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

LEWISGALE MEDICAL CENTER

Salem, VA · CCN 490048 · Rates published

42,346 distinct procedures filed
54 distinct payers
1,430,732 rate rows
2026-07-17 last MRF observed
Data quality

866,660 of 1,430,732 rate rows are consumer-grade (60.6%)

564,072 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 518,339
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 40,687
per-diem day rate — not a per-procedure price 4,581
template filing: same amount across many unrelated codes — excluded 243
placeholder amount (≤ $0.02) — excluded from medians 132
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 60
exceeds 10× this hospital's gross charge — excluded from medians 30
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1760148_LEWISGALE-MEDICAL-CENTER_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.hcavirginia.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaCMS hospital list
Last fetch not_modified · 2026-08-11
Content fingerprint cd05c30cf964a66e… · 466,922,590 bytes · first seen 2026-06-08

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
845
OTHER 		Inj, Atidarsagene Autotem 18 $4,647.15 $4,820,350.00 $4,505,000.00 nat. median
$16,015
outlier · 281.3×
00845
OTHER 		Inj, Atidarsagene Autotem 3 $3,829,250.00 $4,369,850.00 $4,054,500.00 nat. median
$4,414,900
0.9× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 16 $3,672,900.00 $4,223,835.00 $3,736,818.52 nat. median
$3,758,972
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 14 $3,605,000.00 $4,145,750.00 $3,695,125.00 nat. median
$3,646,097
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 19 $5,150.11 $3,824,273.25 $3,336,179.65 nat. median
$3,325,455
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 18 $9,457.92 $3,569,327.40 $3,335,820.00 nat. median
$29,683
outlier · 112.4×
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 3 $3,121,965.00 $3,574,708.99 $3,311,175.15 nat. median
$3,574,709
0.9× median
748
OTHER 		Inj, Lovotibeglogene Auto 19 $8,495.09 $3,778,900.00 $3,286,000.00 nat. median
$3,252,508
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $3,064,250.00 $3,496,850.00 $3,244,500.00 nat. median
$3,496,850
0.9× median
906
OTHER 		Inj Elivaldogene Autoteme 18 $6,197.66 $3,402,600.00 $3,180,000.00 nat. median
$24,604
outlier · 129.2×
00908
OTHER 		Topi Adm Prad Zami Per Tr 3 $2,835,447.00 $3,235,745.40 $3,002,238.00 nat. median
$14,170
outlier · 211.9×
00714
OTHER 		Inj Delandistrogene Mox R 3 $2,826,636.75 $3,228,024.20 $2,993,991.75 nat. median
$3,228,024
0.9× median
746
OTHER 		Inj, Betibeglogene Autote 19 $7,545.33 $3,413,200.00 $2,968,000.00 nat. median
$2,939,969
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 3 $2,764,631.80 $3,187,420.00 $2,942,328.60 nat. median
$3,187,420
0.9× median
00906
OTHER 		Inj Elivaldogene Autoteme 3 $2,703,000.00 $3,084,600.00 $2,862,000.00 nat. median
$3,084,600
0.9× median
00746
OTHER 		Inj, Betibeglogene Autote 3 $2,498,973.65 $2,878,960.00 $2,658,586.05 nat. median
$2,878,960
0.9× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 16 $2,388,614.00 $2,770,209.67 $2,588,981.00 nat. median
$2,588,981
1.0× median
824
OTHER 		Inj, Exagamglogene Autote 18 $13,175.70 $2,495,240.00 $2,332,000.00 nat. median
$58,186
outlier · 40.1×
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 1 $2,311,860.00 $2,311,860.00 $2,311,860.00 nat. median
$809,151
outlier · 2.9×
09141
OTHER 		Inj Onase Abepar-xioi Tre 3 $2,030,321.90 $2,511,311.57 $2,258,794.71 nat. median
$2,511,312
0.9× median
00824
OTHER 		Inj, Exagamglogene Autote 3 $1,982,200.00 $2,262,040.00 $2,098,800.00 nat. median
$2,285,360
0.9× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 1 $834,750.00 $834,750.00 $834,750.00 nat. median
$302,242
outlier · 2.8×
2067
OTHER 		Afamitresgene Autoleucel 15 $770,620.00 $824,563.40 $776,939.08 nat. median
$786,032
1.0× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 $605,007.06 $605,007.06 $605,007.06 nat. median
$209,736
outlier · 2.9×
9498
OTHER 		Ciltacabtagene Car-pos T 15 $527,123.40 $628,785.07 $587,649.60 nat. median
$587,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 16 $529,192.90 $608,571.83 $566,531.30 nat. median
$576,820
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 16 $516,726.10 $601,555.28 $562,201.20 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 15 $526,587.60 $605,575.74 $558,081.80 nat. median
$560,872
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 16 $489,456.00 $569,445.65 $532,192.20 nat. median
$533,230
1.0× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 $440,504.85 $1,699,593.90 $511,793.84 nat. median
$691,418
0.7× median
09498
