Hospital

St. David's Georgetown Hospital

Georgetown, TX · CCN 450191 · Rates published

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You selected 93350 (CPT)

ECHO STRESS

This hospital’s price: $3,024 across 30 payers · range $192-$7,710

Source: https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/74-2781812_ST.-DAVID'S-GEORGETOWN-HOSPITAL_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D · observed 2026-03-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

29,830 distinct procedures filed

68 distinct payers

1,299,007 rate rows

2026-07-17 last MRF observed

Data quality

1,276,951 of 1,299,007 rate rows are consumer-grade (98.3%)

22,056 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 — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	15,374
per-diem day rate — not a per-procedure price	5,011
template filing: same amount across many unrelated codes — excluded	1,084
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	469
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	107
exceeds 10× this hospital's gross charge — excluded from medians	8
placeholder amount (≤ $0.02) — excluded from medians	2
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings	1

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/74-2781812_ST.-DAVID'S-GEORGETOWN-HOSPITAL_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Discovered via	Discovered by HANK (automated)
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-09-21
Content fingerprint	0475aa38517f649c… · 880,515,518 bytes · first seen 2026-05-13

Top 50 most expensive offerings

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

Code	Description	Payers	Min $	Max $	Avg median	vs national
J3399 HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	1	$3,158,557.10	$4,271,819.03	$4,271,819.03	nat. median $2,466,282 1.7× median
J3389 HCPCS	Topical Administration, Prademagene Zamikeracel, Per Treatment	1	$4,069,700.40	$4,069,700.40	$4,069,700.40	nat. median $3,335,820 1.2× median
824 OTHER	Inj, Exagamglogene Autote	24	$2,262,040.00	$4,617,360.00	$2,460,260.00	nat. median $2,262,040 1.1× median
Q2057 HCPCS	Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure…	1	$940,156.40	$1,271,523.00	$1,271,523.00	nat. median $809,217 1.6× median
Q2041 HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	1	$649,274.53	$878,117.20	$878,117.20	nat. median $608,101 1.4× median
33990 CPT	Insertion Impella Lvad	24	$123,666.90	$795,001.50	$379,834.05	nat. median $4,432 outlier · 85.7×
102901 CDM	Tube Inj Cemnt 4.2mm	36	$49,999.95	$899,999.10	$352,999.65	nat. median $475 outlier · 742.9×
J3402 HCPCS	Injection, Remestemcel-l-rknd, Per Therapeutic Dose	1	$246,036.20	$332,753.88	$332,753.88	nat. median $209,753 1.6× median
322996 CDM	Set Vntrc 17.4x13.8in	36	$24,512.50	$441,225.00	$173,058.25	nat. median $171,588 1.0× median
2 MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	1	$167,691.00	$298,508.00	$171,465.00	nat. median $103,967 1.6× median
7 MS_DRG	Lung Transplant	1	$170,613.71	$170,613.71	$170,613.71	nat. median $117,894 1.4× median
5 MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	2	$125,000.00	$136,264.59	$136,264.59	nat. median $94,964 1.4× median
349401 CDM	Device Clsr 20mm	23	$36,366.40	$233,784.00	$96,111.20	nat. median $96,111 1.0× median
349403 CDM	Device Clsr 27mm	23	$36,366.40	$233,784.00	$96,111.20	nat. median $96,111 1.0× median
349404 CDM	Device Clsr 31mm	23	$36,366.40	$233,784.00	$96,111.20	nat. median $15,000 outlier · 6.4×
349402 CDM	Device Clsr 24mm	23	$36,366.40	$233,784.00	$96,111.20	nat. median $44,809 outlier · 2.1×
349405 CDM	Device Clsr 35mm	23	$36,366.40	$233,784.00	$96,111.20	nat. median $26,662 outlier · 3.6×
10 MS_DRG	Pancreas Transplant	1	$95,472.93	$95,472.93	$95,472.93	nat. median $64,903 1.5× median
117107 CDM	Genrator Imp Pulse 7	23	$35,897.96	$230,772.60	$94,873.18	nat. median $527 outlier · 180.0×
339930 CDM	Kit Prfsn Bypass Tube	36	$12,746.50	$229,437.00	$89,990.29	nat. median $89,990 1.0× median
102743 CDM	Kit Prfsn Canula Dil 20d	36	$12,746.50	$229,437.00	$89,990.29	nat. median $414 outlier · 217.6×
Q2043 HCPCS	Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…	1	$66,373.01	$89,766.78	$89,766.78	nat. median $65,720 1.4× median
254137 CDM	Set Ventricle Ab5000	36	$12,655.35	$227,796.30	$89,346.77	nat. median $88,587 1.0× median
J9226 HCPCS	Histrelin Implant (supprelin La), 50 Mg	2	$45,212.00	$95,547.45	$81,582.82	nat. median $55,159 1.5× median
33270 CPT	Ins Sq Dfib Gen W Ex Elc	20	$22,908.62	$165,537.90	$73,634.85	nat. median $32,113 outlier · 2.3×
33240 CPT	Insert Pulse Generator	19	$27,749.10	$146,907.00	$73,453.50	nat. median $22,094 outlier · 3.3×
329734 CDM	Graft Bn Cartiform 25x20	23	$27,669.60	$177,876.00	$73,126.80	nat. median $28,559 outlier · 2.6×
263252 CDM	Kit Implant Unilat Tmj M	23	$27,417.60	$176,256.00	$72,460.80	nat. median $942 outlier · 76.9×
349587 CDM	Matrix Bn Cellular 10cc	23	$26,280.80	$168,948.00	$69,456.40	nat. median $32,382 outlier · 2.1×
261941 CDM	Sys Mitraclip 2 Clip	23	$25,925.90	$166,666.50	$68,518.45	nat. median $25,926 outlier · 2.6×
261940 CDM	Sys Mitraclip 1 Clip	23	$25,925.90	$166,666.50	$68,518.45	nat. median $59,074 1.2× median
261943 CDM	Sys Mitraclip 4 Clip	23	$25,925.90	$166,666.50	$68,518.45	nat. median $898 outlier · 76.3×
261942 CDM	Sys Mitraclip 3 Clip	23	$25,925.90	$166,666.50	$68,518.45	nat. median $898 outlier · 76.3×
231 MS_DRG	Coronary Bypass With Ptca With Mcc	48	$57,493.67	$200,369.83	$67,714.76	nat. median $77,043 0.9× median
107223 CDM	Tiss Aclr Drml 16cm 20cm	23	$24,371.20	$156,672.00	$64,409.60	nat. median $518 outlier · 124.3×
650 MS_DRG	Kidney Transplant With Hemodialysis With Mcc	1	$63,276.06	$63,276.06	$63,276.06	nat. median $42,849 1.5× median
110915 CDM	Graft Nrv 1-2mm 70mm	23	$23,663.78	$152,124.30	$62,539.99	nat. median $2,474 outlier · 25.3×
61782 CPT	Stereotactic Computer-assisted (navigational) Procedure; Cranial, Extradural (Li…	1	$43,403.00	$73,405.00	$62,393.00	nat. median $1,425 outlier · 43.8×
61796 CPT	Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); 1 S…	1	$43,403.00	$73,405.00	$62,393.00	nat. median $3,757 outlier · 16.6×
61800 CPT	Application Of Stereotactic Headframe For Stereotactic Radiosurgery (List Separa…	1	$43,403.00	$73,405.00	$62,393.00	nat. median $1,440 outlier · 43.3×
61781 CPT	Stereotactic Computer-assisted (navigational) Procedure; Cranial, Intradural (Li…	1	$43,403.00	$73,405.00	$62,393.00	nat. median $1,233 outlier · 50.6×
61783 CPT	Stereotactic Computer-assisted (navigational) Procedure; Spinal (List Separately…	1	$43,403.00	$73,405.00	$62,393.00	nat. median $1,641 outlier · 38.0×
61798 CPT	Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); 1 C…	1	$43,403.00	$73,405.00	$62,393.00	nat. median $3,873 outlier · 16.1×
63621 CPT	Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); Eac…	1	$43,403.00	$73,405.00	$62,393.00	nat. median $2,300 outlier · 27.1×
339426 CDM	Mesh Viable Crtlg 20mm	23	$23,514.40	$151,164.00	$62,145.20	nat. median $3,220 outlier · 19.3×
337198 CDM	Kit Revasc Hi-flow	36	$8,286.25	$149,152.50	$58,500.92	nat. median $53,032 1.1× median
346190 CDM	Allograft Dermis 16x20cm	23	$22,030.12	$141,622.20	$58,222.46	nat. median $50,197 1.2× median
C2616 HCPCS	Brachytx Ns Yttrium 90	19	$11,428.20	$247,467.60	$57,141.00	nat. median $26,836 outlier · 2.1×
61645 CPT	Sp Intracranial Thromb	24	$18,486.72	$118,843.20	$56,780.64	nat. median $5,202 outlier · 10.9×
77371 CPT	Srs Dl One Sess Cobalt60	20	$14,996.55	$100,566.00	$54,985.70	nat. median $9,378 outlier · 5.9×

