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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

MAD RIVER COMMUNITY HOSPITAL

Arcata, CA · CCN 050028 · Rates published

11,185 distinct procedures filed
70 distinct payers
79,769 rate rows
2025-07-22 last MRF observed · ⚠ 15 mo old
Data quality

63,491 of 79,769 rate rows are consumer-grade (79.6%)

16,278 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 16,087
per-diem day rate — not a per-procedure price 177
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 8
placeholder amount (≤ $0.02) — excluded from medians 3
exceeds 10× this hospital's gross charge — excluded from medians 2
percent-of-charges filed in the dollar field — excluded from medians 1

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 15 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/8531/941698406_american-hospital-management-corporation_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/MadRiverCommunityHospital/8531
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-09-20
Content fingerprint 4561f43ce4881506… · 34,724,913 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
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 1 $3,710,000.00 $3,710,000.00 $3,710,000.00 nat. median
$3,685,267
1.0× median
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 1 $3,710,000.00 $3,710,000.00 $3,710,000.00 nat. median
$3,508,750
1.1× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 1 $3,321,781.51 $3,321,781.51 $3,321,781.51 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 1 $3,193,000.00 $3,193,000.00 $3,193,000.00 nat. median
$3,248,446
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 1 $2,968,000.00 $2,968,000.00 $2,968,000.00 nat. median
$2,968,000
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 1 $2,403,458.75 $2,403,458.75 $2,403,458.75 nat. median
$2,455,111
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 1 $2,332,000.00 $2,332,000.00 $2,332,000.00 nat. median
$2,332,000
1.0× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 1 $551,318.34 $551,318.34 $551,318.34 nat. median
$599,737
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 1 $528,312.43 $528,312.43 $528,312.43 nat. median
$574,037
0.9× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 1 $516,485.97 $516,485.97 $516,485.97 nat. median
$579,571
0.9× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 1 $488,051.51 $488,051.51 $488,051.51 nat. median
$513,770
0.9× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 2 $309,055.87 $565,623.84 $468,163.26 nat. median
$621,313
0.8× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 2 $276,766.00 $489,517.15 $413,579.72 nat. median
$562,501
0.7× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $363,261.21 $363,261.21 $363,261.21 nat. median
$168,055
outlier · 2.2×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $271,559.45 $271,559.45 $271,559.45 nat. median
$186,516
1.5× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 1 $228,847.94 $228,847.94 $228,847.94 nat. median
$131,925
1.7× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 1 $206,834.52 $206,834.52 $206,834.52 nat. median
$145,435
1.4× median
0100T
CPT 		Prosth Retina Receive&gen 1 $106,750.35 $183,000.60 $144,875.48 nat. median
$11,456
outlier · 12.6×
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And… 1 $136,682.14 $136,682.14 $136,682.14 nat. median
$97,418
1.4× median
38240
CPT 		Transplt Allo Hct/donor 3 $26,524.93 $262,929.97 $134,600.48 nat. median
$28,331
outlier · 4.8×
14
MS_DRG 		Allogeneic Bone Marrow Transplant 1 $126,803.39 $126,803.39 $126,803.39 nat. median
$72,715
1.7× median
7
MS_DRG 		Lung Transplant 1 $126,486.32 $126,486.32 $126,486.32 nat. median
$70,649
1.8× median
K1007
HCPCS 		Bil Hkaf Pc S/d Micro Sensor 1 $111,860.00 $111,860.00 $111,860.00 nat. median
$95,583
1.2× median
0915T
CPT 		Insj Perm Ccm-d Sys Pg&eltrd 2 $40,737.44 $142,536.66 $108,603.59 nat. median
$35,266
outlier · 3.1×
0571T
CPT 		Insj/rplcmt Icds Ss Eltrd 2 $40,737.44 $142,536.66 $108,603.59 nat. median
$32,945
outlier · 3.3×
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 $106,798.96 $106,798.96 $106,798.96 nat. median
$65,418
1.6× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 1 $105,590.30 $105,590.30 $105,590.30 nat. median
$74,509
1.4× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 1 $103,241.21 $103,241.21 $103,241.21 nat. median
$69,922
1.5× median
0674T
