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 FORT WALTON-DESTIN HOSPITAL

Fort Walton Beach, FL · CCN 100223 · Rates published

30,351 distinct procedures filed
50 distinct payers
807,267 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

696,034 of 807,267 rate rows are consumer-grade (86.2%)

111,233 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 74,165
template filing: same amount across many unrelated codes — excluded 24,471
per-diem day rate — not a per-procedure price 8,460
exceeds 10× this hospital's gross charge — excluded from medians 4,065
placeholder amount (≤ $0.02) — excluded from medians 72

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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/61-1259833_HCA-FLORIDA-FORT-WALTON-DESTIN-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
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 18 $3,599,442.00 $4,407,480.00 $3,746,358.00 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 18 $3,532,900.00 $4,326,000.00 $3,677,100.00 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 18 $5,280.60 $3,990,546.00 $3,391,964.10 nat. median
$13,041
outlier · 260.1×
748
OTHER 		Inj, Lovotibeglogene Auto 18 $8,710.34 $3,943,200.00 $3,351,720.00 nat. median
$17,963
outlier · 186.6×
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 18 $7,736.51 $3,561,600.00 $3,027,360.00 nat. median
$21,896
outlier · 138.3×
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 18 $2,340,841.72 $2,866,336.80 $2,436,386.28 nat. median
$2,588,981
0.9× 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 18 $518,609.04 $635,031.48 $539,776.76 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 18 $516,580.93 $632,548.08 $537,665.87 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 18 $516,055.85 $631,905.12 $537,119.35 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 18 $506,391.58 $620,071.32 $527,060.62 nat. median
$562,201
0.9× 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 $1,387,149.28 $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
9035
OTHER 		Axicabtagene Ciloleucel C 18 $479,666.88 $587,347.20 $499,245.12 nat. median
$532,192
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $492,271.12 $1,345,370.55 $492,271.12 nat. median
$674,867
0.7× 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 $1,334,154.50 $470,149.30 nat. median
$625,184
0.8× median
9391
OTHER 		Brexucabtagene Car Pos T 18 $451,319.79 $552,636.48 $469,741.01 nat. median
$489,450
1.0× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $459,839.17 $1,315,434.06 $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 $1,296,212.81 $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 $1,191,016.00 $435,956.80 nat. median
$619,808
0.7× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 23 $2,701.00 $1,658,155.20 $279,936.65 nat. median
$370,174
0.8× median
5834
APR_DRG 		Neonate With Ecmo 13 $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 $1,238,504.77 $213,457.30 nat. median
$265,286
0.8× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 1 $192,914.70 $192,914.70 $192,914.70 nat. median
$76,329
outlier · 2.5×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 23 $2,837.00 $1,043,115.24 $179,486.78 nat. median
$206,474
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
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 $173,512.94 $173,512.94 $173,512.94 nat. median
$62,507
outlier · 2.8×
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 23 $2,837.00 $942,307.32 $162,622.27 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×
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 13 $125,393.00 $188,089.50 $150,471.60 nat. median
$246,434
0.6× median
1907
OTHER 		New Technology - Level 52 18 $144,393.10 $176,807.88 $150,286.70 nat. median
$153,199
1.0× median
1908
OTHER 		New Technology - Level 52 18 $144,393.10 $176,807.88 $150,286.70 nat. median
$152,962
1.0× median
5833
APR_DRG 		Neonate With Ecmo 13 $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
1905
OTHER 		New Technology - Level 51 18 $130,190.55 $159,417.00 $135,504.45 nat. median
$137,903
1.0× median
1906
OTHER 		New Technology - Level 51 18 $130,190.55 $159,417.00 $135,504.45 nat. median
$138,020
1.0× median
24
APR_DRG 		Heart And/or Lung Transplant 13 $111,047.00 $166,570.50 $133,256.40 nat. median
$234,729
0.6× 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 30,351 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
             
