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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

OUR LADY OF FATIMA HOSPITAL

North Providence, RI · CCN 410005 · Rates published

18,880 distinct procedures filed
8 distinct payers
159,348 rate rows
2026-01-01 last MRF observed
Data quality

156,702 of 159,348 rate rows are consumer-grade (98.3%)

2,646 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
placeholder amount (≤ $0.02) — excluded from medians 1,500
per-diem day rate — not a per-procedure price 1,108
percent-of-charges filed in the dollar field — excluded from medians 23
exceeds 10× this hospital's gross charge — excluded from medians 15
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/7916/464661337_prospect-chartercare-sjhsri,-llc_standardcharges.csv
Found on page https://www.chartercare.org/cms-hpt.txt
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-05-18
Content fingerprint a06e670e1ea8c74b… · 65,517,502 bytes · first seen 2026-05-14

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J3391
HCPCS 		Inj, Atidarsagene Autotemcel 3 $4,505,000.00 $4,505,000.00 $4,505,000.00 nat. median
$4,505,000
1.0× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 3 $3,685,266.67 $3,685,266.67 $3,685,266.67 nat. median
$3,710,000
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 3 $3,316,462.59 $3,316,462.59 $3,316,462.59 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 3 $3,248,445.72 $3,248,445.72 $3,248,445.72 nat. median
$3,286,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 3 $2,945,740.00 $2,945,740.00 $2,945,740.00 nat. median
$3,006,423
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 3 $2,455,110.61 $4,352,911.10 $2,455,110.61 nat. median
$2,469,189
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 3 $2,332,000.00 $4,134,636.00 $2,332,000.00 nat. median
$2,448,600
1.0× median
Q2056
HCPCS 		Ciltacabtagene Autolucel Bag 8 $502,083.28 $1,651,770.90 $1,465,852.97 nat. median
$675,122
outlier · 2.2×
Q2041
HCPCS 		Axicabtagene Ciloleucel Bag 8 $470,944.44 $1,497,898.71 $1,329,300.13 nat. median
$634,511
outlier · 2.1×
Q2057
HCPCS 		Afamitresgene Autoleucel 3 $770,620.00 $1,366,309.26 $770,620.00 nat. median
$824,563
0.9× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 3 $591,726.20 $1,049,130.55 $591,726.20 nat. median
$754,974
0.8× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 3 $562,538.19 $997,380.20 $562,538.19 nat. median
$674,188
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 3 $557,317.93 $988,124.70 $557,317.93 nat. median
$625,184
0.9× median
5834
APR_DRG 		Neonate W Ecmo 1 $533,683.55 $533,683.55 $533,683.55 nat. median
$309,665
1.7× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 3 $489,304.61 $867,537.07 $489,304.61 nat. median
$620,080
0.8× median
5884
APR_DRG 		Neonate Bwt <1500g W Major Procedure 1 $480,257.90 $480,257.90 $480,257.90 nat. median
$246,434
1.9× median
5914
APR_DRG 		Neonate Birthwt 500-749g Without Major Procedure 1 $385,008.42 $385,008.42 $385,008.42 nat. median
$164,279
outlier · 2.3×
34
APR_DRG 		Bone Marrow Transplant 1 $354,786.41 $354,786.41 $354,786.41 nat. median
$209,067
1.7× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 $309,001.44 $656,306.01 $354,359.45 nat. median
$370,174
1.0× median
24
APR_DRG 		Heart &/or Lung Transplant 1 $354,213.48 $354,213.48 $354,213.48 nat. median
$234,738
1.5× median
5883
APR_DRG 		Neonate Bwt <1500g W Major Procedure 1 $329,434.29 $329,434.29 $329,434.29 nat. median
$182,736
1.8× median
1614
APR_DRG 		Cardiac Defibrillator & Heart Assist Implant 1 $313,535.50 $313,535.50 $313,535.50 nat. median
$207,730
1.5× median
5934
APR_DRG 		Neonate Birthwt 750-999g Without Major Procedure 1 $290,475.10 $290,475.10 $290,475.10 nat. median
$151,838
1.9× median
8414
APR_DRG 		Extensive 3rd Degree Burns W Skin Graft 1 $280,592.08 $280,592.08 $280,592.08 nat. median
$160,267
1.8× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 3 $278,250.00 $493,337.25 $278,250.00 nat. median
$324,450
0.9× median
14
APR_DRG 		Liver Transplant &/or Intestinal Transplant 1 $276,581.57 $276,581.57 $276,581.57 nat. median
$129,535
outlier · 2.1×
6304
APR_DRG 		Neonate Birthwt >2499g W Major Cardiovascular Procedure 1 $276,151.87 $276,151.87 $276,151.87 nat. median
$150,721
1.8× median
5833
APR_DRG 		Neonate W Ecmo 1 $271,138.74 $271,138.74 $271,138.74 nat. median
$244,017
1.1× median
6094
APR_DRG 		Neonate Bwt 1500-2499g W Major Procedure 1 $258,247.84 $258,247.84 $258,247.84 nat. median
$162,982
1.6× median
J3403
HCPCS 		Revakinagene, Per Implant 3 $257,500.00 $456,547.50 $257,500.00 nat. median
$265,000
1.0× median
5891
APR_DRG 		Neonate Bwt <500g Or Ga <24 Weeks 1 $250,656.53 $250,656.53 $250,656.53 nat. median
$93,260
outlier · 2.7×
6314
APR_DRG 		Neonate Birthwt >2499g W Other Major Procedure 1 $242,205.82 $242,205.82 $242,205.82 nat. median
$122,924
2.0× median
44
APR_DRG 		Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo 1 $236,046.83 $236,046.83 $236,046.83 nat. median
$105,658