CPT 		Laps Insj Nw/rpcmt Prm Isdss 2 $38,719.74 $135,476.89 $103,224.51 nat. median
$29,815
outlier · 3.5×
64582
CPT 		Opn Mpltj Hpglsl Nstm Ary Pg 2 $38,719.74 $135,476.89 $103,224.51 nat. median
$29,815
outlier · 3.5×
33287
CPT 		Rmv&rplcmt Phrnc Nrv Stim Pg 2 $38,719.74 $135,476.89 $103,224.51 nat. median
$27,599
outlier · 3.7×
215
MS_DRG 		Other Heart Assist System Implant 1 $102,716.62 $102,716.62 $102,716.62 nat. median
$73,023
1.4× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 1 $101,569.44 $101,569.44 $101,569.44 nat. median
$2,736
outlier · 37.1×
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 1 $99,999.99 $99,999.99 $99,999.99 nat. median
$108,243
0.9× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 $93,649.72 $93,649.72 $93,649.72 nat. median
$69,822
1.3× median
850
MS_DRG 		Acute Leukemia With Other Procedures 1 $89,429.96 $89,429.96 $89,429.96 nat. median
$2,633
outlier · 34.0×
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 1 $82,339.40 $82,339.40 $82,339.40 nat. median
$60,505
1.4× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 $82,294.25 $82,294.25 $82,294.25 nat. median
$59,651
1.4× median
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 1 $81,058.68 $81,058.68 $81,058.68 nat. median
$2,596
outlier · 31.2×
L8702
HCPCS 		Ewhf S/d Uprt Micro Sensor 1 $80,943.19 $80,943.19 $80,943.19 nat. median
$68,802
1.2× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 $78,373.30 $78,373.30 $78,373.30 nat. median
$56,428
1.4× median
10
MS_DRG 		Pancreas Transplant 1 $77,526.85 $77,526.85 $77,526.85 nat. median
$23,080
outlier · 3.4×
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 $77,087.77 $77,087.77 $77,087.77 nat. median
$45,605
1.7× median
33231
CPT 		Insrt Pulse Gen W/mult Leads 3 $21,459.47 $142,536.66 $76,811.58 nat. median
$31,377
outlier · 2.4×
33264
CPT 		Rmvl & Rplcmt Dfb Gen Mlt Ld 3 $21,459.47 $142,536.66 $76,811.58 nat. median
$32,779
outlier · 2.3×
33270
CPT 		Ins/rep Subq Defibrillator 3 $21,459.47 $142,536.66 $76,811.58 nat. median
$32,475
outlier · 2.4×
33249
CPT 		Insj/rplcmt Defib W/lead(s) 3 $21,459.47 $142,536.66 $76,811.58 nat. median
$32,069
outlier · 2.4×
69930
CPT 		Implant Cochlear Device 3 $22,377.44 $141,408.52 $76,794.16 nat. median
$23,645
outlier · 3.2×
0614T
CPT 		Rmvl&rplcmt Ss Impl Dfb Pg 2 $28,520.13 $99,789.38 $76,032.96 nat. median
$24,111
outlier · 3.2×
0923T
CPT 		Rmvl&rplcmt Perm Ccm-d Pg 2 $28,520.13 $99,789.38 $76,032.96 nat. median
$32,259
outlier · 2.4×

Other procedures at this hospital

Browse this hospital's 11,185 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
             
0600T CPT Ablt Ire 1+ O/t Lv/prst8 Prq 3 2 — — $13,228.50 $46,285.33 $35,266.39 2025-07-22
55882 CPT Ablt Trurl Prst8 Tis Trnsdcr 3 2 — — $16,508.17 $57,760.61 $44,009.80 2025-07-22
0601T CPT Abltj Ire 1+tumors Open 3 2 — — $13,228.50 $46,285.33 $35,266.39 2025-07-22
834 MS_DRG Acute Leukemia With Mcc 1 1 — — $54,029.03 $54,029.03 $54,029.03 2025-07-22
850 MS_DRG Acute Leukemia With Other Procedures 1 1 — — $89,429.96 $89,429.96 $89,429.96 2025-07-22
245 MS_DRG Aicd Generator Procedures 1 1 — — $47,875.23 $47,875.23 $47,875.23 2025-07-22
265 MS_DRG Aicd Lead Procedures 1 1 — — $35,196.77 $35,196.77 $35,196.77 2025-07-22
14 MS_DRG Allogeneic Bone Marrow Transplant 1 1 — — $126,803.39 $126,803.39 $126,803.39 2025-07-22
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 1 1 — — $49,317.36 $49,317.36 $49,317.36 2025-07-22
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 1 1 — — $44,011.93 $44,011.93 $44,011.93 2025-07-22
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 1 1 — — $38,057.96 $38,057.96 $38,057.96 2025-07-22
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 1 1 — — $64,984.81 $64,984.81 $64,984.81 2025-07-22
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 1 1 — — $40,899.00 $40,899.00 $40,899.00 2025-07-22
20696 CPT App Mltpln Uni Xtrnl Fix 1st 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
22633 CPT Arthrd Cmbn 1ntrspc Lumbar 3 2 — — $23,366.40 $81,756.91 $62,293.41 2025-07-22
22630 CPT Arthrd Pst Tq 1ntrspc Lum 3 2 — — $23,366.40 $81,756.91 $62,293.41 2025-07-22
22612 CPT Arthrd Pst Tq 1ntrspc Lumbar 5 3 — — $7,499.72 $81,756.91 $41,447.32 2025-07-22
27278 CPT Arthrd Si Jt Plmt Iartic Dev 3 2 — — $23,366.40 $81,756.91 $62,293.41 2025-07-22
27279 CPT Arthrd Si Jt Plmt Tartclr Dv 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
C9781 HCPCS Arthro/shoul Surg; W/spacer 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