OTHER 		Ciltacabtagene Car-pos T 3 $448,054.89 $570,020.11 $505,405.93 nat. median
$570,020
0.9× median
09194
OTHER 		Tisagenlecleucel Car-pos 3 $449,813.97 $549,535.36 $495,714.89 nat. median
$549,535
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $431,371.60 $1,762,948.71 $495,061.61 nat. median
$631,793
0.8× median
09413
OTHER 		Lisocabtagene Car Pos T 3 $439,217.18 $545,335.16 $489,547.67 nat. median
$545,335
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 16 $460,530.40 $529,609.96 $489,450.20 nat. median
$492,768
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 3 $447,599.46 $541,339.35 $488,321.58 nat. median
$541,339
0.9× median
5834
APR_DRG 		Neonate With Ecmo 8 $470,094.98 $520,079.40 $481,555.00 nat. median
$311,018
1.5× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $411,986.50 $1,674,245.19 $472,504.55 nat. median
$610,161
0.8× median
09035
OTHER 		Axicabtagene Ciloleucel C 3 $416,037.60 $516,226.43 $463,567.84 nat. median
$516,226
0.9× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 $402,951.85 $1,686,603.72 $462,318.48 nat. median
$624,417
0.7× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $390,473.85 $1,596,576.72 $449,078.23 nat. median
$588,565
0.8× median
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 $430,524.29 $476,301.60 $441,020.00 nat. median
$96,420
outlier · 4.6×
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $382,024.00 $1,468,350.60 $438,207.95 nat. median
$577,541
0.8× median
09391
OTHER 		Brexucabtagene Car Pos T 3 $391,450.84 $474,766.69 $428,268.92 nat. median
$474,767
0.9× median
5892
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 $415,292.24 $459,449.28 $425,416.00 nat. median
$89,188
outlier · 4.8×
5833
APR_DRG 		Neonate With Ecmo 8 $412,909.89 $456,814.08 $422,976.00 nat. median
$250,089
1.7× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 8 $332,110.24 $367,422.48 $340,206.00 nat. median
$254,667
1.3× median
1614
APR_DRG 		Implantable Heart Assist Systems 8 $321,653.00 $355,853.52 $329,494.00 nat. median
$209,486
1.6× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 19 $12,503.00 $769,431.13 $323,787.66 nat. median
$370,165
0.9× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 $291,110.40 $322,063.56 $298,207.00 nat. median
$160,171
1.9× median

Other procedures at this hospital

Browse this hospital's 42,346 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
             
845 OTHER Inj, Atidarsagene Autotem 22 18 — — $4,647.15 $4,820,350.00 $4,505,000.00 2026-03-07
00845 OTHER Inj, Atidarsagene Autotem 3 3 — — $3,829,250.00 $4,369,850.00 $4,054,500.00 2026-03-07
9138 OTHER Inj, Hemgenix, Per Tx Dos 30 16 — — $3,672,900.00 $4,223,835.00 $3,736,818.52 2026-03-07
773 OTHER Inj, Beqvez, Per Tx Dose 14 14 — — $3,605,000.00 $4,145,750.00 $3,695,125.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 36 19 — — $5,150.11 $3,824,273.25 $3,336,179.65 2026-03-07
908 OTHER Topi Adm Prad Zami Per Tr 22 18 — — $9,457.92 $3,569,327.40 $3,335,820.00 2026-03-07
09138 OTHER Inj, Hemgenix, Per Tx Dos 6 3 — — $3,121,965.00 $3,574,708.99 $3,311,175.15 2026-03-07
748 OTHER Inj, Lovotibeglogene Auto 36 19 — — $8,495.09 $3,778,900.00 $3,286,000.00 2026-03-07
00773 OTHER Inj, Beqvez, Per Tx Dose 3 2 — — $3,064,250.00 $3,496,850.00 $3,244,500.00 2024-10-01
906 OTHER Inj Elivaldogene Autoteme 22 18 — — $6,197.66 $3,402,600.00 $3,180,000.00 2026-03-07
00908 OTHER Topi Adm Prad Zami Per Tr 3 3 — — $2,835,447.00 $3,235,745.40 $3,002,238.00 2026-03-07
00714 OTHER Inj Delandistrogene Mox R 6 3 — — $2,826,636.75 $3,228,024.20 $2,993,991.75 2026-03-07
746 OTHER Inj, Betibeglogene Autote 36 19 — — $7,545.33 $3,413,200.00 $2,968,000.00 2026-03-07
00748 OTHER Inj, Lovotibeglogene Auto 6 3 — — $2,764,631.80 $3,187,420.00 $2,942,328.60 2026-03-07
00906 OTHER Inj Elivaldogene Autoteme 3 3 — — $2,703,000.00 $3,084,600.00 $2,862,000.00 2026-03-07
00746 OTHER Inj, Betibeglogene Autote 6 3 — — $2,498,973.65 $2,878,960.00 $2,658,586.05 2026-03-07
9141 OTHER Inj Onase Abepar-xioi Tre 30 16 — — $2,388,614.00 $2,770,209.67 $2,588,981.00 2026-03-07
824 OTHER Inj, Exagamglogene Autote 22 18 — — $13,175.70 $2,495,240.00 $2,332,000.00 2026-03-07
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 1 1 — — $2,311,860.00 $2,311,860.00 $2,311,860.00 2026-03-07
09141 OTHER Inj Onase Abepar-xioi Tre 6 3 — — $2,030,321.90 $2,511,311.57 $2,258,794.71 2026-03-07
00824 OTHER Inj, Exagamglogene Autote 3 3 — — $1,982,200.00 $2,262,040.00 $2,098,800.00 2026-03-07
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 1 1 — — $834,750.00 $834,750.00 $834,750.00 2026-03-07
2067 OTHER Afamitresgene Autoleucel 16 15 — — $770,620.00 $824,563.40 $776,939.08 2026-03-07
