Price Transparency Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

GOOD SAMARITAN HOSPITAL

San Jose, CA · CCN 050380 · Rates published

33,987 distinct procedures filed
46 distinct payers
894,163 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

363,356 of 894,163 rate rows are consumer-grade (40.6%)

530,807 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 487,953
template filing: same amount across many unrelated codes — excluded 28,082
per-diem day rate — not a per-procedure price 14,604
placeholder amount (≤ $0.02) — excluded from medians 150
exceeds 10× this hospital's gross charge — excluded from medians 18

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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://core.secure.ehc.com/src/util/json-detail-price-list/62-1763090_good-samaritan-hospital_standardcharges.json
Found on page https://goodsamsanjose.com/about/legal-information/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint c32032bd82954b73… · 647,621,834 bytes · first seen 2026-05-14

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 $4,897,200.00 $4,897,200.00 $4,897,200.00 nat. median
$3,006,423
1.6× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $3,884,946.48 $3,884,946.48 $3,884,946.48 nat. median
$2,469,189
1.6× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,672,900.00 $3,672,900.00 $3,672,900.00 nat. median
$3,574,709
1.0× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 19 $3,672,900.00 $4,774,770.00 $3,672,900.00 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 20 $3,605,000.00 $4,686,500.00 $3,605,000.00 nat. median
$3,605,000
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $3,605,000.00 $3,605,000.00 $3,605,000.00 nat. median
$3,496,850
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,325,455.00 $3,325,455.00 $3,325,455.00 nat. median
$3,228,024
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 21 $9,629.20 $4,323,091.50 $3,325,455.00 nat. median
$13,041
outlier · 255.0×
748
OTHER 		Inj, Lovotibeglogene Auto 21 $15,883.34 $4,271,800.00 $3,286,000.00 nat. median
$17,963
outlier · 182.9×
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,286,000.00 $3,286,000.00 $3,286,000.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 21 $14,107.56 $3,858,400.00 $2,968,000.00 nat. median
$21,896
outlier · 135.6×
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,968,000.00 $2,968,000.00 $2,968,000.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 20 $2,388,614.00 $4,299,505.20 $2,388,614.00 nat. median
$2,588,981
0.9× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,388,614.00 $2,388,614.00 $2,388,614.00 nat. median
$2,457,321
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $529,192.90 $529,192.90 $529,192.90 nat. median
$538,205
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 20 $529,192.90 $952,547.22 $529,192.90 nat. median
$566,531
0.9× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $527,123.40 $527,123.40 $527,123.40 nat. median
$554,552
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 20 $527,123.40 $948,822.12 $527,123.40 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 20 $526,587.60 $947,857.68 $526,587.60 nat. median
$558,082
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $526,587.60 $526,587.60 $526,587.60 nat. median
$530,178
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 20 $516,726.10 $930,106.98 $516,726.10 nat. median
$562,201
0.9× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $516,726.10 $516,726.10 $516,726.10 nat. median
$534,091
1.0× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 5 $84,532.00 $1,929,210.60 $507,496.00 nat. median
$675,122
0.8× median
9035
OTHER 		Axicabtagene Ciloleucel C 21 $489,456.00 $881,020.80 $489,456.00 nat. median
$532,192
0.9× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $489,456.00 $489,456.00 $489,456.00 nat. median
$505,583
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 5 $96,938.00 $1,913,127.21 $484,690.00 nat. median
$625,184
0.8× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 5 $94,770.00 $1,886,282.80 $474,061.00 nat. median
$674,188
0.7× median
9391
OTHER 		Brexucabtagene Car Pos T 20 $460,530.40 $828,954.72 $460,530.40 nat. median
$489,450
0.9× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $460,530.40 $460,530.40 $460,530.40 nat. median
$464,978
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 5 $89,888.00 $1,858,720.26 $459,381.00 nat. median
$634,511
0.7× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 5 $89,888.00 $1,707,872.00 $449,440.00 nat. median