Other procedures at this hospital

Browse this hospital's 29,830 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

J3399	HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	3	1	$1.63	—	$3,158,557.10	$4,271,819.03	$4,271,819.03	2026-07-17
J3389	HCPCS	Topical Administration, Prademagene Zamikeracel, Per Treatment	1	1	—	—	$4,069,700.40	$4,069,700.40	$4,069,700.40	2026-03-01
824	OTHER	Inj, Exagamglogene Autote	42	24	$35,011.82	—	$2,262,040.00	$4,617,360.00	$2,460,260.00	2026-07-17
Q2057	HCPCS	Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure…	3	1	—	—	$940,156.40	$1,271,523.00	$1,271,523.00	2026-03-01
Q2041	HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	3	1	$577,590.50	—	$649,274.53	$878,117.20	$878,117.20	2026-07-17
33990	CPT	Insertion Impella Lvad	36	24	$883,335.00	$883,335.00	$123,666.90	$795,001.50	$379,834.05	2026-03-01
102901	CDM	Tube Inj Cemnt 4.2mm	71	36	$999,999.00	$999,999.00	$49,999.95	$899,999.10	$352,999.65	2026-03-01
J3402	HCPCS	Injection, Remestemcel-l-rknd, Per Therapeutic Dose	3	1	—	—	$246,036.20	$332,753.88	$332,753.88	2026-03-01
322996	CDM	Set Vntrc 17.4x13.8in	71	36	$490,250.00	$490,250.00	$24,512.50	$441,225.00	$173,058.25	2026-03-01
2	MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	3	1	—	—	$167,691.00	$298,508.00	$171,465.00	2026-03-01
7	MS_DRG	Lung Transplant	3	1	—	—	$170,613.71	$170,613.71	$170,613.71	2026-03-01
5	MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	4	2	—	—	$125,000.00	$136,264.59	$136,264.59	2026-03-01
349403	CDM	Device Clsr 27mm	35	23	$259,760.00	$259,760.00	$36,366.40	$233,784.00	$96,111.20	2026-03-01
349404	CDM	Device Clsr 31mm	35	23	$259,760.00	$259,760.00	$36,366.40	$233,784.00	$96,111.20	2026-03-01
349401	CDM	Device Clsr 20mm	35	23	$259,760.00	$259,760.00	$36,366.40	$233,784.00	$96,111.20	2026-03-01
349405	CDM	Device Clsr 35mm	35	23	$259,760.00	$259,760.00	$36,366.40	$233,784.00	$96,111.20	2026-03-01
349402	CDM	Device Clsr 24mm	35	23	$259,760.00	$259,760.00	$36,366.40	$233,784.00	$96,111.20	2026-03-01
10	MS_DRG	Pancreas Transplant	3	1	—	—	$95,472.93	$95,472.93	$95,472.93	2026-03-01
117107	CDM	Genrator Imp Pulse 7	35	23	$256,414.00	$256,414.00	$35,897.96	$230,772.60	$94,873.18	2026-03-01
102743	CDM	Kit Prfsn Canula Dil 20d	71	36	$254,930.00	$254,930.00	$12,746.50	$229,437.00	$89,990.29	2026-03-01
339930	CDM	Kit Prfsn Bypass Tube	71	36	$254,930.00	$254,930.00	$12,746.50	$229,437.00	$89,990.29	2026-03-01
Q2043	HCPCS	Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…	3	1	$99,247.75	—	$66,373.01	$89,766.78	$89,766.78	2026-07-17
254137	CDM	Set Ventricle Ab5000	71	36	$253,107.00	$253,107.00	$12,655.35	$227,796.30	$89,346.77	2026-03-01
J9226	HCPCS	Histrelin Implant (supprelin La), 50 Mg	7	2	$59,900.90	—	$45,212.00	$95,547.45	$81,582.82	2026-07-17
33270	CPT	Ins Sq Dfib Gen W Ex Elc	64	20	$163,633.00	$173,782.00	$22,908.62	$165,537.90	$73,634.85	2026-07-17
33240	CPT	Insert Pulse Generator	30	19	$163,230.00	$163,230.00	$27,749.10	$146,907.00	$73,453.50	2026-07-17
329734	CDM	Graft Bn Cartiform 25x20	35	23	$197,640.00	$197,640.00	$27,669.60	$177,876.00	$73,126.80	2026-03-01
263252	CDM	Kit Implant Unilat Tmj M	35	23	$195,840.00	$195,840.00	$27,417.60	$176,256.00	$72,460.80	2026-03-01
349587	CDM	Matrix Bn Cellular 10cc	35	23	$187,720.00	$187,720.00	$26,280.80	$168,948.00	$69,456.40	2026-03-01
261943	CDM	Sys Mitraclip 4 Clip	35	23	$185,185.00	$185,185.00	$25,925.90	$166,666.50	$68,518.45	2026-03-01
261940	CDM	Sys Mitraclip 1 Clip	35	23	$185,185.00	$185,185.00	$25,925.90	$166,666.50	$68,518.45	2026-03-01
261941	CDM	Sys Mitraclip 2 Clip	35	23	$185,185.00	$185,185.00	$25,925.90	$166,666.50	$68,518.45	2026-03-01
261942	CDM	Sys Mitraclip 3 Clip	35	23	$185,185.00	$185,185.00	$25,925.90	$166,666.50	$68,518.45	2026-03-01
231	MS_DRG	Coronary Bypass With Ptca With Mcc	97	48	—	—	$57,493.67	$200,369.83	$67,714.76	2026-03-01
107223	CDM	Tiss Aclr Drml 16cm 20cm	35	23	$174,080.00	$174,080.00	$24,371.20	$156,672.00	$64,409.60	2026-03-01
650	MS_DRG	Kidney Transplant With Hemodialysis With Mcc	3	1	—	—	$63,276.06	$63,276.06	$63,276.06	2026-03-01
110915	CDM	Graft Nrv 1-2mm 70mm	35	23	$169,027.00	$169,027.00	$23,663.78	$152,124.30	$62,539.99	2026-03-01
63621	CPT	Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); Eac…	6	1	—	—	$43,403.00	$73,405.00	$62,393.00	2026-03-01
61782	CPT	Stereotactic Computer-assisted (navigational) Procedure; Cranial, Extradural (Li…	6	1	—	—	$43,403.00	$73,405.00	$62,393.00	2026-03-01
61783	CPT	Stereotactic Computer-assisted (navigational) Procedure; Spinal (List Separately…	6	1	—	—	$43,403.00	$73,405.00	$62,393.00	2026-03-01
