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 HOSPITAL MONTGOMERY

Blacksburg, VA · CCN 490110 · Rates published

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You selected 93306 (CPT)

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echoc

This hospital’s price: $2,260 across 23 payers · range $542-$2,865

Source: https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/54-0889154_LEWISGALE-HOSPITAL-MONTGOMERY_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D · observed 2026-03-07

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

32,280 distinct procedures filed
43 distinct payers
1,073,886 rate rows
2026-07-31 last MRF observed
Data quality

1,012,438 of 1,073,886 rate rows are consumer-grade (94.3%)

61,448 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 36,083
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 20,289
per-diem day rate — not a per-procedure price 4,099
template filing: same amount across many unrelated codes — excluded 444
percent-of-charges filed in the dollar field — excluded from medians 231
placeholder amount (≤ $0.02) — excluded from medians 196
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 90
exceeds 10× this hospital's gross charge — excluded from medians 16
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/54-0889154_LEWISGALE-HOSPITAL-MONTGOMERY_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 Latest re-check couldn't be parsed — showing last good data · 2026-10-10
Content fingerprint 5447b9185e9305df… · 340,955,456 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 16 $5,022.33 $4,820,350.00 $4,505,000.00 nat. median
$17,146
outlier · 262.7×
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 14 $3,672,900.00 $4,223,835.00 $3,746,358.00 nat. median
$3,758,972
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 13 $3,605,000.00 $4,145,750.00 $3,713,150.00 nat. median
$3,646,097
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 17 $5,565.89 $3,824,273.25 $3,344,499.30 nat. median
$3,325,455
1.0× median
908
OTHER 		Topi Adm Prad Zami Per Tr 16 $10,221.48 $3,569,327.40 $3,335,820.00 nat. median
$30,329
outlier · 110.0×
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 17 $9,180.92 $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 16 $6,698.01 $3,402,600.00 $3,180,000.00 nat. median
$24,952
outlier · 127.4×
00908
OTHER 		Topi Adm Prad Zami Per Tr 3 $2,835,447.00 $3,235,745.40 $3,002,238.00 nat. median
$14,694
outlier · 204.3×
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 17 $8,154.48 $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 14 $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 16 $14,025.63 $2,495,240.00 $2,332,000.00 nat. median
$2,262,040
1.0× median
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
Q2057
HCPCS 		Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 1 $2,042,143.00 $2,042,143.00 $2,042,143.00 nat. median
$809,217
outlier · 2.5×
2067
OTHER 		Afamitresgene Autoleucel 13 $770,620.00 $824,563.40 $776,939.08 nat. median
$789,886
1.0× median
Q2058
HCPCS 		Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,… 1 $737,362.50 $737,362.50 $737,362.50 nat. median
$319,951
outlier · 2.3×
9498
OTHER 		Ciltacabtagene Car-pos T 14 $527,123.40 $628,785.07 $587,649.60 nat. median
$587,650
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 14 $529,192.90 $608,571.83 $566,531.30 nat. median
$577,003
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 14 $516,726.10 $601,555.28 $562,201.20 nat. median
$562,201
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 14 $526,587.60 $605,575.74 $558,081.80 nat. median
$562,826
1.0× median
J3402
HCPCS 		Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 $534,422.90 $534,422.90 $534,422.90 nat. median
$209,753
outlier · 2.5×
9035
OTHER 		Axicabtagene Ciloleucel C 14 $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 $1,501,307.95 $511,793.84 nat. median
$738,272
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 $1,557,271.36 $495,061.61 nat. median
$646,415
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 14 $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 $470,282.90 $520,079.40 $481,555.00 nat. median
$307,273
