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

CHILDRENS MEDICAL CENTER PLANO

Plano, TX · CCN 453316 · Rates published

12,485 distinct procedures filed
39 distinct payers
853,678 rate rows
2026-08-17 last MRF observed
Data quality

852,671 of 853,678 rate rows are consumer-grade (99.9%)

1,007 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
percent-of-charges filed in the dollar field — excluded from medians 930
placeholder amount (≤ $0.02) — excluded from medians 56
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 8
exceeds 10× this hospital's gross charge — excluded from medians 8
per-diem day rate — not a per-procedure price 4
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://assets.childrens.com/m/31582224fcdaa2ad/original/Price-Transparency-CSV-Cost-Estimates.csv
Found on page https://www.childrens.com/patient-families/billing-and-insurance/cost-estimates
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-11-12
Content fingerprint d521669fd10419c6… · 278,235,106 bytes · first seen 2026-10-30

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
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 4 $3,500,000.00 $3,500,000.00 $3,500,000.00 nat. median
$3,710,000
0.9× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 4 $3,100,000.00 $3,100,000.00 $3,100,000.00 nat. median
$3,286,000
0.9× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 4 $2,800,000.00 $2,800,000.00 $2,800,000.00 nat. median
$2,983,626
0.9× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 4 $2,200,000.00 $2,200,000.00 $2,200,000.00 nat. median
$2,401,960
0.9× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 5 $2,125,000.00 $2,368,485.25 $2,125,000.00 nat. median
$2,467,989
0.9× median
5834
APR_DRG 		Neonate With Ecmo 9 $952,201.22 $1,095,031.40 $1,061,704.36 nat. median
$309,665
outlier · 3.4×
74
APR_DRG 		Allogeneic Bone Marrow Transplant 13 $118,800.00 $1,157,877.78 $926,302.22 nat. median
$171,358
outlier · 5.4×
5833
APR_DRG 		Neonate With Ecmo 9 $806,289.00 $927,232.35 $899,012.24 nat. median
$244,017
outlier · 3.7×
24
APR_DRG 		Heart And/or Lung Transplant 14 $77,000.00 $969,533.98 $798,896.00 nat. median
$243,231
outlier · 3.3×
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 9 $602,727.75 $753,409.69 $675,055.08 nat. median
$249,123
outlier · 2.7×
1614
APR_DRG 		Implantable Heart Assist Systems 9 $585,289.99 $673,083.49 $652,598.34 nat. median
$202,660
outlier · 3.2×
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 9 $548,324.56 $685,405.70 $614,123.51 nat. median
$165,169
outlier · 3.7×
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 5 $511,072.00 $591,726.20 $591,726.20 nat. median
$739,658
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 4 $557,317.93 $557,317.93 $557,317.93 nat. median
$621,967
0.9× median
Q2024
HCPCS 		Non Risk Drugs - Q2024 With Mod U1 1 $511,072.00 $511,072.00 $511,072.00 nat. median
$58
outlier · 8842.1×
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 9 $444,495.38 $511,169.69 $500,057.31 nat. median
$165,846
outlier · 3.0×
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 9 $448,469.62 $515,740.06 $500,043.62 nat. median
$154,211
outlier · 3.2×
J3398
HCPCS 		Inj Luxturna 1 Billion Vec G 5 $2,890.00 $456,875.00 $456,875.00 nat. median
$3,383
outlier · 135.1×
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $449,440.00 $449,440.00 $449,440.00 nat. median
$607,251
0.7× median
5832
APR_DRG 		Neonate With Ecmo 9 $401,755.39 $462,018.70 $447,957.26 nat. median
$159,829
outlier · 2.8×
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 9 $381,493.05 $438,717.01 $425,364.76 nat. median
$122,909
outlier · 3.5×
2004
APR_DRG 		Cardiac Structural And Valvular Disorders 9 $354,512.10 $407,688.92 $395,280.99 nat. median
$28,745
outlier · 13.8×
5831
APR_DRG 		Neonate With Ecmo 9 $353,753.61 $406,816.65 $394,435.28 nat. median
$148,245
outlier · 2.7×
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 9 $321,093.40 $401,366.75 $362,835.54 nat. median
$122,016
outlier · 3.0×
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 9 $323,403.97 $371,914.57 $360,595.43 nat. median
$177,531
outlier · 2.0×
5882
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 9 $321,925.86 $370,214.74 $358,947.33 nat. median
$145,336
outlier · 2.5×
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 9 $319,713.07 $367,670.03 $356,480.08 nat. median
$160,390
outlier · 2.2×
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 9 $316,519.89 $395,649.86 $354,502.28 nat. median
$138,094
outlier · 2.6×
8504
APR_DRG 		Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 9 $308,181.51 $354,408.74 $343,622.39 nat. median
$67,082
outlier · 5.1×
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 9 $305,420.86 $351,233.99 $340,544.26 nat. median
$165,334
outlier · 2.1×
1613
APR_DRG 		Implantable Heart Assist Systems 9 $305,061.04 $350,820.20 $340,143.05 nat. median
$121,888
outlier · 2.8×
5881
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 9 $303,448.78 $348,966.10 $338,345.39 nat. median
