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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

TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL

Arlington, TX · CCN 450064 · Rates published

17,280 distinct procedures filed
24 distinct payers
1,258,613 rate rows
2026-04-21 last MRF observed
Data quality

1,251,290 of 1,258,613 rate rows are consumer-grade (99.4%)

7,323 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 6,377
per-diem day rate — not a per-procedure price 489
percent-of-charges filed in the dollar field — excluded from medians 222
exceeds 10× this hospital's gross charge — excluded from medians 113
template filing: same amount across many unrelated codes — excluded 70
placeholder amount (≤ $0.02) — excluded from medians 52
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/13786/750972805_texas-health-arlington-memorial-hospital_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/TexasHealthArlingtonMemorialHospital/13786
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint 85152de07093e997… · 2,051,915,505 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
J3391
HCPCS 		Inj, Atidarsagene Autotemcel 7 $4,505,000.00 $4,955,500.00 $4,707,725.00 nat. median
$4,505,000
1.0× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 8 $3,685,266.67 $4,164,351.33 $3,869,530.00 nat. median
$3,710,000
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 8 $3,316,462.59 $3,747,602.72 $3,482,285.72 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 8 $3,248,445.72 $3,670,743.66 $3,410,868.00 nat. median
$3,286,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 8 $2,945,740.00 $3,328,686.20 $3,093,027.00 nat. median
$3,006,423
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 8 $2,455,110.61 $2,774,274.98 $2,577,866.14 nat. median
$2,469,189
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 8 $2,332,000.00 $2,635,160.00 $2,448,600.00 nat. median
$2,448,600
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 8 $770,620.00 $870,800.60 $809,151.00 nat. median
$824,563
1.0× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 8 $591,726.20 $668,650.61 $621,312.51 nat. median
$754,974
0.8× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 8 $565,868.95 $639,431.91 $594,162.39 nat. median
$675,122
0.9× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 8 $562,538.19 $635,668.15 $590,665.09 nat. median
$674,188
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 8 $557,317.93 $629,769.27 $585,183.83 nat. median
$625,184
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 8 $533,230.17 $602,550.09 $559,891.68 nat. median
$634,511
0.9× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 8 $489,304.61 $552,914.21 $513,769.84 nat. median
$620,080
0.8× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 10 $323,518.82 $2,731,764.38 $359,105.89 nat. median
$370,174
1.0× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 8 $278,250.00 $314,422.50 $292,162.50 nat. median
$324,450
0.9× median
J3403
HCPCS 		Revakinagene, Per Implant 8 $257,500.00 $290,975.00 $270,375.00 nat. median
$265,000
1.0× median
5834
APR_DRG 		Neonate With Ecmo 8 $270,110.21 $297,121.23 $270,110.21 nat. median
$309,665
0.9× median
74
APR_DRG 		Allogeneic Bone Marrow Transplant 8 $262,763.46 $289,039.81 $262,763.46 nat. median
$187,294
1.4× median
5833
APR_DRG 		Neonate With Ecmo 8 $228,719.40 $251,591.34 $228,719.40 nat. median
$244,017
0.9× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 9 $211,204.97 $638,575.36 $221,765.22 nat. median
$265,286
0.8× median
24
APR_DRG 		Heart And/or Lung Transplant 8 $220,021.59 $242,023.75 $220,021.59 nat. median
$234,738
0.9× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 8 $205,640.00 $232,373.20 $215,922.00 nat. median
$209,753
1.0× median
0100T
CPT 		Prosth Retina Receive&gen 4 $47,367.00 $1,274,294.18 $191,693.13 nat. median
$11,210
outlier · 17.1×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 17 $161,761.05 $182,789.99 $172,275.52 nat. median
$206,368
0.8× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 17 $160,832.69 $181,740.94 $171,286.82 nat. median
$202,986
0.8× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 8 $170,975.33 $188,072.86 $170,975.33 nat. median
$246,434
0.7× median
1614
APR_DRG 		Implantable Heart Assist Systems 8 $166,028.78 $182,631.66 $166,028.78 nat. median
$207,730
0.8× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 12 $84,140.31 $605,308.66 $155,782.77 nat. median
$102,358
1.5× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 8 $155,542.82 $171,097.10 $155,542.82 nat. median
$164,834
0.9× median
215
MS_DRG 		Other Heart Assist System Implant 12 $77,345.42 $588,689.47 $151,505.64 nat. median
$99,019
1.5× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 $76,054.76 $536,253.72 $138,010.73 nat. median
$93,672
