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

CENTRAL FLORIDA LAKE MONROE HOSPITAL

Sanford, FL · CCN 100161 · Rates published

31,635 distinct procedures filed
49 distinct payers
889,175 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

793,985 of 889,175 rate rows are consumer-grade (89.3%)

95,190 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 76,524
per-diem day rate — not a per-procedure price 9,830
exceeds 10× this hospital's gross charge — excluded from medians 6,431
template filing: same amount across many unrelated codes — excluded 2,317
placeholder amount (≤ $0.02) — excluded from medians 88

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/59-1978725_HCA-FLORIDA-LAKE-MONROE-HOSPITAL_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.hcafloridahealthcare.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaCMS hospital list
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-06-08

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
$3,006,423
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
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 19 $3,672,900.00 $4,407,480.00 $3,856,545.00 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 19 $3,605,000.00 $4,326,000.00 $3,785,250.00 nat. median
$3,605,000
1.1× 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 20 $5,280.60 $4,821,909.75 $3,491,727.75 nat. median
$13,041
outlier · 267.7×
748
OTHER 		Inj, Lovotibeglogene Auto 20 $8,710.34 $4,764,700.00 $3,450,300.00 nat. median
$17,963
outlier · 192.1×
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 20 $7,736.51 $4,303,600.00 $3,116,400.00 nat. median
$21,896
outlier · 142.3×
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 20 $2,388,614.00 $3,463,490.30 $2,519,987.77 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 20 $529,192.90 $2,116,771.60 $560,944.47 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 20 $527,123.40 $2,108,493.60 $558,750.80 nat. median
$587,650
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 20 $526,587.60 $2,106,350.40 $558,182.86 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 20 $516,726.10 $2,066,904.40 $547,729.67 nat. median
$562,201
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 20 $489,456.00 $1,957,824.00 $518,823.36 nat. median
$532,192
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
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
$754,974
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
$675,122
0.7× median
9391
OTHER 		Brexucabtagene Car Pos T 20 $460,530.40 $1,842,121.60 $488,162.22 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
$674,188
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
$634,511
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
$620,080
0.7× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 30 $2,701.00 $669,846.28 $288,073.34 nat. median
$370,174
0.8× median
5834
APR_DRG 		Neonate With Ecmo 11 $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 31 $2,837.00 $500,319.76 $216,698.93 nat. median
$265,286
0.8× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 30 $2,837.00 $432,111.68 $184,571.61 nat. median
$206,368
0.9× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $178,990.51 $178,990.51 $178,990.51 nat. median
$263,894
0.7× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 30 $2,837.00 $613,527.38 $167,717.33 nat. median
$202,986
0.8× median
1908
OTHER 		New Technology - Level 52 20 $147,339.90 $589,359.60 $156,180.29 nat. median
$152,962
1.0× median
1907
OTHER 		New Technology - Level 52 20 $147,339.90 $589,359.60 $156,180.29 nat. median
$153,199
1.0× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 11 $125,393.00 $188,089.50 $150,471.60 nat. median
$246,434
0.6× median
5833
APR_DRG 		Neonate With Ecmo 11 $124,517.00 $186,775.50 $149,420.40 nat. median
$244,017
0.6× median
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $147,693.56 $147,693.56 $147,693.56 nat. median
$424,868
outlier · 0.3×
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
1906
OTHER 		New Technology - Level 51 20 $132,847.50 $531,390.00 $140,818.35 nat. median
$138,020
1.0× median
1905
OTHER 		New Technology - Level 51 20 $132,847.50 $531,390.00 $140,818.35 nat. median
$137,903
1.0× median
24
APR_DRG 		Heart And/or Lung Transplant 11 $111,047.00 $166,570.50 $133,256.40 nat. median
$234,738
0.6× median
01906
OTHER 		New Technology - Level 51 1 $128,862.07 $128,862.07 $128,862.07 nat. median
$82,736
1.6× median
01905
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 31,635 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
             