$122,978
outlier · 2.8×
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 9 $271,661.14 $312,410.31 $305,618.79 nat. median
$99,544
outlier · 3.1×
6814
APR_DRG 		Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 9 $271,812.84 $312,584.77 $303,071.32 nat. median
$68,030
outlier · 4.5×
93
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 9 $269,390.69 $309,799.29 $300,370.62 nat. median
$79,816
outlier · 3.8×
2464
APR_DRG 		Gastrointestinal Vascular Insufficiency 9 $263,435.60 $302,950.94 $293,730.70 nat. median
$20,493
outlier · 14.3×
6034
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 9 $262,076.58 $301,388.07 $292,215.39 nat. median
$107,562
outlier · 2.7×
64
APR_DRG 		Pancreas Transplant 9 $254,337.47 $292,488.09 $283,586.28 nat. median
$92,076
outlier · 3.1×
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 9 $254,317.41 $292,465.02 $283,563.92 nat. median
$95,269
outlier · 3.0×
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 9 $253,556.42 $291,589.88 $282,715.41 nat. median
$152,569
1.9× median
14
APR_DRG 		Liver Transplant And/or Intestinal Transplant 14 $97,500.00 $347,303.94 $277,843.15 nat. median
$137,215
outlier · 2.0×
5892
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 9 $246,485.53 $283,458.36 $274,831.36 nat. median
$90,073
outlier · 3.1×
1624
APR_DRG 		Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 9 $236,978.70 $272,525.51 $264,231.25 nat. median
$80,771
outlier · 3.3×
6024
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 9 $233,089.72 $291,362.15 $261,060.49 nat. median
$119,800
outlier · 2.2×
5893
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 9 $231,197.88 $265,877.56 $257,785.64 nat. median
$71,594
outlier · 3.6×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 5 $94,500.00 $250,680.43 $250,680.43 nat. median
$247,805
1.0× median
J3403
HCPCS 		Revakinagene, Per Implant 4 $250,000.00 $250,000.00 $250,000.00 nat. median
$265,000
0.9× median
73
APR_DRG 		Allogeneic Bone Marrow Transplant 13 $118,800.00 $375,885.17 $248,428.33 nat. median
$89,273
outlier · 2.8×
6214
APR_DRG 		Neonate Birth Weight 2000-2499 Grams With Major Anomaly 9 $221,345.03 $276,681.29 $247,906.43 nat. median
$68,185
outlier · 3.6×
1612
APR_DRG 		Implantable Heart Assist Systems 9 $219,291.46 $252,185.18 $244,509.98 nat. median
$85,665
outlier · 2.9×

Other procedures at this hospital

Browse this hospital's 12,485 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
             
0N80 LOCAL 2500 And Greater Grams - O.r. Performed 8 4 — — $91,535.45 $91,535.45 $91,535.45 2026-08-17
0812 RC Acquisition Of Body Components-cadaver Donor 179 39 $228,087.00 $171,065.25 25% off $42,797.94 $221,244.39 $152,818.29 2026-08-17
0811 RC Acquisition Of Body Components-living Donor 179 39 $173,955.00 $130,466.25 25% off $31,897.06 $168,736.35 $116,549.85 2026-08-17
1934 APR_DRG Acute And Subacute Endocarditis 16 9 — — $67,857.93 $78,036.62 $75,661.59 2026-08-17
6904 APR_DRG Acute Leukemia 16 9 — — $178,469.64 $205,240.09 $198,993.65 2026-08-17
6903 APR_DRG Acute Leukemia 17 9 — — $78,552.02 $98,190.03 $87,978.26 2026-08-17
6902 APR_DRG Acute Leukemia 16 9 — — $67,120.75 $77,188.86 $74,839.64 2026-08-17
4013 APR_DRG Adrenal Procedures 16 9 — — $86,976.90 $100,023.44 $96,979.24 2026-08-17
4014 APR_DRG Adrenal Procedures 16 9 — — $77,778.48 $89,445.25 $86,723.01 2026-08-17
4012 APR_DRG Adrenal Procedures 16 9 — — $74,117.67 $85,235.32 $82,641.20 2026-08-17
74 APR_DRG Allogeneic Bone Marrow Transplant 33 13 — — $118,800.00 $1,157,877.78 $926,302.22 2026-08-17
73 APR_DRG Allogeneic Bone Marrow Transplant 32 13 — — $118,800.00 $375,885.17 $248,428.33 2026-08-17
72 APR_DRG Allogeneic Bone Marrow Transplant 32 13 — — $118,800.00 $252,552.82 $194,805.58 2026-08-17
71 APR_DRG Allogeneic Bone Marrow Transplant 32 13 — — $118,800.00 $170,000.00 $146,367.75 2026-08-17
14 MS_DRG Allogeneic Bone Marrow Transplant 9 5 — — $123,536.85 $123,536.85 $123,536.85 2026-08-17
3054 APR_DRG Amputation Of Lower Limb Except Toes 16 9 — — $68,402.04 $78,662.35 $76,268.27 2026-08-17
2264 APR_DRG Anal Procedures 16 9 — — $69,046.44 $79,403.41 $76,986.78 2026-08-17
594 APR_DRG Anoxic And Other Severe Brain Damage 16 9 — — $69,396.22 $79,805.65 $77,376.79 2026-08-17
2334 APR_DRG Appendectomy With Complex Principal Diagnosis 16 9 — — $85,987.73 $98,885.89 $95,876.32 2026-08-17
84 APR_DRG Autologous Bone Marrow Transplant Or T-cell Immunotherapy 34 14 — — $50,000.00 $318,239.34 $192,400.00 2026-08-17
83 APR_DRG Autologous Bone Marrow Transplant Or T-cell Immunotherapy 34 14 — — $50,000.00 $215,106.04 $187,048.73 2026-08-17
82 APR_DRG Autologous Bone Marrow Transplant Or T-cell Immunotherapy 34 14 — — $50,000.00 $192,400.00 $109,053.10 2026-08-17
81 APR_DRG Autologous Bone Marrow Transplant Or T-cell Immunotherapy 34 14 — — $50,000.00 $192,400.00 $93,784.95 2026-08-17
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 2 1 — — $449,440.00 $449,440.00 $449,440.00 2026-08-17
