|
9138
|
OTHER
|
Inj, Hemgenix, Per Tx Dose
|
1
|
1
|
—
|
—
|
$4,905,698.71
|
$4,905,698.71
|
$4,905,698.71
|
2025-11-26
|
|
0714
|
OTHER
|
Inj Delandistrogene Mox Rokl
|
2
|
1
|
—
|
—
|
$4,414,759.55
|
$4,972,276.37
|
$4,693,517.96
|
2025-11-26
|
|
9141
|
OTHER
|
Inj Onase Abepar-xioi Treat
|
2
|
1
|
—
|
—
|
$3,268,157.77
|
$3,680,876.26
|
$3,474,517.01
|
2025-11-26
|
|
9194
|
OTHER
|
Tisagenlecleucel Car-pos T
|
6
|
1
|
—
|
—
|
$787,685.32
|
$1,526,861.96
|
$1,526,861.96
|
2025-11-26
|
|
9498
|
OTHER
|
Ciltacabtagene Car-pos T
|
6
|
1
|
—
|
—
|
$753,265.04
|
$1,460,141.13
|
$1,460,141.13
|
2025-11-26
|
|
9413
|
OTHER
|
Lisocabtagene Car Pos T
|
6
|
1
|
—
|
—
|
$748,831.25
|
$1,451,546.60
|
$1,451,546.60
|
2025-11-26
|
|
9422
|
OTHER
|
Idecabtagene Vicleucel Car
|
6
|
1
|
—
|
—
|
$741,882.23
|
$1,438,076.51
|
$1,438,076.51
|
2025-11-26
|
|
9035
|
OTHER
|
Axicabtagene Ciloleucel Car+
|
6
|
1
|
—
|
—
|
$709,817.44
|
$1,375,921.61
|
$1,375,921.61
|
2025-11-26
|
|
9391
|
OTHER
|
Brexucabtagene Car Pos T
|
6
|
1
|
—
|
—
|
$651,345.26
|
$1,262,578.20
|
$1,262,578.20
|
2025-11-26
|
|
1907
|
OTHER
|
New Technology - Level 52 ($145,001-$160,000)
|
6
|
1
|
—
|
—
|
$203,003.35
|
$393,504.98
|
$393,504.98
|
2025-11-26
|
|
1908
|
OTHER
|
New Technology - Level 52 ($145,001-$160,000)
|
6
|
1
|
—
|
—
|
$203,003.35
|
$393,504.98
|
$393,504.98
|
2025-11-26
|
|
1905
|
OTHER
|
New Technology - Level 51 ($130,001-$145,000)
|
6
|
1
|
—
|
—
|
$183,035.87
|
$354,799.70
|
$354,799.70
|
2025-11-26
|
|
1906
|
OTHER
|
New Technology - Level 51 ($130,001-$145,000)
|
6
|
1
|
—
|
—
|
$183,035.87
|
$354,799.70
|
$354,799.70
|
2025-11-26
|
|
1903
|
OTHER
|
New Technology - Level 50 ($115,001-$130,000)
|
6
|
1
|
—
|
—
|
$163,068.40
|
$316,094.42
|
$316,094.42
|
2025-11-26
|
|
1904
|
OTHER
|
New Technology - Level 50 ($115,001-$130,000)
|
6
|
1
|
—
|
—
|
$163,068.40
|
$316,094.42
|
$316,094.42
|
2025-11-26
|
|
1902
|
OTHER
|
New Technology - Level 49 ($100,001-$115,000)
|
6
|
1
|
—
|
—
|
$143,100.92
|
$277,389.14
|
$277,389.14
|
2025-11-26
|
|
1901
|
OTHER
|
New Technology - Level 49 ($100,001-$115,000)
|
6
|
1
|
—
|
—
|
$143,100.92
|
$277,389.14
|
$277,389.14
|
2025-11-26
|
|
1
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
16
|
10
|
—
|
—
|
$1.00
|
$537,324.43
|
$263,911.80
|
2025-11-26
|
|
1599
|
OTHER
|
New Technology - Level 48 ($90,001-$100,000)
|
6
|
1
|
—
|
—
|
$126,461.35
|
$245,134.73
|
$245,134.73
|
2025-11-26
|
|
1585
|
OTHER
|
New Technology - Level 48 ($90,001-$100,000)
|
6
|
1
|
—
|
—
|
$126,461.35
|
$245,134.73
|
$245,134.73
|
2025-11-26
|
|
1584
|
OTHER
|
New Technology - Level 47 ($80,001-$90,000)
|
6
|
1
|
—
|
—
|
$113,149.71
|
$219,331.22
|
$219,331.22
|
2025-11-26
|
|
1598
|
OTHER
|
New Technology - Level 47 ($80,001-$90,000)
|
6
|
1
|
—
|
—
|
$113,149.71
|
$219,331.22
|
$219,331.22
|
2025-11-26
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
14
|
10
|
$13,464.00
|
$11,040.48
|
$1.00
|
$409,532.02
|
$201,145.39
|
2025-11-26
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Pdx Except Face, Mouth And Neck With M…
|
15
|
9
|
—
|
—
|
$1.00
|
$289,681.53
|
$199,966.89
|
2025-11-26
|
|
1597
|
OTHER
|
New Technology - Level 46 ($70,001-$80,000)
|
6
|
1
|
—
|
—
|
$99,838.06
|
$193,527.71
|
$193,527.71
|
2025-11-26
|
|
1583
|
OTHER
|
New Technology - Level 46 ($70,001-$80,000)
|
6
|
1
|
—
|
—
|
$99,838.06
|
$193,527.71
|
$193,527.71
|
2025-11-26
|
|
1596
|
OTHER
|
New Technology - Level 45 ($60,001-$70,000)
|
6
|
1
|
—
|
—
|
$86,526.40
|
$167,724.17
|
$167,724.17
|
2025-11-26
|
|
1582
|
OTHER
|
New Technology - Level 45 ($60,001-$70,000)
|
6
|
1
|
—
|
—
|
$86,526.40
|
$167,724.17
|
$167,724.17
|
2025-11-26
|
|
0717
|
OTHER
|
Instill Adstiladrin, Tx Dose
|
6
|
1
|
—
|
—
|
$84,319.04
|
$163,445.40
|
$163,445.40
|
2025-11-26
|
|
5244
|
OTHER
|
Level 4 Blood Product Exchange And Related Services
|
6
|
1
|
—
|
—
|
$78,729.09
|
$152,609.75
|
$152,609.75
|
2025-11-26
|
|
1643
|
OTHER
|
Y90 Ibritumomab, Rx
|
6
|
1
|
—
|
—
|
$75,642.86
|
$146,627.34
|
$146,627.34
|
2025-11-26
|
|
9273
|
OTHER
|
Sipuleucel-t Auto Cd54+
|
6
|
1
|
—
|
—
|
$73,576.60
|
$142,622.07
|
$142,622.07
|
2025-11-26
|
|
1595
|
OTHER
|
New Technology - Level 44 ($50,001-$60,000)
|
6
|
1
|
—
|
—
|
$73,214.75
|
$141,920.66
