Price Transparencybeta 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

MEDICAL CITY WEATHERFORD

Weatherford, TX · CCN 450203 · Rates published

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You selected 93306 (CPT)

ECHO2D COMP W CF DOP

This hospital’s price: $1,566 across 14 payers · range $320-$6,118

Source: https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/82-2073410_MEDICAL-CITY-WEATHERFORD_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.

42,880 distinct procedures filed
37 distinct payers
1,590,374 rate rows
2026-07-17 last MRF observed
Data quality

1,545,088 of 1,590,374 rate rows are consumer-grade (97.2%)

45,286 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 22,857
per-diem day rate — not a per-procedure price 11,889
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 6,685
template filing: same amount across many unrelated codes — excluded 2,818
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 761
placeholder amount (≤ $0.02) — excluded from medians 204
exceeds 10× this hospital's gross charge — excluded from medians 65
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 7
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/82-2073410_MEDICAL-CITY-WEATHERFORD_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://medicalcityhealthcare.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-10-22
Content fingerprint 5061bdefc36b1af3… · 686,282,395 bytes · first seen 2026-05-06

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
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,850,948.67 $4,850,948.67 $4,850,948.67 nat. median
$2,994,107
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 19 $6,500.17 $4,955,500.00 $4,527,525.00 nat. median
$17,146
outlier · 264.1×
00845
OTHER 		Inj, Atidarsagene Autotem 1 $4,505,000.00 $4,505,000.00 $4,505,000.00 nat. median
$4,414,900
1.0× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $4,271,819.03 $4,271,819.03 $4,271,819.03 nat. median
$2,466,282
1.7× median
J3392
HCPCS 		Injection, Exagamglogene Autotemcel, Per Treatment 1 $3,847,800.00 $3,847,800.00 $3,847,800.00 nat. median
$2,401,960
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 19 $3,611,561.66 $4,790,847.10 $3,722,119.67 nat. median
$3,758,972
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,685,267.00 $3,685,267.00 $3,685,267.00 nat. median
$3,574,709
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 20 $11,769.49 $4,336,566.00 $3,385,857.30 nat. median
$30,329
outlier · 111.6×
714
OTHER 		Inj Delandistrogene Mox R 20 $7,645.08 $4,326,218.00 $3,352,818.95 nat. median
$3,325,455
1.0× median
00908
OTHER 		Topi Adm Prad Zami Per Tr 1 $3,335,820.00 $3,335,820.00 $3,335,820.00 nat. median
$14,694
outlier · 227.0×
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,327,860.00 $3,327,860.00 $3,327,860.00 nat. median
$3,228,024
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 20 $14,552.33 $4,228,260.40 $3,276,901.81 nat. median
$3,252,508
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $3,252,508.00 $3,252,508.00 $3,252,508.00 nat. median
$3,187,420
1.0× median
906
OTHER 		Inj Elivaldogene Autoteme 20 $10,399.72 $4,134,000.00 $3,227,700.00 nat. median
$24,952
outlier · 129.4×
00906
OTHER 		Inj Elivaldogene Autoteme 1 $3,180,000.00 $3,180,000.00 $3,180,000.00 nat. median
$3,084,600
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 2 $1,271,523.00 $4,067,128.80 $3,114,468.00 nat. median
$809,217
outlier · 3.8×
746
OTHER 		Inj, Betibeglogene Autote 21 $13,461.06 $4,674,550.71 $2,998,768.38 nat. median
$2,939,969
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 1 $2,939,969.00 $2,939,969.00 $2,939,969.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 21 $2,455,110.00 $4,634,275.99 $2,666,650.43 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,588,981.00 $2,588,981.00 $2,588,981.00 nat. median
$2,511,312
1.0× median
824
OTHER 		Inj, Exagamglogene Autote 22 $15,762.56 $4,174,280.00 $2,390,300.00 nat. median
$2,262,040
1.1× median
00824
OTHER 		Inj, Exagamglogene Autote 1 $2,332,000.00 $2,332,000.00 $2,332,000.00 nat. median
$2,285,360
1.0× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 2 $459,112.50 $2,937,060.00 $2,249,100.00 nat. median
$319,951
outlier · 7.0×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $553,169.00 $2,880,730.80 $1,968,345.00 nat. median
$646,415
outlier · 3.0×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $527,622.00 $2,598,852.84 $1,775,743.50 nat. median
$622,245
outlier · 2.9×
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $516,442.00 $2,541,857.74 $1,736,799.90 nat. median
$640,950
outlier · 2.7×
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $489,399.00 $2,310,779.76 $1,578,909.00 nat. median
$591,650
outlier · 2.7×
C9301
HCPCS 		Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 1 $959,962.50 $1,544,287.50 $1,405,162.50 nat. median
$459,112
