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

TIMPANOGOS REGIONAL HOSPITAL

Orem, UT · CCN 460052 · Rates published

24,639 distinct procedures filed
32 distinct payers
552,610 rate rows
2026-07-17 last MRF observed
Data quality

526,301 of 552,610 rate rows are consumer-grade (95.2%)

26,309 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 17,932
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 5,352
per-diem day rate — not a per-procedure price 2,391
template filing: same amount across many unrelated codes — excluded 256
percent-of-charges filed in the dollar field — excluded from medians 198
placeholder amount (≤ $0.02) — excluded from medians 94
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 58
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 17
exceeds 10× this hospital's gross charge — excluded from medians 11
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.hcadam.com/api/public/content/66b2df40ef8849b7a94bf34274cf69c7?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 f273903795f1c90c… · 301,130,790 bytes · first seen 2026-05-06

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 8 $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 8 $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 9 $5,166.40 $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 9 $8,521.96 $3,318,860.00 $3,286,000.00 nat. median
$3,351,720
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 9 $7,569.19 $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
9141
OTHER 		Inj Onase Abepar-xioi Tre 8 $2,082,871.41 $2,412,500.14 $2,388,614.00 nat. median
$2,508,045
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
9194
OTHER 		Tisagenlecleucel Car-pos 8 $461,456.21 $534,484.83 $529,192.90 nat. median
$555,653
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
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 8 $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 8 $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
09413
OTHER 		Lisocabtagene Car Pos T 1 $516,726.10 $516,726.10 $516,726.10 nat. median
$501,224
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 8 $450,585.16 $521,893.36 $516,726.10 nat. median
$542,562
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 8 $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
09391
OTHER 		Brexucabtagene Car Pos T 1 $460,530.40 $460,530.40 $460,530.40 nat. median
$446,714
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 8 $401,582.51 $465,135.70 $460,530.40 nat. median
$483,557
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
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
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 25 $235,461.70 $1,026,253.41 $433,276.28 nat. median
$168,055
outlier · 2.6×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 23 $173,187.15 $626,166.29 $297,112.04 nat. median
$186,516
1.6× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 25 $136,258.04 $593,876.96 $252,691.99 nat. median
$145,435
1.7× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 23 $146,105.99 $734,221.59 $240,492.58 nat. median
$131,925
1.8× median
001
OTHER 		$143,270.04 1 $175,119.46 $175,119.46 $175,119.46 nat. median
$177,883
1.0× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 25 $93,947.70 $409,468.50 $162,014.85 nat. median
$97,418
1.7× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 23 $74,794.12 $299,736.06 $158,369.00 nat. median
$65,418
outlier · 2.4×
1908
OTHER 		New Technology - Level 52 8 $127,060.17 $147,168.31 $145,711.20 nat. median
$149,948
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
1907
OTHER 		New Technology - Level 52 8 $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
018
OTHER 		$114,450.56 1 $144,499.39 $144,499.39 $144,499.39 nat. median
$149,977
1.0× median
7
MS_DRG 		Lung Transplant 24 $78,394.56 $271,575.80 $143,490.00 nat. median
$70,649
outlier · 2.0×
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 24 $66,146.85 $253,771.53 $139,083.41 nat. median
$69,922
2.0× median