28705 CPT Arthrodesis Pantalar 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
25446 CPT Arthrp W/prostc Dst Rds&crps 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
25442 CPT Arthrp W/prostc Dstl Ulna 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 1 1 — — $58,915.56 $58,915.56 $58,915.56 2025-07-22
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 1 1 — — $58,915.56 $58,915.56 $58,915.56 2025-07-22
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 3 2 — — $276,766.00 $489,517.15 $413,579.72 2025-07-22
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 1 1 — — $35,358.17 $35,358.17 $35,358.17 2025-07-22
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 1 1 — — $35,979.79 $35,979.79 $35,979.79 2025-07-22
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 1 1 — — $111,860.00 $111,860.00 $111,860.00 2025-07-22
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 1 1 — — $59,884.03 $59,884.03 $59,884.03 2025-07-22
C9783 HCPCS Blind Cor Sinus Reducer Impl 3 2 — — $14,409.33 $50,416.93 $38,414.40 2025-07-22
C2616 HCPCS Brachytx, Non-str,yttrium-90 5 3 — — $11,638.12 $77,733.80 $40,908.38 2025-07-22
Q2053 HCPCS Brexucabtagene Car Pos T 1 1 — — $488,051.51 $488,051.51 $488,051.51 2025-07-22
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 1 1 — — $68,822.18 $68,822.18 $68,822.18 2025-07-22
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 1 1 — — $60,438.40 $60,438.40 $60,438.40 2025-07-22
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 1 1 — — $45,618.34 $45,618.34 $45,618.34 2025-07-22
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $93,649.72 $93,649.72 $93,649.72 2025-07-22
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $62,970.04 $62,970.04 $62,970.04 2025-07-22
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $58,083.52 $58,083.52 $58,083.52 2025-07-22
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $75,264.21 $75,264.21 $75,264.21 2025-07-22
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $51,813.47 $51,813.47 $51,813.47 2025-07-22
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $45,048.60 $45,048.60 $45,048.60 2025-07-22
34 MS_DRG Carotid Artery Stent Procedures With Mcc 1 1 — — $38,285.69 $38,285.69 $38,285.69 2025-07-22
471 MS_DRG Cervical Spinal Fusion With Mcc 1 1 — — $47,591.79 $47,591.79 $47,591.79 2025-07-22
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 1 1 — — $49,032.01 $49,032.01 $49,032.01 2025-07-22
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $363,261.21 $363,261.21 $363,261.21 2025-07-22
Q2056 HCPCS Ciltacabtagene Car-pos T 1 1 — — $551,318.34 $551,318.34 $551,318.34 2025-07-22
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 1 1 — — $81,058.68 $81,058.68 $81,058.68 2025-07-22
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 1 1 — — $53,483.30 $53,483.30 $53,483.30 2025-07-22
93656 CPT Compre Ep Eval Abltj Atr Fib 5 3 — — $13,449.62 $109,063.63 $57,160.82 2025-07-22
93653 CPT Compre Ep Eval Tx Svt 5 3 — — $13,449.62 $109,063.63 $57,160.82 2025-07-22
93654 CPT Compre Ep Eval Tx Vt 5 3 — — $13,449.62 $109,063.63 $57,160.82 2025-07-22
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 1 1 — — $105,590.30 $105,590.30 $105,590.30 2025-07-22
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 1 1 — — $60,361.53 $60,361.53 $60,361.53 2025-07-22
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 1 — — $76,022.27 $76,022.27 $76,022.27 2025-07-22
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 1 1 — — $52,039.25 $52,039.25 $52,039.25 2025-07-22
231 MS_DRG Coronary Bypass With Ptca With Mcc 1 1 — — $82,339.40 $82,339.40 $82,339.40 2025-07-22
232 MS_DRG Coronary Bypass With Ptca Without Mcc 1 1 — — $59,615.02 $59,615.02 $59,615.02 2025-07-22
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 1 1 — — $57,458.05 $57,458.05 $57,458.05 2025-07-22
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 1 1 — — $40,432.06 $40,432.06 $40,432.06 2025-07-22
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 1 1 — — $41,847.28 $41,847.28 $41,847.28 2025-07-22
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 1 1 — — $43,892.79 $43,892.79 $43,892.79 2025-07-22
955 MS_DRG Craniotomy For Multiple Significant Trauma 1 1 — — $66,528.79 $66,528.79 $66,528.79 2025-07-22
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 1 1 — — $55,737.29 $55,737.29 $55,737.29 2025-07-22
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 1 1 — — $37,449.80 $37,449.80 $37,449.80 2025-07-22
