Hospital

Wise Health System

Decatur, TX · CCN 670116 · Rates published

36,570 distinct procedures filed

37 distinct payers

1,607,123 rate rows

2026-03-01 last MRF observed

Data quality

1,586,291 of 1,607,123 rate rows are consumer-grade (98.7%)

20,832 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 — reason	Rows
per-diem day rate — not a per-procedure price	11,192
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	5,587
template filing: same amount across many unrelated codes — excluded	3,758
placeholder amount (≤ $0.02) — excluded from medians	240
exceeds 10× this hospital's gross charge — excluded from medians	55

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/46-4027347_MEDICAL-CITY-SURGERY-CITY-ALLIANCE_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page	https://medicalcityhealthcare.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-05-15
Content fingerprint	906896cefc46d24e… · 686,453,910 bytes · first seen 2026-05-08

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
J3393 HCPCS	Injection, Betibeglogene Autotemcel, Per Treatment	1	$4,850,948.67	$4,850,948.67	$4,850,948.67	nat. median $3,006,423 1.6× median
845 OTHER	Inj, Atidarsagene Autotem	20	$5,291.79	$4,955,500.00	$4,535,408.75	nat. median $9,966 outlier · 455.1×
00845 OTHER	Inj, Atidarsagene Autotem	2	$4,369,850.00	$4,505,000.00	$4,437,425.00	nat. median $4,505,000 1.0× median
J3399 HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	1	$4,271,819.03	$4,271,819.03	$4,271,819.03	nat. median $2,469,189 1.7× median
J3392 HCPCS	Injection, Exagamglogene Autotemcel, Per Treatment	1	$3,847,800.00	$3,847,800.00	$3,847,800.00	nat. median $2,448,600 1.6× median
9138 OTHER	Inj, Hemgenix, Per Tx Dos	20	$3,666,840.67	$4,790,847.10	$3,722,119.67	nat. median $3,746,358 1.0× median
09138 OTHER	Inj, Hemgenix, Per Tx Dos	2	$3,574,708.99	$3,685,267.00	$3,629,988.00	nat. median $3,574,709 1.0× median
714 OTHER	Inj Delandistrogene Mox R	22	$6,223.86	$4,326,218.00	$3,377,777.90	nat. median $13,041 outlier · 259.0×
908 OTHER	Topi Adm Prad Zami Per Tr	20	$9,581.54	$4,336,566.00	$3,369,178.20	nat. median $22,747 outlier · 148.1×
748 OTHER	Inj, Lovotibeglogene Auto	22	$11,847.05	$4,228,260.40	$3,301,295.62	nat. median $17,963 outlier · 183.8×
00908 OTHER	Topi Adm Prad Zami Per Tr	2	$3,235,745.40	$3,335,820.00	$3,285,782.70	nat. median $12,675 outlier · 259.2×
00714 OTHER	Inj Delandistrogene Mox R	2	$3,228,024.20	$3,327,860.00	$3,277,942.10	nat. median $3,228,024 1.0× median
906 OTHER	Inj Elivaldogene Autoteme	20	$8,466.42	$4,134,000.00	$3,211,800.00	nat. median $20,756 outlier · 154.7×
00748 OTHER	Inj, Lovotibeglogene Auto	2	$3,154,932.76	$3,252,508.00	$3,203,720.38	nat. median $3,187,420 1.0× median
00906 OTHER	Inj Elivaldogene Autoteme	2	$3,084,600.00	$3,180,000.00	$3,132,300.00	nat. median $21 outlier · 151392.0×
746 OTHER	Inj, Betibeglogene Autote	22	$10,958.64	$3,821,959.70	$2,984,068.54	nat. median $21,896 outlier · 136.3×
00746 OTHER	Inj, Betibeglogene Autote	2	$2,851,769.93	$2,939,969.00	$2,895,869.46	nat. median $2,878,960 1.0× median
9141 OTHER	Inj Onase Abepar-xioi Tre	21	$2,455,110.00	$4,634,275.99	$2,627,815.71	nat. median $2,588,981 1.0× median
09141 OTHER	Inj Onase Abepar-xioi Tre	2	$2,511,311.57	$2,588,981.00	$2,550,146.29	nat. median $2,457,321 1.0× median
Q2057 HCPCS	Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure…	2	$1,271,523.00	$4,067,128.80	$2,528,215.20	nat. median $824,563 outlier · 3.1×
824 OTHER	Inj, Exagamglogene Autote	22	$12,832.29	$4,174,280.00	$2,353,571.00	nat. median $25,250 outlier · 93.2×
00824 OTHER	Inj, Exagamglogene Autote	2	$2,262,040.00	$2,332,000.00	$2,297,020.00	nat. median $2,332,000 1.0× median
Q2058 HCPCS	Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells,…	2	$459,112.50	$2,937,060.00	$1,825,740.00	nat. median $324,450 outlier · 5.6×
Q2056 HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	4	$536,573.93	$3,186,403.20	$1,597,833.00	nat. median $675,122 outlier · 2.4×
Q2055 HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	4	$511,793.34	$2,874,615.36	$1,441,485.90	nat. median $625,184 outlier · 2.3×
Q2054 HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	4	$500,948.74	$2,811,572.54	$1,409,872.86	nat. median $674,188 outlier · 2.1×
C9301 HCPCS	Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc…	1	$959,962.50	$1,544,287.50	$1,405,162.50	nat. median $459,112 outlier · 3.1×
Q2042 HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	4	$23.68	$2,643,227.20	$1,325,455.50	nat. median $754,974 1.8× median
Q2053 HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	4	$474,717.03	$2,555,975.04	$1,281,702.60	nat. median $620,080 outlier · 2.1×
Q2041 HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	4	$6.22	$2,437,928.00	$1,222,507.50	nat. median $634,511 1.9× median
2067 OTHER	Afamitresgene Autoleucel	23	$766,766.90	$2,019,024.40	$801,444.80	nat. median $786,032 1.0× median
9498 OTHER	Ciltacabtagene Car-pos T	22	$565,868.90	$1,539,641.95	$605,279.09	nat. median $587,650 1.0× median
9194 OTHER	Tisagenlecleucel Car-pos	22	$563,698.64	$1,484,312.01	$591,726.20	nat. median $566,531 1.0× median
9413 OTHER	Lisocabtagene Car Pos T	22	$559,390.19	$1,472,967.14	$579,067.24	nat. median $562,201 1.0× median
09498 OTHER	Ciltacabtagene Car-pos T	2	$570,020.11	$587,649.60	$578,834.85	nat. median $554,552 1.0× median
9422 OTHER	Idecabtagene Vicleucel Ca	22	$555,291.39	$1,462,174.32	$574,824.25	nat. median $558,082 1.0× median
09194 OTHER	Tisagenlecleucel Car-pos	2	$549,535.36	$566,531.30	$558,033.33	nat. median $538,205 1.0× median
09413 OTHER	Lisocabtagene Car Pos T	2	$545,335.16	$562,201.20	$553,768.18	nat. median $534,091 1.0× median
09422 OTHER	Idecabtagene Vicleucel Ca	2	$541,339.35	$558,081.80	$549,710.57	nat. median $530,178 1.0× median
9035 OTHER	Axicabtagene Ciloleucel C	22	$529,531.24	$1,394,343.56	$548,157.97	nat. median $532,192 1.0× median
09035 OTHER	Axicabtagene Ciloleucel C	2	$516,226.43	$532,192.20	$524,209.31	nat. median $505,583 1.0× median
9391 OTHER	Brexucabtagene Car Pos T	22	$487,002.95	$1,282,359.52	$504,133.71	nat. median $489,450 1.0× median
09391 OTHER	Brexucabtagene Car Pos T	2	$474,766.69	$489,450.20	$482,108.45	nat. median $464,978 1.0× median
J9029 HCPCS	Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose	5	$61,338.53	$1,100,800.00	$405,600.00	nat. median $69,774 outlier · 5.8×
1 MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	28	$207,841.14	$842,426.46	$358,453.70	nat. median $265,286 1.4× median
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	17	$318,346.14	$1,273,072.13	$341,085.15	nat. median $370,174 0.9× median
J3402 HCPCS	Injection, Remestemcel-l-rknd, Per Therapeutic Dose	1	$332,753.88	$332,753.88	$332,753.88	nat. median $209,753 1.6× median
90288 CPT	Botulism Immune Globulin, Human, For Intravenous Use	1	$294,713.96	$416,525.16	$329,245.80	nat. median $55,037 outlier · 6.0×
Q2043 HCPCS	Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…	5	$55,306.59	$478,449.94	$310,609.58	nat. median $66,682 outlier · 4.7×
A9543 HCPCS	Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil…	4	$93,760.51	$582,739.61	$302,670.97	nat. median $62,507 outlier · 4.8×