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 54 31 — — $2,837.00 $500,319.76 $216,698.93 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 53 31 — — $2,701.00 $345,378.93 $103,305.54 2024-10-01
7 MS_DRG Lung Transplant 53 31 — — $2,837.00 $291,346.98 $103,050.35 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 54 31 — — $2,837.00 $455,262.00 $87,211.29 2024-10-01
215 MS_DRG Other Heart Assist System Implant 53 31 — — $10,799.00 $407,840.00 $87,087.66 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 53 31 — — $2,837.00 $329,723.44 $86,232.27 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 53 31 — — $2,837.00 $351,045.39 $84,341.52 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 53 31 — — $10,799.00 $320,873.22 $83,050.08 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 51 31 — — $10,799.00 $223,937.16 $78,790.84 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 55 31 — — $2,837.00 $281,985.53 $73,226.64 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 53 31 — — $10,799.00 $225,587.20 $70,068.28 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 51 31 — — $10,799.00 $155,327.30 $68,438.19 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 53 31 — — $10,799.00 $255,312.42 $67,116.00 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 53 31 — — $10,799.00 $221,041.17 $65,237.62 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 53 31 — — $10,799.00 $189,641.41 $64,791.06 2024-10-01
10 MS_DRG Pancreas Transplant 53 31 — — $2,837.00 $176,982.94 $63,647.58 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 51 31 — — $10,799.00 $194,049.68 $63,575.44 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 53 31 — — $2,837.00 $178,779.92 $63,292.63 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 55 31 — — $2,837.00 $151,849.66 $59,712.17 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 51 31 — — $9,599.00 $215,386.95 $57,442.09 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 53 31 — — $10,799.00 $217,312.50 $57,426.27 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 55 31 — — $2,837.00 $214,205.28 $54,795.44 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 53 31 — — $10,799.00 $205,235.67 $54,346.76 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 53 31 — — $10,799.00 $109,734.00 $54,310.54 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 51 31 — — $10,799.00 $223,937.16 $53,400.03 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 53 31 — — $8,879.00 $106,413.58 $53,158.32 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 55 31 — — $2,701.00 $114,885.76 $51,519.29 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 53 31 — — $10,799.00 $225,587.20 $51,088.41 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 55 31 — — $2,837.00 $137,997.28 $50,897.92 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 53 31 — — $10,799.00 $113,240.55 $50,849.81 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 53 31 — — $9,599.00 $152,774.18 $50,364.08 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 55 31 — — $2,837.00 $189,372.02 $49,831.52 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 51 31 — — $10,799.00 $275,272.10 $49,686.43 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 53 31 — — $10,799.00 $107,983.05 $49,467.16 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 51 31 — — $10,799.00 $223,937.16 $49,358.01 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 55 31 — — $2,837.00 $109,381.00 $48,677.35 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 53 31 — — $2,701.00 $345,378.93 $48,667.68 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 53 31 — — $2,701.00 $345,378.93 $48,667.68 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 53 31 — — $10,799.00 $156,065.07 $48,390.69 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 53 31 — — $10,799.00 $136,469.69 $47,849.54 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 51 31 — — $10,799.00 $155,327.30 $47,249.79 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 55 31 — — $2,837.00 $103,612.76 $47,015.88 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 53 31 — — $10,799.00 $221,041.17 $46,425.91 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 55 31 — — $2,837.00 $102,421.91 $45,100.37 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 53 31 — — $10,799.00 $168,530.69 $44,987.23 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 53 31 — — $10,799.00 $144,487.24 $44,761.52 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 53 31 — — $10,799.00 $167,456.17 $44,713.23 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 51 31 — — $10,799.00 $194,049.68 $44,166.93 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 