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 15 $56,633.21 $246,834.30 $132,329.86 nat. median
$2,106
outlier · 62.8×
14
MS_DRG 		Allogeneic Bone Marrow Transplant 24 $73,246.61 $260,108.64 $131,895.91 nat. median
$72,715
1.8× median
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 8 $114,562.49 $132,692.79 $131,379.00 nat. median
$135,199
1.0× median
215
MS_DRG 		Other Heart Assist System Implant 25 $65,282.79 $284,533.25 $121,108.00 nat. median
$73,023
1.7× median

Other procedures at this hospital

Browse this hospital's 24,639 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 11 8 — — $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 11 8 $3,343.43 — $3,143,560.00 $3,641,050.00 $3,605,000.00 2026-07-17
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 12 9 $21,543.51 — $5,166.40 $3,358,709.55 $3,325,455.00 2026-07-17
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 12 9 $31,257.58 — $8,521.96 $3,318,860.00 $3,286,000.00 2026-07-17
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 12 9 $37,378.74 — $7,569.19 $2,997,680.00 $2,968,000.00 2026-07-17
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,388,614.00 $2,388,614.00 $2,388,614.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 11 8 — — $2,082,871.41 $2,412,500.14 $2,388,614.00 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 11 8 $456,125.88 — $461,456.21 $534,484.83 $529,192.90 2026-07-17
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 11 8 $481,344.75 — $459,651.60 $532,394.63 $527,123.40 2026-07-17
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $526,587.60 $526,587.60 $526,587.60 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 11 8 $446,893.35 — $459,184.39 $531,853.48 $526,587.60 2026-07-17
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 11 8 $437,092.59 — $450,585.16 $521,893.36 $516,726.10 2026-07-17
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
9035 OTHER Axicabtagene Ciloleucel C 11 8 $424,999.19 — $426,805.63 $494,350.56 $489,456.00 2026-07-17
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 11 8 $425,054.70 — $401,582.51 $465,135.70 $460,530.40 2026-07-17
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
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 44 25 — — $235,461.70 $1,026,253.41 $433,276.28 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 37 23 — — $173,187.15 $626,166.29 $297,112.04 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 44 25 — — $136,258.04 $593,876.96 $252,691.99 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 36 23 — — $146,105.99 $734,221.59 $240,492.58 2024-10-01
001 OTHER $143,270.04 1 1 $625,739.47 — $175,119.46 $175,119.46 $175,119.46 2026-07-17
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 44 25 — — $93,947.70 $409,468.50 $162,014.85 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 37 23 — — $74,794.12 $299,736.06 $158,369.00 2024-10-01
1907 OTHER New Technology - Level 52 11 8 $149,980.11 — $127,060.17 $147,168.31 $145,711.20 2026-07-17
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
1908 OTHER New Technology - Level 52 11 8 $149,980.11 — $127,060.17 $147,168.31 $145,711.20 2026-07-17
018 OTHER $114,450.56 1 1 $868,655.07 — $144,499.39 $144,499.39 $144,499.39 2026-07-17
7 MS_DRG Lung Transplant 41 24 — — $78,394.56 $271,575.80 $143,490.00 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 41 24 — — $66,146.85 $253,771.53 $139,083.41 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 32 15 — — $56,633.21 $246,834.30 $132,329.86 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 38 24 — — $73,246.61 $260,108.64 $131,895.91 2024-10-01
01906 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 11 8 $135,228.02 — $114,562.49 $132,692.79 $131,379.00 2026-07-17
01905 OTHER New Technology - Level 51 1 1 — — $131,379.00 $131,379.00 $131,379.00 2024-10-01
215 MS_DRG Other Heart Assist System Implant 41 25 — — $65,282.79 $284,533.25 $121,108.00 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 7 1 — — $91,667.21 $147,977.07 $120,476.91 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 45 26 — — $62,026.57 $270,341.13 $118,305.63 2024-10-01
