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

TRISTAR SOUTHERN HILLS MEDICAL CENTER

Nashville, TN · CCN 440197 · Rates published

31,491 distinct procedures filed
36 distinct payers
1,380,428 rate rows
2026-03-12 last MRF observed
Data quality

1,259,512 of 1,380,428 rate rows are consumer-grade (91.2%)

120,916 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
per-diem day rate — not a per-procedure price 45,797
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 40,032
template filing: same amount across many unrelated codes — excluded 30,409
exceeds 10× this hospital's gross charge — excluded from medians 4,200
placeholder amount (≤ $0.02) — excluded from medians 478
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1113737_TRISTAR-SOUTHERN-HILLS-MEDICAL-CENTER_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.tristarhealth.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaCMS hospital list
Last fetch not_modified · 2026-06-08
Content fingerprint e9eed45a5459ff8d… · 332,875,283 bytes · first seen 2026-06-08

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
845
OTHER 		Inj, Atidarsagene Autotem 16 $4,242.21 $4,955,500.00 $4,550,050.00 nat. median
$9,966
outlier · 456.6×
J1414
HCPCS 		Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose 1 $4,200,000.00 $4,200,000.00 $4,200,000.00 nat. median
$3,710,000
1.1× median
J1411
HCPCS 		Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 1 $4,200,000.00 $4,200,000.00 $4,200,000.00 nat. median
$3,710,000
1.1× median
J1413
HCPCS 		Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 1 $3,840,000.00 $3,840,000.00 $3,840,000.00 nat. median
$3,325,455
1.2× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 18 $2,460,843.00 $4,238,057.05 $3,722,119.67 nat. median
$3,746,358
1.0× median
J3394
HCPCS 		Injection, Lovotibeglogene Autotemcel, Per Treatment 1 $3,720,000.00 $3,720,000.00 $3,720,000.00 nat. median
$3,286,000
1.1× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 17 $2,415,350.00 $4,145,750.00 $3,641,050.00 nat. median
$3,605,000
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 20 $8,633.78 $4,903,655.40 $3,385,857.30 nat. median
$22,747
outlier · 148.8×
714
OTHER 		Inj Delandistrogene Mox R 21 $4,701.34 $4,891,954.20 $3,377,777.90 nat. median
$13,041
outlier · 259.0×
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $3,360,000.00 $3,360,000.00 $3,360,000.00 nat. median
$3,006,423
1.1× median
748
OTHER 		Inj, Lovotibeglogene Auto 21 $7,754.85 $4,830,420.00 $3,318,860.00 nat. median
$17,963
outlier · 184.8×
906
OTHER 		Inj Elivaldogene Autoteme 20 $5,657.60 $4,674,600.00 $3,227,700.00 nat. median
$20,756
outlier · 155.5×
746
OTHER 		Inj, Betibeglogene Autote 21 $6,887.84 $4,362,960.00 $2,998,224.19 nat. median
$21,896
outlier · 136.9×
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $2,870,046.83 $2,870,046.83 $2,870,046.83 nat. median
$2,469,189
1.2× median
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $2,640,000.00 $2,640,000.00 $2,640,000.00 nat. median
$2,448,600
1.1× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 21 $1,600,371.38 $3,805,802.07 $2,588,981.00 nat. median
$2,588,981
1.0× median
824
OTHER 		Inj, Exagamglogene Autote 20 $11,888.36 $3,428,040.00 $2,366,980.00 nat. median
$25,250
outlier · 93.7×
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 3 $872,400.00 $2,042,143.00 $1,749,707.25 nat. median
$824,563
outlier · 2.1×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 1 $1,387,149.28 $1,501,307.95 $1,387,149.28 nat. median
$754,974
1.8× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 2 $620,118.79 $1,557,271.36 $1,345,370.55 nat. median
$675,122
2.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $591,090.52 $1,478,916.58 $1,334,154.50 nat. median
$625,184
outlier · 2.1×
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 2 $579,352.98 $1,489,833.29 $1,315,434.06 nat. median
$674,188
2.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 2 $549,504.00 $1,410,309.44 $1,296,212.81 nat. median
$634,511
outlier · 2.0×
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 2 $549,504.00 $1,297,043.03 $1,191,016.00 nat. median
$620,080
1.9× median
2067
OTHER 		Afamitresgene Autoleucel 20 $554,846.40 $1,132,811.40 $789,885.50 nat. median
$786,032
1.0× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 3 $630,000.00 $737,362.50 $710,521.88 nat. median
$324,450
outlier · 2.2×
9498
OTHER 		Ciltacabtagene Car-pos T 21 $353,172.68 $863,844.91 $587,649.60 nat. median
$587,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 21 $354,559.24 $832,801.01 $566,531.30 nat. median
$566,531
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 21 $346,206.49 $826,435.76 $562,201.20 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 21 $352,813.69 $820,380.25 $558,081.80 nat. median