53 31 — — $2,837.00 $178,779.92 $44,068.77 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 55 31 — — $2,837.00 $136,543.16 $43,972.88 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 55 31 — — $2,701.00 $98,174.32 $43,890.55 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 55 31 — — $2,837.00 $99,982.06 $43,719.23 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 53 31 — — $10,799.00 $109,734.00 $43,260.05 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 55 31 — — $2,837.00 $95,932.63 $42,933.04 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 55 31 — — $2,837.00 $157,647.77 $42,212.15 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 55 31 — — $2,837.00 $95,829.61 $42,064.24 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 53 31 — — $10,799.00 $146,339.32 $42,057.10 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 53 31 — — $10,799.00 $77,927.51 $41,779.70 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 53 31 — — $9,599.00 $136,546.23 $41,258.11 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 55 31 — — $2,837.00 $90,212.95 $40,879.27 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 55 31 — — $2,837.00 $101,901.49 $40,671.60 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 55 31 — — $2,837.00 $89,463.35 $40,556.01 2024-10-01
245 MS_DRG Aicd Generator Procedures 53 31 — — $9,599.00 $94,921.73 $40,345.23 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 55 31 — — $2,701.00 $88,935.79 $40,328.49 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 53 31 — — $10,799.00 $75,357.00 $40,113.88 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 53 31 — — $2,837.00 $351,045.39 $39,491.51 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 51 31 — — $10,799.00 $206,689.79 $39,460.13 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 55 31 — — $2,837.00 $99,455.51 $38,761.51 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 55 31 — — $2,837.00 $110,825.18 $38,759.96 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 51 31 — — $10,799.00 $194,049.68 $38,568.71 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 55 31 — — $2,837.00 $84,821.88 $38,554.39 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 53 31 — — $9,599.00 $152,774.18 $38,328.61 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 52 30 — — $2,701.00 $669,846.28 $288,073.34 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 54 30 — — $2,837.00 $432,111.68 $184,571.61 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 54 30 — — $2,837.00 $613,527.38 $167,717.33 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 54 30 — — $2,837.00 $368,231.53 $110,731.96 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 54 30 — — $2,837.00 $130,037.90 $53,387.08 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 38 26 — — $43,080.54 $170,021.54 $48,420.36 2024-10-01
714 OTHER Inj Delandistrogene Mox R 23 20 — — $5,280.60 $4,821,909.75 $3,491,727.75 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 23 20 — — $8,710.34 $4,764,700.00 $3,450,300.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 23 20 — — $7,736.51 $4,303,600.00 $3,116,400.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 22 20 — — $2,388,614.00 $3,463,490.30 $2,519,987.77 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 23 20 — — $529,192.90 $2,116,771.60 $560,944.47 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 23 20 — — $527,123.40 $2,108,493.60 $558,750.80 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 23 20 — — $526,587.60 $2,106,350.40 $558,182.86 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 23 20 — — $516,726.10 $2,066,904.40 $547,729.67 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 23 20 — — $489,456.00 $1,957,824.00 $518,823.36 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 23 20 — — $460,530.40 $1,842,121.60 $488,162.22 2024-10-01
1908 OTHER New Technology - Level 52 23 20 — — $147,339.90 $589,359.60 $156,180.29 2024-10-01
1907 OTHER New Technology - Level 52 23 20 — — $147,339.90 $589,359.60 $156,180.29 2024-10-01
1905 OTHER New Technology - Level 51 23 20 — — $132,847.50 $531,390.00 $140,818.35 2024-10-01
1906 OTHER New Technology - Level 51 23 20 — — $132,847.50 $531,390.00 $140,818.35 2024-10-01
1903 OTHER New Technology - Level 50 23 20 — — $118,355.10 $473,420.40 $125,456.41 2024-10-01
1904 OTHER New Technology - Level 50 23 20 — — $118,355.10 $473,420.40 $125,456.41 2024-10-01
1901 OTHER New Technology - Level 49 23 20 — — $103,862.70 $415,450.80 $110,094.46 2024-10-01
1902 OTHER New Technology - Level 49 23 20 — — $103,862.70 $415,450.80 $110,094.46 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 24 20 — — $96,999.90 $399,999.60 $105,499.89 2024-10-01
