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

32,828 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 Latest re-check couldn't be parsed — showing last good data · 2026-09-21
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
$3,562,713
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
$3,765,001
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
773
OTHER 		Inj, Beqvez, Per Tx Dose 9 $3,143,560.00 $3,641,050.00 $3,605,000.00 nat. median
$3,677,100
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,325,455.00 $3,325,455.00 $3,325,455.00 nat. median
$3,225,691
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 10 $5,323.97 $3,358,709.55 $3,325,455.00 nat. median
$3,391,964
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
$3,351,720
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 10 $7,800.05 $2,997,680.00 $2,968,000.00 nat. median
$3,001,835
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
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,388,614.00 $2,388,614.00 $2,388,614.00 nat. median
$2,316,956
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
$2,508,045
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $529,192.90 $529,192.90 $529,192.90 nat. median
$513,317
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 9 $461,456.21 $534,484.83 $529,192.90 nat. median
$555,653
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $527,123.40 $527,123.40 $527,123.40 nat. median
$511,310
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 9 $459,651.60 $532,394.63 $527,123.40 nat. median
$553,480
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $526,587.60 $526,587.60 $526,587.60 nat. median
$510,790
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 9 $459,184.39 $531,853.48 $526,587.60 nat. median
$552,917
1.0× 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
$621,313
0.8× median
9413
OTHER 		Lisocabtagene Car Pos T 9 $450,585.16 $521,893.36 $516,726.10 nat. median
$542,562
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $516,726.10 $516,726.10 $516,726.10 nat. median
$501,224
1.0× 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
$599,737
0.8× median
9035
OTHER 		Axicabtagene Ciloleucel C 9 $426,805.63 $494,350.56 $489,456.00 nat. median
$513,929
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $489,456.00 $489,456.00 $489,456.00 nat. median
$474,772
1.0× 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
$574,037
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
$579,571
0.8× median
9391
OTHER 		Brexucabtagene Car Pos T 9 $401,582.51 $465,135.70 $460,530.40 nat. median
$483,557
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $460,530.40 $460,530.40 $460,530.40 nat. median
$446,714
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
$562,501
0.8× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 26 $235,461.70 $1,026,253.41 $456,366.92 nat. median
$168,055
outlier · 2.7×
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
$513,770
0.9× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 24 $173,187.15 $584,740.56 $301,183.32 nat. median
$186,516
1.6× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 26 $136,258.04 $593,876.96 $263,476.27 nat. median
$145,435
1.8× 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
$131,925
1.9× 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
$97,418
1.9× median
001
OTHER 		$143,270.04 1 $180,460.61 $180,460.61 $180,460.61 nat. median
$177,883
1.0× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 24 $77,162.65 $302,755.30 $158,369.00 nat. median
$65,418
outlier · 2.4×
018
OTHER 		$119,804.16 1 $148,906.56 $148,906.56 $148,906.56 nat. median
$149,977
1.0× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 25 $66,146.85 $231,265.52 $148,750.20 nat. median
$69,922
outlier · 2.1×
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 15 $56,633.21 $246,834.30 $147,214.18 nat. median
$2,106
outlier · 69.9×
1907
OTHER 		New Technology - Level 52 9 $127,060.17 $147,168.31 $145,711.20 nat. median
$149,948
1.0× median
1908
OTHER 		New Technology - Level 52 9 $127,060.17 $147,168.31 $145,711.20 nat. median
$149,948
1.0× median
01907
OTHER 		New Technology - Level 52 1 $145,711.20 $145,711.20 $145,711.20 nat. median
$145,788
1.0× median
01908
OTHER 		New Technology - Level 52 1 $145,711.20 $145,711.20 $145,711.20 nat. median
$145,788
1.0× median
7
MS_DRG 		Lung Transplant 25 $78,394.56 $247,490.80 $143,848.73 nat. median
$70,649
outlier · 2.0×
14
MS_DRG 		Allogeneic Bone Marrow Transplant 25 $73,246.61 $260,108.64 $132,224.83 nat. median
$72,715
1.8× median
222
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 9 $58,932.85 $170,171.43 $131,979.22 nat. median
$2,024
outlier · 65.2×
01906
OTHER 		New Technology - Level 51 1 $131,379.00 $131,379.00 $131,379.00 nat. median
$131,449
1.0× median
01905
OTHER 		New Technology - Level 51 1 $131,379.00 $131,379.00 $131,379.00 nat. median
$131,449
1.0× median
1906
OTHER 		New Technology - Level 51 9 $114,562.49 $132,692.79 $131,379.00 nat. median
$135,199
1.0× median

Other procedures at this hospital

Browse this hospital's 32,828 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
             
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,672,900.00 $3,672,900.00 $3,672,900.00 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 12 9 — — $3,202,768.80 $3,709,629.00 $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
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,325,455.00 $3,325,455.00 $3,325,455.00 2024-10-01
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
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,286,000.00 $3,286,000.00 $3,286,000.00 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
