Price Transparencybeta 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

HCA FLORIDA LAKE CITY HOSPITAL

Lake City, FL · CCN 100156 · Rates published

21,857 distinct procedures filed
39 distinct payers
453,783 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

364,889 of 453,783 rate rows are consumer-grade (80.4%)

88,894 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 52,956
template filing: same amount across many unrelated codes — excluded 25,758
per-diem day rate — not a per-procedure price 8,504
exceeds 10× this hospital's gross charge — excluded from medians 1,598
placeholder amount (≤ $0.02) — excluded from medians 78

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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://www.hcadam.com/api/public/content/9815d6b65ad24608b00ecabfe373a9a4?download=true
Found on page https://www.hcafloridahealthcare.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 8d3a1a907c7a29d8… · 226,998,585 bytes · first seen 2026-05-08

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,897,200.00 $4,897,200.00 $4,897,200.00 nat. median
$3,004,655
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
$2,468,984
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 15 $3,672,900.00 $4,407,480.00 $3,810,633.75 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 15 $3,605,000.00 $4,326,000.00 $3,740,187.50 nat. median
$3,605,000
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,562,713.00 $3,562,713.00 $3,562,713.00 nat. median
$3,574,709
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 1 $3,496,850.00 $3,496,850.00 $3,496,850.00 nat. median
$3,496,850
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 15 $4,653.25 $3,990,546.00 $3,408,591.37 nat. median
$13,041
outlier · 261.4×
748
OTHER 		Inj, Lovotibeglogene Auto 15 $7,675.52 $3,943,200.00 $3,368,150.00 nat. median
$17,963
outlier · 187.5×
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,225,691.35 $3,225,691.35 $3,225,691.35 nat. median
$3,228,024
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $3,187,420.00 $3,187,420.00 $3,187,420.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 15 $6,817.39 $3,561,600.00 $3,042,200.00 nat. median
$21,896
outlier · 138.9×
00746
OTHER 		Inj, Betibeglogene Autote 1 $2,878,960.00 $2,878,960.00 $2,878,960.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 15 $2,388,614.00 $2,866,336.80 $2,478,187.03 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,316,955.58 $2,316,955.58 $2,316,955.58 nat. median
$2,457,321
0.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 15 $529,192.90 $635,031.48 $549,037.64 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 15 $527,123.40 $632,548.08 $546,890.52 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 15 $526,587.60 $631,905.12 $546,334.64 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 15 $516,726.10 $620,071.32 $536,103.33 nat. median
$562,201
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $513,317.11 $513,317.11 $513,317.11 nat. median
$538,205
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $511,309.70 $511,309.70 $511,309.70 nat. median
$554,552
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $510,789.97 $510,789.97 $510,789.97 nat. median
$530,178
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 15 $489,456.00 $587,347.20 $507,810.60 nat. median
$532,192
1.0× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 $502,693.77 $863,696.72 $502,693.77 nat. median
$753,246
0.7× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $501,224.32 $501,224.32 $501,224.32 nat. median
$534,091
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $492,271.12 $837,683.55 $492,271.12 nat. median
$674,867
0.7× median
9391
OTHER 		Brexucabtagene Car Pos T 15 $460,530.40 $552,636.48 $477,800.29 nat. median
$489,450
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $474,772.32 $474,772.32 $474,772.32 nat. median
$505,583
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $470,149.30 $830,699.97 $470,149.30 nat. median
$625,184
0.8× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $459,839.17 $819,043.85 $459,839.17 nat. median
$673,137
0.7× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $446,714.49 $446,714.49 $446,714.49 nat. median
$464,978
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 3 $445,599.57 $807,075.90 $445,599.57 nat. median
$634,303
0.7× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $435,956.80 $741,576.00 $435,956.80 nat. median