1585 OTHER New Technology - Level 48 23 20 — — $91,785.68 $367,142.72 $97,292.82 2024-10-01
1599 OTHER New Technology - Level 48 23 20 — — $91,785.68 $367,142.72 $97,292.82 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 24 20 — — $88,300.94 $364,127.60 $96,038.65 2024-10-01
1598 OTHER New Technology - Level 47 23 20 — — $82,124.09 $328,496.36 $87,051.54 2024-10-01
1584 OTHER New Technology - Level 47 23 20 — — $82,124.09 $328,496.36 $87,051.54 2024-10-01
1597 OTHER New Technology - Level 46 23 20 — — $72,462.48 $289,849.92 $76,810.23 2024-10-01
1583 OTHER New Technology - Level 46 23 20 — — $72,462.48 $289,849.92 $76,810.23 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 24 20 — — $63,895.55 $263,486.80 $69,494.64 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 23 20 — — $65,476.58 $261,906.32 $69,405.17 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 24 20 — — $12,654.78 $253,419.08 $66,839.29 2024-10-01
1582 OTHER New Technology - Level 45 23 20 — — $62,800.88 $251,203.52 $66,568.93 2024-10-01
1596 OTHER New Technology - Level 45 23 20 — — $62,800.88 $251,203.52 $66,568.93 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 23 20 — — $55,015.23 $220,060.92 $58,316.14 2024-10-01
1581 OTHER New Technology - Level 44 23 20 — — $53,139.28 $212,557.12 $56,327.64 2024-10-01
1595 OTHER New Technology - Level 44 23 20 — — $53,139.28 $212,557.12 $56,327.64 2024-10-01
5244 OTHER Level 4 Blood Product Exc 23 20 — — $50,304.25 $201,217.00 $53,322.51 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 24 20 — — $46,068.21 $189,972.00 $50,105.12 2024-10-01
1142 OTHER Supprelin La Implant 23 20 — — $45,350.21 $181,400.84 $48,071.22 2024-10-01
1580 OTHER New Technology - Level 43 23 20 — — $43,477.68 $173,910.72 $46,086.34 2024-10-01
1594 OTHER New Technology - Level 43 23 20 — — $43,477.68 $173,910.72 $46,086.34 2024-10-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 24 20 — — $37,140.82 $153,158.00 $40,395.42 2024-10-01
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 24 20 — — $36,570.46 $150,806.00 $39,775.08 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 21 19 — — $3,672,900.00 $4,407,480.00 $3,856,545.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 21 19 — — $3,605,000.00 $4,326,000.00 $3,785,250.00 2024-10-01
5834 APR_DRG Neonate With Ecmo 13 11 — — $192,207.00 $288,310.50 $230,648.40 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 13 11 — — $125,393.00 $188,089.50 $150,471.60 2024-10-01
5833 APR_DRG Neonate With Ecmo 13 11 — — $124,517.00 $186,775.50 $149,420.40 2024-10-01
24 APR_DRG Heart And/or Lung Transplant 13 11 — — $111,047.00 $166,570.50 $133,256.40 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 13 11 — — $97,644.00 $146,466.00 $117,172.80 2024-10-01
5832 APR_DRG Neonate With Ecmo 13 11 — — $95,607.00 $143,410.50 $114,728.40 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 13 11 — — $95,167.00 $142,750.50 $114,200.40 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 13 11 — — $91,470.00 $137,205.00 $109,764.00 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 13 11 — — $90,217.00 $135,325.50 $108,260.40 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 13 11 — — $82,446.00 $123,669.00 $98,935.20 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 13 11 — — $81,552.00 $122,328.00 $97,862.40 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 13 11 — — $80,942.00 $121,413.00 $97,130.40 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 13 11 — — $79,657.00 $119,485.50 $95,588.40 2024-10-01
74 APR_DRG Allogeneic Bone Marrow Transplant 13 11 — — $75,611.00 $113,416.50 $90,733.20 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 13 11 — — $75,232.00 $112,848.00 $90,278.40 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 13 11 — — $73,863.00 $110,794.50 $88,635.60 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 13 11 — — $71,560.00 $107,340.00 $85,872.00 2024-10-01
5831 APR_DRG Neonate With Ecmo 13 11 — — $69,493.00 $104,239.50 $83,391.60 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 13 11 — — $68,321.00 $102,481.50 $81,985.20 2024-10-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 13 11 — — $67,242.00 $100,863.00 $80,690.40 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 13 11 — — $66,782.00 $100,173.00 $80,138.40 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 13 11 — — $64,392.00 $96,588.00 $77,270.40 2024-10-01