outlier · 3.1×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 $23.68 $2,389,661.80 $1,325,455.50 nat. median
$738,272
1.8× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $6.22 $2,204,057.00 $1,222,507.50 nat. median
$608,101
outlier · 2.0×
2067
OTHER 		Afamitresgene Autoleucel 22 $755,207.60 $2,019,024.40 $801,444.80 nat. median
$789,886
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 22 $565,868.90 $1,539,641.95 $611,155.58 nat. median
$587,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 22 $555,200.67 $1,484,312.01 $593,292.03 nat. median
$577,003
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $587,649.60 $587,649.60 $587,649.60 nat. median
$570,020
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 22 $550,957.18 $1,472,967.14 $584,689.25 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 22 $546,920.16 $1,462,174.32 $580,405.07 nat. median
$562,826
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $566,531.30 $566,531.30 $566,531.30 nat. median
$549,535
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $562,201.20 $562,201.20 $562,201.20 nat. median
$545,335
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $558,081.80 $558,081.80 $558,081.80 nat. median
$541,339
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 22 $521,548.36 $1,394,343.56 $553,479.89 nat. median
$533,230
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $532,192.20 $532,192.20 $532,192.20 nat. median
$516,226
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 22 $479,661.20 $1,282,359.52 $509,028.21 nat. median
$492,768
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $489,450.20 $489,450.20 $489,450.20 nat. median
$474,767
1.0× median
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 4 $63,235.60 $995,200.00 $405,600.00 nat. median
$68,423
outlier · 5.9×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 15 $353,986.39 $1,273,072.13 $368,434.81 nat. median
$359,358
1.0× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 $332,753.88 $332,753.88 $332,753.88 nat. median
$209,753
1.6× median
90288
CPT 		Botulism Immune Globulin, Human, For Intravenous Use 1 $294,713.96 $416,525.16 $329,245.80 nat. median
$51,570
outlier · 6.4×
Q2043
HCPCS 		Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 5 $57,017.10 $478,449.94 $322,707.41 nat. median
$65,720
outlier · 4.9×
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 4 $93,760.51 $582,739.61 $320,940.30 nat. median
$63,643
outlier · 5.0×
5834
APR_DRG 		Neonate With Ecmo 7 $288,809.37 $361,011.71 $296,029.60 nat. median
$307,273
1.0× median

Other procedures at this hospital

Browse this hospital's 42,880 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
             
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 3 1 — — $4,850,948.67 $4,850,948.67 $4,850,948.67 2026-03-01
845 OTHER Inj, Atidarsagene Autotem 31 19 $23,739.10 — $6,500.17 $4,955,500.00 $4,527,525.00 2026-07-17
00845 OTHER Inj, Atidarsagene Autotem 1 1 — — $4,505,000.00 $4,505,000.00 $4,505,000.00 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 3 1 $4,463,735.93 — $4,271,819.03 $4,271,819.03 $4,271,819.03 2026-07-17
J3392 HCPCS Injection, Exagamglogene Autotemcel, Per Treatment 3 1 — — $3,847,800.00 $3,847,800.00 $3,847,800.00 2026-03-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 31 19 — — $3,611,561.66 $4,790,847.10 $3,722,119.67 2026-03-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,685,267.00 $3,685,267.00 $3,685,267.00 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 30 20 $57,740.35 — $11,769.49 $4,336,566.00 $3,385,857.30 2026-07-17
714 OTHER Inj Delandistrogene Mox R 32 20 $26,903.38 — $7,645.08 $4,326,218.00 $3,352,818.95 2026-07-17
00908 OTHER Topi Adm Prad Zami Per Tr 1 1 — — $3,335,820.00 $3,335,820.00 $3,335,820.00 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,327,860.00 $3,327,860.00 $3,327,860.00 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 32 20 $39,790.72 — $14,552.33 $4,228,260.40 $3,276,901.81 2026-07-17
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,252,508.00 $3,252,508.00 $3,252,508.00 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 30 20 $50,196.06 — $10,399.72 $4,134,000.00 $3,227,700.00 2026-07-17
00906 OTHER Inj Elivaldogene Autoteme 1 1 — — $3,180,000.00 $3,180,000.00 $3,180,000.00 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 8 2 — — $1,271,523.00 $4,067,128.80 $3,114,468.00 2026-03-01
746 OTHER Inj, Betibeglogene Autote 35 21 $43,895.58 — $13,461.06 $4,674,550.71 $2,998,768.38 2026-07-17
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,939,969.00 $2,939,969.00 $2,939,969.00 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 35 21 — — $2,455,110.00 $4,634,275.99 $2,666,650.43 2026-03-01
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,588,981.00 $2,588,981.00 $2,588,981.00 2026-03-01
824 OTHER Inj, Exagamglogene Autote 36 22 $64,304.75 — $15,762.56 $4,174,280.00 $2,390,300.00 2026-07-17
