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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

LEGACY GOOD SAMARITAN MEDICAL CENTER

Portland, OR · CCN 380017 · Rates published

14,187 distinct procedures filed
25 distinct payers
236,799 rate rows
2026-04-01 last MRF observed
Data quality

182,210 of 236,799 rate rows are consumer-grade (76.9%)

54,589 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 46,357
professional (physician) fee — not the facility price 5,769
template filing: same amount across many unrelated codes — excluded 2,417
placeholder amount (≤ $0.02) — excluded from medians 46
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.legacyhealth.org/-/media/Files/JSON/930386793_legacy-good-samaritan-medical-center_IP-REHAB_standardcharges.json
Found on page https://www.legacyhealth.org/Patients-and-Visitors/paying-for-your-care/estimate-hospital-costs
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint f8b1ff03f4e25fe3… · 63,458,812 bytes · first seen 2026-05-09

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
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 7 $3,685,266.67 $4,127,498.67 $3,906,382.67 nat. median
$3,710,000
1.1× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 7 $3,316,462.59 $3,714,438.10 $3,515,450.34 nat. median
$3,325,455
1.1× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 7 $3,248,445.72 $3,638,259.20 $3,443,352.46 nat. median
$3,286,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 7 $2,945,740.00 $3,299,228.80 $3,122,484.40 nat. median
$3,006,423
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 7 $2,455,110.60 $4,910,221.21 $2,626,968.35 nat. median
$2,469,189
1.1× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 7 $2,332,000.00 $4,664,000.00 $2,495,240.00 nat. median
$2,448,600
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 9 $770,620.00 $2,980,372.85 $855,388.20 nat. median
$824,563
1.0× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 9 $591,726.20 $2,288,501.08 $656,816.08 nat. median
$754,974
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 9 $565,868.94 $2,188,498.14 $628,114.53 nat. median
$675,122
0.9× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 9 $562,538.19 $2,175,616.43 $624,417.39 nat. median
$674,188
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 9 $557,317.93 $2,155,427.11 $618,622.91 nat. median
$625,184
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 9 $533,230.17 $2,062,267.69 $591,885.49 nat. median
$634,511
0.9× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 9 $489,304.61 $1,892,385.57 $543,128.11 nat. median
$620,080
0.9× median
18
MS_DRG 		Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 18 $402,924.61 $1,187,527.00 $447,246.32 nat. median
$370,174
1.2× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 18 $261,965.46 $770,657.25 $290,781.67 nat. median
$265,286
1.1× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 8 $205,640.00 $795,312.70 $228,260.40 nat. median
$209,753
1.1× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 18 $199,911.04 $587,732.37 $221,901.25 nat. median
$206,368
1.1× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 18 $101,694.36 $583,693.00 $218,620.49 nat. median
$202,986
1.1× median
J7330
HCPCS 		Cultured Chondrocytes Implnt 1 $177,719.40 $177,719.40 $177,719.40 nat. median
$76,377
outlier · 2.3×
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 18 $16,298.12 $398,959.57 $146,427.27 nat. median
$133,176
1.1× median
7
MS_DRG 		Lung Transplant 18 $121,798.56 $356,130.50 $135,196.41 nat. median
$122,708
1.1× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 18 $113,129.32 $330,492.25 $125,573.54 nat. median
$117,303
1.1× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 18 $106,749.43 $311,624.50 $118,491.86 nat. median
$108,660
1.1× median
209
MS_DRG 		Complex Aortic Arch Procedures 17 $106,628.55 $311,267.00 $117,291.41 nat. median
$98,017
1.2× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 18 $103,861.23 $303,083.00 $115,285.96 nat. median
$98,905
1.2× median
0427T
HCPCS 		Insj/rplc Nstim Apnea Pls Gn 1 $82,074.08 $120,301.16 $114,887.99 nat. median
$15,886
outlier · 7.2×
0431T
HCPCS 		Rmvl/rplc Nstim Apnea Pls Gn 1 $82,074.08 $120,301.16 $114,887.99 nat. median
$18,872
outlier · 6.1×
0424T
HCPCS 		Insj/rplc Nstim Apnea Compl 1 $82,074.08 $120,301.16 $114,887.99 nat. median
$24,752
outlier · 4.6×
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 18 $102,493.38 $299,037.75 $113,767.65 nat. median
$102,358
1.1× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 18 $97,252.60 $283,538.75 $107,950.39 nat. median
$100,136
1.1× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 18 $87,041.92 $269,027.00 $103,427.11 nat. median