23 APR_DRG Heart And/or Lung Transplant 13 11 — — $62,352.00 $93,528.00 $74,822.40 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 13 11 — — $61,338.00 $92,007.00 $73,605.60 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 13 11 — — $59,125.00 $88,687.50 $70,950.00 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 13 11 — — $56,946.00 $85,419.00 $68,335.20 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 13 11 — — $55,523.00 $83,284.50 $66,627.60 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 13 11 — — $54,849.00 $82,273.50 $65,818.80 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 13 11 — — $51,688.00 $77,532.00 $62,025.60 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 13 11 — — $51,226.00 $76,839.00 $61,471.20 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 13 11 — — $49,247.00 $73,870.50 $59,096.40 2024-10-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 13 11 — — $48,983.00 $73,474.50 $58,779.60 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 13 11 — — $48,895.00 $73,342.50 $58,674.00 2024-10-01
64 APR_DRG Pancreas Transplant 13 11 — — $48,372.00 $72,558.00 $58,046.40 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 13 11 — — $47,538.00 $71,307.00 $57,045.60 2024-10-01
8514 APR_DRG Gender Related Procedures 13 11 — — $46,902.00 $70,353.00 $56,282.40 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 13 11 — — $46,525.00 $69,787.50 $55,830.00 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 13 11 — — $46,203.00 $69,304.50 $55,443.60 2024-10-01
22 APR_DRG Heart And/or Lung Transplant 13 11 — — $45,376.00 $68,064.00 $54,451.20 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 13 11 — — $44,835.00 $67,252.50 $53,802.00 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 13 11 — — $43,677.00 $65,515.50 $52,412.40 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 13 11 — — $43,560.00 $65,340.00 $52,272.00 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 13 11 — — $42,035.00 $63,052.50 $50,442.00 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 13 11 — — $41,957.00 $62,935.50 $50,348.40 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 13 11 — — $41,876.00 $62,814.00 $50,251.20 2024-10-01
21 APR_DRG Heart And/or Lung Transplant 13 11 — — $41,730.00 $62,595.00 $50,076.00 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 13 11 — — $39,878.00 $59,817.00 $47,853.60 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 13 11 — — $38,906.00 $58,359.00 $46,687.20 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 13 11 — — $37,904.00 $56,856.00 $45,484.80 2024-10-01
84 APR_DRG Autologous Bone Marrow Transplant 13 11 — — $37,476.00 $56,214.00 $44,971.20 2024-10-01
73 APR_DRG Allogeneic Bone Marrow Transplant 13 11 — — $36,953.00 $55,429.50 $44,343.60 2024-10-01
4404 APR_DRG Kidney Transplant 13 11 — — $35,422.00 $53,133.00 $42,506.40 2024-10-01
8634 APR_DRG Neonatal Aftercare 13 11 — — $35,009.00 $52,513.50 $42,010.80 2024-10-01
63 APR_DRG Pancreas Transplant 13 11 — — $34,364.00 $51,546.00 $41,236.80 2024-10-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 13 11 — — $34,228.00 $51,342.00 $41,073.60 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 13 11 — — $34,068.00 $51,102.00 $40,881.60 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 13 11 — — $32,422.00 $48,633.00 $38,906.40 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 13 11 — — $31,789.00 $47,683.50 $38,146.80 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 13 11 — — $31,574.00 $47,361.00 $37,888.80 2024-10-01
0207 RC — 12 10 — — $11,700.00 $78,315.00 $78,315.00 2024-10-01
G0448 HCPCS Insertion Or Replacement Of A Permanent Pacing Cardioverter-defibrillator System… 11 6 — — $7,968.00 $45,611.00 $39,626.00 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
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
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
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
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
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
459 MS_DRG Spinal Fusion Except Cervical With Mcc 5 3 — — $48,042.00 $124,226.00 $83,345.00 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 5 3 — — $42,278.00 $124,226.00 $73,342.00 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
B0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 4 3 — — $46,000.69 $58,938.38 $51,750.78 2024-10-01
B0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 4 3 — — $45,528.24 $58,333.06 $51,219.27 2024-10-01
B0106 OTHER Stroke; M > 30.05 & M < 34.25 4 3 — — $43,869.40 $56,207.67 $49,353.07 2024-10-01
C0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 4 3 — — $40,907.95 $52,413.31 $46,021.44 2024-10-01
B0205 OTHER Traumatic Brain Injury; M > 28.75 & M < 40.65 4 3 — — $39,825.70 $51,026.68 $44,803.91 2024-10-01