494 APR_DRG Bacterial And Tuberculous Infections Of Nervous System 16 9 — — $79,331.82 $91,231.59 $88,454.98 2026-08-17
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 16 9 — — $109,067.15 $125,427.22 $121,609.88 2026-08-17
J9118 HCPCS CALaspargase Pegol-mknl 750 unit/mL Soln 5 Ml Vial 109 39 $109,458.13 $82,093.60 25% off $50.01 $115,384.38 $76,620.69 2026-08-17
2004 APR_DRG Cardiac Structural And Valvular Disorders 16 9 — — $354,512.10 $407,688.92 $395,280.99 2026-08-17
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 16 9 — — $236,978.70 $272,525.51 $264,231.25 2026-08-17
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 16 9 — — $133,335.08 $153,335.34 $148,668.61 2026-08-17
1622 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 16 9 — — $99,562.82 $114,497.24 $111,012.54 2026-08-17
1621 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 16 9 — — $88,340.93 $101,592.07 $98,500.13 2026-08-17
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 16 9 — — $141,237.17 $162,422.75 $157,479.45 2026-08-17
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 16 9 — — $94,590.64 $108,779.24 $105,468.57 2026-08-17
1632 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 16 9 — — $70,026.83 $80,530.85 $78,079.92 2026-08-17
2054 APR_DRG Cardiomyopathy 16 9 — — $138,499.08 $159,273.94 $154,426.48 2026-08-17
3214 APR_DRG Cervical Spinal Fusion And Other Back Or Neck Procedures Except Disc Excision Or… 16 9 — — $75,620.86 $86,963.99 $84,317.26 2026-08-17
6954 APR_DRG Chemotherapy For Acute Leukemia 16 9 — — $138,321.05 $159,069.21 $155,611.18 2026-08-17
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 16 9 — — $381,493.05 $438,717.01 $425,364.76 2026-08-17
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 16 9 — — $216,784.05 $249,301.66 $241,714.22 2026-08-17
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 16 9 — — $150,651.22 $173,248.90 $167,976.11 2026-08-17
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 16 9 — — $85,674.30 $98,525.45 $95,526.85 2026-08-17
2634 APR_DRG Cholecystectomy 16 9 — — $69,248.29 $79,635.53 $77,211.84 2026-08-17
6614 APR_DRG Coagulation And Platelet Disorders 16 9 — — $93,546.30 $107,578.25 $104,304.12 2026-08-17
6613 APR_DRG Coagulation And Platelet Disorders 16 9 — — $76,697.79 $88,202.46 $85,518.04 2026-08-17
3464 APR_DRG Connective Tissue Disorders 16 9 — — $84,177.38 $96,803.99 $93,857.78 2026-08-17
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 16 9 — — $122,155.81 $140,479.18 $136,203.73 2026-08-17
1653 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 16 9 — — $80,314.72 $92,361.93 $89,550.92 2026-08-17
1652 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 16 9 — — $66,239.40 $76,175.31 $73,856.93 2026-08-17
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 16 9 — — $94,403.84 $108,564.42 $105,260.28 2026-08-17
1663 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 16 9 — — $67,127.02 $77,196.07 $74,846.62 2026-08-17
J0802 HCPCS Corticotropin 80 unit/mL Gel 5 Ml Vial 109 39 $289,245.74 $216,934.31 25% off $3,534.60 $293,872.36 $202,472.02 2026-08-17
9104 APR_DRG Craniotomy For Multiple Significant Trauma 16 9 — — $152,612.01 $175,503.81 $170,162.39 2026-08-17
1794 APR_DRG Defibrillator Implants 16 9 — — $90,355.63 $103,908.97 $100,746.53 2026-08-17
1793 APR_DRG Defibrillator Implants 16 9 — — $69,283.39 $79,675.90 $77,250.98 2026-08-17
2824 APR_DRG Disorders Of Pancreas Except Malignancy 17 9 — — $69,665.77 $87,082.21 $78,025.66 2026-08-17
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 16 9 — — $138,891.49 $159,725.21 $154,864.01 2026-08-17
3043 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 16 9 — — $86,968.12 $100,013.34 $96,969.45 2026-08-17
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 16 9 — — $167,188.82 $192,267.14 $186,415.54 2026-08-17
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 16 9 — — $141,435.25 $162,650.54 $157,700.30 2026-08-17
3032 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 16 9 — — $102,618.10 $118,010.82 $114,419.18 2026-08-17
3031 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 16 9 — — $75,595.78 $86,935.15 $84,289.30 2026-08-17
7594 APR_DRG Eating Disorders 17 9 — — $69,447.62 $86,809.53 $77,781.33 2026-08-17
3 MS_DRG Ecmo Or Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mo… 8 4 — — $144,767.20 $144,767.20 $144,767.20 2026-08-17
J9210 HCPCS Emapalumab-lzsg 5 mg/mL Soln 10 Ml Vial 109 39 $115,945.67 $86,959.26 25% off $384.85 $116,869.54 $80,724.32 2026-08-17
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 16 9 — — $129,294.39 $148,688.55 $144,163.24 2026-08-17
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 17 9 — — $148,081.13 $185,101.41 $165,850.87 2026-08-17
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 16 9 — — $138,925.34 $159,764.14 $154,901.76 2026-08-17
7923 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 16 9 — — $72,440.21 $83,306.24 $80,770.83 2026-08-17
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 16 9 — — $319,713.07 $367,670.03 $356,480.08 2026-08-17