00824 OTHER Inj, Exagamglogene Autote 1 1 — — $2,332,000.00 $2,332,000.00 $2,332,000.00 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 8 2 — — $459,112.50 $2,937,060.00 $2,249,100.00 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 10 3 $2,718,631.80 — $553,169.00 $2,880,730.80 $1,968,345.00 2026-07-17
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 10 3 $2,452,615.14 — $527,622.00 $2,598,852.84 $1,775,743.50 2026-07-17
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 10 3 $2,398,827.16 — $516,442.00 $2,541,857.74 $1,736,799.90 2026-07-17
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 10 3 $2,180,751.96 — $489,399.00 $2,310,779.76 $1,578,909.00 2026-07-17
C9301 HCPCS Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 5 1 — — $959,962.50 $1,544,287.50 $1,405,162.50 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 11 4 $2,255,195.30 — $23.68 $2,389,661.80 $1,325,455.50 2026-07-17
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 11 4 $2,080,034.50 — $6.22 $2,204,057.00 $1,222,507.50 2026-07-17
2067 OTHER Afamitresgene Autoleucel 38 22 — — $755,207.60 $2,019,024.40 $801,444.80 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 38 22 $1,096,795.50 — $565,868.90 $1,539,641.95 $611,155.58 2026-07-17
9194 OTHER Tisagenlecleucel Car-pos 38 22 $1,039,331.61 — $555,200.67 $1,484,312.01 $593,292.03 2026-07-17
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $587,649.60 $587,649.60 $587,649.60 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 38 22 $995,962.22 — $550,957.18 $1,472,967.14 $584,689.25 2026-07-17
9422 OTHER Idecabtagene Vicleucel Ca 38 22 $1,018,294.30 — $546,920.16 $1,462,174.32 $580,405.07 2026-07-17
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $566,531.30 $566,531.30 $566,531.30 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $562,201.20 $562,201.20 $562,201.20 2026-03-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $558,081.80 $558,081.80 $558,081.80 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 38 22 $968,406.12 — $521,548.36 $1,394,343.56 $553,479.89 2026-07-17
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $532,192.20 $532,192.20 $532,192.20 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 38 22 $968,532.60 — $479,661.20 $1,282,359.52 $509,028.21 2026-07-17
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $489,450.20 $489,450.20 $489,450.20 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 16 4 — — $63,235.60 $995,200.00 $405,600.00 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 29 15 — — $353,986.39 $1,273,072.13 $368,434.81 2026-03-01
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 3 1 — — $332,753.88 $332,753.88 $332,753.88 2026-03-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 6 1 — — $294,713.96 $416,525.16 $329,245.80 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 17 5 $357,413.68 — $57,017.10 $478,449.94 $322,707.41 2026-07-17
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 16 4 $385,945.21 — $93,760.51 $582,739.61 $320,940.30 2026-07-17
5834 APR_DRG Neonate With Ecmo 14 7 — — $288,809.37 $361,011.71 $296,029.60 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 19 8 — — $280,954.00 $351,192.54 $295,001.73 2026-03-01
831 OTHER Obecbtge Autol Up To 400 39 23 $33,546.40 — $4,451.03 $729,015.00 $286,597.50 2026-07-17
897 OTHER Revakinagene, Per Implant 36 22 $23,901.95 — $259,700.00 $694,300.00 $278,250.00 2026-07-17
00831 OTHER Obecbtge Autol Up To 400 1 1 — — $278,250.00 $278,250.00 $278,250.00 2026-03-01
00897 OTHER Revakinagene, Per Implant 1 1 — — $265,000.00 $265,000.00 $265,000.00 2026-03-01
018 OTHER $266,137.11 1 1 $1,014,848.78 — $262,442.50 $262,442.50 $262,442.50 2026-07-17
5833 APR_DRG Neonate With Ecmo 14 7 — — $244,553.16 $305,691.45 $250,666.99 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 19 8 — — $235,253.00 $294,066.53 $247,015.88 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 48 20 — — $230,072.84 $842,426.46 $246,506.61 2026-03-01
001 OTHER $217,545.50 1 1 $484,340.00 — $230,691.10 $230,691.10 $230,691.10 2026-07-17
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 16 4 $227,599.37 — $131,717.55 $574,167.94 $224,683.42 2026-07-17
886 OTHER Inj. Remestemcel-l-rknd/ 39 23 $38,325.11 — $9,739.60 $528,372.78 $207,719.07 2026-07-17
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 17 5 $216,892.20 — $45,212.00 $389,632.46 $203,957.06 2026-07-17
00886 OTHER Inj. Remestemcel-l-rknd/ 1 1 — — $201,669.00 $201,669.00 $201,669.00 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 61 24 — — $151,231.85 $638,050.74 $188,742.86 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 53 22 — — $9,825.00 $641,817.38 $188,059.73 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 7 — — $182,811.59 $228,514.49 $187,381.88 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 19 8 — — $177,522.60 $221,903.25 $186,398.73 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 14 7 — — $166,310.72 $207,888.40 $170,468.49 2026-03-01