61781	CPT	Stereotactic Computer-assisted (navigational) Procedure; Cranial, Intradural (Li…	6	1	—	—	$43,403.00	$73,405.00	$62,393.00	2026-03-01
61798	CPT	Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); 1 C…	6	1	$1,096.27	—	$43,403.00	$73,405.00	$62,393.00	2026-07-17
61800	CPT	Application Of Stereotactic Headframe For Stereotactic Radiosurgery (List Separa…	6	1	$118.68	—	$43,403.00	$73,405.00	$62,393.00	2026-07-17
61796	CPT	Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); 1 S…	6	1	—	—	$43,403.00	$73,405.00	$62,393.00	2026-03-01
339426	CDM	Mesh Viable Crtlg 20mm	35	23	$167,960.00	$167,960.00	$23,514.40	$151,164.00	$62,145.20	2026-03-01
337198	CDM	Kit Revasc Hi-flow	71	36	$165,725.00	$165,725.00	$8,286.25	$149,152.50	$58,500.92	2026-03-01
346190	CDM	Allograft Dermis 16x20cm	35	23	$157,358.00	$157,358.00	$22,030.12	$141,622.20	$58,222.46	2026-03-01
C2616	HCPCS	Brachytx Ns Yttrium 90	50	19	$178,297.00	$178,297.00	$11,428.20	$247,467.60	$57,141.00	2026-03-01
61645	CPT	Sp Intracranial Thromb	36	24	$132,048.00	$132,048.00	$18,486.72	$118,843.20	$56,780.64	2026-03-01
77371	CPT	Srs Dl One Sess Cobalt60	84	20	$99,974.00	$99,974.00	$14,996.55	$100,566.00	$54,985.70	2026-03-01
33264	CPT	Rem&repl Icd Gen/bi-v	32	20	$127,767.00	$127,767.00	$17,887.38	$114,990.30	$54,939.81	2026-07-17
33263	CPT	Rem&repl Icd Gen/dual	32	20	$127,767.00	$127,767.00	$17,887.38	$114,990.30	$54,939.81	2026-07-17
33262	CPT	Rem&repl Icd Gen/sgl	32	20	$127,767.00	$127,767.00	$17,887.38	$114,990.30	$54,939.81	2026-07-17
C1982	HCPCS	Cath Micro 120cm .021in	70	35	$151,978.00	$151,978.00	$7,598.90	$136,780.20	$54,180.15	2026-03-01
261559	CDM	Valve Xt Sapien Nf 29mm	35	23	$145,112.00	$145,112.00	$20,315.68	$130,600.80	$53,691.44	2026-03-01
261560	CDM	Valve Xt Sapien As 23mm	35	23	$145,112.00	$145,112.00	$20,315.68	$130,600.80	$53,691.44	2026-03-01
261558	CDM	Valve Xt Sapien Nf 26mm	35	23	$145,112.00	$145,112.00	$20,315.68	$130,600.80	$53,691.44	2026-03-01
261561	CDM	Valve Xt Sapien As 26mm	35	23	$145,112.00	$145,112.00	$20,315.68	$130,600.80	$53,691.44	2026-03-01
261557	CDM	Valve Xt Sapien Nf 23mm	35	23	$145,112.00	$145,112.00	$20,315.68	$130,600.80	$53,691.44	2026-03-01
261562	CDM	Valve Xt Sapien As 29mm	35	23	$145,112.00	$145,112.00	$20,315.68	$130,600.80	$53,691.44	2026-03-01
C2624	HCPCS	Cardiomems Hf System	34	22	$135,825.00	$135,825.00	$19,015.50	$122,242.50	$51,613.50	2026-03-01
118056	CDM	Wedge Augmt 24d 30x12mm	35	23	$135,620.00	$135,620.00	$18,986.80	$122,058.00	$50,179.40	2026-03-01
61635	CPT	Intracral Angioplsty Wst	29	22	$99,366.00	$99,366.00	$16,892.22	$89,429.40	$49,683.00	2026-03-01
692643	CDM	Impella 2.5l Catheter	71	36	$140,614.00	$140,614.00	$7,030.70	$126,552.60	$49,636.74	2026-03-01
33230	CPT	Gen Implant Dual	32	20	$114,877.00	$114,877.00	$16,082.78	$103,389.30	$49,397.11	2026-07-17
33231	CPT	Gen Implant Bi-v	32	20	$114,877.00	$114,877.00	$16,082.78	$103,389.30	$49,397.11	2026-07-17
33224	CPT	Upgrd Dev To Biv Ppm/icd	30	19	$109,300.00	$109,300.00	$18,581.00	$98,370.00	$49,185.00	2026-07-17
C8004	HCPCS	Simulation Angiogram With Use Of A Pressure-generating Catheter (e.g., One-way V…	6	1	—	—	$20,413.03	$61,579.30	$47,403.58	2026-03-01
336007	CDM	Spacer Spnl 42x30x16mm S	35	23	$127,105.00	$127,105.00	$17,794.70	$114,394.50	$47,028.85	2026-03-01
335509	CDM	Spacer Spnl 37x27x14mm	35	23	$127,105.00	$127,105.00	$17,794.70	$114,394.50	$47,028.85	2026-03-01
335052	CDM	Spacer Spnl 37x27x16mm	35	23	$127,105.00	$127,105.00	$17,794.70	$114,394.50	$47,028.85	2026-03-01
345021	CDM	Spacer Spnl 32mmx32mmx16	35	23	$127,105.00	$127,105.00	$17,794.70	$114,394.50	$47,028.85	2026-03-01
28	MS_DRG	Spinal Procedures With Mcc	85	46	—	—	$15,231.00	$110,621.43	$46,793.01	2026-03-01
255210	CDM	Valve Pulm 26mm Sapien	35	23	$125,971.00	$125,971.00	$17,635.94	$113,373.90	$46,609.27	2026-03-01
255209	CDM	Valve Tavr 23mm	35	23	$125,971.00	$125,971.00	$17,635.94	$113,373.90	$46,609.27	2026-03-01
339597	CDM	Algrft Bn 19x12mm	35	23	$123,500.00	$123,500.00	$17,290.00	$111,150.00	$45,695.00	2026-03-01
C9293	HCPCS	Glucarpidase 1000 U Inj	41	23	$122,620.00	$122,620.00	$6,131.00	$110,358.00	$45,369.40	2026-03-01
37227	CPT	Fem/pop Rev Stnt Ath Bi	172	22	$89,284.00	$105,517.50	$4,058.35	$160,713.00	$44,641.93	2026-07-17
37231	CPT	Tib/per Revas Stnt&ather	172	22	$89,284.00	$105,517.50	$4,058.35	$160,713.00	$44,641.93	2026-07-17
327088	CDM	Umtb Moldable 5.0 Cc	35	23	$120,648.00	$120,648.00	$16,890.72	$108,583.20	$44,639.76	2026-03-01
338893	CDM	Dvc Revasc 4x20mm 200cm	71	36	$125,504.00	$125,504.00	$6,275.20	$112,953.60	$44,302.91	2026-03-01