outlier · 2.2×
5913
APR_DRG 		Neonate Birthwt 500-749g Without Major Procedure 1 $233,898.35 $233,898.35 $233,898.35 nat. median
$102,636
outlier · 2.3×
6024
APR_DRG 		Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom 1 $233,468.65 $233,468.65 $233,468.65 nat. median
$118,620
2.0× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 4 $200,762.15 $425,916.20 $230,231.82 nat. median
$265,286
0.9× median
23
APR_DRG 		Heart &/or Lung Transplant 1 $229,601.38 $229,601.38 $229,601.38 nat. median
$93,528
outlier · 2.5×
5892
APR_DRG 		Neonate Bwt <500g Or Ga <24 Weeks 1 $227,882.59 $227,882.59 $227,882.59 nat. median
$89,790
outlier · 2.5×
6034
APR_DRG 		Neonate Birthwt 1000-1249g W Or Without Other Significant Condition 1 $222,439.76 $222,439.76 $222,439.76 nat. median
$109,499
outlier · 2.0×
5832
APR_DRG 		Neonate W Ecmo 1 $213,845.82 $213,845.82 $213,845.82 nat. median
$156,126
1.4× median
5933
APR_DRG 		Neonate Birthwt 750-999g Without Major Procedure 1 $208,116.53 $208,116.53 $208,116.53 nat. median
$108,996
1.9× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 3 $205,640.00 $364,599.72 $205,640.00 nat. median
$209,753
1.0× median
33
APR_DRG 		Bone Marrow Transplant 1 $201,814.31 $201,814.31 $201,814.31 nat. median
$113,142
1.8× median
5831
APR_DRG 		Neonate W Ecmo 1 $192,504.21 $192,504.21 $192,504.21 nat. median
$145,122
1.3× median
64
APR_DRG 		Pancreas Transplant 1 $191,358.35 $191,358.35 $191,358.35 nat. median
$91,748
outlier · 2.1×
6074
APR_DRG 		Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom 1 $188,207.24 $188,207.24 $188,207.24 nat. median
$95,507
2.0× median
8424
APR_DRG 		Full Thickness Burns W Skin Graft 1 $178,610.68 $178,610.68 $178,610.68 nat. median
$80,494
outlier · 2.2×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv &gt;96 Hours With Skin Graft 4 $153,111.99 $324,491.73 $175,587.14 nat. median
$206,368
0.9× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mo… 4 $152,217.31 $322,587.38 $174,561.14 nat. median
$202,986
0.9× median
5893
APR_DRG 		Neonate Bwt <500g Or Ga <24 Weeks 1 $174,170.48 $174,170.48 $174,170.48 nat. median
$69,788
outlier · 2.5×

Other procedures at this hospital

Browse this hospital's 18,880 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
             
3014 APR_DRG Hip Joint Replacement 1 1 — — $51,563.63 $51,563.63 $51,563.63 2026-01-01
6112 APR_DRG Neonate Birthwt 1500-1999g W Major Anomaly 1 1 — — $51,706.86 $51,706.86 $51,706.86 2026-01-01
1663 APR_DRG Coronary Bypass Without Cardiac Cath Or Percutaneous Cardiac Procedure 1 1 — — $51,850.09 $51,850.09 $51,850.09 2026-01-01
2254 APR_DRG Appendectomy 1 1 — — $52,423.02 $52,423.02 $52,423.02 2026-01-01
5424 APR_DRG Vaginal Delivery W Complicating Procedures Exc Sterilization &/or D&c 1 1 — — $52,709.49 $52,709.49 $52,709.49 2026-01-01
434 APR_DRG Multiple Sclerosis & Other Demyelinating Diseases 1 1 — — $52,709.49 $52,709.49 $52,709.49 2026-01-01
6223 APR_DRG Neonate Bwt 2000-2499g W Resp Dist Synd/oth Maj Resp Cond 1 1 — — $52,852.72 $52,852.72 $52,852.72 2026-01-01
903 APR_DRG Major Larynx & Trachea Procedures 1 1 — — $52,995.95 $52,995.95 $52,995.95 2026-01-01
4454 APR_DRG Other Bladder Procedures 1 1 — — $53,282.42 $53,282.42 $53,282.42 2026-01-01
6614 APR_DRG Coagulation & Platelet Disorders 1 1 — — $53,425.65 $53,425.65 $53,425.65 2026-01-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support &gt;96 Hours 8 4 — — $46,608.50 $97,796.63 $53,450.12 2026-01-01
203 APR_DRG Craniotomy For Trauma 1 1 — — $53,712.11 $53,712.11 $53,712.11 2026-01-01
1632 APR_DRG Cardiac Valve Procedures Without Cardiac Catheterization 1 1 — — $53,712.11 $53,712.11 $53,712.11 2026-01-01
1754 APR_DRG Percutaneous Cardiovascular Procedures Without Ami 1 1 — — $53,855.34 $53,855.34 $53,855.34 2026-01-01
6914 APR_DRG Lymphoma, Myeloma & Non-acute Leukemia 1 1 — — $53,855.34 $53,855.34 $53,855.34 2026-01-01
6233 APR_DRG Neonate Bwt 2000-2499g W Congenital/perinatal Infection 1 1 — — $53,855.34 $53,855.34 $53,855.34 2026-01-01
6924 APR_DRG Radiotherapy 1 1 — — $53,998.58 $53,998.58 $53,998.58 2026-01-01
1652 APR_DRG Coronary Bypass W Cardiac Cath Or Percutaneous Cardiac Procedure 1 1 — — $54,141.81 $54,141.81 $54,141.81 2026-01-01
1714 APR_DRG Perm Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock 1 1 — — $54,285.04 $54,285.04 $54,285.04 2026-01-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 8 4 — — $47,441.79 $99,570.27 $54,405.72 2026-01-01
913 APR_DRG Other Major Head & Neck Procedures 1 1 — — $54,571.51 $54,571.51 $54,571.51 2026-01-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 8 4 — — $47,612.42 $99,933.51 $54,601.40 2026-01-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 8 4 — — $47,612.42 $99,933.51 $54,601.40 2026-01-01
6903 APR_DRG Acute Leukemia 1 1 — — $54,714.74 $54,714.74 $54,714.74 2026-01-01
3224 APR_DRG Shoulder & Elbow Joint Replacement 1 1 — — $54,792.08 $54,792.08 $54,792.08 2026-01-01
9123 APR_DRG Musculoskeletal & Other Procedures For Multiple Significant Trauma 1 1 — — $54,857.97 $54,857.97 $54,857.97 2026-01-01