1.5× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 $127,217.05 $139,938.76 $127,217.05 nat. median
$150,721
0.8× median
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 $126,089.68 $138,698.65 $126,089.68 nat. median
$162,982
0.8× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 12 $66,030.97 $470,843.78 $121,176.77 nat. median
$79,312
1.5× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 $85,230.19 $552,985.89 $115,229.40 nat. median
$98,905
1.2× median
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 8 $109,306.05 $123,515.84 $114,771.35 nat. median
$111,989
1.0× median
447
MS_DRG 		Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 12 $53,077.65 $233,567.62 $114,000.01 nat. median
$63,738
1.8× median
5832
APR_DRG 		Neonate With Ecmo 8 $113,965.65 $125,362.22 $113,965.65 nat. median
$156,126
0.7× median
4
MS_DRG 		Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mouth And… 17 $106,199.43 $120,005.36 $113,102.40 nat. median
$133,176
0.8× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 12 $60,217.05 $434,310.45 $111,774.52 nat. median
$73,807
1.5× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 $60,462.31 $429,926.45 $110,646.25 nat. median
$74,915
1.5× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 $108,217.85 $119,039.64 $108,217.85 nat. median
$117,173
0.9× median
7
MS_DRG 		Lung Transplant 9 $99,522.36 $296,269.70 $104,498.48 nat. median
$122,708
0.9× median
28
MS_DRG 		Spinal Procedures With Mcc 12 $48,089.10 $211,789.76 $103,369.74 nat. median
$57,823
1.8× median
461
MS_DRG 		Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 12 $44,493.46 $497,643.77 $101,861.57 nat. median
$55,736
1.8× median
850
MS_DRG 		Acute Leukemia With Other Procedures 12 $67,732.12 $667,273.19 $101,330.90 nat. median
$83,442
1.2× median
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 12 $56,402.85 $392,670.79 $101,058.10 nat. median
$68,887
1.5× median
2004
APR_DRG 		Cardiac Structural And Valvular Disorders 8 $100,564.19 $110,620.61 $100,564.19 nat. median
$32,636
outlier · 3.1×
5831
APR_DRG 		Neonate With Ecmo 8 $100,349.03 $110,383.93 $100,349.03 nat. median
$145,122
0.7× median

Other procedures at this hospital

Browse this hospital's 17,280 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
             
31 MS_DRG Ventricular Shunt Procedures With Mcc 26 17 — — $36,769.47 $41,549.50 $39,159.49 2026-04-21
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 8 8 — — $37,823.06 $41,605.37 $37,823.06 2026-04-21
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 8 8 — — $37,887.43 $41,676.17 $37,887.43 2026-04-21
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 26 17 — — $37,259.94 $42,103.73 $39,681.83 2026-04-21
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $38,289.66 $42,118.63 $38,289.66 2026-04-21
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 8 8 — — $38,409.51 $42,250.46 $38,409.51 2026-04-21
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 8 — — $38,538.60 $42,392.46 $38,538.60 2026-04-21
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $39,197.24 $43,116.96 $39,197.24 2026-04-21
6954 APR_DRG Chemotherapy For Acute Leukemia 8 8 — — $39,237.43 $43,161.17 $39,237.43 2026-04-21
2054 APR_DRG Cardiomyopathy 8 8 — — $39,287.93 $43,216.72 $39,287.93 2026-04-21
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 8 8 — — $39,399.25 $43,339.18 $39,399.25 2026-04-21
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 8 8 — — $39,408.85 $43,349.74 $39,408.85 2026-04-21
L2006 HCPCS Kaf Sng/dbl Swg/stn Mcpr Cus 10 8 — — $38,750.60 $43,788.18 $40,688.13 2026-04-21
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 8 8 — — $40,064.64 $44,071.10 $40,064.64 2026-04-21
1824 APR_DRG Other Peripheral Vascular Procedures 8 8 — — $40,088.47 $44,097.32 $40,088.47 2026-04-21
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 8 — — $40,120.83 $44,132.91 $40,120.83 2026-04-21
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 8 — — $40,360.18 $44,396.20 $40,360.18 2026-04-21
264 APR_DRG Other Nervous System And Related Procedures 8 8 — — $40,535.15 $44,588.67 $40,535.15 2026-04-21
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 8 — — $40,559.69 $44,615.66 $40,559.69 2026-04-21
13 APR_DRG Liver Transplant And/or Intestinal Transplant 8 8 — — $40,607.70 $44,668.47 $40,607.70 2026-04-21
71 APR_DRG Allogeneic Bone Marrow Transplant 8 8 — — $40,906.43 $44,997.07 $40,906.43 2026-04-21
61 APR_DRG Pancreas Transplant 8 8 — — $41,626.96 $45,789.66 $41,626.96 2026-04-21
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 8 8 — — $42,006.06 $46,206.67 $42,006.06 2026-04-21
62 APR_DRG Pancreas Transplant 8 8 — — $42,171.44 $46,388.58 $42,171.44 2026-04-21
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 8 — — $42,200.60 $46,420.66 $42,200.60 2026-04-21