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 1 — — $605,007.06 $605,007.06 $605,007.06 2026-03-07
9498 OTHER Ciltacabtagene Car-pos T 29 15 — — $527,123.40 $628,785.07 $587,649.60 2026-03-07
9194 OTHER Tisagenlecleucel Car-pos 30 16 — — $529,192.90 $608,571.83 $566,531.30 2026-03-07
9413 OTHER Lisocabtagene Car Pos T 30 16 — — $516,726.10 $601,555.28 $562,201.20 2026-03-07
9422 OTHER Idecabtagene Vicleucel Ca 29 15 — — $526,587.60 $605,575.74 $558,081.80 2026-03-07
9035 OTHER Axicabtagene Ciloleucel C 30 16 — — $489,456.00 $569,445.65 $532,192.20 2026-03-07
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 8 4 — — $440,504.85 $1,699,593.90 $511,793.84 2026-03-07
09498 OTHER Ciltacabtagene Car-pos T 6 3 — — $448,054.89 $570,020.11 $505,405.93 2026-03-07
09194 OTHER Tisagenlecleucel Car-pos 6 3 — — $449,813.97 $549,535.36 $495,714.89 2026-03-07
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 8 4 — — $431,371.60 $1,762,948.71 $495,061.61 2026-03-07
09413 OTHER Lisocabtagene Car Pos T 6 3 — — $439,217.18 $545,335.16 $489,547.67 2026-03-07
9391 OTHER Brexucabtagene Car Pos T 30 16 — — $460,530.40 $529,609.96 $489,450.20 2026-03-07
09422 OTHER Idecabtagene Vicleucel Ca 6 3 — — $447,599.46 $541,339.35 $488,321.58 2026-03-07
5834 APR_DRG Neonate With Ecmo 12 8 — — $470,094.98 $520,079.40 $481,555.00 2026-03-07
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 8 4 — — $411,986.50 $1,674,245.19 $472,504.55 2026-03-07
09035 OTHER Axicabtagene Ciloleucel C 6 3 — — $416,037.60 $516,226.43 $463,567.84 2026-03-07
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 8 4 — — $402,951.85 $1,686,603.72 $462,318.48 2026-03-07
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 8 4 — — $390,473.85 $1,596,576.72 $449,078.23 2026-03-07
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 8 — — $430,524.29 $476,301.60 $441,020.00 2026-03-07
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 8 4 — — $382,024.00 $1,468,350.60 $438,207.95 2026-03-07
09391 OTHER Brexucabtagene Car Pos T 6 3 — — $391,450.84 $474,766.69 $428,268.92 2026-03-07
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 8 — — $415,292.24 $459,449.28 $425,416.00 2026-03-07
5833 APR_DRG Neonate With Ecmo 12 8 — — $412,909.89 $456,814.08 $422,976.00 2026-03-07
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 8 — — $332,110.24 $367,422.48 $340,206.00 2026-03-07
1614 APR_DRG Implantable Heart Assist Systems 12 8 — — $321,653.00 $355,853.52 $329,494.00 2026-03-07
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 52 19 — — $12,503.00 $769,431.13 $323,787.66 2026-03-07
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 8 — — $291,110.40 $322,063.56 $298,207.00 2026-03-07
5832 APR_DRG Neonate With Ecmo 12 8 — — $284,108.95 $314,317.80 $291,035.00 2026-03-07
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 8 — — $277,896.12 $307,443.60 $284,670.00 2026-03-07
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 12 8 — — $272,578.25 $301,560.84 $279,223.00 2026-03-07
831 OTHER Obecbtge Autol Up To 400 22 18 — — $2,858.48 $297,727.50 $278,250.00 2026-03-07
897 OTHER Revakinagene, Per Implant 16 15 — — $265,000.00 $283,550.00 $267,173.00 2026-03-07
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 8 — — $258,950.04 $286,482.96 $265,262.00 2026-03-07
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 12 8 — — $258,356.35 $285,826.32 $264,654.00 2026-03-07
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 106 41 — — $23,576.00 $499,329.85 $261,790.64 2026-03-07
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 8 — — $245,576.26 $271,688.04 $251,563.00 2026-03-07
00831 OTHER Obecbtge Autol Up To 400 3 3 — — $236,512.50 $269,902.50 $250,425.00 2026-03-07
00897 OTHER Revakinagene, Per Implant 3 3 — — $225,250.00 $257,050.00 $238,500.00 2026-03-07
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 12 8 — — $232,198.68 $256,887.72 $237,859.00 2026-03-07
77145 CDM Tavr 31 25 $316,284.00 $316,284.00 $49,485.60 $329,904.00 $237,530.88 2026-03-07
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 2 1 — — $218,394.00 $251,178.75 $234,786.38 2026-03-07
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 8 — — $214,377.95 $237,172.32 $219,604.00 2026-03-07
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 3 — — $144,043.80 $258,084.60 $219,371.91 2026-03-07
886 OTHER Inj. Remestemcel-l-rknd/ 22 18 — — $5,390.21 $215,785.83 $201,669.00 2026-03-07
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 12 8 — — $194,555.89 $215,241.84 $199,298.00 2026-03-07
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 7 3 — — $174,567.39 $226,860.50 $199,212.20 2026-03-07
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 8 — — $193,007.75 $213,530.04 $197,713.00 2026-03-07
