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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

CHILDRENS HOSPITAL OF WISCONSIN

Milwaukee, WI · CCN 523300 · Rates published

14,345 distinct procedures filed
47 distinct payers
387,119 rate rows
2026-03-23 last MRF observed
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://7pgcgohua4yc5gik.public.blob.vercel-storage.com/390812532-1750482022_Childrens-Hospital-of-Wisconsin_standardcharges.csv
Found on page https://childrenswi.org/family-resources/insurance-billing-payments/price-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-22
Content fingerprint 51b16dc7754c2714… · 20,575,417 bytes · first seen 2026-05-18

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
J1413
HCPCS 		Delandistrogene Moxeparvovec-rokl 1.33x10exp13 Vg/ml Intravenous Susp 29 $2,243,500.00 $3,044,750.00 $2,724,250.00 nat. median
$3,324,572
0.8× median
J3399
HCPCS 		Onasemnogene Abeparvovec-xioi 2 X 10exp13 Vg/ml IV Suspension,kit 29 $1,627,500.00 $2,273,070.41 $1,976,250.00 nat. median
$2,467,386
0.8× median
Q2057
HCPCS 		Afamitresgene Autoleucel Per Therapeutic Dose 1 $1,656,833.00 $1,656,833.00 $1,656,833.00 nat. median
$813,967
outlier · 2.0×
Q2056
HCPCS 		Cilta Cel To 100 M Auto Bcma Dir Car-pos Tc Dose 1 $1,263,446.58 $1,263,446.58 $1,263,446.58 nat. median
$646,415
2.0× median
Q2054
HCPCS 		Lm >=110 Mil Autol Anti-cd19 Car-pos Viabl Tc 1 $1,208,732.67 $1,208,732.67 $1,208,732.67 nat. median
$640,950
1.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel Auto Bcma Dir Car-pos Tc 1 $1,199,875.72 $1,199,875.72 $1,199,875.72 nat. median
$622,450
1.9× median
Q2041
HCPCS 		Kte-c19 To 200 M Auto Anti-cd19 Car T Cell P Inf 1 $1,144,213.32 $1,144,213.32 $1,144,213.32 nat. median
$608,239
1.9× median
Q2053
HCPCS 		Brexucabtagene Autolcl Au Anti-cd19 Car P V T C 1 $1,052,317.93 $1,052,317.93 $1,052,317.93 nat. median
$591,721
1.8× median
5834
APR_DRG 		Neonate With Ecmo 7 $696,362.42 $870,453.02 $769,480.47 nat. median
$307,206
outlier · 2.5×
Q2042
HCPCS 		Tisagenlecleucel 0.2 X10exp6 To 2.5x10exp8 Cell Intravenous Suspension 30 $605,500.00 $1,218,042.30 $735,250.00 nat. median
$739,258
1.0× median
Q2058
HCPCS 		Obecabtagene Autoleucel 10 Up To 400 Mil Cd19 1 $598,237.50 $598,237.50 $598,237.50 nat. median
$319,951
1.9× median
24
APR_DRG 		Heart And/or Lung Transplant 7 $459,751.93 $574,689.91 $508,025.88 nat. median
$241,437
outlier · 2.1×
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 7 $426,509.24 $533,136.54 $471,292.71 nat. median
$247,214
1.9× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 $398,714.81 $498,393.51 $440,579.86 nat. median
$123,836
outlier · 3.6×
5833
APR_DRG 		Neonate With Ecmo 7 $396,601.16 $495,751.45 $438,244.28 nat. median
$244,017
1.8× median
J3402
HCPCS 		Injection Remestemcel-l-rknd Per Ther Dose 1 $433,588.39 $433,588.39 $433,588.39 nat. median
$209,753
outlier · 2.1×
5832
APR_DRG 		Neonate With Ecmo 7 $304,517.27 $380,646.59 $336,491.59 nat. median
$159,249
outlier · 2.1×
1614
APR_DRG 		Implantable Heart Assist Systems 7 $297,342.86 $371,678.58 $328,563.86 nat. median
$202,993
1.6× median
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 $297,159.28 $371,449.10 $328,361.00 nat. median
$165,000
2.0× median
113
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 $296,728.47 $370,910.59 $327,884.96 nat. median
$67,735
outlier · 4.8×
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 7 $291,491.47 $364,364.33 $322,098.07 nat. median
$163,587
2.0× median
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 $285,813.86 $357,267.33 $315,824.32 nat. median
$133,164
outlier · 2.4×
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 7 $284,055.14 $355,068.93 $313,880.93 nat. median
$175,204
1.8× median
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 7 $279,683.42 $349,604.28 $309,050.18 nat. median
$162,342
1.9× median
5831
APR_DRG 		Neonate With Ecmo 7 $273,341.25 $341,676.57 $302,042.08 nat. median
$146,500
outlier · 2.1×
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 7 $264,493.79 $330,617.23 $292,265.64 nat. median
$155,939
1.9× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 $259,204.16 $324,005.20 $286,420.59 nat. median
$154,011
1.9× median
14
APR_DRG 		Liver Transplant And/or Intestinal Transplant 7 $255,907.29 $319,884.12 $282,777.56 nat. median
$136,566
outlier · 2.1×
23
APR_DRG 		Heart And/or Lung Transplant 7 $250,433.70 $313,042.13 $276,729.24 nat. median
$110,944
outlier · 2.5×
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 7 $245,895.63 $307,369.54 $271,714.67 nat. median
$151,838
1.8× median
5882
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 7 $243,403.80 $304,254.75 $268,961.20 nat. median