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,968,000.00 $2,968,000.00 $2,968,000.00 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
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
9194 OTHER Tisagenlecleucel Car-pos 12 9 $456,125.88 — $461,456.21 $534,484.83 $529,192.90 2026-07-30
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $529,192.90 $529,192.90 $529,192.90 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $527,123.40 $527,123.40 $527,123.40 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 12 9 $481,344.75 — $459,651.60 $532,394.63 $527,123.40 2026-07-30
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
9413 OTHER Lisocabtagene Car Pos T 12 9 $437,092.59 — $450,585.16 $521,893.36 $516,726.10 2026-07-30
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $516,726.10 $516,726.10 $516,726.10 2024-10-01
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
9035 OTHER Axicabtagene Ciloleucel C 12 9 $424,999.19 — $426,805.63 $494,350.56 $489,456.00 2026-07-30
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $489,456.00 $489,456.00 $489,456.00 2024-10-01
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
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $460,530.40 $460,530.40 $460,530.40 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
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
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 45 26 — — $235,461.70 $1,026,253.41 $456,366.92 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 38 24 — — $173,187.15 $584,740.56 $301,183.32 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 45 26 — — $136,258.04 $593,876.96 $263,476.27 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
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
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 38 24 — — $77,162.65 $302,755.30 $158,369.00 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 42 25 — — $66,146.85 $231,265.52 $148,750.20 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
01908 OTHER New Technology - Level 52 1 1 — — $145,711.20 $145,711.20 $145,711.20 2024-10-01
01907 OTHER New Technology - Level 52 1 1 — — $145,711.20 $145,711.20 $145,711.20 2024-10-01
1907 OTHER New Technology - Level 52 12 9 $151,644.55 — $127,060.17 $147,168.31 $145,711.20 2026-07-30
1908 OTHER New Technology - Level 52 12 9 $151,644.55 — $127,060.17 $147,168.31 $145,711.20 2026-07-30
7 MS_DRG Lung Transplant 42 25 — — $78,394.56 $247,490.80 $143,848.73 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 39 25 — — $73,246.61 $260,108.64 $132,224.83 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
1905 OTHER New Technology - Level 51 12 9 $136,728.74 — $114,562.49 $132,692.79 $131,379.00 2026-07-30
1906 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
01906 OTHER New Technology - Level 51 1 1 — — $131,379.00 $131,379.00 $131,379.00 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 46 27 — — $62,026.57 $270,341.13 $129,135.51 2024-10-01
215 MS_DRG Other Heart Assist System Implant 42 26 — — $65,282.79 $284,533.25 $125,189.10 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
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 46 27 — — $54,019.29 $235,441.60 $121,477.89 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
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
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
231 MS_DRG Coronary Bypass With Ptca With Mcc 46 27 — — $51,864.24 $226,048.90 $111,421.80 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
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
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 46 27 — — $49,282.28 $214,795.48 $103,644.90 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
1901 OTHER New Technology - Level 49 12 9 $106,897.12 — $89,567.13 $103,741.75 $102,714.60 2026-07-30
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
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 46 27 — — $49,847.24 $217,257.86 $101,904.54 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
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 35 25 — — $46,222.91 $201,461.29 $99,520.00 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 46 27 — — $53,872.30 $185,192.91 $98,610.50 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
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
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 26 18 — — $68,835.54 $300,017.85 $92,537.51 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
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
1585 OTHER New Technology - Level 48 12 9 $94,467.28 — $79,152.38 $91,678.79 $90,771.08 2026-07-30
01599 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
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 45 26 — — $51,086.46 $222,658.94 $90,443.14 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 46 27 — — $43,808.39 $190,937.67 $89,568.93 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 46 27 — — $39,116.45 $171,068.70 $88,264.20 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 46 27 — — $39,918.83 $173,985.12 $87,827.33 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 46 27 — — $44,512.68 $194,007.29 $86,628.14 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
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 46 27 — — $43,922.79 $191,436.27 $85,403.98 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
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 46 27 — — $40,680.63 $177,305.43 $83,397.26 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 46 27 — — $43,337.80 $189,929.32 $83,304.62 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 46 27 — — $44,149.03 $192,422.34 $81,849.88 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
