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Hospital

HCA FLORIDA MEMORIAL HOSPITAL

Jacksonville, FL · CCN 100179 · Rates published

32,816 distinct procedures filed
59 distinct payers
879,096 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

789,809 of 879,096 rate rows are consumer-grade (89.8%)

89,287 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 65,210
per-diem day rate — not a per-procedure price 10,219
template filing: same amount across many unrelated codes — excluded 7,174
exceeds 10× this hospital's gross charge — excluded from medians 6,571
placeholder amount (≤ $0.02) — excluded from medians 113

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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/59-3283127_HCA-FLORIDA-MEMORIAL-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 success · 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 20 $2,938,320.00 $4,407,480.00 $3,691,264.50 nat. median
$3,746,358
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,672,900.00 $3,672,900.00 $3,672,900.00 nat. median
$3,574,709
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 20 $2,884,000.00 $4,326,000.00 $3,623,025.00 nat. median
$3,605,000
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 1 $3,605,000.00 $3,605,000.00 $3,605,000.00 nat. median
$3,496,850
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 20 $4,093.96 $3,990,546.00 $3,342,082.27 nat. median
$13,041
outlier · 256.3×
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,325,455.00 $3,325,455.00 $3,325,455.00 nat. median
$3,228,024
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 20 $6,752.98 $3,943,200.00 $3,302,430.00 nat. median
$17,963
outlier · 183.8×
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $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 20 $5,997.99 $3,561,600.00 $2,982,840.00 nat. median
$21,896
outlier · 136.2×
00746
OTHER 		Inj, Betibeglogene Autote 1 $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 $1,910,891.20 $2,866,336.80 $2,400,557.07 nat. median
$2,588,981
0.9× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,388,614.00 $2,388,614.00 $2,388,614.00 nat. median
$2,457,321
1.0× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 2 $518,241.00 $863,696.72 $863,696.72 nat. median
$754,974
1.1× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 2 $507,496.00 $837,683.55 $837,683.55 nat. median
$675,122
1.2× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 2 $484,690.00 $830,699.97 $830,699.97 nat. median
$625,184
1.3× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 2 $474,061.00 $819,043.85 $819,043.85 nat. median
$674,188
1.2× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 2 $459,381.00 $807,075.90 $807,075.90 nat. median
$634,511
1.3× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 2 $449,440.00 $741,576.00 $741,576.00 nat. median
$620,080
1.2× median
9194
OTHER 		Tisagenlecleucel Car-pos 20 $423,354.32 $635,031.48 $531,838.86 nat. median
$566,531
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 20 $421,698.72 $632,548.08 $529,759.02 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 20 $421,270.08 $631,905.12 $529,220.54 nat. median
$558,082
0.9× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $529,192.90 $529,192.90 $529,192.90 nat. median
$538,205
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $527,123.40 $527,123.40 $527,123.40 nat. median
$554,552
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $526,587.60 $526,587.60 $526,587.60 nat. median
$530,178
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 20 $413,380.88 $620,071.32 $519,309.73 nat. median
$562,201
0.9× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $516,726.10 $516,726.10 $516,726.10 nat. median
$534,091
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 20 $391,564.80 $587,347.20 $491,903.28 nat. median
$532,192
0.9× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $489,456.00 $489,456.00 $489,456.00 nat. median
$505,583
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 20 $368,424.32 $552,636.48 $462,833.05 nat. median
$489,450
0.9× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $460,530.40 $460,530.40 $460,530.40 nat. median
$464,978
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 29 $6,604.00 $401,329.57 $284,630.90 nat. median
$370,174
0.8× median
5834