258623	CDM	Valve Tavr Sap Xt 29mm	35	23	$116,640.00	$116,640.00	$16,329.60	$104,976.00	$43,156.80	2026-03-01
258621	CDM	Vlv Aor 14.3mm 23mm Sapn	35	23	$116,640.00	$116,640.00	$16,329.60	$104,976.00	$43,156.80	2026-03-01
258622	CDM	Vlv Aor 17.2mm 26mm Sapx	35	23	$116,640.00	$116,640.00	$16,329.60	$104,976.00	$43,156.80	2026-03-01
257745	CDM	Valve Tavr Sapical 26mm	35	23	$116,640.00	$116,640.00	$16,329.60	$104,976.00	$43,156.80	2026-03-01
257744	CDM	Vlv Hrt Spien Trnsap23mm	35	23	$116,640.00	$116,640.00	$16,329.60	$104,976.00	$43,156.80	2026-03-01
93653	CPT	Ep Repos Ele Svt Sgl	32	20	$97,685.00	$97,685.00	$13,675.90	$87,916.50	$42,004.55	2026-03-01
93654	CPT	Ep Repos Ele Vt 3d Map	32	20	$97,685.00	$97,685.00	$13,675.90	$87,916.50	$42,004.55	2026-03-01
269180	CDM	Graft Bn Lg 8cc 1x2in	35	23	$113,324.00	$113,324.00	$15,865.36	$101,991.60	$41,929.88	2026-03-01
269153	CDM	Graft Bn Lgii 8cc 3x4in	35	23	$113,324.00	$113,324.00	$15,865.36	$101,991.60	$41,929.88	2026-03-01
33225	CPT	Insertion Of Biv Ppm/icd	40	23	$110,301.00	$110,301.00	$16,434.85	$99,270.90	$41,914.38	2026-03-01
102112	CDM	Cap Impl Shldr 36mm	35	23	$112,608.00	$112,608.00	$15,765.12	$101,347.20	$41,664.96	2026-03-01
C1767	HCPCS	Generator Nrstm 16 3688	238	22	$82,492.00	$82,492.00	$7,560.00	$233,096.40	$40,657.50	2026-03-01
324737	CDM	Graft Bn Cort Canc 5.0cc	35	23	$109,559.00	$109,559.00	$15,338.26	$98,603.10	$40,536.83	2026-03-01
116180	CDM	Kit Fastener Endo	35	23	$108,322.00	$108,322.00	$15,165.08	$97,489.80	$40,079.14	2026-03-01
260309	CDM	Valve Tavr 9600tfx23clus	35	23	$108,000.00	$108,000.00	$15,120.00	$97,200.00	$39,960.00	2026-03-01
260311	CDM	Valve Tavr 9600tfx29clus	35	23	$108,000.00	$108,000.00	$15,120.00	$97,200.00	$39,960.00	2026-03-01
259892	CDM	Valve Hrt Sapien 26mm	35	23	$108,000.00	$108,000.00	$15,120.00	$97,200.00	$39,960.00	2026-03-01
259891	CDM	Valve Hrt Sapien 23mm	35	23	$108,000.00	$108,000.00	$15,120.00	$97,200.00	$39,960.00	2026-03-01
260310	CDM	Valve Tavr 9600tfx26clus	35	23	$108,000.00	$108,000.00	$15,120.00	$97,200.00	$39,960.00	2026-03-01
63685	CPT	Ins/repl Pulse Generator	26	19	$75,698.00	$75,698.00	$12,868.66	$68,128.20	$39,741.45	2026-07-17
0916T	CPT	Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co…	9	2	—	—	$18,564.00	$72,052.27	$39,729.76	2026-03-01
36908	CPT	Sp Dial Graft Cntrl Stn	42	24	$107,129.00	$107,129.00	$14,998.06	$96,416.10	$39,637.73	2026-03-01
0075T	CPT	Stent Vert/intra Car Ini	46	25	$92,004.00	$92,004.00	$4,600.20	$82,803.60	$39,561.72	2026-03-01
272011	CDM	Spacer Spn 42x30x16 12d	35	23	$106,470.00	$106,470.00	$14,905.80	$95,823.00	$39,393.90	2026-03-01
312387	CDM	Spacer Spn 12d 37x27x14	35	23	$106,470.00	$106,470.00	$14,905.80	$95,823.00	$39,393.90	2026-03-01
249607	CDM	Spacer Spn Svrg 37x27x12	35	23	$106,470.00	$106,470.00	$14,905.80	$95,823.00	$39,393.90	2026-03-01
248461	CDM	Spacer Spn 37x27x14 8d	35	23	$106,470.00	$106,470.00	$14,905.80	$95,823.00	$39,393.90	2026-03-01
241633	CDM	Spacer Spnl 42x30x12mm C	35	23	$106,470.00	$106,470.00	$14,905.80	$95,823.00	$39,393.90	2026-03-01
312852	CDM	Spacer Spn 37x27x16mm 8d	35	23	$106,470.00	$106,470.00	$14,905.80	$95,823.00	$39,393.90	2026-03-01
249311	CDM	Spacer Spn 12d 32x23x14	35	23	$106,470.00	$106,470.00	$14,905.80	$95,823.00	$39,393.90	2026-03-01
22610	CPT	Arthrodesis, Posterior Or Posterolateral Technique, Single Interspace; Thoracic …	2	2	—	—	$35,974.00	$42,253.00	$39,113.50	2026-03-01
277	MS_DRG	Cardiac Defibrillator Implant Without Mcc Trauma	1	1	—	—	$39,095.46	$39,095.46	$39,095.46	2026-03-01
61640	CPT	Dilate Ic Vasospasminit	29	22	$76,736.00	$76,736.00	$13,045.12	$69,062.40	$38,368.00	2026-03-01
61630	CPT	Intracranial Angioplasty	29	22	$76,736.00	$76,736.00	$13,045.12	$69,062.40	$38,368.00	2026-03-01
63620	CPT	Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); 1 S…	12	2	—	—	$16,618.00	$73,405.00	$37,976.50	2026-03-01
269162	CDM	Graft Bn Med 5.6cc 1x2in	35	23	$101,666.00	$101,666.00	$14,233.24	$91,499.40	$37,616.42	2026-03-01
281345	CDM	Valve Tavr Sapien 3 20mm	35	23	$100,005.00	$100,005.00	$14,000.70	$90,004.50	$37,001.85	2026-03-01
281346	CDM	Valve Tavr Sapien 3 23mm	35	23	$100,005.00	$100,005.00	$14,000.70	$90,004.50	$37,001.85	2026-03-01
264267	CDM	Valve Tavr Evolutr 26mm	35	23	$100,005.00	$100,005.00	$14,000.70	$90,004.50	$37,001.85	2026-03-01
264268	CDM	Valve Tavr Evolutr 29mm	35	23	$100,005.00	$100,005.00	$14,000.70	$90,004.50	$37,001.85	2026-03-01
281347	CDM	Valve Tavr Sapien 3 26mm	35	23	$100,005.00	$100,005.00	$14,000.70	$90,004.50	$37,001.85	2026-03-01
281348	CDM	Valve Tavr Sapien 3 29mm	35	23	$100,005.00	$100,005.00	$14,000.70	$90,004.50	$37,001.85	2026-03-01