6132 APR_DRG Neonate Birthwt 1500-1999g W Congenital/perinatal Infection 1 1 — — $54,857.97 $54,857.97 $54,857.97 2026-01-01
233 APR_DRG Spinal Procedures 1 1 — — $55,001.20 $55,001.20 $55,001.20 2026-01-01
7594 APR_DRG Eating Disorders 1 1 — — $55,001.20 $55,001.20 $55,001.20 2026-01-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 5 3 — — $55,272.32 $97,997.83 $55,272.32 2026-01-01
3123 APR_DRG Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses 1 1 — — $55,287.67 $55,287.67 $55,287.67 2026-01-01
5184 APR_DRG Other Female Reproductive System & Related Procedures 1 1 — — $55,287.67 $55,287.67 $55,287.67 2026-01-01
9102 APR_DRG Craniotomy For Multiple Significant Trauma 1 1 — — $55,287.67 $55,287.67 $55,287.67 2026-01-01
1303 APR_DRG Respiratory System Diagnosis W Ventilator Support 96+ Hours 1 1 — — $55,430.90 $55,430.90 $55,430.90 2026-01-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 8 4 — — $48,371.44 $101,549.09 $55,471.84 2026-01-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 8 4 — — $48,406.43 $101,623.57 $55,511.96 2026-01-01
6604 APR_DRG Major Hematologic/immunologic Diag Exc Sickle Cell Crisis & Coagul 1 1 — — $55,574.13 $55,574.13 $55,574.13 2026-01-01
6213 APR_DRG Neonate Bwt 2000-2499g W Major Anomaly 1 1 — — $55,860.60 $55,860.60 $55,860.60 2026-01-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 8 4 — — $48,724.90 $102,301.41 $55,877.18 2026-01-01
223 APR_DRG Ventricular Shunt Procedures 1 1 — — $56,003.83 $56,003.83 $56,003.83 2026-01-01
8904 APR_DRG HIV W Multiple Major HIV Related Conditions 1 1 — — $56,003.83 $56,003.83 $56,003.83 2026-01-01
6122 APR_DRG Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond 1 1 — — $56,433.53 $56,433.53 $56,433.53 2026-01-01
A9543 HCPCS Y90 Ibritumomab, Rx 5 3 — — $56,824.55 $100,749.93 $56,824.55 2026-01-01
6031 APR_DRG Neonate Birthwt 1000-1249g W Or Without Other Significant Condition 1 1 — — $57,006.46 $57,006.46 $57,006.46 2026-01-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 8 4 — — $49,773.09 $104,532.53 $57,079.23 2026-01-01
3624 APR_DRG Mastectomy Procedures 1 1 — — $57,149.69 $57,149.69 $57,149.69 2026-01-01
J7330 HCPCS Cultured Chondrocytes Implnt 1 1 — — $57,294.42 $57,294.42 $57,294.42 2026-01-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv &gt;96 Hours 8 4 — — $50,015.14 $105,047.75 $57,356.81 2026-01-01
984 APR_DRG Other Ear, Nose, Mouth & Throat Procedures 1 1 — — $57,436.15 $57,436.15 $57,436.15 2026-01-01
3644 APR_DRG Other Skin, Subcutaneous Tissue & Related Procedures 1 1 — — $57,436.15 $57,436.15 $57,436.15 2026-01-01
1611 APR_DRG Cardiac Defibrillator & Heart Assist Implant 1 1 — — $57,436.15 $57,436.15 $57,436.15 2026-01-01
3024 APR_DRG Knee Joint Replacement 1 1 — — $57,722.62 $57,722.62 $57,722.62 2026-01-01
704 APR_DRG Orbital Procedures 1 1 — — $58,009.08 $58,009.08 $58,009.08 2026-01-01
2274 APR_DRG Hernia Procedures Except Inguinal, Femoral & Umbilical 1 1 — — $58,295.55 $58,295.55 $58,295.55 2026-01-01
8503 APR_DRG Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service 1 1 — — $58,725.24 $58,725.24 $58,725.24 2026-01-01
1673 APR_DRG Other Cardiothoracic Procedures 1 1 — — $58,868.48 $58,868.48 $58,868.48 2026-01-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 8 4 — — $51,576.03 $108,370.10 $59,146.82 2026-01-01
1744 APR_DRG Percutaneous Cardiovascular Procedures W Ami 1 1 — — $59,154.94 $59,154.94 $59,154.94 2026-01-01
504 APR_DRG Non-bacterial Infections Of Nervous System Exc Viral Meningitis 1 1 — — $59,154.94 $59,154.94 $59,154.94 2026-01-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 8 4 — — $51,606.01 $108,433.93 $59,181.20 2026-01-01
6071 APR_DRG Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom 1 1 — — $59,441.40 $59,441.40 $59,441.40 2026-01-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 8 4 — — $51,878.06 $109,012.99 $59,493.19 2026-01-01
10 MS_DRG Pancreas Transplant 8 4 — — $51,899.48 $109,058.58 $59,517.75 2026-01-01
5124 APR_DRG Uterine & Adnexa Procedures For Non-ovarian & Non-adnexal Malig 1 1 — — $59,584.64 $59,584.64 $59,584.64 2026-01-01
4834 APR_DRG Testes & Scrotal Procedures 1 1 — — $59,584.64 $59,584.64 $59,584.64 2026-01-01
3054 APR_DRG Amputation Of Lower Limb Except Toes 1 1 — — $59,727.87 $59,727.87 $59,727.87 2026-01-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 8 4 — — $52,205.79 $109,710.59 $59,869.03 2026-01-01
1621 APR_DRG Cardiac Valve Procedures W Cardiac Catheterization 1 1 — — $59,871.10 $59,871.10 $59,871.10 2026-01-01
3154 APR_DRG Shoulder, Upper Arm & Forearm Procedures 1 1 — — $60,157.57 $60,157.57 $60,157.57 2026-01-01
4804 APR_DRG Major Male Pelvic Procedures 1 1 — — $60,587.26 $60,587.26 $60,587.26 2026-01-01
4434 APR_DRG Kidney & Urinary Tract Procedures For Nonmalignancy 1 1 — — $60,873.73 $60,873.73 $60,873.73 2026-01-01
1764 APR_DRG Cardiac Pacemaker & Defibrillator Device Replacement 1 1 — — $61,589.89 $61,589.89 $61,589.89 2026-01-01