Q0480 HCPCS Driver Pneumatic Vad, Rep 1 1 — — $99,999.99 $99,999.99 $99,999.99 2025-07-22
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 1 1 — — $206,834.52 $206,834.52 $206,834.52 2025-07-22
L7181 HCPCS Electronic Elbo Simultaneous 1 1 — — $57,614.51 $57,614.51 $57,614.51 2025-07-22
L7180 HCPCS Electronic Elbow Sequential 1 1 — — $52,277.90 $52,277.90 $52,277.90 2025-07-22
C9901 HCPCS Endo Defect Closure Gi Tract 3 2 — — $13,228.50 $46,285.33 $35,266.39 2025-07-22
C9785 HCPCS Endo Outlet Restrict W/tube 3 2 — — $13,228.50 $46,285.33 $35,266.39 2025-07-22
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 1 1 — — $58,482.26 $58,482.26 $58,482.26 2025-07-22
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 1 1 — — $46,125.65 $46,125.65 $46,125.65 2025-07-22
0620T CPT Evasc Ven Artlz Tibl/prnl Vn 1 1 — — $44,471.64 $44,471.64 $44,471.64 2025-07-22
L8701 HCPCS Ewh S/d Uprt Micro Sensor 1 1 — — $41,141.33 $41,141.33 $41,141.33 2025-07-22
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 1 1 — — $80,943.19 $80,943.19 $80,943.19 2025-07-22
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 1 1 — — $228,847.94 $228,847.94 $228,847.94 2025-07-22
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 1 1 — — $42,495.82 $42,495.82 $42,495.82 2025-07-22
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 1 1 — — $46,598.35 $46,598.35 $46,598.35 2025-07-22
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 1 1 — — $58,040.29 $58,040.29 $58,040.29 2025-07-22
793 MS_DRG Full Term Neonate With Major Problems 1 1 — — $40,993.17 $40,993.17 $40,993.17 2025-07-22
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 1 1 — — $65,093.38 $65,093.38 $65,093.38 2025-07-22
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $271,559.45 $271,559.45 $271,559.45 2025-07-22
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $106,798.96 $106,798.96 $106,798.96 2025-07-22
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 1 1 — — $61,686.45 $61,686.45 $61,686.45 2025-07-22
Q2055 HCPCS Idecabtagene Vicleucel Car 1 1 — — $528,312.43 $528,312.43 $528,312.43 2025-07-22
C8003 HCPCS Imp Extar Knee Shck Absrb 3 2 — — $23,366.40 $81,756.91 $62,293.41 2025-07-22
69716 CPT Impl Oi Implt Sk Tc Esp<100 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
69729 CPT Impl Oi Implt Sk Tc Esp>=100 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
69930 CPT Implant Cochlear Device 5 3 — — $22,377.44 $141,408.52 $76,794.16 2025-07-22
67027 CPT Implant Eye Drug System 5 3 — — $11,363.95 $68,307.65 $37,396.57 2025-07-22
63655 CPT Implant Neuroelectrodes 5 3 — — $13,095.01 $95,335.64 $50,692.42 2025-07-22
61886 CPT Implant Neurostim Arrays 5 3 — — $19,388.50 $135,476.89 $72,459.89 2025-07-22
62361 CPT Implant Spine Infusion Pump 5 3 — — $11,247.17 $78,574.09 $42,026.59 2025-07-22
62362 CPT Implant Spine Infusion Pump 5 3 — — $11,247.17 $78,574.09 $42,026.59 2025-07-22
66683 CPT Implantation Iris Prosthesis 3 2 — — $20,858.73 $72,982.82 $55,608.12 2025-07-22
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 1 1 — — $48,975.32 $48,975.32 $48,975.32 2025-07-22
J1413 HCPCS Inj Delandistrogene Mox Rokl 1 1 — — $3,321,781.51 $3,321,781.51 $3,321,781.51 2025-07-22
J3399 HCPCS Inj Onase Abepar-xioi Treat 1 1 — — $2,403,458.75 $2,403,458.75 $2,403,458.75 2025-07-22
J1414 HCPCS Inj, Beqvez, Per Tx Dose 1 1 — — $3,710,000.00 $3,710,000.00 $3,710,000.00 2025-07-22
J3393 HCPCS Inj, Betibeglogene Autotemce 1 1 — — $2,968,000.00 $2,968,000.00 $2,968,000.00 2025-07-22
J3392 HCPCS Inj, Exagamglogene Autotem 1 1 — — $2,332,000.00 $2,332,000.00 $2,332,000.00 2025-07-22
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 1 1 — — $3,710,000.00 $3,710,000.00 $3,710,000.00 2025-07-22
J3394 HCPCS Inj, Lovotibeglogene Autotem 1 1 — — $3,193,000.00 $3,193,000.00 $3,193,000.00 2025-07-22
33270 CPT Ins/rep Subq Defibrillator 5 3 — — $21,459.47 $142,536.66 $76,811.58 2025-07-22
64590 CPT Ins/rpl Prph Sac/gstr Npg/r 5 3 — — $13,095.01 $95,335.64 $50,692.42 2025-07-22
63685 CPT Ins/rplc Spi Npg/rcvr Pocket 5 3 — — $19,388.50 $135,476.89 $72,459.89 2025-07-22
64596 CPT Ins/rplcmt Prq Eltrd Ra Pn 1 3 2 — — $15,844.78 $55,439.46 $42,241.23 2025-07-22
0784T CPT Ins/rplmt Eltrd Ra Spi Nstim 3 2 — — $15,844.78 $55,439.46 $42,241.23 2025-07-22
54405 CPT Insert Multi-comp Penis Pros 5 3 — — $11,423.68 $89,485.87 $47,110.85 2025-07-22
33221 CPT Insert Pulse Gen Mult Leads 5 3 — — $12,375.31 $84,784.96 $45,478.37 2025-07-22
