dos 8 1 — — $28,440.00 $331,866.00 $180,153.00 2026-04-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 12 3 — — $40,566.12 $195,494.54 $178,799.02 2026-04-01
0571T HCPCS Insj/rplcmt Icds Ss Eltrd 4 1 — — $176,344.84 $176,344.84 $176,344.84 2026-04-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 12 3 — — $39,655.60 $191,106.59 $174,785.80 2026-04-01
215 MS_DRG Other Heart Assist System Implant 12 3 — — $39,453.01 $190,130.29 $173,892.88 2026-04-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 3 — — $39,033.69 $188,109.50 $172,044.67 2026-04-01
33270 HCPCS Ins/rep Subq Defibrillator 4 1 — — $165,495.02 $165,495.02 $165,495.02 2026-04-01
64582 HCPCS Opn Mpltj Hpglsl Nstm Ary Pg 4 1 — — $161,440.89 $161,440.89 $161,440.89 2026-04-01
33287 HCPCS Rmv&rplcmt Phrnc Nrv Stim Pg 4 1 — — $159,043.67 $159,043.67 $159,043.67 2026-04-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 3 — — $35,938.28 $173,192.25 $158,401.38 2026-04-01
0266T HCPCS Implt/rpl Crtd Sns Dev Total 4 1 — — $158,117.07 $158,117.07 $158,117.07 2026-04-01
33289 HCPCS Tcat Impl Wrls P-art Prs Snr 4 1 — — $157,559.72 $157,559.72 $157,559.72 2026-04-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 2 1 — — $152,549.00 $152,549.00 $152,549.00 2026-04-01
850 MS_DRG Acute Leukemia With Other Procedures 12 3 — — $34,303.07 $165,311.89 $151,194.00 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 8 1 — — $122,955.60 $176,375.50 $149,665.55 2026-04-01
C9760 HCPCS Non-blind Interatrial Shunt 4 1 — — $147,677.69 $147,677.69 $147,677.69 2026-04-01
0424T HCPCS Insj/rplc Nstim Apnea Compl 4 1 — — $143,531.45 $143,531.45 $143,531.45 2026-04-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 12 3 — — $31,555.11 $152,069.06 $139,082.13 2026-04-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 12 3 — — $31,537.24 $151,982.92 $139,003.35 2026-04-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 12 3 — — $31,058.33 $149,674.98 $136,892.51 2026-04-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 12 3 — — $30,017.46 $144,658.89 $132,304.81 2026-04-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 2 1 — — $131,808.37 $131,808.37 $131,808.37 2026-04-01
10 MS_DRG Pancreas Transplant 12 3 — — $29,690.12 $143,081.38 $130,862.02 2026-04-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 12 3 — — $29,519.19 $142,257.63 $130,108.62 2026-04-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 12 3 — — $29,106.20 $140,267.35 $128,288.31 2026-04-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 3 — — $28,812.74 $138,853.15 $126,994.89 2026-04-01
0614T HCPCS Rmvl&rplcmt Ss Impl Dfb Pg 4 1 — — $123,725.66 $123,725.66 $123,725.66 2026-04-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 12 3 — — $27,794.97 $133,948.34 $122,508.95 2026-04-01
64568 HCPCS Inc For Vagus N Elect Impl 4 1 — — $122,459.74 $122,459.74 $122,459.74 2026-04-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 2 1 — — $122,040.58 $122,040.58 $122,040.58 2026-04-01
33230 HCPCS Insrt Pulse Gen W/dual Leads 4 1 — — $120,889.65 $120,889.65 $120,889.65 2026-04-01
L6880 HCPCS Elec Hand Ind Art Digits 4 1 — — $120,665.89 $120,665.89 $120,665.89 2026-04-01
33240 HCPCS Insrt Pulse Gen W/singl Lead 4 1 — — $118,353.99 $118,353.99 $118,353.99 2026-04-01
J1412 HCPCS Inj Roctavian Ml 2x10^13vc G 8 1 — — $64,481.96 $171,825.00 $118,153.48 2026-04-01
0520T HCPCS Rmvl&rplcmt Pg Wcs New Eltrd 4 1 — — $118,120.99 $118,120.99 $118,120.99 2026-04-01
0515T HCPCS Insj Wcs Lv Compl Sys 4 1 — — $118,120.99 $118,120.99 $118,120.99 2026-04-01
0414T HCPCS Rmvl & Rpl Car Modulj Pls Gn 4 1 — — $117,764.26 $117,764.26 $117,764.26 2026-04-01
0408T HCPCS Insj/rplc Cardiac Modulj Sys 4 1 — — $117,764.26 $117,764.26 $117,764.26 2026-04-01
0409T HCPCS Insj/rplc Car Modulj Pls Gn 4 1 — — $117,764.26 $117,764.26 $117,764.26 2026-04-01