1804 APR_DRG Other Circulatory System Procedures 1 1 — — $61,876.35 $61,876.35 $61,876.35 2026-01-01
494 APR_DRG Bacterial & Tuberculous Infections Of Nervous System 1 1 — — $61,876.35 $61,876.35 $61,876.35 2026-01-01
8423 APR_DRG Full Thickness Burns W Skin Graft 1 1 — — $62,019.59 $62,019.59 $62,019.59 2026-01-01
4814 APR_DRG Penis Procedures 1 1 — — $62,306.05 $62,306.05 $62,306.05 2026-01-01
4044 APR_DRG Thyroid, Parathyroid & Thyroglossal Procedures 1 1 — — $62,306.05 $62,306.05 $62,306.05 2026-01-01
1774 APR_DRG Cardiac Pacemaker & Defibrillator Revision Except Device Replacement 1 1 — — $62,449.28 $62,449.28 $62,449.28 2026-01-01
4444 APR_DRG Renal Dialysis Access Device Procedure Only 1 1 — — $62,592.52 $62,592.52 $62,592.52 2026-01-01
9304 APR_DRG Multiple Significant Trauma Without O.r. Procedure 1 1 — — $62,592.52 $62,592.52 $62,592.52 2026-01-01
4424 APR_DRG Kidney & Urinary Tract Procedures For Malignancy 1 1 — — $62,735.75 $62,735.75 $62,735.75 2026-01-01
3134 APR_DRG Knee & Lower Leg Procedures Except Foot 1 1 — — $63,022.21 $63,022.21 $63,022.21 2026-01-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 8 4 — — $55,071.20 $115,809.68 $63,155.05 2026-01-01
J9029 HCPCS Instill Adstiladrin, Tx Dose 5 3 — — $63,342.28 $112,305.87 $63,342.28 2026-01-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 8 4 — — $55,251.85 $116,194.20 $63,362.21 2026-01-01
9524 APR_DRG Nonextensive Procedure Unrelated To Principal Diagnosis 1 1 — — $63,451.91 $63,451.91 $63,451.91 2026-01-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 8 4 — — $55,488.19 $116,697.26 $63,633.24 2026-01-01
6021 APR_DRG Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom 1 1 — — $64,311.30 $64,311.30 $64,311.30 2026-01-01
213 APR_DRG Craniotomy Except For Trauma 1 1 — — $64,454.54 $64,454.54 $64,454.54 2026-01-01
J9228 HCPCS Ipilimumab 200 Mg/40 Ml 34 8 $156,656.12 $78,328.06 50% off $183.48 $91,894.48 $64,698.98 2026-01-01
1704 APR_DRG Permanent Cardiac Pacemaker Implant W Ami, Heart Failure Or Shock 1 1 — — $64,741.00 $64,741.00 $64,741.00 2026-01-01
2624 APR_DRG Cholecystectomy Except Laparoscopic 1 1 — — $64,884.23 $64,884.23 $64,884.23 2026-01-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 8 4 — — $56,848.43 $119,592.54 $65,193.15 2026-01-01
3094 APR_DRG Hip & Femur Procedures For Non-trauma Except Joint Replacement 1 1 — — $65,313.93 $65,313.93 $65,313.93 2026-01-01
4401 APR_DRG Kidney Transplant 1 1 — — $65,313.93 $65,313.93 $65,313.93 2026-01-01
3031 APR_DRG Dorsal & Lumbar Fusion Proc For Curvature Of Back 1 1 — — $65,600.39 $65,600.39 $65,600.39 2026-01-01
6091 APR_DRG Neonate Bwt 1500-2499g W Major Procedure 1 1 — — $65,600.39 $65,600.39 $65,600.39 2026-01-01
6302 APR_DRG Neonate Birthwt >2499g W Major Cardiovascular Procedure 1 1 — — $66,030.09 $66,030.09 $66,030.09 2026-01-01
3204 APR_DRG Other Musculoskeletal System & Connective Tissue Procedures 1 1 — — $66,173.32 $66,173.32 $66,173.32 2026-01-01
1653 APR_DRG Coronary Bypass W Cardiac Cath Or Percutaneous Cardiac Procedure 1 1 — — $66,173.32 $66,173.32 $66,173.32 2026-01-01
1622 APR_DRG Cardiac Valve Procedures W Cardiac Catheterization 1 1 — — $66,459.79 $66,459.79 $66,459.79 2026-01-01
2614 APR_DRG Major Biliary Tract Procedures 1 1 — — $67,175.95 $67,175.95 $67,175.95 2026-01-01
8434 APR_DRG Extensive 3rd Degree Or Full Thickness Burns Without Skin Graft 1 1 — — $67,319.18 $67,319.18 $67,319.18 2026-01-01
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 5 3 — — $52,038.74 $119,593.57 $67,452.66 2026-01-01
1633 APR_DRG Cardiac Valve Procedures Without Cardiac Catheterization 1 1 — — $67,748.88 $67,748.88 $67,748.88 2026-01-01
934 APR_DRG Sinus & Mastoid Procedures 1 1 — — $68,178.57 $68,178.57 $68,178.57 2026-01-01
2244 APR_DRG Peritoneal Adhesiolysis 1 1 — — $68,321.81 $68,321.81 $68,321.81 2026-01-01
3043 APR_DRG Dorsal & Lumbar Fusion Proc Except For Curvature Of Back 1 1 — — $69,181.20 $69,181.20 $69,181.20 2026-01-01
8633 APR_DRG Neonatal Aftercare 1 1 — — $69,324.43 $69,324.43 $69,324.43 2026-01-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 8 4 — — $60,665.63 $127,717.56 $69,570.68 2026-01-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 8 4 — — $60,854.86 $128,120.32 $69,787.68 2026-01-01
2294 APR_DRG Other Digestive System & Abdominal Procedures 1 1 — — $70,040.59 $70,040.59 $70,040.59 2026-01-01
5114 APR_DRG Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy 1 1 — — $70,040.59 $70,040.59 $70,040.59 2026-01-01
6143 APR_DRG Neonate Bwt 1500-1999g W Or Without Other Significant Condition 1 1 — — $70,040.59 $70,040.59 $70,040.59 2026-01-01
1824 APR_DRG Other Peripheral Vascular Procedures 1 1 — — $70,042.03 $70,042.03 $70,042.03 2026-01-01
3174 APR_DRG Tendon, Muscle & Other Soft Tissue Procedures 1 1 — — $70,183.83 $70,183.83 $70,183.83 2026-01-01
9103 APR_DRG Craniotomy For Multiple Significant Trauma 1 1 — — $71,329.69 $71,329.69 $71,329.69 2026-01-01
4402 APR_DRG Kidney Transplant 1 1 — — $71,472.92 $71,472.92 $71,472.92 2026-01-01