$558,082
1.0× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 $534,422.90 $534,422.90 $534,422.90 nat. median
$209,753
outlier · 2.5×
9035
OTHER 		Axicabtagene Ciloleucel C 21 $327,935.52 $782,322.53 $532,192.20 nat. median
$532,192
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 21 $308,555.37 $719,491.79 $489,450.20 nat. median
$489,450
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 27 $1,854.72 $1,072,056.19 $317,609.49 nat. median
$370,174
0.9× median
831
OTHER 		Obecbtge Autol Up To 400 20 $2,609.40 $409,027.50 $282,423.75 nat. median
$12,362
outlier · 22.8×
897
OTHER 		Revakinagene, Per Implant 20 $190,800.00 $389,550.00 $271,625.00 nat. median
$9,577
outlier · 28.4×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 28 $2,253.12 $695,721.34 $223,195.64 nat. median
$265,286
0.8× median
886
OTHER 		Inj. Remestemcel-l-rknd/ 20 $4,920.52 $296,453.43 $204,694.04 nat. median
$17,985
outlier · 11.4×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 28 $2,253.12 $573,024.23 $172,293.35 nat. median
$206,368
0.8× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 29 $2,253.12 $526,936.82 $169,395.37 nat. median
$202,986
0.8× median
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 3 $72,000.00 $170,328.19 $168,273.22 nat. median
$69,774
outlier · 2.4×
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $159,355.90 $173,990.78 $166,673.34 nat. median
$263,894
0.6× median
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $131,492.15 $197,938.14 $164,715.15 nat. median
$424,868
outlier · 0.4×
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 3 $74,124.43 $173,512.94 $150,585.06 nat. median
$62,507
outlier · 2.4×
1907
OTHER 		New Technology - Level 52 21 $93,893.00 $210,510.03 $144,636.14 nat. median
$153,199
0.9× median
1908
OTHER 		New Technology - Level 52 21 $93,893.00 $210,510.03 $144,636.14 nat. median
$152,962
0.9× median
Q2043
HCPCS 		Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 3 $65,321.65 $147,108.87 $144,170.89 nat. median
$66,682
outlier · 2.2×
1906
OTHER 		New Technology - Level 51 21 $84,657.65 $189,804.20 $130,409.68 nat. median
$138,020
0.9× median
1905
OTHER 		New Technology - Level 51 21 $84,657.65 $189,804.20 $130,409.68 nat. median
$137,903
0.9× median
A9699
HCPCS 		Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 $123,321.96 $123,742.09 $123,321.96 nat. median
$21,806
outlier · 5.7×

Other procedures at this hospital

Browse this hospital's 31,491 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
681605 CDM Rv Fpvt Stn/ath Cl In 25 16 $272,113.76 $272,113.76 $40,817.06 $239,460.11 $77,824.54 2026-03-12
681603 CDM Rv Fpvt Stn/ath Sfl In 25 16 $272,113.76 $272,113.76 $40,817.06 $239,460.11 $77,824.54 2026-03-12
681614 CDM Rvsc Tpvt Stnt Cl In 25 16 $226,988.45 $226,988.45 $34,048.27 $199,749.84 $64,918.70 2026-03-12
J7330 HCPCS Algrf Maci Fnl 1 Membran 33 19 $212,918.00 $212,918.00 $31,937.70 $221,874.56 $87,722.22 2026-03-12
681597 CDM Rvsc Fpvt Stn Cl In 25 16 $174,407.96 $174,407.96 $26,161.19 $153,479.00 $49,880.68 2026-03-12
681599 CDM Rvsc Fpvt Ath Sfl In 25 16 $174,407.96 $174,407.96 $26,161.19 $153,479.00 $49,880.68 2026-03-12
681616 CDM Rvsc Tpvt Ath Sfl In 25 16 $174,407.96 $174,407.96 $26,161.19 $153,479.00 $49,880.68 2026-03-12
681601 CDM Rvsc Fpvt Ath Cl In 25 16 $174,407.96 $174,407.96 $26,161.19 $153,479.00 $49,880.68 2026-03-12
681618 CDM Rvsc Tpvt Ath Cl In 25 16 $174,407.96 $174,407.96 $26,161.19 $153,479.00 $49,880.68 2026-03-12
681595 CDM Rvsc Fpvt Stnt Sfl In 25 16 $174,407.96 $174,407.96 $26,161.19 $153,479.00 $49,880.68 2026-03-12
681649 CDM Ins Icd Gen Only Mult Ld 25 16 $153,161.25 $153,161.25 $22,974.19 $134,781.90 $43,804.12 2026-03-12
681604 CDM Rv Fpvt Stn/ath Sfl Ea 25 16 $136,056.88 $136,056.88 $20,408.53 $119,730.05 $38,912.27 2026-03-12
376536 CDM Graft Fem Kn Cndyl Lt 19 14 $101,142.00 $101,142.00 $15,171.30 $89,004.96 $45,513.90 2026-03-12
845 OTHER Inj, Atidarsagene Autotem 28 16 — — $4,242.21 $4,955,500.00 $4,550,050.00 2026-03-12
J1411 HCPCS Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 2 1 — — $4,200,000.00 $4,200,000.00 $4,200,000.00 2026-03-12
J1414 HCPCS Injection, Fidanacogene Elaparvovec-dzkt, Per Therapeutic Dose 1 1 — — $4,200,000.00 $4,200,000.00 $4,200,000.00 2026-03-12
J1413 HCPCS Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 2 1 — — $3,840,000.00 $3,840,000.00 $3,840,000.00 2026-03-12
9138 OTHER Inj, Hemgenix, Per Tx Dos 54 18 — — $2,460,843.00 $4,238,057.05 $3,722,119.67 2026-03-12
J3394 HCPCS Injection, Lovotibeglogene Autotemcel, Per Treatment 1 1 — — $3,720,000.00 $3,720,000.00 $3,720,000.00 2026-03-12
773 OTHER Inj, Beqvez, Per Tx Dose 27 17 — — $2,415,350.00 $4,145,750.00 $3,641,050.00 2024-10-01
908 OTHER Topi Adm Prad Zami Per Tr 32 20 — — $8,633.78 $4,903,655.40 $3,385,857.30 2026-03-12