|
$141,920.66
|
2025-11-26
|
|
1581
|
OTHER
|
New Technology - Level 44 ($50,001-$60,000)
|
6
|
1
|
—
|
—
|
$73,214.75
|
$141,920.66
|
$141,920.66
|
2025-11-26
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Pdx Except Face, Mouth And Neck Without Major …
|
14
|
10
|
—
|
—
|
$1.00
|
$265,927.86
|
$130,612.90
|
2025-11-26
|
|
7
|
MS_DRG
|
Lung Transplant
|
14
|
10
|
—
|
—
|
$1.00
|
$248,670.31
|
$122,136.69
|
2025-11-26
|
|
1142
|
OTHER
|
Supprelin La Implant
|
6
|
1
|
—
|
—
|
$59,929.92
|
$116,169.13
|
$116,169.13
|
2025-11-26
|
|
1594
|
OTHER
|
New Technology - Level 43 ($40,001-$50,000)
|
6
|
1
|
—
|
—
|
$59,903.09
|
$116,117.13
|
$116,117.13
|
2025-11-26
|
|
1580
|
OTHER
|
New Technology - Level 43 ($40,001-$50,000)
|
6
|
1
|
—
|
—
|
$59,903.09
|
$116,117.13
|
$116,117.13
|
2025-11-26
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
14
|
10
|
—
|
—
|
$1.00
|
$230,817.21
|
$113,367.98
|
2025-11-26
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
16
|
10
|
—
|
—
|
$1.00
|
$217,678.72
|
$106,914.89
|
2025-11-26
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
14
|
10
|
—
|
—
|
$1.00
|
$198,121.32
|
$97,309.10
|
2025-11-26
|
|
1593
|
OTHER
|
New Technology - Level 42 ($30,001-$40,000)
|
6
|
1
|
—
|
—
|
$46,591.45
|
$90,313.62
|
$90,313.62
|
2025-11-26
|
|
1579
|
OTHER
|
New Technology - Level 42 ($30,001-$40,000)
|
6
|
1
|
—
|
—
|
$46,591.45
|
$90,313.62
|
$90,313.62
|
2025-11-26
|
|
A9543
|
HCPCS
|
Wp Radiopharm ,drug And Vaccine Fee Schedule
|
6
|
1
|
—
|
—
|
$87,679.69
|
$104,585.74
|
$87,679.69
|
2025-11-26
|
|
429
|
MS_DRG
|
Combined Anterior/posterior Spinal Fusion With Cc
|
14
|
10
|
—
|
—
|
$1.00
|
$173,209.71
|
$85,073.53
|
2025-11-26
|
|
J9029
|
HCPCS
|
Wp Radiopharm ,drug And Vaccine Fee Schedule
|
6
|
1
|
—
|
—
|
$82,756.38
|
$98,713.14
|
$82,756.38
|
2025-11-26
|
|
5232
|
OTHER
|
Level 2 Icd And Similar Procedures
|
6
|
1
|
—
|
—
|
$42,679.74
|
$82,731.09
|
$82,731.09
|
2025-11-26
|
|
5166
|
OTHER
|
Cochlear Implant Procedure
|
6
|
1
|
—
|
—
|
$42,341.94
|
$82,076.30
|
$82,076.30
|
2025-11-26
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature Or Malignancy Or Infection O…
|
14
|
10
|
—
|
—
|
$1.00
|
$161,601.27
|
$79,371.94
|
2025-11-26
|
|
5465
|
OTHER
|
Level 5 Neurostimulator And Related Procedures
|
6
|
1
|
—
|
—
|
$40,565.83
|
$78,633.46
|
$78,633.46
|
2025-11-26
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Pdx Hemorrhage With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$151,363.94
|
$74,343.78
|
2025-11-26
|
|
5200
|
OTHER
|
Implantation Wireless Pa Pressure Monitor
|
6
|
1
|
—
|
—
|
$37,843.22
|
$73,355.91
|
$73,355.91
|
2025-11-26
|
|
0843
|
OTHER
|
Pegaspargase Injection
|
6
|
1
|
—
|
—
|
$37,837.12
|
$73,344.09
|
$73,344.09
|
2025-11-26
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$146,597.62
|
$72,002.76
|
2025-11-26
|
|
Q2043
|
HCPCS
|
Wp Radiopharm ,drug And Vaccine Fee Schedule
|
6
|
1
|
—
|
—
|
$71,543.64
|
$85,338.40
|
$71,543.64
|
2025-11-26
|
|
1592
|
OTHER
|
New Technology - Level 41 ($25,001-$30,000)
|
6
|
1
|
—
|
—
|
$36,607.71
|
$70,960.98
|
$70,960.98
|
2025-11-26
|
|
1578
|
OTHER
|
New Technology - Level 41 ($25,001-$30,000)
|
6
|
1
|
—
|
—
|
$36,607.71
|
$70,960.98
|
$70,960.98
|
2025-11-26
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
18
|
9
|
—
|
—
|
$1.00
|
$115,051.28
|
$67,975.19
|
2025-11-26
|
|
230
|
MS_DRG
|
Cardiac Procedures (level Of Care (days 7 - 999)
|
4
|
1
|
—
|
—
|
$67,975.19
|
$67,975.19
|
$67,975.19
|
2025-11-26
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
20
|
10
|
—
|
—
|
$1.00
|
$191,351.96
|
$67,975.19
|
2025-11-26
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization With Mcc
|
18
|
9
|
—
|
—
|
$1.00
|
$104,341.69
|
$67,975.19
|
2025-11-26
|
|
02H633Z
|
OTHER
|
Cardiac Procedures (level Of Care (days 7 - 999)
|
4
|
1
|
—
|
—
|
$67,975.19
|
$67,975.19
|
$67,975.19
|
2025-11-26
|
|
06H03DZ
|
OTHER
|
Cardiac Procedures (level Of Care (days 7 - 999)
|
4
|
1
|
—
|
—
|
$67,975.19
|
$67,975.19
|
$67,975.19
|
2025-11-26
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
20
|
10
|
—
|
—
|
$1.00
|
$188,016.12
|
$67,975.19
|
2025-11-26
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
20
|
10
|
—
|
—
|
$1.00
|
$147,715.95
|
$67,975.19
|
2025-11-26