003 OTHER $133,887.96 1 1 $568,197.06 — $162,595.80 $162,595.80 $162,595.80 2026-07-17
1908 OTHER New Technology - Level 52 38 22 $340,572.32 — $145,445.80 $392,862.71 $155,945.51 2026-07-17
1907 OTHER New Technology - Level 52 38 22 $340,572.32 — $145,445.80 $392,862.71 $155,945.51 2026-07-17
01908 OTHER New Technology - Level 52 1 1 — — $145,445.80 $145,445.80 $145,445.80 2026-03-01
01907 OTHER New Technology - Level 52 1 1 — — $145,445.80 $145,445.80 $145,445.80 2026-03-01
1906 OTHER New Technology - Level 51 38 22 $307,073.51 — $131,139.70 $354,220.59 $140,606.65 2026-07-17
1905 OTHER New Technology - Level 51 38 22 $307,073.51 — $131,139.70 $354,220.59 $140,606.65 2026-07-17
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 14 7 — — $136,024.01 $170,030.01 $139,424.61 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 14 7 — — $134,818.60 $168,523.25 $138,189.07 2026-03-01
01905 OTHER New Technology - Level 51 1 1 — — $131,139.70 $131,139.70 $131,139.70 2026-03-01
01906 OTHER New Technology - Level 51 1 1 — — $131,139.70 $131,139.70 $131,139.70 2026-03-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 16 4 $143,344.23 — $39,976.89 $203,447.46 $127,535.01 2026-07-17
004 OTHER $83,627.10 1 1 $385,544.94 — $126,974.40 $126,974.40 $126,974.40 2026-07-17
1903 OTHER New Technology - Level 50 38 22 $273,574.71 — $116,833.60 $315,578.48 $125,267.79 2026-07-17
1904 OTHER New Technology - Level 50 38 22 $273,574.71 — $116,833.60 $315,578.48 $125,267.79 2026-07-17
5832 APR_DRG Neonate With Ecmo 14 7 — — $121,855.26 $152,319.07 $124,901.64 2026-03-01
850516 CDM Device Vntrc Asst 2 Lvas 28 12 $390,000.00 $390,000.00 $52,650.00 $390,000.00 $124,410.00 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 61 24 — — $102,616.99 $416,386.94 $123,546.60 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 14 7 — — $115,709.54 $144,636.92 $118,602.28 2026-03-01
01904 OTHER New Technology - Level 50 1 1 — — $116,833.60 $116,833.60 $116,833.60 2026-03-01
01903 OTHER New Technology - Level 50 1 1 — — $116,833.60 $116,833.60 $116,833.60 2026-03-01
651 OTHER $27,989.12 1 1 $99,566.66 — $113,795.30 $113,795.30 $113,795.30 2026-07-17
7 MS_DRG Lung Transplant 34 19 — — $106,855.67 $381,784.85 $111,217.13 2026-03-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 14 7 — — $107,526.03 $134,407.54 $110,214.18 2026-03-01
5831 APR_DRG Neonate With Ecmo 14 7 — — $107,295.98 $134,119.98 $109,978.38 2026-03-01
1902 OTHER New Technology - Level 49 38 22 $240,075.90 — $102,527.50 $276,936.36 $109,928.93 2026-07-17
1901 OTHER New Technology - Level 49 38 22 $240,075.90 — $102,527.50 $276,936.36 $109,928.93 2026-07-17
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 3 2 $599,885.67 — $109,306.00 $629,884.36 $109,306.00 2026-07-17
730191 CDM Device Ast Vent 00551042 28 12 $340,200.00 $340,200.00 $45,927.00 $340,200.00 $108,523.80 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 19 8 — — $99,137.90 $123,922.43 $104,094.84 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 34 19 — — $99,234.80 $354,299.71 $103,285.20 2026-03-01
E0767 HCPCS Intrabuccal, Systemic Delivery Of Amplitude-modulated, Radiofrequency Electromag… 5 1 — — $80,266.41 $113,137.42 $103,199.67 2026-03-01
J7310 HCPCS Ganciclovir, 4.5 Mg, Long-acting Implant 13 3 $115,548.48 — $54,979.20 $145,041.92 $102,624.96 2026-07-17
01902 OTHER New Technology - Level 49 1 1 — — $102,527.50 $102,527.50 $102,527.50 2026-03-01
01901 OTHER New Technology - Level 49 1 1 — — $102,527.50 $102,527.50 $102,527.50 2026-03-01
866357 CDM Cath Pmp Impella 5.0 9f 44 18 $364,500.00 $364,500.00 $25,515.00 $364,500.00 $101,331.00 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 7 — — $98,090.72 $122,613.40 $100,542.99 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 7 — — $97,642.39 $122,052.99 $100,083.45 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 14 7 — — $97,389.90 $121,737.38 $99,824.65 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 14 7 — — $96,971.24 $121,214.05 $99,395.52 2026-03-01
L5969 HCPCS $93,897.86 1 1 $93,897.86 — $98,593.44 $98,593.44 $98,593.44 2026-07-17
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 8 1 $107,800.00 — $80,850.00 $113,960.00 $98,583.35 2026-07-17
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 14 7 — — $96,002.72 $120,003.40 $98,402.79 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 56 25 — — $60,607.00 $471,244.47 $97,593.68 2026-03-01
007 OTHER $94,727.88 1 1 $157,714.48 — $97,588.53 $97,588.53 $97,588.53 2026-07-17
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 36 19 — — $93,626.38 $554,970.00 $97,447.86 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 48 25 — — $75,983.00 $333,689.54 $97,337.25 2026-03-01
