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

ST MARK'S HOSPITAL

Salt Lake City, UT · CCN 460047 · Rates published

32,831 distinct procedures filed
37 distinct payers
843,416 rate rows
2026-07-30 last MRF observed
Data quality

815,330 of 843,416 rate rows are consumer-grade (96.7%)

28,086 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 19,690
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 6,114
per-diem day rate — not a per-procedure price 1,701
template filing: same amount across many unrelated codes — excluded 256
percent-of-charges filed in the dollar field — excluded from medians 133
placeholder amount (≤ $0.02) — excluded from medians 93
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 59
exceeds 10× this hospital's gross charge — excluded from medians 23
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 17
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.hcadam.com/api/public/content/2ddf8eab94114b028790e2ef86501adc?download=true
Found on page https://www.mountainstar.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-04
Content fingerprint e2057692eef65451… · 437,700,612 bytes · first seen 2026-05-08

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
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,672,900.00 $3,672,900.00 $3,672,900.00 nat. median
$3,574,709
1.0× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 9 $3,202,768.80 $3,709,629.00 $3,672,900.00 nat. median
$3,758,972
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 9 $3,143,560.00 $3,641,050.00 $3,605,000.00 nat. median
$3,646,097
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 1 $3,605,000.00 $3,605,000.00 $3,605,000.00 nat. median
$3,496,850
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,325,455.00 $3,325,455.00 $3,325,455.00 nat. median
$3,228,024
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 10 $5,323.97 $3,358,709.55 $3,325,455.00 nat. median
$3,325,455
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $3,286,000.00 $3,286,000.00 $3,286,000.00 nat. median
$3,187,420
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 10 $8,781.88 $3,318,860.00 $3,286,000.00 nat. median
$3,252,508
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 1 $2,968,000.00 $2,968,000.00 $2,968,000.00 nat. median
$2,878,960
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 10 $7,800.05 $2,997,680.00 $2,968,000.00 nat. median
$2,939,969
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,388,614.00 $2,388,614.00 $2,388,614.00 nat. median
$2,511,312
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 9 $2,082,871.41 $2,412,500.14 $2,388,614.00 nat. median
$2,588,981
0.9× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 33 $235,461.70 $1,026,253.41 $529,503.28 nat. median
$370,165
1.4× median
9194
OTHER 		Tisagenlecleucel Car-pos 9 $461,456.21 $534,484.83 $529,192.90 nat. median
$576,820
0.9× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $529,192.90 $529,192.90 $529,192.90 nat. median
$549,535
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 9 $459,651.60 $532,394.63 $527,123.40 nat. median
$587,650
0.9× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $527,123.40 $527,123.40 $527,123.40 nat. median
$570,020
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $526,587.60 $526,587.60 $526,587.60 nat. median
$541,339
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 9 $459,184.39 $531,853.48 $526,587.60 nat. median
$560,872
0.9× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 1 $518,241.00 $518,241.00 $518,241.00 nat. median
$691,418
0.7× median
9413
OTHER 		Lisocabtagene Car Pos T 9 $450,585.16 $521,893.36 $516,726.10 nat. median
$562,201
0.9× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $516,726.10 $516,726.10 $516,726.10 nat. median
$545,335
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 1 $507,496.00 $507,496.00 $507,496.00 nat. median
$631,793
0.8× median
9035
OTHER 		Axicabtagene Ciloleucel C 9 $426,805.63 $494,350.56 $489,456.00 nat. median
$533,230
0.9× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $489,456.00 $489,456.00 $489,456.00 nat. median
$516,226
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 1 $484,690.00 $484,690.00 $484,690.00 nat. median
$610,161
0.8× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 1 $474,061.00 $474,061.00 $474,061.00 nat. median
$624,417
0.8× median
9391
OTHER 		Brexucabtagene Car Pos T 9 $401,582.51 $465,135.70 $460,530.40 nat. median
$492,768
0.9× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $460,530.40 $460,530.40 $460,530.40 nat. median