714 OTHER Inj Delandistrogene Mox R 62 21 — — $4,701.34 $4,891,954.20 $3,377,777.90 2026-03-12
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 1 1 — — $3,360,000.00 $3,360,000.00 $3,360,000.00 2026-03-12
748 OTHER Inj, Lovotibeglogene Auto 62 21 — — $7,754.85 $4,830,420.00 $3,318,860.00 2026-03-12
906 OTHER Inj Elivaldogene Autoteme 32 20 — — $5,657.60 $4,674,600.00 $3,227,700.00 2026-03-12
746 OTHER Inj, Betibeglogene Autote 62 21 — — $6,887.84 $4,362,960.00 $2,998,224.19 2026-03-12
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 1 — — $2,870,046.83 $2,870,046.83 $2,870,046.83 2026-03-12
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 1 1 — — $2,640,000.00 $2,640,000.00 $2,640,000.00 2026-03-12
9141 OTHER Inj Onase Abepar-xioi Tre 60 21 — — $1,600,371.38 $3,805,802.07 $2,588,981.00 2026-03-12
824 OTHER Inj, Exagamglogene Autote 32 20 — — $11,888.36 $3,428,040.00 $2,366,980.00 2026-03-12
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 6 3 — — $872,400.00 $2,042,143.00 $1,749,707.25 2026-03-12
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 7 1 — — $1,387,149.28 $1,501,307.95 $1,387,149.28 2026-03-12
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 9 2 — — $620,118.79 $1,557,271.36 $1,345,370.55 2026-03-12
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 11 3 — — $591,090.52 $1,478,916.58 $1,334,154.50 2026-03-12
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 9 2 — — $579,352.98 $1,489,833.29 $1,315,434.06 2026-03-12
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 9 2 — — $549,504.00 $1,410,309.44 $1,296,212.81 2026-03-12
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 9 2 — — $549,504.00 $1,297,043.03 $1,191,016.00 2026-03-12
2067 OTHER Afamitresgene Autoleucel 30 20 — — $554,846.40 $1,132,811.40 $789,885.50 2026-03-12
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 6 3 — — $630,000.00 $737,362.50 $710,521.88 2026-03-12
9498 OTHER Ciltacabtagene Car-pos T 60 21 — — $353,172.68 $863,844.91 $587,649.60 2026-03-12
9194 OTHER Tisagenlecleucel Car-pos 60 21 — — $354,559.24 $832,801.01 $566,531.30 2026-03-12
9413 OTHER Lisocabtagene Car Pos T 60 21 — — $346,206.49 $826,435.76 $562,201.20 2026-03-12
9422 OTHER Idecabtagene Vicleucel Ca 60 21 — — $352,813.69 $820,380.25 $558,081.80 2026-03-12
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 3 1 — — $534,422.90 $534,422.90 $534,422.90 2026-03-12
9035 OTHER Axicabtagene Ciloleucel C 60 21 — — $327,935.52 $782,322.53 $532,192.20 2026-03-12
9391 OTHER Brexucabtagene Car Pos T 60 21 — — $308,555.37 $719,491.79 $489,450.20 2026-03-12
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 93 27 — — $1,854.72 $1,072,056.19 $317,609.49 2026-03-12
831 OTHER Obecbtge Autol Up To 400 32 20 — — $2,609.40 $409,027.50 $282,423.75 2026-03-12
897 OTHER Revakinagene, Per Implant 30 20 — — $190,800.00 $389,550.00 $271,625.00 2026-03-12
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 108 28 — — $2,253.12 $695,721.34 $223,195.64 2026-03-12
886 OTHER Inj. Remestemcel-l-rknd/ 32 20 — — $4,920.52 $296,453.43 $204,694.04 2026-03-12
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 100 28 — — $2,253.12 $573,024.23 $172,293.35 2026-03-12
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 117 29 — — $2,253.12 $526,936.82 $169,395.37 2026-03-12
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 12 3 — — $72,000.00 $170,328.19 $168,273.22 2026-03-12
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 1 — — $159,355.90 $173,990.78 $166,673.34 2026-03-12
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 1 — — $131,492.15 $197,938.14 $164,715.15 2026-03-12
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 12 3 — — $74,124.43 $173,512.94 $150,585.06 2026-03-12
1908 OTHER New Technology - Level 52 60 21 — — $93,893.00 $210,510.03 $144,636.14 2026-03-12
1907 OTHER New Technology - Level 52 60 21 — — $93,893.00 $210,510.03 $144,636.14 2026-03-12
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 12 3 — — $65,321.65 $147,108.87 $144,170.89 2026-03-12
1906 OTHER New Technology - Level 51 60 21 — — $84,657.65 $189,804.20 $130,409.68 2026-03-12
1905 OTHER New Technology - Level 51 60 21 — — $84,657.65 $189,804.20 $130,409.68 2026-03-12
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 7 1 — — $123,321.96 $123,742.09 $123,321.96 2026-03-12
1903 OTHER New Technology - Level 50 60 21 — — $75,422.30 $169,098.36 $116,183.23 2026-03-12
1904 OTHER New Technology - Level 50 60 21 — — $75,422.30 $169,098.36 $116,183.23 2026-03-12
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 1 — — $106,736.65 $122,632.24 $114,684.45 2026-03-12
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 12 3 — — $54,500.39 $117,019.36 $114,441.15 2026-03-12