D0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 4 3 — — $39,710.99 $50,879.70 $44,674.86 2024-10-01
B0105 OTHER Stroke; M > 34.25 & M < 38.85 4 3 — — $38,569.87 $49,417.65 $43,391.10 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
C0106 OTHER Stroke; M > 30.05 & M < 34.25 4 3 — — $38,046.11 $48,746.58 $42,801.88 2024-10-01
B1903 OTHER Guillian Barre; M < 18.05 4 3 — — $37,907.25 $48,568.66 $42,645.65 2024-10-01
B0604 OTHER Neurological; M < 25.85 4 3 — — $37,590.27 $48,162.53 $42,289.05 2024-10-01
B0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 4 3 — — $36,581.99 $46,870.67 $41,154.74 2024-10-01
A0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 4 3 — — $36,083.88 $46,232.47 $40,594.36 2024-10-01
A5104 OTHER Expired, Not Orthopedic, Length Of Stay Is 16 Days 4 3 — — $35,975.20 $46,093.23 $40,472.10 2024-10-01
C0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 4 3 — — $35,419.74 $45,381.55 $39,847.21 2024-10-01
B0704 OTHER Fracture Of Lower Extremity; M < 28.15 4 3 — — $35,128.43 $45,008.30 $39,519.48 2024-10-01
B2102 OTHER Burns; M=12-45 4 3 — — $34,982.01 $44,820.71 $39,354.76 2024-10-01
D0106 OTHER Stroke; M > 30.05 & M < 34.25 4 3 — — $34,767.68 $44,546.09 $39,113.64 2024-10-01
B1004 OTHER Amputation, Lower Extremity; M=39-45 4 3 — — $34,732.96 $44,501.61 $39,074.58 2024-10-01
B1504 OTHER Pulmonary; M < 29.15 4 3 — — $34,329.95 $43,985.25 $38,621.19 2024-10-01
B1704 OTHER Major Multiple Trauma,no Brain Or Spinal Cord Inju 4 3 — — $33,724.68 $43,209.74 $37,940.26 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 3 2 — — $79,747.00 $138,351.00 $95,081.00 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 3 2 — — $79,747.00 $138,351.00 $94,719.00 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 4 2 — — $71,631.00 $87,894.00 $79,978.00 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 4 2 — — $71,631.00 $87,894.00 $79,978.00 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
0294T CPT HInsertion Of Left Atrial Hemodynamic Monitor; Pressure Sensor Lead At Time Of I… 3 2 — — $31,159.00 $45,611.00 $41,879.00 2024-10-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 4 2 — — $32,234.00 $41,507.00 $38,638.00 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
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,562,713.00 $3,562,713.00 $3,562,713.00 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
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,225,691.35 $3,225,691.35 $3,225,691.35 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
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,878,960.00 $2,878,960.00 $2,878,960.00 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
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $511,309.70 $511,309.70 $511,309.70 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $510,789.97 $510,789.97 $510,789.97 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $501,224.32 $501,224.32 $501,224.32 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $474,772.32 $474,772.32 $474,772.32 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $446,714.49 $446,714.49 $446,714.49 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $178,990.51 $178,990.51 $178,990.51 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $147,693.56 $147,693.56 $147,693.56 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
01906 OTHER New Technology - Level 51 1 1 — — $128,862.07 $128,862.07 $128,862.07 2024-10-01
01905 OTHER New Technology - Level 51 1 1 — — $128,862.07 $128,862.07 $128,862.07 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 1 1 — — $120,116.70 $120,116.70 $120,116.70 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $119,887.93 $119,887.93 $119,887.93 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
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
01902 OTHER New Technology - Level 49 1 1 — — $100,746.82 $100,746.82 $100,746.82 2024-10-01
01901 OTHER New Technology - Level 49 1 1 — — $100,746.82 $100,746.82 $100,746.82 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 3 1 — — $78,794.00 $96,685.00 $96,685.00 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 3 1 — — $78,794.00 $96,685.00 $96,685.00 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 3 1 — — $77,361.00 $94,927.00 $94,927.00 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 3 1 — — $77,361.00 $94,927.00 $94,927.00 2024-10-01
01599 OTHER New Technology - Level 48 1 1 — — $89,032.11 $89,032.11 $89,032.11 2024-10-01
01585 OTHER New Technology - Level 48 1 1 — — $89,032.11 $89,032.11 $89,032.11 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $84,296.07 $84,296.07 $84,296.07 2024-10-01