$145,061
1.9× median
112
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 $235,895.27 $294,869.08 $260,664.27 nat. median
$67,994
outlier · 3.8×
74
APR_DRG 		Allogeneic Bone Marrow Transplant 7 $234,593.05 $293,241.32 $259,225.32 nat. median
$170,082
1.5× median
1613
APR_DRG 		Implantable Heart Assist Systems 7 $232,825.76 $291,032.20 $257,272.46 nat. median
$120,517
outlier · 2.1×
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 7 $224,015.01 $280,018.77 $247,536.60 nat. median
$122,016
outlier · 2.0×
5913
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 7 $210,930.46 $263,663.08 $233,078.16 nat. median
$101,406
outlier · 2.3×
5881
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 7 $208,632.00 $260,790.01 $230,538.36 nat. median
$120,208
1.9× median
C9293
HCPCS 		Glucarpidase 1,000 Unit Intravenous Solution 30 $964.68 $254,210.23 $226,916.08 nat. median
$30,297
outlier · 7.5×
5892
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 7 $198,812.77 $248,515.97 $219,688.11 nat. median
$89,188
outlier · 2.5×
5893
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 7 $198,812.77 $248,515.97 $219,688.11 nat. median
$71,350
outlier · 3.1×
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 7 $198,812.77 $248,515.97 $219,688.11 nat. median
$93,998
outlier · 2.3×
93
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 7 $195,901.15 $244,876.44 $216,470.78 nat. median
$78,893
outlier · 2.7×
22
APR_DRG 		Heart And/or Lung Transplant 7 $189,638.16 $237,047.70 $209,550.16 nat. median
$92,229
outlier · 2.3×
6024
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 $185,241.11 $231,551.39 $204,691.43 nat. median
$118,620
1.7× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 7 $155,000.00 $342,429.00 $204,000.00 nat. median
$110,307
1.8× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 $202,006.00 $202,006.00 $202,006.00 nat. median
$190,559
1.1× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 $202,006.00 $202,006.00 $202,006.00 nat. median
$126,695
1.6× median
928
MS_DRG 		Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 1 $202,006.00 $202,006.00 $202,006.00 nat. median
$61,308
outlier · 3.3×
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 1 $202,006.00 $202,006.00 $202,006.00 nat. median
$77,028
outlier · 2.6×
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 $202,006.00 $202,006.00 $202,006.00 nat. median
$74,370
outlier · 2.7×

Other procedures at this hospital

Browse this hospital's 14,345 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
             
850 MS_DRG Acute Leukemia With Other Procedures 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
834 MS_DRG Acute Leukemia Without Major O.r. Procedures With Mcc 1 1 — — $167,725.92 $167,725.92 $167,725.92 2026-03-23
Q2057 HCPCS Afamitresgene Autoleucel Per Therapeutic Dose 1 1 — — $1,656,833.00 $1,656,833.00 $1,656,833.00 2026-03-23
245 MS_DRG Aicd Generator Procedures 1 1 — — $148,289.95 $148,289.95 $148,289.95 2026-03-23
265 MS_DRG Aicd Lead Procedures 1 1 — — $108,246.68 $108,246.68 $108,246.68 2026-03-23
74 APR_DRG Allogeneic Bone Marrow Transplant 8 7 — — $234,593.05 $293,241.32 $259,225.32 2026-03-23
14 MS_DRG Allogeneic Bone Marrow Transplant 15 7 — — $155,000.00 $342,429.00 $204,000.00 2026-03-23
73 APR_DRG Allogeneic Bone Marrow Transplant 8 7 — — $149,203.82 $186,504.78 $164,870.22 2026-03-23
72 APR_DRG Allogeneic Bone Marrow Transplant 8 7 — — $105,070.53 $131,338.16 $116,102.93 2026-03-23
71 APR_DRG Allogeneic Bone Marrow Transplant 8 7 — — $92,749.68 $115,937.10 $102,488.39 2026-03-23
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 1 1 — — $88,370.71 $88,370.71 $88,370.71 2026-03-23
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 1 1 — — $152,844.73 $152,844.73 $152,844.73 2026-03-23
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 1 1 — — $136,088.22 $136,088.22 $136,088.22 2026-03-23
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 1 1 — — $117,283.43 $117,283.43 $117,283.43 2026-03-23
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 1 1 — — $126,256.44 $126,256.44 $126,256.44 2026-03-23
J7330 HCPCS Autol Culturd Chondrocytes Impl 1 1 — — $180,011.44 $180,011.44 $180,011.44 2026-03-23
84 APR_DRG Autologous Bone Marrow Transplant 8 7 — — $104,339.87 $130,424.83 $115,295.55 2026-03-23
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 7 7 — — $116,000.00 $213,929.00 $150,000.00 2026-03-23
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 7 7 — — $116,000.00 $213,929.00 $150,000.00 2026-03-23
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 1 1 — — $108,756.48 $108,756.48 $108,756.48 2026-03-23