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 16 9 — — $138,179.38 $158,906.29 $154,070.01 2026-08-17
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 16 9 — — $89,793.97 $103,263.07 $100,120.28 2026-08-17
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 16 9 — — $89,095.66 $102,460.01 $99,341.66 2026-08-17
1784 APR_DRG External Heart Assist Systems 16 9 — — $183,890.65 $211,474.25 $205,038.08 2026-08-17
1783 APR_DRG External Heart Assist Systems 16 9 — — $117,680.09 $135,332.10 $131,213.30 2026-08-17
1782 APR_DRG External Heart Assist Systems 16 9 — — $101,000.82 $116,150.94 $112,615.92 2026-08-17
1781 APR_DRG External Heart Assist Systems 16 9 — — $92,585.97 $106,473.87 $103,233.36 2026-08-17
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 17 9 — — $548,324.56 $685,405.70 $614,123.51 2026-08-17
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 16 9 — — $269,390.69 $309,799.29 $300,370.62 2026-08-17
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 16 9 — — $177,177.07 $203,753.63 $197,552.43 2026-08-17
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 16 9 — — $171,826.26 $197,600.20 $191,586.28 2026-08-17
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 8 4 — — $74,752.09 $74,752.09 $74,752.09 2026-08-17
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 16 9 — — $95,647.51 $109,994.64 $106,646.98 2026-08-17
923 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 16 9 — — $92,254.99 $106,093.24 $102,864.32 2026-08-17
5144 APR_DRG Female Reproductive System Reconstructive Procedures 16 9 — — $74,584.05 $85,771.66 $83,161.22 2026-08-17
2464 APR_DRG Gastrointestinal Vascular Insufficiency 16 9 — — $263,435.60 $302,950.94 $293,730.70 2026-08-17
C9293 HCPCS Glucarpidase 1,000 unit/mL Solr 1 Each Vial 54 39 $276,024.47 $207,018.36 25% off $55,066.88 $267,743.74 $184,936.39 2026-01-27
3164 APR_DRG Hand And Wrist Procedures 16 9 — — $66,839.92 $76,865.91 $74,526.51 2026-08-17
24 APR_DRG Heart And/or Lung Transplant 27 14 — — $77,000.00 $969,533.98 $798,896.00 2026-08-17
23 APR_DRG Heart And/or Lung Transplant 26 14 — — $77,000.00 $219,692.27 $191,036.76 2026-08-17
22 APR_DRG Heart And/or Lung Transplant 26 14 — — $77,000.00 $176,485.65 $158,069.75 2026-08-17
21 APR_DRG Heart And/or Lung Transplant 26 14 — — $77,000.00 $160,000.00 $126,880.00 2026-08-17
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 10 5 — — $94,500.00 $250,680.43 $250,680.43 2026-08-17
8104 APR_DRG Hemorrhage Or Hematoma Due To Complication 16 9 — — $80,283.38 $92,325.89 $89,515.97 2026-08-17
2274 APR_DRG Hernia Procedures Except Inguinal, Femoral And Umbilical 16 9 — — $109,572.39 $126,008.25 $122,173.21 2026-08-17
3084 APR_DRG Hip And Femur Fracture Repair 16 9 — — $75,158.24 $86,431.98 $83,801.44 2026-08-17
J9226 HCPCS Histrelin (supprelin La) 50 Mg (65 Mcg/day) Kit 1 Each Kit 109 39 $292,062.03 $219,046.53 25% off $45,020.65 $297,903.01 $204,443.42 2026-08-17
Q2055 HCPCS Idecabtagene Vicleucel Car 4 4 — — $557,317.93 $557,317.93 $557,317.93 2026-01-27
1614 APR_DRG Implantable Heart Assist Systems 16 9 — — $585,289.99 $673,083.49 $652,598.34 2026-08-17
1613 APR_DRG Implantable Heart Assist Systems 16 9 — — $305,061.04 $350,820.20 $340,143.05 2026-08-17
1612 APR_DRG Implantable Heart Assist Systems 16 9 — — $219,291.46 $252,185.18 $244,509.98 2026-08-17
1611 APR_DRG Implantable Heart Assist Systems 16 9 — — $207,978.04 $239,174.75 $231,895.51 2026-08-17
J1823 HCPCS Inebilizumab-cdon 10 mg/mL Soln 10 Ml Vial 109 39 $298,473.81 $223,855.36 25% off $495.55 $304,132.03 $208,931.67 2026-08-17
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 17 9 — — $100,829.06 $126,036.33 $112,928.55 2026-08-17
2454 APR_DRG Inflammatory Bowel Disease 16 9 — — $71,561.37 $82,295.58 $79,790.92 2026-08-17
J3398 HCPCS Inj Luxturna 1 Billion Vec G 6 5 — — $2,890.00 $456,875.00 $456,875.00 2026-08-17
J3399 HCPCS Inj Onase Abepar-xioi Treat 6 5 — — $2,125,000.00 $2,368,485.25 $2,125,000.00 2026-08-17
J1414 HCPCS Inj, Beqvez, Per Tx Dose 4 4 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2026-01-27
J3393 HCPCS Inj, Betibeglogene Autotemce 4 4 — — $2,800,000.00 $2,800,000.00 $2,800,000.00 2026-01-27
J3392 HCPCS Inj, Exagamglogene Autotem 4 4 — — $2,200,000.00 $2,200,000.00 $2,200,000.00 2026-01-27
J3394 HCPCS Inj, Lovotibeglogene Autotem 4 4 — — $3,100,000.00 $3,100,000.00 $3,100,000.00 2026-01-27
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 4 4 — — $205,640.00 $205,640.00 $205,640.00 2026-01-27
33270 CPT Ins/Rplcmnt Perm Subq Impltbl Dfb W/Subq Eltrd 111 39 $163,106.00 $122,329.50 25% off $472.07 $158,212.82 $109,281.02 2026-08-17
1764 APR_DRG Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 16 9 — — $91,710.88 $105,467.51 $102,257.64 2026-08-17
3104 APR_DRG Intervertebral Disc Excision And Decompression 16 9 — — $86,046.65 $98,953.65 $95,942.01 2026-08-17
4424 APR_DRG Kidney And Urinary Tract Procedures For Malignancy 16 9 — — $131,292.79 $150,986.71 $146,391.46 2026-08-17