1.6× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $411,986.50 $1,478,916.58 $472,504.55 nat. median
$622,245
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 $1,489,833.29 $462,318.48 nat. median
$640,950
0.7× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $390,473.85 $1,410,309.44 $449,078.23 nat. median
$608,101
0.7× median
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 $430,696.39 $476,301.60 $441,020.00 nat. median
$93,998
outlier · 4.7×
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $382,024.00 $1,297,043.03 $438,207.95 nat. median
$591,650
0.7× 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 $415,458.24 $459,449.28 $425,416.00 nat. median
$89,188
outlier · 4.8×
5833
APR_DRG 		Neonate With Ecmo 8 $413,074.95 $456,814.08 $422,976.00 nat. median
$244,017
1.7× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 8 $332,243.00 $367,422.48 $340,206.00 nat. median
$247,214
1.4× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 18 $16,507.00 $665,446.95 $338,967.30 nat. median
$359,358
0.9× median
1614
APR_DRG 		Implantable Heart Assist Systems 8 $321,781.57 $355,853.52 $329,494.00 nat. median
$202,993
1.6× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 $291,226.77 $322,063.56 $298,207.00 nat. median
$154,011
1.9× median

Other procedures at this hospital

Browse this hospital's 32,280 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 20 16 — — $5,022.33 $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 27 14 — — $3,672,900.00 $4,223,835.00 $3,746,358.00 2026-03-07
773 OTHER Inj, Beqvez, Per Tx Dose 13 13 — — $3,605,000.00 $4,145,750.00 $3,713,150.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 33 17 — — $5,565.89 $3,824,273.25 $3,344,499.30 2026-03-07
908 OTHER Topi Adm Prad Zami Per Tr 20 16 — — $10,221.48 $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 33 17 — — $9,180.92 $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 20 16 — — $6,698.01 $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 33 17 — — $8,154.48 $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 27 14 — — $2,388,614.00 $2,770,209.67 $2,588,981.00 2026-03-07
824 OTHER Inj, Exagamglogene Autote 20 16 — — $14,025.63 $2,495,240.00 $2,332,000.00 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
Q2057 HCPCS Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure… 1 1 — — $2,042,143.00 $2,042,143.00 $2,042,143.00 2026-03-07
2067 OTHER Afamitresgene Autoleucel 14 13 — — $770,620.00 $824,563.40 $776,939.08 2026-03-07
Q2058 HCPCS Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, … 1 1 — — $737,362.50 $737,362.50 $737,362.50 2026-03-07
9498 OTHER Ciltacabtagene Car-pos T 27 14 — — $527,123.40 $628,785.07 $587,649.60 2026-03-07
9194 OTHER Tisagenlecleucel Car-pos 27 14 — — $529,192.90 $608,571.83 $566,531.30 2026-03-07
9413 OTHER Lisocabtagene Car Pos T 27 14 — — $516,726.10 $601,555.28 $562,201.20 2026-03-07
9422 OTHER Idecabtagene Vicleucel Ca 27 14 — — $526,587.60 $605,575.74 $558,081.80 2026-03-07
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 1 — — $534,422.90 $534,422.90 $534,422.90 2026-03-07
9035 OTHER Axicabtagene Ciloleucel C 27 14 — — $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 $1,501,307.95 $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 $1,557,271.36 $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 27 14 — — $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 — — $470,282.90 $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 $1,478,916.58 $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 $1,489,833.29 $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 $1,410,309.44 $449,078.23 2026-03-07
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 8 — — $430,696.39 $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 $1,297,043.03 $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 — — $415,458.24 $459,449.28 $425,416.00 2026-03-07
5833 APR_DRG Neonate With Ecmo 12 8 — — $413,074.95 $456,814.08 $422,976.00 2026-03-07
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 8 — — $332,243.00 $367,422.48 $340,206.00 2026-03-07
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 48 18 — — $16,507.00 $665,446.95 $338,967.30 2026-03-07
1614 APR_DRG Implantable Heart Assist Systems 12 8 — — $321,781.57 $355,853.52 $329,494.00 2026-03-07