$620,080
0.7× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 23 $374,380.74 $703,457.88 $415,978.60 nat. median
$370,174
1.1× median
5834
APR_DRG 		Neonate With Ecmo 5 $369,399.28 $894,514.19 $380,824.00 nat. median
$309,665
1.2× median
5833
APR_DRG 		Neonate With Ecmo 5 $321,698.56 $544,976.31 $331,648.00 nat. median
$244,017
1.4× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 2 $326,389.90 $326,389.90 $326,389.90 nat. median
$263,894
1.2× median
104
APR_DRG 		Head Trauma With Deep Coma 1 $324,518.90 $324,518.90 $324,518.90 nat. median
$42,757
outlier · 7.6×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 25 $8,580.00 $455,676.00 $310,775.60 nat. median
$265,286
1.2× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 5 $2,127.00 $1,989,119.73 $305,968.40 nat. median
$754,974
outlier · 0.4×
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 5 $275,524.62 $816,134.21 $284,046.00 nat. median
$246,434
1.2× median
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 $269,319.80 $269,319.80 $269,319.80 nat. median
$424,868
0.6× median
1614
APR_DRG 		Implantable Heart Assist Systems 5 $254,132.24 $697,651.10 $261,992.00 nat. median
$207,730
1.3× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 24 $8,580.00 $443,235.00 $261,793.00 nat. median
$206,368
1.3× median
24
APR_DRG 		Heart And/or Lung Transplant 5 $246,197.64 $645,038.48 $253,812.00 nat. median
$234,738
1.1× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 25 $7,700.00 $588,627.00 $236,521.30 nat. median
$202,986
1.2× median
1907
OTHER 		New Technology - Level 52 21 $229,049.70 $412,289.46 $229,049.70 nat. median
$153,199
1.5× median
1908
OTHER 		New Technology - Level 52 21 $229,049.70 $412,289.46 $229,049.70 nat. median
$152,962
1.5× median
01907
OTHER 		New Technology - Level 52 2 $229,049.70 $229,049.70 $229,049.70 nat. median
$84,819
outlier · 2.7×
01908
OTHER 		New Technology - Level 52 2 $229,049.70 $229,049.70 $229,049.70 nat. median
$82,736
outlier · 2.8×
003
OTHER 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 $218,616.00 $218,616.00 $218,616.00 nat. median
$218,232
1.0× median
5832
APR_DRG 		Neonate With Ecmo 5 $201,874.46 $221,844.30 $208,118.00 nat. median
$156,126
1.3× median

Other procedures at this hospital

Browse this hospital's 33,987 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
             
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 1 1 — — $4,897,200.00 $4,897,200.00 $4,897,200.00 2024-10-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 1 — — $3,884,946.48 $3,884,946.48 $3,884,946.48 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 27 19 — — $3,672,900.00 $4,774,770.00 $3,672,900.00 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $3,672,900.00 $3,672,900.00 $3,672,900.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 28 20 — — $3,605,000.00 $4,686,500.00 $3,605,000.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 2 2 — — $3,605,000.00 $3,605,000.00 $3,605,000.00 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $3,325,455.00 $3,325,455.00 $3,325,455.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 30 21 — — $9,629.20 $4,323,091.50 $3,325,455.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 30 21 — — $15,883.34 $4,271,800.00 $3,286,000.00 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 2 2 — — $3,286,000.00 $3,286,000.00 $3,286,000.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 30 21 — — $14,107.56 $3,858,400.00 $2,968,000.00 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 2 2 — — $2,968,000.00 $2,968,000.00 $2,968,000.00 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $2,388,614.00 $2,388,614.00 $2,388,614.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 28 20 — — $2,388,614.00 $4,299,505.20 $2,388,614.00 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 28 20 — — $529,192.90 $952,547.22 $529,192.90 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $529,192.90 $529,192.90 $529,192.90 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 28 20 — — $527,123.40 $948,822.12 $527,123.40 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 2 2 — — $527,123.40 $527,123.40 $527,123.40 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 2 2 — — $526,587.60 $526,587.60 $526,587.60 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 28 20 — — $526,587.60 $947,857.68 $526,587.60 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 2 2 — — $516,726.10 $516,726.10 $516,726.10 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 