4434 APR_DRG Kidney And Urinary Tract Procedures For Non-malignancy 16 9 — — $83,279.73 $95,771.69 $92,856.90 2026-08-17
4404 APR_DRG Kidney Transplant 30 14 — — $38,000.00 $238,583.63 $207,464.03 2026-08-17
4403 APR_DRG Kidney Transplant 30 14 — — $38,000.00 $155,740.00 $126,977.55 2026-08-17
4402 APR_DRG Kidney Transplant 30 14 — — $38,000.00 $155,740.00 $81,669.97 2026-08-17
4401 APR_DRG Kidney Transplant 30 14 — — $38,000.00 $155,740.00 $76,556.12 2026-08-17
3134 APR_DRG Knee And Lower Leg Procedures Except Foot 16 9 — — $82,358.26 $94,712.00 $91,829.46 2026-08-17
0N24 LOCAL Less Than 1000 Grams - Discharged Alive 8 4 — — $97,622.32 $97,622.32 $97,622.32 2026-08-17
0N14 LOCAL Less Than 750 Grams - Discharged Alive 8 4 — — $128,683.02 $128,683.02 $128,683.02 2026-08-17
J1951 HCPCS Leuprolide 45 Mg Syrg 1 Each Syringe 109 39 $175,221.56 $131,416.17 25% off $140.99 $181,480.61 $122,655.09 2026-08-17
14 APR_DRG Liver Transplant And/or Intestinal Transplant 31 14 — — $97,500.00 $347,303.94 $277,843.15 2026-08-17
13 APR_DRG Liver Transplant And/or Intestinal Transplant 30 14 — — $97,500.00 $164,624.31 $143,151.57 2026-08-17
12 APR_DRG Liver Transplant And/or Intestinal Transplant 30 14 — — $97,500.00 $130,875.00 $119,984.67 2026-08-17
11 APR_DRG Liver Transplant And/or Intestinal Transplant 30 14 — — $97,500.00 $130,875.00 $116,482.92 2026-08-17
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 8 4 — — $141,625.29 $141,625.29 $141,625.29 2026-08-17
1814 APR_DRG Lower Extremity Arterial Procedures 16 9 — — $109,908.38 $126,394.64 $122,547.85 2026-08-17
6944 APR_DRG Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior 16 9 — — $96,818.47 $111,341.24 $107,952.60 2026-08-17
6914 APR_DRG Lymphoma, Myeloma And Non-acute Leukemia 16 9 — — $97,808.89 $112,480.22 $109,056.92 2026-08-17
1694 APR_DRG Major Abdominal Vascular Procedures 16 9 — — $126,537.50 $145,518.13 $141,089.32 2026-08-17
2614 APR_DRG Major Biliary Tract Procedures 16 9 — — $104,600.20 $120,290.23 $116,629.22 2026-08-17
2613 APR_DRG Major Biliary Tract Procedures 16 9 — — $69,140.47 $79,511.54 $77,091.62 2026-08-17
4414 APR_DRG Major Bladder Procedures 16 9 — — $196,336.16 $225,786.58 $218,914.82 2026-08-17
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 16 9 — — $271,661.14 $312,410.31 $305,618.79 2026-08-17
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 16 9 — — $114,801.58 $132,021.82 $128,003.76 2026-08-17
1602 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 16 9 — — $79,766.85 $91,731.88 $88,940.04 2026-08-17
894 APR_DRG Major Cranial Or Facial Bone Procedures 16 9 — — $124,198.09 $142,827.80 $138,480.87 2026-08-17
893 APR_DRG Major Cranial Or Facial Bone Procedures 16 9 — — $66,096.48 $76,010.95 $73,697.57 2026-08-17
6604 APR_DRG Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula… 17 9 — — $109,212.58 $136,515.73 $122,318.09 2026-08-17
2314 APR_DRG Major Large Bowel Procedures 16 9 — — $80,399.97 $92,459.97 $89,645.97 2026-08-17
4804 APR_DRG Major Male Pelvic Procedures 16 9 — — $85,185.36 $97,963.16 $94,981.68 2026-08-17
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 16 9 — — $201,119.04 $231,286.90 $224,247.73 2026-08-17
6803 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 16 9 — — $73,572.31 $84,608.16 $82,033.12 2026-08-17
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 16 9 — — $119,074.20 $136,935.33 $132,767.73 2026-08-17
1204 APR_DRG Major Respiratory And Chest Procedures 16 9 — — $126,023.48 $144,927.00 $140,516.18 2026-08-17
3814 APR_DRG Major Skin Disorders 16 9 — — $66,938.96 $76,979.80 $74,636.95 2026-08-17
2304 APR_DRG Major Small Bowel Procedures 17 9 — — $132,538.97 $165,673.71 $148,443.65 2026-08-17
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 16 9 — — $156,687.80 $180,190.97 $174,706.90 2026-08-17
7404 APR_DRG Mental Illness Diagnosis With O.r. Procedure 16 9 — — $87,304.12 $100,399.74 $97,344.09 2026-08-17
9514 APR_DRG Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 16 9 — — $103,270.02 $118,760.52 $115,146.07 2026-08-17
7934 APR_DRG Moderately Extensive O.r. Procedures For Other Complications Of Treatment 16 9 — — $75,645.93 $86,992.82 $84,345.21 2026-08-17
434 APR_DRG Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies 16 9 — — $177,376.41 $203,982.87 $197,774.70 2026-08-17
433 APR_DRG Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies 16 9 — — $73,819.29 $84,892.18 $82,308.51 2026-08-17
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 16 9 — — $124,033.85 $142,638.93 $138,297.74 2026-08-17
8634 APR_DRG Neonatal Aftercare 16 9 — — $213,421.62 $245,434.86 $237,965.10 2026-08-17
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 16 9 — — $262,076.58 $301,388.07 $292,215.39 2026-08-17
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 16 9 — — $99,943.95 $114,935.54 $111,437.50 2026-08-17
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 16 9 — — $80,056.46 $92,064.93 $89,262.96 2026-08-17
