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 MENTAL HEALTH AND WELLNESS CENTER

Frisco, TX · CCN 454161 · Rates published

Your selected procedure

You selected 27447 (CPT)

Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)

This hospital’s price: $20,261 across 13 payers · range $2,513-$88,845

Source: https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1682203_MEDICAL-CITY-FRISCO_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.

37,697 distinct procedures filed
34 distinct payers
1,395,023 rate rows
2026-03-01 last MRF observed
Data quality

1,374,839 of 1,395,023 rate rows are consumer-grade (98.6%)

20,184 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
per-diem day rate — not a per-procedure price 11,069
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 5,926
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 2,002
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 860
placeholder amount (≤ $0.02) — excluded from medians 256
exceeds 10× this hospital's gross charge — excluded from medians 70
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/62-1682203_MEDICAL-CITY-FRISCO_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 viaCMS hospital list
Last fetch not_modified · 2026-08-03
Content fingerprint 90e9d205f41095db… · 644,532,663 bytes · first seen 2026-06-08

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,850,948.67 $4,850,948.67 $4,850,948.67 nat. median
$2,997,086
1.6× median
845
OTHER 		Inj, Atidarsagene Autotem 14 $5,373.81 $4,955,500.00 $4,550,050.00 nat. median
$16,015
outlier · 284.1×
00845
OTHER 		Inj, Atidarsagene Autotem 2 $4,369,850.00 $4,505,000.00 $4,437,425.00 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
$2,460,273
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
$2,405,851
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 15 $3,666,840.67 $4,790,847.10 $3,789,456.00 nat. median
$3,758,972
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 3 $3,605,000.00 $3,821,300.00 $3,659,075.00 nat. median
$3,646,097
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,574,708.99 $3,685,267.00 $3,629,988.00 nat. median
$3,574,709
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 17 $6,320.33 $4,326,218.00 $3,427,695.80 nat. median
$3,325,455
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 15 $9,730.05 $4,336,566.00 $3,402,536.40 nat. median
$29,683
outlier · 114.6×
748
OTHER 		Inj, Lovotibeglogene Auto 17 $12,030.68 $4,228,260.40 $3,384,580.00 nat. median
$3,252,508
1.0× median
00908
OTHER 		Topi Adm Prad Zami Per Tr 2 $3,235,745.40 $3,335,820.00 $3,285,782.70 nat. median
$14,170
outlier · 231.9×
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,228,024.20 $3,327,860.00 $3,277,942.10 nat. median
$3,228,024
1.0× median
906
OTHER 		Inj Elivaldogene Autoteme 15 $8,597.64 $4,134,000.00 $3,243,600.00 nat. median
$24,604
outlier · 131.8×
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,154,932.76 $3,252,508.00 $3,203,720.38 nat. median
$3,187,420
1.0× median
00906
OTHER 		Inj Elivaldogene Autoteme 2 $3,084,600.00 $3,180,000.00 $3,132,300.00 nat. median
$3,084,600
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 17 $11,128.50 $3,821,959.70 $3,057,040.00 nat. median
$2,939,969
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,851,769.93 $2,939,969.00 $2,895,869.46 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 16 $2,388,614.00 $4,634,275.99 $2,614,870.81 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,511,311.57 $2,588,981.00 $2,550,146.29 nat. median
$2,511,312
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 2 $1,271,523.00 $4,067,128.80 $2,528,215.20 nat. median
$809,151
outlier · 3.1×
824
OTHER 		Inj, Exagamglogene Autote 16 $13,031.19 $4,174,280.00 $2,401,960.00 nat. median
$58,186
outlier · 41.3×
00824
OTHER 		Inj, Exagamglogene Autote 2 $2,262,040.00 $2,332,000.00 $2,297,020.00 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 $1,825,740.00 nat. median
$302,242
outlier · 6.0×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $536,573.93 $2,570,427.00 $1,565,413.20 nat. median
$631,793
outlier · 2.5×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $511,793.34 $2,318,912.10 $1,412,238.36 nat. median
$610,161
outlier · 2.3×
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×
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 $500,948.74 $2,268,056.34 $1,381,266.75 nat. median
$624,417
outlier · 2.2×
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 $23.68 $2,132,254.50 $1,271,668.90 nat. median
$691,418