Other procedures at this hospital

Browse this hospital's 36,570 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

422506	CDM	Kit Pmp Rt Hrt 22f 170cm	45	18	$460,620.00	$460,620.00	$32,243.40	$460,620.00	$118,839.96	2026-03-01
862710	CDM	Set Vntrc 17.4x13.8in	45	18	$460,620.00	$460,620.00	$32,243.40	$460,620.00	$118,839.96	2026-03-01
265596	CDM	Kit Lo Prfl Comp Shth 7f	45	18	$460,620.00	$460,620.00	$32,243.40	$460,620.00	$118,839.96	2026-03-01
437822	CDM	Valve Aor Tavr 23mm	27	11	$392,040.00	$392,040.00	$52,925.40	$392,040.00	$115,651.80	2026-03-01
850516	CDM	Device Vntrc Asst 2 Lvas	27	11	$373,750.00	$373,750.00	$50,456.25	$373,750.00	$110,256.25	2026-03-01
751731	CDM	Set Pump Asst 2.5in	45	18	$368,400.00	$368,400.00	$25,788.00	$368,400.00	$95,047.20	2026-03-01
258384	CDM	Cage Spn 12d 34x28x13mm	27	11	$363,440.00	$363,440.00	$49,064.40	$363,440.00	$107,214.80	2026-03-01
C1822	HCPCS	Pulse Gen Imp	22	9	$313,880.00	$313,880.00	$42,373.80	$313,880.00	$100,127.72	2026-03-01
C2624	HCPCS	Sensor Artery Impl Systm	22	9	$282,240.00	$282,240.00	$38,102.40	$282,240.00	$90,034.56	2026-03-01
248168	CDM	Graft Bn Fem Whole Left	27	11	$269,787.00	$269,787.00	$36,421.25	$269,787.00	$79,587.16	2026-03-01
281817	CDM	Kit Cstm Maxilla	45	18	$257,364.00	$257,364.00	$18,015.48	$257,364.00	$66,399.91	2026-03-01
258440	CDM	Cage Spn 7dg 14x16x7mm	27	11	$240,408.00	$240,408.00	$32,455.08	$240,408.00	$70,920.36	2026-03-01
258441	CDM	Cage Spn 7dg 14x16x8mm	27	11	$240,408.00	$240,408.00	$32,455.08	$240,408.00	$70,920.36	2026-03-01
422734	CDM	Graft Evas 10cm 12mm	27	11	$238,464.00	$238,464.00	$32,192.64	$238,464.00	$70,346.88	2026-03-01
446494	CDM	Graft Bn Cartiform 25x20	27	11	$238,464.00	$238,464.00	$32,192.64	$238,464.00	$70,346.88	2026-03-01
423117	CDM	Graft Evas 10cm 14.5mm	27	11	$238,464.00	$238,464.00	$32,192.64	$238,464.00	$70,346.88	2026-03-01
271184	CDM	Graft Bn Sub 12.5cc	27	11	$238,464.00	$238,464.00	$32,192.64	$238,464.00	$70,346.88	2026-03-01
444727	CDM	Occluder Cv 35x18mm	27	11	$238,381.00	$238,381.00	$32,181.44	$238,381.00	$70,322.40	2026-03-01
442513	CDM	Occluder Cv 25x18mm	27	11	$238,381.00	$238,381.00	$32,181.44	$238,381.00	$70,322.40	2026-03-01
C1767	HCPCS	Generator Nrstm 5 Ipg	286	9	$238,029.00	$238,029.00	$375.03	$331,058.00	$70,457.82	2026-03-01
C1772	HCPCS	Pump Inf Isomd Cnst Flow	66	9	$236,115.00	$236,115.00	$7,494.26	$238,464.00	$62,334.36	2026-03-01
C1820	HCPCS	Kit Generator Ipg	396	9	$236,051.50	$236,051.50	$2,816.64	$418,164.00	$72,017.11	2026-03-01
730191	CDM	Device Ast Vent 00551042	27	11	$225,000.00	$225,000.00	$30,375.00	$225,000.00	$66,375.00	2026-03-01
211753	CDM	Graft Endo Aaa 28.5x12mm	27	11	$208,980.00	$208,980.00	$28,212.30	$208,980.00	$61,649.10	2026-03-01
879051	CDM	Graft Evas 28.5x12m 16cm	27	11	$208,980.00	$208,980.00	$28,212.30	$208,980.00	$61,649.10	2026-03-01
216719	CDM	Graft Endo Aaa 26x12mm	27	11	$208,980.00	$208,980.00	$28,212.30	$208,980.00	$61,649.10	2026-03-01
100505	CDM	Cage Tlif 30x10x11mm	27	11	$206,624.00	$206,624.00	$27,894.24	$206,624.00	$60,954.08	2026-03-01
476763	CDM	Cage Spnl 30x10x12mm 5d	27	11	$206,624.00	$206,624.00	$27,894.24	$206,624.00	$60,954.08	2026-03-01
222739	CDM	Cage Spn 5d 10x13x30mm	27	11	$206,624.00	$206,624.00	$27,894.24	$206,624.00	$60,954.08	2026-03-01
465179	CDM	Cage Spnl 24mmx10mmx13mm	27	11	$204,220.00	$204,220.00	$27,569.70	$204,220.00	$60,244.90	2026-03-01
257394	CDM	Spacer Spn 12mm	27	11	$201,936.00	$201,936.00	$27,261.36	$201,936.00	$59,571.12	2026-03-01
747440	CDM	Graft Nrv 4-5mm 70mm	27	11	$199,196.00	$199,196.00	$26,891.46	$199,196.00	$58,762.82	2026-03-01
257996	CDM	Cage Spn 4.5x12x6 7mm 3d	27	11	$192,320.00	$192,320.00	$25,963.20	$192,320.00	$56,734.40	2026-03-01
C1722	HCPCS	Aicd .99cm 5.37x7.79cm	330	9	$182,585.00	$182,585.00	$7,779.24	$330,807.00	$53,862.57	2026-03-01
481326	CDM	Graft Hemi Cndyl Mdl Lt	27	11	$176,796.00	$176,796.00	$23,867.46	$176,796.00	$52,154.82	2026-03-01
719583	CDM	Graft Hemi Cndyl Mdl Rt	27	11	$176,796.00	$176,796.00	$23,867.46	$176,796.00	$52,154.82	2026-03-01
422126	CDM	Graft Bn Hemi Condrl Rt	27	11	$176,796.00	$176,796.00	$23,867.46	$176,796.00	$52,154.82	2026-03-01
747118	CDM	Graft Bn Fem Hemi Cndyl	27	11	$176,796.00	$176,796.00	$23,867.46	$176,796.00	$52,154.82	2026-03-01
J3393	HCPCS	Injection, Betibeglogene Autotemcel, Per Treatment	3	1	—	—	$4,850,948.67	$4,850,948.67	$4,850,948.67	2026-03-01
845	OTHER	Inj, Atidarsagene Autotem	32	20	—	—	$5,291.79	$4,955,500.00	$4,535,408.75	2026-03-01
00845	OTHER	Inj, Atidarsagene Autotem	2	2	—	—	$4,369,850.00	$4,505,000.00	$4,437,425.00	2026-03-01
J3399	HCPCS	Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…	3	1	—	—	$4,271,819.03	$4,271,819.03	$4,271,819.03	2026-03-01