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 17 5 $102,849.39 — $27,070.50 $243,082.56 $97,242.60 2026-07-17
1613 APR_DRG Implantable Heart Assist Systems 19 8 — — $92,527.18 $115,658.97 $97,153.54 2026-03-01
1585 OTHER New Technology - Level 48 38 22 $212,160.23 — $90,605.77 $244,734.72 $97,146.61 2026-07-17
1599 OTHER New Technology - Level 48 38 22 $212,160.23 — $90,605.77 $244,734.72 $97,146.61 2026-07-17
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 63 27 — — $9,825.00 $326,886.32 $96,305.35 2026-03-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 14 7 — — $93,473.63 $116,842.04 $95,810.47 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 14 7 — — $92,636.31 $115,795.39 $94,952.22 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 7 — — $92,038.16 $115,047.70 $94,339.12 2026-03-01
751731 CDM Pump Impella Circ 2.5 44 18 $337,500.00 $337,500.00 $23,625.00 $337,500.00 $93,825.00 2026-03-01
01599 OTHER New Technology - Level 48 1 1 — — $90,605.77 $90,605.77 $90,605.77 2026-03-01
01585 OTHER New Technology - Level 48 1 1 — — $90,605.77 $90,605.77 $90,605.77 2026-03-01
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 16 4 $102,822.55 — $5,213.67 $142,036.23 $89,197.59 2026-07-17
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 34 19 — — $85,277.94 $303,963.85 $88,758.68 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 19 8 — — $84,271.80 $105,339.75 $88,485.39 2026-03-01
215 MS_DRG Other Heart Assist System Implant 69 27 — — $54,731.00 $567,817.00 $88,273.21 2026-03-01
84 APR_DRG Autologous Bone Marrow Transplant 19 8 — — $83,934.10 $104,917.66 $88,130.84 2026-03-01
877268 CDM Valve Transcth Aor 26mm 28 12 $275,700.00 $275,700.00 $37,219.50 $275,700.00 $87,948.30 2026-03-01
427323 CDM Valve Aor Evolutr-34mm 28 12 $275,700.00 $275,700.00 $37,219.50 $275,700.00 $87,948.30 2026-03-01
437822 CDM Valve Aor Tavr 23mm 28 12 $275,700.00 $275,700.00 $37,219.50 $275,700.00 $87,948.30 2026-03-01
877267 CDM Val Evlt Rtm Trnsct Aort 28 12 $275,700.00 $275,700.00 $37,219.50 $275,700.00 $87,948.30 2026-03-01
877269 CDM Transcth Aortic Vlv 29mm 28 12 $275,700.00 $275,700.00 $37,219.50 $275,700.00 $87,948.30 2026-03-01
432007 CDM Aicd Inventra 7 Hf-t Qp 28 12 $274,536.00 $274,536.00 $37,062.36 $274,536.00 $87,576.98 2026-03-01
1598 OTHER New Technology - Level 47 38 22 $189,827.69 — $81,068.38 $218,973.29 $86,920.70 2026-07-17
1584 OTHER New Technology - Level 47 38 22 $189,827.69 — $81,068.38 $218,973.29 $86,920.70 2026-07-17
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 69 27 — — $54,731.00 $335,921.79 $86,747.54 2026-03-01
422684 CDM Icd Iperia 7 Vr-t Dx Hm 28 12 $271,786.00 $271,786.00 $36,691.11 $271,786.00 $86,699.73 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 19 8 — — $82,396.75 $102,995.94 $86,516.59 2026-03-01
002 OTHER $104,481.60 1 1 $484,340.00 — $86,492.23 $86,492.23 $86,492.23 2026-07-17
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 14 7 — — $82,442.76 $103,053.45 $84,503.83 2026-03-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 14 7 — — $81,708.10 $102,135.13 $83,750.80 2026-03-01
014 OTHER $86,912.11 1 1 $144,701.84 — $83,300.95 $83,300.95 $83,300.95 2026-07-17
005 OTHER $88,561.11 1 1 $147,447.29 — $82,423.52 $82,423.52 $82,423.52 2026-07-17
2464 APR_DRG Gastrointestinal Vascular Insufficiency 14 7 — — $79,901.88 $99,877.35 $81,899.43 2026-03-01
879378 CDM Hndl Pwr Drv + Reldsx 44 18 $293,350.00 $293,350.00 $20,534.50 $293,350.00 $81,551.30 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 14 7 — — $79,489.68 $99,362.10 $81,476.92 2026-03-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 69 27 — — $54,731.00 $276,270.00 $81,187.00 2026-03-01
862710 CDM Set Vntrc 17.4x13.8in 44 18 $291,750.00 $291,750.00 $20,422.50 $291,750.00 $81,106.50 2026-03-01
265596 CDM Kit Lo Prfl Comp Shth 7f 44 18 $291,750.00 $291,750.00 $20,422.50 $291,750.00 $81,106.50 2026-03-01
01584 OTHER New Technology - Level 47 1 1 — — $81,068.38 $81,068.38 $81,068.38 2026-03-01
01598 OTHER New Technology - Level 47 1 1 — — $81,068.38 $81,068.38 $81,068.38 2026-03-01
64 APR_DRG Pancreas Transplant 19 8 — — $77,142.36 $96,427.95 $80,999.48 2026-03-01
C1822 HCPCS Pulse Gen Imp 23 10 $238,940.00 $238,940.00 $32,256.90 $238,940.00 $80,044.90 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 56 25 — — $60,607.00 $385,232.48 $79,975.70 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 14 7 — — $77,136.27 $96,420.34 $79,064.68 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 14 7 — — $76,905.46 $96,131.83 $78,828.10 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 69 27 — — $54,731.00 $289,465.91 $78,465.17 2026-03-01
423 OTHER $14,642.83 1 1 $110,395.96 — $77,244.98 $77,244.98 $77,244.98 2026-07-17
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 1 $78,168.72 — $77,046.96 $77,046.96 $77,046.96 2026-07-17
850 MS_DRG Acute Leukemia With Other Procedures 56 25 — — $9,825.00 $262,963.04 $76,909.44 2026-03-01