APR_DRG 		Neonate With Ecmo 14 $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 30 $8,700.00 $530,922.00 $214,575.34 nat. median
$265,286
0.8× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 28 $8,700.00 $353,785.88 $180,514.48 nat. median
$206,368
0.9× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 29 $8,700.00 $502,317.65 $164,028.04 nat. median
$202,986
0.8× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 14 $125,393.00 $188,089.50 $150,471.60 nat. median
$246,434
0.6× median
5833
APR_DRG 		Neonate With Ecmo 14 $124,517.00 $186,775.50 $149,420.40 nat. median
$244,017
0.6× median
1907
OTHER 		New Technology - Level 52 20 $117,871.92 $176,807.88 $148,076.60 nat. median
$153,199
1.0× median
1908
OTHER 		New Technology - Level 52 20 $117,871.92 $176,807.88 $148,076.60 nat. median
$152,962
1.0× median
01908
OTHER 		New Technology - Level 52 1 $147,339.90 $147,339.90 $147,339.90 nat. median
$82,736
1.8× median
01907
OTHER 		New Technology - Level 52 1 $147,339.90 $147,339.90 $147,339.90 nat. median
$84,819
1.7× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $138,768.38 $138,768.38 $138,768.38 nat. median
$263,894
0.5× median
1906
OTHER 		New Technology - Level 51 20 $106,278.00 $159,417.00 $133,511.74 nat. median
$138,020
1.0× median
1905
OTHER 		New Technology - Level 51 20 $106,278.00 $159,417.00 $133,511.74 nat. median
$137,903
1.0× median
24
APR_DRG 		Heart And/or Lung Transplant 14 $111,047.00 $166,570.50 $133,256.40 nat. median
$234,738
0.6× median
01905
OTHER 		New Technology - Level 51 1 $132,847.50 $132,847.50 $132,847.50 nat. median
$82,736
1.6× median
01906
OTHER 		New Technology - Level 51 1 $132,847.50 $132,847.50 $132,847.50 nat. median
$82,736
1.6× median
455
MS_DRG 		Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 1 $114,899.00 $143,622.00 $129,260.50 nat. median
$48,483
outlier · 2.7×

Other procedures at this hospital

Browse this hospital's 32,816 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 2 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… 2 1 — — $3,884,946.48 $3,884,946.48 $3,884,946.48 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 26 20 — — $2,938,320.00 $4,407,480.00 $3,691,264.50 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,672,900.00 $3,672,900.00 $3,672,900.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 26 20 — — $2,884,000.00 $4,326,000.00 $3,623,025.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 1 1 — — $3,605,000.00 $3,605,000.00 $3,605,000.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 27 20 — — $4,093.96 $3,990,546.00 $3,342,082.27 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,325,455.00 $3,325,455.00 $3,325,455.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 27 20 — — $6,752.98 $3,943,200.00 $3,302,430.00 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,286,000.00 $3,286,000.00 $3,286,000.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 27 20 — — $5,997.99 $3,561,600.00 $2,982,840.00 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,968,000.00 $2,968,000.00 $2,968,000.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 26 20 — — $1,910,891.20 $2,866,336.80 $2,400,557.07 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,388,614.00 $2,388,614.00 $2,388,614.00 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 2 — — $518,241.00 $863,696.72 $863,696.72 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 2 — — $507,496.00 $837,683.55 $837,683.55 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 2 — — $484,690.00 $830,699.97 $830,699.97 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 2 — — $474,061.00 $819,043.85 $819,043.85 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 3 2 — — $459,381.00 $807,075.90 $807,075.90 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 2 — — $449,440.00 $741,576.00 $741,576.00 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 26 20 — — $423,354.32 $635,031.48 $531,838.86 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 26 20 — — $421,698.72 $632,548.08 $529,759.02 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 26 20 — — $421,270.08 $631,905.12 $529,220.54 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $529,192.90 $529,192.90 $529,192.90 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $527,123.40 $527,123.40 $527,123.40 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $526,587.60 $526,587.60 $526,587.60 