J3392	HCPCS	Injection, Exagamglogene Autotemcel, Per Treatment	3	1	—	—	$3,847,800.00	$3,847,800.00	$3,847,800.00	2026-03-01
9138	OTHER	Inj, Hemgenix, Per Tx Dos	31	20	—	—	$3,666,840.67	$4,790,847.10	$3,722,119.67	2026-03-01
09138	OTHER	Inj, Hemgenix, Per Tx Dos	2	2	—	—	$3,574,708.99	$3,685,267.00	$3,629,988.00	2026-03-01
714	OTHER	Inj Delandistrogene Mox R	36	22	—	—	$6,223.86	$4,326,218.00	$3,377,777.90	2026-03-01
908	OTHER	Topi Adm Prad Zami Per Tr	31	20	—	—	$9,581.54	$4,336,566.00	$3,369,178.20	2026-03-01
748	OTHER	Inj, Lovotibeglogene Auto	36	22	—	—	$11,847.05	$4,228,260.40	$3,301,295.62	2026-03-01
00908	OTHER	Topi Adm Prad Zami Per Tr	2	2	—	—	$3,235,745.40	$3,335,820.00	$3,285,782.70	2026-03-01
00714	OTHER	Inj Delandistrogene Mox R	2	2	—	—	$3,228,024.20	$3,327,860.00	$3,277,942.10	2026-03-01
906	OTHER	Inj Elivaldogene Autoteme	31	20	—	—	$8,466.42	$4,134,000.00	$3,211,800.00	2026-03-01
00748	OTHER	Inj, Lovotibeglogene Auto	2	2	—	—	$3,154,932.76	$3,252,508.00	$3,203,720.38	2026-03-01
00906	OTHER	Inj Elivaldogene Autoteme	2	2	—	—	$3,084,600.00	$3,180,000.00	$3,132,300.00	2026-03-01
746	OTHER	Inj, Betibeglogene Autote	36	22	—	—	$10,958.64	$3,821,959.70	$2,984,068.54	2026-03-01
00746	OTHER	Inj, Betibeglogene Autote	2	2	—	—	$2,851,769.93	$2,939,969.00	$2,895,869.46	2026-03-01
9141	OTHER	Inj Onase Abepar-xioi Tre	32	21	—	—	$2,455,110.00	$4,634,275.99	$2,627,815.71	2026-03-01
09141	OTHER	Inj Onase Abepar-xioi Tre	2	2	—	—	$2,511,311.57	$2,588,981.00	$2,550,146.29	2026-03-01
Q2057	HCPCS	Afamitresgene Autoleucel, Including Leukapheresis And Dose Preparation Procedure…	9	2	—	—	$1,271,523.00	$4,067,128.80	$2,528,215.20	2026-03-01
824	OTHER	Inj, Exagamglogene Autote	34	22	—	—	$12,832.29	$4,174,280.00	$2,353,571.00	2026-03-01
00824	OTHER	Inj, Exagamglogene Autote	2	2	—	—	$2,262,040.00	$2,332,000.00	$2,297,020.00	2026-03-01
Q2058	HCPCS	Obecabtagene Autoleucel, 10 Up To 400 Million Cd19 Car-positive Viable T Cells, …	9	2	—	—	$459,112.50	$2,937,060.00	$1,825,740.00	2026-03-01
Q2056	HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	12	4	—	—	$536,573.93	$3,186,403.20	$1,597,833.00	2026-03-01
Q2055	HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	12	4	—	—	$511,793.34	$2,874,615.36	$1,441,485.90	2026-03-01
Q2054	HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	12	4	—	—	$500,948.74	$2,811,572.54	$1,409,872.86	2026-03-01
C9301	HCPCS	Obecabtagene Autoleucel, Up To 400 Million Cd19 Car-positive Viable T Cells, Inc…	6	1	—	—	$959,962.50	$1,544,287.50	$1,405,162.50	2026-03-01
Q2042	HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	13	4	—	—	$23.68	$2,643,227.20	$1,325,455.50	2026-03-01
Q2053	HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	12	4	—	—	$474,717.03	$2,555,975.04	$1,281,702.60	2026-03-01
Q2041	HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	13	4	—	—	$6.22	$2,437,928.00	$1,222,507.50	2026-03-01
2067	OTHER	Afamitresgene Autoleucel	38	23	—	—	$766,766.90	$2,019,024.40	$801,444.80	2026-03-01
9498	OTHER	Ciltacabtagene Car-pos T	35	22	—	—	$565,868.90	$1,539,641.95	$605,279.09	2026-03-01
9194	OTHER	Tisagenlecleucel Car-pos	35	22	—	—	$563,698.64	$1,484,312.01	$591,726.20	2026-03-01
9413	OTHER	Lisocabtagene Car Pos T	35	22	—	—	$559,390.19	$1,472,967.14	$579,067.24	2026-03-01
09498	OTHER	Ciltacabtagene Car-pos T	2	2	—	—	$570,020.11	$587,649.60	$578,834.85	2026-03-01
9422	OTHER	Idecabtagene Vicleucel Ca	35	22	—	—	$555,291.39	$1,462,174.32	$574,824.25	2026-03-01
09194	OTHER	Tisagenlecleucel Car-pos	2	2	—	—	$549,535.36	$566,531.30	$558,033.33	2026-03-01
09413	OTHER	Lisocabtagene Car Pos T	2	2	—	—	$545,335.16	$562,201.20	$553,768.18	2026-03-01
09422	OTHER	Idecabtagene Vicleucel Ca	2	2	—	—	$541,339.35	$558,081.80	$549,710.57	2026-03-01
9035	OTHER	Axicabtagene Ciloleucel C	35	22	—	—	$529,531.24	$1,394,343.56	$548,157.97	2026-03-01
09035	OTHER	Axicabtagene Ciloleucel C	2	2	—	—	$516,226.43	$532,192.20	$524,209.31	2026-03-01
9391	OTHER	Brexucabtagene Car Pos T	35	22	—	—	$487,002.95	$1,282,359.52	$504,133.71	2026-03-01
09391	OTHER	Brexucabtagene Car Pos T	2	2	—	—	$474,766.69	$489,450.20	$482,108.45	2026-03-01
J9029	HCPCS	Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose	18	5	—	—	$61,338.53	$1,100,800.00	$405,600.00	2026-03-01
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	67	28	—	—	$207,841.14	$842,426.46	$358,453.70	2026-03-01
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	30	17	—	—	$318,346.14	$1,273,072.13	$341,085.15	2026-03-01
J3402	HCPCS	Injection, Remestemcel-l-rknd, Per Therapeutic Dose	3	1	—	—	$332,753.88	$332,753.88	$332,753.88	2026-03-01
90288	CPT	Botulism Immune Globulin, Human, For Intravenous Use	6	1	—	—	$294,713.96	$416,525.16	$329,245.80	2026-03-01