$93,672
1.1× median
215
MS_DRG 		Other Heart Assist System Implant 18 $41.24 $273,817.50 $103,362.03 nat. median
$99,019
1.0× median
0312T
HCPCS 		Laps Impltj Nstim Vagus 2 $7,920.26 $120,301.16 $98,481.04 nat. median
$8,204
outlier · 12.0×
0316T
HCPCS 		Replc Vagus Nerve Pls Gen 2 $7,920.26 $120,301.16 $98,481.04 nat. median
$9,564
outlier · 10.3×
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 18 $85,155.82 $247,764.00 $94,522.96 nat. median
$82,712
1.1× median
850
MS_DRG 		Acute Leukemia With Other Procedures 18 $42,526.09 $238,136.25 $90,090.35 nat. median
$83,442
1.1× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 18 $79,518.91 $231,093.50 $88,265.99 nat. median
$81,118
1.1× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 20 $13,301.83 $231,822.25 $87,741.86 nat. median
$79,312
1.1× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 18 $74,547.78 $216,392.00 $82,748.04 nat. median
$77,576
1.1× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 18 $72,468.58 $210,243.00 $80,440.12 nat. median
$73,807
1.1× median
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 18 $72,233.32 $209,547.25 $80,178.99 nat. median
$72,138
1.1× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 18 $71,288.79 $211,153.25 $80,054.01 nat. median
$74,915
1.1× median
0426T
HCPCS 		Insj/rplc Nstim Apnea Stm Ld 1 $54,340.97 $79,651.00 $76,066.95 nat. median
$13,244
outlier · 5.7×
427
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 18 $68,501.72 $198,511.50 $76,036.91 nat. median
$68,090
1.1× median
10
MS_DRG 		Pancreas Transplant 18 $68,102.81 $197,521.17 $75,594.12 nat. median
$68,882
1.1× median
928
MS_DRG 		Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 18 $68,074.91 $197,249.25 $75,563.15 nat. median
$64,027
1.2× median
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 18 $67,720.63 $196,383.99 $75,169.90 nat. median
$71,240
1.1× median
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 18 $67,681.57 $196,086.00 $75,126.54 nat. median
$68,887
1.1× median
0775T
HCPCS 		Arthrd Si Jt Prq Iartic Impl 2 $7,920.26 $90,467.87 $74,058.88 nat. median
$9,524
outlier · 7.8×
0809T
HCPCS 		Arthrd Si Jt Prq Tfx&implt 2 $7,920.26 $90,467.87 $74,058.88 nat. median
$9,875
outlier · 7.5×

Other procedures at this hospital

Browse this hospital's 14,187 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
             
19324 HCPCS Enlarge Breast 4 2 — — $7,920.26 $33,611.25 $27,514.87 2026-04-01
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc 28 18 — — $24,837.48 $69,379.75 $27,569.60 2026-04-01
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 32 18 — — $21,114.89 $69,742.75 $27,705.85 2026-04-01
749 MS_DRG Other Female Reproductive System O.r. Procedures With Cc/Mcc 30 18 — — $16,971.96 $70,609.00 $27,778.45 2026-04-01
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/Mcc 30 19 — — $19,697.26 $70,207.50 $27,880.28 2026-04-01
846 MS_DRG Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc 33 18 — — $32.93 $71,293.75 $28,033.15 2026-04-01
253 MS_DRG Other Vascular Procedures With Cc 29 18 — — $16,439.65 $71,379.00 $28,064.85 2026-04-01
22558 HCPCS Lumbar Spine Fusion 18 11 — — $14,755.00 $116,644.32 $28,130.07 2026-04-01
22630 HCPCS Lumbar Spine Fusion 18 11 — — $14,755.00 $116,644.32 $28,130.07 2026-04-01
96 MS_DRG Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc 28 18 — — $25,361.00 $70,928.00 $28,150.71 2026-04-01
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 28 18 — — $25,394.48 $71,027.00 $28,187.88 2026-04-01
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 33 18 — — $21,560.00 $70,928.00 $28,404.32 2026-04-01
49654 HCPCS Lap Inc Hernia Repair 4 2 — — $7,920.26 $34,757.92 $28,453.56 2026-04-01
49656 HCPCS Lap Inc Hernia Repair Recur 4 2 — — $7,920.26 $34,757.92 $28,453.56 2026-04-01
49657 HCPCS Lap Inc Hern Recur Comp 4 2 — — $7,920.26 $34,757.92 $28,453.56 2026-04-01
49655 HCPCS Lap Inc Hern Repair Comp 4 2 — — $7,920.26 $34,757.92 $28,453.56 2026-04-01
577 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 29 18 — — $17,154.93 $72,894.25 $28,628.45 2026-04-01
970 MS_DRG HIV With Extensive O.r. Procedures Without Mcc 28 18 — — $25,902.19 $72,528.50 $28,751.43 2026-04-01
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 28 18 — — $26,112.34 $73,150.00 $28,984.69 2026-04-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 42 20 — — $10,280.69 $75,589.25 $29,092.11 2026-04-01
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 29 18 — — $23,645.28 $74,178.50 $29,106.13 2026-04-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 29 18 — — $12,078.44 $74,420.50 $29,196.15 2026-04-01