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 26 20 — — $413,380.88 $620,071.32 $519,309.73 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $516,726.10 $516,726.10 $516,726.10 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 26 20 — — $391,564.80 $587,347.20 $491,903.28 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $489,456.00 $489,456.00 $489,456.00 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 26 20 — — $368,424.32 $552,636.48 $462,833.05 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $460,530.40 $460,530.40 $460,530.40 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 50 29 — — $6,604.00 $401,329.57 $284,630.90 2024-10-01
5834 APR_DRG Neonate With Ecmo 17 14 — — $192,207.00 $288,310.50 $230,648.40 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 52 30 — — $8,700.00 $530,922.00 $214,575.34 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 51 28 — — $8,700.00 $353,785.88 $180,514.48 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 52 29 — — $8,700.00 $502,317.65 $164,028.04 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 17 14 — — $125,393.00 $188,089.50 $150,471.60 2024-10-01
5833 APR_DRG Neonate With Ecmo 17 14 — — $124,517.00 $186,775.50 $149,420.40 2024-10-01
1908 OTHER New Technology - Level 52 26 20 — — $117,871.92 $176,807.88 $148,076.60 2024-10-01
1907 OTHER New Technology - Level 52 26 20 — — $117,871.92 $176,807.88 $148,076.60 2024-10-01
01908 OTHER New Technology - Level 52 1 1 — — $147,339.90 $147,339.90 $147,339.90 2024-10-01
01907 OTHER New Technology - Level 52 1 1 — — $147,339.90 $147,339.90 $147,339.90 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $138,768.38 $138,768.38 $138,768.38 2024-10-01
1905 OTHER New Technology - Level 51 26 20 — — $106,278.00 $159,417.00 $133,511.74 2024-10-01
1906 OTHER New Technology - Level 51 26 20 — — $106,278.00 $159,417.00 $133,511.74 2024-10-01
24 APR_DRG Heart And/or Lung Transplant 17 14 — — $111,047.00 $166,570.50 $133,256.40 2024-10-01
01906 OTHER New Technology - Level 51 1 1 — — $132,847.50 $132,847.50 $132,847.50 2024-10-01
01905 OTHER New Technology - Level 51 1 1 — — $132,847.50 $132,847.50 $132,847.50 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 2 1 — — $114,899.00 $143,622.00 $129,260.50 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 2 1 — — $120,116.70 $120,116.70 $120,116.70 2024-10-01
1904 OTHER New Technology - Level 50 26 20 — — $94,684.08 $142,026.12 $118,946.88 2024-10-01
1903 OTHER New Technology - Level 50 26 20 — — $94,684.08 $142,026.12 $118,946.88 2024-10-01
01904 OTHER New Technology - Level 50 1 1 — — $118,355.10 $118,355.10 $118,355.10 2024-10-01
01903 OTHER New Technology - Level 50 1 1 — — $118,355.10 $118,355.10 $118,355.10 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 17 14 — — $97,644.00 $146,466.00 $117,172.80 2024-10-01
5832 APR_DRG Neonate With Ecmo 17 14 — — $95,607.00 $143,410.50 $114,728.40 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $114,504.38 $114,504.38 $114,504.38 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 17 14 — — $95,167.00 $142,750.50 $114,200.40 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 17 14 — — $91,470.00 $137,205.00 $109,764.00 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 52 29 — — $8,700.00 $301,484.83 $108,395.82 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 17 14 — — $90,217.00 $135,325.50 $108,260.40 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 2 1 — — $108,036.36 $108,036.36 $108,036.36 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 3 2 — — $63,505.40 $104,773.89 $104,773.89 2024-10-01
1902 OTHER New Technology - Level 49 26 20 — — $83,090.16 $124,635.24 $104,382.01 2024-10-01
1901 OTHER New Technology - Level 49 26 20 — — $83,090.16 $124,635.24 $104,382.01 2024-10-01
01901 OTHER New Technology - Level 49 1 1 — — $103,862.70 $103,862.70 $103,862.70 2024-10-01
01902 OTHER New Technology - Level 49 1 1 — — $103,862.70 $103,862.70 $103,862.70 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 50 30 — — $6,604.00 $282,774.55 $100,868.03 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 27 20 — — $79,999.92 $119,999.88 $100,499.90 2024-10-01