$474,767
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 1 $459,381.00 $459,381.00 $459,381.00 nat. median
$588,565
0.8× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 1 $449,440.00 $449,440.00 $449,440.00 nat. median
$577,541
0.8× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 32 $173,187.15 $584,740.56 $378,963.85 nat. median
$261,939
1.4× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 33 $136,258.04 $593,876.96 $306,774.20 nat. median
$199,832
1.5× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 24 $146,105.99 $734,221.59 $250,750.00 nat. median
$205,166
1.2× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 32 $77,162.65 $302,755.30 $189,958.98 nat. median
$108,240
1.8× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 26 $93,947.70 $409,468.50 $181,662.60 nat. median
$132,706
1.4× median
001
OTHER 		$143,270.04 1 $180,460.61 $180,460.61 $180,460.61 nat. median
$214,447
0.8× median
215
MS_DRG 		Other Heart Assist System Implant 33 $65,282.79 $284,533.25 $170,148.62 nat. median
$98,002
1.7× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 32 $73,246.61 $260,108.64 $166,677.62 nat. median
$114,305
1.5× median
7
MS_DRG 		Lung Transplant 32 $78,394.56 $247,490.80 $162,942.68 nat. median
$122,690
1.3× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 32 $68,835.54 $300,017.85 $159,874.42 nat. median
$100,978
1.6× median
018
OTHER 		$119,804.16 1 $148,906.56 $148,906.56 $148,906.56 nat. median
$292,434
0.5× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 32 $66,146.85 $231,265.52 $148,706.18 nat. median
$99,646
1.5× median
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 15 $56,633.21 $246,834.30 $147,214.18 nat. median
$83,623
1.8× median
1907
OTHER 		New Technology - Level 52 9 $127,060.17 $147,168.31 $145,711.20 nat. median
$155,877
0.9× median
01908
OTHER 		New Technology - Level 52 1 $145,711.20 $145,711.20 $145,711.20 nat. median
$85,250
1.7× median
01907
OTHER 		New Technology - Level 52 1 $145,711.20 $145,711.20 $145,711.20 nat. median
$85,034
1.7× median
1908
OTHER 		New Technology - Level 52 9 $127,060.17 $147,168.31 $145,711.20 nat. median
$155,877
0.9× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 33 $62,026.57 $270,341.13 $139,932.65 nat. median
$92,900
1.5× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 33 $54,019.29 $235,441.60 $139,608.29 nat. median
$77,385
1.8× median

Other procedures at this hospital

Browse this hospital's 32,831 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
             
9138 OTHER Inj, Hemgenix, Per Tx Dos 12 9 — — $3,202,768.80 $3,709,629.00 $3,672,900.00 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,672,900.00 $3,672,900.00 $3,672,900.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 1 1 — — $3,605,000.00 $3,605,000.00 $3,605,000.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 12 9 $3,499.83 — $3,143,560.00 $3,641,050.00 $3,605,000.00 2026-07-30
714 OTHER Inj Delandistrogene Mox R 13 10 $21,543.51 — $5,323.97 $3,358,709.55 $3,325,455.00 2026-07-30
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,325,455.00 $3,325,455.00 $3,325,455.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 13 10 $31,257.58 — $8,781.88 $3,318,860.00 $3,286,000.00 2026-07-30
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,286,000.00 $3,286,000.00 $3,286,000.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 13 10 $37,378.74 — $7,800.05 $2,997,680.00 $2,968,000.00 2026-07-30
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,968,000.00 $2,968,000.00 $2,968,000.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 12 9 — — $2,082,871.41 $2,412,500.14 $2,388,614.00 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,388,614.00 $2,388,614.00 $2,388,614.00 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 53 33 — — $235,461.70 $1,026,253.41 $529,503.28 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $529,192.90 $529,192.90 $529,192.90 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 12 9 $456,125.88 — $461,456.21 $534,484.83 $529,192.90 2026-07-30
9498 OTHER Ciltacabtagene Car-pos T 12 9 $481,344.75 — $459,651.60 $532,394.63 $527,123.40 2026-07-30
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $527,123.40 $527,123.40 $527,123.40 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $526,587.60 $526,587.60 $526,587.60 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 12 9 $446,893.35 — $459,184.39 $531,853.48 $526,587.60 2026-07-30