849 MS_DRG Radiotherapy 29 18 — — $17,857.99 $74,511.25 $29,229.89 2026-04-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 41 19 — — $2,434.50 $79,972.12 $29,345.48 2026-04-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/Mcc 36 18 — — $25,389.17 $75,570.00 $29,623.69 2026-04-01
61 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 29 18 — — $11,704.42 $75,820.25 $29,716.78 2026-04-01
963 MS_DRG Other Multiple Significant Trauma With Mcc 28 18 — — $26,798.59 $75,179.50 $29,746.43 2026-04-01
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 32 18 — — $24,147.37 $76,227.25 $29,868.17 2026-04-01
503 MS_DRG Foot Procedures With Mcc 29 18 — — $24,673.75 $76,755.25 $30,064.55 2026-04-01
654 MS_DRG Major Bladder Procedures With Cc 32 18 — — $25,473.73 $76,980.75 $30,148.43 2026-04-01
0453T HCPCS Insj/rplcmt Mech-elec Ntrfce 3 1 — — $21,539.32 $31,571.54 $30,150.92 2026-04-01
0454T HCPCS Insj/rplcmt Subq Electrode 3 1 — — $21,539.32 $31,571.54 $30,150.92 2026-04-01
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 31 18 — — $18,752.67 $78,388.75 $30,672.14 2026-04-01
J9266 HCPCS Pegaspargase Injection 15 10 — — $24,657.63 $109,930.05 $30,697.98 2026-04-01
800 MS_DRG Splenic Procedures With Cc 29 18 — — $27,501.58 $77,258.50 $30,801.77 2026-04-01
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 33 18 — — $23,099.02 $78,930.50 $30,873.63 2026-04-01
5200 OTHER Implantation Wireless Pa Pressure Monitor 3 3 — — $30,876.25 $31,083.61 $30,991.28 2026-04-01
974 MS_DRG HIV With Major Related Condition With Mcc 32 18 — — $19,229.19 $79,365.00 $31,035.26 2026-04-01
619 MS_DRG O.r. Procedures For Obesity With Mcc 29 18 — — $17,876.10 $79,403.50 $31,049.57 2026-04-01
27702 HCPCS Reconstruct Ankle Joint 15 10 — — $14,755.00 $116,644.32 $31,064.94 2026-04-01
77 MS_DRG Hypertensive Encephalopathy With Mcc 5 3 — — $21,530.84 $38,307.11 $31,097.64 2026-04-01
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 38 18 — — $18,084.27 $79,755.50 $31,180.50 2026-04-01
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 32 18 — — $18,886.61 $79,805.00 $31,198.92 2026-04-01
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc 28 18 — — $28,174.81 $79,249.50 $31,274.04 2026-04-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 36 18 — — $18,805.31 $80,088.25 $31,304.26 2026-04-01
668 MS_DRG Transurethral Procedures With Mcc 29 18 — — $28,530.02 $80,300.00 $31,383.02 2026-04-01
472 MS_DRG Cervical Spinal Fusion With Cc 31 18 — — $18,995.29 $81,017.75 $31,649.99 2026-04-01
21243 HCPCS Reconstruction Of Jaw Joint 18 11 — — $10,615.00 $116,644.32 $31,818.94 2026-04-01
20696 HCPCS Comp Multiplane Ext Fixation 18 11 — — $10,243.00 $116,644.32 $31,818.94 2026-04-01
570 MS_DRG Skin Debridement With Mcc 28 18 — — $28,726.23 $80,880.25 $31,886.11 2026-04-01
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/Mcc 28 18 — — $28,754.12 $80,962.75 $31,917.07 2026-04-01
93656 HCPCS Tx Atrial Fib Pulm Vein Isol 15 10 — — $17,599.00 $112,361.99 $31,958.16 2026-04-01
93653 HCPCS Ep & Ablate Supravent Arrhyt 15 10 — — $17,599.00 $112,361.99 $31,958.16 2026-04-01
93654 HCPCS Ep & Ablate Ventric Tachy 15 10 — — $17,599.00 $112,361.99 $31,958.16 2026-04-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 28 18 — — $29,054.47 $81,851.00 $32,250.46 2026-04-01
22633 HCPCS Lumbar Spine Fusion Combined 18 11 — — $14,755.00 $116,644.32 $32,271.34 2026-04-01
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 29 19 — — $22,270.97 $83,063.75 $32,411.00 2026-04-01
C9760 HCPCS Non-blind Interatrial Shunt 16 10 — — $7,920.26 $115,713.45 $32,612.19 2026-04-01
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 28 18 — — $29,430.14 $82,962.00 $32,667.46 2026-04-01
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 28 18 — — $29,460.83 $83,052.75 $32,701.52 2026-04-01
263 MS_DRG Vein Ligation And Stripping 29 19 — — $16,206.64 $84,078.50 $32,788.44 2026-04-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 30 18 — — $29,582.64 $83,413.00 $32,836.73 2026-04-01
662 MS_DRG Minor Bladder Procedures With Mcc 28 18 — — $29,845.80 $84,191.25 $33,128.84 2026-04-01
0956T HCPCS Prt Crn Ch Cr&tun Elt S-sclp 15 10 — — $10,243.00 $116,644.32 $33,176.15 2026-04-01
0960T HCPCS Rpl S-sclp Eltr Ra Rcvr&tlmt 15 10 — — $6,072.60 $116,644.32 $33,176.15 2026-04-01
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 33 19 — — $16,116.88 $85,654.25 $33,374.54 2026-04-01
5465 OTHER Level 5 Neurostimulator And Related Procedures 3 3 — — $27,139.76 $112,178.27 $33,423.19 2026-04-01
2050 OTHER Cath Coronary Drug-delivery 1 1 — — $33,446.48 $33,446.48 $33,446.48 2026-04-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 28 18 — — $30,289.35 $85,503.00 $33,621.18 2026-04-01