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 8 — — $291,226.77 $322,063.56 $298,207.00 2026-03-07
5832 APR_DRG Neonate With Ecmo 12 8 — — $284,222.51 $314,317.80 $291,035.00 2026-03-07
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 8 — — $278,007.20 $307,443.60 $284,670.00 2026-03-07
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 12 8 — — $272,687.21 $301,560.84 $279,223.00 2026-03-07
831 OTHER Obecbtge Autol Up To 400 20 16 — — $3,089.25 $297,727.50 $278,250.00 2026-03-07
897 OTHER Revakinagene, Per Implant 14 13 — — $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 — — $259,053.55 $286,482.96 $265,262.00 2026-03-07
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 12 8 — — $258,459.62 $285,826.32 $264,654.00 2026-03-07
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 8 — — $245,674.42 $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
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 49 18 — — $23,576.00 $431,848.30 $248,434.97 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 — — $232,291.50 $256,887.72 $237,859.00 2026-03-07
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 8 — — $214,463.64 $237,172.32 $219,604.00 2026-03-07
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 6 3 — — $188,660.56 $234,249.96 $210,282.78 2026-03-07
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 6 3 — — $155,672.82 $266,491.11 $205,586.65 2026-03-07
886 OTHER Inj. Remestemcel-l-rknd/ 20 16 — — $5,825.38 $215,785.83 $201,669.00 2026-03-07
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 12 8 — — $194,633.66 $215,241.84 $199,298.00 2026-03-07
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 8 — — $193,084.90 $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 — — $191,857.79 $212,172.48 $196,456.00 2026-03-07
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 51 18 — — $11,476.00 $349,104.72 $193,546.27 2026-03-07
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 8 — — $186,786.01 $206,564.04 $191,263.00 2026-03-07
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 51 18 — — $11,476.00 $287,484.00 $186,808.70 2026-03-07
5831 APR_DRG Neonate With Ecmo 12 8 — — $177,903.74 $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
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 12 8 — — $159,940.38 $176,875.92 $163,774.00 2026-03-07
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 2 1 — — $150,585.06 $173,512.94 $162,049.00 2026-03-07
1613 APR_DRG Implantable Heart Assist Systems 12 8 — — $156,043.78 $172,566.72 $159,784.00 2026-03-07
1612 APR_DRG Implantable Heart Assist Systems 12 8 — — $152,344.74 $168,475.68 $155,996.00 2026-03-07
33262 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 15 5 — — $1,995.00 $170,545.00 $153,490.00 2026-03-07
33263 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 15 5 — — $1,995.00 $170,545.00 $153,490.00 2026-03-07
33272 CPT Removal Of Subcutaneous Implantable Defibrillator Electrode 15 5 — — $1,995.00 $170,545.00 $153,490.00 2026-03-07
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 8 — — $147,870.67 $163,528.20 $151,415.00 2026-03-07
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 8 — — $147,232.43 $162,821.88 $150,761.00 2026-03-07
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 8 — — $147,207.10 $162,793.80 $150,735.00 2026-03-07
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 8 — — $145,337.95 $160,726.68 $148,821.00 2026-03-07
1611 APR_DRG Implantable Heart Assist Systems 12 8 — — $144,693.37 $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 — — $144,689.57 $160,009.56 $148,157.00 2026-03-07
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 8 — — $144,257.74 $159,532.20 $147,715.00 2026-03-07
33270 CPT Insertion Or Replacement Of Permanent Subcutaneous Implantable Defibrillator Sys… 12 4 — — $1,995.00 $170,545.00 $145,945.00 2026-03-07
33271 CPT Insertion Of Subcutaneous Implantable Defibrillator Electrode 12 4 — — $1,995.00 $170,545.00 $145,945.00 2026-03-07
33264 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 12 4 — — $1,995.00 $170,545.00 $145,945.00 2026-03-07
1908 OTHER New Technology - Level 52 27 14 — — $140,212.00 $161,243.80 $145,820.48 2026-03-07