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 1 1 — — $110,719.80 $110,719.80 $110,719.80 2026-03-23
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 1 1 — — $186,218.16 $186,218.16 $186,218.16 2026-03-23
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 1 1 — — $86,902.01 $86,902.01 $86,902.01 2026-03-23
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 1 1 — — $106,246.95 $106,246.95 $106,246.95 2026-03-23
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 1 1 — — $104,356.46 $104,356.46 $104,356.46 2026-03-23
90288 CPT Botulism Immune Globulin, Human 100 Mg Intravenous Solution 43 29 $197,577.49 $108,667.62 45% off $138,304.24 $187,698.62 $167,940.87 2026-03-23
Q2053 HCPCS Brexucabtagene Autolcl Au Anti-cd19 Car P V T C 1 1 — — $1,052,317.93 $1,052,317.93 $1,052,317.93 2026-03-23
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 8 7 — — $148,077.85 $185,097.31 $163,626.02 2026-03-23
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
276 MS_DRG Cardiac Defibrillator Implant With Mcc 1 1 — — $187,969.07 $187,969.07 $187,969.07 2026-03-23
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 1 1 — — $141,161.91 $141,161.91 $141,161.91 2026-03-23
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 1 1 — — $85,132.90 $85,132.90 $85,132.90 2026-03-23
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 1 1 — — $103,361.14 $103,361.14 $103,361.14 2026-03-23
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $195,964.98 $195,964.98 $195,964.98 2026-03-23
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $180,531.51 $180,531.51 $180,531.51 2026-03-23
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $160,728.36 $160,728.36 $160,728.36 2026-03-23
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $139,362.45 $139,362.45 $139,362.45 2026-03-23
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 8 7 — — $114,711.07 $143,388.84 $126,755.74 2026-03-23
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 8 7 — — $83,910.78 $104,888.47 $92,721.41 2026-03-23
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 8 7 — — $100,375.70 $125,469.63 $110,915.15 2026-03-23
34 MS_DRG Carotid Artery Stent Procedures With Mcc 1 1 — — $118,002.60 $118,002.60 $118,002.60 2026-03-23
472 MS_DRG Cervical Spinal Fusion With Cc 1 1 — — $87,915.53 $87,915.53 $87,915.53 2026-03-23
471 MS_DRG Cervical Spinal Fusion With Mcc 1 1 — — $147,394.77 $147,394.77 $147,394.77 2026-03-23
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 1 1 — — $151,943.48 $151,943.48 $151,943.48 2026-03-23
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 7 — — $398,714.81 $498,393.51 $440,579.86 2026-03-23
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 7 — — $296,728.47 $370,910.59 $327,884.96 2026-03-23
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 7 — — $235,895.27 $294,869.08 $260,664.27 2026-03-23
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 7 — — $116,179.73 $145,224.66 $128,378.61 2026-03-23
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 1 1 — — $106,322.81 $106,322.81 $106,322.81 2026-03-23
Q2056 HCPCS Cilta Cel To 100 M Auto Bcma Dir Car-pos Tc Dose 1 1 — — $1,263,446.58 $1,263,446.58 $1,263,446.58 2026-03-23
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 1 1 — — $166,002.32 $166,002.32 $166,002.32 2026-03-23
212 MS_DRG Concomitant Aortic And Mitral Valve�procedures 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 1 1 — — $187,726.31 $187,726.31 $187,726.31 2026-03-23
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 8 7 — — $90,178.29 $112,722.87 $99,647.01 2026-03-23
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 1 1 — — $161,441.47 $161,441.47 $161,441.47 2026-03-23
231 MS_DRG Coronary Bypass With Ptca With Mcc 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
232 MS_DRG Coronary Bypass With Ptca Without Mcc 1 1 — — $185,368.50 $185,368.50 $185,368.50 2026-03-23
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 8 7 — — $80,393.33 $100,491.67 $88,834.63 2026-03-23
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 1 1 — — $178,556.05 $178,556.05 $178,556.05 2026-03-23
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 1 1 — — $124,781.67 $124,781.67 $124,781.67 2026-03-23
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 1 1 — — $129,251.49 $129,251.49 $129,251.49 2026-03-23
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 1 1 — — $96,955.31 $96,955.31 $96,955.31 2026-03-23
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 1 1 — — $86,850.42 $86,850.42 $86,850.42 2026-03-23
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 1 1 — — $92,813.22 $92,813.22 $92,813.22 2026-03-23
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 1 1 — — $135,711.94 $135,711.94 $135,711.94 2026-03-23