28 20 — — $516,726.10 $930,106.98 $516,726.10 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 6 5 — — $84,532.00 $1,929,210.60 $507,496.00 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $489,456.00 $489,456.00 $489,456.00 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 29 21 — — $489,456.00 $881,020.80 $489,456.00 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 6 5 — — $96,938.00 $1,913,127.21 $484,690.00 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 6 5 — — $94,770.00 $1,886,282.80 $474,061.00 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $460,530.40 $460,530.40 $460,530.40 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 28 20 — — $460,530.40 $828,954.72 $460,530.40 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 6 5 — — $89,888.00 $1,858,720.26 $459,381.00 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 6 5 — — $89,888.00 $1,707,872.00 $449,440.00 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 33 23 — — $374,380.74 $703,457.88 $415,978.60 2024-10-01
5834 APR_DRG Neonate With Ecmo 5 5 — — $369,399.28 $894,514.19 $380,824.00 2024-10-01
5833 APR_DRG Neonate With Ecmo 5 5 — — $321,698.56 $544,976.31 $331,648.00 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 2 — — $326,389.90 $326,389.90 $326,389.90 2024-10-01
104 APR_DRG Head Trauma With Deep Coma 1 1 — — $324,518.90 $324,518.90 $324,518.90 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 36 25 — — $8,580.00 $455,676.00 $310,775.60 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 8 5 — — $2,127.00 $1,989,119.73 $305,968.40 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 5 5 — — $275,524.62 $816,134.21 $284,046.00 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $269,319.80 $269,319.80 $269,319.80 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 5 5 — — $254,132.24 $697,651.10 $261,992.00 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 34 24 — — $8,580.00 $443,235.00 $261,793.00 2024-10-01
24 APR_DRG Heart And/or Lung Transplant 5 5 — — $246,197.64 $645,038.48 $253,812.00 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 38 25 — — $7,700.00 $588,627.00 $236,521.30 2024-10-01
01908 OTHER New Technology - Level 52 2 2 — — $229,049.70 $229,049.70 $229,049.70 2024-10-01
01907 OTHER New Technology - Level 52 2 2 — — $229,049.70 $229,049.70 $229,049.70 2024-10-01
1907 OTHER New Technology - Level 52 29 21 — — $229,049.70 $412,289.46 $229,049.70 2024-10-01
1908 OTHER New Technology - Level 52 29 21 — — $229,049.70 $412,289.46 $229,049.70 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 2 — — $218,616.00 $218,616.00 $218,616.00 2024-10-01
5832 APR_DRG Neonate With Ecmo 5 5 — — $201,874.46 $221,844.30 $208,118.00 2024-10-01
01905 OTHER New Technology - Level 51 2 2 — — $206,520.20 $206,520.20 $206,520.20 2024-10-01
01906 OTHER New Technology - Level 51 2 2 — — $206,520.20 $206,520.20 $206,520.20 2024-10-01
1906 OTHER New Technology - Level 51 29 21 — — $206,520.20 $371,736.36 $206,520.20 2024-10-01
1905 OTHER New Technology - Level 51 29 21 — — $206,520.20 $371,736.36 $206,520.20 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 5 5 — — $192,573.13 $274,082.74 $198,529.00 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $191,244.23 $197,159.00 $196,173.21 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 5 5 — — $187,273.05 $293,732.66 $193,065.00 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 5 5 — — $182,521.99 $575,460.46 $188,167.00 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 5 5 — — $181,126.16 $573,987.75 $186,728.00 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 5 5 — — $179,320.02 $717,077.88 $184,866.00 2024-10-01
1903 OTHER New Technology - Level 50 29 21 — — $183,990.80 $331,183.44 $183,990.80 2024-10-01
01903 OTHER New Technology - Level 50 2 2 — — $183,990.80 $183,990.80 $183,990.80 2024-10-01
1904 OTHER New Technology - Level 50 29 21 — — $183,990.80 $331,183.44 $183,990.80 2024-10-01
01904 OTHER New Technology - Level 50 2 2 — — $183,990.80 $183,990.80 $183,990.80 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 5 5 — — $176,713.63 $548,089.95 $182,179.00 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 5 5 — — $176,162.67 $261,480.56 $181,611.00 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 5 5 — — $174,148.95 $422,500.73 $179,535.00 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 5 5 — — $172,013.98 $244,683.38 $177,334.00 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 5 5 — — $164,038.64 $461,258.18 $169,112.00 2024-10-01