1.8× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $474,717.03 $2,061,869.40 $1,255,697.04 nat. median
$577,541
outlier · 2.2×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $6.22 $1,966,642.50 $1,172,898.50 nat. median
$588,565
2.0× median
2067
OTHER 		Afamitresgene Autoleucel 17 $766,766.90 $2,019,024.40 $809,151.00 nat. median
$786,032
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 17 $527,123.40 $1,539,641.95 $611,155.58 nat. median
$587,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 17 $529,192.90 $1,484,312.01 $589,192.55 nat. median
$576,820
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 17 $516,726.10 $1,472,967.14 $584,689.25 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 17 $526,587.60 $1,462,174.32 $580,405.07 nat. median
$560,872
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $570,020.11 $587,649.60 $578,834.85 nat. median
$570,020
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $549,535.36 $566,531.30 $558,033.33 nat. median
$549,535
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $545,335.16 $562,201.20 $553,768.18 nat. median
$545,335
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 17 $489,456.00 $1,394,343.56 $553,479.89 nat. median
$533,230
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $541,339.35 $558,081.80 $549,710.57 nat. median
$541,339
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $516,226.43 $532,192.20 $524,209.31 nat. median
$516,226
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 17 $460,530.40 $1,282,359.52 $509,028.21 nat. median
$492,768
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $474,766.69 $489,450.20 $482,108.45 nat. median
$474,767
1.0× median
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 5 $61,338.53 $888,000.00 $405,600.00 nat. median
$69,291
outlier · 5.9×
5834
APR_DRG 		Neonate With Ecmo 4 $352,665.30 $419,839.64 $376,176.32 nat. median
$311,018
1.2× median
74
APR_DRG 		Allogeneic Bone Marrow Transplant 4 $343,073.13 $571,789.00 $365,944.67 nat. median
$175,480
outlier · 2.1×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 13 $314,036.10 $1,273,072.13 $336,467.25 nat. median
$370,165
0.9× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 $332,753.88 $332,753.88 $332,753.88 nat. median
$209,736
1.6× median
90288
CPT 		Botulism Immune Globulin, Human, For Intravenous Use 1 $294,713.96 $416,525.16 $329,245.80 nat. median
$52,716
outlier · 6.2×

Other procedures at this hospital

Browse this hospital's 37,697 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 25 14 — — $5,373.81 $4,955,500.00 $4,550,050.00 2026-03-01
00845 OTHER Inj, Atidarsagene Autotem 2 2 — — $4,369,850.00 $4,505,000.00 $4,437,425.00 2026-03-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 3 1 — — $4,271,819.03 $4,271,819.03 $4,271,819.03 2026-03-01
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 28 15 — — $3,666,840.67 $4,790,847.10 $3,789,456.00 2026-03-01
773 OTHER Inj, Beqvez, Per Tx Dose 4 3 — — $3,605,000.00 $3,821,300.00 $3,659,075.00 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $3,574,708.99 $3,685,267.00 $3,629,988.00 2026-03-01
714 OTHER Inj Delandistrogene Mox R 33 17 — — $6,320.33 $4,326,218.00 $3,427,695.80 2026-03-01
908 OTHER Topi Adm Prad Zami Per Tr 26 15 — — $9,730.05 $4,336,566.00 $3,402,536.40 2026-03-01
748 OTHER Inj, Lovotibeglogene Auto 33 17 — — $12,030.68 $4,228,260.40 $3,384,580.00 2026-03-01
00908 OTHER Topi Adm Prad Zami Per Tr 2 2 — — $3,235,745.40 $3,335,820.00 $3,285,782.70 2026-03-01
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $3,228,024.20 $3,327,860.00 $3,277,942.10 2026-03-01
906 OTHER Inj Elivaldogene Autoteme 26 15 — — $8,597.64 $4,134,000.00 $3,243,600.00 2026-03-01
00748 OTHER Inj, Lovotibeglogene Auto 2 2 — — $3,154,932.76 $3,252,508.00 $3,203,720.38 2026-03-01
00906 OTHER Inj Elivaldogene Autoteme 2 2 — — $3,084,600.00 $3,180,000.00 $3,132,300.00 2026-03-01
746 OTHER Inj, Betibeglogene Autote 33 17 — — $11,128.50 $3,821,959.70 $3,057,040.00 2026-03-01
00746 OTHER Inj, Betibeglogene Autote 2 2 — — $2,851,769.93 $2,939,969.00 $2,895,869.46 2026-03-01
9141 OTHER Inj Onase Abepar-xioi Tre 29 16 — — $2,388,614.00 $4,634,275.99 $2,614,870.81 2026-03-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $2,511,311.57 $2,588,981.00 $2,550,146.29 2026-03-01
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 9 2 — — $1,271,523.00 $4,067,128.80 $2,528,215.20 2026-03-01
824 OTHER Inj, Exagamglogene Autote 27 16 — — $13,031.19 $4,174,280.00 $2,401,960.00 2026-03-01
00824 OTHER Inj, Exagamglogene Autote 2 2 — — $2,262,040.00 $2,332,000.00 $2,297,020.00 2026-03-01