955 MS_DRG Craniotomy For Multiple Significant Trauma 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
9104 APR_DRG Craniotomy For Multiple Significant Trauma 8 7 — — $85,652.37 $107,065.46 $94,645.86 2026-03-23
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 1 1 — — $173,121.26 $173,121.26 $173,121.26 2026-03-23
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 1 1 — — $115,362.59 $115,362.59 $115,362.59 2026-03-23
1794 APR_DRG Defibrillator Implants 8 7 — — $79,344.46 $99,180.58 $87,675.64 2026-03-23
J1413 HCPCS Delandistrogene Moxeparvovec-rokl 1.33x10exp13 Vg/ml Intravenous Susp 43 29 $3,205,000.00 $1,762,750.00 45% off $2,243,500.00 $3,044,750.00 $2,724,250.00 2026-03-23
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 8 7 — — $80,508.38 $100,635.47 $88,961.76 2026-03-23
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 7 — — $114,156.65 $142,695.81 $126,143.10 2026-03-23
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 7 — — $79,224.52 $99,030.65 $87,543.10 2026-03-23
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
J9210 HCPCS Emapalumab-lzsg 5 Mg/ml Intravenous Solution 138 30 $103,915.26 $57,153.39 45% off $13.64 $266,773.66 $88,120.14 2026-03-23
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 1 1 — — $181,790.83 $181,790.83 $181,790.83 2026-03-23
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 1 1 — — $142,764.12 $142,764.12 $142,764.12 2026-03-23
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 8 7 — — $81,467.91 $101,834.88 $90,022.04 2026-03-23
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 1 1 — — $131,299.78 $131,299.78 $131,299.78 2026-03-23
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 1 1 — — $144,257.10 $144,257.10 $144,257.10 2026-03-23
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 8 7 — — $264,493.79 $330,617.23 $292,265.64 2026-03-23
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 8 7 — — $86,017.09 $107,521.36 $95,048.88 2026-03-23
1784 APR_DRG External Heart Assist Systems 8 7 — — $95,449.57 $119,311.96 $105,471.77 2026-03-23
1783 APR_DRG External Heart Assist Systems 8 7 — — $77,017.86 $96,272.32 $85,104.74 2026-03-23
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 7 — — $291,491.47 $364,364.33 $322,098.07 2026-03-23
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 7 — — $195,901.15 $244,876.44 $216,470.78 2026-03-23
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 7 — — $98,322.03 $122,902.53 $108,645.84 2026-03-23
37 MS_DRG Extracranial Procedures With Mcc 1 1 — — $100,772.71 $100,772.71 $100,772.71 2026-03-23
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc 1 1 — — $96,509.24 $96,509.24 $96,509.24 2026-03-23
8514 APR_DRG Gender Related Procedures 8 7 — — $136,639.42 $170,799.27 $150,986.55 2026-03-23
8513 APR_DRG Gender Related Procedures 8 7 — — $136,639.42 $170,799.27 $150,986.55 2026-03-23
C9293 HCPCS Glucarpidase 1,000 Unit Intravenous Solution 44 30 $267,589.72 $147,174.35 45% off $964.68 $254,210.23 $226,916.08 2026-03-23
S2055 HCPCS Hbc Deceased Donor Kidney Acquisition Charges 135 30 $211,752.00 $116,463.60 45% off $108,311.00 $227,637.10 $170,608.02 2026-03-23
50320 CPT Hbc Living Related Kidney Acquisition Charges 48 30 $189,457.00 $104,201.35 45% off $8,006.00 $179,984.15 $158,764.96 2026-03-23
24 APR_DRG Heart And/or Lung Transplant 8 7 — — $459,751.93 $574,689.91 $508,025.88 2026-03-23
23 APR_DRG Heart And/or Lung Transplant 8 7 — — $250,433.70 $313,042.13 $276,729.24 2026-03-23
22 APR_DRG Heart And/or Lung Transplant 8 7 — — $189,638.16 $237,047.70 $209,550.16 2026-03-23
21 APR_DRG Heart And/or Lung Transplant 8 7 — — $167,609.64 $209,512.05 $185,208.65 2026-03-23
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 6 6 — — $145,000.00 $322,772.00 $189,469.00 2026-03-23
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 6 6 — — $145,000.00 $322,772.00 $189,469.00 2026-03-23
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 1 1 — — $107,102.68 $107,102.68 $107,102.68 2026-03-23
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 1 1 — — $89,001.89 $89,001.89 $89,001.89 2026-03-23
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 1 1 — — $89,244.65 $89,244.65 $89,244.65 2026-03-23
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 1 1 — — $88,446.57 $88,446.57 $88,446.57 2026-03-23
J9226 HCPCS Histrelin 50 Mg (65 Mcg/day) Implant Kit 47 30 $114,516.88 $62,984.28 45% off $80,161.82 $108,791.04 $96,881.28 2026-03-23
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 1 1 — — $191,910.88 $191,910.88 $191,910.88 2026-03-23
974 MS_DRG HIV With Major Related Condition With Mcc 1 1 — — $90,616.24 $90,616.24 $90,616.24 2026-03-23