A9607 HCPCS Lutetium Lu 177 Vipivotide 8 1 — — $406.94 $235,071.75 $117,739.35 2026-04-01
0775T HCPCS Arthrd Si Jt Prq Iartic Impl 4 1 — — $117,590.27 $117,590.27 $117,590.27 2026-04-01
L5856 HCPCS Elec Knee-shin Swing/stance 4 1 — — $117,574.81 $117,574.81 $117,574.81 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 8 1 — — $115,020.84 $118,712.98 $116,866.91 2026-04-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 3 — — $26,435.70 $127,397.81 $116,517.85 2026-04-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 12 3 — — $26,315.79 $126,819.93 $115,989.32 2026-04-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 12 3 — — $25,906.15 $124,845.80 $114,183.78 2026-04-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 2 1 — — $114,175.04 $114,175.04 $114,175.04 2026-04-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 12 3 — — $25,427.24 $122,537.86 $112,072.95 2026-04-01
0817T HCPCS Opn Insj/rplcmt Ins Ptn Subf 4 1 — — $112,042.47 $112,042.47 $112,042.47 2026-04-01
0816T HCPCS Opn Insj/rplcmt Ins Ptn Subq 4 1 — — $112,042.47 $112,042.47 $112,042.47 2026-04-01
61891 HCPCS Rev/rplcmt Sk-mnt Crnl Nstm 4 1 — — $112,042.47 $112,042.47 $112,042.47 2026-04-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 2 1 — — $110,191.49 $110,191.49 $110,191.49 2026-04-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 12 3 — — $24,966.57 $120,317.86 $110,042.54 2026-04-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 12 3 — — $24,870.87 $119,856.64 $109,620.70 2026-04-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 12 3 — — $24,828.79 $119,653.84 $109,435.22 2026-04-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 12 3 — — $24,085.84 $116,073.48 $106,160.63 2026-04-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 3 — — $24,047.49 $115,888.63 $105,991.57 2026-04-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 2 1 — — $105,292.10 $105,292.10 $105,292.10 2026-04-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 12 3 — — $23,550.33 $113,492.76 $103,800.30 2026-04-01
81162 HCPCS Brca1&2 Seq & Full Dup/del 4 1 — — $101,705.33 $101,705.33 $101,705.33 2026-04-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 12 3 — — $23,066.58 $111,161.49 $101,668.13 2026-04-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 12 3 — — $23,036.79 $111,017.92 $101,536.82 2026-04-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 12 3 — — $22,931.77 $110,511.82 $101,073.94 2026-04-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 12 3 — — $22,853.19 $110,133.15 $100,727.61 2026-04-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 12 3 — — $22,747.43 $109,623.46 $100,261.45 2026-04-01
0795T HCPCS Tcat Ins 2chmbr Ldls Pm Cmpl 4 1 — — $99,799.68 $99,799.68 $99,799.68 2026-04-01
0801T HCPCS Tcat Rmv&rpl 2chmbr Ldls Pm 4 1 — — $99,799.68 $99,799.68 $99,799.68 2026-04-01
0797T HCPCS Tcat Ins 2chmbr Ldls Pm Rv 4 1 — — $99,799.68 $99,799.68 $99,799.68 2026-04-01
0803T HCPCS Tcat Rmv&rpl2chmb Ldls Pm Rv 4 1 — — $99,799.68 $99,799.68 $99,799.68 2026-04-01
0823T HCPCS Tcat Ins 1chmbr Ldls Pm Ra 4 1 — — $99,799.68 $99,799.68 $99,799.68 2026-04-01
0825T HCPCS Tcat Rmv&rpl1chmb Ldls Pm Ra 4 1 — — $99,799.68 $99,799.68 $99,799.68 2026-04-01
0796T HCPCS Tcat Ins 2chmbr Ldls Pm Ra 4 1 — — $99,799.68 $99,799.68 $99,799.68 2026-04-01
0802T HCPCS Tcat Rmv&rpl2chmb Ldls Pm Ra 4 1 — — $99,799.68 $99,799.68 $99,799.68 2026-04-01
28 MS_DRG Spinal Procedures With Mcc 12 3 — — $22,638.69 $109,099.42 $99,782.17 2026-04-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/Mcc 12 3 — — $22,476.32 $108,316.95 $99,066.52 2026-04-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/Mcc 12 3 — — $22,476.32 $108,316.95 $99,066.52 2026-04-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 12 3 — — $22,308.37 $107,507.55 $98,326.25 2026-04-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 3 — — $22,154.57 $106,766.36 $97,648.35 2026-04-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 12 3 — — $22,139.30 $106,692.77 $97,581.05 2026-04-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 12 3 — — $21,911.39 $105,594.44 $96,576.52 2026-04-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 12 3 — — $21,680.87 $104,483.54 $95,560.49 2026-04-01