1907 OTHER New Technology - Level 52 27 14 — — $140,212.00 $161,243.80 $145,820.48 2026-03-07
33249 CPT Insertion Or Replacement Of Permanent Implantable Defibrillator System, With Tra… 19 6 — — $4,250.00 $170,545.00 $145,801.00 2026-03-07
33231 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multi… 19 6 — — $1,995.00 $170,545.00 $145,801.00 2026-03-07
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 6 3 — — $126,364.91 $165,104.09 $144,441.75 2026-03-07
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 12 8 — — $136,145.42 $150,560.64 $139,408.00 2026-03-07
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 12 8 — — $134,392.77 $148,623.12 $137,614.00 2026-03-07
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 8 — — $134,307.93 $148,529.16 $137,527.00 2026-03-07
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 8 — — $130,878.62 $144,736.20 $134,015.00 2026-03-07
1906 OTHER New Technology - Level 51 27 14 — — $126,420.70 $145,383.80 $131,477.53 2026-03-07
1905 OTHER New Technology - Level 51 27 14 — — $126,420.70 $145,383.80 $131,477.53 2026-03-07
01907 OTHER New Technology - Level 52 6 3 — — $119,180.20 $141,242.18 $128,620.12 2026-03-07
01908 OTHER New Technology - Level 52 6 3 — — $119,180.20 $141,242.18 $128,620.12 2026-03-07
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 8 — — $122,504.16 $135,475.20 $125,440.00 2026-03-07
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $123,321.96 $123,742.09 $123,532.02 2026-03-07
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 8 — — $120,128.46 $132,847.56 $123,007.00 2026-03-07
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 57 18 — — $11,476.00 $213,450.07 $122,053.50 2026-03-07
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 8 — — $119,117.90 $131,730.84 $121,973.00 2026-03-07
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 8 — — $117,386.78 $129,816.00 $120,200.00 2026-03-07
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 8 — — $117,386.78 $129,816.00 $120,200.00 2026-03-07
1904 OTHER New Technology - Level 50 27 14 — — $112,629.40 $129,523.81 $117,134.58 2026-03-07
1903 OTHER New Technology - Level 50 27 14 — — $112,629.40 $129,523.81 $117,134.58 2026-03-07
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 8 — — $113,486.39 $125,502.48 $116,206.00 2026-03-07
01906 OTHER New Technology - Level 51 6 3 — — $107,457.60 $127,349.55 $115,969.01 2026-03-07
01905 OTHER New Technology - Level 51 6 3 — — $107,457.60 $127,349.55 $115,969.01 2026-03-07
7 MS_DRG Lung Transplant 47 18 — — $23,576.00 $199,562.58 $115,425.10 2026-03-07
14 MS_DRG Allogeneic Bone Marrow Transplant 47 18 — — $16,507.00 $192,792.84 $111,249.60 2026-03-07
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 12 8 — — $107,524.35 $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 — — $106,146.55 $117,385.20 $108,690.00 2026-03-07
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 6 3 — — $88,850.16 $128,933.27 $107,188.24 2026-03-07
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 33 17 — — $84,999.91 $115,820.01 $106,999.89 2026-03-07
4404 APR_DRG Kidney Transplant 12 8 — — $102,945.18 $113,844.96 $105,412.00 2026-03-07
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 8 — — $102,300.60 $113,132.16 $104,752.00 2026-03-07
01904 OTHER New Technology - Level 50 6 3 — — $95,734.99 $113,456.92 $103,317.89 2026-03-07
01903 OTHER New Technology - Level 50 6 3 — — $95,734.99 $113,456.92 $103,317.89 2026-03-07
4403 APR_DRG Kidney Transplant 12 8 — — $100,568.22 $111,216.24 $102,978.00 2026-03-07
1901 OTHER New Technology - Level 49 27 14 — — $98,838.11 $113,663.83 $102,791.63 2026-03-07
1902 OTHER New Technology - Level 49 27 14 — — $98,838.11 $113,663.83 $102,791.63 2026-03-07
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 8 — — $100,209.84 $110,819.88 $102,611.00 2026-03-07
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 8 — — $99,769.14 $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 — — $99,741.28 $110,302.56 $102,132.00 2026-03-07
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 12 8 — — $99,536.13 $110,074.68 $101,921.00 2026-03-07
209 MS_DRG Complex Aortic Arch Procedures 26 17 — — $27,878.00 $174,422.71 $101,808.94 2026-03-07