1597 OTHER New Technology - Level 46 38 22 $167,495.15 — $71,530.98 $193,211.87 $76,694.79 2026-07-17
1583 OTHER New Technology - Level 46 38 22 $167,495.15 — $71,530.98 $193,211.87 $76,694.79 2026-07-17
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 14 7 — — $74,760.81 $93,451.01 $76,629.83 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 19 8 — — $71,877.32 $89,846.65 $75,471.19 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 62 25 — — $60,607.00 $359,312.58 $75,022.04 2026-03-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 69 27 — — $54,633.53 $304,994.00 $74,840.06 2026-03-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 69 27 — — $54,633.53 $308,347.00 $74,840.06 2026-03-01
474 OTHER $24,386.27 1 1 $115,028.66 — $74,607.23 $74,607.23 $74,607.23 2026-07-17
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 14 7 — — $70,697.76 $88,372.20 $72,465.20 2026-03-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 62 25 — — $65,185.42 $236,544.00 $71,983.90 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 14 7 — — $70,123.95 $87,654.94 $71,877.05 2026-03-01
C2624 HCPCS System Mntr 2x15mm 4.5cm 23 10 $214,375.00 $214,375.00 $28,940.63 $214,375.00 $71,815.63 2026-03-01
216 OTHER $42,037.00 1 1 $273,523.33 — $71,688.24 $71,688.24 $71,688.24 2026-07-17
01583 OTHER New Technology - Level 46 1 1 — — $71,530.98 $71,530.98 $71,530.98 2026-03-01
01597 OTHER New Technology - Level 46 1 1 — — $71,530.98 $71,530.98 $71,530.98 2026-03-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 67 26 — — $55,453.00 $262,520.88 $71,524.15 2026-03-01
72 APR_DRG Allogeneic Bone Marrow Transplant 19 8 — — $66,609.60 $83,262.02 $69,940.10 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 19 8 — — $66,512.65 $83,140.81 $69,838.28 2026-03-01
563181 CDM Cnla Vntrc Art 42f 28 12 $217,728.00 $217,728.00 $29,393.28 $217,728.00 $69,455.23 2026-03-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 69 27 — — $50,451.11 $208,177.56 $69,004.51 2026-03-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 14 7 — — $67,135.51 $83,919.39 $68,813.90 2026-03-01
429 OTHER $126.00 1 1 $298.00 — $68,767.88 $68,767.88 $68,767.88 2026-07-17
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $68,413.82 $68,413.82 $68,413.82 2026-03-01
020 OTHER $65,588.26 1 1 $261,208.75 — $67,975.72 $67,975.72 $67,975.72 2026-07-17
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 57 25 — — $55,378.67 $229,061.81 $67,804.43 2026-03-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 2 1 — — $67,452.70 $67,452.70 $67,452.70 2026-03-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 14 7 — — $65,752.14 $82,190.18 $67,395.95 2026-03-01
634520 CDM Impl Pulsar Ci Ear 100 H 28 12 $210,504.00 $210,504.00 $28,418.04 $210,504.00 $67,150.78 2026-03-01
1596 OTHER New Technology - Level 45 38 22 $145,162.61 — $61,993.58 $167,450.46 $66,468.88 2026-07-17
1582 OTHER New Technology - Level 45 38 22 $145,162.61 — $61,993.58 $167,450.46 $66,468.88 2026-07-17
8634 APR_DRG Neonatal Aftercare 14 7 — — $64,732.29 $80,915.36 $66,350.60 2026-03-01
1611 APR_DRG Implantable Heart Assist Systems 19 8 — — $63,081.21 $78,851.51 $66,235.27 2026-03-01
717 OTHER Instill Adstiladrin, Tx D 39 23 $49,704.71 — $14,429.93 $168,399.95 $66,203.03 2026-07-17
4404 APR_DRG Kidney Transplant 19 8 — — $62,925.30 $78,656.64 $66,071.58 2026-03-01
E0738 HCPCS Upper Extremity Rehabilitation System Providing Active Assistance To Facilitate … 8 1 — — $1,999.65 $76,656.60 $65,779.65 2026-03-01
E0739 HCPCS Rehabilitation System With Interactive Interface Providing Active Assistance In … 8 1 — — $1,566.33 $76,656.60 $65,779.65 2026-03-01
5244 OTHER Level 4 Blood Product Exc 38 22 $91,623.66 — $56,406.41 $165,551.90 $65,715.26 2026-07-17
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 14 7 — — $64,110.57 $80,138.21 $65,713.34 2026-03-01
431261 CDM Defib Crt-d Cd3357-40c 28 12 $205,950.00 $205,950.00 $27,803.25 $205,950.00 $65,698.05 2026-03-01
0915T CPT Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 8 2 — — $22,045.00 $76,947.79 $65,405.62 2026-03-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 67 26 — — $41,353.71 $169,883.82 $65,365.00 2026-03-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 67 26 — — $49,327.03 $422,445.00 $65,168.56 2026-03-01
231 OTHER $42,037.00 1 1 $235,655.88 — $64,342.97 $64,342.97 $64,342.97 2026-07-17
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 56 25 — — $59,881.34 $308,652.90 $64,289.78 2026-03-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $64,274.79 $64,274.79 $64,274.79 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 14 7 — — $62,637.83 $78,297.29 $64,203.78 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 14 7 — — $62,616.54 $78,270.68 $64,181.96 2026-03-01
275 OTHER $596.00 1 1 $596.00 — $64,135.30 $64,135.30 $64,135.30 2026-07-17
