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.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
0202T HCPCS Post Vert Arthrplst 1 Lumbar 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
0220T HCPCS Plmt Post Facet Implt Thor 4 1 — — $66,130.26 $66,130.26 $66,130.26 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
0268T HCPCS Implt/rpl Crtd Sns Dev Gen 4 1 — — $88,039.70 $88,039.70 $88,039.70 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
0414T HCPCS Rmvl & Rpl Car Modulj Pls Gn 4 1 — — $117,764.26 $117,764.26 $117,764.26 2026-04-01
0424T HCPCS Insj/rplc Nstim Apnea Compl 4 1 — — $143,531.45 $143,531.45 $143,531.45 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
0427T HCPCS Insj/rplc Nstim Apnea Pls Gn 4 1 — — $93,219.82 $93,219.82 $93,219.82 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
0515T HCPCS Insj Wcs Lv Compl Sys 4 1 — — $118,120.99 $118,120.99 $118,120.99 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
0571T HCPCS Insj/rplcmt Icds Ss Eltrd 4 1 — — $176,344.84 $176,344.84 $176,344.84 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
0620T HCPCS Evasc Ven Artlz Tibl/prnl Vn 4 1 — — $86,263.68 $86,263.68 $86,263.68 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
0629T HCPCS Perq Njx Algc CT Lmbr 1st 4 1 — — $66,130.26 $66,130.26 $66,130.26 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
0645T HCPCS Tcat Impltj C Sins Rdctj Dev 4 1 — — $92,243.71 $92,243.71 $92,243.71 2026-04-01
0686T HCPCS Histotripsy Mal Hepatcel Tis 4 1 — — $67,127.69 $67,127.69 $67,127.69 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
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
0793T HCPCS Prq Tcat Thrm Ablt Nrv P-art 4 1 — — $89,811.64 $89,811.64 $89,811.64 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
0796T HCPCS Tcat Ins 2chmbr Ldls Pm Ra 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
0801T HCPCS Tcat Rmv&rpl 2chmbr Ldls Pm 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
0803T HCPCS Tcat Rmv&rpl2chmb Ldls Pm Rv 4 1 — — $99,799.68 $99,799.68 $99,799.68 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
0817T HCPCS Opn Insj/rplcmt Ins Ptn Subf 4 1 — — $112,042.47 $112,042.47 $112,042.47 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
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
10 MS_DRG Pancreas Transplant 12 3 — — $29,690.12 $143,081.38 $130,862.02 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
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
14 MS_DRG Allogeneic Bone Marrow Transplant 12 3 — — $48,788.01 $235,117.14 $215,037.78 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
16 MS_DRG Autologous Bone Marrow Transplant With Cc/Mcc 12 3 — — $22,476.32 $108,316.95 $99,066.52 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
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/Mcc 12 3 — — $22,476.32 $108,316.95 $99,066.52 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
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 12 3 — — $29,519.19 $142,257.63 $130,108.62 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
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
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
20802 HCPCS Replantation Arm Complete 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
20808 HCPCS Replantation Hand Complete 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
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
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 12 3 — — $40,566.12 $195,494.54 $178,799.02 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
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
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
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
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
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
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
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
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
22318 HCPCS Treat Odontoid Fx Without Graft 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
22325 HCPCS Treat Spine Fracture 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
22327 HCPCS Treat Thorax Spine Fracture 4 1 — — $66,130.26 $66,130.26 $66,130.26 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
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
22532 HCPCS Lat Thorax Spine Fusion 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
22548 HCPCS Neck 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
22590 HCPCS Spine & Skull Spinal Fusion 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
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
22600 HCPCS Neck Spine Fusion 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
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
228 MS_DRG Other Cardiothoracic Procedures With Mcc 12 3 — — $18,556.42 $89,426.31 $81,789.17 2026-04-01
22800 HCPCS Post Fusion <=6 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
22804 HCPCS Post Fusion 13/> Vert Seg 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
22810 HCPCS Ant Fusion 4-7 Vert Seg 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
22818 HCPCS Kyphectomy 1-2 Segments 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
22830 HCPCS Exploration Of Spinal Fusion 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22849 HCPCS Reinsert Spinal Fixation 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
22850 HCPCS Remove Spine Fixation Device 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
22855 HCPCS Remove Spine Fixation Device 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
22857 HCPCS Lumbar Artif Diskectomy 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
22865 HCPCS Remove Lumb Artif Disc 4 1 — — $66,130.26 $66,130.26 $66,130.26 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