7 MS_DRG Lung Transplant 50 30 — — $8,700.00 $238,536.59 $100,368.74 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 17 14 — — $82,446.00 $123,669.00 $98,935.20 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 17 14 — — $81,552.00 $122,328.00 $97,862.40 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 17 14 — — $80,942.00 $121,413.00 $97,130.40 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 17 14 — — $79,657.00 $119,485.50 $95,588.40 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $92,947.13 $92,947.13 $92,947.13 2024-10-01
1585 OTHER New Technology - Level 48 26 20 — — $73,428.54 $110,142.82 $92,244.61 2024-10-01
1599 OTHER New Technology - Level 48 26 20 — — $73,428.54 $110,142.82 $92,244.61 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 2 1 — — $81,685.00 $102,106.00 $91,895.50 2024-10-01
01585 OTHER New Technology - Level 48 1 1 — — $91,785.68 $91,785.68 $91,785.68 2024-10-01
01599 OTHER New Technology - Level 48 1 1 — — $91,785.68 $91,785.68 $91,785.68 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 3 2 — — $55,453.60 $91,596.09 $91,596.09 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 27 20 — — $72,825.52 $109,238.28 $91,487.06 2024-10-01
74 APR_DRG Allogeneic Bone Marrow Transplant 17 14 — — $75,611.00 $113,416.50 $90,733.20 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 2 1 — — $80,518.00 $100,647.00 $90,582.50 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 17 14 — — $75,232.00 $112,848.00 $90,278.40 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 17 14 — — $73,863.00 $110,794.50 $88,635.60 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 17 14 — — $71,560.00 $107,340.00 $85,872.00 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 52 30 — — $8,700.00 $323,541.15 $85,086.56 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 54 31 — — $8,700.00 $269,956.82 $84,126.56 2024-10-01
215 MS_DRG Other Heart Assist System Implant 54 31 — — $10,799.00 $291,942.97 $83,886.29 2024-10-01
5831 APR_DRG Neonate With Ecmo 17 14 — — $69,493.00 $104,239.50 $83,391.60 2024-10-01
1584 OTHER New Technology - Level 47 26 20 — — $65,699.27 $98,548.91 $82,534.71 2024-10-01
1598 OTHER New Technology - Level 47 26 20 — — $65,699.27 $98,548.91 $82,534.71 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 50 30 — — $8,700.00 $287,413.90 $82,272.55 2024-10-01
01584 OTHER New Technology - Level 47 1 1 — — $82,124.09 $82,124.09 $82,124.09 2024-10-01
01598 OTHER New Technology - Level 47 1 1 — — $82,124.09 $82,124.09 $82,124.09 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 17 14 — — $68,321.00 $102,481.50 $81,985.20 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 54 31 — — $10,799.00 $262,710.82 $81,006.21 2024-10-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 17 14 — — $67,242.00 $100,863.00 $80,690.40 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 17 14 — — $66,782.00 $100,173.00 $80,138.40 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 54 31 — — $10,799.00 $217,811.00 $77,500.09 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 17 14 — — $64,392.00 $96,588.00 $77,270.40 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $76,785.37 $76,785.37 $76,785.37 2024-10-01
23 APR_DRG Heart And/or Lung Transplant 17 14 — — $62,352.00 $93,528.00 $74,822.40 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 17 14 — — $61,338.00 $92,007.00 $73,605.60 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 3 2 — — $44,578.80 $72,861.11 $72,861.11 2024-10-01
1583 OTHER New Technology - Level 46 26 20 — — $57,969.98 $86,954.98 $72,824.79 2024-10-01
1597 OTHER New Technology - Level 46 26 20 — — $57,969.98 $86,954.98 $72,824.79 2024-10-01
01597 OTHER New Technology - Level 46 1 1 — — $72,462.48 $72,462.48 $72,462.48 2024-10-01
01583 OTHER New Technology - Level 46 1 1 — — $72,462.48 $72,462.48 $72,462.48 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 54 31 — — $8,700.00 $230,872.02 $71,197.02 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 17 14 — — $59,125.00 $88,687.50 $70,950.00 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 17 14 — — $56,946.00 $85,419.00 $68,335.20 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 54 31 — — $10,799.00 $184,696.62 $67,080.83 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 17 14 — — $55,523.00 $83,284.50 $66,627.60 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 27 20 — — $52,697.36 $79,046.04 $66,201.06 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 17 14 — — $54,849.00 $82,273.50 $65,818.80 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 26 20 — — $52,381.26 $78,571.90 $65,803.96 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 52 31 — — $10,799.00 $186,718.00 $65,741.89 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $65,476.58 $65,476.58 $65,476.58 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $65,353.35 $65,353.35 $65,353.35 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 54 31 — — $10,799.00 $209,033.76 $64,766.73 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 27 20 — — $9,811.04 $76,025.72 $63,671.54 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $63,354.77 $63,354.77 $63,354.77 2024-10-01