27278 HCPCS Arthrd Si Jt Prq Wo Tfxj Dev 4 1 — — $95,450.46 $95,450.46 $95,450.46 2026-04-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 12 3 — — $21,372.15 $102,995.77 $94,199.77 2026-04-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 12 3 — — $21,244.42 $102,380.20 $93,636.77 2026-04-01
L6975 HCPCS Interscap-thor Myoelectronic 4 1 — — $93,533.59 $93,533.59 $93,533.59 2026-04-01
J7310 HCPCS Ganciclovir Long Act Implant 4 1 — — $93,517.91 $93,517.91 $93,517.91 2026-04-01
0431T HCPCS Rmvl/rplc Nstim Apnea Pls Gn 4 1 — — $93,219.82 $93,219.82 $93,219.82 2026-04-01
0427T HCPCS Insj/rplc Nstim Apnea Pls Gn 4 1 — — $93,219.82 $93,219.82 $93,219.82 2026-04-01
0426T HCPCS Insj/rplc Nstim Apnea Stm Ld 4 1 — — $93,219.82 $93,219.82 $93,219.82 2026-04-01
L6970 HCPCS Interscapular-thor Switch CT 4 1 — — $93,034.23 $93,034.23 $93,034.23 2026-04-01
33902 HCPCS Perq P-art Revsc 1 Abnor Uni 4 1 — — $92,243.71 $92,243.71 $92,243.71 2026-04-01
36837 HCPCS Prq Av Fstl Crt Uxtr Sep Acs 4 1 — — $92,243.71 $92,243.71 $92,243.71 2026-04-01
36836 HCPCS Prq Av Fstl Crtj Uxtr 1 Acs 4 1 — — $92,243.71 $92,243.71 $92,243.71 2026-04-01
0645T HCPCS Tcat Impltj C Sins Rdctj Dev 4 1 — — $92,243.71 $92,243.71 $92,243.71 2026-04-01
Q0483 HCPCS Monitor Elec Vad, Rep 4 1 — — $91,830.38 $91,830.38 $91,830.38 2026-04-01
L6965 HCPCS Shldr Disartic Myoelectronic 4 1 — — $91,530.20 $91,530.20 $91,530.20 2026-04-01
653 MS_DRG Major Bladder Procedures With Mcc 12 3 — — $20,758.43 $100,038.16 $91,494.75 2026-04-01
L5858 HCPCS Stance Phase Only 4 1 — — $91,025.85 $91,025.85 $91,025.85 2026-04-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 12 3 — — $20,583.78 $99,196.46 $90,724.94 2026-04-01
834 MS_DRG Acute Leukemia With Mcc 12 3 — — $20,582.29 $99,189.28 $90,718.37 2026-04-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 3 — — $20,501.47 $98,799.84 $90,362.19 2026-04-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 2 1 — — $89,839.92 $89,839.92 $89,839.92 2026-04-01
0793T HCPCS Prq Tcat Thrm Ablt Nrv P-art 4 1 — — $89,811.64 $89,811.64 $89,811.64 2026-04-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 12 3 — — $20,370.76 $98,169.92 $89,786.06 2026-04-01
E0194 HCPCS Air Fluidized Bed 8 1 — — $15,597.17 $163,770.23 $89,683.70 2026-04-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 12 3 — — $20,261.65 $97,644.08 $89,305.13 2026-04-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 12 3 — — $20,215.47 $97,421.54 $89,101.59 2026-04-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 12 3 — — $20,112.31 $96,924.42 $88,646.93 2026-04-01
C2616 HCPCS Brachytx, Non-str,yttrium-90 4 1 — — $88,646.51 $88,646.51 $88,646.51 2026-04-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 12 3 — — $20,093.32 $96,832.89 $88,563.22 2026-04-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 12 3 — — $20,090.72 $96,820.33 $88,551.73 2026-04-01
0632T HCPCS Perq Tcat US Abltj Nrv P-art 4 1 — — $88,080.40 $88,080.40 $88,080.40 2026-04-01
0268T HCPCS Implt/rpl Crtd Sns Dev Gen 4 1 — — $88,039.70 $88,039.70 $88,039.70 2026-04-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 12 3 — — $19,811.41 $95,474.33 $87,320.68 2026-04-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 2 1 — — $87,068.31 $87,068.31 $87,068.31 2026-04-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 3 — — $19,723.53 $95,050.79 $86,933.31 2026-04-01
J9226 HCPCS Supprelin La Implant 8 1 — — $81,322.85 $92,462.93 $86,892.89 2026-04-01