5831 APR_DRG Neonate With Ecmo 5 5 — — $140,491.43 $168,537.00 $166,851.63 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 5 5 — — $161,004.48 $470,616.26 $165,984.00 2024-10-01
74 APR_DRG Allogeneic Bone Marrow Transplant 5 5 — — $159,389.43 $489,153.92 $164,319.00 2024-10-01
01901 OTHER New Technology - Level 49 2 2 — — $161,461.50 $161,461.50 $161,461.50 2024-10-01
1901 OTHER New Technology - Level 49 29 21 — — $161,461.50 $290,630.70 $161,461.50 2024-10-01
1902 OTHER New Technology - Level 49 29 21 — — $161,461.50 $290,630.70 $161,461.50 2024-10-01
01902 OTHER New Technology - Level 49 2 2 — — $161,461.50 $161,461.50 $161,461.50 2024-10-01
23 APR_DRG Heart And/or Lung Transplant 5 5 — — $155,819.83 $418,274.83 $160,639.00 2024-10-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 5 5 — — $154,521.97 $483,723.07 $159,301.00 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 5 5 — — $154,432.73 $171,899.03 $159,209.00 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 38 25 — — $7,700.00 $363,881.00 $156,040.00 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 2 — — $153,714.20 $153,714.20 $153,714.20 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 5 5 — — $131,589.92 $151,430.00 $149,915.70 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 33 23 — — $130,235.40 $217,838.17 $144,706.00 2024-10-01
7 MS_DRG Lung Transplant 34 24 — — $8,580.00 $237,578.47 $144,342.20 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 2 2 — — $142,826.90 $142,826.90 $142,826.90 2024-10-01
01599 OTHER New Technology - Level 48 2 2 — — $142,687.00 $142,687.00 $142,687.00 2024-10-01
1585 OTHER New Technology - Level 48 29 21 — — $142,687.00 $256,836.60 $142,687.00 2024-10-01
1599 OTHER New Technology - Level 48 29 21 — — $142,687.00 $256,836.60 $142,687.00 2024-10-01
01585 OTHER New Technology - Level 48 2 2 — — $142,687.00 $142,687.00 $142,687.00 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 5 5 — — $135,870.81 $396,870.70 $140,073.00 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 2 2 — — $139,092.60 $139,092.60 $139,092.60 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 6 3 — — $95,681.68 $276,632.40 $135,036.37 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 5 5 — — $130,697.80 $429,555.34 $134,740.00 2024-10-01
3024 APR_DRG Knee Joint Replacement 1 1 — — $130,841.55 $130,841.55 $130,841.55 2024-10-01
3014 APR_DRG Hip Joint Replacement 1 1 — — $129,382.57 $129,382.57 $129,382.57 2024-10-01
5464 APR_DRG Other O.r. Proc For Obstetric Diagnoses Except Delivery Diagnoses 1 1 — — $129,156.00 $129,156.00 $129,156.00 2024-10-01
01584 OTHER New Technology - Level 47 2 2 — — $127,667.40 $127,667.40 $127,667.40 2024-10-01
1598 OTHER New Technology - Level 47 29 21 — — $127,667.40 $229,801.32 $127,667.40 2024-10-01
01598 OTHER New Technology - Level 47 2 2 — — $127,667.40 $127,667.40 $127,667.40 2024-10-01
1584 OTHER New Technology - Level 47 29 21 — — $127,667.40 $229,801.32 $127,667.40 2024-10-01
64 APR_DRG Pancreas Transplant 5 5 — — $123,117.25 $479,747.77 $126,925.00 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $76,785.37 $176,839.04 $126,812.21 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 5 5 — — $121,999.81 $372,253.38 $125,773.00 2024-10-01
007 OTHER Lung Transplant 2 2 — — $123,233.70 $123,233.70 $123,233.70 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 2 — — $123,010.10 $123,010.10 $123,010.10 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 36 25 — — $8,580.00 $283,406.00 $121,764.50 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 5 5 — — $117,400.07 $445,267.73 $121,031.00 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 34 24 — — $8,580.00 $181,114.00 $120,369.00 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 5 5 — — $115,877.17 $290,056.02 $119,461.00 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 5 5 — — $114,408.59 $169,132.12 $117,947.00 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 34 24 — — $8,580.00 $222,003.03 $117,673.80 2024-10-01
215 MS_DRG Other Heart Assist System Implant 44 28 — — $7,700.00 $200,520.88 $117,074.20 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 32 22 — — $8,580.00 $150,582.90 $115,833.00 2024-10-01
22 APR_DRG Heart And/or Lung Transplant 5 5 — — $112,148.49 $347,732.17 $115,617.00 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 5 5 — — $110,547.02 $333,066.82 $113,966.00 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 2 2 — — $113,844.30 $113,844.30 $113,844.30 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 8 5 — — $61,770.00 $296,127.12 $113,243.61 2024-10-01