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 9 2 — — $459,112.50 $2,937,060.00 $1,825,740.00 2026-03-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 12 4 — — $536,573.93 $2,570,427.00 $1,565,413.20 2026-03-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 12 4 — — $511,793.34 $2,318,912.10 $1,412,238.36 2026-03-01
C9301 HCPCS Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc… 6 1 — — $959,962.50 $1,544,287.50 $1,405,162.50 2026-03-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 12 4 — — $500,948.74 $2,268,056.34 $1,381,266.75 2026-03-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 13 4 — — $23.68 $2,132,254.50 $1,271,668.90 2026-03-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 12 4 — — $474,717.03 $2,061,869.40 $1,255,697.04 2026-03-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 13 4 — — $6.22 $1,966,642.50 $1,172,898.50 2026-03-01
2067 OTHER Afamitresgene Autoleucel 31 17 — — $766,766.90 $2,019,024.40 $809,151.00 2026-03-01
9498 OTHER Ciltacabtagene Car-pos T 32 17 — — $527,123.40 $1,539,641.95 $611,155.58 2026-03-01
9194 OTHER Tisagenlecleucel Car-pos 32 17 — — $529,192.90 $1,484,312.01 $589,192.55 2026-03-01
9413 OTHER Lisocabtagene Car Pos T 32 17 — — $516,726.10 $1,472,967.14 $584,689.25 2026-03-01
9422 OTHER Idecabtagene Vicleucel Ca 32 17 — — $526,587.60 $1,462,174.32 $580,405.07 2026-03-01
09498 OTHER Ciltacabtagene Car-pos T 2 2 — — $570,020.11 $587,649.60 $578,834.85 2026-03-01
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $549,535.36 $566,531.30 $558,033.33 2026-03-01
09413 OTHER Lisocabtagene Car Pos T 2 2 — — $545,335.16 $562,201.20 $553,768.18 2026-03-01
9035 OTHER Axicabtagene Ciloleucel C 32 17 — — $489,456.00 $1,394,343.56 $553,479.89 2026-03-01
09422 OTHER Idecabtagene Vicleucel Ca 2 2 — — $541,339.35 $558,081.80 $549,710.57 2026-03-01
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $516,226.43 $532,192.20 $524,209.31 2026-03-01
9391 OTHER Brexucabtagene Car Pos T 32 17 — — $460,530.40 $1,282,359.52 $509,028.21 2026-03-01
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $474,766.69 $489,450.20 $482,108.45 2026-03-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 18 5 — — $61,338.53 $888,000.00 $405,600.00 2026-03-01
5834 APR_DRG Neonate With Ecmo 12 4 — — $352,665.30 $419,839.64 $376,176.32 2026-03-01
74 APR_DRG Allogeneic Bone Marrow Transplant 16 4 — — $343,073.13 $571,789.00 $365,944.67 2026-03-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 26 13 — — $314,036.10 $1,273,072.13 $336,467.25 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
5833 APR_DRG Neonate With Ecmo 12 4 — — $298,624.01 $355,504.78 $318,532.28 2026-03-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 19 5 — — $55,306.59 $478,449.94 $307,485.36 2026-03-01
24 APR_DRG Heart And/or Lung Transplant 16 4 — — $287,267.84 $478,780.00 $306,419.03 2026-03-01
831 OTHER Obecbtge Autol Up To 400 30 17 — — $3,679.75 $729,015.00 $292,162.50 2026-03-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 17 4 — — $93,760.51 $582,739.61 $289,037.14 2026-03-01
897 OTHER Revakinagene, Per Implant 28 16 — — $263,675.00 $694,300.00 $278,250.00 2026-03-01
00831 OTHER Obecbtge Autol Up To 400 2 2 — — $269,902.50 $278,250.00 $274,076.25 2026-03-01
00897 OTHER Revakinagene, Per Implant 2 2 — — $257,050.00 $265,000.00 $261,025.00 2026-03-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 4 — — $223,231.34 $265,751.60 $238,113.43 2026-03-01
1614 APR_DRG Implantable Heart Assist Systems 12 4 — — $216,772.95 $258,063.04 $231,224.48 2026-03-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 43 17 — — $204,442.99 $916,157.34 $229,476.83 2026-03-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $216,966.01 $223,676.30 $220,321.15 2026-03-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 12 4 — — $203,082.13 $241,764.44 $216,620.94 2026-03-01
886 OTHER Inj. Remestemcel-l-rknd/ 30 17 — — $8,051.91 $528,372.78 $211,752.45 2026-03-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 17 4 — — $126,372.49 $574,167.94 $202,348.70 2026-03-01
00886 OTHER Inj. Remestemcel-l-rknd/ 2 2 — — $195,618.93 $201,669.00 $198,643.96 2026-03-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 2 — — $190,716.55 $196,615.00 $193,665.77 2026-03-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 19 5 — — $43,855.64 $389,632.46 $185,582.55 2026-03-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 4 — — $166,099.01 $197,736.91 $177,172.27 2026-03-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 4 — — $164,627.07 $195,984.61 $175,602.21 2026-03-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 53 22 — — $155,291.00 $693,894.24 $174,306.22 2026-03-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 43 17 — — $156,196.91 $697,990.55 $167,353.83 2026-03-01