1596 OTHER New Technology - Level 45 26 20 — — $50,240.70 $75,361.06 $63,114.88 2024-10-01
1582 OTHER New Technology - Level 45 26 20 — — $50,240.70 $75,361.06 $63,114.88 2024-10-01
01582 OTHER New Technology - Level 45 1 1 — — $62,800.88 $62,800.88 $62,800.88 2024-10-01
01596 OTHER New Technology - Level 45 1 1 — — $62,800.88 $62,800.88 $62,800.88 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 52 31 — — $10,799.00 $180,974.61 $62,647.32 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 54 31 — — $10,799.00 $155,266.47 $62,641.41 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 52 31 — — $10,799.00 $173,856.00 $62,291.25 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 17 14 — — $51,688.00 $77,532.00 $62,025.60 2024-10-01
10 MS_DRG Pancreas Transplant 50 30 — — $8,700.00 $144,902.50 $61,827.36 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 17 14 — — $51,226.00 $76,839.00 $61,471.20 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 51 30 — — $8,700.00 $146,373.76 $61,395.92 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $60,724.50 $60,724.50 $60,724.50 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $59,136.79 $59,136.79 $59,136.79 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 17 14 — — $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 17 14 — — $48,983.00 $73,474.50 $58,779.60 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 17 14 — — $48,895.00 $73,342.50 $58,674.00 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 54 31 — — $8,700.00 $124,324.96 $58,121.85 2024-10-01
64 APR_DRG Pancreas Transplant 17 14 — — $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 17 14 — — $47,538.00 $71,307.00 $57,045.60 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 54 31 — — $10,799.00 $176,345.29 $56,416.08 2024-10-01
8514 APR_DRG Gender Related Procedures 17 14 — — $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 17 14 — — $46,525.00 $69,787.50 $55,830.00 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 17 14 — — $46,203.00 $69,304.50 $55,443.60 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 54 31 — — $10,799.00 $177,921.82 $55,354.11 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 26 20 — — $44,012.18 $66,018.28 $55,290.31 2024-10-01
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $55,015.23 $55,015.23 $55,015.23 2024-10-01
22 APR_DRG Heart And/or Lung Transplant 17 14 — — $45,376.00 $68,064.00 $54,451.20 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 17 14 — — $44,835.00 $67,252.50 $53,802.00 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 54 31 — — $8,000.00 $75,771.20 $53,738.44 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 54 31 — — $10,799.00 $183,345.67 $53,490.69 2024-10-01
1581 OTHER New Technology - Level 44 26 20 — — $42,511.42 $63,767.14 $53,404.98 2024-10-01
1595 OTHER New Technology - Level 44 26 20 — — $42,511.42 $63,767.14 $53,404.98 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 54 31 — — $8,700.00 $175,377.82 $53,300.67 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 54 31 — — $10,799.00 $117,503.00 $53,272.18 2024-10-01
01595 OTHER New Technology - Level 44 1 1 — — $53,139.28 $53,139.28 $53,139.28 2024-10-01
01581 OTHER New Technology - Level 44 1 1 — — $53,139.28 $53,139.28 $53,139.28 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 54 31 — — $10,799.00 $168,034.07 $52,621.88 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 17 14 — — $43,677.00 $65,515.50 $52,412.40 2024-10-01
007 OTHER Lung Transplant 1 1 — — $52,394.20 $52,394.20 $52,394.20 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $52,299.15 $52,299.15 $52,299.15 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 17 14 — — $43,560.00 $65,340.00 $52,272.00 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 51 28 — — $8,700.00 $106,466.86 $51,909.53 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 2 1 — — $45,570.00 $56,963.00 $51,266.50 2024-10-01