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 29 18 — — $24,789.40 $86,407.75 $33,654.81 2026-04-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 33 18 — — $29,160.68 $86,611.25 $33,730.50 2026-04-01
665 MS_DRG Prostatectomy With Mcc 28 18 — — $30,400.94 $85,833.00 $33,745.04 2026-04-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 30 18 — — $16,539.15 $86,900.00 $33,837.90 2026-04-01
500 MS_DRG Soft Tissue Procedures With Mcc 32 19 — — $16,229.18 $87,032.00 $33,887.00 2026-04-01
52 MS_DRG Spinal Disorders And Injuries With Cc/Mcc 40 18 — — $18,220.48 $267,262.48 $33,943.51 2026-04-01
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 36 20 — — $25,327.37 $93,232.39 $34,052.62 2026-04-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 29 18 — — $27,435.61 $87,639.75 $34,113.06 2026-04-01
33289 HCPCS Tcat Impl Wrls P-art Prs Snr 18 11 — — $12,230.00 $123,304.62 $34,114.01 2026-04-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 35 18 — — $30,438.55 $87,802.00 $34,173.40 2026-04-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 28 18 — — $30,923.53 $87,465.66 $34,325.11 2026-04-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 29 18 — — $18,507.94 $88,286.00 $34,353.43 2026-04-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 30 18 — — $17,685.48 $87,554.50 $34,391.17 2026-04-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 33 18 — — $20,233.14 $88,836.00 $34,558.00 2026-04-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 34 19 — — $16,793.83 $88,959.75 $34,604.03 2026-04-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 31 18 — — $24,860.18 $89,058.75 $34,640.85 2026-04-01
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc 28 18 — — $31,327.09 $88,572.00 $34,773.07 2026-04-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 30 19 — — $22,487.49 $89,452.00 $34,787.12 2026-04-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 29 18 — — $31,385.68 $256,997.13 $35,151.96 2026-04-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 30 18 — — $28,177.28 $90,521.75 $35,185.02 2026-04-01
37 MS_DRG Extracranial Procedures With Mcc 29 18 — — $21,454.08 $90,532.75 $35,189.11 2026-04-01
C9790 HCPCS Kidney Histotripsy W/image 5 3 — — $13,746.00 $51,644.57 $35,233.91 2026-04-01
5166 OTHER Cochlear Implant Procedure 7 7 — — $23,408.50 $60,321.89 $35,308.56 2026-04-01
509 MS_DRG Arthroscopy 5 3 — — $24,459.26 $43,517.29 $35,327.25 2026-04-01
652 MS_DRG Kidney Transplant 42 18 — — $24,409.53 $192,433.40 $35,465.22 2026-04-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 30 18 — — $23,815.16 $90,840.75 $35,624.61 2026-04-01
5232 OTHER Level 2 Icd And Similar Procedures 9 6 — — $27,783.79 $110,141.40 $35,702.31 2026-04-01
0908T HCPCS Opn Imp Int Nstm Sys Vgs Nrv 13 9 — — $6,072.60 $132,651.74 $36,014.05 2026-04-01
0909T HCPCS Rplcmt Int Nstim Sys Vgs Nrv 13 9 — — $6,072.60 $132,651.74 $36,014.05 2026-04-01
0674T HCPCS Laps Insj Nw/rpcmt Prm Isdss 14 10 — — $10,243.00 $132,651.74 $36,185.54 2026-04-01
61891 HCPCS Rev/rplcmt Sk-mnt Crnl Nstm 18 11 — — $9,105.00 $132,651.74 $36,185.54 2026-04-01
264 MS_DRG Other Circulatory System O.r. Procedures 31 18 — — $20,770.60 $91,866.50 $36,334.02 2026-04-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 35 18 — — $13,910.78 $94,281.00 $36,583.27 2026-04-01
359 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc 24 17 — — $33,352.37 $94,561.50 $36,687.61 2026-04-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 28 18 — — $33,059.46 $93,695.25 $36,696.01 2026-04-01
63685 HCPCS Insrt/redo Spine N Generator 18 11 — — $4,275.00 $132,651.74 $36,700.03 2026-04-01
61886 HCPCS Implant Neurostim Arrays 18 11 — — $8,991.00 $132,651.74 $36,700.03 2026-04-01
64582 HCPCS Opn Mpltj Hpglsl Nstm Ary Pg 18 11 — — $4,275.00 $132,651.74 $36,700.03 2026-04-01
64656 HCPCS Revj/rplcmt Bat Mod Sys Pg 10 7 — — $7,920.26 $132,651.74 $36,700.03 2026-04-01
61885 HCPCS Insrt/redo Neurostim 1 Array 18 11 — — $4,275.00 $132,651.74 $36,700.03 2026-04-01
33287 HCPCS Rmv&rplcmt Phrnc Nrv Stim Pg 18 11 — — $9,105.00 $132,651.74 $36,700.03 2026-04-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 28 18 — — $33,101.30 $93,819.00 $36,742.44 2026-04-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 31 18 — — $19,887.73 $95,001.50 $36,851.27 2026-04-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 29 18 — — $33,438.61 $95,463.50 $37,023.11 2026-04-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 32 18 — — $14,463.72 $95,903.50 $37,186.77 2026-04-01
252 MS_DRG Other Vascular Procedures With Mcc 37 19 — — $5,851.51 $95,928.25 $37,195.97 2026-04-01
33249 HCPCS Insj/rplcmt Defib W/lead(s) 18 11 — — $14,755.00 $134,935.12 $37,331.76 2026-04-01