Q2055 HCPCS Idecabtagene Vicleucel Auto Bcma Dir Car-pos Tc 1 1 — — $1,199,875.72 $1,199,875.72 $1,199,875.72 2026-03-23
1614 APR_DRG Implantable Heart Assist Systems 8 7 — — $297,342.86 $371,678.58 $328,563.86 2026-03-23
1613 APR_DRG Implantable Heart Assist Systems 8 7 — — $232,825.76 $291,032.20 $257,272.46 2026-03-23
1612 APR_DRG Implantable Heart Assist Systems 8 7 — — $171,314.53 $214,143.16 $189,302.55 2026-03-23
1611 APR_DRG Implantable Heart Assist Systems 8 7 — — $171,314.53 $214,143.16 $189,302.55 2026-03-23
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 1 1 — — $151,764.45 $151,764.45 $151,764.45 2026-03-23
J3402 HCPCS Injection Remestemcel-l-rknd Per Ther Dose 1 1 — — $433,588.39 $433,588.39 $433,588.39 2026-03-23
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $167,725.92 $167,725.92 $167,725.92 2026-03-23
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 1 1 — — $107,129.99 $107,129.99 $107,129.99 2026-03-23
J9029 HCPCS Ives Instal Nadofaragn Firadenovc-vncg Per Thr D 1 1 — — $138,190.80 $138,190.80 $138,190.80 2026-03-23
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 1 1 — — $98,864.01 $98,864.01 $98,864.01 2026-03-23
4404 APR_DRG Kidney Transplant 8 7 — — $129,605.18 $162,006.48 $143,213.73 2026-03-23
4403 APR_DRG Kidney Transplant 8 7 — — $88,115.48 $110,144.35 $97,367.61 2026-03-23
652 MS_DRG Kidney Transplant 8 6 — — $65,000.00 $124,797.00 $88,200.00 2026-03-23
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 8 6 — — $65,000.00 $124,797.00 $88,200.00 2026-03-23
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 8 6 — — $65,000.00 $124,797.00 $88,200.00 2026-03-23
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 1 1 — — $97,689.66 $97,689.66 $97,689.66 2026-03-23
Q2041 HCPCS Kte-c19 To 200 M Auto Anti-cd19 Car T Cell P Inf 1 1 — — $1,144,213.32 $1,144,213.32 $1,144,213.32 2026-03-23
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $115,990.73 $115,990.73 $115,990.73 2026-03-23
14 APR_DRG Liver Transplant And/or Intestinal Transplant 8 7 — — $255,907.29 $319,884.12 $282,777.56 2026-03-23
13 APR_DRG Liver Transplant And/or Intestinal Transplant 8 7 — — $132,860.25 $166,075.31 $146,810.58 2026-03-23
12 APR_DRG Liver Transplant And/or Intestinal Transplant 8 7 — — $102,676.42 $128,345.52 $113,457.45 2026-03-23
11 APR_DRG Liver Transplant And/or Intestinal Transplant 8 7 — — $90,202.68 $112,753.35 $99,673.96 2026-03-23
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 5 5 — — $66,000.00 $240,000.00 $195,000.00 2026-03-23
6 MS_DRG Liver Transplant Without Mcc 5 5 — — $66,000.00 $240,000.00 $195,000.00 2026-03-23
Q2054 HCPCS Lm >=110 Mil Autol Anti-cd19 Car-pos Viabl Tc 1 1 — — $1,208,732.67 $1,208,732.67 $1,208,732.67 2026-03-23
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 1 1 — — $106,832.61 $106,832.61 $106,832.61 2026-03-23
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 1 1 — — $107,761.16 $107,761.16 $107,761.16 2026-03-23
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 1 1 — — $176,677.69 $176,677.69 $176,677.69 2026-03-23
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 1 1 — — $96,770.21 $96,770.21 $96,770.21 2026-03-23
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 1 1 — — $141,999.43 $141,999.43 $141,999.43 2026-03-23
654 MS_DRG Major Bladder Procedures With Cc 1 1 — — $85,636.62 $85,636.62 $85,636.62 2026-03-23
653 MS_DRG Major Bladder Procedures With Mcc 1 1 — — $169,161.24 $169,161.24 $169,161.24 2026-03-23
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 8 7 — — $170,690.35 $213,362.93 $188,612.84 2026-03-23
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 8 7 — — $79,115.60 $98,894.50 $87,422.74 2026-03-23
163 MS_DRG Major Chest Procedures With Mcc 1 1 — — $139,866.17 $139,866.17 $139,866.17 2026-03-23
140 MS_DRG Major Head And Neck Procedures With Mcc 1 1 — — $128,335.07 $128,335.07 $128,335.07 2026-03-23
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 1 1 — — $99,188.70 $99,188.70 $99,188.70 2026-03-23
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 8 7 — — $83,256.00 $104,070.00 $91,997.88 2026-03-23
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 1 1 — — $139,341.21 $139,341.21 $139,341.21 2026-03-23
662 MS_DRG Minor Bladder Procedures With Mcc 1 1 — — $94,664.26 $94,664.26 $94,664.26 2026-03-23
2994 APR_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 8 7 — — $98,351.40 $122,939.25 $108,678.30 2026-03-23
2993 APR_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 8 7 — — $76,907.71 $96,134.64 $84,983.01 2026-03-23
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 1 1 — — $167,021.91 $167,021.91 $167,021.91 2026-03-23
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 1 1 — — $123,913.81 $123,913.81 $123,913.81 2026-03-23