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 8 — — $191,781.13 $212,172.48 $196,456.00 2026-03-07
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 8 — — $186,711.38 $206,564.04 $191,263.00 2026-03-07
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 55 19 — — $16,458.00 $418,754.87 $186,347.50 2026-03-07
5831 APR_DRG Neonate With Ecmo 12 8 — — $177,832.65 $196,741.44 $182,168.00 2026-03-07
00886 OTHER Inj. Remestemcel-l-rknd/ 3 3 — — $171,418.65 $195,618.93 $181,502.10 2026-03-07
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 110 42 — — $23,576.00 $308,989.00 $168,794.50 2026-03-07
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 12 8 — — $159,876.47 $176,875.92 $163,774.00 2026-03-07
84398 CDM Ins/repl Subq Icd W/eval 29 25 $198,014.00 $198,014.00 $32,078.25 $213,855.00 $160,391.25 2026-03-07
1613 APR_DRG Implantable Heart Assist Systems 12 8 — — $155,981.43 $172,566.72 $159,784.00 2026-03-07
1612 APR_DRG Implantable Heart Assist Systems 12 8 — — $152,283.86 $168,475.68 $155,996.00 2026-03-07
A9543 HCPCS Y90 Ibritum Tiu Tx 40mci 34 25 $199,929.00 $199,929.00 $37,570.60 $196,429.74 $154,384.95 2026-03-07
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 8 — — $147,811.59 $163,528.20 $151,415.00 2026-03-07
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 8 — — $147,173.60 $162,821.88 $150,761.00 2026-03-07
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 8 — — $147,148.28 $162,793.80 $150,735.00 2026-03-07
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 8 — — $145,279.88 $160,726.68 $148,821.00 2026-03-07
1611 APR_DRG Implantable Heart Assist Systems 12 8 — — $144,635.55 $160,013.88 $148,161.00 2026-03-07
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 8 — — $144,631.76 $160,009.56 $148,157.00 2026-03-07
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 8 — — $144,200.10 $159,532.20 $147,715.00 2026-03-07
1907 OTHER New Technology - Level 52 30 16 — — $140,029.00 $161,033.35 $145,638.00 2026-03-07
1908 OTHER New Technology - Level 52 30 16 — — $140,029.00 $161,033.35 $145,638.00 2026-03-07
33249 CPT Insertion Or Replacement Of Permanent Implantable Defibrillator System, With Tra… 21 7 — — $4,250.00 $147,784.00 $140,395.00 2026-03-07
33240 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Singl… 21 7 — — $4,250.00 $147,784.00 $140,395.00 2026-03-07
33271 CPT Insertion Of Subcutaneous Implantable Defibrillator Electrode 15 5 — — $1,995.00 $147,784.00 $140,395.00 2026-03-07
33230 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Dual … 21 7 — — $1,995.00 $147,784.00 $140,395.00 2026-03-07
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $139,609.77 $140,085.39 $139,847.58 2026-03-07
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 12 8 — — $136,091.02 $150,560.64 $139,408.00 2026-03-07
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 12 8 — — $134,339.07 $148,623.12 $137,614.00 2026-03-07
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 8 — — $134,254.26 $148,529.16 $137,527.00 2026-03-07
33264 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 12 4 — — $1,995.00 $147,784.00 $136,728.50 2026-03-07
33272 CPT Removal Of Subcutaneous Implantable Defibrillator Electrode 12 4 — — $1,995.00 $147,784.00 $136,728.50 2026-03-07
33262 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 12 4 — — $1,995.00 $147,784.00 $136,728.50 2026-03-07
33270 CPT Insertion Or Replacement Of Permanent Subcutaneous Implantable Defibrillator Sys… 12 4 — — $1,995.00 $147,784.00 $136,728.50 2026-03-07
33263 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 12 4 — — $1,995.00 $147,784.00 $136,728.50 2026-03-07
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 7 3 — — $116,925.24 $159,895.80 $135,911.43 2026-03-07
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 8 — — $130,826.32 $144,736.20 $134,015.00 2026-03-07
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 116 42 — — $16,458.00 $249,406.87 $132,132.62 2026-03-07
1905 OTHER New Technology - Level 51 30 16 — — $126,255.70 $145,194.05 $131,313.00 2026-03-07
1906 OTHER New Technology - Level 51 30 16 — — $126,255.70 $145,194.05 $131,313.00 2026-03-07
33231 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multi… 18 6 — — $1,995.00 $147,784.00 $129,706.00 2026-03-07
01908 OTHER New Technology - Level 52 6 3 — — $119,024.65 $141,242.18 $128,537.77 2026-03-07
01907 OTHER New Technology - Level 52 6 3 — — $119,024.65 $141,242.18 $128,537.77 2026-03-07
7 MS_DRG Lung Transplant 101 41 — — $23,576.00 $230,746.66 $128,531.29 2026-03-07
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 8 — — $122,455.21 $135,475.20 $125,440.00 2026-03-07
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 8 — — $120,080.46 $132,847.56 $123,007.00 2026-03-07