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $42,733.34 $47,006.67 $42,733.34 2026-04-21
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $42,735.12 $47,008.63 $42,735.12 2026-04-21
9104 APR_DRG Craniotomy For Multiple Significant Trauma 8 8 — — $43,291.34 $47,620.47 $43,291.34 2026-04-21
234 APR_DRG Spinal Procedures 8 8 — — $43,448.53 $47,793.38 $43,448.53 2026-04-21
22 APR_DRG Heart And/or Lung Transplant 8 8 — — $43,533.53 $47,886.88 $43,533.53 2026-04-21
4474 APR_DRG Other Kidney, Urinary Tract And Related Procedures 8 8 — — $44,101.83 $48,512.01 $44,101.83 2026-04-21
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 8 8 — — $44,205.32 $48,625.85 $44,205.32 2026-04-21
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 8 8 — — $44,447.51 $48,892.26 $44,447.51 2026-04-21
64654 CPT 1st Opn Implt Bat Modulj Sys 10 8 — — $44,320.09 $50,081.70 $46,536.10 2026-04-21
63 APR_DRG Pancreas Transplant 8 8 — — $46,624.72 $51,287.19 $46,624.72 2026-04-21
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $46,643.93 $51,308.32 $46,643.93 2026-04-21
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $47,104.83 $51,815.31 $47,104.83 2026-04-21
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 10 8 — — $45,855.99 $51,817.27 $48,148.79 2026-04-21
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 26 17 — — $2,645.11 $52,013.18 $49,021.27 2026-04-21
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 8 — — $47,426.33 $52,168.96 $47,426.33 2026-04-21
33225 CPT L Ventric Pacing Lead Add-on 66 21 $55,705.75 $33,423.45 40% off $387.84 $52,419.11 $39,300.40 2026-04-21
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 8 8 — — $47,717.24 $52,488.96 $47,717.24 2026-04-21
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $48,741.83 $53,616.01 $48,741.83 2026-04-21
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 10 8 — — $47,608.99 $53,798.16 $49,989.44 2026-04-21
L7181 HCPCS Electronic Elbo Simultaneous 10 8 — — $48,628.26 $54,949.93 $51,059.67 2026-04-21
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $50,259.69 $55,285.66 $50,259.69 2026-04-21
434 APR_DRG Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies 8 8 — — $50,316.23 $55,347.85 $50,316.23 2026-04-21
L7180 HCPCS Electronic Elbow Sequential 10 8 — — $49,026.62 $55,400.08 $51,477.95 2026-04-21
6904 APR_DRG Acute Leukemia 8 8 — — $50,626.35 $55,688.99 $50,626.35 2026-04-21
1674 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 8 8 — — $51,085.12 $56,193.63 $51,085.12 2026-04-21
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 8 8 — — $51,312.02 $56,443.22 $51,312.02 2026-04-21
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 8 — — $51,371.05 $56,508.16 $51,371.05 2026-04-21
1784 APR_DRG External Heart Assist Systems 8 8 — — $52,164.12 $57,380.53 $52,164.12 2026-04-21
83 APR_DRG Autologous Bone Marrow Transplant Or T-cell Immunotherapy 8 8 — — $53,059.97 $58,365.97 $53,059.97 2026-04-21
J7311 HCPCS Fluocinolone 0.59 Mg Intravitreal Impl [38567] 132 24 $62,782.50 $37,669.50 40% off $340.31 $59,078.33 $38,479.39 2026-04-21
23 APR_DRG Heart And/or Lung Transplant 8 8 — — $54,191.25 $59,610.38 $54,191.25 2026-04-21
955 MS_DRG Craniotomy For Multiple Significant Trauma 26 17 — — $53,444.40 $60,392.17 $56,918.29 2026-04-21
4414 APR_DRG Major Bladder Procedures 8 8 — — $55,694.53 $61,263.98 $55,694.53 2026-04-21
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 10 8 — — $55,272.32 $62,457.73 $58,035.94 2026-04-21
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 8 8 — — $56,889.47 $62,578.42 $56,889.47 2026-04-21
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $57,051.29 $62,756.42 $57,051.29 2026-04-21
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 8 8 — — $57,051.29 $62,756.42 $57,051.29 2026-04-21
J9274 HCPCS Tebentafusp-tebn 100 Mcg/0.5 Ml Intravenous Soln [152604] 132 24 $66,858.00 $40,114.80 40% off $217.09 $62,913.38 $40,977.27 2026-04-21
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 26 17 — — $56,716.26 $64,089.37 $60,402.82 2026-04-21
A9543 HCPCS Y90 Ibritumomab, Rx 10 8 — — $56,824.55 $64,211.74 $59,665.78 2026-04-21
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $58,562.39 $64,418.63 $58,562.39 2026-04-21
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 8 — — $58,582.30 $64,440.53 $58,582.30 2026-04-21
4404 APR_DRG Kidney Transplant 8 8 — — $58,851.17 $64,736.29 $58,851.17 2026-04-21
1611 APR_DRG Implantable Heart Assist Systems 8 8 — — $58,996.98 $64,896.68 $58,996.98 2026-04-21
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 8 — — $59,959.69 $65,955.66 $59,959.69 2026-04-21
8634 APR_DRG Neonatal Aftercare 8 8 — — $60,541.15 $66,595.27 $60,541.15 2026-04-21
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $61,494.97 $67,644.47 $61,494.97 2026-04-21
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 26 17 — — $60,029.61 $67,833.46 $63,931.54 2026-04-21