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 1 1 — — $144,912.55 $144,912.55 $144,912.55 2026-03-23
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 1 1 — — $93,577.91 $93,577.91 $93,577.91 2026-03-23
J9348 HCPCS Naxitamab-gqgk 4 Mg/ml Intravenous Solution 44 30 $100,258.72 $55,142.30 45% off $1,475.07 $95,245.78 $85,019.40 2026-03-23
8634 APR_DRG Neonatal Aftercare 8 7 — — $116,479.58 $145,599.48 $128,709.94 2026-03-23
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 7 — — $135,487.74 $169,359.68 $149,713.96 2026-03-23
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 7 — — $185,241.11 $231,551.39 $204,691.43 2026-03-23
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 7 — — $128,615.63 $160,769.53 $142,120.27 2026-03-23
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 7 — — $102,772.07 $128,465.09 $113,563.14 2026-03-23
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 8 7 — — $81,672.29 $102,090.37 $90,247.89 2026-03-23
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 7 — — $143,192.10 $178,990.12 $158,227.27 2026-03-23
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 7 — — $98,175.16 $122,718.95 $108,483.55 2026-03-23
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 8 7 — — $117,999.65 $147,499.56 $130,389.61 2026-03-23
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 8 7 — — $119,095.03 $148,868.78 $131,600.01 2026-03-23
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 8 7 — — $78,733.75 $98,417.18 $87,000.79 2026-03-23
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 8 7 — — $93,814.46 $117,268.07 $103,664.98 2026-03-23
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 7 — — $297,159.28 $371,449.10 $328,361.00 2026-03-23
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 7 — — $103,081.71 $128,852.14 $113,905.30 2026-03-23
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 8 7 — — $92,003.11 $115,003.88 $101,663.43 2026-03-23
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 8 7 — — $81,552.35 $101,940.44 $90,115.35 2026-03-23
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 7 — — $279,683.42 $349,604.28 $309,050.18 2026-03-23
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 7 — — $210,930.46 $263,663.08 $233,078.16 2026-03-23
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 7 — — $180,917.13 $226,146.41 $199,913.42 2026-03-23
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 7 — — $245,895.63 $307,369.54 $271,714.67 2026-03-23
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 7 — — $179,879.27 $224,849.09 $198,766.60 2026-03-23
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 7 — — $144,682.79 $180,853.49 $159,874.48 2026-03-23
5931 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 7 — — $110,109.26 $137,636.58 $121,670.74 2026-03-23
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 7 — — $426,509.24 $533,136.54 $471,292.71 2026-03-23
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 7 — — $284,055.14 $355,068.93 $313,880.93 2026-03-23
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 7 — — $243,403.80 $304,254.75 $268,961.20 2026-03-23
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 7 — — $208,632.00 $260,790.01 $230,538.36 2026-03-23
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 8 7 — — $198,812.77 $248,515.97 $219,688.11 2026-03-23
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 8 7 — — $198,812.77 $248,515.97 $219,688.11 2026-03-23
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 8 7 — — $198,812.77 $248,515.97 $219,688.11 2026-03-23
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 8 7 — — $93,568.46 $116,960.57 $103,393.14 2026-03-23
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 7 — — $259,204.16 $324,005.20 $286,420.59 2026-03-23
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 7 — — $142,880.01 $178,600.01 $157,882.41 2026-03-23
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 8 7 — — $285,813.86 $357,267.33 $315,824.32 2026-03-23
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 8 7 — — $84,005.02 $105,006.27 $92,825.54 2026-03-23
5834 APR_DRG Neonate With Ecmo 8 7 — — $696,362.42 $870,453.02 $769,480.47 2026-03-23
5833 APR_DRG Neonate With Ecmo 8 7 — — $396,601.16 $495,751.45 $438,244.28 2026-03-23
5832 APR_DRG Neonate With Ecmo 8 7 — — $304,517.27 $380,646.59 $336,491.59 2026-03-23
5831 APR_DRG Neonate With Ecmo 8 7 — — $273,341.25 $341,676.57 $302,042.08 2026-03-23
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 1 1 — — $108,774.69 $108,774.69 $108,774.69 2026-03-23
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 1 1 — — $106,289.43 $106,289.43 $106,289.43 2026-03-23