01584 OTHER New Technology - Level 47 1 1 — — $79,660.37 $79,660.37 $79,660.37 2024-10-01
01598 OTHER New Technology - Level 47 1 1 — — $79,660.37 $79,660.37 $79,660.37 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $78,325.54 $78,325.54 $78,325.54 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 1 — — $76,785.37 $76,785.37 $76,785.37 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $76,277.63 $76,277.63 $76,277.63 2024-10-01
01583 OTHER New Technology - Level 46 1 1 — — $70,288.61 $70,288.61 $70,288.61 2024-10-01
01597 OTHER New Technology - Level 46 1 1 — — $70,288.61 $70,288.61 $70,288.61 2024-10-01
007 OTHER Lung Transplant 1 1 — — $67,580.69 $67,580.69 $67,580.69 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $67,458.10 $67,458.10 $67,458.10 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $63,512.28 $63,512.28 $63,512.28 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $62,431.63 $62,431.63 $62,431.63 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $61,454.13 $61,454.13 $61,454.13 2024-10-01
01582 OTHER New Technology - Level 45 1 1 — — $60,916.85 $60,916.85 $60,916.85 2024-10-01
01596 OTHER New Technology - Level 45 1 1 — — $60,916.85 $60,916.85 $60,916.85 2024-10-01
C2616 HCPCS Brachytherapy Source, Non-stranded, Yttrium-90, Per Source 1 1 — — $58,219.00 $58,219.00 $58,219.00 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $57,539.16 $57,539.16 $57,539.16 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $55,450.54 $55,450.54 $55,450.54 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $55,323.98 $55,323.98 $55,323.98 2024-10-01
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $53,364.77 $53,364.77 $53,364.77 2024-10-01
01581 OTHER New Technology - Level 44 1 1 — — $51,545.10 $51,545.10 $51,545.10 2024-10-01
01595 OTHER New Technology - Level 44 1 1 — — $51,545.10 $51,545.10 $51,545.10 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $51,453.49 $51,453.49 $51,453.49 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $49,806.62 $49,806.62 $49,806.62 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $49,529.65 $49,529.65 $49,529.65 2024-10-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $48,795.12 $48,795.12 $48,795.12 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $45,148.93 $45,148.93 $45,148.93 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $44,710.16 $44,710.16 $44,710.16 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $44,039.60 $44,039.60 $44,039.60 2024-10-01
01142 OTHER Supprelin La Implant 1 1 — — $43,989.70 $43,989.70 $43,989.70 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $43,339.76 $43,339.76 $43,339.76 2024-10-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $42,827.53 $42,827.53 $42,827.53 2024-10-01
01594 OTHER New Technology - Level 43 1 1 — — $42,173.35 $42,173.35 $42,173.35 2024-10-01
01580 OTHER New Technology - Level 43 1 1 — — $42,173.35 $42,173.35 $42,173.35 2024-10-01
834 OTHER Acute Leukemia With Mcc 1 1 — — $42,052.24 $42,052.24 $42,052.24 2024-10-01
4A020N8 OTHER Measurement Of Cardiac Sampling And Pressure, Bilateral, Open Approach 2 1 — — $41,409.00 $41,409.00 $41,409.00 2024-10-01
4A023N8 OTHER Measurement Of Cardiac Sampling And Pressure, Bilateral, Percutaneous Approach 2 1 — — $41,409.00 $41,409.00 $41,409.00 2024-10-01
4A023N7 OTHER Measurement Of Cardiac Sampling And Pressure, Left Heart, Percutaneous Approach 2 1 — — $41,409.00 $41,409.00 $41,409.00 2024-10-01
4A023N6 OTHER Measurement Of Cardiac Sampling And Pressure, Right Heart, Percutaneous Approach… 2 1 — — $41,409.00 $41,409.00 $41,409.00 2024-10-01
4A020N6 OTHER Measurement Of Cardiac Sampling And Pressure, Right Heart, Open Approach 2 1 — — $41,409.00 $41,409.00 $41,409.00 2024-10-01
4A020N7 OTHER Measurement Of Cardiac Sampling And Pressure, Left Heart, Open Approach 2 1 — — $41,409.00 $41,409.00 $41,409.00 2024-10-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $41,091.81 $41,091.81 $41,091.81 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
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 1 1 — — $38,803.31 $38,803.31 $38,803.31 2024-10-01
247 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 3 1 — — $32,234.00 $38,638.00 $38,638.00 2024-10-01
232 OTHER Coronary Bypass With Ptca Without Mcc 1 1 — — $37,952.93 $37,952.93 $37,952.93 2024-10-01
219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $37,949.46 $37,949.46 $37,949.46 2024-10-01
969 OTHER HIV With Extensive O.r. Procedures With Mcc 1 1 — — $37,864.09 $37,864.09 $37,864.09 2024-10-01
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