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 1 1 — — $518,241.00 $518,241.00 $518,241.00 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $516,726.10 $516,726.10 $516,726.10 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 12 9 $437,092.59 — $450,585.16 $521,893.36 $516,726.10 2026-07-30
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 1 1 — — $507,496.00 $507,496.00 $507,496.00 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $489,456.00 $489,456.00 $489,456.00 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 12 9 $424,999.19 — $426,805.63 $494,350.56 $489,456.00 2026-07-30
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 1 1 — — $484,690.00 $484,690.00 $484,690.00 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 1 1 — — $474,061.00 $474,061.00 $474,061.00 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 12 9 $425,054.70 — $401,582.51 $465,135.70 $460,530.40 2026-07-30
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $460,530.40 $460,530.40 $460,530.40 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 1 1 — — $459,381.00 $459,381.00 $459,381.00 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 1 1 — — $449,440.00 $449,440.00 $449,440.00 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 50 32 — — $173,187.15 $584,740.56 $378,963.85 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 53 33 — — $136,258.04 $593,876.96 $306,774.20 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 37 24 — — $146,105.99 $734,221.59 $250,750.00 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 50 32 — — $77,162.65 $302,755.30 $189,958.98 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 45 26 — — $93,947.70 $409,468.50 $181,662.60 2024-10-01
001 OTHER $143,270.04 1 1 $569,561.13 — $180,460.61 $180,460.61 $180,460.61 2026-07-30
215 MS_DRG Other Heart Assist System Implant 53 33 — — $65,282.79 $284,533.25 $170,148.62 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 49 32 — — $73,246.61 $260,108.64 $166,677.62 2024-10-01
7 MS_DRG Lung Transplant 49 32 — — $78,394.56 $247,490.80 $162,942.68 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 49 32 — — $68,835.54 $300,017.85 $159,874.42 2024-10-01
018 OTHER $119,804.16 1 1 $868,655.07 — $148,906.56 $148,906.56 $148,906.56 2026-07-30
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 49 32 — — $66,146.85 $231,265.52 $148,706.18 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 32 15 — — $56,633.21 $246,834.30 $147,214.18 2024-10-01
1908 OTHER New Technology - Level 52 12 9 $151,644.55 — $127,060.17 $147,168.31 $145,711.20 2026-07-30
1907 OTHER New Technology - Level 52 12 9 $151,644.55 — $127,060.17 $147,168.31 $145,711.20 2026-07-30
01907 OTHER New Technology - Level 52 1 1 — — $145,711.20 $145,711.20 $145,711.20 2024-10-01
01908 OTHER New Technology - Level 52 1 1 — — $145,711.20 $145,711.20 $145,711.20 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 53 33 — — $62,026.57 $270,341.13 $139,932.65 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 53 33 — — $54,019.29 $235,441.60 $139,608.29 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 20 9 — — $58,932.85 $170,171.43 $131,979.22 2024-10-01
01906 OTHER New Technology - Level 51 1 1 — — $131,379.00 $131,379.00 $131,379.00 2024-10-01
1905 OTHER New Technology - Level 51 12 9 $136,728.74 — $114,562.49 $132,692.79 $131,379.00 2026-07-30
01905 OTHER New Technology - Level 51 1 1 — — $131,379.00 $131,379.00 $131,379.00 2024-10-01
1906 OTHER New Technology - Level 51 12 9 $136,728.74 — $114,562.49 $132,692.79 $131,379.00 2026-07-30
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 53 33 — — $46,222.91 $201,461.29 $123,842.10 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 20 9 — — $54,565.57 $152,066.28 $123,466.36 2024-10-01
003 OTHER $109,359.47 1 1 $443,152.07 — $120,872.54 $120,872.54 $120,872.54 2026-07-30
231 MS_DRG Coronary Bypass With Ptca With Mcc 53 33 — — $51,864.24 $226,048.90 $120,559.92 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 49 32 — — $44,965.80 $195,982.21 $120,474.01 2024-10-01
01903 OTHER New Technology - Level 50 1 1 — — $117,046.80 $117,046.80 $117,046.80 2024-10-01
1903 OTHER New Technology - Level 50 12 9 $121,812.93 — $102,064.81 $118,217.27 $117,046.80 2026-07-30
01904 OTHER New Technology - Level 50 1 1 — — $117,046.80 $117,046.80 $117,046.80 2024-10-01
1904 OTHER New Technology - Level 50 12 9 $121,812.93 — $102,064.81 $118,217.27 $117,046.80 2026-07-30