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 1 1 — — $96,315.03 $96,315.03 $96,315.03 2026-03-23
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 1 1 — — $119,243.71 $119,243.71 $119,243.71 2026-03-23
Q2058 HCPCS Obecabtagene Autoleucel 10 Up To 400 Mil Cd19 1 1 — — $598,237.50 $598,237.50 $598,237.50 2026-03-23
J3399 HCPCS Onasemnogene Abeparvovec-xioi 2 X 10exp13 Vg/ml IV Suspension,kit 86 29 $2,358,852.84 $1,297,369.06 45% off $1,627,500.00 $2,273,070.41 $1,976,250.00 2026-03-23
214 APR_DRG Open Craniotomy Except Trauma 8 7 — — $77,560.04 $96,950.05 $85,703.85 2026-03-23
1674 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 8 7 — — $88,357.15 $110,446.44 $97,634.65 2026-03-23
228 MS_DRG Other Cardiothoracic Procedures With Mcc 1 1 — — $151,218.24 $151,218.24 $151,218.24 2026-03-23
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 1 1 — — $94,260.67 $94,260.67 $94,260.67 2026-03-23
264 MS_DRG Other Circulatory System O.r. Procedures 1 1 — — $106,058.81 $106,058.81 $106,058.81 2026-03-23
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 1 1 — — $129,442.67 $129,442.67 $129,442.67 2026-03-23
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 1 1 — — $100,196.16 $100,196.16 $100,196.16 2026-03-23
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 1 1 — — $119,732.27 $119,732.27 $119,732.27 2026-03-23
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 1 1 — — $133,299.52 $133,299.52 $133,299.52 2026-03-23
215 MS_DRG Other Heart Assist System Implant 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $123,425.25 $123,425.25 $123,425.25 2026-03-23
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 1 1 — — $127,133.41 $127,133.41 $127,133.41 2026-03-23
271 MS_DRG Other Major Cardiovascular Procedures With Cc 1 1 — — $104,520.32 $104,520.32 $104,520.32 2026-03-23
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 1 1 — — $155,760.89 $155,760.89 $155,760.89 2026-03-23
914 APR_DRG Other Major Head And Neck Procedures 8 7 — — $78,881.84 $98,602.30 $87,164.43 2026-03-23
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 1 1 — — $93,838.88 $93,838.88 $93,838.88 2026-03-23
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 1 1 — — $120,885.38 $120,885.38 $120,885.38 2026-03-23
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 1 1 — — $124,711.88 $124,711.88 $124,711.88 2026-03-23
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 1 1 — — $108,780.76 $108,780.76 $108,780.76 2026-03-23
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 1 1 — — $116,837.35 $116,837.35 $116,837.35 2026-03-23
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 1 1 — — $98,906.49 $98,906.49 $98,906.49 2026-03-23
252 MS_DRG Other Vascular Procedures With Mcc 1 1 — — $104,095.49 $104,095.49 $104,095.49 2026-03-23
64 APR_DRG Pancreas Transplant 8 7 — — $167,157.74 $208,947.18 $184,709.30 2026-03-23
63 APR_DRG Pancreas Transplant 8 7 — — $128,821.43 $161,026.78 $142,347.68 2026-03-23
62 APR_DRG Pancreas Transplant 8 7 — — $111,059.09 $138,823.86 $122,720.29 2026-03-23
61 APR_DRG Pancreas Transplant 8 7 — — $77,140.06 $96,425.07 $85,239.76 2026-03-23
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 1 1 — — $85,220.90 $85,220.90 $85,220.90 2026-03-23
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 1 1 — — $164,733.90 $164,733.90 $164,733.90 2026-03-23
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 1 1 — — $118,658.05 $118,658.05 $118,658.05 2026-03-23
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 1 1 — — $94,706.75 $94,706.75 $94,706.75 2026-03-23
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 1 1 — — $86,386.15 $86,386.15 $86,386.15 2026-03-23
1834 APR_DRG Percutaneous Structural Cardiac Procedures 8 7 — — $85,905.71 $107,382.14 $94,925.82 2026-03-23
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 1 1 — — $114,464.37 $114,464.37 $114,464.37 2026-03-23
335 MS_DRG Peritoneal Adhesiolysis With Mcc 1 1 — — $109,952.07 $109,952.07 $109,952.07 2026-03-23
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 1 1 — — $102,930.24 $102,930.24 $102,930.24 2026-03-23
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 1 1 — — $136,904.50 $136,904.50 $136,904.50 2026-03-23
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 8 7 — — $77,670.19 $97,087.74 $85,825.56 2026-03-23
665 MS_DRG Prostatectomy With Mcc 1 1 — — $104,192.59 $104,192.59 $104,192.59 2026-03-23
A9699 HCPCS Radiopharmaceutical Therapeutic Noc 1 1 — — $100,394.53 $100,394.53 $100,394.53 2026-03-23
332 MS_DRG Rectal Resection With Mcc 1 1 — — $105,257.70 $105,257.70 $105,257.70 2026-03-23
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 1 1 — — $196,247.18 $196,247.18 $196,247.18 2026-03-23