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 8 — — $98,776.31 $109,234.44 $101,143.00 2026-03-07
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 8 — — $98,339.42 $108,751.68 $100,696.00 2026-03-07
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 49 18 — — $23,576.00 $334,277.00 $99,272.39 2026-03-07
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 54 18 — — $23,576.00 $212,437.00 $99,143.21 2026-03-07
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 51 18 — — $11,476.00 $167,569.88 $98,135.46 2026-03-07
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 8 — — $95,821.89 $105,967.44 $98,118.00 2026-03-07
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 12 8 — — $94,254.13 $104,234.04 $96,513.00 2026-03-07
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 6 3 — — $80,398.57 $115,550.76 $96,502.39 2026-03-07
6904 APR_DRG Acute Leukemia 12 8 — — $93,120.74 $102,980.16 $95,352.00 2026-03-07
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 8 — — $93,004.23 $102,851.64 $95,233.00 2026-03-07
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 33 17 — — $77,377.11 $104,686.68 $95,081.00 2026-03-07
8634 APR_DRG Neonatal Aftercare 12 8 — — $92,022.80 $101,766.24 $94,228.00 2026-03-07
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 12 8 — — $91,116.08 $100,764.00 $93,300.00 2026-03-07
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 12 8 — — $91,094.56 $100,740.24 $93,278.00 2026-03-07
9104 APR_DRG Craniotomy For Multiple Significant Trauma 12 8 — — $90,795.69 $100,409.76 $92,972.00 2026-03-07
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 47 18 — — $23,576.00 $158,884.80 $92,904.50 2026-03-07
215 MS_DRG Other Heart Assist System Implant 51 18 — — $34,835.00 $155,904.25 $92,246.31 2026-03-07
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 8 — — $89,601.51 $99,088.92 $91,749.00 2026-03-07
1585 OTHER New Technology - Level 48 27 14 — — $87,345.36 $100,447.16 $90,839.17 2026-03-07
1599 OTHER New Technology - Level 48 27 14 — — $87,345.36 $100,447.16 $90,839.17 2026-03-07
01901 OTHER New Technology - Level 49 6 3 — — $84,012.39 $99,564.29 $90,666.77 2026-03-07
01902 OTHER New Technology - Level 49 6 3 — — $84,012.39 $99,564.29 $90,666.77 2026-03-07
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 12 8 — — $88,294.63 $97,643.88 $90,411.00 2026-03-07
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 12 8 — — $86,398.88 $95,546.52 $88,469.00 2026-03-07
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 8 — — $85,996.18 $95,101.56 $88,057.00 2026-03-07
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 51 18 — — $34,835.00 $150,752.95 $88,050.32 2026-03-07
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 12 8 — — $85,973.38 $95,076.72 $88,034.00 2026-03-07
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 8 — — $85,883.47 $94,977.36 $87,942.00 2026-03-07
204 APR_DRG Open Craniotomy For Trauma 12 8 — — $85,734.04 $94,812.12 $87,789.00 2026-03-07
8904 APR_DRG HIV With Multiple Major HIV Related Conditions 12 8 — — $85,651.73 $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 — — $84,515.80 $93,464.28 $86,541.00 2026-03-07
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 12 8 — — $82,598.53 $91,344.24 $84,578.00 2026-03-07
007 OTHER Lung Transplant 6 3 — — $71,231.78 $99,094.04 $84,061.51 2026-03-07
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 12 8 — — $81,857.70 $90,524.52 $83,819.00 2026-03-07
014 OTHER Allogeneic Bone Marrow Transplant 6 3 — — $74,121.76 $94,212.24 $83,571.57 2026-03-07
4402 APR_DRG Kidney Transplant 12 8 — — $81,410.68 $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 — — $81,347.36 $89,960.76 $83,297.00 2026-03-07
459 MS_DRG Spinal Fusion Except Cervical With Mcc 3 2 — — $76,640.00 $146,475.00 $82,509.00 2024-10-01
33230 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Dual … 16 5 — — $1,995.00 $170,545.00 $82,121.00 2026-03-07
33240 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Singl… 16 5 — — $4,250.00 $170,545.00 $82,121.00 2026-03-07
1598 OTHER New Technology - Level 47 27 14 — — $78,151.16 $89,873.83 $81,277.21 2026-03-07
1584 OTHER New Technology - Level 47 27 14 — — $78,151.16 $89,873.83 $81,277.21 2026-03-07