003 OTHER $109,359.47 1 1 $443,152.07 — $117,295.01 $117,295.01 $117,295.01 2026-07-17
1904 OTHER New Technology - Level 50 11 8 $120,475.92 — $102,064.81 $118,217.27 $117,046.80 2026-07-17
1903 OTHER New Technology - Level 50 11 8 $120,475.92 — $102,064.81 $118,217.27 $117,046.80 2026-07-17
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
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 20 9 — — $58,932.85 $170,336.38 $116,985.19 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 45 26 — — $54,019.29 $235,441.60 $112,979.28 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 20 9 — — $54,565.57 $158,171.79 $108,315.88 2024-10-01
1901 OTHER New Technology - Level 49 11 8 $105,723.83 — $89,567.13 $103,741.75 $102,714.60 2026-07-17
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 11 8 $105,723.83 — $89,567.13 $103,741.75 $102,714.60 2026-07-17
231 MS_DRG Coronary Bypass With Ptca With Mcc 45 26 — — $51,864.24 $226,048.90 $100,287.64 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 19 9 $96,923.94 — $87,199.91 $100,999.90 $99,999.90 2026-07-17
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 25 17 — — $68,835.54 $300,017.85 $98,459.00 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 45 26 — — $49,282.28 $214,795.48 $98,015.64 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 45 26 — — $53,872.30 $187,969.35 $97,905.00 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 20 9 — — $49,267.73 $142,400.82 $97,799.35 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 32 15 — — $42,387.03 $184,742.72 $97,400.57 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 34 24 — — $46,222.91 $201,461.29 $94,756.55 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 45 26 — — $49,847.24 $217,257.86 $94,054.07 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 12 9 — — $79,379.82 $91,942.22 $91,031.90 2024-10-01
1599 OTHER New Technology - Level 48 11 8 $93,430.42 — $79,152.38 $91,678.79 $90,771.08 2026-07-17
01585 OTHER New Technology - Level 48 1 1 — — $90,771.08 $90,771.08 $90,771.08 2024-10-01
01599 OTHER New Technology - Level 48 1 1 — — $90,771.08 $90,771.08 $90,771.08 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 32 15 — — $33,877.00 $170,369.54 $89,627.39 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 44 25 — — $51,086.46 $222,658.94 $86,188.89 2024-10-01
0424T CPT Insertion Or Replacement Of Neurostimulator System For Treatment Of Central Slee… 11 2 — — $5,528.00 $124,301.13 $85,250.78 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 45 26 — — $43,501.16 $191,436.27 $85,191.00 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 45 26 — — $43,808.39 $190,937.67 $84,046.20 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 45 26 — — $44,512.68 $194,007.29 $83,495.40 2024-10-01
004 OTHER $70,165.69 1 1 $276,542.39 — $82,472.97 $82,472.97 $82,472.97 2026-07-17
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 45 26 — — $38,192.60 $171,068.70 $82,448.04 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 11 2 $55,114.75 — $55,453.60 $119,921.11 $82,246.78 2026-07-17
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 11 8 $83,595.69 — $70,820.60 $82,028.44 $81,216.28 2026-07-17
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 11 8 $83,595.69 — $70,820.60 $82,028.44 $81,216.28 2026-07-17
834 MS_DRG Acute Leukemia With Mcc 45 26 — — $16,243.00 $155,960.15 $80,468.83 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 45 26 — — $39,918.83 $173,985.12 $80,158.90 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 $79,736.51 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 34 24 — — $38,922.47 $169,642.52 $79,178.00 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 45 26 — — $44,149.03 $192,422.34 $77,947.86 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 45 26 — — $42,253.66 $189,929.32 $77,906.19 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 20 9 — — $38,929.12 $118,176.04 $77,276.60 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 45 26 — — $40,680.63 $177,305.43 $77,099.83 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 20 9 — — $38,644.33 $111,695.51 $76,711.27 2024-10-01