33264 HCPCS Rmvl & Rplcmt Dfb Gen Mlt Ld 18 11 — — $10,243.00 $134,935.12 $37,331.76 2026-04-01
33270 HCPCS Ins/rep Subq Defibrillator 18 11 — — $10,243.00 $134,935.12 $37,331.76 2026-04-01
33231 HCPCS Insrt Pulse Gen W/mult Leads 18 11 — — $10,243.00 $134,935.12 $37,331.76 2026-04-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 35 18 — — $16,709.60 $96,783.50 $37,514.08 2026-04-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 34 18 — — $26,765.14 $96,981.50 $37,587.73 2026-04-01
0571T HCPCS Insj/rplcmt Icds Ss Eltrd 17 11 — — $14,884.00 $134,935.12 $37,680.66 2026-04-01
0915T HCPCS Insj Perm Ccm-d Sys Pg&eltrd 17 11 — — $14,884.00 $134,935.12 $37,680.66 2026-04-01
0408T HCPCS Insj/rplc Cardiac Modulj Sys 17 11 — — $14,884.00 $134,935.12 $37,680.66 2026-04-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 31 18 — — $30,938.04 $97,798.25 $37,891.51 2026-04-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 29 19 — — $28,668.94 $97,878.00 $37,921.18 2026-04-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 35 18 — — $28,187.92 $121,576.88 $38,040.85 2026-04-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 31 18 — — $33,919.07 $98,298.75 $38,077.68 2026-04-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 28 18 — — $34,505.41 $97,971.50 $38,301.00 2026-04-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 28 18 — — $34,533.31 $98,054.00 $38,331.97 2026-04-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 31 18 — — $16,100.88 $99,324.50 $38,459.20 2026-04-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 30 18 — — $25,674.90 $98,621.84 $38,509.51 2026-04-01
0100T HCPCS Prosth Retina Receive&Gen 8 5 — — $15,483.00 $630,040.57 $38,698.00 2026-04-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 28 18 — — $34,912.70 $99,176.00 $38,753.10 2026-04-01
265 MS_DRG Aicd Lead Procedures 28 18 — — $35,022.43 $99,500.50 $38,874.90 2026-04-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 28 18 — — $35,092.17 $99,706.75 $38,952.31 2026-04-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 28 18 — — $35,118.20 $99,783.75 $38,981.20 2026-04-01
69930 HCPCS Implant Cochlear Device 18 11 — — $12,230.00 $141,741.27 $39,214.77 2026-04-01
332 MS_DRG Rectal Resection With Mcc 29 18 — — $35,045.67 $99,569.25 $39,251.15 2026-04-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 28 18 — — $35,518.98 $100,969.00 $39,426.07 2026-04-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 30 18 — — $34,764.21 $102,487.00 $39,635.50 2026-04-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 29 18 — — $35,364.38 $102,775.75 $39,742.90 2026-04-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 34 18 — — $35,206.41 $102,786.75 $39,746.99 2026-04-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 28 18 — — $35,837.00 $101,909.50 $39,779.07 2026-04-01
904 MS_DRG Skin Grafts For Injuries With Cc/Mcc 29 18 — — $35,532.93 $101,010.25 $39,796.88 2026-04-01
0686T HCPCS Histotripsy Mal Hepatcel Tis 16 10 — — $13,746.00 $147,271.09 $40,173.49 2026-04-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 28 18 — — $36,216.39 $103,031.50 $40,200.19 2026-04-01
69718 HCPCS Revise Temple Bone Implant 4 2 — — $7,920.26 $49,166.59 $40,248.79 2026-04-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 28 18 — — $36,368.89 $103,482.50 $40,369.47 2026-04-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 34 19 — — $30,464.35 $105,580.75 $40,786.22 2026-04-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 29 19 — — $20,576.32 $106,183.00 $41,010.23 2026-04-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 44 20 — — $17,226.00 $106,284.75 $41,421.24 2026-04-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 28 18 — — $37,370.37 $106,444.25 $41,481.11 2026-04-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 30 18 — — $3,217.28 $107,577.25 $41,528.83 2026-04-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 28 18 — — $37,588.89 $107,193.99 $41,723.67 2026-04-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 32 18 — — $25,200.25 $110,563.75 $43,027.29 2026-04-01
791 MS_DRG Prematurity With Major Problems 32 18 — — $5,396.32 $111,622.50 $43,033.45 2026-04-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 29 18 — — $38,424.85 $109,562.75 $43,035.83 2026-04-01
793 MS_DRG Full Term Neonate With Major Problems 39 19 — — $979.64 $114,664.00 $43,361.75 2026-04-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 28 18 — — $39,739.69 $113,451.25 $44,111.06 2026-04-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 33 18 — — $27,064.40 $115,544.00 $44,492.06 2026-04-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 28 18 — — $40,328.31 $115,192.00 $44,764.43 2026-04-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 31 18 — — $38,250.52 $114,207.50 $44,794.86 2026-04-01