L5973 HCPCS Ank-foot Sys Dors-plant Flex 4 1 — — $86,890.09 $86,890.09 $86,890.09 2026-04-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 2 1 — — $86,431.35 $86,431.35 $86,431.35 2026-04-01
C9773 HCPCS Revasc Lithotr-stent Tib/per 4 1 — — $86,263.68 $86,263.68 $86,263.68 2026-04-01
C9767 HCPCS Revasc Lithotrip-stent-ather 4 1 — — $86,263.68 $86,263.68 $86,263.68 2026-04-01
61624 HCPCS Transcath Occlusion Cns 4 1 — — $86,263.68 $86,263.68 $86,263.68 2026-04-01
C9774 HCPCS Revasc Lithotr-ather Tib/per 4 1 — — $86,263.68 $86,263.68 $86,263.68 2026-04-01
C9775 HCPCS Revasc Lith-sten-ath Tib/per 4 1 — — $86,263.68 $86,263.68 $86,263.68 2026-04-01
0620T HCPCS Evasc Ven Artlz Tibl/prnl Vn 4 1 — — $86,263.68 $86,263.68 $86,263.68 2026-04-01
27591 HCPCS Amputate Leg At Thigh 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22818 HCPCS Kyphectomy 1-2 Segments 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22857 HCPCS Lumbar Artif Diskectomy 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22610 HCPCS Thorax Spine Fusion 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22556 HCPCS Thorax Spine Fusion 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27590 HCPCS Amputate Leg At Thigh 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
20838 HCPCS Replantation Foot Complete 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22804 HCPCS Post Fusion 13/> Vert Seg 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22600 HCPCS Neck Spine Fusion 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27592 HCPCS Amputate Leg At Thigh 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22819 HCPCS Kyphectomy 3 Or More 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22533 HCPCS Lat Lumbar Spine Fusion 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
20802 HCPCS Replantation Arm Complete 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22862 HCPCS Revise Lumbar Artif Disc 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22548 HCPCS Neck Spine Fusion 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27295 HCPCS Amputation Of Leg At Hip 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
20805 HCPCS Replant Forearm Complete 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22808 HCPCS Ant Fusion 2-3 Vert Seg 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27286 HCPCS Fusion Of Hip Joint 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27290 HCPCS Amputation Of Leg At Hip 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27280 HCPCS Fusion Of Sacroiliac Joint 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22810 HCPCS Ant Fusion 4-7 Vert Seg 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22802 HCPCS Post Fusion 7-12 Vert Seg 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22800 HCPCS Post Fusion <=6 Vert Seg 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27880 HCPCS Amputation Of Lower Leg 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22590 HCPCS Spine & Skull Spinal Fusion 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
20808 HCPCS Replantation Hand Complete 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22849 HCPCS Reinsert Spinal Fixation 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22595 HCPCS Neck Spinal Fusion 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22532 HCPCS Lat Thorax Spine Fusion 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27284 HCPCS Fusion Of Hip Joint 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22812 HCPCS Ant Fusion 8/> Vert Seg 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 12 3 — — $19,177.59 $92,419.81 $84,527.02 2026-04-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 12 3 — — $19,114.65 $92,116.51 $84,249.63 2026-04-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 12 3 — — $18,971.28 $91,425.57 $83,617.69 2026-04-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 12 3 — — $18,913.18 $91,145.60 $83,361.63 2026-04-01