014 OTHER $63,324.19 1 1 $233,374.58 — $76,631.57 $76,631.57 $76,631.57 2026-07-17
651 OTHER $24,957.60 1 1 $85,784.39 — $74,627.95 $74,627.95 $74,627.95 2026-07-17
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 25 17 — — $44,965.80 $195,982.21 $74,608.11 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 17 13 — — $1,751.00 $113,368.99 $74,175.21 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 45 26 — — $38,827.24 $136,647.75 $74,170.19 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 36 23 — — $45,864.23 $192,748.24 $74,163.01 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 45 26 — — $37,582.91 $163,804.11 $72,672.45 2024-10-01
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 11 8 $73,760.96 — $62,488.81 $72,378.09 $71,661.48 2026-07-17
01583 OTHER New Technology - Level 46 1 1 — — $71,661.48 $71,661.48 $71,661.48 2024-10-01
1583 OTHER New Technology - Level 46 11 8 $73,760.96 — $62,488.81 $72,378.09 $71,661.48 2026-07-17
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 37 23 — — $39,477.21 $140,409.88 $71,518.00 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 45 26 — — $38,512.81 $167,857.02 $71,376.36 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 45 26 — — $39,739.88 $173,205.18 $71,291.35 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 45 26 — — $38,017.50 $165,698.25 $71,137.12 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 45 26 — — $36,407.61 $158,681.58 $70,399.82 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 45 26 — — $36,229.30 $157,904.42 $69,602.12 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 32 15 — — $28,534.00 $128,288.99 $69,001.05 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 45 26 — — $36,320.69 $158,302.75 $68,601.46 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 45 26 — — $33,219.78 $144,787.50 $67,340.00 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 45 26 — — $35,183.73 $153,347.35 $67,300.83 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 45 26 — — $34,598.32 $150,795.83 $66,901.27 2024-10-01
007 OTHER $55,047.40 1 1 $250,614.36 — $66,119.11 $66,119.11 $66,119.11 2026-07-17
002 OTHER $73,265.43 1 1 $323,982.90 — $65,999.16 $65,999.16 $65,999.16 2026-07-17
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 12 9 — — $57,440.12 $66,530.42 $65,871.70 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 42 25 — — $33,627.52 $124,385.20 $65,720.00 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 11 8 $60,092.80 — $57,095.58 $66,131.35 $65,476.58 2026-07-17
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 25 17 — — $39,689.39 $172,985.12 $65,396.25 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 17 13 — — $1,751.00 $99,629.42 $65,357.18 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 45 26 — — $30,958.00 $134,929.62 $65,074.61 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 45 26 — — $38,644.46 $168,430.83 $64,987.83 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 45 26 — — $33,518.24 $146,088.33 $64,812.77 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 45 26 — — $33,147.56 $144,472.74 $63,696.49 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 45 26 — — $36,196.71 $157,762.36 $63,653.99 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
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 12 9 $41,764.92 — $12,381.09 $63,988.32 $63,354.77 2026-07-17
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 45 26 — — $32,953.91 $143,628.74 $62,726.19 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 45 26 — — $31,189.36 $135,937.97 $62,670.33 2024-10-01
01596 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 11 8 $63,926.23 — $54,157.02 $62,727.75 $62,106.68 2026-07-17