$619,808
0.7× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 22 $1,579.00 $1,652,159.28 $276,027.86 nat. median
$370,174
0.7× median
5834
APR_DRG 		Neonate With Ecmo 10 $192,207.00 $288,310.50 $230,648.40 nat. median
$309,665
0.7× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 23 $2,837.00 $1,234,026.32 $215,773.21 nat. median
$265,286
0.8× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 22 $2,837.00 $1,039,343.31 $179,568.84 nat. median
$206,474
0.9× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 22 $2,837.00 $938,899.92 $162,215.10 nat. median
$202,976
0.8× median
455
MS_DRG 		Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 1 $137,848.00 $184,270.00 $161,059.00 nat. median
$48,483
outlier · 3.3×
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $157,725.78 $157,725.78 $157,725.78 nat. median
$263,894
0.6× median
1908
OTHER 		New Technology - Level 52 16 $132,605.91 $176,807.88 $151,023.40 nat. median
$152,962
1.0× median
1907
OTHER 		New Technology - Level 52 16 $132,605.91 $176,807.88 $151,023.40 nat. median
$153,199
1.0× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 10 $125,393.00 $188,089.50 $150,471.60 nat. median
$246,434
0.6× median
5833
APR_DRG 		Neonate With Ecmo 10 $124,517.00 $186,775.50 $149,420.40 nat. median
$244,017
0.6× median
01908
OTHER 		New Technology - Level 52 1 $142,919.70 $142,919.70 $142,919.70 nat. median
$82,736
1.7× median
01907
OTHER 		New Technology - Level 52 1 $142,919.70 $142,919.70 $142,919.70 nat. median
$84,819
1.7× median
1905
OTHER 		New Technology - Level 51 16 $119,562.75 $159,417.00 $136,168.69 nat. median
$137,903
1.0× median
1906
OTHER 		New Technology - Level 51 16 $119,562.75 $159,417.00 $136,168.69 nat. median
$138,020
1.0× median
24
APR_DRG 		Heart And/or Lung Transplant 10 $111,047.00 $166,570.50 $133,256.40 nat. median
$234,729
0.6× median
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $130,147.03 $130,147.03 $130,147.03 nat. median
$424,868
outlier · 0.3×
01906
OTHER 		New Technology - Level 51 1 $128,862.07 $128,862.07 $128,862.07 nat. median
$82,736
1.6× median

Other procedures at this hospital

Browse this hospital's 21,857 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
             
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $157,725.78 $157,725.78 $157,725.78 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $59,443.83 $59,443.83 $59,443.83 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $105,644.74 $105,644.74 $105,644.74 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $74,281.40 $74,281.40 $74,281.40 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $48,862.83 $48,862.83 $48,862.83 2024-10-01
007 OTHER Lung Transplant 1 1 — — $59,551.87 $59,551.87 $59,551.87 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,225,691.35 $3,225,691.35 $3,225,691.35 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $61,454.13 $61,454.13 $61,454.13 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,878,960.00 $2,878,960.00 $2,878,960.00 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,187,420.00 $3,187,420.00 $3,187,420.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 1 1 — — $3,496,850.00 $3,496,850.00 $3,496,850.00 2024-10-01
0100T CPT Placement Of A Subconjunctival Retinal Prosthesis Receiver And Pulse Generator, … 2 2 — — $8,840.00 $60,908.00 $34,874.00 2024-10-01
01142 OTHER Supprelin La Implant 1 1 — — $43,989.70 $43,989.70 $43,989.70 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $69,020.19 $69,020.19 $69,020.19 2024-10-01
01580 OTHER New Technology - Level 43 1 1 — — $42,173.35 $42,173.35 $42,173.35 2024-10-01
01581 OTHER New Technology - Level 44 1 1 — — $51,545.10 $51,545.10 $51,545.10 2024-10-01
01582 OTHER New Technology - Level 45 1 1 — — $60,916.85 $60,916.85 $60,916.85 2024-10-01
01583 OTHER New Technology - Level 46 1 1 — — $70,288.61 $70,288.61 $70,288.61 2024-10-01
01584 OTHER New Technology - Level 47 1 1 — — $79,660.37 $79,660.37 $79,660.37 2024-10-01
01585 OTHER New Technology - Level 48 1 1 — — $89,032.11 $89,032.11 $89,032.11 2024-10-01
01594 OTHER New Technology - Level 43 1 1 — — $42,173.35 $42,173.35 $42,173.35 2024-10-01
01595 OTHER New Technology - Level 44 1 1 — — $51,545.10 $51,545.10 $51,545.10 2024-10-01
01596 OTHER New Technology - Level 45 1 1 — — $60,916.85 $60,916.85 $60,916.85 2024-10-01
01597 OTHER New Technology - Level 46 1 1 — — $70,288.61 $70,288.61 $70,288.61 2024-10-01