1612 APR_DRG Implantable Heart Assist Systems 8 8 — — $62,206.25 $68,426.88 $62,206.25 2026-04-21
72 APR_DRG Allogeneic Bone Marrow Transplant 8 8 — — $62,296.93 $68,526.62 $62,296.93 2026-04-21
J9229 HCPCS Inotuzumab Ozogamicin 0.9 Mg (0.25 Mg/ml Initial) Intravenous Solr [138459] 132 24 $73,377.12 $44,026.28 40% off $2,698.05 $69,047.87 $44,972.84 2026-04-21
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 8 8 — — $62,788.78 $69,067.66 $62,788.78 2026-04-21
J9029 HCPCS Instill Adstiladrin, Tx Dose 10 8 — — $63,342.28 $71,576.78 $66,509.40 2026-04-21
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 8 8 — — $65,583.73 $72,142.10 $65,583.73 2026-04-21
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $66,120.39 $72,732.43 $66,120.39 2026-04-21
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 8 8 — — $67,223.57 $73,945.93 $67,223.57 2026-04-21
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 10 8 — — $67,452.66 $76,221.51 $70,825.29 2026-04-21
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 8 8 — — $69,920.37 $76,912.41 $69,920.37 2026-04-21
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 8 — — $71,926.16 $79,118.78 $71,926.16 2026-04-21
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 8 8 — — $72,142.03 $79,356.23 $72,142.03 2026-04-21
64 APR_DRG Pancreas Transplant 8 8 — — $72,147.72 $79,362.49 $72,147.72 2026-04-21
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 8 — — $74,343.07 $81,777.38 $74,343.07 2026-04-21
2464 APR_DRG Gastrointestinal Vascular Insufficiency 8 8 — — $74,728.58 $82,201.44 $74,728.58 2026-04-21
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 21 12 — — $22,363.20 $83,648.44 $40,824.20 2026-04-21
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $76,417.86 $84,059.65 $76,417.86 2026-04-21
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 8 8 — — $77,061.91 $84,768.10 $77,061.91 2026-04-21
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 8 8 — — $77,104.95 $84,815.45 $77,104.95 2026-04-21
33224 CPT Insert Pacing Lead Connect 77 21 $55,705.75 $33,423.45 40% off $6,252.51 $85,665.21 $39,300.40 2026-04-21
84 APR_DRG Autologous Bone Marrow Transplant Or T-cell Immunotherapy 8 8 — — $78,499.76 $86,349.74 $78,499.76 2026-04-21
14 APR_DRG Liver Transplant And/or Intestinal Transplant 8 8 — — $78,815.56 $86,697.12 $78,815.56 2026-04-21
J2507 HCPCS Pegloticase 8 Mg/ml Intravenous Soln [108958] 132 24 $94,484.28 $56,690.57 40% off $3,627.97 $88,909.71 $57,909.42 2026-04-21
J0202 HCPCS Lemtrada 12 Mg/1.2 Ml Intravenous Soln [127557] 132 24 $95,033.99 $57,020.40 40% off $2,429.89 $89,426.98 $58,246.33 2026-04-21
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $86,079.09 $94,687.00 $86,079.09 2026-04-21
1613 APR_DRG Implantable Heart Assist Systems 8 8 — — $86,536.44 $95,190.08 $86,536.44 2026-04-21
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $86,638.51 $95,302.36 $86,638.51 2026-04-21
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 8 8 — — $87,421.62 $96,163.78 $87,421.62 2026-04-21
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 8 8 — — $89,786.96 $98,765.66 $89,786.96 2026-04-21
209 MS_DRG Complex Aortic Arch Procedures 10 8 — — $87,435.15 $98,801.72 $91,806.91 2026-04-21
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $90,692.77 $99,762.05 $90,692.77 2026-04-21
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $91,084.33 $100,192.76 $91,084.33 2026-04-21
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $91,320.47 $100,452.52 $91,320.47 2026-04-21
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $91,739.76 $100,913.74 $91,739.76 2026-04-21
73 APR_DRG Allogeneic Bone Marrow Transplant 8 8 — — $92,719.19 $101,991.11 $92,719.19 2026-04-21
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 13 10 — — $38,406.14 $104,447.49 $40,326.45 2026-04-21
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 10 8 — — $93,216.70 $105,334.87 $97,877.54 2026-04-21
6 MS_DRG Liver Transplant Without Mcc 12 9 — — $37,929.00 $109,931.36 $39,825.45 2026-04-21
5831 APR_DRG Neonate With Ecmo 8 8 — — $100,349.03 $110,383.93 $100,349.03 2026-04-21
2004 APR_DRG Cardiac Structural And Valvular Disorders 8 8 — — $100,564.19 $110,620.61 $100,564.19 2026-04-21
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 21 12 — — $28,849.88 $116,937.10 $57,073.97 2026-04-21
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $108,217.85 $119,039.64 $108,217.85 2026-04-21
4 MS_DRG Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mouth And … 26 17 — — $106,199.43 $120,005.36 $113,102.40 2026-04-21
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 12 9 — — $45,098.05 $123,349.74 $47,352.95 2026-04-21
Q0480 HCPCS Driver Pneumatic Vad, Rep 10 8 — — $109,306.05 $123,515.84 $114,771.35 2026-04-21
5832 APR_DRG Neonate With Ecmo 8 8 — — $113,965.65 $125,362.22 $113,965.65 2026-04-21