901 MS_DRG Wound Debridements For Injuries With Mcc 28 18 — — $40,400.84 $115,406.50 $44,844.93 2026-04-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 31 18 — — $28,432.58 $116,622.00 $44,893.02 2026-04-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 30 18 — — $40,177.66 $114,746.50 $44,998.98 2026-04-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 28 18 — — $40,561.70 $115,882.25 $45,023.49 2026-04-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 28 18 — — $40,581.23 $115,940.00 $45,045.17 2026-04-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 28 18 — — $40,648.18 $116,138.00 $45,119.48 2026-04-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 33 19 — — $3,677.98 $118,054.75 $45,425.94 2026-04-01
140 MS_DRG Major Head And Neck Procedures With Mcc 28 18 — — $41,039.66 $117,295.75 $45,554.02 2026-04-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 35 18 — — $23.40 $119,003.50 $45,778.82 2026-04-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 36 18 — — $21,032.13 $120,802.00 $46,447.78 2026-04-01
C9752 HCPCS Intraosseous Des Lumb/sacrum 3 1 — — $33,543.34 $49,166.59 $46,954.25 2026-04-01
163 MS_DRG Major Chest Procedures With Mcc 38 20 — — $24,793.42 $123,249.50 $47,358.14 2026-04-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 28 18 — — $42,877.10 $122,729.75 $47,593.58 2026-04-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 28 18 — — $43,040.76 $123,213.75 $47,775.24 2026-04-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 33 18 — — $18,955.00 $125,089.25 $48,042.42 2026-04-01
799 MS_DRG Splenic Procedures With Mcc 28 18 — — $43,490.82 $124,544.75 $48,274.81 2026-04-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 33 18 — — $213.57 $126,082.00 $48,411.68 2026-04-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 28 18 — — $43,656.34 $125,034.25 $48,458.54 2026-04-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 49 20 — — $3,765.89 $150,149.43 $48,531.35 2026-04-01
245 MS_DRG Aicd Generator Procedures 28 18 — — $43,802.33 $125,466.00 $48,620.58 2026-04-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 30 18 — — $40,875.43 $127,008.75 $48,756.39 2026-04-01
0398T HCPCS Mrgfus Strtctc Les Abltj 3 1 — — $35,233.91 $51,644.57 $49,320.72 2026-04-01
6 MS_DRG Liver Transplant Without Mcc 28 18 — — $44,496.01 $127,517.50 $49,390.57 2026-04-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 36 20 — — $20,446.82 $165,590.60 $49,506.15 2026-04-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 28 18 — — $44,875.40 $128,639.50 $49,811.69 2026-04-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 33 19 — — $38,744.26 $139,585.30 $50,237.92 2026-04-01
J9226 HCPCS Supprelin La Implant 15 10 — — $45,020.65 $174,117.36 $50,423.13 2026-04-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 28 18 — — $45,647.20 $130,922.00 $50,668.39 2026-04-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 51 19 — — $4,133.09 $246,180.99 $51,084.56 2026-04-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 28 18 — — $46,051.70 $132,118.25 $51,117.39 2026-04-01
471 MS_DRG Cervical Spinal Fusion With Mcc 28 18 — — $46,278.59 $132,789.25 $51,369.24 2026-04-01
0620T HCPCS Evasc Ven Artlz Tibl/prnl Vn 17 11 — — $13,746.00 $189,347.94 $51,406.68 2026-04-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 34 18 — — $42,632.44 $135,346.75 $51,857.71 2026-04-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 29 18 — — $46,952.75 $134,783.00 $52,091.21 2026-04-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 35 18 — — $30,527.16 $136,053.50 $52,120.58 2026-04-01
64568 HCPCS Inc For Vagus N Elect Impl 18 11 — — $6,072.60 $189,347.94 $52,385.85 2026-04-01
64654 HCPCS 1st Opn Implt Bat Modulj Sys 10 7 — — $7,920.26 $189,347.94 $52,385.85 2026-04-01
33276 HCPCS Insj Phrnc Nrv Stim Sys 18 11 — — $9,105.00 $189,347.94 $52,385.85 2026-04-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 46 20 — — $100.10 $153,552.08 $53,007.28 2026-04-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 28 18 — — $48,245.28 $138,605.50 $53,552.26 2026-04-01
G2170 HCPCS Avf By Tissue W Thermal E 4 2 — — $7,920.26 $65,854.39 $53,909.78 2026-04-01
G2171 HCPCS Avf Use Magnetic/art/ven 4 2 — — $7,920.26 $65,854.39 $53,909.78 2026-04-01
69715 HCPCS Temple Bne Implnt W/Stimulat 4 2 — — $7,920.26 $65,879.63 $53,930.44 2026-04-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 33 19 — — $75.90 $143,148.50 $54,759.58 2026-04-01