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 53 33 — — $49,282.28 $214,795.48 $116,754.90 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 53 33 — — $49,847.24 $217,257.86 $112,095.85 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 20 9 — — $49,267.73 $136,382.27 $109,673.48 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 32 15 — — $42,387.03 $184,742.72 $108,510.35 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 53 33 — — $51,086.46 $222,658.94 $107,643.37 2024-10-01
0424T CPT Insertion Or Replacement Of Neurostimulator System For Treatment Of Central Slee… 11 2 — — $5,642.00 $156,751.43 $107,250.97 2024-10-01
452318 CDM Bundle Max1 Fsn Mini Mze 35 22 $249,351.00 $249,351.00 $52,812.54 $211,948.35 $107,220.93 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 49 32 — — $39,689.39 $172,985.12 $106,337.26 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 52 32 — — $47,090.88 $192,748.24 $106,239.62 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 53 33 — — $38,922.47 $169,642.52 $104,282.49 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 11 3 $55,114.75 — $55,453.60 $151,227.95 $103,471.76 2026-07-30
01901 OTHER New Technology - Level 49 1 1 — — $102,714.60 $102,714.60 $102,714.60 2024-10-01
01902 OTHER New Technology - Level 49 1 1 — — $102,714.60 $102,714.60 $102,714.60 2024-10-01
1902 OTHER New Technology - Level 49 12 9 $106,897.12 — $89,567.13 $103,741.75 $102,714.60 2026-07-30
1901 OTHER New Technology - Level 49 12 9 $106,897.12 — $89,567.13 $103,741.75 $102,714.60 2026-07-30
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 53 33 — — $39,116.45 $171,068.70 $101,437.50 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 53 33 — — $44,512.68 $194,007.29 $100,099.54 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 20 11 $96,923.94 — $87,199.91 $100,999.90 $99,999.90 2026-07-30
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 53 33 — — $53,872.30 $185,192.91 $99,812.58 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 53 33 — — $43,808.39 $190,937.67 $99,410.37 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 32 15 — — $33,877.00 $170,369.54 $98,190.31 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 53 33 — — $43,337.80 $189,929.32 $97,995.48 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 53 33 — — $39,918.83 $173,985.12 $95,428.57 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 53 33 — — $43,922.79 $191,436.27 $94,303.37 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 20 9 — — $40,168.33 $122,417.14 $93,444.44 2024-10-01
83496 CDM Ins Icd Lead/generator 23 16 $231,971.38 $231,971.38 $49,131.54 $197,175.67 $92,788.55 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 53 33 — — $44,149.03 $192,422.34 $92,437.25 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 53 33 — — $40,680.63 $177,305.43 $91,482.09 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 13 10 — — $79,379.82 $91,942.22 $91,031.90 2024-10-01
A9543 HCPCS Y90 Ibritum Tiu Tx 40mci 34 20 $189,598.72 $189,598.72 $40,157.01 $186,608.25 $91,007.39 2024-10-01
01599 OTHER New Technology - Level 48 1 1 — — $90,771.08 $90,771.08 $90,771.08 2024-10-01
1585 OTHER New Technology - Level 48 12 9 $94,467.28 — $79,152.38 $91,678.79 $90,771.08 2026-07-30
1599 OTHER New Technology - Level 48 12 9 $94,467.28 — $79,152.38 $91,678.79 $90,771.08 2026-07-30
01585 OTHER New Technology - Level 48 1 1 — — $90,771.08 $90,771.08 $90,771.08 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 20 9 — — $38,929.12 $115,195.98 $90,530.85 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 49 32 — — $39,477.21 $140,409.88 $89,943.54 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 53 33 — — $39,739.88 $173,205.18 $89,262.60 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 53 33 — — $38,512.81 $167,857.02 $86,607.11 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 20 9 — — $38,644.33 $106,639.08 $86,530.11 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 53 33 — — $37,582.91 $163,804.11 $86,040.36 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 53 33 — — $38,827.24 $132,825.73 $85,500.00 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 53 33 — — $38,017.50 $165,698.25 $85,493.28 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 53 33 — — $36,407.61 $158,681.58 $85,303.49 2024-10-01
004 OTHER $70,165.69 1 1 $276,542.39 — $84,988.40 $84,988.40 $84,988.40 2026-07-30