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 53 22 — — $9,825.00 $215,618.53 $63,887.78 2026-03-01
881517 CDM Crt-d Volume 40mm 28 12 $199,827.00 $199,827.00 $26,976.65 $199,827.00 $63,744.81 2026-03-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 63 27 — — $54,731.00 $329,192.00 $63,517.30 2026-03-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 64 26 — — $54,731.00 $294,489.00 $63,057.45 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 14 7 — — $61,000.83 $76,251.04 $62,525.85 2026-03-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 14 7 — — $61,000.83 $76,251.04 $62,525.85 2026-03-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 14 7 — — $60,827.81 $76,034.76 $62,348.50 2026-03-01
10 MS_DRG Pancreas Transplant 34 19 — — $59,653.11 $211,546.81 $62,087.93 2026-03-01
0936T CPT Photobiomodulation Therapy Of Retina, Single Session 5 1 — — $59,084.21 $64,941.69 $62,031.14 2026-03-01
L8687 HCPCS $14,043.32 1 1 $59,060.67 — $62,014.14 $62,014.14 $62,014.14 2026-07-17
01596 OTHER New Technology - Level 45 1 1 — — $61,993.58 $61,993.58 $61,993.58 2026-03-01
01582 OTHER New Technology - Level 45 1 1 — — $61,993.58 $61,993.58 $61,993.58 2026-03-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 35 20 — — $59,317.15 $210,335.14 $61,738.25 2026-03-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 62 25 — — $5,441.00 $207,775.62 $61,602.75 2026-03-01
C1882 HCPCS Crt-d Hf-t Df4 1,058 10 $177,095.50 $177,095.50 $11,663.73 $255,750.00 $61,407.50 2026-03-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $61,290.69 $61,290.69 $61,290.69 2026-03-01
4414 APR_DRG Major Bladder Procedures 14 7 — — $59,550.15 $74,437.69 $61,038.90 2026-03-01
429545 CDM Kit Generator Nrstm Ipg 28 12 $190,819.00 $190,819.00 $25,760.56 $190,819.00 $60,871.26 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 19 8 — — $57,942.80 $72,428.50 $60,839.94 2026-03-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 69 27 — — $44,497.67 $276,270.00 $60,697.93 2026-03-01
0896T CPT Connection Of Liver Allograft To Normothermic Machine Perfusion Device, Hemostas… 6 1 — — $5,348.14 $64,941.69 $60,557.68 2026-03-01
0895T CPT Connection Of Liver Allograft To Normothermic Machine Perfusion Device, Hemostas… 6 1 — — $5,348.14 $64,941.69 $60,557.68 2026-03-01
850 OTHER $326.32 1 1 $762.52 — $60,281.82 $60,281.82 $60,281.82 2026-07-17
955 MS_DRG Craniotomy For Multiple Significant Trauma 57 25 — — $50,338.13 $202,343.60 $60,020.15 2026-03-01
866222 CDM *dc*s-icd Sbq Sq-rx 1010 28 12 $187,842.00 $187,842.00 $25,358.67 $187,842.00 $59,921.60 2026-03-01
C2616 HCPCS Brachytherapy Source, Non-stranded, Yttrium-90, Per Source 9 2 $91,952.65 — $17,424.00 $88,363.42 $59,820.49 2026-07-17
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 56 25 — — $53,366.00 $229,601.04 $59,629.54 2026-03-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 56 25 — — $36,089.00 $285,691.85 $59,586.62 2026-03-01
83 APR_DRG Autologous Bone Marrow Transplant 19 8 — — $56,733.20 $70,916.50 $59,569.86 2026-03-01
C1820 HCPCS Kit Generator Ipg 506 10 $167,090.00 $167,090.00 $2,407.18 $237,529.00 $59,141.61 2026-03-01
1643 OTHER Y90 Ibritumomab, Rx 38 22 $136,927.86 — $55,688.06 $148,880.32 $59,097.54 2026-07-17
0873T CPT Revision Of A Subcutaneously Implanted Peritoneal Ascites Pump System, Any Compo… 9 2 — — $5,348.14 $64,941.69 $59,084.21 2026-03-01
0874T CPT Removal Of A Peritoneal Ascites Pump System, Including Implanted Peritoneal Asci… 9 2 — — $5,348.14 $64,941.69 $59,084.21 2026-03-01
0943T CPT Cystourethroscopy, Flexible; With Removal Of Prostatic Urethral Scaffold 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0935T CPT Cystourethroscopy With Renal Pelvic Sympathetic Denervation, Radiofrequency Abla… 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0909T CPT Replacement Of Integrated Neurostimulation System, Vagus Nerve, Including Analys… 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0955T CPT Totally Implantable Active Middle Ear Hearing Implant; Removal, Including Remova… 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0952T CPT Totally Implantable Active Middle Ear Hearing Implant; Revision Or Replacement, … 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0871T CPT Replacement Of A Subcutaneous Peritoneal Ascites Pump, Including Reconnection Be… 9 2 — — $5,348.14 $64,941.69 $59,084.21 2026-03-01
0969T CPT Removal Of Epicranial Neurostimulator System 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0951T CPT Totally Implantable Active Middle Ear Hearing Implant; Initial Placement, Includ… 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0901T CPT Placement Of Bone Marrow Sampling Port, Including Imaging Guidance When Performe… 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0872T CPT Replacement Of Indwelling Bladder And Peritoneal Catheters, Including Tunneling … 9 2 — — $5,348.14 $64,941.69 $59,084.21 2026-03-01