0620T CPT Evasc Ven Artlz Tibl/prnl Vn 17 10 — — $14,351.00 $134,230.78 $45,206.49 2026-04-21
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 12 9 — — $47,506.74 $136,833.85 $49,882.08 2026-04-21
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 12 9 — — $43,821.45 $136,833.85 $46,012.52 2026-04-21
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 8 — — $126,089.68 $138,698.65 $126,089.68 2026-04-21
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 8 — — $127,217.05 $139,938.76 $127,217.05 2026-04-21
509 MS_DRG Orthopedic 11 6 — — $29,869.17 $145,925.56 $44,976.94 2026-04-21
263 MS_DRG Vein Ligation And Stripping 21 12 — — $26,225.59 $149,028.20 $38,354.03 2026-04-21
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 21 12 — — $26,853.12 $155,884.80 $40,118.65 2026-04-21
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 21 12 — — $23,731.67 $158,179.60 $40,709.24 2026-04-21
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 21 12 — — $27,359.15 $159,029.72 $40,928.03 2026-04-21
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 21 12 — — $24,692.64 $161,813.48 $41,644.46 2026-04-21
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 21 12 — — $25,625.42 $170,503.69 $43,880.98 2026-04-21
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $155,542.82 $171,097.10 $155,542.82 2026-04-21
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 21 12 — — $26,907.93 $172,598.45 $44,420.09 2026-04-21
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 21 12 — — $27,961.53 $173,415.24 $44,630.30 2026-04-21
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 21 12 — — $26,919.06 $177,532.54 $45,689.93 2026-04-21
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 21 12 — — $32,181.01 $177,601.78 $40,165.32 2026-04-21
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 21 12 — — $30,293.16 $178,049.28 $45,822.92 2026-04-21
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 21 12 — — $43,060.54 $179,410.40 $87,567.15 2026-04-21
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 12 9 — — $56,433.97 $179,711.89 $59,255.67 2026-04-21
10 MS_DRG Pancreas Transplant 12 9 — — $56,738.49 $180,747.91 $59,575.41 2026-04-21
3 MS_DRG Ecmo Or Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mo… 26 17 — — $160,832.69 $181,740.94 $171,286.82 2026-04-21
1614 APR_DRG Implantable Heart Assist Systems 8 8 — — $166,028.78 $182,631.66 $166,028.78 2026-04-21
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv &gt;96 Hours With Skin Graft 26 17 — — $161,761.05 $182,789.99 $172,275.52 2026-04-21
34 MS_DRG Carotid Artery Stent Procedures With Mcc 21 12 — — $32,251.40 $183,091.66 $41,406.88 2026-04-21
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $170,975.33 $188,072.86 $170,975.33 2026-04-21
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 21 12 — — $27,228.77 $188,473.09 $48,505.60 2026-04-21
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 21 12 — — $31,263.02 $189,195.78 $39,424.00 2026-04-21
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 21 12 — — $27,673.31 $189,262.10 $48,708.66 2026-04-21
33230 CPT Insrt Icd Pulse Gen Dual Lead 77 21 $71,587.50 $42,952.50 40% off $16,993.10 $189,788.91 $50,504.99 2026-04-21
33262 CPT Remove/replce Icd Gen Sng Lead 77 21 $60,724.75 $36,434.85 40% off $16,178.06 $189,788.91 $42,841.31 2026-04-21
33263 CPT Remove/rplce Icd Gen Dual Lead 77 21 $60,724.75 $36,434.85 40% off $16,336.46 $189,788.91 $42,841.31 2026-04-21
252 MS_DRG Other Vascular Procedures With Mcc 21 12 — — $29,418.15 $190,606.75 $49,054.72 2026-04-21
271 MS_DRG Other Major Cardiovascular Procedures With Cc 21 12 — — $29,921.97 $191,384.64 $49,254.92 2026-04-21
264 MS_DRG Other Circulatory System O.r. Procedures 21 12 — — $28,323.85 $194,201.74 $49,979.93 2026-04-21
478 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Cc 21 12 — — $21,793.45 $194,262.82 $39,763.22 2026-04-21
265 MS_DRG Aicd Lead Procedures 21 12 — — $30,380.59 $198,207.90 $51,010.96 2026-04-21
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 21 12 — — $33,361.28 $206,521.13 $43,034.20 2026-04-21
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 21 12 — — $25,924.76 $209,738.39 $42,930.87 2026-04-21
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 21 12 — — $24,110.27 $211,673.88 $43,327.04 2026-04-21
28 MS_DRG Spinal Procedures With Mcc 21 12 — — $48,089.10 $211,789.76 $103,369.74 2026-04-21
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 12 9 — — $87,531.47 $213,200.02 $91,908.04 2026-04-21
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 21 12 — — $34,993.50 $215,563.88 $44,918.50 2026-04-21
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 21 12 — — $34,139.23 $217,271.91 $55,917.29 2026-04-21
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 21 12 — — $23,933.19 $217,912.28 $44,603.97 2026-04-21