6394 APR_DRG Neonate Birthwt >2499g W Other Significant Condition 1 1 — — $71,472.92 $71,472.92 $71,472.92 2026-01-01
850 MS_DRG Acute Leukemia With Other Procedures 8 4 — — $62,494.28 $131,609.85 $71,667.75 2026-01-01
9514 APR_DRG Moderately Extensive Procedure Unrelated To Principal Diagnosis 1 1 — — $71,759.38 $71,759.38 $71,759.38 2026-01-01
6082 APR_DRG Neonate Bwt 1250-1499g W Or Without Other Significant Condition 1 1 — — $71,759.38 $71,759.38 $71,759.38 2026-01-01
1612 APR_DRG Cardiac Defibrillator & Heart Assist Implant 1 1 — — $72,332.31 $72,332.31 $72,332.31 2026-01-01
6954 APR_DRG Chemotherapy For Acute Leukemia 1 1 — — $73,515.41 $73,515.41 $73,515.41 2026-01-01
2234 APR_DRG Other Small & Large Bowel Procedures 1 1 — — $74,480.80 $74,480.80 $74,480.80 2026-01-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 8 4 — — $64,994.09 $136,930.78 $74,534.51 2026-01-01
2224 APR_DRG Other Stomach, Esophageal & Duodenal Procedures 1 1 — — $74,767.26 $74,767.26 $74,767.26 2026-01-01
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 1 1 — — $75,053.73 $75,053.73 $75,053.73 2026-01-01
924 APR_DRG Facial Bone Procedures Except Major Cranial/facial Bone Procedures 1 1 — — $75,483.42 $75,483.42 $75,483.42 2026-01-01
3032 APR_DRG Dorsal & Lumbar Fusion Proc For Curvature Of Back 1 1 — — $75,483.42 $75,483.42 $75,483.42 2026-01-01
6092 APR_DRG Neonate Bwt 1500-2499g W Major Procedure 1 1 — — $76,486.05 $76,486.05 $76,486.05 2026-01-01
1304 APR_DRG Respiratory System Diagnosis W Ventilator Support 96+ Hours 1 1 — — $77,202.21 $77,202.21 $77,202.21 2026-01-01
51 APR_DRG Tracheostomy W Mv 96+ Hours Without Extensive Procedure 1 1 — — $77,345.44 $77,345.44 $77,345.44 2026-01-01
4474 APR_DRG Other Kidney, Urinary Tract & Related Procedures 1 1 — — $77,345.44 $77,345.44 $77,345.44 2026-01-01
5464 APR_DRG Other O.r. Proc For Obstetric Diagnoses Except Delivery Diagnoses 1 1 — — $77,918.37 $77,918.37 $77,918.37 2026-01-01
8411 APR_DRG Extensive 3rd Degree Burns W Skin Graft 1 1 — — $79,350.69 $79,350.69 $79,350.69 2026-01-01
1814 APR_DRG Lower Extremity Arterial Procedures 1 1 — — $79,846.28 $79,846.28 $79,846.28 2026-01-01
8444 APR_DRG Partial Thickness Burns W Or Without Skin Graft 1 1 — — $79,923.62 $79,923.62 $79,923.62 2026-01-01
6234 APR_DRG Neonate Bwt 2000-2499g W Congenital/perinatal Infection 1 1 — — $80,353.32 $80,353.32 $80,353.32 2026-01-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 8 4 — — $70,514.99 $148,682.12 $80,865.81 2026-01-01
6514 APR_DRG Other Procedures Of Blood & Blood-forming Organs 1 1 — — $81,069.48 $81,069.48 $81,069.48 2026-01-01
914 APR_DRG Other Major Head & Neck Procedures 1 1 — — $81,212.71 $81,212.71 $81,212.71 2026-01-01
264 APR_DRG Other Nervous System & Related Procedures 1 1 — — $81,355.95 $81,355.95 $81,355.95 2026-01-01
215 MS_DRG Other Heart Assist System Implant 8 4 — — $71,758.82 $151,329.67 $82,292.22 2026-01-01
4054 APR_DRG Other Procedures For Endocrine, Nutritional & Metabolic Disorders 1 1 — — $82,358.57 $82,358.57 $82,358.57 2026-01-01
6133 APR_DRG Neonate Birthwt 1500-1999g W Congenital/perinatal Infection 1 1 — — $82,358.57 $82,358.57 $82,358.57 2026-01-01
7914 APR_DRG O.r. Procedure For Other Complications Of Treatment 1 1 — — $82,645.04 $82,645.04 $82,645.04 2026-01-01
6123 APR_DRG Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond 1 1 — — $82,788.27 $82,788.27 $82,788.27 2026-01-01
1214 APR_DRG Other Respiratory & Chest Procedures 1 1 — — $82,931.50 $82,931.50 $82,931.50 2026-01-01
6504 APR_DRG Splenectomy 1 1 — — $82,931.50 $82,931.50 $82,931.50 2026-01-01
6072 APR_DRG Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom 1 1 — — $83,790.90 $83,790.90 $83,790.90 2026-01-01
6032 APR_DRG Neonate Birthwt 1000-1249g W Or Without Other Significant Condition 1 1 — — $84,507.06 $84,507.06 $84,507.06 2026-01-01
7114 APR_DRG Post-op, Post-trauma, Other Device Infections W O.r. Procedure 1 1 — — $84,650.29 $84,650.29 $84,650.29 2026-01-01
244 APR_DRG Extracranial Vascular Procedures 1 1 — — $84,650.29 $84,650.29 $84,650.29 2026-01-01
1623 APR_DRG Cardiac Valve Procedures W Cardiac Catheterization 1 1 — — $85,079.99 $85,079.99 $85,079.99 2026-01-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 8 4 — — $74,282.93 $156,702.28 $85,186.85 2026-01-01
6113 APR_DRG Neonate Birthwt 1500-1999g W Major Anomaly 1 1 — — $85,652.92 $85,652.92 $85,652.92 2026-01-01
6254 APR_DRG Neonate Bwt 2000-2499g W Other Significant Condition 1 1 — — $85,652.92 $85,652.92 $85,652.92 2026-01-01
2214 APR_DRG Major Small & Large Bowel Procedures 1 1 — — $85,796.15 $85,796.15 $85,796.15 2026-01-01
52 APR_DRG Tracheostomy W Mv 96+ Hours Without Extensive Procedure 1 1 — — $86,082.61 $86,082.61 $86,082.61 2026-01-01
7104 APR_DRG Infectious & Parasitic Diseases Including HIV W O.r. Procedure 1 1 — — $87,228.47 $87,228.47 $87,228.47 2026-01-01
5912 APR_DRG Neonate Birthwt 500-749g Without Major Procedure 1 1 — — $87,801.40 $87,801.40 $87,801.40 2026-01-01
31 APR_DRG Bone Marrow Transplant 1 1 — — $87,801.40 $87,801.40 $87,801.40 2026-01-01