01583 OTHER New Technology - Level 46 2 2 — — $112,647.80 $112,647.80 $112,647.80 2024-10-01
1597 OTHER New Technology - Level 46 29 21 — — $112,647.80 $202,766.04 $112,647.80 2024-10-01
1583 OTHER New Technology - Level 46 29 21 — — $112,647.80 $202,766.04 $112,647.80 2024-10-01
01597 OTHER New Technology - Level 46 2 2 — — $112,647.80 $112,647.80 $112,647.80 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 5 5 — — $106,413.85 $317,326.98 $109,705.00 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 48 29 — — $7,700.00 $247,840.00 $106,670.50 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $102,760.83 $105,939.00 $105,409.30 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 2 2 — — $104,922.90 $104,922.90 $104,922.90 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 5 5 — — $101,597.80 $343,430.75 $104,740.00 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 5 5 — — $101,445.51 $140,783.23 $104,583.00 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 5 5 — — $100,655.93 $330,131.69 $103,769.00 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 5 5 — — $99,626.76 $298,754.99 $102,708.00 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 5 5 — — $99,096.17 $321,721.09 $102,161.00 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 32 22 — — $8,580.00 $132,379.26 $101,830.20 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 5 5 — — $98,732.42 $311,254.18 $101,786.00 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 2 2 — — $101,114.30 $101,114.30 $101,114.30 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 2 2 — — $100,883.50 $100,883.50 $100,883.50 2024-10-01
63 APR_DRG Pancreas Transplant 5 5 — — $97,470.45 $318,394.61 $100,485.00 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 31 22 — — $99,999.90 $179,999.82 $99,999.90 2024-10-01
B0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 1 1 — — $97,832.31 $97,832.31 $97,832.31 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 5 5 — — $94,858.24 $226,269.30 $97,792.00 2024-10-01
01582 OTHER New Technology - Level 45 2 2 — — $97,628.15 $97,628.15 $97,628.15 2024-10-01
01596 OTHER New Technology - Level 45 2 2 — — $97,628.15 $97,628.15 $97,628.15 2024-10-01
1596 OTHER New Technology - Level 45 29 21 — — $97,628.15 $175,730.67 $97,628.15 2024-10-01
1582 OTHER New Technology - Level 45 29 21 — — $97,628.15 $175,730.67 $97,628.15 2024-10-01
B0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 1 1 — — $96,827.54 $96,827.54 $96,827.54 2024-10-01
4404 APR_DRG Kidney Transplant 5 5 — — $93,408.09 $294,518.79 $96,297.00 2024-10-01
21 APR_DRG Heart And/or Lung Transplant 5 5 — — $92,196.56 $305,984.68 $95,048.00 2024-10-01
73 APR_DRG Allogeneic Bone Marrow Transplant 5 5 — — $91,366.24 $256,296.88 $94,192.00 2024-10-01
C9150 HCPCS Xenon Xe-129 Hyperpolarized Gas, Diagnostic, Per Study Dose 2 1 — — $88,576.80 $99,715.20 $94,146.00 2024-10-01
215 OTHER Other Heart Assist System Implant 2 2 — — $93,825.63 $93,825.63 $93,825.63 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 48 29 — — $7,700.00 $193,083.00 $93,696.22 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 45 27 — — $7,700.00 $164,438.33 $93,643.30 2024-10-01
B0106 OTHER Stroke; M > 30.05 & M < 34.25 1 1 — — $93,299.59 $93,299.59 $93,299.59 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 32 22 — — $8,580.00 $119,893.45 $92,225.73 2024-10-01
103 APR_DRG Head Trauma With Deep Coma 1 1 — — $91,792.31 $91,792.31 $91,792.31 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 31 22 — — $91,031.90 $163,857.42 $91,031.90 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 2 — — $90,822.56 $90,822.56 $90,822.56 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 8 5 — — $30,332.00 $178,170.72 $90,799.46 2024-10-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 5 5 — — $87,921.77 $303,760.16 $90,641.00 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 10 7 — — $53,426.00 $252,062.74 $90,409.30 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 2 — — $90,317.52 $90,317.52 $90,317.52 2024-10-01
8514 APR_DRG Gender Related Procedures 4 4 — — $87,707.40 $90,420.00 $89,967.90 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 42 27 — — $7,700.00 $181,060.82 $89,144.75 2024-10-01
10 MS_DRG Pancreas Transplant 34 24 — — $8,580.00 $114,628.55 $88,175.81 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 34 24 — — $8,580.00 $138,853.59 $87,669.84 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 47 28 — — $7,700.00 $175,053.00 $87,363.00 2024-10-01