01598 OTHER New Technology - Level 47 1 1 — — $79,660.37 $79,660.37 $79,660.37 2024-10-01
01599 OTHER New Technology - Level 48 1 1 — — $89,032.11 $89,032.11 $89,032.11 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $63,512.28 $63,512.28 $63,512.28 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $130,147.03 $130,147.03 $130,147.03 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $38,807.54 $38,807.54 $38,807.54 2024-10-01
01901 OTHER New Technology - Level 49 1 1 — — $100,746.82 $100,746.82 $100,746.82 2024-10-01
01902 OTHER New Technology - Level 49 1 1 — — $100,746.82 $100,746.82 $100,746.82 2024-10-01
01903 OTHER New Technology - Level 50 1 1 — — $114,804.45 $114,804.45 $114,804.45 2024-10-01
01904 OTHER New Technology - Level 50 1 1 — — $114,804.45 $114,804.45 $114,804.45 2024-10-01
01905 OTHER New Technology - Level 51 1 1 — — $128,862.07 $128,862.07 $128,862.07 2024-10-01
01906 OTHER New Technology - Level 51 1 1 — — $128,862.07 $128,862.07 $128,862.07 2024-10-01
01907 OTHER New Technology - Level 52 1 1 — — $142,919.70 $142,919.70 $142,919.70 2024-10-01
01908 OTHER New Technology - Level 52 1 1 — — $142,919.70 $142,919.70 $142,919.70 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $50,703.31 $50,703.31 $50,703.31 2024-10-01
0207 RC — 10 8 — — $11,700.00 $55,381.00 $55,381.00 2024-10-01
0208 RC — 23 17 — — $6,000.00 $52,531.00 $52,531.00 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $39,785.07 $39,785.07 $39,785.07 2024-10-01
0266T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Total… 1 1 — — $45,677.00 $45,677.00 $45,677.00 2024-10-01
0409T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 2 2 — — $11,354.00 $60,908.00 $36,131.00 2024-10-01
0414T CPT Removal And Replacement Of Permanent Cardiac Contractility Modulation System Pul… 2 2 — — $11,354.00 $60,908.00 $36,131.00 2024-10-01
0515T CPT Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including … 1 1 — — $60,908.00 $60,908.00 $60,908.00 2024-10-01
0520T CPT Removal And Replacement Of Pulse Generator For Wireless Cardiac Stimulator For L… 1 1 — — $60,908.00 $60,908.00 $60,908.00 2024-10-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $48,795.12 $48,795.12 $48,795.12 2024-10-01
0571T CPT Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S… 1 1 — — $60,908.00 $60,908.00 $60,908.00 2024-10-01
0614T CPT Removal And Replacement Of Substernal Implantable Defibrillator Pulse Generator 1 1 — — $60,908.00 $60,908.00 $60,908.00 2024-10-01
0888T CPT Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 1 1 — — $39,376.13 $39,376.13 $39,376.13 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $474,772.32 $474,772.32 $474,772.32 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,562,713.00 $3,562,713.00 $3,562,713.00 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,316,955.58 $2,316,955.58 $2,316,955.58 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $513,317.11 $513,317.11 $513,317.11 2024-10-01
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $53,364.77 $53,364.77 $53,364.77 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $446,714.49 $446,714.49 $446,714.49 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $501,224.32 $501,224.32 $501,224.32 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $510,789.97 $510,789.97 $510,789.97 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $511,309.70 $511,309.70 $511,309.70 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 44 23 — — $2,837.00 $1,234,026.32 $215,773.21 2024-10-01
10 MS_DRG Pancreas Transplant 43 23 — — $2,837.00 $349,295.55 $61,075.39 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 45 23 — — $2,837.00 $236,392.03 $40,349.73 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 10 — — $48,895.00 $73,342.50 $58,674.00 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 10 — — $56,946.00 $85,419.00 $68,335.20 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 10 — — $97,644.00 $146,466.00 $117,172.80 2024-10-01
1142 OTHER Supprelin La Implant 19 16 — — $40,815.19 $54,420.25 $46,483.97 2024-10-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 12 10 — — $31,456.00 $47,184.00 $37,747.20 2024-10-01
133 MS_DRG Other Ear, Nose, Mouth & Throat O.r. Procedures W Cc/mcc 3 1 — — $20,167.00 $48,710.00 $48,710.00 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 44 23 — — $1,579.00 $573,976.63 $99,166.79 2024-10-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 12 10 — — $67,242.00 $100,863.00 $80,690.40 2024-10-01