503 MS_DRG Foot Procedures With Mcc 21 12 — — $24,252.52 $219,847.77 $45,000.14 2026-04-21
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 21 12 — — $34,488.20 $227,942.90 $47,498.00 2026-04-21
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 21 12 — — $34,608.23 $228,484.72 $58,803.03 2026-04-21
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 21 12 — — $34,863.11 $231,185.13 $59,498.01 2026-04-21
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 10 8 — — $205,640.00 $232,373.20 $215,922.00 2026-04-21
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 21 12 — — $53,077.65 $233,567.62 $114,000.01 2026-04-21
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 21 12 — — $35,635.14 $236,669.30 $60,909.42 2026-04-21
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 21 12 — — $25,952.18 $237,416.65 $48,596.27 2026-04-21
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 21 12 — — $23,281.19 $237,890.14 $48,693.19 2026-04-21
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 12 9 — — $79,964.53 $241,421.90 $83,962.76 2026-04-21
24 APR_DRG Heart And/or Lung Transplant 8 8 — — $220,021.59 $242,023.75 $220,021.59 2026-04-21
64568 CPT Opn Impltj Crnl Nrv Nea&pg 25 13 — — $19,861.72 $243,316.19 $46,092.90 2026-04-21
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 21 12 — — $25,150.51 $244,302.99 $50,005.82 2026-04-21
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 21 12 — — $26,650.10 $244,934.30 $50,135.05 2026-04-21
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 21 12 — — $29,292.94 $250,983.50 $38,113.90 2026-04-21
332 MS_DRG Rectal Resection With Mcc 21 12 — — $30,399.12 $251,258.75 $38,155.70 2026-04-21
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 21 12 — — $42,795.31 $251,465.59 $56,869.90 2026-04-21
5833 APR_DRG Neonate With Ecmo 8 8 — — $228,719.40 $251,591.34 $228,719.40 2026-04-21
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 21 12 — — $29,990.88 $253,620.17 $38,514.30 2026-04-21
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 21 12 — — $28,974.34 $253,721.58 $38,529.70 2026-04-21
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 21 12 — — $29,968.64 $253,801.26 $38,541.80 2026-04-21
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 21 12 — — $40,916.34 $255,183.23 $65,674.18 2026-04-21
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 21 12 — — $28,816.54 $255,662.86 $38,824.50 2026-04-21
471 MS_DRG Cervical Spinal Fusion With Mcc 21 12 — — $39,349.33 $256,412.01 $53,430.30 2026-04-21
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 21 12 — — $27,185.06 $256,879.48 $52,580.08 2026-04-21
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 21 12 — — $37,791.93 $258,478.17 $66,522.17 2026-04-21
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 21 12 — — $30,333.18 $259,654.09 $39,430.60 2026-04-21
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 21 12 — — $33,091.60 $259,668.57 $39,432.80 2026-04-21
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 21 12 — — $38,846.23 $261,411.95 $67,277.21 2026-04-21
335 MS_DRG Peritoneal Adhesiolysis With Mcc 21 12 — — $30,030.15 $262,464.60 $39,857.40 2026-04-21
500 MS_DRG Soft Tissue Procedures With Mcc 21 12 — — $27,021.31 $263,217.57 $53,877.41 2026-04-21
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 21 12 — — $29,648.58 $264,297.23 $40,135.70 2026-04-21
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 21 12 — — $27,482.89 $267,420.81 $54,737.76 2026-04-21
33249 CPT Insert Of Icd Gen + Lead 77 21 $86,388.00 $51,832.80 40% off $21,852.74 $269,753.74 $60,946.74 2026-04-21
33264 CPT Remove/rplce Icd Gen Mult Lead 77 21 $60,724.75 $36,434.85 40% off $17,610.18 $269,753.74 $42,841.31 2026-04-21
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 21 12 — — $29,943.45 $271,055.51 $41,162.00 2026-04-21
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 21 12 — — $26,046.27 $271,524.37 $55,577.71 2026-04-21
245 MS_DRG Aicd Generator Procedures 21 12 — — $37,376.27 $271,530.16 $69,881.24 2026-04-21
228 MS_DRG Other Cardiothoracic Procedures With Mcc 21 12 — — $40,228.78 $276,892.08 $71,261.19 2026-04-21
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 21 12 — — $44,813.54 $278,003.36 $71,547.19 2026-04-21
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 21 12 — — $31,265.97 $278,900.33 $42,353.30 2026-04-21
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 21 12 — — $30,787.36 $279,682.64 $42,472.10 2026-04-21
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 21 12 — — $40,038.37 $279,870.31 $72,027.67 2026-04-21
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 21 12 — — $29,411.48 $279,965.14 $42,515.00 2026-04-21
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 21 12 — — $29,701.92 $284,524.51 $58,238.68 2026-04-21