8412 APR_DRG Extensive 3rd Degree Burns W Skin Graft 1 1 — — $88,087.86 $88,087.86 $88,087.86 2026-01-01
3614 APR_DRG Skin Graft For Skin & Subcutaneous Tissue Diagnoses 1 1 — — $88,231.10 $88,231.10 $88,231.10 2026-01-01
1664 APR_DRG Coronary Bypass Without Cardiac Cath Or Percutaneous Cardiac Procedure 1 1 — — $88,517.56 $88,517.56 $88,517.56 2026-01-01
1204 APR_DRG Major Respiratory & Chest Procedures 1 1 — — $88,947.26 $88,947.26 $88,947.26 2026-01-01
4414 APR_DRG Major Bladder Procedures 1 1 — — $89,090.49 $89,090.49 $89,090.49 2026-01-01
61 APR_DRG Pancreas Transplant 1 1 — — $89,663.42 $89,663.42 $89,663.42 2026-01-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 8 4 — — $78,307.21 $165,268.05 $89,801.85 2026-01-01
4403 APR_DRG Kidney Transplant 1 1 — — $89,806.65 $89,806.65 $89,806.65 2026-01-01
6224 APR_DRG Neonate Bwt 2000-2499g W Resp Dist Synd/oth Maj Resp Cond 1 1 — — $90,093.12 $90,093.12 $90,093.12 2026-01-01
7404 APR_DRG Mental Illness Diagnosis W O.r. Procedure 1 1 — — $90,379.58 $90,379.58 $90,379.58 2026-01-01
3214 APR_DRG Cervical Spinal Fusion & Other Back/neck Proc Exc Disc Excis/decomp 1 1 — — $90,522.81 $90,522.81 $90,522.81 2026-01-01
734 APR_DRG Eye Procedures Except Orbit 1 1 — — $90,809.28 $90,809.28 $90,809.28 2026-01-01
5104 APR_DRG Pelvic Evisceration, Radical Hysterectomy & Other Radical GYN Procs 1 1 — — $90,952.51 $90,952.51 $90,952.51 2026-01-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 8 4 — — $79,357.55 $167,503.72 $91,006.37 2026-01-01
6313 APR_DRG Neonate Birthwt >2499g W Other Major Procedure 1 1 — — $92,098.37 $92,098.37 $92,098.37 2026-01-01
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 5 3 — — $50,067.65 $165,273.21 $93,216.70 2026-01-01
2644 APR_DRG Other Hepatobiliary, Pancreas & Abdominal Procedures 1 1 — — $93,244.23 $93,244.23 $93,244.23 2026-01-01
209 MS_DRG Complex Aortic Arch Procedures 8 4 — — $81,482.51 $172,026.74 $93,443.24 2026-01-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 8 4 — — $81,575.33 $172,224.32 $93,549.69 2026-01-01
6814 APR_DRG Other O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms 1 1 — — $95,106.25 $95,106.25 $95,106.25 2026-01-01
4014 APR_DRG Pituitary & Adrenal Procedures 1 1 — — $95,106.25 $95,106.25 $95,106.25 2026-01-01
8413 APR_DRG Extensive 3rd Degree Burns W Skin Graft 1 1 — — $97,970.89 $97,970.89 $97,970.89 2026-01-01
9504 APR_DRG Extensive Procedure Unrelated To Principal Diagnosis 1 1 — — $98,114.13 $98,114.13 $98,114.13 2026-01-01
2204 APR_DRG Major Stomach, Esophageal & Duodenal Procedures 1 1 — — $98,400.59 $98,400.59 $98,400.59 2026-01-01
14 MS_DRG Allogeneic Bone Marrow Transplant 8 4 — — $86,474.30 $182,651.89 $99,167.77 2026-01-01
4034 APR_DRG Procedures For Obesity 1 1 — — $99,259.98 $99,259.98 $99,259.98 2026-01-01
204 APR_DRG Craniotomy For Trauma 1 1 — — $100,549.07 $100,549.07 $100,549.07 2026-01-01
1694 APR_DRG Major Thoracic & Abdominal Vascular Procedures 1 1 — — $100,835.54 $100,835.54 $100,835.54 2026-01-01
11 APR_DRG Liver Transplant &/or Intestinal Transplant 1 1 — — $101,408.47 $101,408.47 $101,408.47 2026-01-01
41 APR_DRG Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo 1 1 — — $102,697.56 $102,697.56 $102,697.56 2026-01-01
6144 APR_DRG Neonate Bwt 1500-1999g W Or Without Other Significant Condition 1 1 — — $102,984.02 $102,984.02 $102,984.02 2026-01-01
1654 APR_DRG Coronary Bypass W Cardiac Cath Or Percutaneous Cardiac Procedure 1 1 — — $103,127.26 $103,127.26 $103,127.26 2026-01-01
6344 APR_DRG Neonate, Birthwt >2499g W Resp Dist Synd/oth Maj Resp Cond 1 1 — — $105,132.51 $105,132.51 $105,132.51 2026-01-01
Q0480 HCPCS Driver Pneumatic Vad, Rep 5 3 — — $58,956.36 $188,152.41 $106,120.93 2026-01-01
7 MS_DRG Lung Transplant 8 4 — — $93,131.21 $196,821.28 $106,801.85 2026-01-01
894 APR_DRG Major Cranial/facial Bone Procedures 1 1 — — $107,567.46 $107,567.46 $107,567.46 2026-01-01
6334 APR_DRG Neonate Birthwt >2499g W Major Anomaly 1 1 — — $107,567.46 $107,567.46 $107,567.46 2026-01-01
6022 APR_DRG Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom 1 1 — — $108,140.39 $108,140.39 $108,140.39 2026-01-01
6364 APR_DRG Neonate Birthwt >2499g W Congenital/perinatal Infection 1 1 — — $108,570.08 $108,570.08 $108,570.08 2026-01-01
62 APR_DRG Pancreas Transplant 1 1 — — $108,713.32 $108,713.32 $108,713.32 2026-01-01
234 APR_DRG Spinal Procedures 1 1 — — $108,713.32 $108,713.32 $108,713.32 2026-01-01
1674 APR_DRG Other Cardiothoracic Procedures 1 1 — — $109,286.24 $109,286.24 $109,286.24 2026-01-01
9124 APR_DRG Musculoskeletal & Other Procedures For Multiple Significant Trauma 1 1 — — $109,429.48 $109,429.48 $109,429.48 2026-01-01
6083 APR_DRG Neonate Bwt 1250-1499g W Or Without Other Significant Condition 1 1 — — $110,002.41 $110,002.41 $110,002.41 2026-01-01
12 APR_DRG Liver Transplant &/or Intestinal Transplant 1 1 — — $110,718.57 $110,718.57 $110,718.57 2026-01-01
904 APR_DRG Major Larynx & Trachea Procedures 1 1 — — $110,861.80 $110,861.80 $110,861.80 2026-01-01
