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 — reason	Rows
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 via	Discovered 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.

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

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
748	OTHER	Inj, Lovotibeglogene Auto	13	10	$31,257.58	—	$8,781.88	$3,318,860.00	$3,286,000.00	2026-07-30
746	OTHER	Inj, Betibeglogene Autote	13	10	$37,378.74	—	$7,800.05	$2,997,680.00	$2,968,000.00	2026-07-30
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
9422	OTHER	Idecabtagene Vicleucel Ca	12	9	$446,893.35	—	$459,184.39	$531,853.48	$526,587.60	2026-07-30
9413	OTHER	Lisocabtagene Car Pos T	12	9	$437,092.59	—	$450,585.16	$521,893.36	$516,726.10	2026-07-30
9035	OTHER	Axicabtagene Ciloleucel C	12	9	$424,999.19	—	$426,805.63	$494,350.56	$489,456.00	2026-07-30
9391	OTHER	Brexucabtagene Car Pos T	12	9	$425,054.70	—	$401,582.51	$465,135.70	$460,530.40	2026-07-30
001	OTHER	$143,270.04	1	1	$569,561.13	—	$180,460.61	$180,460.61	$180,460.61	2026-07-30
018	OTHER	$119,804.16	1	1	$868,655.07	—	$148,906.56	$148,906.56	$148,906.56	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
1907	OTHER	New Technology - Level 52	12	9	$151,644.55	—	$127,060.17	$147,168.31	$145,711.20	2026-07-30
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
003	OTHER	$109,359.47	1	1	$443,152.07	—	$120,872.54	$120,872.54	$120,872.54	2026-07-30
1903	OTHER	New Technology - Level 50	12	9	$121,812.93	—	$102,064.81	$118,217.27	$117,046.80	2026-07-30
1904	OTHER	New Technology - Level 50	12	9	$121,812.93	—	$102,064.81	$118,217.27	$117,046.80	2026-07-30
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
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
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
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
004	OTHER	$70,165.69	1	1	$276,542.39	—	$84,988.40	$84,988.40	$84,988.40	2026-07-30
1584	OTHER	New Technology - Level 47	12	9	$84,523.41	—	$70,820.60	$82,028.44	$81,216.28	2026-07-30
1598	OTHER	New Technology - Level 47	12	9	$84,523.41	—	$70,820.60	$82,028.44	$81,216.28	2026-07-30
014	OTHER	$66,286.28	1	1	$233,374.58	—	$78,968.84	$78,968.84	$78,968.84	2026-07-30
651	OTHER	$25,453.78	1	1	$85,784.39	—	$76,904.11	$76,904.11	$76,904.11	2026-07-30
1583	OTHER	New Technology - Level 46	12	9	$74,579.54	—	$62,488.81	$72,378.09	$71,661.48	2026-07-30
1597	OTHER	New Technology - Level 46	12	9	$74,579.54	—	$62,488.81	$72,378.09	$71,661.48	2026-07-30
007	OTHER	$57,622.32	1	1	$228,114.42	—	$68,135.74	$68,135.74	$68,135.74	2026-07-30
002	OTHER	$75,287.60	1	1	$294,896.00	—	$68,012.14	$68,012.14	$68,012.14	2026-07-30
1643	OTHER	Y90 Ibritumomab, Rx	12	9	$60,092.80	—	$57,095.58	$66,131.35	$65,476.58	2026-07-30
717	OTHER	Instill Adstiladrin, Tx D	13	10	$41,764.92	—	$12,758.72	$63,988.32	$63,354.77	2026-07-30
955	OTHER	$29,055.54	1	1	$145,880.31	—	$62,944.38	$62,944.38	$62,944.38	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
1582	OTHER	New Technology - Level 45	12	9	$64,635.67	—	$54,157.02	$62,727.75	$62,106.68	2026-07-30
020	OTHER	$42,675.94	1	1	$239,766.72	—	$58,011.73	$58,011.73	$58,011.73	2026-07-30
B0404	HCPCS	$54,331.51	1	1	$55,496.95	—	$56,384.01	$56,384.01	$56,384.01	2026-07-30
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
00714	OTHER	Inj Delandistrogene Mox R	1	1	—	—	$3,325,455.00	$3,325,455.00	$3,325,455.00	2024-10-01
00748	OTHER	Inj, Lovotibeglogene Auto	1	1	—	—	$3,286,000.00	$3,286,000.00	$3,286,000.00	2024-10-01
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
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
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
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
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
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
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
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
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
01905	OTHER	New Technology - Level 51	1	1	—	—	$131,379.00	$131,379.00	$131,379.00	2024-10-01
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
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
01904	OTHER	New Technology - Level 50	1	1	—	—	$117,046.80	$117,046.80	$117,046.80	2024-10-01
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
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
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
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
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
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
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
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
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
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
01583	OTHER	New Technology - Level 46	1	1	—	—	$71,661.48	$71,661.48	$71,661.48	2024-10-01
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
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
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
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
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
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
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
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
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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