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
14
|
10
|
—
|
—
|
$1.00
|
$138,091.40
|
$67,824.85
|
2025-11-26
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
14
|
10
|
$13,464.00
|
$11,040.48
|
$1.00
|
$138,033.95
|
$67,796.64
|
2025-11-26
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
14
|
10
|
—
|
—
|
$1.00
|
$133,037.84
|
$65,342.75
|
2025-11-26
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
16
|
10
|
—
|
—
|
$1.00
|
$132,388.68
|
$65,023.91
|
2025-11-26
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
14
|
10
|
—
|
—
|
$1.00
|
$129,577.53
|
$63,643.19
|
2025-11-26
|
|
5213
|
OTHER
|
Level 3 Electrophysiologic Procedures
|
6
|
1
|
—
|
—
|
$32,656.91
|
$63,302.68
|
$63,302.68
|
2025-11-26
|
|
0856
|
OTHER
|
Porfimer Sodium Injection
|
6
|
1
|
—
|
—
|
$32,252.02
|
$62,517.85
|
$62,517.85
|
2025-11-26
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
20
|
10
|
—
|
—
|
$1.00
|
$126,594.03
|
$62,177.81
|
2025-11-26
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
18
|
10
|
—
|
—
|
$1.00
|
$126,594.03
|
$62,177.81
|
2025-11-26
|
|
573
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$126,136.36
|
$61,953.02
|
2025-11-26
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
14
|
10
|
—
|
—
|
$1.00
|
$123,901.61
|
$60,855.41
|
2025-11-26
|
|
J9226
|
HCPCS
|
Wp Radiopharm ,drug And Vaccine Fee Schedule
|
9
|
2
|
—
|
—
|
$57,736.37
|
$71,201.15
|
$59,691.64
|
2025-11-26
|
|
1591
|
OTHER
|
New Technology - Level 40 ($20,001-$25,000)
|
6
|
1
|
—
|
—
|
$29,951.88
|
$58,059.21
|
$58,059.21
|
2025-11-26
|
|
1577
|
OTHER
|
New Technology - Level 40 ($20,001-$25,000)
|
6
|
1
|
—
|
—
|
$29,951.88
|
$58,059.21
|
$58,059.21
|
2025-11-26
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
16
|
10
|
—
|
—
|
$1.00
|
$118,036.11
|
$57,974.51
|
2025-11-26
|
|
5231
|
OTHER
|
Level 1 Icd And Similar Procedures
|
6
|
1
|
—
|
—
|
$29,879.92
|
$57,919.73
|
$57,919.73
|
2025-11-26
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedure With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$117,900.15
|
$57,907.74
|
2025-11-26
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
18
|
9
|
—
|
—
|
$1.00
|
$82,742.36
|
$57,421.32
|
2025-11-26
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$115,736.25
|
$56,844.92
|
2025-11-26
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
18
|
9
|
—
|
—
|
$1.00
|
$80,094.65
|
$56,508.99
|
2025-11-26
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature Or Malignancy Or Infection O…
|
14
|
10
|
—
|
—
|
$1.00
|
$114,870.70
|
$56,419.79
|
2025-11-26
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
14
|
10
|
—
|
—
|
$1.00
|
$114,495.36
|
$56,235.44
|
2025-11-26
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/mcc Or T-cell Immunotherapy
|
14
|
10
|
—
|
—
|
$1.00
|
$114,231.10
|
$56,105.65
|
2025-11-26
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedure With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$112,988.30
|
$55,495.23
|
2025-11-26
|
|
5464
|
OTHER
|
Level 4 Neurostimulator And Related Procedures
|
6
|
1
|
—
|
—
|
$28,546.34
|
$55,334.69
|
$55,334.69
|
2025-11-26
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Without Mcc
|
18
|
9
|
—
|
—
|
$1.00
|
$74,554.93
|
$54,600.15
|
2025-11-26
|
|
430
|
MS_DRG
|
Combined Anterior/posterior Spinal Fusion Without Cc/mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$111,117.39
|
$54,576.32
|
2025-11-26
|
|
23
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Pdx With Mcc Or Chemot…
|
15
|
10
|
—
|
—
|
$1.00
|
$110,412.69
|
$54,230.20
|
2025-11-26
|
|
220
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
20
|
10
|
—
|
—
|
$1.00
|
$102,800.75
|
$53,989.26
|
2025-11-26
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal System And Conn…
|
14
|
10
|
—
|
—
|
$1.00
|
$109,822.88
|
$53,940.51
|
2025-11-26
|
|
8
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant
|
14
|
10
|
—
|
—
|
$1.00
|
$108,005.59
|
$53,047.93
|
2025-11-26
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$106,442.99
|
$52,280.45
|
2025-11-26
|
|
228
|
MS_DRG
|
Other Cardiothoracic Procedures With Mcc
|
20
|
10
|
—
|
—
|
$1.00
|
$95,420.53
|
$52,059.29
|
2025-11-26
|
|
834
|
MS_DRG
|
Acute Leukemia Without Major O.r. Procedure With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$105,809.14