834 MS_DRG Acute Leukemia With Mcc 53 33 — — $16,243.00 $155,960.15 $84,950.07 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 53 33 — — $36,229.30 $157,904.42 $82,325.83 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 53 33 — — $38,644.46 $168,430.83 $82,263.27 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 49 32 — — $30,564.32 $133,213.75 $81,889.04 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 53 33 — — $36,320.69 $158,302.75 $81,601.53 2024-10-01
1584 OTHER New Technology - Level 47 12 9 $84,523.41 — $70,820.60 $82,028.44 $81,216.28 2026-07-30
01584 OTHER New Technology - Level 47 1 1 — — $81,216.28 $81,216.28 $81,216.28 2024-10-01
1598 OTHER New Technology - Level 47 12 9 $84,523.41 — $70,820.60 $82,028.44 $81,216.28 2026-07-30
01598 OTHER New Technology - Level 47 1 1 — — $81,216.28 $81,216.28 $81,216.28 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 53 33 — — $36,196.71 $157,762.36 $81,087.55 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 53 33 — — $34,598.32 $150,795.83 $79,816.44 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 53 33 — — $35,183.73 $153,347.35 $79,603.85 2024-10-01
014 OTHER $66,286.28 1 1 $233,374.58 — $78,968.84 $78,968.84 $78,968.84 2026-07-30
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 53 33 — — $33,518.24 $146,088.33 $78,069.78 2024-10-01
88356 CDM Rem/replace Icd Gen Mult 23 16 $193,754.96 $193,754.96 $41,037.30 $164,691.72 $77,501.98 2024-10-01
651 OTHER $25,453.78 1 1 $85,784.39 — $76,904.11 $76,904.11 $76,904.11 2026-07-30
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 32 15 — — $28,534.00 $128,288.99 $76,560.67 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 18 14 — — $1,751.00 $113,368.99 $76,494.99 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 53 33 — — $31,189.36 $135,937.97 $75,796.92 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 53 33 — — $33,147.56 $144,472.74 $75,340.62 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 53 33 — — $31,664.85 $138,010.38 $74,803.40 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 53 33 — — $33,219.78 $144,787.50 $74,704.22 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 53 33 — — $30,958.00 $134,929.62 $74,434.81 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 53 33 — — $32,953.91 $143,628.74 $74,192.93 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 49 32 — — $33,627.52 $114,529.13 $74,078.32 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 53 33 — — $29,575.63 $128,904.58 $73,858.25 2024-10-01
150896 CDM Ins/repl Sq Icd With Elec 23 16 $184,019.14 $184,019.14 $38,975.25 $156,416.27 $73,607.66 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 53 33 — — $32,318.65 $140,859.95 $73,437.39 2024-10-01
245 MS_DRG Aicd Generator Procedures 53 33 — — $28,960.18 $126,222.15 $73,357.01 2024-10-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 53 33 — — $25,850.32 $112,667.90 $72,939.16 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 53 33 — — $32,202.33 $140,352.99 $72,416.20 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 53 33 — — $31,437.33 $137,018.74 $72,351.47 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 53 33 — — $31,950.53 $139,255.50 $71,849.94 2024-10-01
1583 OTHER New Technology - Level 46 12 9 $74,579.54 — $62,488.81 $72,378.09 $71,661.48 2026-07-30
01583 OTHER New Technology - Level 46 1 1 — — $71,661.48 $71,661.48 $71,661.48 2024-10-01
1597 OTHER New Technology - Level 46 12 9 $74,579.54 — $62,488.81 $72,378.09 $71,661.48 2026-07-30
01597 OTHER New Technology - Level 46 1 1 — — $71,661.48 $71,661.48 $71,661.48 2024-10-01
88355 CDM Rem/replace Icd Gen Dual 23 16 $176,198.91 $176,198.91 $37,318.93 $149,769.07 $70,479.56 2024-10-01
88354 CDM Rem/replace Icd Gen Sgl 23 16 $176,198.91 $176,198.91 $37,318.93 $149,769.07 $70,479.56 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 49 32 — — $28,506.42 $124,244.44 $69,883.72 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 53 33 — — $30,124.62 $131,297.33 $69,574.91 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 53 33 — — $30,720.26 $133,893.41 $69,083.33 2024-10-01
007 OTHER $57,622.32 1 1 $228,114.42 — $68,135.74 $68,135.74 $68,135.74 2026-07-30
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 53 33 — — $30,295.90 $132,043.84 $68,129.03 2024-10-01
0266T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Total… 7 1 — — $51,670.92 $83,671.67 $68,111.67 2024-10-01
0268T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Pulse… 7 1 — — $51,670.92 $83,671.67 $68,111.67 2024-10-01
002 OTHER $75,287.60 1 1 $294,896.00 — $68,012.14 $68,012.14 $68,012.14 2026-07-30