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 21 12 — — $42,665.63 $285,210.01 $73,401.90 2026-04-21
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 21 12 — — $30,056.81 $285,223.99 $43,313.60 2026-04-21
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 21 12 — — $29,168.47 $285,670.85 $58,473.32 2026-04-21
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 21 12 — — $31,185.23 $285,810.73 $43,402.70 2026-04-21
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 21 12 — — $30,118.33 $288,360.47 $43,789.90 2026-04-21
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 21 12 — — $32,018.76 $288,563.29 $43,820.70 2026-04-21
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 21 12 — — $46,302.02 $288,782.22 $60,175.50 2026-04-21
74 APR_DRG Allogeneic Bone Marrow Transplant 8 8 — — $262,763.46 $289,039.81 $262,763.46 2026-04-21
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 21 12 — — $45,226.97 $290,555.93 $60,545.10 2026-04-21
J3403 HCPCS Revakinagene, Per Implant 10 8 — — $257,500.00 $290,975.00 $270,375.00 2026-04-21
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 21 12 — — $30,436.18 $292,449.20 $59,860.76 2026-04-21
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 21 12 — — $43,084.25 $294,305.84 $75,742.81 2026-04-21
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 21 12 — — $34,343.00 $294,626.19 $44,741.40 2026-04-21
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 21 12 — — $30,776.24 $294,991.08 $60,381.05 2026-04-21
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 21 12 — — $44,046.69 $295,611.59 $76,078.86 2026-04-21
7 MS_DRG Lung Transplant 12 9 — — $99,522.36 $296,269.70 $104,498.48 2026-04-21
14 MS_DRG Allogeneic Bone Marrow Transplant 12 9 — — $92,614.84 $297,017.81 $97,245.58 2026-04-21
5834 APR_DRG Neonate With Ecmo 8 8 — — $270,110.21 $297,121.23 $270,110.21 2026-04-21
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 21 12 — — $34,809.76 $297,255.61 $45,140.70 2026-04-21
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 21 12 — — $47,754.20 $302,977.19 $63,133.40 2026-04-21
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 21 12 — — $34,703.08 $303,477.87 $46,085.60 2026-04-21
140 MS_DRG Major Head And Neck Procedures With Mcc 21 12 — — $35,175.04 $306,346.33 $46,521.20 2026-04-21
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 21 12 — — $36,119.68 $308,990.25 $46,922.70 2026-04-21
38240 CPT Transplt Allo Hct/donor 17 10 — — $9,883.00 $312,814.21 $66,456.45 2026-04-21
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 10 8 — — $278,250.00 $314,422.50 $292,162.50 2026-04-21
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 21 12 — — $36,639.06 $318,196.86 $48,320.80 2026-04-21
901 MS_DRG Wound Debridements For Injuries With Mcc 21 12 — — $34,666.01 $320,927.70 $48,735.50 2026-04-21
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 21 12 — — $37,274.77 $326,802.26 $49,627.60 2026-04-21
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 21 12 — — $47,054.05 $326,949.69 $84,144.06 2026-04-21
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 21 12 — — $52,290.06 $330,566.91 $85,074.99 2026-04-21
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 21 12 — — $37,628.93 $332,618.87 $50,510.90 2026-04-21
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 21 12 — — $48,978.93 $332,872.81 $85,668.44 2026-04-21
163 MS_DRG Major Chest Procedures With Mcc 21 12 — — $36,779.10 $333,872.01 $50,701.20 2026-04-21
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 21 12 — — $37,542.24 $338,964.26 $51,474.50 2026-04-21
232 MS_DRG Coronary Bypass With Ptca Without Mcc 21 12 — — $48,491.40 $339,423.81 $87,354.41 2026-04-21
J9226 HCPCS Supprelin La 50 Mg (65 Mcg/day) Implant Kit [91426] 132 24 $156,396.80 $93,838.08 40% off $15,764.80 $342,206.87 $95,855.60 2026-04-21
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 21 12 — — $53,113.94 $343,741.13 $88,465.52 2026-04-21
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 21 12 — — $48,076.50 $344,185.64 $88,579.92 2026-04-21
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 21 12 — — $38,335.02 $344,353.50 $52,292.90 2026-04-21
799 MS_DRG Splenic Procedures With Mcc 21 12 — — $37,128.07 $344,418.69 $52,302.80 2026-04-21
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 21 12 — — $38,231.28 $345,918.12 $52,530.50 2026-04-21
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 21 12 — — $52,290.06 $358,826.76 $92,347.97 2026-04-21
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 21 12 — — $40,163.57 $362,274.17 $55,014.30 2026-04-21
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 21 12 — — $39,168.54 $362,701.54 $55,079.20 2026-04-21
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 21 12 — — $40,525.15 $367,902.44 $55,869.00 2026-04-21
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 21 12 — — $54,532.05 $370,478.53 $95,346.68 2026-04-21