273014	CDM	Closure Dvc 33mm Watchmn	35	23	$100,000.00	$100,000.00	$14,000.00	$90,000.00	$37,000.00	2026-03-01
263286	CDM	Vlv Aor 26-29mm 0-43mm	35	23	$100,000.00	$100,000.00	$14,000.00	$90,000.00	$37,000.00	2026-03-01
263289	CDM	Valve Aor 18-20mm 0-34mm	35	23	$100,000.00	$100,000.00	$14,000.00	$90,000.00	$37,000.00	2026-03-01
263288	CDM	Valve Aor 20-23mm 0-40m	35	23	$100,000.00	$100,000.00	$14,000.00	$90,000.00	$37,000.00	2026-03-01
263287	CDM	Valve Aor 23-26mm 0-43mm	35	23	$100,000.00	$100,000.00	$14,000.00	$90,000.00	$37,000.00	2026-03-01
319298	CDM	Device Embl 4.25x14mm Pl	35	23	$100,000.00	$100,000.00	$14,000.00	$90,000.00	$37,000.00	2026-03-01
324798	CDM	Disc Spnl 13x17x5mm	35	23	$99,372.00	$99,372.00	$13,912.08	$89,434.80	$36,767.64	2026-03-01
324796	CDM	Disc Intvrtb 15x15mm	35	23	$99,372.00	$99,372.00	$13,912.08	$89,434.80	$36,767.64	2026-03-01
349123	CDM	Disc Cerv 6x15x16mm	35	23	$99,372.00	$99,372.00	$13,912.08	$89,434.80	$36,767.64	2026-03-01
108036	CDM	Disc Spn Sm 4mm	35	23	$99,372.00	$99,372.00	$13,912.08	$89,434.80	$36,767.64	2026-03-01
108263	CDM	Disc Spnl Cerv Md 4mm	35	23	$99,372.00	$99,372.00	$13,912.08	$89,434.80	$36,767.64	2026-03-01
324925	CDM	Disc Intvrtb 15x5x13mm	35	23	$99,372.00	$99,372.00	$13,912.08	$89,434.80	$36,767.64	2026-03-01
327727	CDM	Disc Spnl Mobi-c 15x15x5	35	23	$99,372.00	$99,372.00	$13,912.08	$89,434.80	$36,767.64	2026-03-01
324761	CDM	Disc Intvrtb 15x7x15mm	35	23	$99,372.00	$99,372.00	$13,912.08	$89,434.80	$36,767.64	2026-03-01
324760	CDM	Disc Intvrtb 19x5x15mm	35	23	$99,372.00	$99,372.00	$13,912.08	$89,434.80	$36,767.64	2026-03-01
261724	CDM	Disc Intvrtb 17mm 5mm	35	23	$99,372.00	$99,372.00	$13,912.08	$89,434.80	$36,767.64	2026-03-01
323	MS_DRG	Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc	1	1	—	—	$36,714.47	$36,714.47	$36,714.47	2026-03-01
345006	CDM	Spacer Spnl 42x30x18mm	35	23	$99,068.00	$99,068.00	$13,869.52	$89,161.20	$36,655.16	2026-03-01
37215	CPT	Carotid Stents - Bilat	102	23	$71,071.00	$71,071.00	$11,922.95	$95,949.00	$36,460.62	2026-03-01
C1761	HCPCS	Cath Ivl 3.5x12mm	70	35	$102,272.00	$102,272.00	$5,113.60	$92,044.80	$36,459.97	2026-03-01
93656	CPT	Com Ep Repo Cth Tx Afib	39	25	$97,685.00	$97,685.00	$13,675.90	$87,916.50	$36,143.45	2026-03-01
33993	CPT	Repos Perc Ventr Dev	36	24	$83,970.00	$83,970.00	$11,755.80	$75,573.00	$36,107.10	2026-03-01
C1820	HCPCS	Eon Mini Charging System	444	35	$80,118.00	$80,118.00	$187.15	$253,036.80	$36,053.10	2026-03-01
333404	CDM	Bone Mtrx Cllr V92 5cc	35	23	$96,824.00	$96,824.00	$13,555.36	$87,141.60	$35,824.88	2026-03-01
0686T	CPT	Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant…	6	1	—	—	$18,750.75	$40,126.60	$35,751.43	2026-03-01
61642	CPT	Dilate Ic Vasospasmadl	29	22	$71,050.00	$71,050.00	$12,078.50	$63,945.00	$35,525.00	2026-03-01
325150	CDM	Vlv Sapien 20mm G150278	71	36	$100,005.00	$100,005.00	$5,000.25	$90,004.50	$35,301.76	2026-03-01
325151	CDM	Vlv Sapien 23mm G150278	71	36	$100,005.00	$100,005.00	$5,000.25	$90,004.50	$35,301.76	2026-03-01
325152	CDM	Vlv Sapien 26mm G150278	71	36	$100,005.00	$100,005.00	$5,000.25	$90,004.50	$35,301.76	2026-03-01
325153	CDM	Vlv Sapien 29mm G150278	71	36	$100,005.00	$100,005.00	$5,000.25	$90,004.50	$35,301.76	2026-03-01
272058	CDM	Coag Dvc Kit Gd Tst 3cm	71	36	$99,999.00	$99,999.00	$4,999.95	$89,999.10	$35,299.65	2026-03-01
37241	CPT	Vasc Emboliz Venous	32	20	$81,002.00	$81,002.00	$11,340.28	$72,901.80	$34,830.86	2026-07-17
37243	CPT	Vasc Embol Tum/org/inf	32	20	$81,002.00	$81,002.00	$11,340.28	$72,901.80	$34,830.86	2026-07-17
342233	CDM	Capsule Camera Endo Pill	71	36	$97,920.00	$97,920.00	$4,896.00	$88,128.00	$34,565.76	2026-03-01
324738	CDM	Fluid Amniotic Pro3 2ml	35	23	$93,304.00	$93,304.00	$13,062.56	$83,973.60	$34,522.48	2026-03-01
36906	CPT	Sp Dial Graft Thrb Stn	47	25	$107,129.00	$107,129.00	$3,226.00	$96,416.10	$34,388.41	2026-07-17
326725	CDM	Cage Spn Xpd 12x15-20mm	35	23	$92,214.00	$92,214.00	$12,909.96	$82,992.60	$34,119.18	2026-03-01
335929	CDM	Cage Spnl 12x17x12mm	35	23	$92,214.00	$92,214.00	$12,909.96	$82,992.60	$34,119.18	2026-03-01
93582	CPT	Perc Trans Clos Pda	88	22	$106,388.50	$106,388.50	$5,319.40	$95,750.10	$33,937.93	2026-03-01
33213	CPT	Repl Gen Atr/vent Dual	25	18	$61,598.00	$61,598.00	$10,471.66	$55,438.20	$33,878.90	2026-07-17
37244	CPT	Vasc Embol Art Ven Hem	64	20	$77,320.00	$77,320.00	$10,309.32	$72,901.80	$33,137.10	2026-03-01
05166	OTHER	Cochlear Implant Procedur	1	1	—	—	$32,645.37	$32,645.37	$32,645.37	2026-03-01
33214	CPT	Upgrade Pacer System	30	19	$72,227.00	$72,227.00	$12,278.59	$65,004.30	$32,502.15	2026-07-17