5832 APR_DRG Neonate With Ecmo 12 4 — — $148,797.53 $177,139.91 $158,717.36 2026-03-01
1907 OTHER New Technology - Level 52 35 18 — — $148,181.70 $392,862.71 $157,444.98 2026-03-01
1908 OTHER New Technology - Level 52 35 18 — — $148,181.70 $392,862.71 $157,444.98 2026-03-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 4 — — $141,292.99 $168,205.94 $150,712.52 2026-03-01
01908 OTHER New Technology - Level 52 2 2 — — $142,262.92 $146,662.80 $144,462.86 2026-03-01
01907 OTHER New Technology - Level 52 2 2 — — $142,262.92 $146,662.80 $144,462.86 2026-03-01
249696 CDM Algrf Maci Fnl 1 Membran 27 11 $485,088.00 $485,088.00 $65,486.88 $485,088.00 $143,100.96 2026-03-01
1905 OTHER New Technology - Level 51 35 18 — — $133,606.50 $354,220.59 $141,958.64 2026-03-01
1906 OTHER New Technology - Level 51 35 18 — — $133,606.50 $354,220.59 $141,958.64 2026-03-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 12 4 — — $131,300.11 $156,309.65 $140,053.45 2026-03-01
5831 APR_DRG Neonate With Ecmo 12 4 — — $131,019.18 $155,975.21 $139,753.79 2026-03-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 2 — — $134,420.85 $138,578.20 $136,499.53 2026-03-01
01906 OTHER New Technology - Level 51 2 2 — — $128,269.89 $132,237.00 $130,253.45 2026-03-01
01905 OTHER New Technology - Level 51 2 2 — — $128,269.89 $132,237.00 $130,253.45 2026-03-01
73 APR_DRG Allogeneic Bone Marrow Transplant 16 4 — — $121,057.40 $201,762.00 $129,127.89 2026-03-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 4 — — $119,778.63 $142,593.61 $127,763.88 2026-03-01
437822 CDM Valve Aor Tavr 23mm 27 11 $433,026.00 $433,026.00 $58,458.51 $433,026.00 $127,742.67 2026-03-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 4 — — $119,231.19 $141,941.89 $127,179.93 2026-03-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 4 — — $118,922.86 $141,574.84 $126,851.05 2026-03-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 54 22 — — $101,981.25 $452,829.97 $126,593.19 2026-03-01
1903 OTHER New Technology - Level 50 35 18 — — $119,031.30 $315,578.48 $126,472.29 2026-03-01
1904 OTHER New Technology - Level 50 35 18 — — $119,031.30 $315,578.48 $126,472.29 2026-03-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 12 4 — — $118,411.64 $140,966.24 $126,305.75 2026-03-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 12 4 — — $117,228.98 $139,558.31 $125,044.25 2026-03-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 12 4 — — $114,140.71 $135,881.80 $121,750.09 2026-03-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 4 — — $113,118.25 $134,664.59 $120,659.47 2026-03-01
1613 APR_DRG Implantable Heart Assist Systems 12 4 — — $112,984.99 $134,505.94 $120,517.32 2026-03-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 4 — — $112,387.86 $133,795.08 $119,880.39 2026-03-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 34 18 — — $108,147.24 $629,884.36 $117,066.60 2026-03-01
862710 CDM Set Vntrc 17.4x13.8in 40 17 $396,544.00 $396,544.00 $53,533.44 $396,544.00 $116,385.67 2026-03-01
866357 CDM Set Pump 21fr 5.0 40 17 $396,544.00 $396,544.00 $53,533.44 $396,544.00 $116,385.67 2026-03-01
265596 CDM Kit Lo Prfl Comp Shth 7f 40 17 $396,544.00 $396,544.00 $53,533.44 $396,544.00 $116,385.67 2026-03-01
286360 CDM Kit Stim W/elec Trnsmt 40 17 $396,544.00 $396,544.00 $53,533.44 $396,544.00 $116,385.67 2026-03-01
751731 CDM Pump Impella Circ 2.5 40 17 $396,544.00 $396,544.00 $53,533.44 $396,544.00 $116,385.67 2026-03-01
01904 OTHER New Technology - Level 50 2 2 — — $114,276.86 $117,811.20 $116,044.03 2026-03-01
01903 OTHER New Technology - Level 50 2 2 — — $114,276.86 $117,811.20 $116,044.03 2026-03-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 17 4 — — $39,976.89 $203,447.46 $114,857.36 2026-03-01
284920 CDM Sphere Ankle 40.6x44mm 27 11 $388,643.00 $388,643.00 $52,466.81 $388,643.00 $114,649.68 2026-03-01
1901 OTHER New Technology - Level 49 35 18 — — $104,456.10 $276,936.36 $110,985.94 2026-03-01
1902 OTHER New Technology - Level 49 35 18 — — $104,456.10 $276,936.36 $110,985.94 2026-03-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 16 4 — — $102,904.34 $171,507.00 $109,764.63 2026-03-01