C0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 1 1 — — $87,001.29 $87,001.29 $87,001.29 2024-10-01
90288 CPT Botulism Ig Human IV 2 1 $66,835.00 $66,835.00 $81,337.35 $91,565.40 $86,451.38 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 5 5 — — $83,842.92 $281,096.15 $86,436.00 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 48 29 — — $7,700.00 $247,840.00 $86,434.54 2024-10-01
B0205 OTHER Traumatic Brain Injury; M > 28.75 & M < 40.65 1 1 — — $84,699.62 $84,699.62 $84,699.62 2024-10-01
D0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 1 1 — — $84,455.65 $84,455.65 $84,455.65 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 7 4 — — $48,500.00 $97,712.86 $83,801.00 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 6 3 — — $74,582.00 $137,970.01 $83,801.00 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 6 3 — — $74,582.00 $101,566.34 $83,801.00 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 6 3 — — $74,582.00 $98,432.96 $83,801.00 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 7 4 — — $48,500.00 $124,574.32 $83,801.00 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 6 3 — — $74,582.00 $149,012.75 $83,801.00 2024-10-01
5444 APR_DRG D&c, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses 1 1 — — $83,690.67 $83,690.67 $83,690.67 2024-10-01
8634 APR_DRG Neonatal Aftercare 5 5 — — $80,929.04 $195,507.09 $83,432.00 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 8 6 — — $15,000.00 $241,297.45 $82,854.70 2024-10-01
1784 APR_DRG External Heart Assist Devices 4 4 — — $80,559.47 $83,051.00 $82,635.74 2024-10-01
1595 OTHER New Technology - Level 44 29 21 — — $82,608.55 $148,695.39 $82,608.55 2024-10-01
1581 OTHER New Technology - Level 44 29 21 — — $82,608.55 $148,695.39 $82,608.55 2024-10-01
01595 OTHER New Technology - Level 44 2 2 — — $82,608.55 $82,608.55 $82,608.55 2024-10-01
01581 OTHER New Technology - Level 44 2 2 — — $82,608.55 $82,608.55 $82,608.55 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 36 25 — — $8,580.00 $144,223.15 $82,566.12 2024-10-01
62 APR_DRG Pancreas Transplant 5 5 — — $80,064.77 $257,010.92 $82,541.00 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 2 2 — — $82,329.25 $82,329.25 $82,329.25 2024-10-01
B0105 OTHER Stroke; M > 34.25 & M < 38.85 1 1 — — $82,028.78 $82,028.78 $82,028.78 2024-10-01
3013 APR_DRG Hip Joint Replacement 1 1 — — $81,637.79 $81,637.79 $81,637.79 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 2 2 — — $81,529.15 $81,529.15 $81,529.15 2024-10-01
C0106 OTHER Stroke; M > 30.05 & M < 34.25 1 1 — — $80,914.86 $80,914.86 $80,914.86 2024-10-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 5 5 — — $78,280.94 $231,507.91 $80,702.00 2024-10-01
B1903 OTHER Guillian Barre; M < 18.05 1 1 — — $80,619.53 $80,619.53 $80,619.53 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 2 2 — — $80,306.38 $80,306.38 $80,306.38 2024-10-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 5 5 — — $77,660.14 $256,506.29 $80,062.00 2024-10-01
B0604 OTHER Neurological; M < 25.85 1 1 — — $79,945.40 $79,945.40 $79,945.40 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 5 5 — — $77,515.61 $221,830.57 $79,913.00 2024-10-01
84 APR_DRG Autologous Bone Marrow Transplant 5 5 — — $77,368.17 $316,873.83 $79,761.00 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 5 5 — — $77,055.83 $260,999.95 $79,439.00 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 2 2 — — $79,030.21 $79,030.21 $79,030.21 2024-10-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 5 5 — — $76,595.08 $224,250.76 $78,964.00 2024-10-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 5 5 — — $76,454.43 $246,338.04 $78,819.00 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 32 22 — — $8,580.00 $102,105.46 $78,542.66 2024-10-01
3023 APR_DRG Knee Joint Replacement 1 1 — — $78,452.06 $78,452.06 $78,452.06 2024-10-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 5 5 — — $75,957.79 $238,397.74 $78,307.00 2024-10-01
5244 OTHER Level 4 Blood Product Exc 29 21 — — $78,201.30 $140,762.34 $78,201.30 2024-10-01
05244 OTHER Level 4 Blood Product Exc 2 2 — — $78,201.30 $78,201.30 $78,201.30 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 39 27 — — $8,580.00 $199,464.00 $78,187.71 2024-10-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 2 2 — — $78,096.16 $78,096.16 $78,096.16 2024-10-01