53 APR_DRG Tracheostomy W Mv 96+ Hours Without Extensive Procedure 1 1 — — $111,148.26 $111,148.26 $111,148.26 2026-01-01
3033 APR_DRG Dorsal & Lumbar Fusion Proc For Curvature Of Back 1 1 — — $111,148.26 $111,148.26 $111,148.26 2026-01-01
6904 APR_DRG Acute Leukemia 1 1 — — $111,864.43 $111,864.43 $111,864.43 2026-01-01
9114 APR_DRG Extensive Abdominal/thoracic Procedures For Mult Significant Trauma 1 1 — — $113,726.45 $113,726.45 $113,726.45 2026-01-01
4 MS_DRG Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mouth And … 8 4 — — $99,566.06 $210,518.01 $114,181.26 2026-01-01
2604 APR_DRG Major Pancreas, Liver & Shunt Procedures 1 1 — — $115,015.54 $115,015.54 $115,015.54 2026-01-01
6073 APR_DRG Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom 1 1 — — $115,445.23 $115,445.23 $115,445.23 2026-01-01
224 APR_DRG Ventricular Shunt Procedures 1 1 — — $115,588.47 $115,588.47 $115,588.47 2026-01-01
214 APR_DRG Craniotomy Except For Trauma 1 1 — — $117,880.18 $117,880.18 $117,880.18 2026-01-01
1613 APR_DRG Cardiac Defibrillator & Heart Assist Implant 1 1 — — $118,166.65 $118,166.65 $118,166.65 2026-01-01
6214 APR_DRG Neonate Bwt 2000-2499g W Major Anomaly 1 1 — — $118,309.88 $118,309.88 $118,309.88 2026-01-01
1634 APR_DRG Cardiac Valve Procedures Without Cardiac Catheterization 1 1 — — $119,598.97 $119,598.97 $119,598.97 2026-01-01
6804 APR_DRG Major O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms 1 1 — — $120,888.06 $120,888.06 $120,888.06 2026-01-01
32 APR_DRG Bone Marrow Transplant 1 1 — — $122,893.31 $122,893.31 $122,893.31 2026-01-01
3124 APR_DRG Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses 1 1 — — $125,328.26 $125,328.26 $125,328.26 2026-01-01
63 APR_DRG Pancreas Transplant 1 1 — — $125,471.49 $125,471.49 $125,471.49 2026-01-01
3044 APR_DRG Dorsal & Lumbar Fusion Proc Except For Curvature Of Back 1 1 — — $125,614.73 $125,614.73 $125,614.73 2026-01-01
6124 APR_DRG Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond 1 1 — — $127,619.98 $127,619.98 $127,619.98 2026-01-01
42 APR_DRG Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo 1 1 — — $128,049.68 $128,049.68 $128,049.68 2026-01-01
8504 APR_DRG Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service 1 1 — — $129,625.23 $129,625.23 $129,625.23 2026-01-01
6093 APR_DRG Neonate Bwt 1500-2499g W Major Procedure 1 1 — — $133,206.04 $133,206.04 $133,206.04 2026-01-01
5932 APR_DRG Neonate Birthwt 750-999g Without Major Procedure 1 1 — — $135,927.45 $135,927.45 $135,927.45 2026-01-01
6303 APR_DRG Neonate Birthwt >2499g W Major Cardiovascular Procedure 1 1 — — $135,927.45 $135,927.45 $135,927.45 2026-01-01
21 APR_DRG Heart &/or Lung Transplant 1 1 — — $136,500.38 $136,500.38 $136,500.38 2026-01-01
4404 APR_DRG Kidney Transplant 1 1 — — $136,786.85 $136,786.85 $136,786.85 2026-01-01
1624 APR_DRG Cardiac Valve Procedures W Cardiac Catheterization 1 1 — — $137,359.78 $137,359.78 $137,359.78 2026-01-01
6033 APR_DRG Neonate Birthwt 1000-1249g W Or Without Other Significant Condition 1 1 — — $140,510.89 $140,510.89 $140,510.89 2026-01-01
13 APR_DRG Liver Transplant &/or Intestinal Transplant 1 1 — — $141,513.51 $141,513.51 $141,513.51 2026-01-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 1 1 — — $143,948.46 $143,948.46 $143,948.46 2026-01-01
5881 APR_DRG Neonate Bwt <1500g W Major Procedure 1 1 — — $144,091.69 $144,091.69 $144,091.69 2026-01-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 1 1 — — $149,820.99 $149,820.99 $149,820.99 2026-01-01
6023 APR_DRG Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom 1 1 — — $150,250.68 $150,250.68 $150,250.68 2026-01-01
6084 APR_DRG Neonate Bwt 1250-1499g W Or Without Other Significant Condition 1 1 — — $152,972.10 $152,972.10 $152,972.10 2026-01-01
43 APR_DRG Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo 1 1 — — $154,547.65 $154,547.65 $154,547.65 2026-01-01
6134 APR_DRG Neonate Birthwt 1500-1999g W Congenital/perinatal Infection 1 1 — — $157,698.76 $157,698.76 $157,698.76 2026-01-01
3034 APR_DRG Dorsal & Lumbar Fusion Proc For Curvature Of Back 1 1 — — $158,128.46 $158,128.46 $158,128.46 2026-01-01
5882 APR_DRG Neonate Bwt <1500g W Major Procedure 1 1 — — $160,133.71 $160,133.71 $160,133.71 2026-01-01
22 APR_DRG Heart &/or Lung Transplant 1 1 — — $162,711.89 $162,711.89 $162,711.89 2026-01-01
54 APR_DRG Tracheostomy W Mv 96+ Hours Without Extensive Procedure 1 1 — — $164,287.45 $164,287.45 $164,287.45 2026-01-01
8634 APR_DRG Neonatal Aftercare 1 1 — — $172,165.22 $172,165.22 $172,165.22 2026-01-01
6114 APR_DRG Neonate Birthwt 1500-1999g W Major Anomaly 1 1 — — $173,740.78 $173,740.78 $173,740.78 2026-01-01
5893 APR_DRG Neonate Bwt <500g Or Ga <24 Weeks 1 1 — — $174,170.48 $174,170.48 $174,170.48 2026-01-01
3 MS_DRG Ecmo Or Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mo… 8 4 — — $152,217.31 $322,587.38 $174,561.14 2026-01-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv &gt;96 Hours With Skin Graft 8 4 — — $153,111.99 $324,491.73 $175,587.14 2026-01-01