382626	CDM	Stent Pipeline 4.5x30	35	23	$86,921.00	$86,921.00	$12,168.94	$78,228.90	$32,160.77	2026-03-01
36909	CPT	Sp Dial Graft Vasc Embo	42	24	$86,451.00	$86,451.00	$12,103.14	$77,805.90	$31,986.87	2026-03-01
107455	CDM	Cage Spn 15d 6x38x28mm	35	23	$86,393.00	$86,393.00	$12,095.02	$77,753.70	$31,965.41	2026-03-01
258273	CDM	Stent Aaa Exldr 13x31	35	23	$85,398.00	$85,398.00	$11,955.72	$76,858.20	$31,597.26	2026-03-01
37218	CPT	Stnt Plc Com Car/inn Art	36	24	$73,471.00	$73,471.00	$10,285.94	$66,123.90	$31,592.53	2026-03-01
37216	CPT	Stent Plc Cartid Wo Emb	34	23	$70,135.00	$70,135.00	$11,922.95	$63,121.50	$31,560.75	2026-03-01
93457	CPT	Cth Plc/inj Graft W Rhc	54	19	$63,034.50	$63,034.50	$8,485.54	$58,912.20	$31,517.25	2026-03-01
D2005	HCPCS	Miscellaneous; M=12-32 And A Tm81	13	7	$30,610.58	—	$31,005.56	$32,482.01	$31,413.94	2026-07-17
C1772	HCPCS	Pump Inf 20ml Snchr	34	22	$82,492.00	$82,492.00	$11,548.88	$74,242.80	$31,346.96	2026-03-01
326935	CDM	Tissue Amtic Thin 4x8cm	35	23	$84,417.00	$84,417.00	$11,818.38	$75,975.30	$31,234.29	2026-03-01
0148	RC	—	64	10	—	—	$19,464.23	$38,753.82	$31,019.74	2026-03-01
351211	CDM	Transcth Stnt Plc Ia	62	32	$83,538.00	$83,538.00	$4,176.90	$75,184.20	$30,909.06	2026-03-01
351216	CDM	Transcth Stnt Plc In Vn	62	32	$83,538.00	$83,538.00	$4,176.90	$75,184.20	$30,909.06	2026-03-01
36903	CPT	Sp Dial Graft Angio Stn	32	20	$71,848.00	$71,848.00	$10,058.72	$64,663.20	$30,894.64	2026-07-17
36905	CPT	Sp Dial Graft Thrb Pta	32	20	$71,848.00	$71,848.00	$10,058.72	$64,663.20	$30,894.64	2026-07-17
0138	RC	—	160	10	—	—	$16,800.06	$45,643.16	$30,800.31	2026-03-01
266487	CDM	Graft Evas 16cm 26mm	35	23	$82,592.00	$82,592.00	$11,562.88	$74,332.80	$30,559.04	2026-03-01
261916	CDM	Valve Portico Tavi 25mm	35	23	$82,512.00	$82,512.00	$11,551.68	$74,260.80	$30,529.44	2026-03-01
261915	CDM	Valve Portico Tavi 23mm	35	23	$82,512.00	$82,512.00	$11,551.68	$74,260.80	$30,529.44	2026-03-01
261917	CDM	Valve Portico Tavi 27mm	35	23	$82,512.00	$82,512.00	$11,551.68	$74,260.80	$30,529.44	2026-03-01
261918	CDM	Valve Portico Tavi 29mm	35	23	$82,512.00	$82,512.00	$11,551.68	$74,260.80	$30,529.44	2026-03-01
C1882	HCPCS	Bt Lumax 340 Hf-t 57	750	23	$74,650.00	$74,650.00	$5,330.92	$201,499.20	$30,519.83	2026-03-01
243489	CDM	Tmj Mndb Bilat Chg020	35	23	$81,630.00	$81,630.00	$11,428.20	$73,467.00	$30,203.10	2026-03-01
61797	CPT	Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); Eac…	29	11	$169.91	—	$15,000.00	$73,405.00	$30,098.00	2026-07-17
317619	CDM	Cement Bn Hydro 397015	35	23	$81,078.00	$81,078.00	$11,350.92	$72,970.20	$29,998.86	2026-03-01
61799	CPT	Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); Eac…	16	3	$234.58	—	$929.00	$73,405.00	$29,956.00	2026-07-17
119345	CDM	Graft St Tiss 6cm 9cm	35	23	$80,837.00	$80,837.00	$11,317.18	$72,753.30	$29,909.69	2026-03-01
D1804	HCPCS	Major Multiple Trauma With Brain Or Spinal Code In	13	7	$28,998.23	—	$29,231.23	$30,623.20	$29,616.25	2026-07-17
101563	CDM	Cap Bn Shldr 39mm	35	23	$79,720.00	$79,720.00	$11,160.80	$71,748.00	$29,496.40	2026-03-01
111971	CDM	Matrix Tiss Fbr 2.5mm	35	23	$79,040.00	$79,040.00	$11,065.60	$71,136.00	$29,244.80	2026-03-01
93583	CPT	Alcohol Septal Ablation	35	23	$64,747.00	$64,747.00	$3,237.35	$58,272.30	$29,136.15	2026-03-01
93456	CPT	Cth Plc/inj Cor Rhc 59	54	19	$58,266.00	$58,266.00	$7,843.50	$54,456.30	$29,133.00	2026-03-01
33212	CPT	Repl Gen Art/vent Sgl	25	18	$52,935.00	$52,935.00	$8,998.95	$47,641.50	$29,114.25	2026-07-17
C1062	HCPCS	Kit Case Spn Instr 5.8mm	70	35	$81,568.00	$81,568.00	$4,078.40	$73,411.20	$29,078.99	2026-03-01
33207	CPT	Ppm Vent	30	19	$64,056.00	$64,056.00	$10,889.52	$57,650.40	$28,825.20	2026-07-17
0408T	CPT	Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I…	22	9	—	—	$7,691.00	$72,908.38	$28,549.00	2026-03-01
0801T	CPT	Repl Ppm Ldls Dul A&v	46	24	$75,117.00	$75,117.00	$3,755.85	$67,605.30	$28,544.46	2026-03-01
0795T	CPT	Ins Ppm Ldls Dul A&v	46	24	$75,117.00	$75,117.00	$3,755.85	$67,605.30	$28,544.46	2026-03-01
324961	CDM	Spacer Spnl 23mmx7mm Ele	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
326388	CDM	Spacer Spnl 28mmx8mm Ele	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
326385	CDM	Spacer Spnl 32mmx8mm Ele	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
106808	CDM	Cage Spnl 10x22x55mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
106074	CDM	Cage Spn Xlw 10d 8x22x45	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
326823	CDM	Spacer 36x10x8-12mm 8d	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
107385	CDM	Cage Spn 10d 12x22x50mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