1579 OTHER New Technology - Level 42 19 16 — — $30,434.47 $40,579.30 $34,661.48 2024-10-01
1580 OTHER New Technology - Level 43 19 16 — — $39,129.91 $52,173.22 $44,564.62 2024-10-01
1581 OTHER New Technology - Level 44 19 16 — — $47,825.35 $63,767.14 $54,467.76 2024-10-01
1582 OTHER New Technology - Level 45 19 16 — — $56,520.79 $75,361.06 $64,370.90 2024-10-01
1583 OTHER New Technology - Level 46 19 16 — — $65,216.23 $86,954.98 $74,274.04 2024-10-01
1584 OTHER New Technology - Level 47 19 16 — — $73,911.68 $98,548.91 $84,177.19 2024-10-01
1585 OTHER New Technology - Level 48 19 16 — — $82,607.11 $110,142.82 $94,080.32 2024-10-01
1593 OTHER New Technology - Level 42 19 16 — — $30,434.47 $40,579.30 $34,661.48 2024-10-01
1594 OTHER New Technology - Level 43 19 16 — — $39,129.91 $52,173.22 $44,564.62 2024-10-01
1595 OTHER New Technology - Level 44 19 16 — — $47,825.35 $63,767.14 $54,467.76 2024-10-01
1596 OTHER New Technology - Level 45 19 16 — — $56,520.79 $75,361.06 $64,370.90 2024-10-01
1597 OTHER New Technology - Level 46 19 16 — — $65,216.23 $86,954.98 $74,274.04 2024-10-01
1598 OTHER New Technology - Level 47 19 16 — — $73,911.68 $98,548.91 $84,177.19 2024-10-01
1599 OTHER New Technology - Level 48 19 16 — — $82,607.11 $110,142.82 $94,080.32 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 44 23 — — $1,579.00 $286,226.88 $45,685.49 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 12 10 — — $55,523.00 $83,284.50 $66,627.60 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 12 10 — — $49,247.00 $73,870.50 $59,096.40 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 12 10 — — $51,688.00 $77,532.00 $62,025.60 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 12 10 — — $64,392.00 $96,588.00 $77,270.40 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 12 10 — — $95,167.00 $142,750.50 $114,200.40 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 10 — — $37,904.00 $56,856.00 $45,484.80 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 45 23 — — $2,837.00 $201,925.13 $34,466.58 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 12 10 — — $31,574.00 $47,361.00 $37,888.80 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 19 16 — — $58,928.92 $78,571.90 $67,113.49 2024-10-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 12 10 — — $29,487.00 $44,230.50 $35,384.40 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 12 10 — — $31,789.00 $47,683.50 $38,146.80 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 44 23 — — $1,579.00 $286,226.88 $45,685.49 2024-10-01
1784 APR_DRG External Heart Assist Devices 12 10 — — $30,258.00 $45,387.00 $36,309.60 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 43 22 — — $1,579.00 $1,652,159.28 $276,027.86 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 43 23 — — $2,837.00 $347,284.58 $60,723.77 2024-10-01
1901 OTHER New Technology - Level 49 19 16 — — $93,476.43 $124,635.24 $106,459.27 2024-10-01
1902 OTHER New Technology - Level 49 19 16 — — $93,476.43 $124,635.24 $106,459.27 2024-10-01
1903 OTHER New Technology - Level 50 19 16 — — $106,519.59 $142,026.12 $121,313.98 2024-10-01
1904 OTHER New Technology - Level 50 19 16 — — $106,519.59 $142,026.12 $121,313.98 2024-10-01
1905 OTHER New Technology - Level 51 19 16 — — $119,562.75 $159,417.00 $136,168.69 2024-10-01
1906 OTHER New Technology - Level 51 19 16 — — $119,562.75 $159,417.00 $136,168.69 2024-10-01
1907 OTHER New Technology - Level 52 19 16 — — $132,605.91 $176,807.88 $151,023.40 2024-10-01
1908 OTHER New Technology - Level 52 19 16 — — $132,605.91 $176,807.88 $151,023.40 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 44 23 — — $2,837.00 $482,795.10 $84,418.19 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 43 23 — — $10,799.00 $353,146.63 $63,218.98 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 46 23 — — $1,579.00 $283,362.87 $48,249.21 2024-10-01
21 APR_DRG Heart And/or Lung Transplant 12 10 — — $41,730.00 $62,595.00 $50,076.00 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 43 23 — — $10,799.00 $242,162.07 $46,375.42 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 45 23 — — $2,837.00 $477,248.50 $83,448.35 2024-10-01