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 12 8 — — $79,238.87 $87,629.04 $81,138.00 2026-03-07
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 54 18 — — $23,576.00 $169,145.00 $81,124.44 2026-03-07
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 12 8 — — $78,327.08 $86,620.32 $80,204.00 2026-03-07
01599 OTHER New Technology - Level 48 6 3 — — $74,243.56 $87,987.13 $80,124.18 2026-03-07
01585 OTHER New Technology - Level 48 6 3 — — $74,243.56 $87,987.13 $80,124.18 2026-03-07
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 12 8 — — $78,148.53 $86,422.68 $80,021.00 2026-03-07
C1772 HCPCS Pump Infs Pain 40ml 41 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $80,000.00 2026-03-07
C1882 HCPCS Icd Viva Xt Crt-d Df1 21 17 $100,000.00 $100,000.00 $18,400.00 $90,000.00 $80,000.00 2024-10-01
C1822 HCPCS Implant Pulse 8.5x15.5in 41 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $80,000.00 2026-03-07
C1820 HCPCS Nrstm Impl 1.9inx.6in 41 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $80,000.00 2026-03-07
C2621 HCPCS Pacemkr Cnslt 2ch C4tr01 21 17 $100,000.00 $100,000.00 $18,400.00 $90,000.00 $80,000.00 2024-10-01
C2622 HCPCS Prosth Penl 16cm14mm Spc 41 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $80,000.00 2026-03-07
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 12 8 — — $78,075.08 $86,341.68 $79,946.00 2026-03-07
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 6 3 — — $71,102.55 $87,826.54 $79,050.98 2026-03-07
1774 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 12 8 — — $76,920.15 $85,064.04 $78,763.00 2026-03-07
850 MS_DRG Acute Leukemia With Other Procedures 51 18 — — $11,476.00 $135,553.49 $78,753.03 2026-03-07
608695 CDM Cage Spn 10d 6x34x24mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
456480 CDM Graft Hemi Cndyl Mdl Rt 42 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
612039 CDM Cage Spn 20d 6x34x28mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
576093 CDM Grft Mtrx Clgn 1x21x29.7 22 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2024-10-01
474445 CDM Spacer Spn 30x12x8-15mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
476588 CDM Graft Bn Hemi Condrl Rt 22 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2024-10-01
564025 CDM Cage Spn 15d 6x38x28mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
439337 CDM Graft Bn Ostchnd Algrf 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
469083 CDM Spacer Spn 30x10x8-15mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
476117 CDM Spacer Spn 12x30x10-17 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
608034 CDM Cage Spn 15d 8x38x28mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
468442 CDM Spacer Spn 10mm 22mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
362576 CDM Valve Shnt Chpv Csf Prgm 42 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
552125 CDM Allograft Femor Med Rt 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
607149 CDM Implant Spn Disc Sz2 5mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
438515 CDM Graft Bn Tndn Ptla 8cm 42 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
438987 CDM Spacer Spn 9-13 10x26mm 42 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
390289 CDM Cage Crnt Peek 10x18x55 22 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2024-10-01
438218 CDM Spacer Spn 4d 26x10x8mm 42 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
609800 CDM Cage Spnl 15d 10x38x28mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
383439 CDM Cage Spn Vlift 22x32mm 22 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2024-10-01
468752 CDM Spacer Spn 30x10x7-14mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
609304 CDM Cage Spn Alf 15d 8x34x24 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
399145 CDM Graft Bn Lt Dis Fem Medl 22 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2024-10-01
561829 CDM Cage Spn 15d 6x34x24mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
494096 CDM Valve Aortic 25mm 22 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2024-10-01
392308 CDM Cage Crnt Peek 10x18x50 22 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2024-10-01