Q2043	HCPCS	Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…	19	5	—	—	$55,306.59	$478,449.94	$310,609.58	2026-03-01
A9543	HCPCS	Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil…	17	4	—	—	$93,760.51	$582,739.61	$302,670.97	2026-03-01
831	OTHER	Obecbtge Autol Up To 400	37	23	—	—	$3,623.59	$729,015.00	$283,815.00	2026-03-01
74	APR_DRG	Allogeneic Bone Marrow Transplant	31	9	—	—	$262,763.46	$459,836.00	$283,785.00	2026-03-01
5834	APR_DRG	Neonate With Ecmo	22	8	—	—	$270,110.21	$337,637.76	$283,615.72	2026-03-01
00831	OTHER	Obecbtge Autol Up To 400	2	2	—	—	$269,902.50	$278,250.00	$274,076.25	2026-03-01
897	OTHER	Revakinagene, Per Implant	33	21	—	—	$263,675.00	$694,300.00	$272,950.00	2026-03-01
00897	OTHER	Revakinagene, Per Implant	2	2	—	—	$257,050.00	$265,000.00	$261,025.00	2026-03-01
5833	APR_DRG	Neonate With Ecmo	22	8	—	—	$228,719.40	$285,899.25	$240,155.37	2026-03-01
24	APR_DRG	Heart And/or Lung Transplant	31	9	—	—	$220,021.59	$385,038.00	$237,623.00	2026-03-01
018	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	2	2	—	—	$213,654.33	$220,262.20	$216,958.27	2026-03-01
J7330	HCPCS	Autologous Cultured Chondrocytes, Implant	17	4	—	—	$131,717.55	$574,167.94	$211,893.45	2026-03-01
886	OTHER	Inj. Remestemcel-l-rknd/	37	23	—	—	$7,929.01	$528,372.78	$205,702.38	2026-03-01
00886	OTHER	Inj. Remestemcel-l-rknd/	2	2	—	—	$195,618.93	$201,669.00	$198,643.96	2026-03-01
J9226	HCPCS	Histrelin Implant (supprelin La), 50 Mg	19	5	—	—	$43,855.64	$389,632.46	$194,769.81	2026-03-01
001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	2	2	—	—	$187,805.58	$193,614.00	$190,709.79	2026-03-01
5884	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	22	8	—	—	$170,975.33	$213,719.16	$179,524.10	2026-03-01
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	64	27	—	—	$151,231.85	$638,050.74	$176,046.23	2026-03-01
1614	APR_DRG	Implantable Heart Assist Systems	27	9	—	—	$166,028.78	$207,535.98	$174,330.22	2026-03-01
927	MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	53	23	—	—	$10,500.00	$641,817.38	$170,564.52	2026-03-01
94	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	22	8	—	—	$155,542.82	$194,428.53	$163,319.96	2026-03-01
1907	OTHER	New Technology - Level 52	38	23	—	—	$145,692.90	$393,510.11	$156,202.49	2026-03-01
1908	OTHER	New Technology - Level 52	38	23	—	—	$145,692.90	$393,510.11	$156,202.49	2026-03-01
01907	OTHER	New Technology - Level 52	2	2	—	—	$141,322.11	$145,692.90	$143,507.51	2026-03-01
01908	OTHER	New Technology - Level 52	2	2	—	—	$141,322.11	$145,692.90	$143,507.51	2026-03-01
1906	OTHER	New Technology - Level 51	38	23	—	—	$131,362.50	$354,804.33	$140,838.36	2026-03-01
1905	OTHER	New Technology - Level 51	38	23	—	—	$131,362.50	$354,804.33	$140,838.36	2026-03-01
003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	2	2	—	—	$132,369.21	$136,463.10	$134,416.15	2026-03-01
6304	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	22	8	—	—	$127,217.05	$159,021.31	$133,577.90	2026-03-01
6094	APR_DRG	Neonate Birth Weight 1500-2499 Grams With Major Procedure	22	8	—	—	$126,089.68	$157,612.10	$132,394.16	2026-03-01
01905	OTHER	New Technology - Level 51	2	2	—	—	$127,421.63	$131,362.50	$129,392.07	2026-03-01
01906	OTHER	New Technology - Level 51	2	2	—	—	$127,421.63	$131,362.50	$129,392.07	2026-03-01
1904	OTHER	New Technology - Level 50	38	23	—	—	$117,032.10	$316,098.55	$125,474.24	2026-03-01
1903	OTHER	New Technology - Level 50	38	23	—	—	$117,032.10	$316,098.55	$125,474.24	2026-03-01
J9600	HCPCS	Injection, Porfimer Sodium, 75 Mg	17	4	—	—	$39,976.89	$203,447.46	$120,275.16	2026-03-01
5832	APR_DRG	Neonate With Ecmo	22	8	—	—	$113,965.65	$142,457.06	$119,663.93	2026-03-01
4	MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	64	27	—	—	$102,616.99	$416,386.94	$116,259.29	2026-03-01
01903	OTHER	New Technology - Level 50	2	2	—	—	$113,521.14	$117,032.10	$115,276.62	2026-03-01
01904	OTHER	New Technology - Level 50	2	2	—	—	$113,521.14	$117,032.10	$115,276.62	2026-03-01
Q0480	HCPCS	Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only	41	24	—	—	$108,147.24	$629,884.36	$114,836.76	2026-03-01
114	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	22	8	—	—	$108,217.85	$135,272.31	$113,628.74	2026-03-01
1901	OTHER	New Technology - Level 49	38	23	—	—	$102,701.70	$277,392.76	$110,110.11	2026-03-01
1902	OTHER	New Technology - Level 49	38	23	—	—	$102,701.70	$277,392.76	$110,110.11	2026-03-01
2004	APR_DRG	Cardiac Structural And Valvular Disorders	22	8	—	—	$100,564.19	$125,705.24	$105,592.40	2026-03-01
5831	APR_DRG	Neonate With Ecmo	22	8	—	—	$100,349.03	$125,436.29	$105,366.48	2026-03-01
004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	2	2	—	—	$103,369.89	$106,566.90	$104,968.39	2026-03-01