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 8 — — $119,070.31 $131,730.84 $121,973.00 2026-03-07
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 8 — — $117,339.88 $129,816.00 $120,200.00 2026-03-07
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 8 — — $117,339.88 $129,816.00 $120,200.00 2026-03-07
76843 CDM Rmv Icd W Rplc Dual Ld 29 25 $147,395.00 $147,395.00 $23,878.05 $159,187.00 $119,390.25 2026-03-07
76842 CDM Rmv Icd W Rplc Sgl Ld 29 25 $147,395.00 $147,395.00 $23,878.05 $159,187.00 $119,390.25 2026-03-07
76844 CDM Rmv Icd W Rplc Mult Ld 29 25 $147,395.00 $147,395.00 $23,878.05 $159,187.00 $119,390.25 2026-03-07
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 110 42 — — $25,032.00 $213,205.00 $118,063.00 2026-03-07
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 113 42 — — $23,576.00 $201,034.00 $117,672.00 2026-03-07
1903 OTHER New Technology - Level 50 30 16 — — $112,482.40 $129,354.76 $116,988.00 2026-03-07
1904 OTHER New Technology - Level 50 30 16 — — $112,482.40 $129,354.76 $116,988.00 2026-03-07
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 8 — — $113,441.04 $125,502.48 $116,206.00 2026-03-07
01905 OTHER New Technology - Level 51 6 3 — — $107,317.35 $127,349.55 $115,894.76 2026-03-07
01906 OTHER New Technology - Level 51 6 3 — — $107,317.35 $127,349.55 $115,894.76 2026-03-07
209 MS_DRG Complex Aortic Arch Procedures 55 40 — — $27,878.00 $201,678.38 $114,778.19 2026-03-07
14 MS_DRG Allogeneic Bone Marrow Transplant 103 42 — — $12,503.00 $231,257.09 $113,767.47 2026-03-07
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 106 41 — — $23,576.00 $316,328.00 $110,453.87 2026-03-07
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 12 8 — — $107,481.39 $118,909.08 $110,101.00 2026-03-07
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 12 8 — — $106,104.13 $117,385.20 $108,690.00 2026-03-07
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 116 42 — — $65,226.00 $149,731.78 $107,356.87 2026-03-07
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 36 19 — — $84,999.91 $115,820.01 $106,999.89 2026-03-07
66661 CDM Icd Ins/repl Ld/gen 29 25 $131,475.00 $131,475.00 $21,298.95 $141,993.00 $106,494.75 2026-03-07
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 7 3 — — $82,212.97 $124,866.00 $106,136.10 2026-03-07
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 101 41 — — $23,576.00 $187,969.09 $105,795.24 2026-03-07
4404 APR_DRG Kidney Transplant 12 8 — — $102,904.05 $113,844.96 $105,412.00 2026-03-07
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 8 — — $102,259.73 $113,132.16 $104,752.00 2026-03-07
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 110 42 — — $16,458.00 $193,754.71 $104,371.50 2026-03-07
01903 OTHER New Technology - Level 50 6 3 — — $95,610.04 $113,456.92 $103,251.74 2026-03-07
01904 OTHER New Technology - Level 50 6 3 — — $95,610.04 $113,456.92 $103,251.74 2026-03-07
215 MS_DRG Other Heart Assist System Implant 110 42 — — $26,388.00 $187,008.82 $103,006.91 2026-03-07
4403 APR_DRG Kidney Transplant 12 8 — — $100,528.03 $111,216.24 $102,978.00 2026-03-07
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 110 42 — — $26,388.00 $186,850.00 $102,810.50 2026-03-07
1902 OTHER New Technology - Level 49 30 16 — — $98,709.11 $113,515.48 $102,663.00 2026-03-07
1901 OTHER New Technology - Level 49 30 16 — — $98,709.11 $113,515.48 $102,663.00 2026-03-07
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 8 — — $100,169.80 $110,819.88 $102,611.00 2026-03-07
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 8 — — $99,729.28 $110,332.80 $102,160.00 2026-03-07
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 12 8 — — $99,701.43 $110,302.56 $102,132.00 2026-03-07
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 12 8 — — $99,496.36 $110,074.68 $101,921.00 2026-03-07
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 8 — — $98,736.85 $109,234.44 $101,143.00 2026-03-07
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 8 — — $98,300.13 $108,751.68 $100,696.00 2026-03-07
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 113 42 — — $23,576.00 $146,475.00 $100,524.24 2026-03-07
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 110 42 — — $62,666.54 $136,811.95 $99,739.24 2026-03-07
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 116 42 — — $62,397.77 $137,964.50 $99,339.88 2026-03-07
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 110 42 — — $26,388.00 $174,309.93 $98,368.43 2026-03-07
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 8 — — $95,783.60 $105,967.44 $98,118.00 2026-03-07
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 55 40 — — $21,132.00 $174,366.00 $97,749.00 2026-03-07