653 MS_DRG Major Bladder Procedures With Mcc 30 18 — — $24,872.39 $142,901.00 $55,164.50 2026-04-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 28 18 — — $50,603.45 $145,579.50 $56,169.83 2026-04-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 35 18 — — $4,217.83 $145,098.25 $56,331.99 2026-04-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 28 18 — — $50,936.34 $146,564.00 $56,539.33 2026-04-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 28 18 — — $50,966.10 $146,652.00 $56,572.37 2026-04-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 32 18 — — $35,387.43 $149,987.75 $57,303.44 2026-04-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/Mcc 28 18 — — $51,891.33 $149,529.51 $57,599.38 2026-04-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 28 18 — — $52,174.01 $150,224.25 $57,913.15 2026-04-01
834 MS_DRG Acute Leukemia With Mcc 28 18 — — $52,426.94 $150,972.25 $58,193.90 2026-04-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 34 18 — — $51,560.41 $267,924.25 $58,516.12 2026-04-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 28 18 — — $52,734.73 $152,036.74 $58,535.55 2026-04-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 29 19 — — $15,947.24 $154,126.50 $58,842.86 2026-04-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 28 18 — — $53,136.43 $153,070.50 $58,981.43 2026-04-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 30 18 — — $51,356.18 $154,605.00 $59,557.39 2026-04-01
0268T HCPCS Implt/rpl Crtd Sns Dev Gen 6 3 — — $14,884.00 $120,301.16 $59,613.04 2026-04-01
0266T HCPCS Implt/rpl Crtd Sns Dev Total 6 3 — — $14,884.00 $120,301.16 $59,613.04 2026-04-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 30 18 — — $28,886.78 $156,736.25 $59,813.56 2026-04-01
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 23 17 — — $54,444.77 $156,939.75 $59,889.25 2026-04-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 28 18 — — $54,662.36 $157,583.25 $60,675.22 2026-04-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 28 18 — — $55,004.56 $158,595.25 $61,055.07 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 15 10 — — $55,272.32 $213,765.71 $61,905.00 2026-04-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 28 18 — — $55,913.05 $161,282.00 $62,063.49 2026-04-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 28 18 — — $55,948.38 $161,386.50 $62,102.71 2026-04-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 28 18 — — $56,644.86 $163,446.25 $62,875.79 2026-04-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 33 18 — — $177.60 $165,181.50 $62,954.77 2026-04-01
A9543 HCPCS Y90 Ibritumomab, Rx 12 8 — — $56,824.55 $219,768.94 $63,075.24 2026-04-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 28 18 — — $56,827.12 $163,985.25 $63,078.10 2026-04-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/Mcc 31 18 — — $56,516.54 $163,066.75 $63,298.52 2026-04-01
28 MS_DRG Spinal Procedures With Mcc 28 18 — — $57,247.42 $165,228.25 $63,544.64 2026-04-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 28 18 — — $57,752.34 $166,721.50 $64,105.10 2026-04-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 28 18 — — $58,298.18 $168,335.75 $64,710.98 2026-04-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 28 18 — — $58,364.20 $168,531.00 $64,784.26 2026-04-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 38 20 — — $8,659.39 $176,954.25 $66,109.41 2026-04-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 28 18 — — $62,297.58 $180,163.50 $69,150.32 2026-04-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 28 18 — — $62,519.82 $180,820.75 $69,397.00 2026-04-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 28 18 — — $62,519.82 $180,820.75 $69,397.00 2026-04-01
J9029 HCPCS Inj, Adstiladrin, Per Tx Dos 12 9 — — $63,342.28 $244,976.28 $70,309.93 2026-04-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 28 18 — — $63,553.85 $183,878.75 $70,544.77 2026-04-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 28 18 — — $63,968.57 $185,105.25 $71,005.11 2026-04-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 29 18 — — $63,508.28 $183,744.00 $71,129.27 2026-04-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 38 19 — — $92.51 $190,074.50 $72,213.75 2026-04-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 28 18 — — $65,333.63 $189,142.25 $72,520.33 2026-04-01
38240 HCPCS Transplt Allo Hct/donor 18 11 — — $13,821.00 $270,400.67 $73,761.53 2026-04-01
0809T HCPCS Arthrd Si Jt Prq Tfx&implt 4 2 — — $7,920.26 $90,467.87 $74,058.88 2026-04-01
0775T HCPCS Arthrd Si Jt Prq Iartic Impl 4 2 — — $7,920.26 $90,467.87 $74,058.88 2026-04-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 28 18 — — $67,681.57 $196,086.00 $75,126.54 2026-04-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 28 18 — — $67,720.63 $196,383.99 $75,169.90 2026-04-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 28 18 — — $68,074.91 $197,249.25 $75,563.15 2026-04-01