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 119 29 — — $2,253.12 $343,874.86 $112,302.92 2026-03-12
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 60 21 — — $66,999.93 $163,909.41 $111,503.00 2026-03-12
7 MS_DRG Lung Transplant 96 28 — — $2,253.12 $321,501.67 $104,083.45 2026-03-12
1902 OTHER New Technology - Level 49 60 21 — — $66,186.96 $148,392.53 $101,956.77 2026-03-12
1901 OTHER New Technology - Level 49 60 21 — — $66,186.96 $148,392.53 $101,956.77 2026-03-12
14 MS_DRG Allogeneic Bone Marrow Transplant 99 28 — — $1,854.72 $316,452.24 $100,861.27 2026-03-12
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 60 21 — — $60,991.37 $139,769.07 $95,583.49 2026-03-12
209 MS_DRG Complex Aortic Arch Procedures 63 31 — — $18,507.00 $281,000.53 $93,483.84 2026-03-12
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 108 28 — — $2,253.12 $547,402.00 $90,912.09 2026-03-12
1599 OTHER New Technology - Level 48 60 21 — — $58,490.84 $131,137.63 $90,101.36 2026-03-12
1585 OTHER New Technology - Level 48 60 21 — — $58,490.84 $131,137.63 $90,101.36 2026-03-12
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 126 33 — — $21,031.00 $253,183.05 $89,272.65 2026-03-12
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 117 29 — — $2,253.12 $269,960.41 $87,419.11 2026-03-12
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 1 — — $75,049.09 $95,766.03 $85,407.56 2026-03-12
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 96 28 — — $2,253.12 $257,216.93 $84,750.01 2026-03-12
215 MS_DRG Other Heart Assist System Implant 116 29 — — $2,253.12 $452,304.00 $84,090.81 2026-03-12
30240G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Open Approach… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30233U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30233Y3 OTHER Transfusion Of Allogeneic Unrelated Hamatopoietic Stem Cells Into Peripheral Vei… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30230X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein, … 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30243G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Central Vein, Percutaneous Ap… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30230U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30230G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Peripheral Vein, Open Appro… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30233X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein, … 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30243Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein, … 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30230U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30233G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Percutaneous… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30243U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30230G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Open Approac… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30243Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Central Vein, Pe… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30233X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Pe… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30240X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Ope… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30230Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Peripheral Vein,… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30243X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Central Vein, Percu… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30240U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30243G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Percutaneous … 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30243U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30233G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Peripheral Vein, Percutaneo… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30230Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Peripheral Vei… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30240X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Central Vein, Open … 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30240Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Central Vein, Op… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30230X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Op… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30243X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Per… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30240U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30233U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30240Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein, … 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30240G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Central Vein, Open Approach 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