B0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 1 1 — — $77,801.02 $77,801.02 $77,801.02 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 6 4 — — $34,080.00 $93,184.06 $77,057.77 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 35 24 — — $9,391.00 $132,164.50 $76,975.16 2024-10-01
A0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 1 1 — — $76,741.67 $76,741.67 $76,741.67 2024-10-01
834 OTHER Acute Leukemia With Mcc 2 2 — — $76,682.42 $76,682.42 $76,682.42 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 5 5 — — $74,283.57 $317,326.98 $76,581.00 2024-10-01
A5104 OTHER Expired, Not Orthopedic, Length Of Stay Is 16 Days 1 1 — — $76,510.54 $76,510.54 $76,510.54 2024-10-01
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 5 5 — — $74,066.29 $236,022.17 $76,357.00 2024-10-01
12 APR_DRG Liver Transplant And/or Intestinal Transplant 5 5 — — $73,355.28 $246,846.11 $75,624.00 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 36 25 — — $8,580.00 $131,096.03 $75,557.58 2024-10-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 5 5 — — $73,109.87 $259,561.57 $75,371.00 2024-10-01
C0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 1 1 — — $75,329.21 $75,329.21 $75,329.21 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $73,401.84 $75,672.00 $75,293.64 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 46 28 — — $7,700.00 $193,010.00 $75,261.88 2024-10-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 2 2 — — $74,931.09 $74,931.09 $74,931.09 2024-10-01
B0704 OTHER Fracture Of Lower Extremity; M < 28.15 1 1 — — $74,709.65 $74,709.65 $74,709.65 2024-10-01
B2102 OTHER Burns; M=12-45 1 1 — — $74,398.27 $74,398.27 $74,398.27 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 32 22 — — $8,580.00 $96,452.23 $74,194.02 2024-10-01
72 APR_DRG Allogeneic Bone Marrow Transplant 5 5 — — $71,968.18 $193,636.16 $74,194.00 2024-10-01
D0106 OTHER Stroke; M > 30.05 & M < 34.25 1 1 — — $73,942.43 $73,942.43 $73,942.43 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 34 24 — — $8,580.00 $116,358.00 $73,910.72 2024-10-01
1834 APR_DRG Percutaneous Structural Cardiac Procedures 4 4 — — $72,021.53 $74,249.00 $73,877.76 2024-10-01
B1004 OTHER Amputation, Lower Extremity; M=39-45 1 1 — — $73,868.60 $73,868.60 $73,868.60 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 10 7 — — $44,575.00 $204,642.70 $73,651.46 2024-10-01
B1504 OTHER Pulmonary; M < 29.15 1 1 — — $73,011.49 $73,011.49 $73,011.49 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 48 29 — — $7,700.00 $247,840.00 $72,902.96 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 8 5 — — $30,332.00 $129,091.45 $72,244.88 2024-10-01
B1704 OTHER Major Multiple Trauma,no Brain Or Spinal Cord Inju 1 1 — — $71,724.22 $71,724.22 $71,724.22 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 35 24 — — $9,391.00 $127,785.55 $71,587.03 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 5 5 — — $69,396.71 $261,082.34 $71,543.00 2024-10-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 5 5 — — $69,281.28 $225,187.94 $71,424.00 2024-10-01
B2005 OTHER Miscellaneous; M=12-32 And A Tm81 1 1 — — $71,303.69 $71,303.69 $71,303.69 2024-10-01
D0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 1 1 — — $71,165.66 $71,165.66 $71,165.66 2024-10-01
C0105 OTHER Stroke; M > 34.25 & M < 38.85 1 1 — — $71,139.98 $71,139.98 $71,139.98 2024-10-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 5 5 — — $68,911.71 $289,623.47 $71,043.00 2024-10-01
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 5 5 — — $68,817.62 $247,082.98 $70,946.00 2024-10-01
1794 APR_DRG Defibrillator Implants 4 4 — — $69,014.53 $71,149.00 $70,793.26 2024-10-01
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 5 5 — — $68,361.72 $228,359.94 $70,476.00 2024-10-01
A0106 OTHER Stroke; M > 30.05 & M < 34.25 1 1 — — $70,465.85 $70,465.85 $70,465.85 2024-10-01
B1204 OTHER Osteoarthritis; M=39-47 1 1 — — $70,099.89 $70,099.89 $70,099.89 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 36 25 — — $8,580.00 $141,052.79 $70,001.90 2024-10-01
C0205 OTHER Traumatic Brain Injury; M > 28.75 & M < 40.65 1 1 — — $69,759.61 $69,759.61 $69,759.61 2024-10-01
B0504 OTHER Nontraumatic Spinal Cord Injury; M > 29.25 & M < 3 1 1 — — $69,682.57 $69,682.57 $69,682.57 2024-10-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 5 5 — — $67,446.04 $206,416.84 $69,532.00 2024-10-01
B0304 OTHER Nontraumatic Brain Injury; M < 26.15 1 1 — — $69,406.50 $69,406.50 $69,406.50 2024-10-01
232 OTHER Coronary Bypass With Ptca Without Mcc 2 2 — — $69,207.33 $69,207.33 $69,207.33 2024-10-01
