Price Transparency 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

30,130 distinct procedures filed
42 distinct payers
964,392 rate rows
2026-03-07 last MRF observed
Data quality

646,849 of 964,392 rate rows are consumer-grade (67.1%)

317,543 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 312,818
per-diem day rate — not a per-procedure price 4,099
template filing: same amount across many unrelated codes — excluded 444
placeholder amount (≤ $0.02) — excluded from medians 166
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 not_modified · 2026-06-08
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
$9,966
outlier · 452.1×
00845
OTHER 		Inj, Atidarsagene Autotem 3 $3,829,250.00 $4,369,850.00 $4,054,500.00 nat. median
$4,505,000
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
$3,746,358
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
$3,605,000
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 17 $5,565.89 $3,824,273.25 $3,344,499.30 nat. median
$13,041
outlier · 256.5×
908
OTHER 		Topi Adm Prad Zami Per Tr 16 $10,221.48 $3,569,327.40 $3,335,820.00 nat. median
$22,747
outlier · 146.6×
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
$17,963
outlier · 182.9×
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
$20,756
outlier · 153.2×
00908
OTHER 		Topi Adm Prad Zami Per Tr 3 $2,835,447.00 $3,235,745.40 $3,002,238.00 nat. median
$12,675
outlier · 236.9×
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 17 $8,154.48 $3,413,200.00 $2,968,000.00 nat. median
$21,896
outlier · 135.6×
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
$21
outlier · 138327.7×
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
$25,250
outlier · 92.4×
09141
OTHER 		Inj Onase Abepar-xioi Tre 3 $2,030,321.90 $2,511,311.57 $2,258,794.71 nat. median
$2,457,321
0.9× median
00824
OTHER 		Inj, Exagamglogene Autote 3 $1,982,200.00 $2,262,040.00 $2,098,800.00 nat. median
$2,332,000
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
$824,563
outlier · 2.5×
2067
OTHER 		Afamitresgene Autoleucel 13 $770,620.00 $824,563.40 $776,939.08 nat. median
$786,032
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
$324,450
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
$566,531
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
$558,082
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
$532,192
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
$754,974
0.7× median
09498
OTHER 		Ciltacabtagene Car-pos T 3 $448,054.89 $570,020.11 $505,405.93 nat. median
$554,552
0.9× median
09194
OTHER 		Tisagenlecleucel Car-pos 3 $449,813.97 $549,535.36 $495,714.89 nat. median
$538,205
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
$675,122
0.7× median
09413
OTHER 		Lisocabtagene Car Pos T 3 $439,217.18 $545,335.16 $489,547.67 nat. median
$534,091
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 14 $460,530.40 $529,609.96 $489,450.20 nat. median
$489,450
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 3 $447,599.46 $541,339.35 $488,321.58 nat. median
$530,178
0.9× median
5834
APR_DRG 		Neonate With Ecmo 8 $470,282.90 $520,079.40 $481,555.00 nat. median
$309,665
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
$625,184
0.8× median
09035
OTHER 		Axicabtagene Ciloleucel C 3 $416,037.60 $516,226.43 $463,567.84 nat. median
$505,583
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
$674,188
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
$634,511
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
$93,260
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
$620,080
0.7× median
09391
OTHER 		Brexucabtagene Car Pos T 3 $391,450.84 $474,766.69 $428,268.92 nat. median
$464,978
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
$89,790
outlier · 4.7×
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
$246,434
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
$370,174
0.9× median
1614
APR_DRG 		Implantable Heart Assist Systems 8 $321,781.57 $355,853.52 $329,494.00 nat. median
$207,730
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
$150,721
2.0× median

Other procedures at this hospital

Browse this hospital's 30,130 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
             
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 104 35 — — $11,476.00 $213,450.07 $112,812.54 2026-03-07
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 104 35 — — $62,500.00 $130,925.00 $98,123.00 2026-03-07
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 104 35 — — $33,311.00 $130,925.00 $81,470.00 2026-03-07
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 104 35 — — $33,311.00 $130,925.00 $81,470.00 2026-03-07
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 101 35 — — $23,576.00 $212,437.00 $123,373.50 2026-03-07
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 101 35 — — $23,576.00 $169,145.00 $101,727.50 2026-03-07
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 101 35 — — $23,576.00 $146,475.00 $101,600.57 2026-03-07
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 101 35 — — $23,576.00 $146,475.00 $95,407.34 2026-03-07
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 101 35 — — $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… 101 35 — — $23,576.00 $146,475.00 $90,392.50 2026-03-07
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 101 35 — — $23,576.00 $146,475.00 $90,392.50 2026-03-07