54401 CPT Insert Self-contd Prosthesis 5 3 — — $11,423.68 $89,485.87 $47,110.85 2025-07-22
62360 CPT Insert Spine Infusion Device 5 3 — — $11,247.17 $78,574.09 $42,026.59 2025-07-22
53444 CPT Insert Tandem Cuff 5 3 — — $11,423.68 $89,485.87 $47,110.85 2025-07-22
53445 CPT Insert Uro/ves Nck Sphincter 5 3 — — $11,423.68 $89,485.87 $47,110.85 2025-07-22
0308T CPT Insj Ocular Telescope Prosth 5 3 — — $11,363.95 $72,982.82 $39,533.88 2025-07-22
0916T CPT Insj Perm Ccm-d Sys Pg Only 3 2 — — $28,520.13 $99,789.38 $76,032.96 2025-07-22
0915T CPT Insj Perm Ccm-d Sys Pg&eltrd 3 2 — — $40,737.44 $142,536.66 $108,603.59 2025-07-22
33276 CPT Insj Phrnc Nrv Stim Sys 1 1 — — $57,177.64 $57,177.64 $57,177.64 2025-07-22
22867 CPT Insj Stablj Dev W/dcmprn 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
0515T CPT Insj Wcs Lv Compl Sys 5 3 — — $15,397.52 $99,789.38 $53,978.43 2025-07-22
0409T CPT Insj/rplc Car Modulj Pls Gn 5 3 — — $15,397.52 $99,789.38 $53,978.43 2025-07-22
0408T CPT Insj/rplc Cardiac Modulj Sys 5 3 — — $15,397.52 $142,536.66 $73,520.81 2025-07-22
0525T CPT Insj/rplcmt Compl Iims 5 3 — — $6,915.54 $84,784.96 $42,514.50 2025-07-22
33249 CPT Insj/rplcmt Defib W/lead(s) 5 3 — — $21,459.47 $142,536.66 $76,811.58 2025-07-22
0571T CPT Insj/rplcmt Icds Ss Eltrd 3 2 — — $40,737.44 $142,536.66 $108,603.59 2025-07-22
0680T CPT Insj/rplcmt Pg Only Isdss 3 2 — — $27,247.24 $95,335.64 $72,639.51 2025-07-22
33230 CPT Insrt Pulse Gen W/dual Leads 5 3 — — $15,397.52 $99,789.38 $53,978.43 2025-07-22
33231 CPT Insrt Pulse Gen W/mult Leads 5 3 — — $21,459.47 $142,536.66 $76,811.58 2025-07-22
33240 CPT Insrt Pulse Gen W/singl Lead 5 3 — — $15,397.52 $99,789.38 $53,978.43 2025-07-22
61885 CPT Insrt/redo Neurostim 1 Array 5 3 — — $13,095.01 $95,335.64 $50,692.42 2025-07-22
J9029 HCPCS Instill Adstiladrin, Tx Dose 1 1 — — $63,402.04 $63,402.04 $63,402.04 2025-07-22
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $54,029.03 $54,029.03 $54,029.03 2025-07-22
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $78,373.30 $78,373.30 $78,373.30 2025-07-22
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 1 1 — — $34,843.20 $34,843.20 $34,843.20 2025-07-22
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 1 1 — — $45,189.85 $45,189.85 $45,189.85 2025-07-22
0675T CPT Laps Insj Nw/rpcmt Isdss 1ld 3 2 — — $15,844.78 $55,439.46 $42,241.23 2025-07-22
0674T CPT Laps Insj Nw/rpcmt Prm Isdss 3 2 — — $38,719.74 $135,476.89 $103,224.51 2025-07-22
0677T CPT Laps Repos Lead Isdss 1st Ld 3 2 — — $13,228.50 $46,285.33 $35,266.39 2025-07-22
0679T CPT Laps Rmvl Lead Isdss 3 2 — — $13,228.50 $46,285.33 $35,266.39 2025-07-22
55867 CPT Laps Surg Prst8ect Smpl Stot 3 2 — — $13,228.50 $46,285.33 $35,266.39 2025-07-22
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $37,648.68 $37,648.68 $37,648.68 2025-07-22
Q2054 HCPCS Lisocabtagene Mara Car Pos T 1 1 — — $516,485.97 $516,485.97 $516,485.97 2025-07-22
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $103,241.21 $103,241.21 $103,241.21 2025-07-22
6 MS_DRG Liver Transplant Without Mcc 1 1 — — $47,513.98 $47,513.98 $47,513.98 2025-07-22
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 1 1 — — $35,043.03 $35,043.03 $35,043.03 2025-07-22
7 MS_DRG Lung Transplant 1 1 — — $126,486.32 $126,486.32 $126,486.32 2025-07-22
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 1 1 — — $56,863.33 $56,863.33 $56,863.33 2025-07-22
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 1 1 — — $45,883.53 $45,883.53 $45,883.53 2025-07-22
653 MS_DRG Major Bladder Procedures With Mcc 1 1 — — $54,483.48 $54,483.48 $54,483.48 2025-07-22
163 MS_DRG Major Chest Procedures With Mcc 1 1 — — $45,208.10 $45,208.10 $45,208.10 2025-07-22
140 MS_DRG Major Head And Neck Procedures With Mcc 1 1 — — $41,557.13 $41,557.13 $41,557.13 2025-07-22
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 1 1 — — $45,041.88 $45,041.88 $45,041.88 2025-07-22
61715 CPT Mrgfus Strtctc Ablt Trgt Icr 3 2 — — $15,844.78 $55,439.46 $42,241.23 2025-07-22
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 1 1 — — $101,569.44 $101,569.44 $101,569.44 2025-07-22
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 1 1 — — $69,165.17 $69,165.17 $69,165.17 2025-07-22
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 1 1 — — $53,806.12 $53,806.12 $53,806.12 2025-07-22
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 1 1 — — $65,341.26 $65,341.26 $65,341.26 2025-07-22