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 113 42 — — $23,576.00 $160,533.05 $97,421.52 2026-03-07
459 MS_DRG Spinal Fusion Except Cervical With Mcc 4 2 — — $76,640.00 $146,475.00 $96,731.50 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 12 8 — — $94,216.47 $104,234.04 $96,513.00 2026-03-07
652 MS_DRG Kidney Transplant 101 41 — — $23,576.00 $173,634.00 $95,958.37 2026-03-07
6904 APR_DRG Acute Leukemia 12 8 — — $93,083.53 $102,980.16 $95,352.00 2026-03-07
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 8 — — $92,967.07 $102,851.64 $95,233.00 2026-03-07
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 36 19 — — $77,377.11 $104,686.68 $95,081.00 2026-03-07
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 113 42 — — $23,576.00 $146,475.00 $94,409.25 2026-03-07
8634 APR_DRG Neonatal Aftercare 12 8 — — $91,986.03 $101,766.24 $94,228.00 2026-03-07
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 12 8 — — $91,079.68 $100,764.00 $93,300.00 2026-03-07
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 12 8 — — $91,058.16 $100,740.24 $93,278.00 2026-03-07
9104 APR_DRG Craniotomy For Multiple Significant Trauma 12 8 — — $90,759.42 $100,409.76 $92,972.00 2026-03-07
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 110 42 — — $25,032.00 $160,731.00 $92,086.00 2026-03-07
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 8 — — $89,565.71 $99,088.92 $91,749.00 2026-03-07
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 110 42 — — $26,388.00 $157,872.00 $91,348.50 2026-03-07
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 110 42 — — $26,388.00 $157,872.00 $91,348.50 2026-03-07
1585 OTHER New Technology - Level 48 30 16 — — $87,231.36 $100,316.06 $90,725.48 2026-03-07
1599 OTHER New Technology - Level 48 30 16 — — $87,231.36 $100,316.06 $90,725.48 2026-03-07
01901 OTHER New Technology - Level 49 6 3 — — $83,902.74 $99,564.29 $90,608.72 2026-03-07
01902 OTHER New Technology - Level 49 6 3 — — $83,902.74 $99,564.29 $90,608.72 2026-03-07
44081 CDM Ppi Ins Ven To Exist Pcr 31 25 $120,638.00 $120,638.00 $18,874.95 $125,833.00 $90,599.76 2026-03-07
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 12 8 — — $88,259.35 $97,643.88 $90,411.00 2026-03-07
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 113 42 — — $23,576.00 $146,475.00 $90,392.50 2026-03-07
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 113 42 — — $23,576.00 $146,475.00 $90,392.50 2026-03-07
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 113 42 — — $23,576.00 $146,475.00 $90,392.50 2026-03-07
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 6 3 — — $74,392.68 $108,548.53 $90,007.51 2026-03-07
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 113 42 — — $23,576.00 $146,475.00 $89,423.38 2026-03-07
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 116 42 — — $43,734.07 $136,282.00 $89,333.54 2026-03-07
76838 CDM Rmv Ppm W Rplc Mult Ld 29 25 $110,193.00 $110,193.00 $17,851.20 $119,008.00 $89,256.00 2026-03-07
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 12 8 — — $86,364.36 $95,546.52 $88,469.00 2026-03-07
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 8 — — $85,961.82 $95,101.56 $88,057.00 2026-03-07
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 12 8 — — $85,939.03 $95,076.72 $88,034.00 2026-03-07
231 MS_DRG Coronary Bypass With Ptca With Mcc 110 42 — — $26,388.00 $150,203.96 $87,980.23 2026-03-07
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 8 — — $85,849.16 $94,977.36 $87,942.00 2026-03-07
204 APR_DRG Open Craniotomy For Trauma 12 8 — — $85,699.78 $94,812.12 $87,789.00 2026-03-07
8904 APR_DRG HIV With Multiple Major HIV Related Conditions 12 8 — — $85,617.50 $94,720.32 $87,704.00 2026-03-07
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 8 — — $84,482.03 $93,464.28 $86,541.00 2026-03-07
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 110 42 — — $43,541.25 $129,371.00 $86,456.12 2026-03-07
850 MS_DRG Acute Leukemia With Other Procedures 110 42 — — $16,458.00 $162,597.87 $85,877.99 2026-03-07
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 110 42 — — $26,388.00 $145,328.00 $85,138.50 2026-03-07
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 12 8 — — $82,565.52 $91,344.24 $84,578.00 2026-03-07
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 116 42 — — $26,388.00 $142,283.95 $84,042.14 2026-03-07
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 12 8 — — $81,825.00 $90,524.52 $83,819.00 2026-03-07
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 110 42 — — $37,789.43 $129,371.00 $83,580.21 2026-03-07
4402 APR_DRG Kidney Transplant 12 8 — — $81,378.15 $90,030.96 $83,362.00 2026-03-07