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 11 8 $63,926.23 — $54,157.02 $62,727.75 $62,106.68 2026-07-17
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 45 26 — — $32,318.65 $140,859.95 $62,087.41 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 45 26 — — $31,664.85 $138,010.38 $61,519.06 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 44 25 — — $32,459.89 $141,475.54 $61,432.11 2024-10-01
955 OTHER $27,757.16 1 1 $145,880.31 — $61,081.39 $61,081.39 $61,081.39 2026-07-17
228 MS_DRG Other Cardiothoracic Procedures With Mcc 45 26 — — $32,202.33 $140,352.99 $60,861.37 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 45 26 — — $31,437.33 $137,018.74 $60,789.00 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 45 26 — — $29,575.63 $128,904.58 $60,742.20 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 45 26 — — $31,950.53 $139,255.50 $59,517.74 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 17 13 — — $1,751.00 $90,205.44 $59,308.87 2024-10-01
245 MS_DRG Aicd Generator Procedures 45 26 — — $28,960.18 $126,222.15 $59,214.14 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 45 26 — — $28,957.62 $107,077.04 $58,913.00 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 45 26 — — $30,124.62 $131,297.33 $58,250.67 2024-10-01
10 MS_DRG Pancreas Transplant 42 25 — — $30,763.72 $92,253.86 $57,893.65 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 45 26 — — $29,709.20 $129,486.75 $57,447.40 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 45 26 — — $28,222.66 $123,007.68 $56,532.00 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 41 24 — — $30,912.63 $106,992.50 $56,530.00 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 45 26 — — $30,720.26 $133,893.41 $56,470.81 2024-10-01
020 OTHER $40,768.91 1 1 $239,766.72 — $56,294.75 $56,294.75 $56,294.75 2026-07-17
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 45 26 — — $28,866.87 $125,815.46 $55,818.61 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 45 26 — — $30,295.90 $132,043.84 $55,624.38 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 44 25 — — $28,743.52 $125,277.86 $55,219.51 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 11 8 $53,773.06 — $47,973.28 $55,565.38 $55,015.23 2026-07-17
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $55,015.23 $55,015.23 $55,015.23 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 32 15 — — $23,377.64 $101,890.80 $54,948.38 2024-10-01
131 MS_DRG Cranial/facial Procedures W Cc/mcc 1 1 — — $54,842.89 $54,842.89 $54,842.89 2024-10-01
005 OTHER $50,789.07 1 1 $221,505.87 — $54,251.30 $54,251.30 $54,251.30 2026-07-17
453 OTHER $30,683.05 1 1 $213,115.66 — $54,127.47 $54,127.47 $54,127.47 2026-07-17
0268T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Pulse… 7 1 — — $41,101.87 $66,350.16 $54,019.60 2024-10-01
0266T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Total… 7 1 — — $41,101.87 $66,350.16 $54,019.60 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 4 2 $42,302.58 — $44,578.80 $65,181.79 $53,617.28 2026-07-17
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 45 26 — — $28,301.90 $123,353.08 $53,587.83 2024-10-01
901 MS_DRG Wound Debridements For Injuries With Mcc 45 26 — — $27,658.97 $120,550.87 $53,416.60 2024-10-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 45 26 — — $24,885.20 $109,266.81 $52,929.62 2024-10-01
01595 OTHER New Technology - Level 44 1 1 — — $52,551.88 $52,551.88 $52,551.88 2024-10-01
01581 OTHER New Technology - Level 44 1 1 — — $52,551.88 $52,551.88 $52,551.88 2024-10-01
1595 OTHER New Technology - Level 44 11 8 $54,091.50 — $45,825.24 $53,077.40 $52,551.88 2026-07-17
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 45 26 — — $28,771.64 $125,400.42 $52,539.80 2024-10-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 45 26 — — $27,876.90 $121,500.72 $52,299.35 2024-10-01
208208 CDM Graft Endo Aaa 26x12mm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
208542 CDM Graft Evas 40x40x10cm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