5244 OTHER Level 4 Blood Product Exc 26 20 — — $40,243.40 $60,365.10 $50,555.77 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 17 14 — — $42,035.00 $63,052.50 $50,442.00 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 17 14 — — $41,957.00 $62,935.50 $50,348.40 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 54 31 — — $6,604.00 $79,595.74 $50,318.97 2024-10-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $50,304.25 $50,304.25 $50,304.25 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 17 14 — — $41,876.00 $62,814.00 $50,251.20 2024-10-01
21 APR_DRG Heart And/or Lung Transplant 17 14 — — $41,730.00 $62,595.00 $50,076.00 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 54 31 — — $10,799.00 $183,345.67 $49,407.35 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 54 31 — — $8,700.00 $112,983.50 $49,233.96 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 54 31 — — $10,799.00 $139,824.00 $49,214.10 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 54 31 — — $10,799.00 $225,375.49 $49,041.85 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 54 31 — — $10,799.00 $184,696.62 $48,871.68 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 54 31 — — $8,700.00 $155,045.90 $48,433.22 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $48,402.20 $48,402.20 $48,402.20 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 54 31 — — $10,799.00 $97,435.00 $48,249.55 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 54 31 — — $8,700.00 $67,316.16 $47,980.67 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 17 14 — — $39,878.00 $59,817.00 $47,853.60 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 54 31 — — $10,799.00 $127,776.27 $47,740.65 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 27 20 — — $37,994.40 $56,991.60 $47,730.46 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 52 31 — — $10,799.00 $109,134.00 $47,622.61 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 50 30 — — $6,604.00 $282,774.55 $47,292.00 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 50 30 — — $6,604.00 $282,774.55 $47,292.00 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 17 14 — — $38,906.00 $58,359.00 $46,687.20 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 37 25 — — $33,409.00 $65,063.46 $46,605.74 2024-10-01
1142 OTHER Supprelin La Implant 26 20 — — $36,280.17 $54,420.25 $45,576.96 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 17 14 — — $37,904.00 $56,856.00 $45,484.80 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 52 31 — — $10,799.00 $111,732.81 $45,448.68 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 54 31 — — $8,700.00 $84,831.61 $45,446.19 2024-10-01
01142 OTHER Supprelin La Implant 1 1 — — $45,350.21 $45,350.21 $45,350.21 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 52 31 — — $10,799.00 $127,346.00 $45,266.67 2024-10-01
84 APR_DRG Autologous Bone Marrow Transplant 17 14 — — $37,476.00 $56,214.00 $44,971.20 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $44,609.16 $44,609.16 $44,609.16 2024-10-01
J9266 HCPCS Pegaspargase Singl Vial 3 2 $51,967.00 $51,967.00 $25,781.50 $44,574.52 $44,574.52 2024-10-01
73 APR_DRG Allogeneic Bone Marrow Transplant 17 14 — — $36,953.00 $55,429.50 $44,343.60 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 52 31 — — $10,799.00 $180,974.61 $44,082.12 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 54 31 — — $10,799.00 $118,297.07 $43,730.99 2024-10-01
1594 OTHER New Technology - Level 43 26 20 — — $34,782.14 $52,173.22 $43,695.07 2024-10-01
1580 OTHER New Technology - Level 43 26 20 — — $34,782.14 $52,173.22 $43,695.07 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 54 31 — — $8,700.00 $83,856.62 $43,577.21 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 52 31 — — $10,799.00 $158,875.68 $43,544.07 2024-10-01
01594 OTHER New Technology - Level 43 1 1 — — $43,477.68 $43,477.68 $43,477.68 2024-10-01