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 21 12 — — $35,379.52 $372,535.06 $76,253.35 2026-04-21
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 21 12 — — $57,056.34 $374,944.43 $78,129.70 2026-04-21
33276 CPT Insj Phrnc Nrv Stim Sys 25 13 — — $32,454.62 $376,024.18 $46,536.10 2026-04-21
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 21 12 — — $61,873.74 $379,540.77 $85,834.59 2026-04-21
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 21 12 — — $39,886.48 $390,813.95 $59,348.30 2026-04-21
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 21 12 — — $43,982.98 $390,857.41 $59,354.90 2026-04-21
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 21 12 — — $56,402.85 $392,670.79 $101,058.10 2026-04-21
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 21 12 — — $44,104.48 $393,233.31 $59,715.70 2026-04-21
834 MS_DRG Acute Leukemia With Mcc 21 12 — — $44,248.22 $400,375.50 $60,800.30 2026-04-21
653 MS_DRG Major Bladder Procedures With Mcc 21 12 — — $42,073.64 $403,801.73 $61,320.60 2026-04-21
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 21 12 — — $47,025.90 $421,744.12 $64,045.30 2026-04-21
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 21 12 — — $42,140.34 $423,198.23 $86,623.48 2026-04-21
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 21 12 — — $60,462.31 $429,926.45 $110,646.25 2026-04-21
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 21 12 — — $60,217.05 $434,310.45 $111,774.52 2026-04-21
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 21 12 — — $70,326.03 $440,291.93 $91,746.60 2026-04-21
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 21 12 — — $52,112.99 $446,075.38 $67,740.20 2026-04-21
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 21 12 — — $65,834.64 $447,080.60 $93,161.20 2026-04-21
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 21 12 — — $45,801.17 $448,650.27 $91,833.20 2026-04-21
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 21 12 — — $48,926.32 $458,106.99 $69,567.30 2026-04-21
207 MS_DRG Respiratory System Diagnosis With Ventilator Support &gt;96 Hours 21 12 — — $51,248.34 $468,458.10 $71,139.20 2026-04-21
231 MS_DRG Coronary Bypass With Ptca With Mcc 21 12 — — $66,030.97 $470,843.78 $121,176.77 2026-04-21
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 21 12 — — $44,493.46 $497,643.77 $101,861.57 2026-04-21
870 MS_DRG Septicemia Or Severe Sepsis With Mv &gt;96 Hours 21 12 — — $54,783.22 $503,901.03 $76,521.50 2026-04-21
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 21 12 — — $76,054.76 $536,253.72 $138,010.73 2026-04-21
Q2053 HCPCS Brexucabtagene Car Pos T 10 8 — — $489,304.61 $552,914.21 $513,769.84 2026-04-21
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 21 12 — — $85,230.19 $552,985.89 $115,229.40 2026-04-21
215 MS_DRG Other Heart Assist System Implant 21 12 — — $77,345.42 $588,689.47 $151,505.64 2026-04-21
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 10 8 — — $533,230.17 $602,550.09 $559,891.68 2026-04-21
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 21 12 — — $84,140.31 $605,308.66 $155,782.77 2026-04-21
Q2055 HCPCS Idecabtagene Vicleucel Car 10 8 — — $557,317.93 $629,769.27 $585,183.83 2026-04-21
Q2054 HCPCS Lisocabtagene Mara Car Pos T 10 8 — — $562,538.19 $635,668.15 $590,665.09 2026-04-21
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 12 9 — — $211,204.97 $638,575.36 $221,765.22 2026-04-21
Q2056 HCPCS Ciltacabtagene Car-pos T 10 8 — — $565,868.95 $639,431.91 $594,162.39 2026-04-21
850 MS_DRG Acute Leukemia With Other Procedures 21 12 — — $67,732.12 $667,273.19 $101,330.90 2026-04-21
Q2042 HCPCS Tisagenlecleucel Car-pos T 10 8 — — $591,726.20 $668,650.61 $621,312.51 2026-04-21
Q2057 HCPCS Afamitresgene Autoleucel 10 8 — — $770,620.00 $870,800.60 $809,151.00 2026-04-21
0100T CPT Prosth Retina Receive&gen 7 4 — — $47,367.00 $1,274,294.18 $191,693.13 2026-04-21
J3392 HCPCS Inj, Exagamglogene Autotem 10 8 — — $2,332,000.00 $2,635,160.00 $2,448,600.00 2026-04-21
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 17 10 — — $323,518.82 $2,731,764.38 $359,105.89 2026-04-21
J3399 HCPCS Inj Onase Abepar-xioi Treat 10 8 — — $2,455,110.61 $2,774,274.98 $2,577,866.14 2026-04-21
J3393 HCPCS Inj, Betibeglogene Autotemce 10 8 — — $2,945,740.00 $3,328,686.20 $3,093,027.00 2026-04-21
J3394 HCPCS Inj, Lovotibeglogene Autotem 10 8 — — $3,248,445.72 $3,670,743.66 $3,410,868.00 2026-04-21
J1413 HCPCS Inj Delandistrogene Mox Rokl 10 8 — — $3,316,462.59 $3,747,602.72 $3,482,285.72 2026-04-21
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 10 8 — — $3,685,266.67 $4,164,351.33 $3,869,530.00 2026-04-21
J3391 HCPCS Inj, Atidarsagene Autotemcel 8 7 — — $4,505,000.00 $4,955,500.00 $4,707,725.00 2026-04-21
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