219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 2 2 — — $69,200.99 $69,200.99 $69,200.99 2024-10-01
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 5 5 — — $67,117.21 $214,195.80 $69,193.00 2024-10-01
C0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 1 1 — — $69,188.21 $69,188.21 $69,188.21 2024-10-01
969 OTHER HIV With Extensive O.r. Procedures With Mcc 2 2 — — $69,045.31 $69,045.31 $69,045.31 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 48 29 — — $7,700.00 $200,094.00 $68,977.81 2024-10-01
466 OTHER Revision Of Hip Or Knee Replacement With Mcc 2 2 — — $68,933.09 $68,933.09 $68,933.09 2024-10-01
B1404 OTHER Cardiac; M < 31.15 1 1 — — $68,883.25 $68,883.25 $68,883.25 2024-10-01
B1304 OTHER Rheumatoid, Other Arthritis; M=12-35 1 1 — — $68,748.42 $68,748.42 $68,748.42 2024-10-01
B0904 OTHER Other Orthopedic; M < 24.15 1 1 — — $68,748.42 $68,748.42 $68,748.42 2024-10-01
914 APR_DRG Other Major Head And Neck Procedures 5 5 — — $66,671.01 $168,727.04 $68,733.00 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 39 27 — — $8,580.00 $198,127.00 $68,569.99 2024-10-01
61 APR_DRG Pancreas Transplant 5 5 — — $66,509.99 $193,059.43 $68,567.00 2024-10-01
461 OTHER Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 2 2 — — $68,501.36 $68,501.36 $68,501.36 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 32 22 — — $8,580.00 $136,868.00 $68,481.80 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 36 25 — — $8,580.00 $114,251.67 $68,170.95 2024-10-01
233 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 2 2 — — $68,161.05 $68,161.05 $68,161.05 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 8 5 — — $30,332.00 $118,541.10 $67,949.76 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 41 27 — — $23,276.00 $124,852.62 $67,938.36 2024-10-01
870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 2 2 — — $67,922.10 $67,922.10 $67,922.10 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 46 28 — — $7,700.00 $267,642.00 $67,652.18 2024-10-01
B2004 OTHER Miscellaneous; M < 27.85 1 1 — — $67,647.34 $67,647.34 $67,647.34 2024-10-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 5 5 — — $65,607.89 $248,329.12 $67,637.00 2024-10-01
01594 OTHER New Technology - Level 43 2 2 — — $67,588.95 $67,588.95 $67,588.95 2024-10-01
1594 OTHER New Technology - Level 43 29 21 — — $67,588.95 $121,660.11 $67,588.95 2024-10-01
01580 OTHER New Technology - Level 43 2 2 — — $67,588.95 $67,588.95 $67,588.95 2024-10-01
1580 OTHER New Technology - Level 43 29 21 — — $67,588.95 $121,660.11 $67,588.95 2024-10-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 5 5 — — $65,555.51 $789,151.62 $67,583.00 2024-10-01
11 APR_DRG Liver Transplant And/or Intestinal Transplant 5 5 — — $65,381.88 $242,609.91 $67,404.00 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 42 27 — — $7,700.00 $114,387.91 $67,303.43 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 48 29 — — $7,700.00 $247,840.00 $67,187.82 2024-10-01
D0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 1 1 — — $67,162.61 $67,162.61 $67,162.61 2024-10-01
B1203 OTHER Osteoarthritis; M < 30.75 1 1 — — $66,848.01 $66,848.01 $66,848.01 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 33 23 — — $60,140.54 $103,869.00 $66,822.82 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 33 23 — — $60,140.54 $118,414.59 $66,822.82 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 47 28 — — $7,700.00 $175,053.00 $66,453.61 2024-10-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 5 5 — — $64,366.29 $145,015.99 $66,357.00 2024-10-01
B0805 OTHER Replacement Of Lower Extremity Joint; M > 22.05 & 1 1 — — $66,170.67 $66,170.67 $66,170.67 2024-10-01
B0204 OTHER Traumatic Brain Injury; M > 40.65 & M < 44.25 1 1 — — $66,122.52 $66,122.52 $66,122.52 2024-10-01
006 OTHER Liver Transplant Without Mcc 2 2 — — $65,973.45 $65,973.45 $65,973.45 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 31 22 — — $65,871.70 $118,569.06 $65,871.70 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 31 22 — — $59,242.70 $100,894.00 $65,825.22 2024-10-01
B0104 OTHER Stroke; M > 38.85 & M < 44.45 1 1 — — $65,599.27 $65,599.27 $65,599.27 2024-10-01
A0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 1 1 — — $65,580.01 $65,580.01 $65,580.01 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 2 2 — — $65,476.58 $65,476.58 $65,476.58 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 29 21 — — $65,476.58 $117,857.84 $65,476.58 2024-10-01
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