01580 OTHER New Technology - Level 43 1 1 — — $43,477.68 $43,477.68 $43,477.68 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 54 31 — — $10,799.00 $137,982.33 $43,270.80 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 54 31 — — $6,604.00 $60,637.47 $43,220.33 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 54 31 — — $10,799.00 $137,230.00 $43,004.64 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $42,989.90 $42,989.90 $42,989.90 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $42,891.76 $42,891.76 $42,891.76 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 50 30 — — $8,700.00 $146,373.76 $42,782.47 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 54 31 — — $8,700.00 $111,792.96 $42,582.78 2024-10-01
4404 APR_DRG Kidney Transplant 17 14 — — $35,422.00 $53,133.00 $42,506.40 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 54 31 — — $8,700.00 $113,265.00 $42,268.10 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 54 31 — — $8,700.00 $81,859.02 $42,229.62 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 54 31 — — $8,700.00 $59,240.12 $42,014.27 2024-10-01
8634 APR_DRG Neonatal Aftercare 17 14 — — $35,009.00 $52,513.50 $42,010.80 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 54 31 — — $10,799.00 $95,908.00 $41,848.56 2024-10-01
63 APR_DRG Pancreas Transplant 17 14 — — $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 17 14 — — $34,228.00 $51,342.00 $41,073.60 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 54 31 — — $10,799.00 $161,061.00 $41,061.71 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 17 14 — — $34,068.00 $51,102.00 $40,881.60 2024-10-01
0207 RC — 13 9 — — $8,000.00 $40,694.00 $40,694.00 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 54 31 — — $8,700.00 $129,072.08 $40,575.09 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 54 31 — — $10,799.00 $99,753.00 $40,154.99 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $39,891.04 $39,891.04 $39,891.04 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 54 31 — — $8,700.00 $67,362.01 $39,838.50 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 54 31 — — $8,700.00 $63,524.71 $39,520.09 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 54 31 — — $10,799.00 $111,795.47 $39,461.92 2024-10-01
0888T CPT Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 2 1 — — $39,376.13 $39,376.13 $39,376.13 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 54 31 — — $6,604.00 $64,504.71 $39,295.99 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 54 31 — — $8,700.00 $83,430.54 $39,256.00 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 17 14 — — $32,422.00 $48,633.00 $38,906.40 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 54 31 — — $10,799.00 $169,224.61 $38,855.79 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 52 31 — — $10,799.00 $98,648.00 $38,829.67 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 2 1 — — $38,803.31 $38,803.31 $38,803.31 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $38,614.25 $38,614.25 $38,614.25 2024-10-01
245 MS_DRG Aicd Generator Procedures 52 31 — — $10,799.00 $86,585.00 $38,579.27 2024-10-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 27 20 — — $30,631.60 $45,947.40 $38,480.95 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $38,399.53 $38,399.53 $38,399.53 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 51 30 — — $8,700.00 $287,413.90 $38,294.16 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 17 14 — — $31,789.00 $47,683.50 $38,146.80 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 52 31 — — $10,799.00 $158,875.68 $37,967.88 2024-10-01
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 27 20 — — $30,161.20 $45,241.80 $37,890.01 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 17 14 — — $31,574.00 $47,361.00 $37,888.80 2024-10-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 17 14 — — $31,456.00 $47,184.00 $37,747.20 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 54 31 — — $8,700.00 $63,416.93 $37,548.49 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 54 31 — — $8,700.00 $90,736.69 $37,483.81 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 54 31 — — $8,700.00 $81,427.92 $37,392.30 2024-10-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 17 14 — — $31,113.00 $46,669.50 $37,335.60 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 54 31 — — $10,799.00 $125,081.89 $37,224.86 2024-10-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 17 14 — — $30,783.00 $46,174.50 $36,939.60 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 54 31 — — $8,700.00 $51,663.73 $36,824.14 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 51 30 — — $8,700.00 $115,963.61 $36,459.87 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 54 31 — — $8,700.00 $73,690.67 $36,343.84 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 52 31 — — $10,799.00 $103,035.00 $36,313.31 2024-10-01