208467 CDM Stnt Thorac 26x26mm 10cm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
184730 CDM Stent Thor 40x40mm 20cm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
208444 CDM Stent Thor Act Cntrl 40x 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
565918 CDM Valve Aortic 29mm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
C1822 HCPCS Implant Pulse 8.5x15.5in 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
184729 CDM Stent Gft Thor Act 37x37 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
208442 CDM Stent Graft 20cm 45x45mm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
565916 CDM Valve Aortic 25mm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
565917 CDM Valve Aortic 27mm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
561707 CDM Valve Aortic 21mm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
208443 CDM Graft Stnt 15cm 37mm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
334978 CDM Stent Graft 20cm 34x20mm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
565915 CDM Valve Aortic 23mm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
183471 CDM Graft Evas 45x45mm 10cm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
334977 CDM Stent Gft 31x31mm 20cm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
186061 CDM Graft Evas 34x34x10cm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
334618 CDM Gft Evs 15f 20x14.5x12mm 18 13 $108,000.00 $108,000.00 $34,344.00 $91,800.00 $51,840.00 2024-10-01
C1767 HCPCS Ipg Nrstm Rechgfre 1.1cm 36 13 $107,999.50 $107,999.50 $34,343.68 $91,800.00 $51,839.52 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 37 23 — — $33,636.66 $97,221.61 $51,624.84 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 45 26 — — $26,577.61 $115,837.80 $51,391.98 2024-10-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 45 26 — — $27,345.17 $119,183.19 $51,278.04 2024-10-01
208348 CDM Graft Endo Aaa 23x12mm 18 13 $106,457.00 $106,457.00 $33,853.33 $90,488.45 $51,099.36 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 17 13 — — $1,751.00 $76,779.54 $50,692.14 2024-10-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 45 26 — — $24,843.10 $108,277.96 $50,385.67 2024-10-01
215 OTHER $42,674.09 1 1 $289,621.00 — $50,340.69 $50,340.69 $50,340.69 2026-07-17
31 MS_DRG Ventricular Shunt Procedures With Mcc 45 26 — — $26,309.19 $114,667.89 $50,045.42 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 45 26 — — $25,827.31 $112,567.63 $49,941.15 2024-10-01
565334 CDM Pump Pain Infn 148gm 18 13 $103,950.00 $103,950.00 $33,056.10 $88,357.50 $49,896.00 2024-10-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 45 26 — — $27,499.19 $119,854.49 $49,752.75 2024-10-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $49,748.18 $49,748.18 $49,748.18 2024-10-01
5244 OTHER Level 4 Blood Product Exc 11 8 $41,352.63 — $43,380.41 $50,245.66 $49,748.18 2026-07-17
0571T CPT Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S… 11 2 — — $6,465.00 $72,492.51 $49,718.31 2024-10-01
0408T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 11 2 — — $10,265.00 $72,492.51 $49,718.31 2024-10-01
140 MS_DRG Major Head And Neck Procedures With Mcc 44 25 — — $24,145.84 $105,238.98 $48,977.13 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 25 17 — — $30,564.32 $133,213.75 $48,791.00 2024-10-01
216 OTHER $40,531.82 1 1 $232,861.56 — $48,729.44 $48,729.44 $48,729.44 2026-07-17
217 OTHER $26,935.67 1 1 $150,384.78 — $48,458.47 $48,458.47 $48,458.47 2026-07-17
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 13 12 — — $46,035.49 $72,512.63 $48,433.18 2024-10-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 45 26 — — $24,933.85 $108,673.50 $48,213.50 2024-10-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 45 26 — — $24,905.73 $108,550.93 $48,159.13 2024-10-01
C1722 HCPCS Icd Crd .99x5.37x7.79cm 18 13 $100,000.00 $100,000.00 $31,800.00 $85,000.00 $48,000.00 2024-10-01
332 MS_DRG Rectal Resection With Mcc 45 26 — — $23,354.63 $101,790.53 $47,964.63 2024-10-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 45 26 — — $24,994.56 $108,938.12 $47,794.61 2024-10-01