|
$51,969.13
|
2025-11-26
|
|
5378
|
OTHER
|
Level 8 Urology And Related Services
|
6
|
1
|
—
|
—
|
$26,794.74
|
$51,939.37
|
$51,939.37
|
2025-11-26
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$105,437.64
|
$51,786.66
|
2025-11-26
|
|
11
|
MS_DRG
|
Tracheostomy For Face, Mouth & Neck Diagnoses Or Laryngectomy With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$105,123.59
|
$51,632.41
|
2025-11-26
|
|
17
|
MS_DRG
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$104,706.13
|
$51,427.37
|
2025-11-26
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Pdx Hemorrhage With Cc
|
14
|
10
|
—
|
—
|
$1.00
|
$102,053.92
|
$50,124.72
|
2025-11-26
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures With Mcc
|
16
|
10
|
—
|
—
|
$1.00
|
$101,718.80
|
$49,960.12
|
2025-11-26
|
|
466
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$100,361.10
|
$49,293.27
|
2025-11-26
|
|
5224
|
OTHER
|
Level 4 Pacemaker And Similar Procedures
|
6
|
1
|
—
|
—
|
$25,387.15
|
$49,210.87
|
$49,210.87
|
2025-11-26
|
|
653
|
MS_DRG
|
Major Bladder Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$100,188.76
|
$49,208.62
|
2025-11-26
|
|
221
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
18
|
10
|
—
|
—
|
$1.00
|
$97,197.60
|
$47,809.03
|
2025-11-26
|
|
236
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization Without Mcc
|
18
|
9
|
—
|
—
|
$1.00
|
$67,975.19
|
$47,778.29
|
2025-11-26
|
|
5116
|
OTHER
|
Level 6 Musculoskeletal Procedures
|
6
|
1
|
—
|
—
|
$24,480.46
|
$47,453.32
|
$47,453.32
|
2025-11-26
|
|
326
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$96,186.51
|
$47,242.88
|
2025-11-26
|
|
853
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedure With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$95,252.01
|
$46,783.90
|
2025-11-26
|
|
239
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$94,928.38
|
$46,624.94
|
2025-11-26
|
|
576
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$94,535.82
|
$46,432.13
|
2025-11-26
|
|
5194
|
OTHER
|
Level 4 Endovascular Procedures
|
6
|
1
|
—
|
—
|
$23,903.63
|
$46,335.18
|
$46,335.18
|
2025-11-26
|
|
471
|
MS_DRG
|
Cervical Spinal Fusion With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$93,147.48
|
$45,750.24
|
2025-11-26
|
|
5471
|
OTHER
|
Implantation Of Drug Infusion Device
|
6
|
1
|
—
|
—
|
$23,527.43
|
$45,605.95
|
$45,605.95
|
2025-11-26
|
|
837
|
MS_DRG
|
Chemotherapy With Acute Leukemia As Sdx Or With High Dose Chemotherapy Agent Wit…
|
14
|
10
|
—
|
—
|
$1.00
|
$92,680.23
|
$45,520.74
|
2025-11-26
|
|
1576
|
OTHER
|
New Technology - Level 39 ($15,001-$20,000)
|
6
|
1
|
—
|
—
|
$23,296.06
|
$45,157.46
|
$45,157.46
|
2025-11-26
|
|
1590
|
OTHER
|
New Technology - Level 39 ($15,001-$20,000)
|
6
|
1
|
—
|
—
|
$23,296.06
|
$45,157.46
|
$45,157.46
|
2025-11-26
|
|
2616
|
OTHER
|
Brachytx, Non-str,yttrium-90
|
6
|
1
|
—
|
—
|
$23,275.82
|
$45,118.23
|
$45,118.23
|
2025-11-26
|
|
267
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
16
|
10
|
—
|
—
|
$1.00
|
$91,847.23
|
$45,111.60
|
2025-11-26
|
|
5094
|
OTHER
|
Level 4 Breast/Lymphatic Surgery And Related Procedures
|
6
|
1
|
—
|
—
|
$23,160.34
|
$44,894.38
|
$44,894.38
|
2025-11-26
|
|
981
|
MS_DRG
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$90,525.91
|
$44,462.63
|
2025-11-26
|
|
826
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …
|
14
|
10
|
—
|
—
|
$1.00
|
$90,257.82
|
$44,330.95
|
2025-11-26
|
|
6
|
MS_DRG
|
Liver Transplant Without Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$89,476.52
|
$43,947.21
|
2025-11-26
|
|
329
|
MS_DRG
|
Major Small And Large Bowel Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$88,700.96
|
$43,566.29
|
2025-11-26
|
|
823
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Other Procedure With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$88,476.91
|
$43,456.24
|
2025-11-26
|
|
245
|
MS_DRG
|
Aicd Generator Procedures
|
15
|
11
|
—
|
—
|
$1.00
|
$88,047.96
|
$43,245.56
|
2025-11-26
|
|
856
|
MS_DRG
|
Postoperative Or Post-traumatic Infections With O.r. Procedure With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$87,785.61
|
$43,116.71
|
2025-11-26
|
|
25
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