84 APR_DRG Autologous Bone Marrow Transplant 16 4 — — $102,492.01 $170,820.00 $109,324.81 2026-03-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 4 — — $100,670.90 $119,846.31 $107,382.30 2026-03-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 12 4 — — $100,614.72 $119,779.42 $107,322.36 2026-03-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 2 — — $104,972.14 $108,218.70 $106,595.42 2026-03-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 12 4 — — $99,773.81 $118,778.35 $106,425.40 2026-03-01
299900 CDM Icd Card Thk1400 27 11 $358,093.00 $358,093.00 $48,342.56 $358,093.00 $105,637.43 2026-03-01
2464 APR_DRG Gastrointestinal Vascular Insufficiency 12 4 — — $97,568.24 $116,152.66 $104,072.79 2026-03-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 4 — — $97,064.90 $115,553.45 $103,535.89 2026-03-01
E0767 HCPCS Intrabuccal, Systemic Delivery Of Amplitude-modulated, Radiofrequency Electromag… 6 1 — — $80,266.41 $113,137.42 $103,199.67 2026-03-01
7 MS_DRG Lung Transplant 29 16 — — $95,465.93 $381,784.85 $102,284.92 2026-03-01
474140 CDM Fixator Elbow Rt Exfix 40 17 $348,017.00 $348,017.00 $46,982.29 $348,017.00 $102,142.99 2026-03-01
01902 OTHER New Technology - Level 49 2 2 — — $100,283.84 $103,385.40 $101,834.62 2026-03-01
01901 OTHER New Technology - Level 49 2 2 — — $100,283.84 $103,385.40 $101,834.62 2026-03-01
C1822 HCPCS Pulse Gen Imp 110 9 $322,810.00 $322,810.00 $34,986.60 $348,295.00 $100,909.00 2026-03-01
875506 CDM Cann 20d Ang Dil Cirbtrp 40 17 $343,720.00 $343,720.00 $46,402.20 $343,720.00 $100,881.82 2026-03-01
877253 CDM Cann Dil Strt Circ Bltrp 40 17 $343,720.00 $343,720.00 $46,402.20 $343,720.00 $100,881.82 2026-03-01
64 APR_DRG Pancreas Transplant 16 4 — — $94,198.58 $156,998.00 $100,478.48 2026-03-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 4 — — $94,191.15 $112,132.32 $100,470.56 2026-03-01
276338 CDM Spacer Spn Cstm 27 11 $339,800.00 $339,800.00 $45,873.00 $339,800.00 $100,241.00 2026-03-01
276089 CDM Spacer Spn Cstm Implant 27 11 $339,800.00 $339,800.00 $45,873.00 $339,800.00 $100,241.00 2026-03-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 4 — — $93,909.30 $111,796.79 $100,169.92 2026-03-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 40 19 — — $80,850.00 $249,112.22 $99,835.05 2026-03-01
442639 CDM Kit Impl Crnl Cstm Lg 27 11 $336,447.00 $336,447.00 $45,420.35 $336,447.00 $99,251.87 2026-03-01
210923 CDM Set Exfx Rgd Distrt 40 17 $337,284.00 $337,284.00 $45,533.34 $337,284.00 $98,992.85 2026-03-01
L5969 HCPCS Addition, Endoskeletal Ankle-foot Or Ankle System, Power Assist, Includes Any Ty… 1 1 — — $98,593.44 $98,593.44 $98,593.44 2026-03-01
1585 OTHER New Technology - Level 48 35 18 — — $92,310.09 $244,734.72 $98,080.71 2026-03-01
1599 OTHER New Technology - Level 48 35 18 — — $92,310.09 $244,734.72 $98,080.71 2026-03-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 4 — — $91,290.47 $108,679.13 $97,376.50 2026-03-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 58 24 — — $58,729.34 $257,246.81 $97,189.47 2026-03-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 58 24 — — $60,607.00 $457,699.58 $96,349.43 2026-03-01
J7310 HCPCS Ganciclovir, 4.5 Mg, Long-acting Implant 14 3 — — $52,748.16 $145,041.92 $95,534.88 2026-03-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 2 2 — — $94,076.67 $96,986.26 $95,531.46 2026-03-01
14 MS_DRG Allogeneic Bone Marrow Transplant 29 16 — — $88,725.75 $354,299.71 $95,063.30 2026-03-01
215 MS_DRG Other Heart Assist System Implant 65 26 — — $55,453.00 $567,817.00 $94,166.11 2026-03-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 4 — — $87,769.44 $104,487.43 $93,620.73 2026-03-01
281768 CDM Spacer Spn 21x26x36mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
286593 CDM Spacer Spn 7x28x35mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
283386 CDM Spacer Spn 6.75x28x34mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
220559 CDM Cage Spnl 6h 12x4x24mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
283387 CDM Spacer Spn 6x25x38mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
285385 CDM Spacer Spn 6.5x30x42mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
285660 CDM Implant Spn 5.5x27x40mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
285659 CDM Implant Spn 6.5x30x40mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
480687 CDM Cage 6d 14mmx16mmx16mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
284733 CDM Spacer Spn 6x25x40mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
281380 CDM Spacer Spn 6.5x27x35mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