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 12 8 — — $81,314.86 $89,960.76 $83,297.00 2026-03-07
007 OTHER Lung Transplant 7 3 — — $65,910.66 $95,968.05 $81,572.84 2026-03-07
1598 OTHER New Technology - Level 47 30 16 — — $78,049.16 $89,756.53 $81,175.48 2026-03-07
1584 OTHER New Technology - Level 47 30 16 — — $78,049.16 $89,756.53 $81,175.48 2026-03-07
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 12 8 — — $79,207.20 $87,629.04 $81,138.00 2026-03-07
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 12 8 — — $78,295.79 $86,620.32 $80,204.00 2026-03-07
01585 OTHER New Technology - Level 48 6 3 — — $74,146.66 $87,987.13 $80,072.88 2026-03-07
01599 OTHER New Technology - Level 48 6 3 — — $74,146.66 $87,987.13 $80,072.88 2026-03-07
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 12 8 — — $78,117.30 $86,422.68 $80,021.00 2026-03-07
C1822 HCPCS Implant Pulse 8.5x15.5in 25 21 $99,999.50 $99,999.50 $15,000.00 $100,000.00 $80,000.00 2026-03-07
478737 CDM Graft Evas 10cm 14.5mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
614173 CDM Valve Heart Trnscth 20mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
476745 CDM Graft Evas 23x12mm 12cm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
773095 CDM Device Clsr 24mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
459377 CDM Graft Evas 31x14.5m 15cm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
587989 CDM Device Clsr 24mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
598386 CDM Valve Tavr 34mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
773098 CDM Device Clsr 35mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
613242 CDM Valve Tavr 29mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
777081 CDM Valve Aor Tavr 34mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
575011 CDM Valve Tavr Sz 29mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
484071 CDM Allograft Vein 70-79cm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
587991 CDM Device Clsr 20mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
468315 CDM Graft Evas 31x14.5m 13cm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
568157 CDM Mesh Surg 19.5x19.5in 25 21 $99,999.00 $99,999.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
595991 CDM Valve Tavr 29mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
773094 CDM Device Clsr 20mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
587992 CDM Device Clsr 31mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
431762 CDM Valve Trfcta 18x25x31mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
482282 CDM Graft Evas 23x14.5m 12cm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
551580 CDM Valve Heart Trnscth 26mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
587988 CDM Device Clsr 27mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
551581 CDM Valve Heart Trnscth 23mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
587990 CDM Device Clsr 40mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
469507 CDM Kit Aor Vlv 14fr 29mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
575010 CDM Valve Tavr Size 34mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
598801 CDM Valve Tavr 23mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
587993 CDM Device Clsr 35mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
478864 CDM Graft Nrv 4-5mm 70mm 25 21 $96,151.00 $96,151.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
22810 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 Verteb… 14 5 — — $4,250.00 $117,140.00 $80,000.00 2026-03-07
773096 CDM Device Clsr 27mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
575012 CDM Valve Tavr Sz 26mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
596518 CDM Valve Tavr 26mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
773097 CDM Device Clsr 31mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
473744 CDM Graft Evas 14.5mm 16cm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
418576 CDM Graft Bn Fem Hemi Cndyl 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
482331 CDM Graft Evas 10cm 10mm 25 21 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $80,000.00 2026-03-07
482286 CDM Graft Evas 26x12mm 16cm 25 21 $94,153.00 $94,153.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
474099 CDM Graft Evas 14.5mm 14cm 25 21 $94,153.00 $94,153.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
476831 CDM Graft Evas 10cm 12mm 25 21 $94,153.00 $94,153.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
467555 CDM Graft Evas 26x14.5m 12cm 25 21 $96,979.00 $96,979.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
594774 CDM Pump Pain Infn 148gm 25 21 $99,999.00 $99,999.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