L8687 HCPCS Implt Nrostm Pls Gen Dua Rec 4 1 — — $83,350.78 $83,350.78 $83,350.78 2026-04-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 12 3 — — $18,756.03 $90,388.25 $82,668.96 2026-04-01
33274 HCPCS Tcat Insj/rpl Perm Ldls Pm 4 1 — — $82,453.67 $82,453.67 $82,453.67 2026-04-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 12 3 — — $18,645.42 $89,855.24 $82,181.46 2026-04-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 12 3 — — $18,630.90 $89,785.25 $82,117.45 2026-04-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 12 3 — — $18,625.69 $89,760.12 $82,094.47 2026-04-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 12 3 — — $18,556.42 $89,426.31 $81,789.17 2026-04-01
245 MS_DRG Aicd Generator Procedures 12 3 — — $18,197.42 $87,696.26 $80,206.86 2026-04-01
471 MS_DRG Cervical Spinal Fusion With Mcc 12 3 — — $18,087.57 $87,166.83 $79,722.65 2026-04-01
Q0489 HCPCS Pwr Pck Base Combo Vad, Rep 4 1 — — $79,612.08 $79,612.08 $79,612.08 2026-04-01
6 MS_DRG Liver Transplant Without Mcc 12 3 — — $18,057.40 $87,021.46 $79,589.70 2026-04-01
36906 HCPCS Thrmbc/nfs Dialysis Circuit 4 1 — — $79,380.09 $79,380.09 $79,380.09 2026-04-01
93591 HCPCS Perq Transcath Cls Aortic 4 1 — — $79,380.09 $79,380.09 $79,380.09 2026-04-01
93590 HCPCS Perq Transcath Cls Mitral 4 1 — — $79,380.09 $79,380.09 $79,380.09 2026-04-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc 2 1 — — $79,285.40 $79,285.40 $79,285.40 2026-04-01
22867 HCPCS Insj Stablj Dev W/dcmprn 4 1 — — $78,961.18 $78,961.18 $78,961.18 2026-04-01
22869 HCPCS Insj Stablj Dev Without Dcmprn 4 1 — — $78,961.18 $78,961.18 $78,961.18 2026-04-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 12 3 — — $17,782.94 $85,698.80 $78,379.99 2026-04-01
799 MS_DRG Splenic Procedures With Mcc 12 3 — — $17,705.85 $85,327.30 $78,040.22 2026-04-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 12 3 — — $17,705.11 $85,323.71 $78,036.94 2026-04-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 12 3 — — $17,519.28 $84,428.17 $77,217.88 2026-04-01
54411 HCPCS Remov/replc Penis Pros Comp 4 1 — — $77,132.59 $77,132.59 $77,132.59 2026-04-01
54417 HCPCS Remv/replc Penis Pros Compl 4 1 — — $77,132.59 $77,132.59 $77,132.59 2026-04-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 12 3 — — $17,425.43 $83,975.92 $76,804.25 2026-04-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 12 3 — — $17,324.89 $83,491.36 $76,361.07 2026-04-01
163 MS_DRG Major Chest Procedures With Mcc 12 3 — — $17,163.64 $82,714.27 $75,650.35 2026-04-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 12 3 — — $17,156.56 $82,680.17 $75,619.16 2026-04-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 3 — — $17,101.82 $82,416.35 $75,377.87 2026-04-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 12 3 — — $17,099.58 $82,405.59 $75,368.03 2026-04-01
L5859 HCPCS Knee-shin Pro Flex/ext Cont 4 1 — — $75,120.34 $75,120.34 $75,120.34 2026-04-01
37231 HCPCS Tib/per Revasc Stent & Ather 4 1 — — $74,636.07 $74,636.07 $74,636.07 2026-04-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 12 3 — — $16,800.17 $80,962.68 $74,048.34 2026-04-01
L5969 HCPCS Ak/ft Power Asst Incl Motors 4 1 — — $74,010.20 $74,010.20 $74,010.20 2026-04-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 12 3 — — $16,700.00 $80,479.91 $73,606.81 2026-04-01
K0606 HCPCS Aed Garment W Elec Analysis 8 1 — — $12,789.25 $134,287.11 $73,538.18 2026-04-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 12 3 — — $16,653.82 $80,257.37 $73,403.27 2026-04-01
901 MS_DRG Wound Debridements For Injuries With Mcc 12 3 — — $16,498.15 $79,507.20 $72,717.17 2026-04-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 12 3 — — $16,357.76 $78,830.62 $72,098.36 2026-04-01