7	MS_DRG	Lung Transplant	51	27	—	—	$97,957.19	$381,784.85	$104,954.14	2026-03-01
E0767	HCPCS	Intrabuccal, Systemic Delivery Of Amplitude-modulated, Radiofrequency Electromag…	6	1	—	—	$80,266.41	$113,137.42	$103,199.67	2026-03-01
J7310	HCPCS	Ganciclovir, 4.5 Mg, Long-acting Implant	14	3	—	—	$54,979.20	$145,041.92	$102,675.84	2026-03-01
01902	OTHER	New Technology - Level 49	2	2	—	—	$99,620.65	$102,701.70	$101,161.17	2026-03-01
01901	OTHER	New Technology - Level 49	2	2	—	—	$99,620.65	$102,701.70	$101,161.17	2026-03-01
73	APR_DRG	Allogeneic Bone Marrow Transplant	31	9	—	—	$92,719.19	$162,259.00	$100,137.00	2026-03-01
L5969	HCPCS	Addition, Endoskeletal Ankle-foot Or Ankle System, Power Assist, Includes Any Ty…	1	1	—	—	$98,593.44	$98,593.44	$98,593.44	2026-03-01
K1007	HCPCS	Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin…	47	24	—	—	$80,850.00	$249,112.22	$97,933.43	2026-03-01
14	MS_DRG	Allogeneic Bone Marrow Transplant	51	27	—	—	$91,160.94	$354,299.71	$97,672.44	2026-03-01
1585	OTHER	New Technology - Level 48	38	23	—	—	$90,759.68	$245,137.92	$97,306.65	2026-03-01
1599	OTHER	New Technology - Level 48	38	23	—	—	$90,759.68	$245,137.92	$97,306.65	2026-03-01
2	MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	55	28	—	—	$86,159.42	$554,970.00	$96,709.56	2026-03-01
5883	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	22	8	—	—	$91,739.76	$114,674.70	$96,326.75	2026-03-01
5882	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	22	8	—	—	$91,320.47	$114,150.59	$95,886.49	2026-03-01
44	APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	22	8	—	—	$91,084.33	$113,855.41	$95,638.55	2026-03-01
8414	APR_DRG	Extensive Third Degree Burns With Skin Graft	22	8	—	—	$90,692.77	$113,365.96	$95,227.41	2026-03-01
6314	APR_DRG	Neonate Birth Weight > 2499 Grams With Other Major Procedure	22	8	—	—	$89,786.96	$112,233.70	$94,276.31	2026-03-01
651	OTHER	Kidney Transplant With Hemodialysis Without Mcc	2	2	—	—	$92,640.73	$95,505.91	$94,073.32	2026-03-01
J9266	HCPCS	Injection, Pegaspargase, Per Single Dose Vial	19	5	—	—	$26,258.38	$243,082.56	$92,862.31	2026-03-01
209	MS_DRG	Complex Aortic Arch Procedures	50	27	—	—	$75,983.00	$333,689.54	$92,212.13	2026-03-01
8504	APR_DRG	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	22	8	—	—	$87,421.62	$109,277.02	$91,792.70	2026-03-01
5914	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	22	8	—	—	$86,638.51	$108,298.14	$90,970.44	2026-03-01
1613	APR_DRG	Implantable Heart Assist Systems	27	9	—	—	$86,536.44	$108,170.55	$90,863.26	2026-03-01
5881	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	22	8	—	—	$86,079.09	$107,598.86	$90,383.04	2026-03-01
426	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	58	28	—	—	$60,607.00	$471,244.47	$89,887.74	2026-03-01
01585	OTHER	New Technology - Level 48	2	2	—	—	$88,036.89	$90,759.68	$89,398.29	2026-03-01
01599	OTHER	New Technology - Level 48	2	2	—	—	$88,036.89	$90,759.68	$89,398.29	2026-03-01
212	MS_DRG	Concomitant Aortic And Mitral Valve Procedures	63	28	—	—	$10,500.00	$326,886.32	$88,738.82	2026-03-01
1584	OTHER	New Technology - Level 47	38	23	—	—	$81,206.08	$219,334.06	$87,063.90	2026-03-01
1598	OTHER	New Technology - Level 47	38	23	—	—	$81,206.08	$219,334.06	$87,063.90	2026-03-01
14	APR_DRG	Liver Transplant And/or Intestinal Transplant	31	9	—	—	$78,815.56	$137,927.00	$85,120.80	2026-03-01
84	APR_DRG	Autologous Bone Marrow Transplant	31	9	—	—	$78,499.76	$137,375.00	$84,779.70	2026-03-01
5	MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	51	27	—	—	$78,714.37	$303,963.85	$84,336.83	2026-03-01
A9604	HCPCS	Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri…	17	4	—	—	$5,213.67	$142,036.23	$84,120.07	2026-03-01
216	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	71	29	—	—	$55,453.00	$335,921.79	$83,271.06	2026-03-01
215	MS_DRG	Other Heart Assist System Implant	71	29	—	—	$55,453.00	$567,817.00	$82,352.75	2026-03-01
232	MS_DRG	Coronary Bypass With Ptca Without Mcc	79	32	—	—	$47,650.68	$208,177.56	$81,187.00	2026-03-01
6814	APR_DRG	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	22	8	—	—	$77,104.95	$96,381.19	$80,960.20	2026-03-01
1604	APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	27	9	—	—	$77,061.91	$96,327.39	$80,915.01	2026-03-01
007	OTHER	Lung Transplant	2	2	—	—	$79,446.81	$81,903.93	$80,675.37	2026-03-01
93	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	22	8	—	—	$76,417.86	$95,522.32	$80,238.75	2026-03-01
01584	OTHER	New Technology - Level 47	2	2	—	—	$78,769.90	$81,206.08	$79,987.99	2026-03-01
01598	OTHER	New Technology - Level 47	2	2	—	—	$78,769.90	$81,206.08	$79,987.99	2026-03-01
2464	APR_DRG	Gastrointestinal Vascular Insufficiency	22	8	—	—	$74,728.58	$93,410.73	$78,465.01	2026-03-01