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 101 35 — — $23,576.00 $146,475.00 $90,187.94 2026-03-07
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 101 35 — — $26,741.00 $121,258.21 $72,679.66 2026-03-07
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 100 35 — — $23,576.00 $146,475.00 $82,402.00 2026-03-07
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 98 35 — — $11,476.00 $287,484.00 $120,162.29 2026-03-07
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 98 35 — — $25,032.00 $221,131.00 $113,987.72 2026-03-07
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 98 35 — — $34,835.00 $186,850.00 $107,034.00 2026-03-07
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 98 35 — — $64,849.80 $144,015.00 $104,432.40 2026-03-07
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 98 35 — — $34,835.00 $166,833.00 $100,008.00 2026-03-07
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 98 35 — — $65,128.85 $129,371.00 $97,249.93 2026-03-07
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 98 35 — — $34,835.00 $166,833.00 $96,284.86 2026-03-07
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 98 35 — — $45,795.38 $144,015.00 $94,192.19 2026-03-07
215 MS_DRG Other Heart Assist System Implant 98 35 — — $34,835.00 $155,904.25 $94,136.18 2026-03-07
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 98 35 — — $11,476.00 $167,569.88 $89,872.44 2026-03-07
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 98 35 — — $26,741.00 $153,578.00 $89,399.00 2026-03-07
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 98 35 — — $34,835.00 $150,752.95 $88,425.15 2026-03-07
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 98 35 — — $25,032.00 $166,710.00 $88,176.64 2026-03-07
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 98 35 — — $45,355.05 $129,371.00 $87,363.02 2026-03-07
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 98 35 — — $34,835.00 $136,759.00 $85,120.00 2026-03-07
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 98 35 — — $39,572.30 $129,371.00 $84,471.65 2026-03-07
228 MS_DRG Other Cardiothoracic Procedures With Mcc 98 35 — — $34,835.00 $135,975.00 $83,425.00 2026-03-07
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 98 35 — — $35,462.64 $136,759.00 $82,749.41 2026-03-07
231 MS_DRG Coronary Bypass With Ptca With Mcc 98 35 — — $34,835.00 $136,211.00 $82,746.50 2026-03-07
232 MS_DRG Coronary Bypass With Ptca Without Mcc 98 35 — — $34,835.00 $136,211.00 $82,746.50 2026-03-07
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 98 35 — — $23,576.00 $122,380.00 $73,954.50 2026-03-07
850 MS_DRG Acute Leukemia With Other Procedures 98 35 — — $11,476.00 $135,553.49 $73,514.74 2026-03-07
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 98 35 — — $19,270.00 $137,457.00 $71,381.26 2026-03-07
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 98 35 — — $26,741.00 $115,313.00 $70,456.00 2026-03-07
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 96 35 — — $23,576.00 $431,848.30 $229,863.15 2026-03-07
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 96 35 — — $23,576.00 $334,277.00 $99,272.39 2026-03-07
7 MS_DRG Lung Transplant 91 35 — — $23,576.00 $199,562.58 $113,720.29 2026-03-07
14 MS_DRG Allogeneic Bone Marrow Transplant 91 35 — — $16,507.00 $192,792.84 $104,649.92 2026-03-07
652 MS_DRG Kidney Transplant 91 35 — — $23,576.00 $173,634.00 $96,558.75 2026-03-07
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 91 35 — — $23,576.00 $158,884.80 $92,904.50 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
209 MS_DRG Complex Aortic Arch Procedures 49 34 — — $27,878.00 $174,422.71 $101,150.35 2026-03-07
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 49 34 — — $21,132.00 $180,850.00 $87,943.33 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
714 OTHER Inj Delandistrogene Mox R 33 17 — — $5,565.89 $3,824,273.25 $3,344,499.30 2026-03-07
748 OTHER Inj, Lovotibeglogene Auto 33 17 — — $9,180.92 $3,778,900.00 $3,286,000.00 2026-03-07
746 OTHER Inj, Betibeglogene Autote 33 17 — — $8,154.48 $3,413,200.00 $2,968,000.00 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
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
J7330 HCPCS Autolog Chondro 1 Imp 30 20 $82,500.00 $82,500.00 $15,000.00 $221,874.56 $73,500.00 2026-03-07
548860 CDM Kit Algrf Cartliage 28 20 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $71,500.00 2026-03-07
589193 CDM Kit Lo Prfl Comp Shth 7f 28 20 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $71,500.00 2026-03-07
C1761 HCPCS Cath Corn 3.0mm 12mm 28 20 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $71,500.00 2026-03-07
C1886 HCPCS Probe Rf Ablat 17ga 10mm 28 20 $92,973.00 $92,973.00 $14,922.45 $89,534.70 $71,130.35 2026-03-07
596306 CDM Kit Inst Khpyo Spn 15/2 28 20 $92,062.00 $92,062.00 $14,776.20 $88,657.20 $70,433.22 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
9141 OTHER Inj Onase Abepar-xioi Tre 27 14 — — $2,388,614.00 $2,770,209.67 $2,588,981.00 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
9035 OTHER Axicabtagene Ciloleucel C 27 14 — — $489,456.00 $569,445.65 $532,192.20 2026-03-07
9391 OTHER Brexucabtagene Car Pos T 27 14 — — $460,530.40 $529,609.96 $489,450.20 2026-03-07
1907 OTHER New Technology - Level 52 27 14 — — $140,212.00 $161,243.80 $145,820.48 2026-03-07
1908 OTHER New Technology - Level 52 27 14 — — $140,212.00 $161,243.80 $145,820.48 2026-03-07