106350	CDM	Cage Spn 10d 12x18x50	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
106075	CDM	Cage Spn 10d 10x18x45mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
330916	CDM	Spcr Spnl 32x7mm Elev Pk	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
845459	CDM	Cage Spn Pk 10d 10x18x50	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
104478	CDM	Cage Spn 10d 8x18x45mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
326738	CDM	Spacer Spnl 23mmx9mm Ele	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
331577	CDM	Spacer X-lor 28x11mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
104022	CDM	Cage Spn 45x22x12mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
326521	CDM	Spacer Spnl Xlor 23x8mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
324114	CDM	Spacer X-lor 28x7mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
328979	CDM	Spacer Spn 31x10x8-12mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
324206	CDM	Spacer Spnl 28x9mm Elev	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
337482	CDM	Cage Spn 15d 12x22x55mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
105227	CDM	Cage Spn 10d 10x18x55mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
339750	CDM	Cage Spn 10d 55x22x12mm	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
345944	CDM	Cage Spnl 50x22x12mm Mod	35	23	$77,064.00	$77,064.00	$10,788.96	$69,357.60	$28,513.68	2026-03-01
C7564	HCPCS	Percutaneous Transluminal Mechanical Thrombectomy, Vein(s), Including Intraproce…	9	2	—	—	$8,576.00	$59,198.40	$28,236.44	2026-03-01
107289	CDM	Particles Embl 40-90um	35	23	$76,160.00	$76,160.00	$10,662.40	$68,544.00	$28,179.20	2026-03-01
117665	CDM	Allograft Bn 5.0cc	35	23	$76,085.00	$76,085.00	$10,651.90	$68,476.50	$28,151.45	2026-03-01
3104	APR_DRG	Vertebral And Intervertebral Spinal Procedures Including Disc Procedures	10	6	—	—	$27,302.46	$33,458.90	$28,105.48	2026-03-01
C1102	HCPCS	Amputation, Non-lower Extremity; M < 36.35	13	7	$30,412.73	—	$27,481.34	$28,789.98	$27,843.31	2026-07-17
318390	CDM	Coil Soft 16mm X 45cm	35	23	$75,172.00	$75,172.00	$10,524.08	$67,654.80	$27,813.64	2026-03-01
109171	CDM	Graft Tnd Pre-sut	35	23	$74,921.00	$74,921.00	$10,488.94	$67,428.90	$27,720.77	2026-03-01
616	MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	85	46	—	—	$11,384.00	$75,345.90	$27,673.40	2026-03-01
256955	CDM	Heart Valve 9969469	35	23	$74,751.00	$74,751.00	$10,465.14	$67,275.90	$27,657.87	2026-03-01
339951	CDM	Guide Surg Ti Mandible	71	36	$77,836.00	$77,836.00	$3,891.80	$70,052.40	$27,476.11	2026-03-01
248062	CDM	Graft St Tis 6.3x3.1in	35	23	$74,224.00	$74,224.00	$10,391.36	$66,801.60	$27,462.88	2026-03-01
327234	CDM	Graft Inj Amnio 4cc Xl	35	23	$73,876.00	$73,876.00	$10,342.64	$66,488.40	$27,334.12	2026-03-01
318389	CDM	Coil Soft 14mm X 40cm	35	23	$73,844.00	$73,844.00	$10,338.16	$66,459.60	$27,322.28	2026-03-01
336882	CDM	Cement Bn Ca Phs Ha 15cc	35	23	$73,699.00	$73,699.00	$10,317.86	$66,329.10	$27,268.63	2026-03-01
338616	CDM	Matrixss 8x4cm Thn	35	23	$73,606.00	$73,606.00	$10,304.84	$66,245.40	$27,234.22	2026-03-01
0158	RC	—	144	10	—	—	$16,072.60	$35,075.64	$27,198.25	2026-03-01
C1722	HCPCS	Aicd Crt-d Inogn D140	614	23	$62,986.00	$62,986.00	$5,888.68	$180,585.90	$27,182.79	2026-03-01
241420	CDM	Stent Viabahn 6x2.5x120	35	23	$73,331.00	$73,331.00	$10,266.34	$65,997.90	$27,132.47	2026-03-01
241421	CDM	Stent Viabahn 7x2.5x120	35	23	$73,331.00	$73,331.00	$10,266.34	$65,997.90	$27,132.47	2026-03-01
241422	CDM	Stent Viabahn 8x2.5x120	35	23	$73,331.00	$73,331.00	$10,266.34	$65,997.90	$27,132.47	2026-03-01
0128	RC	—	80	10	—	—	$15,874.55	$32,713.46	$27,110.14	2026-03-01
0024	RC	Cardiac; M < 31.15	44	4	—	—	$15,550.51	$65,935.47	$27,099.97	2026-03-01
338785	CDM	Matrix Tiss Amn 3x6cm	35	23	$73,112.00	$73,112.00	$10,235.68	$65,800.80	$27,051.44	2026-03-01
256632	CDM	Fixator Exfx Cortrck40mm	71	36	$76,160.00	$76,160.00	$3,808.00	$68,544.00	$26,884.48	2026-03-01
318395	CDM	Coil Soft 11mm X 35mm	35	23	$72,487.00	$72,487.00	$10,148.18	$65,238.30	$26,820.19	2026-03-01
318387	CDM	Coil Soft 12mm X 35cm	35	23	$72,487.00	$72,487.00	$10,148.18	$65,238.30	$26,820.19	2026-03-01
318388	CDM	Coil Soft 13mm X 35cm	35	23	$72,487.00	$72,487.00	$10,148.18	$65,238.30	$26,820.19	2026-03-01
324856	CDM	Grft Collederm 10cmx5cm	35	23	$72,272.00	$72,272.00	$10,118.08	$65,044.80	$26,740.64	2026-03-01
33206	CPT	Ppm Atrial	30	19	$59,313.00	$59,313.00	$10,083.21	$53,381.70	$26,690.85	2026-07-17
318213	CDM	Kit Mntr 3v Mrs Disp	71	36	$75,551.00	$75,551.00	$3,777.55	$67,995.90	$26,669.50	2026-03-01