15
|
10
|
—
|
—
|
$1.00
|
$87,747.31
|
$43,097.90
|
2025-11-26
|
|
799
|
MS_DRG
|
Splenectomy With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$87,406.45
|
$42,930.48
|
2025-11-26
|
|
163
|
MS_DRG
|
Major Chest Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$86,504.51
|
$42,487.48
|
2025-11-26
|
|
31
|
MS_DRG
|
Ventricular Shunt Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$86,479.62
|
$42,475.25
|
2025-11-26
|
|
5496
|
OTHER
|
Level 6 Intraocular Procedures
|
6
|
1
|
—
|
—
|
$21,853.24
|
$42,360.67
|
$42,360.67
|
2025-11-26
|
|
319
|
MS_DRG
|
Other Endovascular Cardiac Valve Procedures With Mcc
|
16
|
10
|
—
|
—
|
$1.00
|
$86,142.58
|
$42,309.72
|
2025-11-26
|
|
356
|
MS_DRG
|
Other Digestive System O.r. Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$84,800.20
|
$41,650.39
|
2025-11-26
|
|
474
|
MS_DRG
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$82,887.17
|
$40,710.79
|
2025-11-26
|
|
140
|
MS_DRG
|
Major Head And Neck Procedures With Cc/mcc Or Major Device
|
14
|
10
|
—
|
—
|
$1.00
|
$82,358.64
|
$40,451.20
|
2025-11-26
|
|
269
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc
|
16
|
10
|
—
|
—
|
$1.00
|
$81,552.44
|
$40,055.23
|
2025-11-26
|
|
12
|
MS_DRG
|
Tracheostomy For Face, Mouth & Neck Diagnoses Or Laryngectomy With Cc
|
14
|
10
|
—
|
—
|
$1.00
|
$81,414.57
|
$39,987.51
|
2025-11-26
|
|
958
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Cc
|
14
|
10
|
—
|
—
|
$1.00
|
$81,374.35
|
$39,967.76
|
2025-11-26
|
|
673
|
MS_DRG
|
Other Kidney And Urinary Tract Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$81,138.82
|
$39,852.07
|
2025-11-26
|
|
901
|
MS_DRG
|
Wound Debridements For Injuries With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$81,043.07
|
$39,805.04
|
2025-11-26
|
|
5495
|
OTHER
|
Level 5 Intraocular Procedures
|
6
|
1
|
—
|
—
|
$20,453.35
|
$39,647.11
|
$39,647.11
|
2025-11-26
|
|
458
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature Or Malignancy Or Infection O…
|
14
|
10
|
—
|
—
|
$1.00
|
$80,583.48
|
$39,579.31
|
2025-11-26
|
|
793
|
MS_DRG
|
Full Term Neonate With Major Problems
|
14
|
10
|
—
|
—
|
$1.00
|
$80,526.03
|
$39,551.10
|
2025-11-26
|
|
423
|
MS_DRG
|
Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$80,208.15
|
$39,394.96
|
2025-11-26
|
|
791
|
MS_DRG
|
Prematurity With Major Problems
|
14
|
10
|
—
|
—
|
$1.00
|
$78,408.09
|
$38,510.85
|
2025-11-26
|
|
802
|
MS_DRG
|
Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$76,973.79
|
$37,806.38
|
2025-11-26
|
|
24
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Pdx Without Mcc
|
15
|
10
|
—
|
—
|
$1.00
|
$75,591.20
|
$37,127.31
|
2025-11-26
|
|
229
|
MS_DRG
|
Other Cardiothoracic Procedures Without Mcc
|
20
|
10
|
—
|
—
|
$1.00
|
$67,975.19
|
$37,055.19
|
2025-11-26
|
|
933
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft
|
14
|
10
|
$13,464.00
|
$11,040.48
|
$1.00
|
$75,252.25
|
$36,960.83
|
2025-11-26
|
|
5494
|
OTHER
|
Level 4 Intraocular Procedures
|
6
|
1
|
—
|
—
|
$19,021.64
|
$36,871.85
|
$36,871.85
|
2025-11-26
|
|
34
|
MS_DRG
|
Carotid Artery Stent Procedure With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$74,802.24
|
$36,739.80
|
2025-11-26
|
|
876
|
MS_DRG
|
O.r. Procedure With Principal Diagnoses Of Mental Illness
|
14
|
10
|
—
|
—
|
$1.00
|
$74,691.17
|
$36,685.25
|
2025-11-26
|
|
40
|
MS_DRG
|
Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$74,620.32
|
$36,650.45
|
2025-11-26
|
|
907
|
MS_DRG
|
Other O.r. Procedures For Injuries With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$74,200.94
|
$36,444.47
|
2025-11-26
|
|
956
|
MS_DRG
|
Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma
|
14
|
10
|
—
|
—
|
$1.00
|
$72,739.84
|
$35,726.83
|
2025-11-26
|
|
143
|
MS_DRG
|
Other Ear, Nose, Mouth And Throat O.r. Procedures With Cc/mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$72,425.78
|
$35,572.59
|
2025-11-26
|
|
166
|
MS_DRG
|
Other Respiratory System O.r. Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$72,255.35
|
$35,488.88
|
2025-11-26
|
|
518
|
MS_DRG
|
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…
|
14
|
10
|
—
|
—
|
$1.00
|
$72,247.69
|
$35,485.11
|
2025-11-26
|
|
628
|
MS_DRG
|
Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$72,046.62
|
$35,386.36