1905 OTHER New Technology - Level 51 27 14 — — $126,420.70 $145,383.80 $131,477.53 2026-03-07
1906 OTHER New Technology - Level 51 27 14 — — $126,420.70 $145,383.80 $131,477.53 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
1902 OTHER New Technology - Level 49 27 14 — — $98,838.11 $113,663.83 $102,791.63 2026-03-07
1901 OTHER New Technology - Level 49 27 14 — — $98,838.11 $113,663.83 $102,791.63 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
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
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
1583 OTHER New Technology - Level 46 27 14 — — $68,956.96 $79,300.50 $71,715.24 2026-03-07
1597 OTHER New Technology - Level 46 27 14 — — $68,956.96 $79,300.50 $71,715.24 2026-03-07
845 OTHER Inj, Atidarsagene Autotem 20 16 — — $5,022.33 $4,820,350.00 $4,505,000.00 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
906 OTHER Inj Elivaldogene Autoteme 20 16 — — $6,698.01 $3,402,600.00 $3,180,000.00 2026-03-07
824 OTHER Inj, Exagamglogene Autote 20 16 — — $14,025.63 $2,495,240.00 $2,332,000.00 2026-03-07
831 OTHER Obecbtge Autol Up To 400 20 16 — — $3,089.25 $297,727.50 $278,250.00 2026-03-07
886 OTHER Inj. Remestemcel-l-rknd/ 20 16 — — $5,825.38 $215,785.83 $201,669.00 2026-03-07
492136 CDM Concorde Lift Expandable 20 16 $98,340.00 $98,340.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
362576 CDM Valve Shnt Chpv Csf Prgm 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
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
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
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
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
567174 CDM Spacer Tissue Shldr Lg 20 16 $97,613.00 $97,613.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
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
C1820 HCPCS Nrstm Impl 1.9inx.6in 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
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
438218 CDM Spacer Spn 4d 26x10x8mm 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
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
494333 CDM Cage Spn 23x9x10-15mm 20 16 $98,340.00 $98,340.00 $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
C1767 HCPCS Gen Nrstm 1.8x1.3x.27in 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
C1822 HCPCS Implant Pulse 8.5x15.5in 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
C2622 HCPCS Prosth Penl 16cm14mm Spc 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
C1721 HCPCS Icd 6.5x5.9cm 2dr 20 16 $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 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 20 16 $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
C1772 HCPCS Pump Infs Pain 40ml 20 16 $100,000.00 $100,000.00 $15,000.00 $90,000.00 $78,500.00 2026-03-07
367402 CDM Graft Bone Infuse Bmp Me 20 16 $37,911.00 $37,911.00 $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
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
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
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
491085 CDM Cage Spn 60x22x10mm 10d 20 16 $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
438515 CDM Graft Bn Tndn Ptla 8cm 20 16 $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
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
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
567634 CDM Spacer Tissue Shldr Med 20 16 $97,613.00 $97,613.00 $15,000.00 $90,000.00 $78,500.00 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
473707 CDM Kit Surg Bngf Strl 20 16 $89,836.00 $89,836.00 $14,553.45 $87,320.70 $76,163.05 2026-03-07
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
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
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
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
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
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
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
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
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
476009 CDM Sys Reflux Mgmt Bead 16 20 16 $83,886.00 $83,886.00 $13,589.40 $81,536.40 $71,117.86 2026-03-07
476007 CDM Sys Reflux Mgmt Bead 14 20 16 $83,886.00 $83,886.00 $13,589.40 $81,536.40 $71,117.86 2026-03-07
476010 CDM Sys Reflux Mgmt Bead 17 20 16 $83,886.00 $83,886.00 $13,589.40 $81,536.40 $71,117.86 2026-03-07
476006 CDM System Gs Impl Anrflx 20 16 $83,886.00 $83,886.00 $13,589.40 $81,536.40 $71,117.86 2026-03-07
476008 CDM Sys Reflux Mgmt Bead 15 20 16 $83,886.00 $83,886.00 $13,589.40 $81,536.40 $71,117.86 2026-03-07
546148 CDM Graft St Tis 8x3cm 20 16 $83,133.00 $83,133.00 $13,467.45 $80,804.70 $70,479.65 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
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
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
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
33272 CPT Removal Of Subcutaneous Implantable Defibrillator Electrode 15 5 — — $1,995.00 $170,545.00 $153,490.00 2026-03-07
2067 OTHER Afamitresgene Autoleucel 14 13 — — $770,620.00 $824,563.40 $776,939.08 2026-03-07
897 OTHER Revakinagene, Per Implant 14 13 — — $265,000.00 $283,550.00 $267,173.00 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