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 53 33 — — $29,709.20 $129,486.75 $67,964.70 2024-10-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 49 32 — — $26,458.74 $115,319.70 $67,525.35 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 18 14 — — $1,751.00 $99,629.42 $67,328.90 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 53 33 — — $28,743.52 $125,277.86 $66,704.98 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 53 33 — — $28,866.87 $125,815.46 $66,409.08 2024-10-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 53 33 — — $24,785.58 $108,027.26 $66,406.42 2024-10-01
464864 CDM Pack Stroke Fast 3 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
458776 CDM Stroke Fast Pack (3 Pack 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
457456 CDM Kit Device Guided 3cm 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
458777 CDM Kit 6x25 Trevo 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
342251 CDM Kit Cath Rt Heart 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
337566 CDM Frame Exfx 180mm 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
554187 CDM Cann W Dilator Strgt Tip 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
554186 CDM Cannula Systm W Circuit 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
562906 CDM Kit Lo Prfl Comp Shth 7f 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
466538 CDM Can Prfsn 22fr Vsn 20d 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
569370 CDM Kit Cath Rt Heart 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
467005 CDM Kit Pmp Rt Hrt 22f 170cm 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
472150 CDM System Mech Thrmb 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
561485 CDM Guides Crnmxlf Cstm Bndl 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
453318 CDM Set Pump 21fr 5.0 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
88606 CDM Set Vntrc Asst 2.5in 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
456896 CDM Kit Device Guided 3cm 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
467444 CDM Cath Vasc Acc 6fr 35 22 $153,360.00 $153,360.00 $32,481.65 $130,356.00 $65,944.80 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 49 32 — — $33,636.66 $98,201.68 $65,919.17 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 13 10 — — $57,440.12 $66,530.42 $65,871.70 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 53 33 — — $28,957.62 $101,273.70 $65,494.81 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 12 9 $60,092.80 — $57,095.58 $66,131.35 $65,476.58 2026-07-30
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $65,476.58 $65,476.58 $65,476.58 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 53 33 — — $28,222.66 $123,007.68 $65,219.74 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 49 32 — — $30,912.63 $99,352.66 $65,132.64 2024-10-01
83493 CDM Ins Icd Gen Only Sgl Ld 23 16 $162,708.89 $162,708.89 $34,461.74 $138,302.56 $65,083.56 2024-10-01
451301 CDM Kit Abl Cobra Fsn 150 35 22 $151,253.00 $151,253.00 $32,035.39 $128,565.05 $65,038.79 2024-10-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 53 33 — — $25,069.98 $109,266.81 $64,791.24 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 53 33 — — $28,771.64 $125,400.42 $64,701.31 2024-10-01
87877 CDM Revsc Tib/per St/ath Ini 23 16 $159,702.61 $159,702.61 $33,825.01 $135,747.22 $63,881.04 2024-10-01
87856 CDM Revsc Tib/per St/ath Ini 23 16 $159,702.61 $159,702.61 $33,825.01 $135,747.22 $63,881.04 2024-10-01
87860 CDM Revsc Fem/pop W Stnt/ath 23 16 $159,702.61 $159,702.61 $33,825.01 $135,747.22 $63,881.04 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 46 27 — — $6,248.00 $141,475.54 $63,775.35 2024-10-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 53 33 — — $28,301.90 $123,353.08 $63,644.96 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 1 1 — — $63,505.40 $63,505.40 $63,505.40 2024-10-01
472006 CDM Model Lf Vsp Bndl Recon 35 22 $147,571.00 $147,571.00 $31,255.54 $125,435.35 $63,455.53 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $63,354.77 $63,354.77 $63,354.77 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 13 10 $41,764.92 — $12,758.72 $63,988.32 $63,354.77 2026-07-30
901 MS_DRG Wound Debridements For Injuries With Mcc 53 33 — — $27,658.97 $120,550.87 $63,181.49 2024-10-01
470065 CDM System Embl 20% 1.5ml 35 22 $146,917.00 $146,917.00 $31,117.02 $124,879.45 $63,174.31 2024-10-01
955 OTHER $29,055.54 1 1 $145,880.31 — $62,944.38 $62,944.38 $62,944.38 2026-07-30
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 53 33 — — $27,876.90 $121,500.72 $62,689.23 2024-10-01