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 1 1 — — $40,157.27 $40,157.27 $40,157.27 2025-07-22
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 1 1 — — $46,805.86 $46,805.86 $46,805.86 2025-07-22
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 1 1 — — $35,363.93 $35,363.93 $35,363.93 2025-07-22
C9760 HCPCS Non-blind Interatrial Shunt 1 1 — — $34,942.14 $34,942.14 $34,942.14 2025-07-22
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 1 1 — — $38,678.63 $38,678.63 $38,678.63 2025-07-22
64568 CPT Opn Impltj Crnl Nrv Nea&pg 5 3 — — $19,388.50 $135,476.89 $72,459.89 2025-07-22
64580 CPT Opn Impltj Nea Neuromuscular 5 3 — — $13,095.01 $95,335.64 $50,692.42 2025-07-22
0817T CPT Opn Insj/rplcmt Ins Ptn Subf 3 2 — — $27,247.24 $95,335.64 $72,639.51 2025-07-22
0816T CPT Opn Insj/rplcmt Ins Ptn Subq 3 2 — — $27,247.24 $95,335.64 $72,639.51 2025-07-22
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 3 2 — — $38,719.74 $135,476.89 $103,224.51 2025-07-22
23616 CPT Optx Prx Hmrl Fx Fix Rpr Rpl 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
228 MS_DRG Other Cardiothoracic Procedures With Mcc 1 1 — — $48,802.38 $48,802.38 $48,802.38 2025-07-22
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 1 1 — — $41,907.81 $41,907.81 $41,907.81 2025-07-22
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 1 1 — — $38,833.30 $38,833.30 $38,833.30 2025-07-22
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 1 1 — — $43,128.96 $43,128.96 $43,128.96 2025-07-22
215 MS_DRG Other Heart Assist System Implant 1 1 — — $102,716.62 $102,716.62 $102,716.62 2025-07-22
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $40,002.58 $40,002.58 $40,002.58 2025-07-22
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 1 1 — — $41,176.66 $41,176.66 $41,176.66 2025-07-22
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 1 1 — — $50,240.68 $50,240.68 $50,240.68 2025-07-22
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 1 1 — — $39,198.41 $39,198.41 $39,198.41 2025-07-22
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 1 1 — — $40,409.96 $40,409.96 $40,409.96 2025-07-22
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $72,638.40 $72,638.40 $72,638.40 2025-07-22
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 1 1 — — $35,365.86 $35,365.86 $35,365.86 2025-07-22
C9784 HCPCS Other Outpatient Services 3 2 — — $13,228.50 $46,285.33 $35,266.39 2025-07-22
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 1 1 — — $37,916.73 $37,916.73 $37,916.73 2025-07-22
0268T CPT Outpatient Services 5 3 — — $13,095.01 $135,476.89 $69,043.42 2025-07-22
37229 CPT Outpatient Services 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
37227 CPT Outpatient Services 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
37231 CPT Outpatient Services 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
37230 CPT Outpatient Services 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
37225 CPT Outpatient Services 5 3 — — $6,768.33 $79,830.46 $40,169.58 2025-07-22
10 MS_DRG Pancreas Transplant 1 1 — — $77,526.85 $77,526.85 $77,526.85 2025-07-22
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 1 1 — — $53,081.70 $53,081.70 $53,081.70 2025-07-22
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
C9602 HCPCS Perc D-e Cor Stent Ather S 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 1 1 — — $38,493.20 $38,493.20 $38,493.20 2025-07-22
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 1 1 — — $37,165.39 $37,165.39 $37,165.39 2025-07-22
335 MS_DRG Peritoneal Adhesiolysis With Mcc 1 1 — — $35,736.72 $35,736.72 $35,736.72 2025-07-22
0629T CPT Perq Njx Algc CT Lmbr 1st 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
0627T CPT Perq Njx Algc Fluor Lmbr 1st 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
33903 CPT Perq P-art Revsc 1 Abnor Bi 3 2 — — $14,409.33 $50,416.93 $38,414.40 2025-07-22
33902 CPT Perq P-art Revsc 1 Abnor Uni 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
33901 CPT Perq P-art Revsc 1 Nm Nt Bi 3 2 — — $14,409.33 $50,416.93 $38,414.40 2025-07-22
33900 CPT Perq P-art Revsc 1 Nm Nt Uni 3 2 — — $14,409.33 $50,416.93 $38,414.40 2025-07-22
0632T CPT Perq Tcat US Abltj Nrv P-art 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
93582 CPT Perq Transcath Closure Pda 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
93591 CPT Perq Transcath Cls Aortic 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