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
231 MS_DRG Coronary Bypass With Ptca With Mcc 12 3 — — $31,555.11 $152,069.06 $139,082.13 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
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
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
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 12 3 — — $21,911.39 $105,594.44 $96,576.52 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
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
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
245 MS_DRG Aicd Generator Procedures 12 3 — — $18,197.42 $87,696.26 $80,206.86 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
24931 HCPCS Amputate Upper Arm & Implant 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
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 12 3 — — $16,653.82 $80,257.37 $73,403.27 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
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
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
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
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
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 12 3 — — $19,114.65 $92,116.51 $84,249.63 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
27078 HCPCS Rsect Hip Tum Incl Femur 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
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
27130 HCPCS Total Hip Arthroplasty 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
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
27138 HCPCS Revise Hip Joint Replacement 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
27176 HCPCS Treat Slipped Epiphysis 4 1 — — $66,130.26 $66,130.26 $66,130.26 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
27280 HCPCS Fusion Of Sacroiliac Joint 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27282 HCPCS Fusion Of Pubic Bones 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27284 HCPCS Fusion Of Hip Joint 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
27295 HCPCS Amputation Of Leg At Hip 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27445 HCPCS Revision Of Knee Joint 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
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
27580 HCPCS Fusion Of Knee 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
27590 HCPCS Amputate Leg At Thigh 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27591 HCPCS Amputate Leg At Thigh 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
27598 HCPCS Amputate Lower Leg At Knee 4 1 — — $66,130.26 $66,130.26 $66,130.26 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
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 12 3 — — $17,324.89 $83,491.36 $76,361.07 2026-04-01
27702 HCPCS Reconstruct Ankle Joint 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
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
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
27880 HCPCS Amputation Of Lower Leg 4 1 — — $85,211.86 $85,211.86 $85,211.86 2026-04-01
27888 HCPCS Amputation Of Foot At Ankle 4 1 — — $66,130.26 $66,130.26 $66,130.26 2026-04-01
28 MS_DRG Spinal Procedures With Mcc 12 3 — — $22,638.69 $109,099.42 $99,782.17 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
31 MS_DRG Ventricular Shunt Procedures With Mcc 12 3 — — $15,604.76 $75,201.81 $68,779.46 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
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 12 3 — — $16,357.76 $78,830.62 $72,098.36 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
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 12 3 — — $18,913.18 $91,145.60 $83,361.63 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
33230 HCPCS Insrt Pulse Gen W/dual Leads 4 1 — — $120,889.65 $120,889.65 $120,889.65 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
33249 HCPCS Insj/rplcmt Defib W/lead(s) 4 1 — — $65,567.66 $65,567.66 $65,567.66 2026-04-01
33270 HCPCS Ins/rep Subq Defibrillator 4 1 — — $165,495.02 $165,495.02 $165,495.02 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
33276 HCPCS Insj Phrnc Nrv Stim Sys 4 1 — — $241,652.69 $241,652.69 $241,652.69 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
33288 HCPCS Rmv&rplcmt Phrnc Nrv Stim Ld 4 1 — — $69,769.51 $69,769.51 $69,769.51 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
33902 HCPCS Perq P-art Revsc 1 Abnor Uni 4 1 — — $92,243.71 $92,243.71 $92,243.71 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
36836 HCPCS Prq Av Fstl Crtj Uxtr 1 Acs 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
36906 HCPCS Thrmbc/nfs Dialysis Circuit 4 1 — — $79,380.09 $79,380.09 $79,380.09 2026-04-01
37231 HCPCS Tib/per Revasc Stent & Ather 4 1 — — $74,636.07 $74,636.07 $74,636.07 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
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 12 3 — — $20,215.47 $97,421.54 $89,101.59 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
459 MS_DRG Spinal Fusion Except Cervical With Mcc 2 1 — — $114,175.04 $114,175.04 $114,175.04 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
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
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
471 MS_DRG Cervical Spinal Fusion With Mcc 12 3 — — $18,087.57 $87,166.83 $79,722.65 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
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 12 3 — — $39,655.60 $191,106.59 $174,785.80 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
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
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
6 MS_DRG Liver Transplant Without Mcc 12 3 — — $18,057.40 $87,021.46 $79,589.70 2026-04-01
61624 HCPCS Transcath Occlusion Cns 4 1 — — $86,263.68 $86,263.68 $86,263.68 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