391752 CDM Spacer Pk Crnt50x18x8 Xl 22 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2024-10-01
565221 CDM Cage Spn 10d 6x38x28mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
615868 CDM Spacer Spn 22mm 8mm 7mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
490227 CDM Cage Spn 10d 10x18x45mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
403783 CDM Graft Hemi Cndyl Mdl Lt 22 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2024-10-01
486830 CDM Graft Bn Cartiform 25x20 22 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2024-10-01
608797 CDM Spacer Spn 22x10x8-14mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
491085 CDM Cage Spn 60x22x10mm 10d 42 18 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
606212 CDM Cage Spnl 8x34x24mm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 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
382543 CDM Spnl Ti H8mm X-stp Intrb 22 18 $99,885.00 $99,885.00 $14,982.75 $89,896.50 $78,409.73 2024-10-01
399516 CDM Spacer Spnl Lmbr 10mm 22 18 $99,885.00 $99,885.00 $14,982.75 $89,896.50 $78,409.73 2024-10-01
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 12 8 — — $76,408.54 $84,499.20 $78,240.00 2026-03-07
494333 CDM Cage Spn 23x9x10-15mm 42 18 $98,340.00 $98,340.00 $14,751.00 $90,000.00 $77,836.00 2026-03-07
492136 CDM Concorde Lift Expandable 42 18 $98,340.00 $98,340.00 $14,751.00 $90,000.00 $77,836.00 2026-03-07
567174 CDM Spacer Tissue Shldr Lg 42 18 $97,613.00 $97,613.00 $14,641.95 $90,000.00 $77,545.20 2026-03-07
567634 CDM Spacer Tissue Shldr Med 42 18 $97,613.00 $97,613.00 $14,641.95 $90,000.00 $77,545.20 2026-03-07
4414 APR_DRG Major Bladder Procedures 12 8 — — $75,010.48 $82,952.64 $76,808.00 2026-03-07
231 MS_DRG Coronary Bypass With Ptca With Mcc 51 18 — — $34,835.00 $136,211.00 $76,036.03 2026-03-07
1834 APR_DRG Percutaneous Structural Cardiac Procedures 12 8 — — $74,053.11 $81,894.24 $75,828.00 2026-03-07
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 57 18 — — $62,500.00 $130,925.00 $75,694.43 2026-03-07
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 8 — — $73,773.24 $81,584.28 $75,541.00 2026-03-07
C2624 HCPCS Sensor Artery Impl Systm 29 22 $100,000.00 $100,000.00 $18,400.00 $90,000.00 $75,000.00 2024-10-01
548860 CDM Kit Algrf Cartliage 50 22 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $75,000.00 2026-03-07
1694 APR_DRG Major Abdominal Vascular Procedures 12 8 — — $72,827.27 $80,537.76 $74,572.00 2026-03-07
C1722 HCPCS Icd 6.3x7.1cm 1 Chmbr 42 17 $96,390.00 $96,390.00 $17,071.52 $90,000.00 $74,224.00 2024-10-01
612250 CDM Graft Bn Lg 8cc 1x2in 20 16 $94,467.00 $94,467.00 $14,170.05 $85,020.30 $74,156.60 2026-03-07
463217 CDM Grft St Tis 13x10mm 22 18 $94,048.00 $94,048.00 $14,107.20 $84,643.20 $73,827.68 2024-10-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 12 8 — — $72,083.91 $79,715.88 $73,811.00 2026-03-07
371977 CDM Cath Impella Cp Pump Set 30 22 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $73,500.00 2024-10-01
477470 CDM Brace Extreme Lower Foot 30 22 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $73,500.00 2024-10-01
576017 CDM Wnd Mtrx Clgn 21x29.7cm 30 22 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $73,500.00 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 12 8 — — $71,505.19 $79,076.52 $73,219.00 2026-03-07
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition… 12 8 — — $71,208.86 $78,748.20 $72,915.00 2026-03-07
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 12 8 — — $70,544.02 $78,012.72 $72,234.00 2026-03-07
C9610 HCPCS Cath Dcb 2.5mm 20mm 27 20 $100,000.00 $100,000.00 $17,400.00 $90,000.00 $72,000.00 2026-03-07
C1761 HCPCS Cath Corn 3.0mm 12mm 58 22 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $72,000.00 2026-03-07
589193 CDM Kit Lo Prfl Comp Shth 7f 58 22 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $72,000.00 2026-03-07
473707 CDM Kit Surg Bngf Strl 42 18 $89,836.00 $89,836.00 $13,475.40 $87,320.70 $71,868.80 2026-03-07
1597 OTHER New Technology - Level 46 27 14 — — $68,956.96 $79,300.50 $71,715.24 2026-03-07
1583 OTHER New Technology - Level 46 27 14 — — $68,956.96 $79,300.50 $71,715.24 2026-03-07
01584 OTHER New Technology - Level 47 6 3 — — $66,428.49 $78,725.37 $71,690.10 2026-03-07