93590 CPT Perq Transcath Cls Mitral 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 1 1 — — $44,270.37 $44,270.37 $44,270.37 2025-07-22
791 MS_DRG Prematurity With Major Problems 1 1 — — $39,930.53 $39,930.53 $39,930.53 2025-07-22
37184 CPT Prim Art M-thrmbc 1st Vsl 5 3 — — $3,274.97 $79,830.46 $38,273.19 2025-07-22
0100T CPT Prosth Retina Receive&gen 2 1 — — $106,750.35 $183,000.60 $144,875.48 2025-07-22
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
0793T CPT Prq Tcat Thrm Ablt Nrv P-art 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
92933 CPT Prq Trlml C Athrc St Angiop1 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
27702 CPT Reconstruct Ankle Joint 3 2 — — $23,366.40 $81,756.91 $62,293.41 2025-07-22
24361 CPT Reconstruct Elbow Joint 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
23472 CPT Reconstruct Shoulder Joint 3 2 — — $23,366.40 $81,756.91 $62,293.41 2025-07-22
21243 CPT Reconstruction Of Jaw Joint 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
54411 CPT Remov/replc Penis Pros Comp 5 3 — — $11,423.68 $89,485.87 $47,110.85 2025-07-22
54410 CPT Remove/replace Penis Prosth 5 3 — — $11,423.68 $89,485.87 $47,110.85 2025-07-22
53447 CPT Remove/replace Ur Sphincter 5 3 — — $11,423.68 $89,485.87 $47,110.85 2025-07-22
33229 CPT Remv&replc Pm Gen Mult Leads 5 3 — — $12,375.31 $84,784.96 $45,478.37 2025-07-22
54416 CPT Remv/repl Penis Contain Pros 5 3 — — $11,423.68 $89,485.87 $47,110.85 2025-07-22
24363 CPT Replace Elbow Joint 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
207 MS_DRG Respiratory System Diagnosis With Ventilator Support &gt;96 Hours 1 1 — — $63,059.41 $63,059.41 $63,059.41 2025-07-22
61891 CPT Rev/rplcmt Sk-mnt Crnl Nstm 3 2 — — $27,247.24 $95,335.64 $72,639.51 2025-07-22
64583 CPT Rev/rplct Hpglsl Nstm Ary Pg 3 2 — — $15,844.78 $55,439.46 $42,241.23 2025-07-22
C9766 HCPCS Revasc Intra Lithotrip-ather 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
C9765 HCPCS Revasc Intra Lithotrip-stent 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
C9764 HCPCS Revasc Intravasc Lithotripsy 3 2 — — $14,409.33 $50,416.93 $38,414.40 2025-07-22
C9775 HCPCS Revasc Lith-sten-ath Tib/per 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
C9774 HCPCS Revasc Lithotr-ather Tib/per 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
C9773 HCPCS Revasc Lithotr-stent Tib/per 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
C9772 HCPCS Revasc Lithotrip Tibi/perone 3 2 — — $14,409.33 $50,416.93 $38,414.40 2025-07-22
C9767 HCPCS Revasc Lithotrip-stent-ather 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
24371 CPT Revise Reconst Elbow Joint 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 1 1 — — $49,871.74 $49,871.74 $49,871.74 2025-07-22
33288 CPT Rmv&rplcmt Phrnc Nrv Stim Ld 3 2 — — $15,844.78 $55,439.46 $42,241.23 2025-07-22
33287 CPT Rmv&rplcmt Phrnc Nrv Stim Pg 3 2 — — $38,719.74 $135,476.89 $103,224.51 2025-07-22
0414T CPT Rmvl & Rpl Car Modulj Pls Gn 5 3 — — $15,397.52 $99,789.38 $53,978.43 2025-07-22
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 5 3 — — $15,397.52 $99,789.38 $53,978.43 2025-07-22
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 5 3 — — $21,459.47 $142,536.66 $76,811.58 2025-07-22
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 5 3 — — $15,397.52 $99,789.38 $53,978.43 2025-07-22
0923T CPT Rmvl&rplcmt Perm Ccm-d Pg 3 2 — — $28,520.13 $99,789.38 $76,032.96 2025-07-22
0614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 3 2 — — $28,520.13 $99,789.38 $76,032.96 2025-07-22
69730 CPT Rplc Oi Implt Sk Tc Esp>=100 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
69719 CPT Rplcm Oi Implt Sk Tc Esp<100 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
870 MS_DRG Septicemia Or Severe Sepsis With Mv &gt;96 Hours 1 1 — — $67,760.51 $67,760.51 $67,760.51 2025-07-22
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 1 1 — — $53,200.85 $53,200.85 $53,200.85 2025-07-22
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $77,087.77 $77,087.77 $77,087.77 2025-07-22
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 1 1 — — $38,511.46 $38,511.46 $38,511.46 2025-07-22
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 1 1 — — $50,404.98 $50,404.98 $50,404.98 2025-07-22
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 3 2 — — $32,461.94 $55,649.04 $47,882.49 2025-07-22
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 1 1 — — $52,760.80 $52,760.80 $52,760.80 2025-07-22