0910T CPT Removal Of Integrated Neurostimulation System, Vagus Nerve 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0908T CPT Open Implantation Of Integrated Neurostimulation System, Vagus Nerve, Including … 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0954T CPT Totally Implantable Active Middle Ear Hearing Implant; Replacement Of Sound Proc… 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0894T CPT Cannulation Of The Liver Allograft In Preparation For Connection To The Normothe… 9 2 — — $5,348.14 $64,941.69 $59,084.21 2026-03-01
0942T CPT Cystourethroscopy, Flexible; With Removal And Replacement Of Prostatic Urethral … 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0941T CPT Cystourethroscopy, Flexible; With Insertion And Expansion Of Prostatic Urethral … 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0968T CPT Insertion Or Replacement Of Epicranial Neurostimulator System, Including Electro… 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0953T CPT Totally Implantable Active Middle Ear Hearing Implant; Revision Or Replacement, … 8 2 — — $7,977.00 $64,941.69 $59,084.21 2026-03-01
0870T CPT Implantation Of Subcutaneous Peritoneal Ascites Pump System, Percutaneous, Inclu… 9 2 — — $5,348.14 $64,941.69 $59,084.21 2026-03-01
441570 CDM Crt Defib Card 51x73mm 28 12 $183,653.00 $183,653.00 $24,793.15 $183,653.00 $58,585.31 2026-03-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 61 25 — — $12,121.00 $196,941.64 $58,446.31 2026-03-01
957 OTHER $52,244.03 1 1 $208,064.61 — $58,282.19 $58,282.19 $58,282.19 2026-07-17
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 69 27 — — $42,110.74 $261,868.00 $57,612.00 2026-03-01
233 OTHER $42,037.00 1 1 $217,453.56 — $57,518.23 $57,518.23 $57,518.23 2026-07-17
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 62 25 — — $5,441.00 $193,433.52 $57,424.23 2026-03-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 19 8 — — $54,621.64 $68,277.05 $57,352.72 2026-03-01
425713 CDM Generator Nrstm 5 Ipg 28 12 $179,580.00 $179,580.00 $24,243.30 $179,580.00 $57,286.02 2026-03-01
1784 APR_DRG External Heart Assist Devices 14 7 — — $55,775.34 $69,719.17 $57,169.72 2026-03-01
J1412 HCPCS Injection, Valoctocogene Roxaparvovec-rvox, Per Ml, Containing Nominal 2 X 10°13… 9 2 — — $20,713.62 $70,179.08 $56,978.19 2026-03-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $56,824.55 $56,824.55 $56,824.55 2026-03-01
9273 OTHER Sipuleucel-t Auto Cd54+ 38 22 $122,527.67 — $53,316.03 $142,538.77 $56,580.28 2026-07-17
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 14 7 — — $54,927.36 $68,659.20 $56,300.54 2026-03-01
1581 OTHER New Technology - Level 44 38 22 $122,830.08 — $52,456.18 $141,689.05 $56,242.98 2026-07-17
1595 OTHER New Technology - Level 44 38 22 $122,830.08 — $52,456.18 $141,689.05 $56,242.98 2026-07-17
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 14 7 — — $54,864.24 $68,580.30 $56,235.85 2026-03-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 64 26 — — $44,036.77 $222,011.00 $56,171.50 2026-03-01
433230 CDM Assurity MRI Ppm 28 12 $175,945.00 $175,945.00 $23,752.58 $175,945.00 $56,126.46 2026-03-01
447 OTHER Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 1 1 — — $55,933.25 $55,933.25 $55,933.25 2026-03-01
6904 APR_DRG Acute Leukemia 14 7 — — $54,131.10 $67,663.88 $55,484.38 2026-03-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 67 26 — — $38,757.22 $187,578.19 $55,453.00 2026-03-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 63 27 — — $49,994.28 $206,254.63 $55,453.00 2026-03-01
434 APR_DRG Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies 14 7 — — $53,799.52 $67,249.40 $55,144.51 2026-03-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 14 7 — — $53,739.06 $67,173.82 $55,082.54 2026-03-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 69 27 — — $44,763.27 $201,515.99 $54,964.60 2026-03-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 62 25 — — $45,113.01 $254,970.23 $54,816.54 2026-03-01
010 OTHER $32,617.09 1 1 $54,304.89 — $54,769.78 $54,769.78 $54,769.78 2026-07-17
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 62 25 — — $9,825.00 $184,012.40 $54,679.40 2026-03-01
019 OTHER $55,639.81 1 1 $200,318.16 — $54,456.21 $54,456.21 $54,456.21 2026-07-17
217 OTHER $42,037.00 1 1 $269,104.00 — $54,409.46 $54,409.46 $54,409.46 2026-07-17
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $54,404.11 $54,404.11 $54,404.11 2026-03-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 67 26 — — $38,565.16 $317,198.00 $54,187.43 2026-03-01
28 MS_DRG Spinal Procedures With Mcc 62 25 — — $35,407.00 $180,615.51 $53,689.73 2026-03-01
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 14 7 — — $52,116.12 $65,145.15 $53,419.03 2026-03-01
245 MS_DRG Aicd Generator Procedures 64 26 — — $38,213.03 $137,150.31 $53,330.12 2026-03-01
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