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 17 9 — — $233,089.72 $291,362.15 $261,060.49 2026-08-17
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 16 9 — — $150,644.95 $173,241.69 $167,969.11 2026-08-17
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 16 9 — — $113,819.93 $130,892.92 $126,909.22 2026-08-17
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 16 9 — — $200,548.60 $230,630.89 $223,611.69 2026-08-17
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 16 9 — — $79,482.26 $91,404.60 $88,622.72 2026-08-17
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 16 9 — — $164,430.67 $189,095.27 $183,340.20 2026-08-17
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 16 9 — — $104,226.60 $119,860.59 $116,212.66 2026-08-17
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 16 9 — — $74,986.48 $86,234.45 $83,609.93 2026-08-17
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 16 9 — — $155,834.03 $179,209.13 $173,754.94 2026-08-17
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 16 9 — — $180,886.78 $208,019.80 $201,688.76 2026-08-17
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 16 9 — — $70,845.50 $81,472.33 $78,992.74 2026-08-17
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 16 9 — — $133,562.00 $153,596.30 $148,921.63 2026-08-17
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 16 9 — — $115,901.08 $133,286.24 $129,229.71 2026-08-17
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 16 9 — — $67,738.83 $77,899.65 $75,528.80 2026-08-17
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 16 9 — — $444,495.38 $511,169.69 $500,057.31 2026-08-17
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 16 9 — — $142,982.32 $164,429.67 $159,425.29 2026-08-17
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 16 9 — — $109,190.01 $125,568.51 $121,746.86 2026-08-17
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 17 9 — — $221,345.03 $276,681.29 $247,906.43 2026-08-17
6213 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 16 9 — — $66,179.22 $76,106.10 $73,789.83 2026-08-17
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 16 9 — — $116,235.82 $133,671.19 $129,602.94 2026-08-17
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 16 9 — — $305,420.86 $351,233.99 $340,544.26 2026-08-17
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 16 9 — — $201,119.04 $231,286.90 $224,247.73 2026-08-17
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 16 9 — — $166,055.47 $190,963.79 $185,151.85 2026-08-17
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 16 9 — — $119,727.38 $137,686.49 $133,496.03 2026-08-17
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 16 9 — — $253,556.42 $291,589.88 $282,715.41 2026-08-17
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 16 9 — — $181,094.89 $208,259.12 $201,920.80 2026-08-17
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 16 9 — — $142,278.99 $163,620.84 $158,641.08 2026-08-17
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 17 9 — — $602,727.75 $753,409.69 $675,055.08 2026-08-17
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 16 9 — — $323,403.97 $371,914.57 $360,595.43 2026-08-17
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 16 9 — — $321,925.86 $370,214.74 $358,947.33 2026-08-17
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 16 9 — — $303,448.78 $348,966.10 $338,345.39 2026-08-17
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 16 9 — — $254,317.41 $292,465.02 $283,563.92 2026-08-17
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 16 9 — — $246,485.53 $283,458.36 $274,831.36 2026-08-17
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 16 9 — — $231,197.88 $265,877.56 $257,785.64 2026-08-17
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 17 9 — — $168,214.35 $210,267.94 $188,400.07 2026-08-17
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 16 9 — — $448,469.62 $515,740.06 $500,043.62 2026-08-17
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 16 9 — — $211,371.82 $243,077.59 $235,679.58 2026-08-17
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 16 9 — — $76,297.86 $87,742.54 $85,072.11 2026-08-17
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 17 9 — — $316,519.89 $395,649.86 $354,502.28 2026-08-17
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 16 9 — — $117,182.37 $134,759.73 $130,658.34 2026-08-17
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 16 9 — — $85,547.68 $98,379.83 $95,385.66 2026-08-17
5834 APR_DRG Neonate With Ecmo 16 9 — — $952,201.22 $1,095,031.40 $1,061,704.36 2026-08-17
5833 APR_DRG Neonate With Ecmo 16 9 — — $806,289.00 $927,232.35 $899,012.24 2026-08-17
5832 APR_DRG Neonate With Ecmo 16 9 — — $401,755.39 $462,018.70 $447,957.26 2026-08-17
5831 APR_DRG Neonate With Ecmo 16 9 — — $353,753.61 $406,816.65 $394,435.28 2026-08-17
4624 APR_DRG Nephritis And Nephrosis 16 9 — — $69,507.80 $79,933.97 $77,501.20 2026-08-17
Q2024 HCPCS Non Risk Drugs - Q2024 With Mod U1 2 1 — — $511,072.00 $511,072.00 $511,072.00 2026-08-17