|
2025-11-26
|
|
00164KB
|
OTHER
|
Bariatric Surgery
|
1
|
1
|
—
|
—
|
$35,344.05
|
$35,344.05
|
$35,344.05
|
2025-11-26
|
|
904
|
MS_DRG
|
Skin Grafts For Injuries With Cc/mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$71,018.29
|
$34,881.28
|
2025-11-26
|
|
5881
|
OTHER
|
Ancillary Outpatient Services When Patient Dies
|
6
|
1
|
—
|
—
|
$17,987.96
|
$34,868.16
|
$34,868.16
|
2025-11-26
|
|
492
|
MS_DRG
|
Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$70,989.57
|
$34,867.18
|
2025-11-26
|
|
J9266
|
HCPCS
|
Wp Radiopharm ,drug And Vaccine Fee Schedule
|
9
|
2
|
$30,636.12
|
$25,121.62
|
$33,304.05
|
$41,180.73
|
$34,523.95
|
2025-11-26
|
|
0DL68DZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
0DL67ZZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
3E0G3GC
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
0DP643Z
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
00168KB
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
0D764ZZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
0D767DZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
0D768DZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
0D763ZZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
0D764DZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
00160KB
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
0D760ZZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
0D767ZZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
0D763DZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
ODV63CZ
|
OTHER
|
Bariatric Surgery
|
2
|
1
|
—
|
—
|
$33,661.00
|
$35,344.05
|
$34,502.53
|
2025-11-26
|
|
939
|
MS_DRG
|
O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$70,164.23
|
$34,461.80
|
2025-11-26
|
|
495
|
MS_DRG
|
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit…
|
14
|
10
|
—
|
—
|
$1.00
|
$70,110.61
|
$34,435.46
|
2025-11-26
|
|
332
|
MS_DRG
|
Rectal Resection With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$70,014.86
|
$34,388.44
|
2025-11-26
|
|
265
|
MS_DRG
|
Aicd Lead Procedures
|
14
|
10
|
—
|
—
|
$1.00
|
$69,966.99
|
$34,364.92
|
2025-11-26
|
|
0800
|
RC
|
Outpatient Procedure Grouper
|
2
|
1
|
$17,243.00
|
$14,139.26
|
$33,475.00
|
$35,148.75
|
$34,311.88
|
2025-11-26
|
|
97
|
MS_DRG
|
Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$69,844.43
|
$34,304.73
|
2025-11-26
|
|
4438
|
OTHER
|
Bariatric Surgery (Case Rate)
|
1
|
1
|
—
|
—
|
$34,271.96
|
$34,271.96
|
$34,271.96
|
2025-11-26
|
|
4439
|
OTHER
|
Bariatric Surgery (Case Rate)
|
1
|
1
|
—
|
—
|
$34,271.96
|
$34,271.96
|
$34,271.96
|
2025-11-26
|
|
739
|
MS_DRG
|
Uterine, Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$69,289.09
|
$34,031.97
|
2025-11-26
|
|
736
|
MS_DRG
|
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$69,130.15
|
$33,953.91
|
2025-11-26
|
|
335
|
MS_DRG
|
Peritoneal Adhesiolysis With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$69,061.21
|
$33,920.05
|
2025-11-26
|
|
408
|
MS_DRG
|
Biliary Tract Procedure Except Only Cholecystectomy With Or Without C.d.e. With …
|
14
|
10
|
—
|
—
|
$1.00
|
$68,959.72
|
$33,870.20
|
2025-11-26
|
|
414
|
MS_DRG
|
Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$68,902.27
|
$33,841.98
|
2025-11-26
|
|
622
|
MS_DRG
|
Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…
|
14
|
10
|
—
|
—
|
$1.00
|
$68,837.16
|
$33,810.00
|
2025-11-26
|
|
271
|
MS_DRG
|
Other Major Cardiovascular Procedures With Cc
|
16
|
10
|
—
|
—
|
$1.00
|
$68,781.63
|
$33,782.73
|
2025-11-26
|
|
0D760DZ
|
OTHER
|
Bariatric Surgery
|
1
|
1
|
—
|
—
|
$33,661.00
|
$33,661.00
|
$33,661.00
|
2025-11-26
|
|
ODL64CZ
|
OTHER
|
Bariatric Surgery
|
1
|
1
|
—
|
—
|
$33,661.00
|
$33,661.00
|
$33,661.00
|
2025-11-26
|
|
5377
|
OTHER
|
Level 7 Urology And Related Services
|
6
|
1
|
—
|
—
|
$17,295.25
|
$33,525.40
|
$33,525.40
|
2025-11-26
|
|
467
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Cc
|
14
|
10
|
—
|
—
|
$1.00
|
$68,212.89
|
$33,503.38
|
2025-11-26
|
|
94
|
MS_DRG
|
Bacterial And Tuberculous Infections Of Nervous System With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$68,075.01
|
$33,435.66
|
2025-11-26
|
|
5115
|
OTHER
|
Level 5 Musculoskeletal Procedures
|
6
|
1
|
—
|
—
|
$17,128.05
|
$33,201.30
|
$33,201.30
|
2025-11-26
|