215 MS_DRG Other Heart Assist System Implant 43 23 — — $10,799.00 $464,153.09 $86,569.16 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $45,340.63 $45,340.63 $45,340.63 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 43 23 — — $10,799.00 $185,584.09 $78,857.02 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $43,889.42 $43,889.42 $43,889.42 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 43 23 — — $10,799.00 $185,584.09 $54,179.19 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $43,645.35 $43,645.35 $43,645.35 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 43 23 — — $10,799.00 $185,584.09 $49,914.43 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 41 23 — — $10,799.00 $173,955.00 $64,915.36 2024-10-01
22 APR_DRG Heart And/or Lung Transplant 12 10 — — $45,376.00 $68,064.00 $54,451.20 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 41 23 — — $10,799.00 $173,955.00 $44,437.28 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 41 23 — — $10,799.00 $173,955.00 $38,530.54 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 3 1 — — $71,038.00 $87,168.00 $87,168.00 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 3 1 — — $71,038.00 $87,168.00 $87,168.00 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 3 1 — — $69,717.00 $85,547.00 $85,547.00 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 3 1 — — $69,717.00 $85,547.00 $85,547.00 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 3 1 — — $65,187.00 $79,989.00 $79,989.00 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 3 1 — — $65,187.00 $79,989.00 $79,989.00 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 41 23 — — $10,799.00 $173,955.00 $41,807.77 2024-10-01
23 APR_DRG Heart And/or Lung Transplant 12 10 — — $62,352.00 $93,528.00 $74,822.40 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 43 23 — — $10,799.00 $249,934.32 $47,471.00 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 43 23 — — $10,799.00 $371,236.60 $71,093.93 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $39,398.43 $39,398.43 $39,398.43 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 43 23 — — $10,799.00 $267,616.84 $51,250.16 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 41 23 — — $10,799.00 $173,955.00 $63,865.82 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 41 23 — — $10,799.00 $173,955.00 $44,635.28 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 41 23 — — $10,799.00 $173,955.00 $49,366.54 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 41 23 — — $10,799.00 $173,955.00 $34,499.02 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 45 23 — — $2,837.00 $220,659.14 $37,664.28 2024-10-01
24 APR_DRG Heart And/or Lung Transplant 12 10 — — $111,047.00 $166,570.50 $133,256.40 2024-10-01
245 MS_DRG Aicd Generator Procedures 43 23 — — $10,799.00 $214,087.34 $38,325.10 2024-10-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 3 1 — — $31,488.00 $38,638.00 $38,638.00 2024-10-01
247 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 3 1 — — $31,488.00 $38,638.00 $38,638.00 2024-10-01
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 3 1 — — $30,898.00 $37,916.00 $37,916.00 2024-10-01
249 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc 3 1 — — $30,898.00 $37,916.00 $37,916.00 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 43 23 — — $10,799.00 $96,687.61 $36,418.00 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 43 23 — — $10,799.00 $228,127.04 $50,260.95 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 43 23 — — $10,799.00 $173,955.00 $39,471.08 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 41 23 — — $10,799.00 $173,955.00 $53,507.32 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 43 23 — — $10,799.00 $173,955.00 $34,906.79 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 41 23 — — $10,799.00 $173,955.00 $43,065.46 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 43 23 — — $10,799.00 $309,597.50 $56,711.88 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 43 23 — — $9,905.00 $271,371.53 $48,579.91 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 43 23 — — $9,905.00 $203,822.19 $36,487.48 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 41 23 — — $10,799.00 $219,187.05 $39,238.04 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 43 23 — — $10,799.00 $266,337.53 $47,678.73 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 44 22 — — $2,837.00 $938,899.92 $162,215.10 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 10 — — $39,878.00 $59,817.00 $47,853.60 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 45 23 — — $2,837.00 $271,021.03 $47,388.85 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 45 23 — — $2,837.00 $222,508.00 $37,979.87 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 45 23 — — $2,837.00 $201,171.56 $35,175.46 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 44 22 — — $2,837.00 $619,024.13 $106,949.76 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 45 23 — — $2,837.00 $237,829.06 $40,595.01 2024-10-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $36,209.96 $36,209.96 $36,209.96 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 43 23 — — $9,905.00 $459,219.86 $80,296.00 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 43 23 — — $9,905.00 $311,008.24 $54,898.65 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 43 23 — — $9,905.00 $241,193.82 $43,177.60 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 43 23 — — $9,905.00 $365,392.08 $63,889.92 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 10 — — $41,876.00 $62,814.00 $50,251.20 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 43 23 — — $9,905.00 $239,656.02 $42,902.31 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 12 10 — — $66,782.00 $100,173.00 $80,138.40 2024-10-01
4404 APR_DRG Kidney Transplant 12 10 — — $35,422.00 $53,133.00 $42,506.40 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 43 23 — — $9,905.00 $164,024.96 $51,847.74 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 45 23 — — $2,837.00 $127,286.00 $39,450.12 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $48,751.30 $48,751.30 $48,751.30 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 2 1 — — $105,575.00 $110,589.00 $108,082.00 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 2 1 — — $137,848.00 $184,270.00 $161,059.00 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 41 23 — — $10,799.00 $371,026.30 $65,492.94 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 41 23 — — $10,799.00 $251,437.07 $46,058.09 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 41 23 — — $10,799.00 $189,167.07 $35,281.53 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 4 2 — — $83,213.00 $122,984.00 $88,349.00 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 4 2 — — $74,602.00 $97,456.00 $83,213.00 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 43 23 — — $10,799.00 $268,861.10 $48,130.49 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 45 23 — — $2,837.00 $236,615.47 $41,372.94 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 43 23 — — $10,799.00 $94,182.00 $40,134.00 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 43 23 — — $10,799.00 $88,529.00 $38,093.74 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 43 23 — — $2,837.00 $466,536.46 $81,575.33 2024-10-01
5244 OTHER Level 4 Blood Product Exc 19 16 — — $45,273.83 $60,365.10 $51,561.86 2024-10-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 12 10 — — $30,089.00 $45,133.50 $36,106.80 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 12 10 — — $43,560.00 $65,340.00 $52,272.00 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 45 23 — — $2,837.00 $269,785.53 $46,044.73 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 45 23 — — $2,837.00 $236,361.36 $37,471.18 2024-10-01
5831 APR_DRG Neonate With Ecmo 12 10 — — $69,493.00 $104,239.50 $83,391.60 2024-10-01
5832 APR_DRG Neonate With Ecmo 12 10 — — $95,607.00 $143,410.50 $114,728.40 2024-10-01
5833 APR_DRG Neonate With Ecmo 12 10 — — $124,517.00 $186,775.50 $149,420.40 2024-10-01
5834 APR_DRG Neonate With Ecmo 12 10 — — $192,207.00 $288,310.50 $230,648.40 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 10 — — $61,338.00 $92,007.00 $73,605.60 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 10 — — $71,560.00 $107,340.00 $85,872.00 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 10 — — $81,552.00 $122,328.00 $97,862.40 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 12 10 — — $125,393.00 $188,089.50 $150,471.60 2024-10-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 10 — — $48,983.00 $73,474.50 $58,779.60 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 10 — — $47,538.00 $71,307.00 $57,045.60 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 12 10 — — $46,525.00 $69,787.50 $55,830.00 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 10 — — $44,835.00 $67,252.50 $53,802.00 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 10 — — $59,125.00 $88,687.50 $70,950.00 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 