Q0481 HCPCS Microprcsr Cu Elec Vad, Rep 4 1 — — $71,168.72 $71,168.72 $71,168.72 2026-04-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 12 3 — — $16,112.72 $77,649.73 $71,018.32 2026-04-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 12 3 — — $16,079.20 $77,488.21 $70,870.60 2026-04-01
69729 HCPCS Impl Oi Implt Sk Tc Esp>=100 4 1 — — $70,068.19 $70,068.19 $70,068.19 2026-04-01
69730 HCPCS Rplc Oi Implt Sk Tc Esp>=100 4 1 — — $70,068.19 $70,068.19 $70,068.19 2026-04-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 12 3 — — $15,884.43 $76,549.60 $70,012.15 2026-04-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 12 3 — — $15,861.35 $76,438.33 $69,910.38 2026-04-01
33288 HCPCS Rmv&rplcmt Phrnc Nrv Stim Ld 4 1 — — $69,769.51 $69,769.51 $69,769.51 2026-04-01
0784T HCPCS Ins/rplmt Eltrd Ra Spi Nstim 4 1 — — $69,769.51 $69,769.51 $69,769.51 2026-04-01
0786T HCPCS Insj/rplcmt Prq Ra Sac Nstim 4 1 — — $69,769.51 $69,769.51 $69,769.51 2026-04-01
64596 HCPCS Ins/rplcmt Prq Eltrd Ra Pn 1 4 1 — — $69,769.51 $69,769.51 $69,769.51 2026-04-01
140 MS_DRG Major Head And Neck Procedures With Mcc 12 3 — — $15,748.88 $75,896.34 $69,414.68 2026-04-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 12 3 — — $15,604.76 $75,201.81 $68,779.46 2026-04-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 12 3 — — $15,603.64 $75,196.42 $68,774.53 2026-04-01
793 MS_DRG Full Term Neonate With Major Problems 12 3 — — $15,531.40 $74,848.26 $68,456.10 2026-04-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 12 3 — — $15,493.41 $74,665.20 $68,288.68 2026-04-01
64628 HCPCS Trml Dstrj Ios Bvn 1st 2 L/s 4 1 — — $67,625.97 $67,625.97 $67,625.97 2026-04-01
69719 HCPCS Revj/rplcmt Oi Implt Tc Esp 4 1 — — $67,625.97 $67,625.97 $67,625.97 2026-04-01
69716 HCPCS Impltj Oi Implt Skl Tc Esp 4 1 — — $67,625.97 $67,625.97 $67,625.97 2026-04-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 12 3 — — $15,312.43 $73,792.99 $67,490.96 2026-04-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 12 3 — — $15,303.86 $73,751.72 $67,453.21 2026-04-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 12 3 — — $15,281.14 $73,642.24 $67,353.08 2026-04-01
0686T HCPCS Histotripsy Mal Hepatcel Tis 4 1 — — $67,127.69 $67,127.69 $67,127.69 2026-04-01
C9758 HCPCS Interatrial Shunt Ide 4 1 — — $67,127.69 $67,127.69 $67,127.69 2026-04-01
C9790 HCPCS Kidney Histotripsy W/image 4 1 — — $67,127.69 $67,127.69 $67,127.69 2026-04-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 12 3 — — $15,205.92 $73,279.72 $67,021.52 2026-04-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 12 3 — — $15,145.96 $72,990.78 $66,757.26 2026-04-01
791 MS_DRG Prematurity With Major Problems 12 3 — — $15,119.89 $72,865.15 $66,642.36 2026-04-01
22318 HCPCS Treat Odontoid Fx Without Graft 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27580 HCPCS Fusion Of Knee 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22319 HCPCS Treat Odontoid Fx W/graft 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27486 HCPCS Revise/replace Knee Joint 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27487 HCPCS Revise/replace Knee Joint 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27598 HCPCS Amputate Lower Leg At Knee 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27712 HCPCS Realignment Of Lower Leg 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27715 HCPCS Revision Of Lower Leg 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27445 HCPCS Revision Of Knee Joint 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27282 HCPCS Fusion Of Pubic Bones 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22327 HCPCS Treat Thorax Spine Fracture 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