504 APR_DRG Non-bacterial Infections Of Nervous System Except Viral Meningitis 16 9 — — $101,581.29 $116,818.48 $113,263.13 2026-08-17
3254 APR_DRG Non-elective Or Complex Knee Joint Replacement 16 9 — — $77,615.50 $89,257.83 $86,541.29 2026-08-17
9524 APR_DRG Non-extensive O.r. Procedure Unrelated To Principal Diagnosis 17 9 — — $130,486.66 $163,108.33 $146,145.06 2026-08-17
J2350 HCPCS Ocrelizumab 30 mg/mL Soln 10 Ml Vial 110 39 $131,796.88 $98,847.66 25% off $59.41 $136,764.35 $92,656.99 2026-08-17
J2351 HCPCS Ocrelizumab-hyaluronidase-ocsq 920 Mg-23,000 Unit/23 Ml Soln 23 Ml Vial 55 38 $281,963.35 $211,472.52 25% off $47.23 $273,504.45 $188,915.45 2026-08-17
214 APR_DRG Open Craniotomy Except Trauma 17 9 — — $133,019.14 $166,273.93 $148,981.44 2026-08-17
213 APR_DRG Open Craniotomy Except Trauma 16 9 — — $76,129.86 $87,549.34 $85,646.09 2026-08-17
204 APR_DRG Open Craniotomy For Trauma 17 9 — — $111,738.79 $139,673.49 $125,147.44 2026-08-17
203 APR_DRG Open Craniotomy For Trauma 16 9 — — $70,249.99 $80,787.49 $78,328.74 2026-08-17
244 APR_DRG Open Extracranial Vascular Procedures 16 9 — — $75,466.65 $86,786.65 $84,145.32 2026-08-17
734 APR_DRG Orbit And Eye Procedures 16 9 — — $83,008.93 $95,460.27 $92,554.96 2026-08-17
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 16 9 — — $271,812.84 $312,584.77 $303,071.32 2026-08-17
6813 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 16 9 — — $72,163.14 $82,987.61 $80,461.90 2026-08-17
4454 APR_DRG Other Bladder Procedures 16 9 — — $67,689.93 $77,843.42 $75,474.27 2026-08-17
1674 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 16 9 — — $180,086.91 $207,099.95 $202,597.77 2026-08-17
1673 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 16 9 — — $78,226.05 $89,959.96 $87,222.05 2026-08-17
2074 APR_DRG Other Circulatory System Diagnoses 16 9 — — $68,448.42 $78,715.68 $76,319.99 2026-08-17
1804 APR_DRG Other Circulatory System Procedures 16 9 — — $83,238.36 $95,724.11 $92,810.77 2026-08-17
1801 APR_DRG Other Circulatory System Procedures 16 9 — — $75,411.49 $86,723.21 $84,083.81 2026-08-17
2294 APR_DRG Other Digestive System And Abdominal Procedures 16 9 — — $65,937.26 $75,827.85 $73,520.04 2026-08-17
984 APR_DRG Other Ear, Nose, Mouth And Throat Procedures 17 9 — — $80,707.13 $100,883.91 $90,391.99 2026-08-17
5184 APR_DRG Other Female Reproductive System And Related Procedures 16 9 — — $65,984.90 $75,882.64 $73,573.17 2026-08-17
2644 APR_DRG Other Hepatobiliary, Pancreas And Abdominal Procedures 16 9 — — $88,626.77 $101,920.79 $98,818.85 2026-08-17
8154 APR_DRG Other Injury, Poisoning And Toxic Effect Diagnoses 16 9 — — $81,624.84 $93,868.57 $91,011.70 2026-08-17
4684 APR_DRG Other Kidney And Urinary Tract Diagnoses, Signs And Symptoms 16 9 — — $82,590.19 $94,978.72 $92,088.06 2026-08-17
4474 APR_DRG Other Kidney, Urinary Tract And Related Procedures 16 9 — — $155,469.20 $178,789.58 $173,348.15 2026-08-17
914 APR_DRG Other Major Head And Neck Procedures 16 9 — — $112,890.94 $129,824.58 $125,873.40 2026-08-17
913 APR_DRG Other Major Head And Neck Procedures 16 9 — — $80,997.99 $93,147.69 $90,312.76 2026-08-17
4844 APR_DRG Other Male Reproductive System And Related Procedures 16 9 — — $79,546.20 $91,478.13 $88,694.01 2026-08-17
264 APR_DRG Other Nervous System And Related Procedures 16 9 — — $142,895.81 $164,330.18 $159,328.83 2026-08-17
274 APR_DRG Other Open Craniotomy 16 9 — — $76,606.27 $88,097.21 $85,415.99 2026-08-17
273 APR_DRG Other Open Craniotomy 16 9 — — $69,468.94 $79,889.28 $77,457.87 2026-08-17
294 APR_DRG Other Percutaneous Intracranial Procedures 16 9 — — $83,175.67 $95,652.02 $92,740.87 2026-08-17
293 APR_DRG Other Percutaneous Intracranial Procedures 16 9 — — $73,300.25 $84,295.29 $81,729.78 2026-08-17
1824 APR_DRG Other Peripheral Vascular Procedures 17 9 — — $141,321.16 $176,651.45 $158,279.70 2026-08-17
4054 APR_DRG Other Procedures For Endocrine, Nutritional And Metabolic Disorders 16 9 — — $78,059.31 $89,768.21 $87,036.13 2026-08-17
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 16 9 — — $135,402.43 $155,712.79 $150,973.71 2026-08-17
1214 APR_DRG Other Respiratory And Chest Procedures 16 9 — — $117,612.39 $135,254.25 $131,137.82 2026-08-17
2234 APR_DRG Other Small And Large Bowel Procedures 16 9 — — $98,414.43 $113,176.59 $109,732.09 2026-08-17
2224 APR_DRG Other Stomach, Esophageal And Duodenal Procedures 16 9 — — $74,518.85 $85,696.68 $83,088.51 2026-08-17
64 APR_DRG Pancreas Transplant 16 9 — — $254,337.47 $292,488.09 $283,586.28 2026-08-17
63 APR_DRG Pancreas Transplant 16 9 — — $164,362.97 $189,017.42 $183,264.71 2026-08-17
62 APR_DRG Pancreas Transplant 16 9 — — $148,664.10 $170,963.72 $165,760.47 2026-08-17
61 APR_DRG Pancreas Transplant 16 9 — — $146,744.68 $168,756.38 $163,620.32 2026-08-17
5104 APR_DRG Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced… 16 9 — — $87,390.62 $100,499.21 $97,440.54 2026-08-17
4834 APR_DRG Penis, Testes And Scrotal Procedures 16 9 — — $125,544.56 $144,376.24 $139,982.18 2026-08-17