1784 APR_DRG External Heart Assist Devices 17 14 — — $30,258.00 $45,387.00 $36,309.60 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 54 31 — — $8,700.00 $74,630.57 $36,293.71 2024-10-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 17 14 — — $30,178.00 $45,267.00 $36,213.60 2024-10-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 17 14 — — $30,089.00 $45,133.50 $36,106.80 2024-10-01
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 17 14 — — $30,025.00 $45,037.50 $36,030.00 2024-10-01
0515T CPT Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including … 2 1 — — $30,769.00 $40,932.00 $35,850.50 2024-10-01
0520T CPT Removal And Replacement Of Pulse Generator For Wireless Cardiac Stimulator For L… 2 1 — — $30,769.00 $40,932.00 $35,850.50 2024-10-01
0614T CPT Removal And Replacement Of Substernal Implantable Defibrillator Pulse Generator 2 1 — — $30,769.00 $40,932.00 $35,850.50 2024-10-01
0571T CPT Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S… 2 1 — — $30,769.00 $40,932.00 $35,850.50 2024-10-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 17 14 — — $29,751.00 $44,626.50 $35,701.20 2024-10-01
72 APR_DRG Allogeneic Bone Marrow Transplant 17 14 — — $29,633.00 $44,449.50 $35,559.60 2024-10-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 54 31 — — $8,700.00 $83,430.54 $35,557.28 2024-10-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 17 14 — — $29,487.00 $44,230.50 $35,384.40 2024-10-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 54 31 — — $8,700.00 $49,601.57 $35,354.31 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $35,003.22 $35,003.22 $35,003.22 2024-10-01
901 MS_DRG Wound Debridements For Injuries With Mcc 54 31 — — $8,700.00 $51,183.19 $34,945.36 2024-10-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 17 14 — — $29,098.00 $43,647.00 $34,917.60 2024-10-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 54 31 — — $10,799.00 $128,428.00 $34,833.33 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $34,663.05 $34,663.05 $34,663.05 2024-10-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 17 14 — — $28,871.00 $43,306.50 $34,645.20 2024-10-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 17 14 — — $28,840.00 $43,260.00 $34,608.00 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 52 31 — — $10,799.00 $127,761.00 $34,603.73 2024-10-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 17 14 — — $28,815.00 $43,222.50 $34,578.00 2024-10-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 17 14 — — $28,549.00 $42,823.50 $34,258.80 2024-10-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 51 28 — — $6,604.00 $47,932.16 $34,164.41 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 54 31 — — $10,799.00 $110,082.00 $34,161.96 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $34,143.17 $34,143.17 $34,143.17 2024-10-01
1593 OTHER New Technology - Level 42 26 20 — — $27,052.86 $40,579.30 $33,985.16 2024-10-01
1579 OTHER New Technology - Level 42 26 20 — — $27,052.86 $40,579.30 $33,985.16 2024-10-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 54 31 — — $9,191.00 $103,764.96 $33,822.54 2024-10-01
01579 OTHER New Technology - Level 42 1 1 — — $33,816.08 $33,816.08 $33,816.08 2024-10-01
01593 OTHER New Technology - Level 42 1 1 — — $33,816.08 $33,816.08 $33,816.08 2024-10-01
71 APR_DRG Allogeneic Bone Marrow Transplant 17 14 — — $28,151.00 $42,226.50 $33,781.20 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 52 31 — — $10,799.00 $92,789.00 $33,728.27 2024-10-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 54 31 — — $8,700.00 $69,204.21 $33,701.88 2024-10-01
L8701 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand With S… 27 20 — — $26,784.72 $40,177.08 $33,648.30 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $33,600.59 $33,600.59 $33,600.59 2024-10-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 17 14 — — $27,960.00 $41,940.00 $33,552.00 2024-10-01
140 MS_DRG Major Head And Neck Procedures With Mcc 54 31 — — $8,700.00 $72,038.95 $33,427.23 2024-10-01
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