12 10 — — $79,657.00 $119,485.50 $95,588.40 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 10 — — $41,957.00 $62,935.50 $50,348.40 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 10 — — $51,226.00 $76,839.00 $61,471.20 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 12 10 — — $73,863.00 $110,794.50 $88,635.60 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 43 23 — — $2,837.00 $290,922.86 $37,145.79 2024-10-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 10 — — $31,113.00 $46,669.50 $37,335.60 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 10 — — $38,906.00 $58,359.00 $46,687.20 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 10 — — $54,849.00 $82,273.50 $65,818.80 2024-10-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 10 — — $30,178.00 $45,267.00 $36,213.60 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 10 — — $68,321.00 $102,481.50 $81,985.20 2024-10-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 10 — — $29,098.00 $43,647.00 $34,917.60 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 10 — — $42,035.00 $63,052.50 $50,442.00 2024-10-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 10 — — $30,783.00 $46,174.50 $36,939.60 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 10 — — $82,446.00 $123,669.00 $98,935.20 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 12 10 — — $34,068.00 $51,102.00 $40,881.60 2024-10-01
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 12 10 — — $30,025.00 $45,037.50 $36,030.00 2024-10-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 12 10 — — $34,228.00 $51,342.00 $41,073.60 2024-10-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 12 10 — — $28,840.00 $43,260.00 $34,608.00 2024-10-01
63 APR_DRG Pancreas Transplant 12 10 — — $34,364.00 $51,546.00 $41,236.80 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 10 — — $43,677.00 $65,515.50 $52,412.40 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 10 — — $91,470.00 $137,205.00 $109,764.00 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 12 10 — — $80,942.00 $121,413.00 $97,130.40 2024-10-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 12 10 — — $28,549.00 $42,823.50 $34,258.80 2024-10-01
64 APR_DRG Pancreas Transplant 12 10 — — $48,372.00 $72,558.00 $58,046.40 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 43 23 — — $2,837.00 $201,841.88 $35,292.67 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $67,215.58 $67,215.58 $67,215.58 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 45 23 — — $2,837.00 $244,216.85 $41,685.35 2024-10-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 10 — — $28,815.00 $43,222.50 $34,578.00 2024-10-01
7 MS_DRG Lung Transplant 43 23 — — $2,837.00 $572,530.83 $100,108.76 2024-10-01
714 OTHER Inj Delandistrogene Mox R 19 15 — — $4,653.25 $3,990,546.00 $3,408,591.37 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 19 15 — — $11,151.35 $76,025.72 $64,938.64 2024-10-01
72 APR_DRG Allogeneic Bone Marrow Transplant 12 10 — — $29,633.00 $44,449.50 $35,559.60 2024-10-01
73 APR_DRG Allogeneic Bone Marrow Transplant 12 10 — — $36,953.00 $55,429.50 $44,343.60 2024-10-01
74 APR_DRG Allogeneic Bone Marrow Transplant 12 10 — — $75,611.00 $113,416.50 $90,733.20 2024-10-01
746 OTHER Inj, Betibeglogene Autote 19 15 — — $6,817.39 $3,561,600.00 $3,042,200.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 19 15 — — $7,675.52 $3,943,200.00 $3,368,150.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 18 15 — — $3,605,000.00 $4,326,000.00 $3,740,187.50 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 27 17 — — $39,036.55 $140,902.44 $46,626.99 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 45 23 — — $2,837.00 $208,304.15 $35,555.42 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 43 23 — — $2,837.00 $238,372.33 $41,680.13 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 45 23 — — $2,837.00 $255,069.08 $43,537.72 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 45 23 — — $2,837.00 $205,005.11 $34,992.30 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 45 23 — — $2,837.00 $209,211.06 $35,710.21 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 46 23 — — $1,579.00 $242,144.54 $41,230.82 2024-10-01
834 OTHER Acute Leukemia With Mcc 1 1 — — $37,056.29 $37,056.29 $37,056.29 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 46 23 — — $1,579.00 $219,357.92 $37,350.85 2024-10-01