|
252
|
MS_DRG
|
Other Vascular Procedures With Mcc
|
16
|
10
|
—
|
—
|
$1.00
|
$67,479.46
|
$33,143.15
|
2025-11-26
|
|
616
|
MS_DRG
|
Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…
|
14
|
10
|
—
|
—
|
$1.00
|
$67,462.23
|
$33,134.69
|
2025-11-26
|
|
574
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Cc
|
14
|
10
|
—
|
—
|
$1.00
|
$67,155.84
|
$32,984.20
|
2025-11-26
|
|
477
|
MS_DRG
|
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$66,834.12
|
$32,826.19
|
2025-11-26
|
|
987
|
MS_DRG
|
Non-extensive O.r. Procedure Unrelated To Principal Diagnosis With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$66,332.41
|
$32,579.77
|
2025-11-26
|
|
29
|
MS_DRG
|
Spinal Procedures With Cc Or Spinal Neurostimulators
|
14
|
10
|
—
|
—
|
$1.00
|
$66,010.69
|
$32,421.76
|
2025-11-26
|
|
0713
|
OTHER
|
Inj Roctavian Ml 2x10^13vc G
|
6
|
1
|
—
|
—
|
$16,711.06
|
$32,392.99
|
$32,392.99
|
2025-11-26
|
|
420
|
MS_DRG
|
Hepatobiliary Diagnostic Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$65,924.52
|
$32,379.43
|
2025-11-26
|
|
1575
|
OTHER
|
New Technology - Level 38 ($10,001-$15,000)
|
6
|
1
|
—
|
—
|
$16,640.23
|
$32,255.70
|
$32,255.70
|
2025-11-26
|
|
1589
|
OTHER
|
New Technology - Level 38 ($10,001-$15,000)
|
6
|
1
|
—
|
—
|
$16,640.23
|
$32,255.70
|
$32,255.70
|
2025-11-26
|
|
5463
|
OTHER
|
Level 3 Neurostimulator And Related Procedures
|
6
|
1
|
—
|
—
|
$16,600.23
|
$32,178.16
|
$32,178.16
|
2025-11-26
|
|
264
|
MS_DRG
|
Other Circulatory System O.r. Procedures
|
14
|
10
|
—
|
—
|
$1.00
|
$64,651.08
|
$31,753.97
|
2025-11-26
|
|
411
|
MS_DRG
|
Cholecystectomy With C.d.e. With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$63,936.80
|
$31,403.14
|
2025-11-26
|
|
37
|
MS_DRG
|
Extracranial Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$63,722.33
|
$31,297.80
|
2025-11-26
|
|
0DB64Z3
|
OTHER
|
Bariatric Surgery
|
10
|
5
|
—
|
—
|
$24,077.00
|
$34,271.96
|
$31,036.00
|
2025-11-26
|
|
0DV64CZ
|
OTHER
|
Bariatric Surgery
|
10
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D1807L
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D1807K
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D18078
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D1807H
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D18074
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0DQ67ZZ
|
OTHER
|
Ip Baritric Surgery
|
7
|
3
|
—
|
—
|
$31,036.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D168Z9
|
OTHER
|
Bariatric Surgery
|
8
|
3
|
—
|
—
|
$28,032.53
|
$34,271.96
|
$31,036.00
|
2025-11-26
|
|
0DQ68ZZ
|
OTHER
|
Ip Baritric Surgery
|
7
|
3
|
—
|
—
|
$31,036.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D168ZA
|
OTHER
|
Bariatric Surgery
|
11
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D168KB
|
OTHER
|
Ip Baritric Surgery
|
8
|
3
|
—
|
—
|
$28,032.53
|
$34,271.96
|
$31,036.00
|
2025-11-26
|
|
0D168KL
|
OTHER
|
Bariatric Surgery
|
9
|
4
|
—
|
—
|
$28,032.53
|
$34,271.96
|
$31,036.00
|
2025-11-26
|
|
0D168K9
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D168KA
|
OTHER
|
Bariatric Surgery
|
11
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D168Z4
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D168JA
|
OTHER
|
Bariatric Surgery
|
11
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D168JB
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D168J9
|
OTHER
|
Bariatric Surgery
|
9
|
4
|
—
|
—
|
$28,032.53
|
$34,271.96
|
$31,036.00
|
2025-11-26
|
|
0D168JL
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D1687L
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D1687B
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D168J4
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D168K4
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D168ZB
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D16874
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D16879
|
OTHER
|
Bariatric Surgery
|
11
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D1687A
|
OTHER
|
Bariatric Surgery
|
11
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164ZB
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164ZL
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164ZA
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164Z9