C1820 HCPCS Ipg Nrstm 17mm 47mm 72 13 $103,999.50 $103,999.50 $23,969.25 $91,800.00 $47,760.00 2024-10-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 45 26 — — $25,595.32 $111,556.49 $47,476.97 2024-10-01
181537 CDM Procssr Dual Naida Ciq90 33 20 $118,450.00 $118,450.00 $25,087.71 $100,682.50 $47,380.00 2024-10-01
180677 CDM Set Pump Asst 2.5in 33 20 $118,450.00 $118,450.00 $25,087.71 $100,682.50 $47,380.00 2024-10-01
185748 CDM Distractr Exfx Mod Red2 33 20 $118,450.00 $118,450.00 $25,087.71 $100,682.50 $47,380.00 2024-10-01
185509 CDM System Mech Thrmb 33 20 $118,450.00 $118,450.00 $25,087.71 $100,682.50 $47,380.00 2024-10-01
562906 CDM Kit Lo Prfl Comp Shth 7f 33 20 $118,450.00 $118,450.00 $25,087.71 $100,682.50 $47,380.00 2024-10-01
181606 CDM Set Vntrc 17.4x13.8in 33 20 $118,450.00 $118,450.00 $25,087.71 $100,682.50 $47,380.00 2024-10-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 45 26 — — $24,214.22 $105,537.02 $46,821.99 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 19 9 $42,819.53 — $41,642.36 $48,232.55 $46,799.90 2026-07-17
129 MS_DRG Major Head & Neck Procedures W Cc/mcc Or Major Device 1 1 — — $46,685.69 $46,685.69 $46,685.69 2024-10-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 45 26 — — $23,111.77 $100,732.04 $46,098.34 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 25 17 — — $28,506.42 $124,244.44 $46,035.00 2024-10-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 45 26 — — $24,608.55 $107,255.68 $46,006.33 2024-10-01
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 20 9 — — $23,166.43 $66,959.02 $45,986.74 2024-10-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 45 26 — — $23,771.32 $103,606.67 $45,965.58 2024-10-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 45 26 — — $23,243.43 $101,305.85 $45,931.51 2024-10-01
177889 CDM Graft Evas 26x14.5m 12cm 18 13 $95,662.00 $95,662.00 $30,420.52 $81,312.70 $45,917.76 2024-10-01
208241 CDM Graft Evas 23x12mm 16cm 18 13 $95,662.00 $95,662.00 $30,420.52 $81,312.70 $45,917.76 2024-10-01
176769 CDM Graft Evas 23x14.5m 12cm 18 13 $95,662.00 $95,662.00 $30,420.52 $81,312.70 $45,917.76 2024-10-01
178879 CDM Graft Evas 14.5mm 12cm 18 13 $95,662.00 $95,662.00 $30,420.52 $81,312.70 $45,917.76 2024-10-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 20 9 — — $23,055.59 $66,638.66 $45,766.71 2024-10-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 45 26 — — $25,293.66 $110,241.73 $45,716.09 2024-10-01
0431T CPT Removal And Replacement Of Neurostimulator System For Treatment Of Central Sleep… 11 2 — — $5,528.00 $66,350.16 $45,505.64 2024-10-01
0427T CPT Insertion Or Replacement Of Neurostimulator System For Treatment Of Central Slee… 11 2 — — $2,344.00 $66,350.16 $45,505.64 2024-10-01
01142 OTHER Supprelin La Implant 1 1 — — $45,350.21 $45,350.21 $45,350.21 2024-10-01
1142 OTHER Supprelin La Implant 11 8 $38,460.27 — $39,545.38 $45,803.71 $45,350.21 2026-07-17
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 45 26 — — $23,633.92 $103,007.79 $45,319.04 2024-10-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 45 26 — — $21,926.24 $95,564.93 $45,032.04 2024-10-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 25 17 — — $26,458.74 $115,319.70 $44,968.63 2024-10-01
33264 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 23 10 — — $1,348.00 $73,093.00 $44,906.86 2024-10-01
33270 CPT Insertion Or Replacement Of Permanent Subcutaneous Implantable Defibrillator Sys… 23 10 — — $1,348.00 $73,093.00 $44,906.86 2024-10-01
33231 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multi… 23 10 — — $1,568.00 $73,093.00 $44,906.86 2024-10-01
33249 CPT Insertion Or Replacement Of Permanent Implantable Defibrillator System, With Tra… 23 10 — — $1,568.00 $73,093.00 $44,906.86 2024-10-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 45 26 — — $22,847.83 $99,581.63 $44,684.34 2024-10-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 45 26 — — $23,788.58 $103,681.88 $44,562.41 2024-10-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 45 26 — — $25,933.40 $113,030.02 $44,517.48 2024-10-01