01584 OTHER New Technology - Level 47 1 1 — — $81,216.28 $81,216.28 $81,216.28 2024-10-01
01598 OTHER New Technology - Level 47 1 1 — — $81,216.28 $81,216.28 $81,216.28 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
834 MS_DRG Acute Leukemia With Mcc 46 27 — — $16,243.00 $155,960.15 $81,207.81 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 35 25 — — $38,922.47 $169,642.52 $79,178.00 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
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 46 27 — — $37,582.91 $163,804.11 $78,517.04 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 46 27 — — $36,407.61 $158,681.58 $78,160.45 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
232 MS_DRG Coronary Bypass With Ptca Without Mcc 46 27 — — $38,017.50 $165,698.25 $77,063.62 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
28 MS_DRG Spinal Procedures With Mcc 46 27 — — $38,512.81 $167,857.02 $76,657.65 2024-10-01
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
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 46 27 — — $39,739.88 $173,205.18 $75,921.35 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 46 27 — — $38,644.46 $168,430.83 $75,553.57 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 46 27 — — $38,827.24 $132,825.73 $74,731.78 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 46 27 — — $35,183.73 $153,347.35 $73,802.74 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
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 46 27 — — $36,229.30 $157,904.42 $73,426.28 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 37 24 — — $47,090.88 $192,748.24 $73,138.87 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
01597 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
01583 OTHER New Technology - Level 46 1 1 — — $71,661.48 $71,661.48 $71,661.48 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 38 24 — — $39,477.21 $140,409.88 $71,518.00 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 46 27 — — $36,196.71 $157,762.36 $71,352.93 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
653 MS_DRG Major Bladder Procedures With Mcc 46 27 — — $34,598.32 $150,795.83 $70,409.42 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 46 27 — — $33,219.78 $144,787.50 $69,963.07 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 46 27 — — $30,958.00 $134,929.62 $69,534.82 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 46 27 — — $33,518.24 $146,088.33 $69,528.38 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 46 27 — — $36,320.69 $158,302.75 $69,397.12 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 46 27 — — $31,189.36 $135,937.97 $69,177.73 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 46 27 — — $33,147.56 $144,472.74 $68,761.74 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
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
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
002 OTHER $75,287.60 1 1 $294,896.00 — $68,012.14 $68,012.14 $68,012.14 2026-07-30
228 MS_DRG Other Cardiothoracic Procedures With Mcc 46 27 — — $32,202.33 $140,352.99 $67,872.57 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
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 46 27 — — $32,318.65 $140,859.95 $66,720.38 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 46 27 — — $31,664.85 $138,010.38 $66,211.01 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 43 26 — — $33,627.52 $114,529.13 $66,048.60 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 46 27 — — $32,953.91 $143,628.74 $65,855.66 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 26 18 — — $44,965.80 $195,982.21 $65,606.16 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $65,476.58 $65,476.58 $65,476.58 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
245 MS_DRG Aicd Generator Procedures 46 27 — — $28,960.18 $126,222.15 $65,125.28 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
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 45 26 — — $32,459.89 $141,475.54 $64,784.43 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 46 27 — — $31,437.33 $137,018.74 $64,568.40 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 46 27 — — $31,950.53 $139,255.50 $64,522.68 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 46 27 — — $30,124.62 $131,297.33 $64,378.36 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 46 27 — — $29,575.63 $128,904.58 $63,990.79 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
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
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
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
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
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 46 27 — — $28,957.62 $101,273.70 $63,071.07 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
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
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 46 27 — — $30,720.26 $133,893.41 $62,305.54 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 46 27 — — $28,866.87 $125,815.46 $62,229.34 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
1582 OTHER New Technology - Level 45 12 9 $64,635.67 — $54,157.02 $62,727.75 $62,106.68 2026-07-30
1596 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
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
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 46 27 — — $30,295.90 $132,043.84 $60,531.10 2024-10-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 46 27 — — $28,301.90 $123,353.08 $59,991.75 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 46 27 — — $29,709.20 $129,486.75 $59,729.62 2024-10-01
10 MS_DRG Pancreas Transplant 43 26 — — $30,763.72 $86,231.64 $59,564.64 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