1754 APR_DRG Percutaneous Cardiac Intervention Without Ami 16 9 — — $80,868.86 $92,999.19 $90,168.77 2026-08-17
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 16 9 — — $84,455.70 $97,124.06 $94,168.11 2026-08-17
1834 APR_DRG Percutaneous Structural Cardiac Procedures 16 9 — — $106,286.43 $122,229.39 $118,509.37 2026-08-17
1833 APR_DRG Percutaneous Structural Cardiac Procedures 16 9 — — $103,676.22 $119,227.65 $115,598.99 2026-08-17
1832 APR_DRG Percutaneous Structural Cardiac Procedures 16 9 — — $67,307.55 $77,403.68 $75,047.92 2026-08-17
2244 APR_DRG Peritoneal Adhesiolysis 16 9 — — $114,618.54 $131,811.32 $127,799.67 2026-08-17
1704 APR_DRG Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock 16 9 — — $78,860.43 $90,689.49 $87,929.38 2026-08-17
1714 APR_DRG Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock 16 9 — — $89,318.82 $102,716.64 $99,590.49 2026-08-17
7114 APR_DRG Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 16 9 — — $84,676.35 $97,377.80 $94,414.13 2026-08-17
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 16 9 — — $308,181.51 $354,408.74 $343,622.39 2026-08-17
6924 APR_DRG Radiotherapy 16 9 — — $80,812.44 $92,934.31 $90,105.87 2026-08-17
4444 APR_DRG Renal Dialysis Access Device Procedures And Vessel Repair 16 9 — — $71,664.17 $82,413.80 $79,905.55 2026-08-17
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 17 9 — — $124,002.51 $155,003.14 $138,882.81 2026-08-17
1303 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 16 9 — — $84,198.69 $96,828.49 $93,881.54 2026-08-17
1302 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 16 9 — — $73,611.17 $84,652.85 $82,076.45 2026-08-17
J3403 HCPCS Revakinagene, Per Implant 4 4 — — $250,000.00 $250,000.00 $250,000.00 2026-01-27
J3590 HCPCS Risankizumab-rzaa (skyrizi) 360 Mg/2.4 Ml Injt 2.4 Ml Cartridge 51 38 $154,784.02 $116,088.02 25% off $30,879.41 $150,140.50 $103,705.29 2026-08-17
3224 APR_DRG Shoulder And Elbow Joint Replacement 16 9 — — $70,075.73 $80,587.09 $78,134.44 2026-08-17
3154 APR_DRG Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement 16 9 — — $126,968.77 $146,014.09 $141,570.17 2026-08-17
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 16 9 — — $113,501.49 $130,526.71 $126,554.16 2026-08-17
3124 APR_DRG Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 16 9 — — $90,232.77 $103,767.69 $100,609.54 2026-08-17
404 APR_DRG Spinal Disorders And Injuries 16 9 — — $73,571.05 $84,606.71 $82,031.73 2026-08-17
234 APR_DRG Spinal Procedures 16 9 — — $153,166.15 $176,141.07 $170,780.26 2026-08-17
233 APR_DRG Spinal Procedures 16 9 — — $74,566.49 $85,751.46 $83,141.64 2026-08-17
6504 APR_DRG Splenectomy 16 9 — — $69,285.90 $79,678.79 $77,253.78 2026-08-17
33289 CPT Tcat Impl Wrls P-art S Snr L-t Hemodyn Mntr 104 39 $152,884.00 $114,663.00 25% off $30,500.36 $148,297.48 $102,432.28 2026-08-17
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 16 9 — — $83,914.10 $96,501.22 $93,564.22 2026-08-17
Q2042 HCPCS Tisagenlecleucel Car-pos T 6 5 — — $511,072.00 $591,726.20 $591,726.20 2026-08-17
4 MS_DRG Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mouth And … 8 4 — — $94,690.95 $94,690.95 $94,690.95 2026-08-17
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 17 9 — — $321,093.40 $401,366.75 $362,835.54 2026-08-17
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 16 9 — — $206,446.02 $237,412.92 $230,187.31 2026-08-17
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 16 9 — — $134,979.93 $155,226.92 $150,502.62 2026-08-17
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 16 9 — — $110,765.91 $127,380.80 $123,503.99 2026-08-17
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 16 9 — — $206,516.23 $237,493.66 $230,265.60 2026-08-17
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 16 9 — — $148,766.91 $171,081.95 $165,875.10 2026-08-17
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 16 9 — — $135,857.53 $156,236.16 $151,481.14 2026-08-17
51 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 16 9 — — $110,979.04 $127,625.90 $123,741.62 2026-08-17
J3316 HCPCS Triptorelin 22.5 Mg Susr 1 Each Vial 109 39 $142,373.33 $106,780.00 25% off $3,817.28 $144,650.44 $99,661.33 2026-08-17
J3357 HCPCS Ustekinumab 45 Mg/0.5 Ml Syrg 0.5 Ml Syringe 183 39 $99,382.01 $74,536.51 25% off $155.88 $192,776.66 $74,451.17 2026-08-17
5134 APR_DRG Uterine And Adnexa Procedures For Non-malignancy Except Leiomyoma 16 9 — — $90,410.79 $103,972.41 $100,808.03 2026-08-17
5124 APR_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy 16 9 — — $74,431.09 $85,595.75 $82,990.67 2026-08-17
5114 APR_DRG Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 16 9 — — $85,863.61 $98,743.15 $95,737.93 2026-08-17
224 APR_DRG Ventricular Shunt Procedures 16 9 — — $132,016.18 $151,818.61 $147,198.04 2026-08-17
7234 APR_DRG Viral Illness 16 9 — — $96,686.83 $111,189.85 $107,805.82 2026-08-17
A9543 HCPCS Y90 Ibritumomab, Rx 4 4 — — $73,939.13 $73,939.13 $73,939.13 2026-01-27
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