C1721 HCPCS Icd Defb Dlchmbr MRI Is1 54 13 $96,671.00 $96,671.00 $23,215.59 $85,000.00 $44,461.51 2024-10-01
178958 CDM Graft Evas 10cm 14.5mm 18 13 $92,573.00 $92,573.00 $29,438.21 $78,687.05 $44,435.04 2024-10-01
177883 CDM Graft Evas 10cm 12mm 18 13 $92,573.00 $92,573.00 $29,438.21 $78,687.05 $44,435.04 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 17 13 — — $1,751.00 $66,907.78 $44,356.45 2024-10-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 45 26 — — $25,656.67 $111,823.90 $44,262.45 2024-10-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 45 26 — — $22,887.45 $99,754.33 $44,256.47 2024-10-01
021 OTHER $44,038.71 1 1 $174,971.48 — $44,172.48 $44,172.48 $44,172.48 2026-07-17
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 45 26 — — $18,351.00 $101,720.89 $44,036.08 2024-10-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 45 26 — — $24,449.41 $106,562.09 $43,974.64 2024-10-01
133 MS_DRG Other Ear, Nose, Mouth & Throat O.r. Procedures W Cc/mcc 1 1 — — $43,781.73 $43,781.73 $43,781.73 2024-10-01
231 OTHER $42,980.20 1 1 $202,165.30 — $43,743.20 $43,743.20 $43,743.20 2026-07-17
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 34 15 — — $2,975.00 $99,103.65 $43,537.17 2024-10-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 45 26 — — $20,155.94 $87,849.10 $43,500.00 2024-10-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 45 26 — — $23,152.68 $100,910.31 $43,396.58 2024-10-01
652 MS_DRG Kidney Transplant 41 24 — — $19,201.12 $69,028.27 $43,179.24 2024-10-01
019 OTHER $32,691.41 1 1 $154,935.64 — $43,087.14 $43,087.14 $43,087.14 2026-07-17
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 45 26 — — $22,280.94 $97,110.89 $43,083.70 2024-10-01
01594 OTHER New Technology - Level 43 1 1 — — $42,997.08 $42,997.08 $42,997.08 2024-10-01
1594 OTHER New Technology - Level 43 11 8 $44,256.77 — $37,493.45 $43,427.05 $42,997.08 2026-07-17
1580 OTHER New Technology - Level 43 11 8 $44,256.77 — $37,493.45 $43,427.05 $42,997.08 2026-07-17
01580 OTHER New Technology - Level 43 1 1 — — $42,997.08 $42,997.08 $42,997.08 2024-10-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 45 26 — — $22,529.55 $98,194.45 $42,925.40 2024-10-01
335965 CDM Valve Mitral 25mm 18 13 $89,021.00 $89,021.00 $28,308.68 $75,667.85 $42,730.08 2024-10-01
336873 CDM Valve Mitral 27mm 18 13 $89,021.00 $89,021.00 $28,308.68 $75,667.85 $42,730.08 2024-10-01
329128 CDM Valve Aortic 27mm 18 13 $89,021.00 $89,021.00 $28,308.68 $75,667.85 $42,730.08 2024-10-01
336875 CDM Valve Aortic 19mm 18 13 $89,021.00 $89,021.00 $28,308.68 $75,667.85 $42,730.08 2024-10-01
C9760 HCPCS Non-randomized, Non-blinded Procedure For Nyha Class Ii, Iii, IV Heart Failure; … 11 2 — — $10,265.00 $62,151.13 $42,625.78 2024-10-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 45 26 — — $22,081.54 $96,241.81 $42,561.74 2024-10-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 45 26 — — $20,810.37 $90,701.45 $42,554.89 2024-10-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 44 25 — — $22,102.63 $96,333.73 $42,483.62 2024-10-01
956 OTHER $26,689.57 1 1 $89,300.75 — $42,402.43 $42,402.43 $42,402.43 2026-07-17
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 45 26 — — $22,126.28 $96,436.80 $42,332.77 2024-10-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 45 26 — — $22,088.57 $96,272.45 $42,307.27 2024-10-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 45 26 — — $21,766.47 $94,868.56 $42,088.88 2024-10-01
957 OTHER $35,718.26 1 1 $172,127.78 — $41,901.28 $41,901.28 $41,901.28 2026-07-17
93656 CPT Comprehensive Electrophysiologic Evaluation With Transseptal Catheterizations, I… 39 19 $104,903.51 $104,903.51 $3,280.00 $89,167.98 $41,856.50 2024-10-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 45 26 — — $21,909.63 $95,492.51 $41,503.33 2024-10-01
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