6034	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	22	8	—	—	$74,343.07	$92,928.84	$78,060.22	2026-03-01
64	APR_DRG	Pancreas Transplant	31	9	—	—	$72,147.72	$126,259.00	$77,919.50	2026-03-01
A9699	HCPCS	Radiopharmaceutical, Therapeutic, Not Otherwise Classified	3	1	—	—	$77,046.96	$77,046.96	$77,046.96	2026-03-01
1583	OTHER	New Technology - Level 46	38	23	—	—	$71,652.48	$193,530.20	$76,821.14	2026-03-01
1597	OTHER	New Technology - Level 46	38	23	—	—	$71,652.48	$193,530.20	$76,821.14	2026-03-01
219	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	71	29	—	—	$55,453.00	$276,270.00	$75,926.30	2026-03-01
5891	APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational	22	8	—	—	$72,142.03	$90,177.54	$75,749.13	2026-03-01
5934	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	22	8	—	—	$71,926.16	$89,907.70	$75,522.47	2026-03-01
429	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	58	28	—	—	$60,607.00	$385,232.48	$74,176.18	2026-03-01
0915T	CPT	Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co…	9	2	—	—	$25,963.00	$90,413.66	$73,421.02	2026-03-01
5892	APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational	22	8	—	—	$69,920.37	$87,400.46	$73,416.39	2026-03-01
231	MS_DRG	Coronary Bypass With Ptca With Mcc	71	29	—	—	$55,453.00	$289,465.91	$72,965.04	2026-03-01
456	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	65	28	—	—	$60,607.00	$359,312.58	$72,086.86	2026-03-01
002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	2	2	—	—	$70,413.32	$72,591.05	$71,502.18	2026-03-01
850	MS_DRG	Acute Leukemia With Other Procedures	58	28	—	—	$10,500.00	$262,963.04	$71,441.73	2026-03-01
L8702	HCPCS	Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge…	40	24	—	—	$66,737.65	$180,260.45	$70,865.75	2026-03-01
1624	APR_DRG	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	27	9	—	—	$67,223.57	$84,029.46	$70,584.75	2026-03-01
01597	OTHER	New Technology - Level 46	2	2	—	—	$69,502.91	$71,652.48	$70,577.70	2026-03-01
01583	OTHER	New Technology - Level 46	2	2	—	—	$69,502.91	$71,652.48	$70,577.70	2026-03-01
270	MS_DRG	Other Major Cardiovascular Procedures With Mcc	74	32	—	—	$41,930.43	$222,011.00	$69,705.20	2026-03-01
6024	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	22	8	—	—	$66,120.39	$82,650.49	$69,426.41	2026-03-01
014	OTHER	Allogeneic Bone Marrow Transplant	2	2	—	—	$67,815.28	$69,912.66	$68,863.97	2026-03-01
5893	APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational	22	8	—	—	$65,583.73	$81,979.66	$68,862.92	2026-03-01
453	MS_DRG	Combined Anterior And Posterior Spinal Fusion With Mcc	1	1	—	—	$68,413.82	$68,413.82	$68,413.82	2026-03-01
005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	2	2	—	—	$67,100.98	$69,176.27	$68,138.62	2026-03-01
20	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	65	28	—	—	$60,790.61	$236,544.00	$67,752.32	2026-03-01
228	MS_DRG	Other Cardiothoracic Procedures With Mcc	79	32	—	—	$39,537.71	$169,883.82	$67,522.12	2026-03-01
72	APR_DRG	Allogeneic Bone Marrow Transplant	31	9	—	—	$62,296.93	$109,020.00	$67,280.70	2026-03-01
235	MS_DRG	Coronary Bypass Without Cardiac Catheterization With Mcc	79	32	—	—	$44,763.27	$201,515.99	$66,796.41	2026-03-01
1582	OTHER	New Technology - Level 45	38	23	—	—	$62,098.88	$167,726.35	$66,578.40	2026-03-01
1596	OTHER	New Technology - Level 45	38	23	—	—	$62,098.88	$167,726.35	$66,578.40	2026-03-01
233	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	70	28	—	—	$55,453.00	$262,520.88	$66,241.83	2026-03-01
717	OTHER	Instill Adstiladrin, Tx D	40	24	—	—	$11,747.40	$168,399.95	$66,203.03	2026-03-01
6214	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	22	8	—	—	$62,788.78	$78,485.98	$65,928.22	2026-03-01
5244	OTHER	Level 4 Blood Product Exc	38	23	—	—	$56,502.21	$165,824.67	$65,823.54	2026-03-01
217	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	71	29	—	—	$51,380.52	$308,347.00	$65,670.40	2026-03-01
218	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	71	29	—	—	$51,380.52	$304,994.00	$65,670.40	2026-03-01
1612	APR_DRG	Implantable Heart Assist Systems	27	9	—	—	$62,206.25	$77,757.81	$65,316.56	2026-03-01
113	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	22	8	—	—	$61,494.97	$76,868.71	$64,569.72	2026-03-01
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	2	2	—	—	$62,885.13	$64,830.03	$63,857.58	2026-03-01
8634	APR_DRG	Neonatal Aftercare	22	8	—	—	$60,541.15	$75,676.44	$63,568.21	2026-03-01
4404	APR_DRG	Kidney Transplant	31	9	—	—	$58,851.17	$102,990.00	$63,559.30	2026-03-01
957	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Mcc	59	28	—	—	$55,378.67	$229,061.81	$63,321.96	2026-03-01
00717	OTHER	Instill Adstiladrin, Tx D	2	2	—	—	$62,346.55	$64,274.79	$63,310.67	2026-03-01
6303	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	22	8	—	—	$59,959.69	$74,949.61	$62,957.67	2026-03-01