30233Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Peripheral Vein,… 2 1 — — $83,298.00 $83,298.00 $83,298.00 2026-03-12
1584 OTHER New Technology - Level 47 60 21 — — $52,333.94 $117,333.74 $80,617.06 2026-03-12
1598 OTHER New Technology - Level 47 60 21 — — $52,333.94 $117,333.74 $80,617.06 2026-03-12
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 116 29 — — $2,253.12 $242,867.79 $79,866.15 2026-03-12
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 2 1 — — $67,910.25 $85,826.17 $76,868.21 2026-03-12
C9150 HCPCS Xenon Xe-129 Hyperpolarized Gas, Diagnostic, Per Study Dose 3 1 — — $65,769.60 $74,786.40 $74,786.40 2026-03-12
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 14 4 — — $2,253.12 $92,326.93 $74,471.21 2026-03-12
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 126 33 — — $21,031.00 $201,452.70 $74,246.96 2026-03-12
850 MS_DRG Acute Leukemia With Other Procedures 114 32 — — $9,025.00 $222,498.95 $73,047.24 2026-03-12
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 12 3 — — $31,521.48 $75,323.76 $71,589.38 2026-03-12
1583 OTHER New Technology - Level 46 60 21 — — $46,177.04 $103,529.85 $71,132.75 2026-03-12
1597 OTHER New Technology - Level 46 60 21 — — $46,177.04 $103,529.85 $71,132.75 2026-03-12
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 117 29 — — $2,253.12 $307,671.84 $70,473.11 2026-03-12
231 MS_DRG Coronary Bypass With Ptca With Mcc 117 29 — — $2,253.12 $220,352.00 $69,440.15 2026-03-12
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 60 21 — — $44,134.04 $101,138.50 $69,165.29 2026-03-12
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 3 1 — — $60,394.20 $68,674.05 $68,674.05 2026-03-12
007 OTHER Lung Transplant 2 1 — — $60,167.34 $73,602.77 $66,885.05 2026-03-12
014 OTHER Allogeneic Bone Marrow Transplant 2 1 — — $62,826.85 $69,733.52 $66,280.18 2026-03-12
1643 OTHER Y90 Ibritumomab, Rx 60 21 — — $40,913.68 $96,250.57 $65,476.58 2026-03-12
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 117 29 — — $2,253.12 $195,350.83 $65,298.66 2026-03-12
717 OTHER Instill Adstiladrin, Tx D 62 21 — — $10,883.27 $94,483.94 $65,086.48 2026-03-12
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 116 29 — — $2,253.12 $253,492.35 $64,024.23 2026-03-12
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 117 29 — — $2,253.12 $189,799.74 $63,403.33 2026-03-12
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 99 28 — — $2,253.12 $191,469.44 $62,657.38 2026-03-12
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 1 — — $60,058.19 $65,233.77 $62,645.98 2026-03-12
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 12 3 — — $26,766.00 $64,205.31 $62,320.47 2026-03-12
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 117 29 — — $2,253.12 $189,171.64 $61,970.80 2026-03-12
1596 OTHER New Technology - Level 45 60 21 — — $40,020.15 $89,725.96 $61,648.45 2026-03-12
1582 OTHER New Technology - Level 45 60 21 — — $40,020.15 $89,725.96 $61,648.45 2026-03-12
10 MS_DRG Pancreas Transplant 96 28 — — $2,253.12 $192,578.15 $60,971.14 2026-03-12
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 126 33 — — $21,031.00 $171,469.10 $60,686.85 2026-03-12
5244 OTHER Level 4 Blood Product Exc 60 21 — — $32,056.61 $88,708.65 $60,346.02 2026-03-12
B0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $59,624.46 $59,624.46 $59,624.46 2026-03-12
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 117 29 — — $2,253.12 $258,803.00 $59,128.86 2026-03-12
B0505 HCPCS Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 3 1 — — $58,642.76 $58,642.76 $58,642.76 2026-03-12
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 117 29 — — $1,854.72 $174,747.67 $57,180.46 2026-03-12
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 126 33 — — $21,031.00 $161,939.95 $56,881.27 2026-03-12
B0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $56,812.82 $56,812.82 $56,812.82 2024-10-01
B0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 3 1 — — $56,229.33 $56,229.33 $56,229.33 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 100 28 — — $2,253.12 $178,069.45 $56,200.11 2026-03-12
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 117 29 — — $2,253.12 $170,750.75 $56,110.02 2026-03-12
9273 OTHER Sipuleucel-t Auto Cd54+ 60 21 — — $36,860.20 $80,872.39 $55,800.81 2026-03-12
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 2 1 — — $49,367.82 $62,165.09 $55,766.46 2026-03-12
955 MS_DRG Craniotomy For Multiple Significant Trauma 117 29 — — $2,253.12 $167,106.29 $55,751.57 2026-03-12
459 MS_DRG Spinal Fusion Except Cervical With Mcc 14 4 — — $2,253.12 $69,101.93 $55,737.85 2026-03-12