287004 CDM Spacer Spn 10d 7x26x34mm 27 11 $315,783.00 $315,783.00 $42,630.71 $315,783.00 $93,155.99 2026-03-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 65 26 — — $55,453.00 $350,478.59 $92,559.74 2026-03-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $92,481.79 $92,481.79 $92,481.79 2026-03-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 4 — — $86,329.08 $102,772.71 $92,084.35 2026-03-01
266635 CDM Talus W/sbtlr Bn Right 27 11 $310,245.00 $310,245.00 $41,883.07 $310,245.00 $91,522.27 2026-03-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 4 — — $85,628.40 $101,938.57 $91,336.96 2026-03-01
C1820 HCPCS Kit Generator Ipg 321 15 $285,760.00 $285,760.00 $22,695.26 $333,715.00 $90,706.00 2026-03-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 51 23 — — $60,607.00 $600,280.68 $90,670.19 2026-03-01
01585 OTHER New Technology - Level 48 2 2 — — $88,622.96 $91,363.88 $89,993.42 2026-03-01
01599 OTHER New Technology - Level 48 2 2 — — $88,622.96 $91,363.88 $89,993.42 2026-03-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 31 16 — — $83,765.51 $554,970.00 $89,748.76 2026-03-01
209 MS_DRG Complex Aortic Arch Procedures 43 23 — — $75,983.00 $333,689.54 $89,648.07 2026-03-01
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 19 5 — — $26,258.38 $243,082.56 $88,482.01 2026-03-01
1584 OTHER New Technology - Level 47 35 18 — — $82,593.29 $218,973.29 $87,756.47 2026-03-01
1598 OTHER New Technology - Level 47 35 18 — — $82,593.29 $218,973.29 $87,756.47 2026-03-01
C1767 HCPCS Generator Nrstm 5 Ipg 264 9 $274,969.50 $274,969.50 $20,305.08 $370,935.00 $87,516.48 2026-03-01
280485 CDM Spacr Spn 12d6x26x36mm 27 11 $296,514.00 $296,514.00 $40,029.39 $296,514.00 $87,471.63 2026-03-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 12 4 — — $81,979.21 $97,594.30 $87,444.49 2026-03-01
C1882 HCPCS Crt-d Quad Dtmb1qq 352 9 $258,706.50 $258,706.50 $17,921.25 $400,950.00 $87,442.80 2026-03-01
72 APR_DRG Allogeneic Bone Marrow Transplant 16 4 — — $81,337.04 $135,562.00 $86,759.51 2026-03-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 57 24 — — $56,929.90 $249,109.77 $86,729.70 2026-03-01
1612 APR_DRG Implantable Heart Assist Systems 12 4 — — $81,218.64 $96,688.86 $86,633.22 2026-03-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 58 25 — — $11,000.00 $355,496.08 $86,203.40 2026-03-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 57 24 — — $50,504.21 $220,053.12 $85,983.07 2026-03-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 4 — — $80,289.97 $95,583.30 $85,642.64 2026-03-01
853516 CDM Stnt Gft C Tag 37x37x20 27 11 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $85,641.15 2026-03-01
861960 CDM Stnt Gft Xcldr-c 16x35 27 11 $290,309.00 $290,309.00 $39,191.71 $290,309.00 $85,641.15 2026-03-01
737806 CDM Grft Xcldr Aaa 31/14/15 27 11 $290,155.00 $290,155.00 $39,170.93 $290,155.00 $85,595.73 2026-03-01
276906 CDM Intbdy Spn 19x27-37mm 27 11 $287,378.00 $287,378.00 $38,796.03 $287,378.00 $84,776.51 2026-03-01
8634 APR_DRG Neonatal Aftercare 12 4 — — $79,044.64 $94,100.76 $84,314.28 2026-03-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 4 — — $78,285.46 $93,196.98 $83,504.49 2026-03-01
1611 APR_DRG Implantable Heart Assist Systems 12 4 — — $77,028.50 $91,700.60 $82,163.74 2026-03-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 72 29 — — $45,671.20 $217,198.71 $81,964.68 2026-03-01
4404 APR_DRG Kidney Transplant 16 4 — — $76,838.13 $128,064.00 $81,960.67 2026-03-01
007 OTHER Lung Transplant 2 2 — — $80,678.24 $83,173.44 $81,925.84 2026-03-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 29 16 — — $76,381.91 $303,963.85 $81,837.76 2026-03-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 12 4 — — $76,487.09 $91,056.06 $81,586.23 2026-03-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 72 29 — — $45,266.35 $215,192.45 $81,582.54 2026-03-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 4 — — $76,461.09 $91,025.11 $81,558.50 2026-03-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 63 25 — — $55,453.00 $273,896.94 $81,187.00 2026-03-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 65 26 — — $55,453.00 $276,270.00 $81,187.00 2026-03-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 65 26 — — $55,453.00 $302,009.60 $81,187.00 2026-03-01
01598 OTHER New Technology - Level 47 2 2 — — $79,294.28 $81,746.68 $80,520.48 2026-03-01
01584 OTHER New Technology - Level 47 2 2 — — $79,294.28 $81,746.68 $80,520.48 2026-03-01
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 17 4 — — $5,213.67 $142,036.23 $80,330.88 2026-03-01
270458 CDM Cage Spn 18mm 24mm 27 11 $270,009.00 $270,009.00 $36,451.21 $270,009.00 $79,652.65 2026-03-01
281190 CDM Cage Spn 18x60x106mm 27 11 $270,009.00 $270,009.00 $36,451.21 $270,009.00 $79,652.65 2026-03-01