10 MS_DRG Pancreas Transplant 28 18 — — $68,102.81 $197,521.17 $75,594.12 2026-04-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 28 18 — — $68,501.72 $198,511.50 $76,036.91 2026-04-01
0426T HCPCS Insj/rplc Nstim Apnea Stm Ld 3 1 — — $54,340.97 $79,651.00 $76,066.95 2026-04-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 29 18 — — $71,288.79 $211,153.25 $80,054.01 2026-04-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 28 18 — — $72,233.32 $209,547.25 $80,178.99 2026-04-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 28 18 — — $72,468.58 $210,243.00 $80,440.12 2026-04-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 28 18 — — $74,547.78 $216,392.00 $82,748.04 2026-04-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 31 20 — — $13,301.83 $231,822.25 $87,741.86 2026-04-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 28 18 — — $79,518.91 $231,093.50 $88,265.99 2026-04-01
850 MS_DRG Acute Leukemia With Other Procedures 29 18 — — $42,526.09 $238,136.25 $90,090.35 2026-04-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 28 18 — — $85,155.82 $247,764.00 $94,522.96 2026-04-01
0316T HCPCS Replc Vagus Nerve Pls Gen 4 2 — — $7,920.26 $120,301.16 $98,481.04 2026-04-01
0312T HCPCS Laps Impltj Nstim Vagus 4 2 — — $7,920.26 $120,301.16 $98,481.04 2026-04-01
215 MS_DRG Other Heart Assist System Implant 32 18 — — $41.24 $273,817.50 $103,362.03 2026-04-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 31 18 — — $87,041.92 $269,027.00 $103,427.11 2026-04-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 28 18 — — $97,252.60 $283,538.75 $107,950.39 2026-04-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 28 18 — — $102,493.38 $299,037.75 $113,767.65 2026-04-01
0431T HCPCS Rmvl/rplc Nstim Apnea Pls Gn 3 1 — — $82,074.08 $120,301.16 $114,887.99 2026-04-01
0427T HCPCS Insj/rplc Nstim Apnea Pls Gn 3 1 — — $82,074.08 $120,301.16 $114,887.99 2026-04-01
0424T HCPCS Insj/rplc Nstim Apnea Compl 3 1 — — $82,074.08 $120,301.16 $114,887.99 2026-04-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 28 18 — — $103,861.23 $303,083.00 $115,285.96 2026-04-01
209 MS_DRG Complex Aortic Arch Procedures 23 17 — — $106,628.55 $311,267.00 $117,291.41 2026-04-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 28 18 — — $106,749.43 $311,624.50 $118,491.86 2026-04-01
14 MS_DRG Allogeneic Bone Marrow Transplant 28 18 — — $113,129.32 $330,492.25 $125,573.54 2026-04-01
7 MS_DRG Lung Transplant 28 18 — — $121,798.56 $356,130.50 $135,196.41 2026-04-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 34 18 — — $16,298.12 $398,959.57 $146,427.27 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 1 1 — — $177,719.40 $177,719.40 $177,719.40 2026-04-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 32 18 — — $101,694.36 $583,693.00 $218,620.49 2026-04-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 28 18 — — $199,911.04 $587,732.37 $221,901.25 2026-04-01
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 12 8 — — $205,640.00 $795,312.70 $228,260.40 2026-04-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 28 18 — — $261,965.46 $770,657.25 $290,781.67 2026-04-01
18 MS_DRG Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 28 18 — — $402,924.61 $1,187,527.00 $447,246.32 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 12 9 — — $489,304.61 $1,892,385.57 $543,128.11 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 12 9 — — $533,230.17 $2,062,267.69 $591,885.49 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 12 9 — — $557,317.93 $2,155,427.11 $618,622.91 2026-04-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 12 9 — — $562,538.19 $2,175,616.43 $624,417.39 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 12 9 — — $565,868.94 $2,188,498.14 $628,114.53 2026-04-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 12 9 — — $591,726.20 $2,288,501.08 $656,816.08 2026-04-01
Q2057 HCPCS Afamitresgene Autoleucel 12 9 — — $770,620.00 $2,980,372.85 $855,388.20 2026-04-01
J3392 HCPCS Inj, Exagamglogene Autotem 8 7 — — $2,332,000.00 $4,664,000.00 $2,495,240.00 2026-04-01
J3399 HCPCS Inj Onase Abepar-xioi Treat 8 7 — — $2,455,110.60 $4,910,221.21 $2,626,968.35 2026-04-01
J3393 HCPCS Inj, Betibeglogene Autotemce 7 7 — — $2,945,740.00 $3,299,228.80 $3,122,484.40 2026-04-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 7 7 — — $3,248,445.72 $3,638,259.20 $3,443,352.46 2026-04-01
J1413 HCPCS Inj Delandistrogene Mox Rokl 7 7 — — $3,316,462.59 $3,714,438.10 $3,515,450.34 2026-04-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 7 7 — — $3,685,266.67 $4,127,498.67 $3,906,382.67 2026-04-01
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