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164K9
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164K4
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D164KA
|
OTHER
|
Bariatric Surgery
|
8
|
3
|
—
|
—
|
$28,032.53
|
$33,661.00
|
$31,036.00
|
2025-11-26
|
|
0D164JB
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164JL
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164Z4
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D164J9
|
OTHER
|
Bariatric Surgery
|
9
|
3
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164KB
|
OTHER
|
Ip Baritric Surgery
|
7
|
2
|
—
|
—
|
$28,032.53
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D164JA
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164KL
|
OTHER
|
Bariatric Surgery
|
9
|
3
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D168ZL
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D1647A
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D16479
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D1647B
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D1647L
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D164J4
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D160ZL
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D163J4
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D160ZA
|
OTHER
|
Bariatric Surgery
|
11
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D160ZB
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D16474
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D160KA
|
OTHER
|
Bariatric Surgery
|
11
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D160KB
|
OTHER
|
Ip Baritric Surgery
|
8
|
3
|
—
|
—
|
$28,032.53
|
$34,271.96
|
$31,036.00
|
2025-11-26
|
|
0D160K4
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D160K9
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D160KL
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D160Z9
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D160JB
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D160JA
|
OTHER
|
Bariatric Surgery
|
11
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D160Z4
|
OTHER
|
Ip Baritric Surgery
|
4
|
1
|
—
|
—
|
$31,036.00
|
$31,036.00
|
$31,036.00
|
2025-11-26
|
|
0D160J9
|
OTHER
|
Bariatric Surgery
|
9
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D160JL
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0DQ60ZZ
|
OTHER
|
Bariatric Surgery
|
10
|
4
|
—
|
—
|
$28,032.53
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D16079
|
OTHER
|
Bariatric Surgery
|
11
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0D1607A
|
OTHER
|
Bariatric Surgery
|
11
|
5
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0DQ63ZZ
|
OTHER
|
Ip Baritric Surgery
|
7
|
3
|
—
|
—
|
$31,036.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
0DQ64ZZ
|
OTHER
|
Ip Baritric Surgery
|
7
|
4
|
—
|
—
|
$24,077.00
|
$35,344.05
|
$31,036.00
|
2025-11-26
|
|
579
|
MS_DRG
|
Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$62,695.91
|
$30,793.67
|
2025-11-26
|
|
840
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$62,626.97
|
$30,759.81
|
2025-11-26
|
|
652
|
MS_DRG
|
Kidney Transplant
|
14
|
10
|
—
|
—
|
$1.00
|
$62,523.57
|
$30,709.02
|
2025-11-26
|
|
485
|
MS_DRG
|
Knee Procedures With Pdx Of Infection With Mcc
|
14
|
10
|
—
|
—
|
$1.00
|
$62,477.61
|
$30,686.45
|
2025-11-26
|
|
T2000XA
|
OTHER
|
Ip Burn Care Unit
|
5
|
2
|
$13,464.00
|
$11,040.48
|
$20,423.83
|
$30,627.19
|
$30,627.19
|
2025-11-26
|
|
T20011A
|
OTHER
|
Ip Burn Care Unit
|
5
|
2
|
$13,464.00
|
$11,040.48
|
$20,423.83
|
$30,627.19
|
$30,627.19
|
2025-11-26
|
|
T2000XD
|
OTHER
|
Ip Burn Care Unit
|
5
|
2
|
$13,464.00
|
$11,040.48
|
$20,423.83
|
$30,627.19
|
$30,627.19
|
2025-11-26
|
|
T20011D
|
OTHER
|
Ip Burn Care Unit
|
5
|
2
|
$13,464.00
|
$11,040.48
|
$20,423.83
|
$30,627.19
|
$30,627.19
|
2025-11-26
|
|
929
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc
|
14
|
10
|
$13,464.00
|
$11,040.48
|
$1.00
|
$62,356.97
|
$30,627.19
|
2025-11-26
|
|
T20012A
|
OTHER
|
Ip Burn Care Unit
|
5
|
2
|
$13,464.00
|
$11,040.48
|
$20,423.83
|
$30,627.19
|
$30,627.19
|
2025-11-26
|
|
T20012D
|
OTHER
|
Ip Burn Care Unit
|
5
|
2
|
$13,464.00
|
$11,040.48
|
$20,423.83
|
$30,627.19
|
$30,627.19
|
2025-11-26
|