5834 APR_DRG Neonate With Ecmo 12 8 — — $470,282.90 $520,079.40 $481,555.00 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
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
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
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
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
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
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
5831 APR_DRG Neonate With Ecmo 12 8 — — $177,903.74 $196,741.44 $182,168.00 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
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
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
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
33271 CPT Insertion Of Subcutaneous Implantable Defibrillator Electrode 12 4 — — $1,995.00 $170,545.00 $145,945.00 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
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
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
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
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
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
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
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
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
4403 APR_DRG Kidney Transplant 12 8 — — $100,568.22 $111,216.24 $102,978.00 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
4414 APR_DRG Major Bladder Procedures 12 8 — — $75,010.48 $82,952.64 $76,808.00 2026-03-07
1834 APR_DRG Percutaneous Structural Cardiac Procedures 12 8 — — $74,053.11 $81,894.24 $75,828.00 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
1694 APR_DRG Major Abdominal Vascular Procedures 12 8 — — $72,827.27 $80,537.76 $74,572.00 2026-03-07
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
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
234 APR_DRG Spinal Procedures 12 8 — — $69,774.07 $77,161.68 $71,446.00 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
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
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
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
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
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
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
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
09138 OTHER Inj, Hemgenix, Per Tx Dos 6 3 — — $3,121,965.00 $3,574,708.99 $3,311,175.15 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
00748 OTHER Inj, Lovotibeglogene Auto 6 3 — — $2,764,631.80 $3,187,420.00 $2,942,328.60 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
09141 OTHER Inj Onase Abepar-xioi Tre 6 3 — — $2,030,321.90 $2,511,311.57 $2,258,794.71 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
09413 OTHER Lisocabtagene Car Pos T 6 3 — — $439,217.18 $545,335.16 $489,547.67 2026-03-07
09422 OTHER Idecabtagene Vicleucel Ca 6 3 — — $447,599.46 $541,339.35 $488,321.58 2026-03-07
09035 OTHER Axicabtagene Ciloleucel C 6 3 — — $416,037.60 $516,226.43 $463,567.84 2026-03-07
09391 OTHER Brexucabtagene Car Pos T 6 3 — — $391,450.84 $474,766.69 $428,268.92 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
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
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
01905 OTHER New Technology - Level 51 6 3 — — $107,457.60 $127,349.55 $115,969.01 2026-03-07
01906 OTHER New Technology - Level 51 6 3 — — $107,457.60 $127,349.55 $115,969.01 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
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
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 6 3 — — $80,398.57 $115,550.76 $96,502.39 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
007 OTHER Lung Transplant 6 3 — — $71,231.78 $99,094.04 $84,061.51 2026-03-07
014 OTHER Allogeneic Bone Marrow Transplant 6 3 — — $74,121.76 $94,212.24 $83,571.57 2026-03-07
01585 OTHER New Technology - Level 48 6 3 — — $74,243.56 $87,987.13 $80,124.18 2026-03-07
01599 OTHER New Technology - Level 48 6 3 — — $74,243.56 $87,987.13 $80,124.18 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
230 MS_DRG Other Cardiothoracic Procedures Without Cc/mcc 6 1 — — $76,801.00 $80,065.00 $78,433.00 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
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 6 3 — — $58,446.29 $83,695.05 $70,019.28 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
00773 OTHER Inj, Beqvez, Per Tx Dose 3 2 — — $3,064,250.00 $3,496,850.00 $3,244,500.00 2024-10-01
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
00906 OTHER Inj Elivaldogene Autoteme 3 3 — — $2,703,000.00 $3,084,600.00 $2,862,000.00 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
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
00886 OTHER Inj. Remestemcel-l-rknd/ 3 3 — — $171,418.65 $195,618.93 $181,502.10 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
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
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $123,321.96 $123,742.09 $123,532.02 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
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
J3402 HCPCS Injection, Remestemcel-l-rknd, Per Therapeutic Dose 1 1 — — $534,422.90 $534,422.90 $534,422.90 2026-03-07
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