0408T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 11 2 — — $9,243.00 $91,417.54 $62,548.84 2024-10-01
0571T CPT Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S… 11 2 — — $6,778.00 $91,417.54 $62,548.84 2024-10-01
236794 CDM Template Trn Bndl Recon 35 22 $144,440.00 $144,440.00 $30,592.39 $122,774.00 $62,109.20 2024-10-01
01596 OTHER New Technology - Level 45 1 1 — — $62,106.68 $62,106.68 $62,106.68 2024-10-01
01582 OTHER New Technology - Level 45 1 1 — — $62,106.68 $62,106.68 $62,106.68 2024-10-01
1596 OTHER New Technology - Level 45 12 9 $64,635.67 — $54,157.02 $62,727.75 $62,106.68 2026-07-30
1582 OTHER New Technology - Level 45 12 9 $64,635.67 — $54,157.02 $62,727.75 $62,106.68 2026-07-30
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 32 15 — — $23,377.64 $101,890.80 $61,880.38 2024-10-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 53 33 — — $27,499.19 $119,854.49 $61,839.84 2024-10-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 53 33 — — $27,345.17 $119,183.19 $61,493.48 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 53 33 — — $26,577.61 $115,837.80 $61,424.77 2024-10-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 53 33 — — $24,843.10 $108,277.96 $61,265.33 2024-10-01
51947 CDM Set Vntrc 17.4x13.8in 35 22 $142,000.00 $142,000.00 $30,075.60 $120,700.00 $61,060.00 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 18 14 — — $1,751.00 $90,205.44 $61,041.87 2024-10-01
140 MS_DRG Major Head And Neck Procedures With Mcc 53 33 — — $24,145.84 $105,238.98 $59,701.09 2024-10-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 53 33 — — $26,309.19 $114,667.89 $59,194.04 2024-10-01
87881 CDM Revsc Fem/pop W Stnt/ath 23 16 $147,872.79 $147,872.79 $31,319.46 $125,691.87 $59,149.12 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 53 33 — — $25,827.31 $112,567.63 $58,582.14 2024-10-01
10 MS_DRG Pancreas Transplant 49 32 — — $30,763.72 $86,231.64 $58,497.68 2024-10-01
467171 CDM Retriever Endo 3mm 20mm 35 22 $135,754.00 $135,754.00 $28,752.70 $115,390.90 $58,374.22 2024-10-01
469315 CDM Retriever Endo 6x25mm 35 22 $135,754.00 $135,754.00 $28,752.70 $115,390.90 $58,374.22 2024-10-01
467172 CDM Retriever 20mm 4mm Endo 35 22 $135,754.00 $135,754.00 $28,752.70 $115,390.90 $58,374.22 2024-10-01
332 MS_DRG Rectal Resection With Mcc 53 33 — — $23,354.63 $101,790.53 $58,322.15 2024-10-01
020 OTHER $42,675.94 1 1 $239,766.72 — $58,011.73 $58,011.73 $58,011.73 2026-07-30
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 53 33 — — $24,905.73 $108,550.93 $57,642.73 2024-10-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 53 33 — — $25,595.32 $111,556.49 $57,558.42 2024-10-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 53 33 — — $24,933.85 $108,673.50 $57,447.38 2024-10-01
0431T CPT Removal And Replacement Of Neurostimulator System For Treatment Of Central Sleep… 11 2 — — $5,642.00 $83,671.67 $57,249.04 2024-10-01
0427T CPT Insertion Or Replacement Of Neurostimulator System For Treatment Of Central Slee… 11 2 — — $3,188.00 $83,671.67 $57,249.04 2024-10-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 53 33 — — $25,293.66 $110,241.73 $56,880.06 2024-10-01
45970 CDM Dvc Revasc 4mm 31mm 35 22 $131,961.00 $131,961.00 $27,949.34 $112,166.85 $56,743.23 2024-10-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 53 33 — — $24,214.22 $105,537.02 $56,720.56 2024-10-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 53 33 — — $25,933.40 $113,030.02 $56,709.93 2024-10-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 53 33 — — $24,994.56 $108,938.12 $56,677.09 2024-10-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 53 33 — — $25,656.67 $111,823.90 $56,385.06 2024-10-01
B0404 HCPCS $54,331.51 1 1 $55,496.95 — $56,384.01 $56,384.01 $56,384.01 2026-07-30
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 53 33 — — $23,111.77 $100,732.04 $56,052.64 2024-10-01
476541 CDM Device Embl 4.5mm 18mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476542 CDM Device Embl 4.50x25mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476543 CDM Device Embl 4.75mm 16mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470012 CDM Device Embl 30mm 3.25mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476540 CDM Device Embl 4.5mm 14mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470022 CDM Device Embl 4x35mm Pline 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476539 CDM Device Embl 4.25mm 20mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476550 CDM Device Embl 5mm 16mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470018 CDM Device Embl 30mm 3.75mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476549 CDM Device Embl 4.75mm 20mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