84 APR_DRG Autologous Bone Marrow Transplant 12 10 — — $37,476.00 $56,214.00 $44,971.20 2024-10-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 12 10 — — $28,871.00 $43,306.50 $34,645.20 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 12 10 — — $90,217.00 $135,325.50 $108,260.40 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 12 10 — — $46,203.00 $69,304.50 $55,443.60 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 45 23 — — $2,837.00 $403,565.48 $68,884.55 2024-10-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 12 10 — — $29,751.00 $44,626.50 $35,701.20 2024-10-01
8514 APR_DRG Gender Related Procedures 12 10 — — $46,902.00 $70,353.00 $56,282.40 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 45 23 — — $2,837.00 $219,125.72 $37,402.55 2024-10-01
8634 APR_DRG Neonatal Aftercare 12 10 — — $35,009.00 $52,513.50 $42,010.80 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 43 23 — — $10,311.00 $102,260.55 $48,317.53 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 18 15 — — $489,456.00 $587,347.20 $507,810.60 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 18 15 — — $3,672,900.00 $4,407,480.00 $3,810,633.75 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 18 15 — — $2,388,614.00 $2,866,336.80 $2,478,187.03 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 18 15 — — $529,192.90 $635,031.48 $549,037.64 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 44 22 — — $2,837.00 $1,039,343.31 $179,568.84 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 18 15 — — $55,015.23 $66,018.28 $57,078.30 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 44 22 — — $2,837.00 $292,598.44 $50,552.67 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 12 10 — — $32,422.00 $48,633.00 $38,906.40 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 18 15 — — $460,530.40 $552,636.48 $477,800.29 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 12 10 — — $75,232.00 $112,848.00 $90,278.40 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 18 15 — — $516,726.10 $620,071.32 $536,103.33 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 18 15 — — $526,587.60 $631,905.12 $546,334.64 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 18 15 — — $527,123.40 $632,548.08 $546,890.52 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $55,014.52 $55,014.52 $55,014.52 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 45 23 — — $2,837.00 $299,143.95 $51,060.85 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $38,190.84 $38,190.84 $38,190.84 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 45 23 — — $2,837.00 $326,999.62 $55,815.53 2024-10-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $37,739.46 $37,739.46 $37,739.46 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 45 23 — — $2,837.00 $277,062.71 $47,291.80 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 45 23 — — $2,837.00 $208,295.39 $35,553.92 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 1 — — $108,036.36 $108,036.36 $108,036.36 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 1 — — $76,785.37 $76,785.37 $76,785.37 2024-10-01
C9782 HCPCS Blinded Procedure For New York Heart Association (nyha) Class Ii Or Iii Heart Fa… 1 1 — — $45,677.00 $45,677.00 $45,677.00 2024-10-01
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
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 1 1 — — $120,116.70 $120,116.70 $120,116.70 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 5 3 — — $61,600.24 $104,773.89 $61,600.24 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 5 3 — — $43,241.44 $72,861.11 $43,241.44 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 1 1 — — $38,803.31 $38,803.31 $38,803.31 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 5 3 — — $445,599.57 $807,075.90 $445,599.57 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 5 3 — — $502,693.77 $863,696.72 $502,693.77 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 2 2 — — $53,789.99 $91,596.09 $72,693.04 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 5 3 — — $435,956.80 $741,576.00 $435,956.80 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 5 3 — — $459,839.17 $819,043.85 $459,839.17 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 5 3 — — $470,149.30 $830,699.97 $470,149.30 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 5 3 — — $492,271.12 $837,683.55 $492,271.12 2024-10-01
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