243980 CDM Cage Spn Crpctmy 18mm 27 11 $270,009.00 $270,009.00 $36,451.21 $270,009.00 $79,652.65 2026-03-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 4 — — $74,488.14 $88,676.36 $79,454.02 2026-03-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 4 — — $74,488.14 $88,676.36 $79,454.02 2026-03-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 12 4 — — $74,276.87 $88,424.85 $79,228.67 2026-03-01
254829 CDM Frame 220mm 40 17 $269,098.00 $269,098.00 $36,328.23 $269,098.00 $78,980.26 2026-03-01
316885 CDM Frame Exfx 180mm 40 17 $269,098.00 $269,098.00 $36,328.23 $269,098.00 $78,980.26 2026-03-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 63 25 — — $46,146.92 $422,445.00 $78,284.18 2026-03-01
4414 APR_DRG Major Bladder Procedures 12 4 — — $72,716.72 $86,567.53 $77,564.50 2026-03-01
1597 OTHER New Technology - Level 46 35 18 — — $72,876.48 $193,211.87 $77,432.24 2026-03-01
1583 OTHER New Technology - Level 46 35 18 — — $72,876.48 $193,211.87 $77,432.24 2026-03-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 60 25 — — $51,565.52 $294,489.00 $77,372.63 2026-03-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 1 — — $77,046.96 $77,046.96 $77,046.96 2026-03-01
C1772 HCPCS Pump Infs Pain 20ml 44 9 $244,944.00 $244,944.00 $31,492.80 $256,608.00 $76,924.08 2026-03-01
746296 CDM Dev Emb Pipeln 4x10mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
880573 CDM Implant Peek Crani Sz Md 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853433 CDM Dev Emb Pipeln 2.75x16mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
746292 CDM Coil Embl Pipeln 3.75x20 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
746281 CDM Dev Emb Pipeln 3x16mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
746289 CDM Dev Emb Pipeln 3.75x14mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853434 CDM Dev Emb Pipeln 2.75x18mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
746288 CDM Dev Emb Pipeln 12x3.75mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
751387 CDM Dev Emb Pipln 18x4.25mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853422 CDM Dev Emb Pipeln 2.50x10mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853426 CDM Dev Emb Pipeln 2.50x18mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
751413 CDM Dev Embl Pipeln 30x5 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
879051 CDM Grft Evas 16cm28.5x12mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853423 CDM Dev Emb Pipeln 2.50x12mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853393 CDM Coil Emb Pipeln 4.0x20mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
746290 CDM Dev Emb Pipeln 3.75x16mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
747118 CDM Graft Bn Fem Hemi Cndyl 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
876981 CDM Graft Evas 14cm 26mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853429 CDM Dev Emb Pipeln 2.75x10mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853435 CDM Dev Emb Pipeln 2.75x20mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853498 CDM Dev Emb Pipeln 5.00x35mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
270066 CDM Pump Pain Infn 148gm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
746297 CDM Dev Emb Pipeln 4x12mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853436 CDM Dev Emb Pipeln 3.00x10mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853497 CDM Dev Emb Pipeln 4.75x20mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
751292 CDM Dev Embl Pipeln 25x4.25 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853424 CDM Dev Emb Pipeln 2.50x14mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
873698 CDM Gft Ilac 14cm 28.5x14.5 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853391 CDM Dev Emb Pipeln 4x16mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853425 CDM Dev Emb Pipeln 2.50x16mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
872182 CDM Impl Crnl Ostmtch 20-100 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
746282 CDM Dev Emb Pipeln 3x18mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
861098 CDM Dev Embl Pipeln 20x5mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
746291 CDM Dev Emb Pipeln 18x3.75mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
858368 CDM Dev Emb Pipeln 4.50x18 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853438 CDM Dev Emb Pipeln 3.00x14mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
859730 CDM Stnt/gft Xcldr17x31x14.5 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