0936T	CPT	Photobiomodulation Therapy Of Retina, Single Session	6	1	—	—	$59,084.21	$64,941.69	$62,867.93	2026-03-01
0895T	CPT	Connection Of Liver Allograft To Normothermic Machine Perfusion Device, Hemostas…	7	1	—	—	$5,238.99	$64,941.69	$62,031.14	2026-03-01
0896T	CPT	Connection Of Liver Allograft To Normothermic Machine Perfusion Device, Hemostas…	7	1	—	—	$5,238.99	$64,941.69	$62,031.14	2026-03-01
L8687	HCPCS	Implantable Neurostimulator Pulse Generator, Dual Array, Rechargeable, Includes …	1	1	—	—	$62,014.14	$62,014.14	$62,014.14	2026-03-01
1611	APR_DRG	Implantable Heart Assist Systems	27	9	—	—	$58,996.98	$73,746.23	$61,946.83	2026-03-01
275	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	63	28	—	—	$55,418.82	$329,192.00	$61,765.35	2026-03-01
474	OTHER	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	2	2	—	—	$60,737.73	$62,616.22	$61,676.98	2026-03-01
54	APR_DRG	Tracheostomy With Mv >96 Hours Without Extensive Procedure	22	8	—	—	$58,582.30	$73,227.88	$61,511.42	2026-03-01
43	APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	22	8	—	—	$58,562.39	$73,202.99	$61,490.51	2026-03-01
01596	OTHER	New Technology - Level 45	2	2	—	—	$60,235.91	$62,098.88	$61,167.40	2026-03-01
01582	OTHER	New Technology - Level 45	2	2	—	—	$60,235.91	$62,098.88	$61,167.40	2026-03-01
05244	OTHER	Level 4 Blood Product Exc	2	2	—	—	$59,552.96	$61,394.80	$60,473.88	2026-03-01
427	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	58	28	—	—	$56,060.47	$308,652.90	$60,397.31	2026-03-01
245	MS_DRG	Aicd Generator Procedures	74	32	—	—	$36,736.88	$137,150.31	$60,273.87	2026-03-01
6804	APR_DRG	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	22	8	—	—	$57,051.29	$71,314.11	$59,903.85	2026-03-01
5913	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	22	8	—	—	$57,051.29	$71,314.11	$59,903.85	2026-03-01
10	MS_DRG	Pancreas Transplant	50	26	—	—	$55,862.38	$211,546.81	$59,852.55	2026-03-01
928	MS_DRG	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	53	23	—	—	$10,500.00	$215,618.53	$59,829.12	2026-03-01
C2616	HCPCS	Brachytherapy Source, Non-stranded, Yttrium-90, Per Source	10	2	—	—	$17,424.00	$88,363.42	$59,820.49	2026-03-01
6084	APR_DRG	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	22	8	—	—	$56,889.47	$71,111.84	$59,733.94	2026-03-01
268	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	66	29	—	—	$53,581.91	$294,489.00	$59,718.08	2026-03-01
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	51	27	—	—	$55,562.77	$210,335.14	$59,531.53	2026-03-01
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	2	2	—	—	$58,361.39	$60,166.38	$59,263.88	2026-03-01
1643	OTHER	Y90 Ibritumomab, Rx	38	23	—	—	$56,540.43	$148,880.32	$59,097.54	2026-03-01
0901T	CPT	Placement Of Bone Marrow Sampling Port, Including Imaging Guidance When Performe…	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0872T	CPT	Replacement Of Indwelling Bladder And Peritoneal Catheters, Including Tunneling …	10	2	—	—	$5,238.99	$64,941.69	$59,084.21	2026-03-01
0969T	CPT	Removal Of Epicranial Neurostimulator System	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0943T	CPT	Cystourethroscopy, Flexible; With Removal Of Prostatic Urethral Scaffold	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0968T	CPT	Insertion Or Replacement Of Epicranial Neurostimulator System, Including Electro…	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0894T	CPT	Cannulation Of The Liver Allograft In Preparation For Connection To The Normothe…	10	2	—	—	$5,238.99	$64,941.69	$59,084.21	2026-03-01
0955T	CPT	Totally Implantable Active Middle Ear Hearing Implant; Removal, Including Remova…	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0908T	CPT	Open Implantation Of Integrated Neurostimulation System, Vagus Nerve, Including …	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0954T	CPT	Totally Implantable Active Middle Ear Hearing Implant; Replacement Of Sound Proc…	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0953T	CPT	Totally Implantable Active Middle Ear Hearing Implant; Revision Or Replacement, …	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0941T	CPT	Cystourethroscopy, Flexible; With Insertion And Expansion Of Prostatic Urethral …	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0935T	CPT	Cystourethroscopy With Renal Pelvic Sympathetic Denervation, Radiofrequency Abla…	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0870T	CPT	Implantation Of Subcutaneous Peritoneal Ascites Pump System, Percutaneous, Inclu…	10	2	—	—	$5,238.99	$64,941.69	$59,084.21	2026-03-01