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 1 1 — — $60,090.60 $60,090.60 $60,090.60 2025-07-22
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 1 1 — — $36,876.22 $36,876.22 $36,876.22 2025-07-22
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 1 1 — — $38,020.50 $38,020.50 $38,020.50 2025-07-22
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 1 — — $82,294.25 $82,294.25 $82,294.25 2025-07-22
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 1 — — $56,066.84 $56,066.84 $56,066.84 2025-07-22
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 1 — — $42,410.31 $42,410.31 $42,410.31 2025-07-22
28 MS_DRG Spinal Procedures With Mcc 1 1 — — $59,334.46 $59,334.46 $59,334.46 2025-07-22
C9757 HCPCS Spine Device Implant Surgery 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
799 MS_DRG Splenic Procedures With Mcc 1 1 — — $46,606.99 $46,606.99 $46,606.99 2025-07-22
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 1 1 — — $49,721.85 $49,721.85 $49,721.85 2025-07-22
J9226 HCPCS Supprelin La Implant 3 2 — — $25,653.32 $45,261.80 $38,297.41 2025-07-22
0645T CPT Tcat Impltj C Sins Rdctj Dev 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
0823T CPT Tcat Ins 1chmbr Ldls Pm Ra 3 2 — — $24,231.82 $84,784.96 $64,600.58 2025-07-22
0795T CPT Tcat Ins 2chmbr Ldls Pm Cmpl 3 2 — — $24,231.82 $84,784.96 $64,600.58 2025-07-22
0796T CPT Tcat Ins 2chmbr Ldls Pm Ra 3 2 — — $24,231.82 $84,784.96 $64,600.58 2025-07-22
0797T CPT Tcat Ins 2chmbr Ldls Pm Rv 3 2 — — $24,231.82 $84,784.96 $64,600.58 2025-07-22
0801T CPT Tcat Rmv&rpl 2chmbr Ldls Pm 3 2 — — $24,231.82 $84,784.96 $64,600.58 2025-07-22
0825T CPT Tcat Rmv&rpl1chmb Ldls Pm Ra 3 2 — — $24,231.82 $84,784.96 $64,600.58 2025-07-22
0802T CPT Tcat Rmv&rpl2chmb Ldls Pm Ra 3 2 — — $24,231.82 $84,784.96 $64,600.58 2025-07-22
0803T CPT Tcat Rmv&rpl2chmb Ldls Pm Rv 3 2 — — $24,231.82 $84,784.96 $64,600.58 2025-07-22
36906 CPT Thrmbc/nfs Dialysis Circuit 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
Q2042 HCPCS Tisagenlecleucel Car-pos T 3 2 — — $309,055.87 $565,623.84 $468,163.26 2025-07-22
19357 CPT Tiss Xpndr Plmt Brst Rcnstj 5 3 — — $8,489.00 $77,348.12 $39,968.83 2025-07-22
22856 CPT Tot Disc Arthrp 1ntrspc Crv 5 3 — — $10,781.72 $81,756.91 $43,228.98 2025-07-22
27130 CPT Total Hip Arthroplasty 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
53451 CPT Tprnl Balo Cntnc Dev Bi 3 2 — — $16,508.17 $57,760.61 $44,009.80 2025-07-22
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 1 1 — — $40,351.35 $40,351.35 $40,351.35 2025-07-22
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 1 1 — — $52,766.57 $52,766.57 $52,766.57 2025-07-22
4 MS_DRG Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mouth And … 1 1 — — $136,682.14 $136,682.14 $136,682.14 2025-07-22
93580 CPT Transcath Closure Of Asd 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
93581 CPT Transcath Closure Of Vsd 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
33289 CPT Transcatheter Implant Of Wireless Pulm A 14 6 $222,463.92 $222,463.92 $20,538.51 $126,384.25 $68,927.39 2025-07-22
33274 CPT Transcatheter Insertion Of Pacemaker 14 6 $116,419.10 $116,419.10 $10,748.15 $84,784.96 $44,595.06 2025-07-22
38240 CPT Transplt Allo Hct/donor 5 3 — — $26,524.93 $262,929.97 $134,600.48 2025-07-22
0238T CPT Trluml Perip Athrc Iliac Art 5 3 — — $10,748.15 $79,830.46 $42,330.06 2025-07-22
64628 CPT Trml Dstrj Ios Bvn 1st 2 L/s 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 1 1 — — $48,994.54 $48,994.54 $48,994.54 2025-07-22
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 1 1 — — $39,171.51 $39,171.51 $39,171.51 2025-07-22
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 1 1 — — $38,755.50 $38,755.50 $38,755.50 2025-07-22
C9797 HCPCS Vasc Emb/occ W/prs Cath 3 2 — — $22,815.81 $79,830.46 $60,825.58 2025-07-22
37242 CPT Vasc Embolize/occlude Artery 5 3 — — $6,768.33 $79,830.46 $40,169.58 2025-07-22
31 MS_DRG Ventricular Shunt Procedures With Mcc 1 1 — — $41,186.27 $41,186.27 $41,186.27 2025-07-22
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 1 1 — — $52,815.56 $52,815.56 $52,815.56 2025-07-22
901 MS_DRG Wound Debridements For Injuries With Mcc 1 1 — — $43,491.18 $43,491.18 $43,491.18 2025-07-22
0737T CPT Xenograft Impltj Artclr Surf 3 2 — — $16,348.58 $57,202.22 $43,584.34 2025-07-22
A9543 HCPCS Y90 Ibritumomab, Rx 3 2 — — $29,730.87 $56,824.55 $45,840.88 2025-07-22
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