24940 HCPCS Revision Of Upper Arm 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22326 HCPCS Treat Neck Spine Fracture 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27138 HCPCS Revise Hip Joint Replacement 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22865 HCPCS Remove Lumb Artif Disc 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27140 HCPCS Transplant Femur Ridge 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27134 HCPCS Revise Hip Joint Replacement 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27137 HCPCS Revise Hip Joint Replacement 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
0220T HCPCS Plmt Post Facet Implt Thor 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27176 HCPCS Treat Slipped Epiphysis 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22850 HCPCS Remove Spine Fixation Device 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
0219T HCPCS Plmt Post Facet Implt Cerv 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22852 HCPCS Remove Spine Fixation Device 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
24900 HCPCS Amputation Of Upper Arm 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
24920 HCPCS Amputation Of Upper Arm 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
0202T HCPCS Post Vert Arthrplst 1 Lumbar 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22855 HCPCS Remove Spine Fixation Device 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27122 HCPCS Reconstruction Of Hip Socket 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27125 HCPCS Partial Hip Replacement 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27888 HCPCS Amputation Of Foot At Ankle 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27130 HCPCS Total Hip Arthroplasty 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27702 HCPCS Reconstruct Ankle Joint 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27078 HCPCS Rsect Hip Tum Incl Femur 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27077 HCPCS Resect Hip Tum W/innom Bone 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22325 HCPCS Treat Spine Fracture 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
0629T HCPCS Perq Njx Algc CT Lmbr 1st 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
0627T HCPCS Perq Njx Algc Fluor Lmbr 1st 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27132 HCPCS Total Hip Arthroplasty 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
25900 HCPCS Amputation Of Forearm 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
25905 HCPCS Amputation Of Forearm 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27120 HCPCS Reconstruction Of Hip Socket 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22830 HCPCS Exploration Of Spinal Fusion 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27703 HCPCS Reconstruction Ankle Joint 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
24931 HCPCS Amputate Upper Arm & Implant 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
23900 HCPCS Amputation Of Arm & Girdle 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
23920 HCPCS Amputation At Shoulder Joint 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
33249 HCPCS Insj/rplcmt Defib W/lead(s) 4 1 — — $65,567.66 $65,567.66 $65,567.66 2026-04-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 12 3 — — $14,834.63 $71,490.44 $65,385.05 2026-04-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 12 3 — — $14,824.21 $71,440.19 $65,339.09 2026-04-01
62361 HCPCS Implant Spine Infusion Pump 4 1 — — $65,200.18 $65,200.18 $65,200.18 2026-04-01
62362 HCPCS Implant Spine Infusion Pump 4 1 — — $65,200.18 $65,200.18 $65,200.18 2026-04-01
A9543 HCPCS Y90 Ibritumomab, Rx 8 1 — — $54,186.88 $75,404.25 $64,795.57 2026-04-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 12 3 — — $14,696.10 $70,822.83 $64,774.45 2026-04-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 12 3 — — $14,662.58 $70,661.31 $64,626.72 2026-04-01
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