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 126 33 — — $18,507.00 $165,999.05 $55,461.05 2026-03-12
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 116 29 — — $2,253.12 $163,238.40 $54,437.21 2026-03-12
B0106 OTHER Stroke; M > 30.05 & M < 34.25 3 1 — — $54,180.60 $54,180.60 $54,180.60 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 117 29 — — $1,854.72 $159,747.86 $53,480.88 2026-03-12
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 116 29 — — $2,253.12 $163,238.40 $53,273.88 2026-03-12
B0106 HCPCS Stroke; M > 30.05 & M < 34.25 3 1 — — $53,167.41 $53,167.41 $53,167.41 2026-03-12
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 117 29 — — $2,253.12 $162,645.06 $52,365.93 2026-03-12
1581 OTHER New Technology - Level 44 60 21 — — $33,863.25 $75,922.07 $52,164.15 2026-03-12
1595 OTHER New Technology - Level 44 60 21 — — $33,863.25 $75,922.07 $52,164.15 2026-03-12
429 OTHER Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 1 1 — — $51,865.79 $51,865.79 $51,865.79 2026-03-12
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 117 29 — — $2,253.12 $152,753.80 $51,847.84 2026-03-12
B1903 HCPCS Guillian Barre; M < 18.05 3 1 — — $51,800.92 $51,800.92 $51,800.92 2026-03-12
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 14 4 — — $2,253.12 $63,725.73 $51,401.39 2026-03-12
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 117 29 — — $2,253.12 $168,302.00 $51,340.15 2026-03-12
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 2 1 — — $51,227.32 $51,268.33 $51,247.82 2026-03-12
232 MS_DRG Coronary Bypass With Ptca Without Mcc 117 29 — — $2,253.12 $220,352.00 $51,161.80 2026-03-12
B0205 HCPCS Traumatic Brain Injury; M > 28.75 & M < 40.65 3 1 — — $51,145.83 $51,145.83 $51,145.83 2026-03-12
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 116 29 — — $2,253.12 $209,513.60 $50,713.69 2026-03-12
C0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $50,523.07 $50,523.07 $50,523.07 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 117 29 — — $2,253.12 $149,162.06 $50,285.31 2026-03-12
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 60 21 — — $31,820.31 $72,919.94 $49,867.65 2026-03-12
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 91 26 — — $1,854.72 $132,936.15 $49,790.78 2026-03-12
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 97 28 — — $1,854.72 $147,210.73 $49,685.46 2026-03-12
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 117 29 — — $2,253.12 $192,851.77 $49,636.99 2026-03-12
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 63 31 — — $18,507.00 $141,679.50 $49,396.47 2026-03-12
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $49,255.14 $49,255.14 $49,255.14 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 117 29 — — $2,253.12 $145,693.86 $49,219.17 2026-03-12
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 1 — — $44,343.01 $54,068.38 $49,205.69 2026-03-12
B0205 OTHER Traumatic Brain Injury; M > 28.75 & M < 40.65 3 1 — — $49,186.45 $49,186.45 $49,186.45 2024-10-01
D0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $49,044.77 $49,044.77 $49,044.77 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 126 33 — — $21,031.00 $132,130.27 $48,981.46 2026-03-12
C0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $48,735.70 $48,735.70 $48,735.70 2026-03-12
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 113 29 — — $2,253.12 $314,996.79 $48,707.92 2026-03-12
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 117 29 — — $2,253.12 $148,231.99 $48,504.48 2026-03-12
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 117 29 — — $2,253.12 $168,016.30 $48,163.73 2026-03-12
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 97 28 — — $1,854.72 $145,787.50 $48,138.99 2026-03-12
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 126 33 — — $21,031.00 $132,978.11 $47,805.40 2026-03-12
B2102 HCPCS Burns; M=12-45 3 1 — — $47,772.77 $47,772.77 $47,772.77 2026-03-12
B0105 OTHER Stroke; M > 34.25 & M < 38.85 3 1 — — $47,635.45 $47,635.45 $47,635.45 2024-10-01
D0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $47,453.67 $47,453.67 $47,453.67 2026-03-12
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 2 1 — — $36,584.19 $58,259.35 $47,421.77 2026-03-12
B0405 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 3 1 — — $47,228.43 $47,228.43 $47,228.43 2026-03-12
C0106 HCPCS Stroke; M > 30.05 & M < 34.25 3 1 — — $47,213.41 $47,213.41 $47,213.41 2026-03-12
B0105 HCPCS Stroke; M > 34.25 & M < 38.85 3 1 — — $47,200.27 $47,200.27 $47,200.27 2026-03-12
C0106 OTHER Stroke; M > 30.05 & M < 34.25 3 1 — — $46,988.58 $46,988.58 $46,988.58 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 117 29 — — $2,253.12 $141,495.79 $46,888.25 2026-03-12
B1903 OTHER Guillian Barre; M < 18.05 3 1 — — $46,817.08 $46,817.08 $46,817.08 2024-10-01