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 1 1 — — $103,937.69 $103,937.69 $103,937.69 2026-03-23
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 1 1 — — $154,595.64 $154,595.64 $154,595.64 2026-03-23
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 1 1 — — $86,729.04 $86,729.04 $86,729.04 2026-03-23
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 1 1 — — $118,715.71 $118,715.71 $118,715.71 2026-03-23
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 1 1 — — $156,279.78 $156,279.78 $156,279.78 2026-03-23
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 1 1 — — $93,644.67 $93,644.67 $93,644.67 2026-03-23
Q2043 HCPCS Sipuleucel-t Including Leukapheresis Per Infus 1 1 — — $116,968.84 $116,968.84 $116,968.84 2026-03-23
570 MS_DRG Skin Debridement With Mcc 1 1 — — $91,344.52 $91,344.52 $91,344.52 2026-03-23
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 1 1 — — $163,720.38 $163,720.38 $163,720.38 2026-03-23
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 1 1 — — $105,142.39 $105,142.39 $105,142.39 2026-03-23
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 1 1 — — $186,870.58 $186,870.58 $186,870.58 2026-03-23
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 1 1 — — $113,550.99 $113,550.99 $113,550.99 2026-03-23
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 1 1 — — $117,165.08 $117,165.08 $117,165.08 2026-03-23
500 MS_DRG Soft Tissue Procedures With Mcc 1 1 — — $96,154.20 $96,154.20 $96,154.20 2026-03-23
J1747 HCPCS Spesolimab-sbzo 60 Mg/ml Intravenous Solution 47 30 $160,433.04 $88,238.17 45% off $141.32 $152,411.39 $135,726.35 2026-03-23
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 1 — — $174,162.09 $174,162.09 $174,162.09 2026-03-23
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 1 — — $131,029.71 $131,029.71 $131,029.71 2026-03-23
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 1 1 — — $101,859.06 $101,859.06 $101,859.06 2026-03-23
28 MS_DRG Spinal Procedures With Mcc 1 1 — — $184,482.43 $184,482.43 $184,482.43 2026-03-23
800 MS_DRG Splenic Procedures With Cc 1 1 — — $88,419.26 $88,419.26 $88,419.26 2026-03-23
799 MS_DRG Splenic Procedures With Mcc 1 1 — — $144,284.41 $144,284.41 $144,284.41 2026-03-23
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 1 1 — — $154,122.26 $154,122.26 $154,122.26 2026-03-23
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 1 1 — — $87,002.15 $87,002.15 $87,002.15 2026-03-23
Q2042 HCPCS Tisagenlecleucel 0.2 X10exp6 To 2.5x10exp8 Cell Intravenous Suspension 44 30 $865,000.00 $475,750.00 45% off $605,500.00 $1,218,042.30 $735,250.00 2026-03-23
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 1 1 — — $124,526.78 $124,526.78 $124,526.78 2026-03-23
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 1 1 — — $163,738.59 $163,738.59 $163,738.59 2026-03-23
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $202,006.00 $202,006.00 $202,006.00 2026-03-23
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 7 — — $224,015.01 $280,018.77 $247,536.60 2026-03-23
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 7 — — $154,475.09 $193,093.87 $170,694.98 2026-03-23
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 7 — — $98,714.89 $123,393.62 $109,079.95 2026-03-23
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 7 — — $156,057.58 $195,071.97 $172,443.62 2026-03-23
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 7 — — $113,255.87 $141,569.84 $125,147.74 2026-03-23
668 MS_DRG Transurethral Procedures With Mcc 1 1 — — $88,495.12 $88,495.12 $88,495.12 2026-03-23
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 1 1 — — $151,825.14 $151,825.14 $151,825.14 2026-03-23
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 1 1 — — $97,237.52 $97,237.52 $97,237.52 2026-03-23
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 1 1 — — $93,116.67 $93,116.67 $93,116.67 2026-03-23
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 1 1 — — $120,800.41 $120,800.41 $120,800.41 2026-03-23
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 1 1 — — $119,486.47 $119,486.47 $119,486.47 2026-03-23
31 MS_DRG Ventricular Shunt Procedures With Mcc 1 1 — — $127,163.76 $127,163.76 $127,163.76 2026-03-23
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 1 1 — — $163,893.35 $163,893.35 $163,893.35 2026-03-23
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 1 1 — — $89,475.27 $89,475.27 $89,475.27 2026-03-23
901 MS_DRG Wound Debridements For Injuries With Mcc 1 1 — — $134,443.52 $134,443.52 $134,443.52 2026-03-23
A9543 HCPCS Y-90 Ibritumomb Tiuxtn Tx To 40 Mci 1 1 — — $122,172.78 $122,172.78 $122,172.78 2026-03-23
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