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 46 27 — — $28,222.66 $123,007.68 $58,854.73 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
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
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
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 46 27 — — $28,771.64 $125,400.42 $58,294.43 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
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 26 18 — — $39,689.39 $172,985.12 $57,563.85 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
6 MS_DRG Liver Transplant Without Mcc 42 25 — — $30,912.63 $99,352.66 $57,021.49 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
B0404 HCPCS $54,331.51 1 1 $55,496.95 — $56,384.01 $56,384.01 $56,384.01 2026-07-30
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 46 27 — — $25,069.98 $109,266.81 $56,377.04 2024-10-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 46 27 — — $26,309.19 $114,667.89 $56,218.66 2024-10-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 46 27 — — $27,876.90 $121,500.72 $56,184.37 2024-10-01
470051 CDM Device Embl 10mm 3.25mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470046 CDM Device Embl 12mm 3mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
458549 CDM Graft Evas 23x14.5m 12cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470052 CDM Dev Embl Ped 12x3.25mm 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
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
470044 CDM Device Embl 20mm 2.75mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470048 CDM Dev Embl 16x3mm 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
470058 CDM Device Embl 12mm 3.5mm 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
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
470027 CDM Device Embl 30mm 4.5mm 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
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
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
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
470031 CDM Device Embl 4.75x35mm Pl 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470021 CDM Device Embl 30mm 4mm 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
470011 CDM Device Embl 25mm 3.25mm 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
470033 CDM Device Embl 5x30mm 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
476656 CDM Device Embl 4.25mm 12mm 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
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
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
470030 CDM Device Embl 30mm 4.75mm 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
470007 CDM Device Embl Pip2.75x12mm 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
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
476553 CDM Device Embl 5mm 25mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476554 CDM Device Embl 5mm 30mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
465796 CDM Kit Impl Crnl Cstm Lg 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
470025 CDM Device Embl 35mm 4.25mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
476613 CDM Device Embl 2.5mm 12mm 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
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
455140 CDM Graft Evas 14.5mm 18cm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470019 CDM Device Embl 35mm 3.75mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
463940 CDM Implant Cranial Med 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470042 CDM Dev Embl 16x2.75mm 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
470004 CDM Device Embl 18mm 2.5mm P 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
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
470010 CDM Device Embl 35mm 3mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
340637 CDM Device Embl 2.5mm 14mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470055 CDM Dev Embl 18x3.25mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
340778 CDM Device Embl 4.5mm 20mm 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
470005 CDM Device Embl 20mm 2.5mm 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
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
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
470057 CDM Device Embl 3.5x10mm 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
470204 CDM Graft Stnt 15cm 37mm 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
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
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
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
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
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
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
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
470009 CDM Device Embl 30mm 3mm 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
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
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
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
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
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
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
337897 CDM Device Embl 5mm 35mm 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470050 CDM Device Emb 20mm 3mm Pip 20 15 $116,640.00 $116,640.00 $37,091.52 $99,144.00 $55,987.20 2024-10-01
470060 CDM Device Embl Pipln 16x3.5 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
470347 CDM Device Embl 5x20mm Pipln 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
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
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