01598 OTHER New Technology - Level 47 6 3 — — $66,428.49 $78,725.37 $71,690.10 2026-03-07
607160 CDM Cage Spn 10d 10x22x55mm 20 16 $91,035.00 $91,035.00 $13,655.25 $81,931.50 $71,462.48 2026-03-07
615029 CDM Cage Spn 15d 45x22x10mm 20 16 $91,035.00 $91,035.00 $13,655.25 $81,931.50 $71,462.48 2026-03-07
612040 CDM Cage Spn 10d 60x22x12mm 20 16 $91,035.00 $91,035.00 $13,655.25 $81,931.50 $71,462.48 2026-03-07
491087 CDM Cage Spn 10d 50x18x8mm 20 16 $91,035.00 $91,035.00 $13,655.25 $81,931.50 $71,462.48 2026-03-07
610424 CDM Cage Spn 60x22x0x14mm 20 16 $91,035.00 $91,035.00 $13,655.25 $81,931.50 $71,462.48 2026-03-07
610117 CDM Cage Spn 8x22x45mm 5d 20 16 $91,035.00 $91,035.00 $13,655.25 $81,931.50 $71,462.48 2026-03-07
616102 CDM Cage Spn 50x22x12mm 10d 20 16 $91,035.00 $91,035.00 $13,655.25 $81,931.50 $71,462.48 2026-03-07
611219 CDM Cage Spn 10d 10x22x50mm 20 16 $91,035.00 $91,035.00 $13,655.25 $81,931.50 $71,462.48 2026-03-07
234 APR_DRG Spinal Procedures 12 8 — — $69,774.07 $77,161.68 $71,446.00 2026-03-07
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 51 18 — — $65,128.85 $129,371.00 $71,234.68 2026-03-07
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 12 8 — — $69,475.21 $76,831.20 $71,140.00 2026-03-07
1204 APR_DRG Major Respiratory And Chest Procedures 12 8 — — $69,415.69 $76,765.32 $71,079.00 2026-03-07
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 51 18 — — $64,849.80 $144,015.00 $70,929.47 2026-03-07
1784 APR_DRG External Heart Assist Devices 12 8 — — $69,177.61 $76,501.80 $70,835.00 2026-03-07
4014 APR_DRG Adrenal Procedures 12 8 — — $69,132.02 $76,452.12 $70,789.00 2026-03-07
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 54 18 — — $26,741.00 $121,258.21 $70,668.61 2026-03-07
2304 APR_DRG Major Small Bowel Procedures 12 8 — — $68,999.05 $76,304.16 $70,652.00 2026-03-07
914 APR_DRG Other Major Head And Neck Procedures 12 8 — — $68,892.68 $76,187.52 $70,544.00 2026-03-07
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 6 3 — — $58,446.29 $83,695.05 $70,019.28 2026-03-07
274 APR_DRG Other Open Craniotomy 12 8 — — $68,279.76 $75,509.28 $69,916.00 2026-03-07
22804 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 13 Or More V… 15 5 — — $4,250.00 $117,700.00 $69,705.50 2026-03-07
22808 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 2 To 3 Verteb… 15 5 — — $4,250.00 $117,700.00 $69,705.50 2026-03-07
22810 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 Verteb… 15 5 — — $4,250.00 $117,700.00 $69,705.50 2026-03-07
22800 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; Up To 6 Vert… 15 5 — — $4,250.00 $117,700.00 $69,705.50 2026-03-07
22802 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 7 To 12 Vert… 15 5 — — $4,250.00 $117,700.00 $69,705.50 2026-03-07
22812 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 8 Or More Ver… 15 5 — — $4,250.00 $117,700.00 $69,705.50 2026-03-07
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 12 8 — — $67,888.45 $75,076.20 $69,515.00 2026-03-07
214 APR_DRG Open Craniotomy Except Trauma 12 8 — — $67,530.07 $74,679.84 $69,148.00 2026-03-07
596306 CDM Kit Inst Khpyo Spn 15/2 58 22 $92,062.00 $92,062.00 $13,809.30 $88,657.20 $69,046.50 2026-03-07
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 33 17 — — $55,990.94 $75,752.45 $68,801.70 2026-03-07
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 8 — — $66,539.78 $73,584.72 $68,134.00 2026-03-07
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 12 8 — — $65,964.85 $72,949.68 $67,546.00 2026-03-07
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 12 8 — — $65,798.96 $72,766.08 $67,376.00 2026-03-07
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 51 18 — — $11,476.00 $117,422.66 $67,329.70 2026-03-07
1783 APR_DRG External Heart Assist Devices 12 8 — — $65,619.13 $72,567.36 $67,192.00 2026-03-07
476010 CDM Sys Reflux Mgmt Bead 17 42 18 $83,886.00 $83,886.00 $12,582.90 $81,536.40 $67,108.80 2026-03-07
476009 CDM Sys Reflux Mgmt Bead 16 42 18 $83,886.00 $83,886.00 $12,582.90 $81,536.40 $67,108.80 2026-03-07
476007 CDM Sys Reflux Mgmt Bead 14 42 18 $83,886.00 $83,886.00 $12,582.90 $81,536.40 $67,108.80 2026-03-07
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