37226	CPT	Fem/popl Revas Stent Bi	172	22	$53,182.00	$62,853.50	$2,417.45	$95,733.90	$26,591.95	2026-07-17
36907	CPT	Sp Dial Graft Cntrl Pta	42	24	$71,848.00	$71,848.00	$10,058.72	$64,663.20	$26,583.76	2026-03-01
92928	CPT	Ptca Stnt W Ang Sgl Rc	27	19	$53,043.00	$53,043.00	$7,426.02	$47,738.70	$26,521.50	2026-03-01
92933	CPT	Ptca Stn W Ath Sgl Ld	27	19	$53,043.00	$53,043.00	$7,426.02	$47,738.70	$26,521.50	2026-03-01
92943	CPT	Rvsc Chr Stn Thrm Sgl Ld	27	19	$53,043.00	$53,043.00	$7,426.02	$47,738.70	$26,521.50	2026-03-01
117297	CDM	Spacer Sys Rdthpy 10ml	35	23	$71,264.00	$71,264.00	$9,976.96	$64,137.60	$26,367.68	2026-03-01
312411	CDM	Coil Embl Sft 30cmx10mm	35	23	$71,159.00	$71,159.00	$9,962.26	$64,043.10	$26,328.83	2026-03-01
336148	CDM	Allograft St Tis 11mm Pr	35	23	$71,136.00	$71,136.00	$9,959.04	$64,022.40	$26,320.32	2026-03-01
C1721	HCPCS	Autogenx4 Fd-1 G130222	893	35	$64,674.00	$64,674.00	$3,080.45	$90,310.50	$26,299.00	2026-03-01
113057	CDM	Probe Ablate 15mm	71	36	$74,441.00	$74,441.00	$3,722.05	$66,996.90	$26,277.67	2026-03-01
113058	CDM	Probe Ablate 20mm	71	36	$74,441.00	$74,441.00	$3,722.05	$66,996.90	$26,277.67	2026-03-01
259443	CDM	Endplate Assy 13x14mm 6d	35	23	$70,980.00	$70,980.00	$9,937.20	$63,882.00	$26,262.60	2026-03-01
322043	CDM	Endplast Assay 12x11mm	35	23	$70,980.00	$70,980.00	$9,937.20	$63,882.00	$26,262.60	2026-03-01
278510	CDM	Coil 400 J Soft 15 Cm	35	23	$70,340.00	$70,340.00	$9,847.60	$63,306.00	$26,025.80	2026-03-01
254476	CDM	Spacer Spnl 12d 18xl	35	23	$70,251.00	$70,251.00	$9,835.14	$63,225.90	$25,992.87	2026-03-01
324680	CDM	Graft Allogn Xlg Spn 2ml	35	23	$69,998.00	$69,998.00	$9,799.72	$62,998.20	$25,899.26	2026-03-01
37221	CPT	Iliac Revasc W/stent	192	28	$51,599.00	$72,708.50	$2,345.50	$92,880.90	$25,847.41	2026-07-17
318371	CDM	Coil Embl Std 60cm16mm	35	23	$69,803.00	$69,803.00	$9,772.42	$62,822.70	$25,827.11	2026-03-01
318374	CDM	Coil Embl Std 22mmx60cm	35	23	$69,803.00	$69,803.00	$9,772.42	$62,822.70	$25,827.11	2026-03-01
318373	CDM	Coil Std 20mm X 60cm	35	23	$69,803.00	$69,803.00	$9,772.42	$62,822.70	$25,827.11	2026-03-01
318385	CDM	Coil Embl Sft 25cmx9mm	35	23	$69,803.00	$69,803.00	$9,772.42	$62,822.70	$25,827.11	2026-03-01
D0303	HCPCS	Nontraumatic Brain Injury; M > 26.15 & M < 35.05	13	7	$25,586.78	—	$25,363.06	$26,570.82	$25,697.12	2026-07-17
33274	CPT	Ins Ppm Ldls Sys Or Repl	57	28	$75,117.00	$75,117.00	$3,346.00	$67,605.30	$25,690.01	2026-03-01
318375	CDM	Coil Embl Std 57cm24mm	35	23	$69,407.00	$69,407.00	$9,716.98	$62,466.30	$25,680.59	2026-03-01
318370	CDM	Coil Std 15mm X 57cm	35	23	$69,407.00	$69,407.00	$9,716.98	$62,466.30	$25,680.59	2026-03-01
318372	CDM	Coil Embl Std 18mmx57cm	35	23	$69,407.00	$69,407.00	$9,716.98	$62,466.30	$25,680.59	2026-03-01
243170	CDM	Stent Graft Thor 45x20	35	23	$69,385.00	$69,385.00	$9,713.90	$62,446.50	$25,672.45	2026-03-01
243171	CDM	Stent Graft Thor 45x15	35	23	$69,385.00	$69,385.00	$9,713.90	$62,446.50	$25,672.45	2026-03-01
37230	CPT	Tib/per Revasc W/stnt Bi	193	29	$53,182.00	$62,853.50	$2,417.45	$95,733.90	$25,601.33	2026-07-17
335488	CDM	Graft Bn Thk Rstr10x21mm	35	23	$69,160.00	$69,160.00	$9,682.40	$62,244.00	$25,589.20	2026-03-01
333593	CDM	Algrftt Bn Dbm 5.0cc	35	23	$69,160.00	$69,160.00	$9,682.40	$62,244.00	$25,589.20	2026-03-01
325	MS_DRG	Coronary Intravascular Lithotripsy Without Intraluminal Device	79	46	—	—	$11,384.00	$53,080.75	$25,572.50	2026-03-01
106322	CDM	Cage Spn 7x11x31 20d	35	23	$68,952.00	$68,952.00	$9,653.28	$62,056.80	$25,512.24	2026-03-01
0266T	CPT	Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Total…	17	8	—	—	$5,681.00	$93,471.16	$25,460.00	2026-03-01
335463	CDM	Device Embl Lc Bead Lumi	71	36	$71,808.00	$71,808.00	$3,590.40	$64,627.20	$25,348.22	2026-03-01
318386	CDM	Coil Embl Sft 20cmx10mm	35	23	$68,474.00	$68,474.00	$9,586.36	$61,626.60	$25,335.38	2026-03-01
318364	CDM	Coil Embl 50cm 14mm Cmpl	35	23	$68,474.00	$68,474.00	$9,586.36	$61,626.60	$25,335.38	2026-03-01
318383	CDM	Coil Embl Sft 20cmx7mm	35	23	$68,474.00	$68,474.00	$9,586.36	$61,626.60	$25,335.38	2026-03-01
318384	CDM	Coil Soft 8mm X 20cm	35	23	$68,474.00	$68,474.00	$9,586.36	$61,626.60	$25,335.38	2026-03-01
92920	CPT	Ptca Single Vessel Lc	27	19	$50,532.00	$50,532.00	$7,074.48	$45,478.80	$25,266.00	2026-03-01
285885	CDM	Stent Vasc 28x16x100mm	35	23	$68,025.00	$68,025.00	$9,523.50	$61,222.50	$25,169.25	2026-03-01
285880	CDM	Stent Aaa Exldr 17x31	35	23	$67,990.00	$67,990.00	$9,518.60	$61,191.00	$25,156.30	2026-03-01
285891	CDM	Stent Aaa Exldr Trk16cm	35	23	$67,990.00	$67,990.00	$9,518.60	$61,191.00	$25,156.30	2026-03-01

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