0909T	CPT	Replacement Of Integrated Neurostimulation System, Vagus Nerve, Including Analys…	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0951T	CPT	Totally Implantable Active Middle Ear Hearing Implant; Initial Placement, Includ…	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0952T	CPT	Totally Implantable Active Middle Ear Hearing Implant; Revision Or Replacement, …	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0871T	CPT	Replacement Of A Subcutaneous Peritoneal Ascites Pump, Including Reconnection Be…	10	2	—	—	$5,238.99	$64,941.69	$59,084.21	2026-03-01
0910T	CPT	Removal Of Integrated Neurostimulation System, Vagus Nerve	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0874T	CPT	Removal Of A Peritoneal Ascites Pump System, Including Implanted Peritoneal Asci…	10	2	—	—	$5,238.99	$64,941.69	$59,084.21	2026-03-01
0942T	CPT	Cystourethroscopy, Flexible; With Removal And Replacement Of Prostatic Urethral …	9	2	—	—	$7,977.00	$64,941.69	$59,084.21	2026-03-01
0873T	CPT	Revision Of A Subcutaneously Implanted Peritoneal Ascites Pump System, Any Compo…	10	2	—	—	$5,238.99	$64,941.69	$59,084.21	2026-03-01
23	APR_DRG	Heart And/or Lung Transplant	31	9	—	—	$54,191.25	$94,834.70	$58,526.60	2026-03-01
266	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	70	28	—	—	$48,129.38	$422,445.00	$58,484.03	2026-03-01
4414	APR_DRG	Major Bladder Procedures	22	8	—	—	$55,694.53	$69,618.16	$58,479.26	2026-03-01
870	MS_DRG	Septicemia Or Severe Sepsis With Mv >96 Hours	65	28	—	—	$5,441.00	$207,775.62	$57,791.36	2026-03-01
269	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	74	32	—	—	$34,269.24	$183,055.00	$57,625.12	2026-03-01
220	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	71	29	—	—	$42,341.46	$276,270.00	$57,612.00	2026-03-01
221	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	71	29	—	—	$40,212.83	$261,868.00	$57,367.56	2026-03-01
83	APR_DRG	Autologous Bone Marrow Transplant	31	9	—	—	$53,059.97	$92,854.90	$57,304.80	2026-03-01
429	OTHER	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	2	2	—	—	$55,983.92	$57,715.38	$56,849.65	2026-03-01
955	MS_DRG	Craniotomy For Multiple Significant Trauma	59	28	—	—	$50,338.13	$202,343.60	$56,380.01	2026-03-01
1595	OTHER	New Technology - Level 44	38	23	—	—	$52,545.28	$141,922.49	$56,335.65	2026-03-01
1581	OTHER	New Technology - Level 44	38	23	—	—	$52,545.28	$141,922.49	$56,335.65	2026-03-01
020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	2	2	—	—	$55,339.02	$57,050.54	$56,194.78	2026-03-01
9273	OTHER	Sipuleucel-t Auto Cd54+	35	22	—	—	$54,132.09	$142,538.77	$56,036.23	2026-03-01
317	MS_DRG	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	58	28	—	—	$52,189.49	$229,601.04	$56,031.66	2026-03-01
447	MS_DRG	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	58	28	—	—	$36,089.00	$285,691.85	$55,993.39	2026-03-01
01643	OTHER	Y90 Ibritumomab, Rx	2	2	—	—	$55,119.81	$56,824.55	$55,972.18	2026-03-01
27445	CPT	Arthroplasty, Knee, Hinge Prosthesis (eg, Walldius Type)	19	7	—	—	$1,874.49	$70,440.00	$55,684.00	2026-03-01
573	MS_DRG	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	65	28	—	—	$10,500.00	$196,941.64	$54,976.47	2026-03-01
1784	APR_DRG	External Heart Assist Devices	22	8	—	—	$52,164.12	$65,205.15	$54,772.33	2026-03-01
207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	65	28	—	—	$5,441.00	$193,433.52	$54,064.98	2026-03-01
5933	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	22	8	—	—	$51,371.05	$64,213.81	$53,939.60	2026-03-01
6114	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	22	8	—	—	$51,312.02	$64,140.02	$53,877.62	2026-03-01
1674	APR_DRG	Other Cardiothoracic And Thoracic Circulatory Procedures	27	9	—	—	$51,085.12	$63,856.40	$53,639.38	2026-03-01
09273	OTHER	Sipuleucel-t Auto Cd54+	2	2	—	—	$52,771.99	$54,404.11	$53,588.05	2026-03-01
231	OTHER	Coronary Bypass With Ptca With Mcc	2	2	—	—	$52,381.60	$54,001.65	$53,191.62	2026-03-01
6904	APR_DRG	Acute Leukemia	22	8	—	—	$50,626.35	$63,282.94	$53,157.67	2026-03-01
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	2	2	—	—	$52,212.54	$53,827.36	$53,019.95	2026-03-01
434	APR_DRG	Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies	22	8	—	—	$50,316.23	$62,895.29	$52,832.04	2026-03-01
92	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	22	8	—	—	$50,259.69	$62,824.61	$52,772.67	2026-03-01
276	MS_DRG	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	63	28	—	—	$47,243.29	$206,254.63	$52,653.56	2026-03-01
457	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	65	28	—	—	$45,113.01	$254,970.23	$52,300.87	2026-03-01
969	MS_DRG	HIV With Extensive O.r. Procedures With Mcc	65	28	—	—	$10,500.00	$184,012.40	$52,108.77	2026-03-01
234	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	70	28	—	—	$38,757.22	$187,578.19	$52,069.61	2026-03-01

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