879609 CDM Device Embl 5x18mm Pipln 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
746298 CDM Dev Emb Pipeln 4x14mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853432 CDM Dev Emb Pipeln 2.75x14mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853392 CDM Dev Emb Pipeln 18x2.5mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
853428 CDM Dev Emb Pipeln 2.50x20mm 27 11 $259,160.00 $259,160.00 $34,986.60 $259,160.00 $76,452.20 2026-03-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 65 26 — — $49,377.84 $308,347.00 $75,983.00 2026-03-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 65 26 — — $49,377.84 $304,994.00 $75,983.00 2026-03-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 72 29 — — $44,268.67 $210,248.46 $75,474.25 2026-03-01
23 APR_DRG Heart And/or Lung Transplant 16 4 — — $70,753.99 $117,923.00 $75,470.92 2026-03-01
716979 CDM Stnt Bfr Aaa 28x14x140 27 11 $254,013.00 $254,013.00 $34,291.75 $254,013.00 $74,933.84 2026-03-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 72 29 — — $35,230.92 $165,462.38 $74,887.00 2026-03-01
423241 CDM Model Lf Vsp Bndl Recon 40 17 $253,932.00 $253,932.00 $34,280.82 $253,932.00 $74,529.04 2026-03-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 51 23 — — $60,607.00 $490,716.87 $74,494.71 2026-03-01
83 APR_DRG Autologous Bone Marrow Transplant 16 4 — — $69,276.95 $115,462.00 $73,895.42 2026-03-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 63 25 — — $41,334.16 $195,706.69 $73,250.00 2026-03-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 67 28 — — $39,986.56 $222,011.00 $73,159.00 2026-03-01
717390 CDM Cage Expndg Ctrpc 22x23 27 11 $247,903.00 $247,903.00 $33,466.90 $247,903.00 $73,131.38 2026-03-01
864569 CDM Cage Brgd 20d 10x34x24 27 11 $247,000.00 $247,000.00 $33,345.00 $247,000.00 $72,865.00 2026-03-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 65 26 — — $40,395.03 $276,270.00 $72,782.05 2026-03-01
1784 APR_DRG External Heart Assist Devices 12 4 — — $68,107.29 $81,080.11 $72,647.78 2026-03-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 2 — — $71,504.72 $73,716.21 $72,610.46 2026-03-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 33 18 — — $66,737.65 $180,260.45 $72,241.79 2026-03-01
C1721 HCPCS Defib Energen Dr Is-1 396 9 $225,087.50 $225,087.50 $12,672.45 $283,908.00 $71,966.40 2026-03-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 58 25 — — $53,391.00 $329,192.00 $71,568.00 2026-03-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 4 — — $67,071.84 $79,847.43 $71,543.29 2026-03-01
715204 CDM Evas L155mm Od26x 18mm T 27 11 $242,352.00 $242,352.00 $32,717.52 $242,352.00 $71,493.84 2026-03-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 12 4 — — $66,994.76 $79,755.66 $71,461.07 2026-03-01
C1722 HCPCS Aicd .99cm 5.37x7.79cm 308 9 $223,289.00 $223,289.00 $11,827.35 $336,472.00 $71,313.84 2026-03-01
474653 CDM Spacer Spn 10-17 20x55mm 27 11 $241,587.00 $241,587.00 $32,614.24 $241,587.00 $71,268.16 2026-03-01
474652 CDM Spacer Spn 7-14 20x55mm 27 11 $241,587.00 $241,587.00 $32,614.24 $241,587.00 $71,268.16 2026-03-01
225490 CDM Spacer 20mmx50mm 8-15mm 27 11 $241,587.00 $241,587.00 $32,614.24 $241,587.00 $71,268.16 2026-03-01
473587 CDM Spcr Spn 7-14mm 20x50mm 27 11 $241,587.00 $241,587.00 $32,614.24 $241,587.00 $71,268.16 2026-03-01
455885 CDM Spacer Spn 20mmx55mmx18m 27 11 $241,587.00 $241,587.00 $32,614.24 $241,587.00 $71,268.16 2026-03-01
472919 CDM Spacer Spn 20mmx60mm 27 11 $241,587.00 $241,587.00 $32,614.24 $241,587.00 $71,268.16 2026-03-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 12 4 — — $66,698.51 $79,402.99 $71,145.08 2026-03-01
647353 CDM Gft Bfr 22x13x16.5 27 11 $240,949.00 $240,949.00 $32,528.12 $240,949.00 $71,079.96 2026-03-01
01583 OTHER New Technology - Level 46 2 2 — — $69,965.60 $72,129.48 $71,047.54 2026-03-01
01597 OTHER New Technology - Level 46 2 2 — — $69,965.60 $72,129.48 $71,047.54 2026-03-01
6904 APR_DRG Acute Leukemia 12 4 — — $66,099.53 $78,689.91 $70,506.16 2026-03-01
879722 CDM Retrieve Rpr Trv Xp 4x30 40 17 $240,008.00 $240,008.00 $32,401.08 $240,008.00 $70,442.35 2026-03-01
865610 CDM Retr Trvo-xp Kt .018 180 40 17 $240,008.00 $240,008.00 $32,401.08 $240,008.00 $70,442.35 2026-03-01
875180 CDM Retriever Prvue 4x20mm 40 17 $240,008.00 $240,008.00 $32,401.08 $240,008.00 $70,442.35 2026-03-01
481772 CDM Cage Spnl 13x16mm 5d 27 11 $238,674.00 $238,674.00 $32,220.99 $238,674.00 $70,408.83 2026-03-01
254556 CDM Cage Spn 12x14mm 18-21mm 27 11 $238,674.00 $238,674.00 $32,220.99 $238,674.00 $70,408.83 2026-03-01
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