B0604 OTHER Neurological; M < 25.85 3 1 — — $46,425.60 $46,425.60 $46,425.60 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 96 28 — — $2,253.12 $139,139.80 $46,278.86 2026-03-12
834 MS_DRG Acute Leukemia With Mcc 117 29 — — $1,854.72 $136,292.26 $46,122.48 2026-03-12
B0604 HCPCS Neurological; M < 25.85 3 1 — — $45,983.94 $45,983.94 $45,983.94 2026-03-12
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 117 29 — — $2,253.12 $135,810.63 $45,792.39 2026-03-12
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 117 29 — — $2,253.12 $156,158.93 $45,711.60 2026-03-12
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 126 33 — — $21,031.00 $124,391.00 $45,547.96 2026-03-12
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 117 29 — — $2,253.12 $135,403.49 $45,533.35 2026-03-12
653 MS_DRG Major Bladder Procedures With Mcc 117 29 — — $2,253.12 $134,644.80 $45,385.96 2026-03-12
1142 OTHER Supprelin La Implant 60 21 — — $30,384.64 $66,664.81 $45,350.21 2026-03-12
955 OTHER Craniotomy For Multiple Significant Trauma 2 1 — — $34,955.62 $55,583.10 $45,269.36 2026-03-12
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 117 29 — — $2,253.12 $135,616.99 $45,217.17 2026-03-12
B0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 3 1 — — $45,180.32 $45,180.32 $45,180.32 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 116 29 — — $2,253.12 $132,392.09 $45,130.17 2026-03-12
C0505 HCPCS Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 3 1 — — $45,066.07 $45,066.07 $45,066.07 2026-03-12
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 117 29 — — $2,253.12 $138,186.48 $44,933.74 2026-03-12
A0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $44,565.14 $44,565.14 $44,565.14 2024-10-01
A5104 OTHER Expired, Not Orthopedic, Length Of Stay Is 16 Days 3 1 — — $44,430.92 $44,430.92 $44,430.92 2024-10-01
B1004 HCPCS Amputation, Lower Extremity; M=39-45 3 1 — — $44,362.17 $44,362.17 $44,362.17 2026-03-12
231 OTHER Coronary Bypass With Ptca With Mcc 2 1 — — $39,805.61 $48,528.46 $44,167.04 2026-03-12
B1504 HCPCS Pulmonary; M < 29.15 3 1 — — $43,969.87 $43,969.87 $43,969.87 2026-03-12
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 117 29 — — $2,253.12 $130,989.42 $43,875.78 2026-03-12
C0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 3 1 — — $43,744.90 $43,744.90 $43,744.90 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 117 29 — — $2,253.12 $129,229.26 $43,568.82 2026-03-12
B0704 OTHER Fracture Of Lower Extremity; M < 28.15 3 1 — — $43,385.12 $43,385.12 $43,385.12 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 117 29 — — $2,253.12 $130,313.81 $43,338.98 2026-03-12
B2102 OTHER Burns; M=12-45 3 1 — — $43,204.29 $43,204.29 $43,204.29 2024-10-01
B0704 HCPCS Fracture Of Lower Extremity; M < 28.15 3 1 — — $43,059.50 $43,059.50 $43,059.50 2026-03-12
B1304 HCPCS Rheumatoid, Other Arthritis; M=12-35 3 1 — — $43,006.94 $43,006.94 $43,006.94 2026-03-12
A0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $42,941.25 $42,941.25 $42,941.25 2026-03-12
D0106 OTHER Stroke; M > 30.05 & M < 34.25 3 1 — — $42,939.58 $42,939.58 $42,939.58 2024-10-01
B1004 OTHER Amputation, Lower Extremity; M=39-45 3 1 — — $42,896.70 $42,896.70 $42,896.70 2024-10-01
D0106 HCPCS Stroke; M > 30.05 & M < 34.25 3 1 — — $42,776.07 $42,776.07 $42,776.07 2026-03-12
1594 OTHER New Technology - Level 43 60 21 — — $27,706.35 $62,118.19 $42,679.84 2026-03-12
1580 OTHER New Technology - Level 43 60 21 — — $27,706.35 $62,118.19 $42,679.84 2026-03-12
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 1 — — $41,036.46 $44,096.43 $42,566.44 2026-03-12
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 117 29 — — $2,253.12 $123,817.19 $42,494.21 2026-03-12
B1504 OTHER Pulmonary; M < 29.15 3 1 — — $42,398.96 $42,398.96 $42,398.96 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 117 29 — — $2,253.12 $170,621.24 $42,345.23 2026-03-12
B0904 HCPCS Other Orthopedic; M < 24.15 3 1 — — $42,199.81 $42,199.81 $42,199.81 2026-03-12
447 OTHER Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 1 1 — — $42,185.72 $42,185.72 $42,185.72 2026-03-12
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 117 29 — — $2,253.12 $122,605.68 $42,014.12 2026-03-12
D0505 HCPCS Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 3 1 — — $41,925.76 $41,925.76 $41,925.76 2026-03-12
C0105 HCPCS Stroke; M > 34.25 & M < 38.85 3 1 — — $41,914.50 $41,914.50 $41,914.50 2026-03-12
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 117 29 — — $2,253.12 $162,950.88 $41,876.30 2026-03-12
B1704 OTHER Major Multiple Trauma,no Brain Or Spinal Cord Inju 3 1 — — $41,651.43 $41,651.43 $41,651.43 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 116 29 — — $2,253.12 $125,128.01 $41,532.96 2026-03-12