8424 APR_DRG Full Thickness Burns W Skin Graft 1 1 — — $178,610.68 $178,610.68 $178,610.68 2026-01-01
6074 APR_DRG Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom 1 1 — — $188,207.24 $188,207.24 $188,207.24 2026-01-01
64 APR_DRG Pancreas Transplant 1 1 — — $191,358.35 $191,358.35 $191,358.35 2026-01-01
5831 APR_DRG Neonate W Ecmo 1 1 — — $192,504.21 $192,504.21 $192,504.21 2026-01-01
33 APR_DRG Bone Marrow Transplant 1 1 — — $201,814.31 $201,814.31 $201,814.31 2026-01-01
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 5 3 — — $205,640.00 $364,599.72 $205,640.00 2026-01-01
5933 APR_DRG Neonate Birthwt 750-999g Without Major Procedure 1 1 — — $208,116.53 $208,116.53 $208,116.53 2026-01-01
5832 APR_DRG Neonate W Ecmo 1 1 — — $213,845.82 $213,845.82 $213,845.82 2026-01-01
6034 APR_DRG Neonate Birthwt 1000-1249g W Or Without Other Significant Condition 1 1 — — $222,439.76 $222,439.76 $222,439.76 2026-01-01
5892 APR_DRG Neonate Bwt <500g Or Ga <24 Weeks 1 1 — — $227,882.59 $227,882.59 $227,882.59 2026-01-01
23 APR_DRG Heart &/or Lung Transplant 1 1 — — $229,601.38 $229,601.38 $229,601.38 2026-01-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 8 4 — — $200,762.15 $425,916.20 $230,231.82 2026-01-01
6024 APR_DRG Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom 1 1 — — $233,468.65 $233,468.65 $233,468.65 2026-01-01
5913 APR_DRG Neonate Birthwt 500-749g Without Major Procedure 1 1 — — $233,898.35 $233,898.35 $233,898.35 2026-01-01
44 APR_DRG Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo 1 1 — — $236,046.83 $236,046.83 $236,046.83 2026-01-01
6314 APR_DRG Neonate Birthwt >2499g W Other Major Procedure 1 1 — — $242,205.82 $242,205.82 $242,205.82 2026-01-01
5891 APR_DRG Neonate Bwt <500g Or Ga <24 Weeks 1 1 — — $250,656.53 $250,656.53 $250,656.53 2026-01-01
J3403 HCPCS Revakinagene, Per Implant 5 3 — — $257,500.00 $456,547.50 $257,500.00 2026-01-01
6094 APR_DRG Neonate Bwt 1500-2499g W Major Procedure 1 1 — — $258,247.84 $258,247.84 $258,247.84 2026-01-01
5833 APR_DRG Neonate W Ecmo 1 1 — — $271,138.74 $271,138.74 $271,138.74 2026-01-01
6304 APR_DRG Neonate Birthwt >2499g W Major Cardiovascular Procedure 1 1 — — $276,151.87 $276,151.87 $276,151.87 2026-01-01
14 APR_DRG Liver Transplant &/or Intestinal Transplant 1 1 — — $276,581.57 $276,581.57 $276,581.57 2026-01-01
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 5 3 — — $278,250.00 $493,337.25 $278,250.00 2026-01-01
8414 APR_DRG Extensive 3rd Degree Burns W Skin Graft 1 1 — — $280,592.08 $280,592.08 $280,592.08 2026-01-01
5934 APR_DRG Neonate Birthwt 750-999g Without Major Procedure 1 1 — — $290,475.10 $290,475.10 $290,475.10 2026-01-01
1614 APR_DRG Cardiac Defibrillator & Heart Assist Implant 1 1 — — $313,535.50 $313,535.50 $313,535.50 2026-01-01
5883 APR_DRG Neonate Bwt <1500g W Major Procedure 1 1 — — $329,434.29 $329,434.29 $329,434.29 2026-01-01
24 APR_DRG Heart &/or Lung Transplant 1 1 — — $354,213.48 $354,213.48 $354,213.48 2026-01-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 4 — — $309,001.44 $656,306.01 $354,359.45 2026-01-01
34 APR_DRG Bone Marrow Transplant 1 1 — — $354,786.41 $354,786.41 $354,786.41 2026-01-01
5914 APR_DRG Neonate Birthwt 500-749g Without Major Procedure 1 1 — — $385,008.42 $385,008.42 $385,008.42 2026-01-01
5884 APR_DRG Neonate Bwt <1500g W Major Procedure 1 1 — — $480,257.90 $480,257.90 $480,257.90 2026-01-01
Q2053 HCPCS Brexucabtagene Car Pos T 5 3 — — $489,304.61 $867,537.07 $489,304.61 2026-01-01
5834 APR_DRG Neonate W Ecmo 1 1 — — $533,683.55 $533,683.55 $533,683.55 2026-01-01
Q2055 HCPCS Idecabtagene Vicleucel Car 5 3 — — $557,317.93 $988,124.70 $557,317.93 2026-01-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 5 3 — — $562,538.19 $997,380.20 $562,538.19 2026-01-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 5 3 — — $591,726.20 $1,049,130.55 $591,726.20 2026-01-01
Q2057 HCPCS Afamitresgene Autoleucel 5 3 — — $770,620.00 $1,366,309.26 $770,620.00 2026-01-01
Q2041 HCPCS Axicabtagene Ciloleucel Bag 31 8 $2,266,110.00 $1,133,055.00 50% off $470,944.44 $1,497,898.71 $1,329,300.13 2026-01-01
Q2056 HCPCS Ciltacabtagene Autolucel Bag 31 8 $2,498,896.98 $1,249,448.49 50% off $502,083.28 $1,651,770.90 $1,465,852.97 2026-01-01
J3392 HCPCS Inj, Exagamglogene Autotem 5 3 — — $2,332,000.00 $4,134,636.00 $2,332,000.00 2026-01-01
J3399 HCPCS Inj Onase Abepar-xioi Treat 5 3 — — $2,455,110.61 $4,352,911.10 $2,455,110.61 2026-01-01
J3393 HCPCS Inj, Betibeglogene Autotemce 4 3 — — $2,945,740.00 $2,945,740.00 $2,945,740.00 2026-01-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 4 3 — — $3,248,445.72 $3,248,445.72 $3,248,445.72 2026-01-01
J1413 HCPCS Inj Delandistrogene Mox Rokl 4 3 — — $3,316,462.59 $3,316,462.59 $3,316,462.59 2026-01-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 4 3 — — $3,685,266.67 $3,685,266.67 $3,685,266.67 2026-01-01
J3391 HCPCS Inj, Atidarsagene Autotemcel 4 3 — — $4,505,000.00 $4,505,000.00 $4,505,000.00 2026-01-01
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