342704 CDM Device Embl 4.25mm 25mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476536 CDM Device Embl 4mm 18mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476535 CDM Device Embl 4mm 16mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
469033 CDM Graft Evas 26x14.5m 18cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476537 CDM Device Embl 4mm 30mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470003 CDM Device Embl 16mm 2.5mm P 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470014 CDM Device Embl 25mm 3.5mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476532 CDM Device Embl 3.75mm 16mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476538 CDM Device Emb 4.25mm 16mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476533 CDM Device Embl 3.75mm 20mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476552 CDM Device Embl 5mm 20mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470024 CDM Device Embl Pln 30x4.25 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470028 CDM Dev Embl Ppln 35x4.5mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476531 CDM Device Embl 3.5mm 18mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476534 CDM Device Embl 4mm 14mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476526 CDM Device Embl 2.75mm 16mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
558337 CDM Prosthesis Tmj Pt Cstm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476527 CDM Device Embl 3mm 14mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
456797 CDM Graft Evas 23x12mm 16cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476528 CDM Device Embl 3.25mm 16mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
466040 CDM Graft Evas 26x14.5m 12cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476529 CDM Device Embl 3.25mm 20mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
337896 CDM Device Embl 4.5mm 30mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476551 CDM Device Embl 5mm 18mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476525 CDM Device Embl 2.75mm 12mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470023 CDM Device Embl 25mm 4.25mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476349 CDM Device Embl 4.75mm 14mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476730 CDM Gft Evs 15f 20x14.5x12mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
50934 CDM Graft Evas 31x14.5m 13cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
562075 CDM Device Embl 4.75mm 12mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470034 CDM Device Embl 5x35mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470032 CDM Device Embl 5x25mm Pipln 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
464589 CDM Graft Evas 31x14.5m 17cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470015 CDM Dev Embl Ped 3.50x30mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
472066 CDM Graft Evas 26x14.5m 16cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470013 CDM Device Embl 35mm 3.25mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470016 CDM Device Embl 35mm 3.5mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
C1772 HCPCS Pump Infs Impl Hflo Cnst 19 14 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470001 CDM Device Embl 12mm 2.5mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470017 CDM Device Embl 25mm 3.75mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476530 CDM Device Embl 3.5mm 14mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
471389 CDM Stnt Thorac 28x28mm 10cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
471390 CDM Stent Graft 15cn 28x28mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
565213 CDM Device Embl 4.5mm 16mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
468084 CDM Stent Thor 37x37mm 20cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
566039 CDM Device Embl 3.25mm 14mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470693 CDM Graft Evas 10cm 10mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470851 CDM Stent Thor 31x26mm 10cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
341725 CDM Device Embl 4.25mm 14mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
471351 CDM Stent Thor 40x40mm 20cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
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