B2005 HCPCS Miscellaneous; M=12-32 And A Tm81 3 1 — — $41,516.57 $41,516.57 $41,516.57 2026-03-12
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 117 29 — — $1,854.72 $156,531.73 $41,499.78 2026-03-12
B2005 OTHER Miscellaneous; M=12-32 And A Tm81 3 1 — — $41,407.22 $41,407.22 $41,407.22 2024-10-01
D0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 3 1 — — $41,327.06 $41,327.06 $41,327.06 2024-10-01
C0105 OTHER Stroke; M > 34.25 & M < 38.85 3 1 — — $41,312.15 $41,312.15 $41,312.15 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 117 29 — — $2,253.12 $151,226.32 $41,283.08 2026-03-12
B0504 HCPCS Nontraumatic Spinal Cord Injury; M > 29.25 & M < 3 3 1 — — $41,274.43 $41,274.43 $41,274.43 2026-03-12
B1704 HCPCS Major Multiple Trauma,no Brain Or Spinal Cord Inju 3 1 — — $41,206.85 $41,206.85 $41,206.85 2026-03-12
A5104 HCPCS Expired, Not Orthopedic, Length Of Stay Is 16 Days 3 1 — — $41,071.71 $41,071.71 $41,071.71 2026-03-12
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 2 1 — — $38,129.51 $43,957.32 $41,043.42 2026-03-12
A0106 OTHER Stroke; M > 30.05 & M < 34.25 3 1 — — $40,920.67 $40,920.67 $40,920.67 2024-10-01
B1204 OTHER Osteoarthritis; M=39-47 3 1 — — $40,708.15 $40,708.15 $40,708.15 2024-10-01
C0205 HCPCS Traumatic Brain Injury; M > 28.75 & M < 40.65 3 1 — — $40,666.26 $40,666.26 $40,666.26 2026-03-12
B0304 HCPCS Nontraumatic Brain Injury; M < 26.15 3 1 — — $40,609.95 $40,609.95 $40,609.95 2026-03-12
A0106 HCPCS Stroke; M > 30.05 & M < 34.25 3 1 — — $40,574.29 $40,574.29 $40,574.29 2026-03-12
C0205 OTHER Traumatic Brain Injury; M > 28.75 & M < 40.65 3 1 — — $40,510.55 $40,510.55 $40,510.55 2024-10-01
215 OTHER Other Heart Assist System Implant 2 1 — — $35,175.51 $45,809.22 $40,492.37 2026-03-12
B0504 OTHER Nontraumatic Spinal Cord Injury; M > 29.25 & M < 3 3 1 — — $40,465.81 $40,465.81 $40,465.81 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 116 29 — — $2,253.12 $157,314.61 $40,460.03 2026-03-12
245 MS_DRG Aicd Generator Procedures 117 29 — — $2,253.12 $135,650.27 $40,405.22 2026-03-12
B0304 OTHER Nontraumatic Brain Injury; M < 26.15 3 1 — — $40,305.49 $40,305.49 $40,305.49 2024-10-01
B1404 HCPCS Cardiac; M < 31.15 3 1 — — $40,296.48 $40,296.48 $40,296.48 2026-03-12
B1204 HCPCS Osteoarthritis; M=39-47 3 1 — — $40,290.85 $40,290.85 $40,290.85 2026-03-12
6 MS_DRG Liver Transplant Without Mcc 97 28 — — $2,253.12 $117,125.18 $40,210.50 2026-03-12
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 60 21 — — $25,653.97 $58,789.12 $40,203.97 2026-03-12
C0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 3 1 — — $40,178.72 $40,178.72 $40,178.72 2024-10-01
C2102 HCPCS Burns; M=12-45 3 1 — — $40,163.21 $40,163.21 $40,163.21 2026-03-12
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 2 1 — — $39,208.61 $41,071.72 $40,140.17 2026-03-12
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 113 29 — — $2,253.12 $241,075.40 $40,131.47 2026-03-12
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 117 29 — — $2,253.12 $116,478.63 $40,079.65 2026-03-12
B1404 OTHER Cardiac; M < 31.15 3 1 — — $40,001.63 $40,001.63 $40,001.63 2024-10-01
B1304 OTHER Rheumatoid, Other Arthritis; M=12-35 3 1 — — $39,923.33 $39,923.33 $39,923.33 2024-10-01
B0904 OTHER Other Orthopedic; M < 24.15 3 1 — — $39,923.33 $39,923.33 $39,923.33 2024-10-01
360 OTHER Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc 1 1 — — $39,888.74 $39,888.74 $39,888.74 2026-03-12
B0204 HCPCS Traumatic Brain Injury; M > 40.65 & M < 44.25 3 1 — — $39,866.64 $39,866.64 $39,866.64 2026-03-12
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 117 29 — — $2,253.12 $168,302.00 $39,678.92 2026-03-12
B2004 HCPCS Miscellaneous; M < 27.85 3 1 — — $39,663.92 $39,663.92 $39,663.92 2026-03-12
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 60 21 — — $25,260.01 $57,886.25 $39,586.58 2026-03-12
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 100 28 — — $2,253.12 $116,716.96 $39,521.16 2026-03-12
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 113 29 — — $2,253.12 $234,521.98 $39,421.74 2026-03-12
799 MS_DRG Splenic Procedures With Mcc 117 29 — — $2,253.12 $114,844.95 $39,377.44 2026-03-12
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 2 1 — — $38,585.54 $40,127.31 $39,356.43 2026-03-12
B2004 OTHER Miscellaneous; M < 27.85 3 1 — — $39,283.91 $39,283.91 $39,283.91 2024-10-01
B0805 HCPCS Replacement Of Lower Extremity Joint; M > 22.05 & 3 1 — — $39,249.09 $39,249.09 $39,249.09 2026-03-12
B1203 HCPCS Osteoarthritis; M < 30.75 3 1 — — $39,136.47 $39,136.47 $39,136.47 2026-03-12
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 117 29 — — $2,253.12 $114,112.71 $39,123.66 2026-03-12
D0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 3 1 — — $39,002.42 $39,002.42 $39,002.42 2024-10-01
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