482283 CDM Graft Evas 23x14.5m14cm 25 21 $94,153.00 $94,153.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
562279 CDM Graft Evasc 20x12mmx12cm 25 21 $99,999.00 $99,999.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
612470 CDM Graft Endo Aaa 26x12mm 25 21 $99,999.00 $99,999.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
474489 CDM Graft Evas 14.5mm 18cm 25 21 $96,979.00 $96,979.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
482289 CDM Graft Evas 26x14.5m 18cm 25 21 $96,979.00 $96,979.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
551632 CDM Graft Bn Ost Talus Rt 25 21 $99,999.00 $99,999.00 $14,999.85 $99,999.00 $79,999.20 2026-03-07
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 12 8 — — $78,043.88 $86,341.68 $79,946.00 2026-03-07
434367 CDM Valve Aortic 23mm 25 21 $92,511.00 $92,511.00 $14,988.90 $99,926.00 $79,940.80 2026-03-07
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 116 42 — — $33,311.00 $126,000.00 $79,655.50 2026-03-07
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 116 42 — — $33,311.00 $126,000.00 $79,655.50 2026-03-07
014 OTHER Allogeneic Bone Marrow Transplant 7 3 — — $69,630.06 $87,174.46 $79,460.19 2026-03-07
228 MS_DRG Other Cardiothoracic Procedures With Mcc 110 42 — — $26,388.00 $135,975.00 $79,201.50 2026-03-07
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 110 42 — — $23,576.00 $135,771.38 $79,068.62 2026-03-07
1774 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 12 8 — — $76,889.42 $85,064.04 $78,763.00 2026-03-07
232 MS_DRG Coronary Bypass With Ptca Without Mcc 110 42 — — $26,388.00 $136,211.00 $78,523.00 2026-03-07
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 116 42 — — $33,863.65 $129,413.00 $78,433.00 2026-03-07
230 MS_DRG Other Cardiothoracic Procedures Without Cc/mcc 6 1 — — $76,801.00 $80,065.00 $78,433.00 2026-03-07
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 12 8 — — $76,378.01 $84,499.20 $78,240.00 2026-03-07
469290 CDM Implant Cranial Peek 25 21 $90,979.00 $90,979.00 $14,602.95 $97,353.00 $77,882.40 2026-03-07
10 MS_DRG Pancreas Transplant 101 41 — — $23,576.00 $140,732.34 $77,867.31 2026-03-07
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 102 41 — — $23,576.00 $139,922.11 $77,501.15 2026-03-07
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 116 42 — — $26,388.00 $129,413.00 $77,260.00 2026-03-07
610296 CDM Graft St Tis 16x20cm 25 21 $96,380.00 $96,380.00 $14,457.00 $96,380.00 $77,104.00 2026-03-07
4414 APR_DRG Major Bladder Procedures 12 8 — — $74,980.51 $82,952.64 $76,808.00 2026-03-07
1834 APR_DRG Percutaneous Structural Cardiac Procedures 12 8 — — $74,023.52 $81,894.24 $75,828.00 2026-03-07
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 8 — — $73,743.77 $81,584.28 $75,541.00 2026-03-07
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 110 42 — — $19,270.00 $132,527.00 $75,242.50 2026-03-07
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 7 3 — — $65,791.10 $85,056.02 $75,079.25 2026-03-07
C1820 HCPCS Kit Generator Ipg 75 21 $99,999.00 $99,999.00 $13,961.10 $100,000.00 $74,999.25 2026-03-07
493316 CDM Valve Aortic 25mm 25 21 $86,672.00 $86,672.00 $14,039.70 $93,598.00 $74,878.40 2026-03-07
493313 CDM Valve Aortic 19mm 25 21 $86,672.00 $86,672.00 $14,039.70 $93,598.00 $74,878.40 2026-03-07
493314 CDM Valve Aortic 21mm 25 21 $86,672.00 $86,672.00 $14,039.70 $93,598.00 $74,878.40 2026-03-07
493317 CDM Valve Aortic 27mm 25 21 $87,570.00 $87,570.00 $14,039.70 $93,598.00 $74,878.40 2026-03-07
1694 APR_DRG Major Abdominal Vascular Procedures 12 8 — — $72,798.17 $80,537.76 $74,572.00 2026-03-07
405606 CDM Valve Aortic 23mm 25 21 $85,971.00 $85,971.00 $13,926.15 $92,841.00 $74,272.80 2026-03-07
405617 CDM Valve Aortic 29mm 25 21 $85,971.00 $85,971.00 $13,926.15 $92,841.00 $74,272.80 2026-03-07
405432 CDM Valve Aortic 19mm 25 21 $85,971.00 $85,971.00 $13,926.15 $92,841.00 $74,272.80 2026-03-07
405616 CDM Valve Aortic 27mm 25 21 $85,971.00 $85,971.00 $13,926.15 $92,841.00 $74,272.80 2026-03-07
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 12 8 — — $72,055.11 $79,715.88 $73,811.00 2026-03-07
955 MS_DRG Craniotomy For Multiple Significant Trauma 110 42 — — $23,576.00 $120,526.09 $73,457.04 2026-03-07
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 4 2 — — $33,311.00 $146,475.00 $73,413.50 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 4 2 — — $33,311.00 $146,475.00 $73,413.50 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 4 2 — — $33,311.00 $146,475.00 $73,413.50 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 12 8 — — $71,476.62 $79,076.52 $73,219.00 2026-03-07
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