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
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
64568 HCPCS Inc For Vagus N Elect Impl 4 1 — — $122,459.74 $122,459.74 $122,459.74 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
64596 HCPCS Ins/rplcmt Prq Eltrd Ra Pn 1 4 1 — — $69,769.51 $69,769.51 $69,769.51 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
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 12 3 — — $17,156.56 $82,680.17 $75,619.16 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
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
69716 HCPCS Impltj Oi Implt Skl Tc Esp 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
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
7 MS_DRG Lung Transplant 12 3 — — $48,665.12 $234,524.90 $214,496.12 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
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
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 12 3 — — $22,139.30 $106,692.77 $97,581.05 2026-04-01
791 MS_DRG Prematurity With Major Problems 12 3 — — $15,119.89 $72,865.15 $66,642.36 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
799 MS_DRG Splenic Procedures With Mcc 12 3 — — $17,705.85 $85,327.30 $78,040.22 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
81162 HCPCS Brca1&2 Seq & Full Dup/del 4 1 — — $101,705.33 $101,705.33 $101,705.33 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
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
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
834 MS_DRG Acute Leukemia With Mcc 12 3 — — $20,582.29 $99,189.28 $90,718.37 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
850 MS_DRG Acute Leukemia With Other Procedures 12 3 — — $34,303.07 $165,311.89 $151,194.00 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
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
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
901 MS_DRG Wound Debridements For Injuries With Mcc 12 3 — — $16,498.15 $79,507.20 $72,717.17 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
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
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
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
93590 HCPCS Perq Transcath Cls Mitral 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
955 MS_DRG Craniotomy For Multiple Significant Trauma 12 3 — — $25,427.24 $122,537.86 $112,072.95 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
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
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
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
A9543 HCPCS Y90 Ibritumomab, Rx 8 1 — — $54,186.88 $75,404.25 $64,795.57 2026-04-01
A9607 HCPCS Lutetium Lu 177 Vipivotide 8 1 — — $406.94 $235,071.75 $117,739.35 2026-04-01
C2616 HCPCS Brachytx, Non-str,yttrium-90 4 1 — — $88,646.51 $88,646.51 $88,646.51 2026-04-01
C9758 HCPCS Interatrial Shunt Ide 4 1 — — $67,127.69 $67,127.69 $67,127.69 2026-04-01
C9760 HCPCS Non-blind Interatrial Shunt 4 1 — — $147,677.69 $147,677.69 $147,677.69 2026-04-01
C9767 HCPCS Revasc Lithotrip-stent-ather 4 1 — — $86,263.68 $86,263.68 $86,263.68 2026-04-01
C9773 HCPCS Revasc Lithotr-stent Tib/per 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
C9790 HCPCS Kidney Histotripsy W/image 4 1 — — $67,127.69 $67,127.69 $67,127.69 2026-04-01
E0194 HCPCS Air Fluidized Bed 8 1 — — $15,597.17 $163,770.23 $89,683.70 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
J3399 HCPCS Inj Onase Abepar-xioi Treat 4 1 — — $4,402,595.74 $4,402,595.74 $4,402,595.74 2026-04-01
J7310 HCPCS Ganciclovir Long Act Implant 4 1 — — $93,517.91 $93,517.91 $93,517.91 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 8 1 — — $115,020.84 $118,712.98 $116,866.91 2026-04-01
J9029 HCPCS Inj, Adstiladrin, Per Tx Dos 8 1 — — $28,440.00 $331,866.00 $180,153.00 2026-04-01
J9226 HCPCS Supprelin La Implant 8 1 — — $81,322.85 $92,462.93 $86,892.89 2026-04-01
K0606 HCPCS Aed Garment W Elec Analysis 8 1 — — $12,789.25 $134,287.11 $73,538.18 2026-04-01
L5856 HCPCS Elec Knee-shin Swing/stance 4 1 — — $117,574.81 $117,574.81 $117,574.81 2026-04-01
L5858 HCPCS Stance Phase Only 4 1 — — $91,025.85 $91,025.85 $91,025.85 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
L5969 HCPCS Ak/ft Power Asst Incl Motors 4 1 — — $74,010.20 $74,010.20 $74,010.20 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
L6880 HCPCS Elec Hand Ind Art Digits 4 1 — — $120,665.89 $120,665.89 $120,665.89 2026-04-01
L6965 HCPCS Shldr Disartic Myoelectronic 4 1 — — $91,530.20 $91,530.20 $91,530.20 2026-04-01
L6970 HCPCS Interscapular-thor Switch CT 4 1 — — $93,034.23 $93,034.23 $93,034.23 2026-04-01
L6975 HCPCS Interscap-thor Myoelectronic 4 1 — — $93,533.59 $93,533.59 $93,533.59 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
L8687 HCPCS Implt Nrostm Pls Gen Dua Rec 4 1 — — $83,350.78 $83,350.78 $83,350.78 2026-04-01
Q0480 HCPCS Driver Pneumatic Vad, Rep 4 1 — — $441,114.19 $441,114.19 $441,114.19 2026-04-01
Q0481 HCPCS Microprcsr Cu Elec Vad, Rep 4 1 — — $71,168.72 $71,168.72 $71,168.72 2026-04-01
Q0483 HCPCS Monitor Elec Vad, Rep 4 1 — — $91,830.38 $91,830.38 $91,830.38 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
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 8 1 — — $875,952.00 $2,123,190.60 $1,499,571.30 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
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 8 1 — — $122,955.60 $176,375.50 $149,665.55 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
Q2054 HCPCS Lisocabtagene Mara Car Pos T 8 1 — — $924,257.25 $2,335,509.66 $1,629,883.46 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 8 1 — — $944,981.41 $2,387,877.90 $1,666,429.65 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
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