9138 OTHER Inj, Hemgenix, Per Tx Dos 21 18 — — $3,599,442.00 $4,407,480.00 $3,746,358.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 21 18 — — $3,532,900.00 $4,326,000.00 $3,677,100.00 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
714 OTHER Inj Delandistrogene Mox R 22 18 — — $5,280.60 $3,990,546.00 $3,391,964.10 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 22 18 — — $8,710.34 $3,943,200.00 $3,351,720.00 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
746 OTHER Inj, Betibeglogene Autote 22 18 — — $7,736.51 $3,561,600.00 $3,027,360.00 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
9141 OTHER Inj Onase Abepar-xioi Tre 21 18 — — $2,340,841.72 $2,866,336.80 $2,436,386.28 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
9194 OTHER Tisagenlecleucel Car-pos 21 18 — — $518,609.04 $635,031.48 $539,776.76 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 21 18 — — $516,580.93 $632,548.08 $537,665.87 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 21 18 — — $516,055.85 $631,905.12 $537,119.35 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 21 18 — — $506,391.58 $620,071.32 $527,060.62 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
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 5 3 — — $502,693.77 $1,387,149.28 $502,693.77 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $501,224.32 $501,224.32 $501,224.32 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 21 18 — — $479,666.88 $587,347.20 $499,245.12 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 5 3 — — $492,271.12 $1,345,370.55 $492,271.12 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $474,772.32 $474,772.32 $474,772.32 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 5 3 — — $470,149.30 $1,334,154.50 $470,149.30 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 21 18 — — $451,319.79 $552,636.48 $469,741.01 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 5 3 — — $459,839.17 $1,315,434.06 $459,839.17 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $446,714.49 $446,714.49 $446,714.49 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 5 3 — — $445,599.57 $1,296,212.81 $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 $1,191,016.00 $435,956.80 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 44 23 — — $2,701.00 $1,658,155.20 $279,936.65 2024-10-01
5834 APR_DRG Neonate With Ecmo 16 13 — — $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 45 23 — — $2,837.00 $1,238,504.77 $213,457.30 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 1 1 — — $192,914.70 $192,914.70 $192,914.70 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 46 23 — — $2,837.00 $1,043,115.24 $179,486.78 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
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 1 — — $173,512.94 $173,512.94 $173,512.94 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 46 23 — — $2,837.00 $942,307.32 $162,622.27 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
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 16 13 — — $125,393.00 $188,089.50 $150,471.60 2024-10-01
1907 OTHER New Technology - Level 52 21 18 — — $144,393.10 $176,807.88 $150,286.70 2024-10-01
1908 OTHER New Technology - Level 52 21 18 — — $144,393.10 $176,807.88 $150,286.70 2024-10-01
5833 APR_DRG Neonate With Ecmo 16 13 — — $124,517.00 $186,775.50 $149,420.40 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
01908 OTHER New Technology - Level 52 1 1 — — $142,919.70 $142,919.70 $142,919.70 2024-10-01
01907 OTHER New Technology - Level 52 1 1 — — $142,919.70 $142,919.70 $142,919.70 2024-10-01
1905 OTHER New Technology - Level 51 21 18 — — $130,190.55 $159,417.00 $135,504.45 2024-10-01
1906 OTHER New Technology - Level 51 21 18 — — $130,190.55 $159,417.00 $135,504.45 2024-10-01
24 APR_DRG Heart And/or Lung Transplant 16 13 — — $111,047.00 $166,570.50 $133,256.40 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
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 1 — — $123,321.96 $123,321.96 $123,321.96 2024-10-01
1904 OTHER New Technology - Level 50 21 18 — — $115,988.00 $142,026.12 $120,722.20 2024-10-01
1903 OTHER New Technology - Level 50 21 18 — — $115,988.00 $142,026.12 $120,722.20 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
459 MS_DRG Spinal Fusion Except Cervical With Mcc 4 2 — — $93,485.00 $122,984.00 $118,877.00 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 16 13 — — $97,644.00 $146,466.00 $117,172.80 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
5832 APR_DRG Neonate With Ecmo 16 13 — — $95,607.00 $143,410.50 $114,728.40 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 16 13 — — $95,167.00 $142,750.50 $114,200.40 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 16 13 — — $91,470.00 $137,205.00 $109,764.00 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 16 13 — — $90,217.00 $135,325.50 $108,260.40 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 4 2 — — $74,602.00 $118,877.00 $108,166.50 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
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 46 23 — — $2,837.00 $621,270.66 $107,263.29 2024-10-01
1902 OTHER New Technology - Level 49 21 18 — — $101,785.45 $124,635.24 $105,939.95 2024-10-01
1901 OTHER New Technology - Level 49 21 18 — — $101,785.45 $124,635.24 $105,939.95 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 22 18 — — $96,999.90 $119,999.88 $101,999.90 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
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 2 2 — — $53,789.99 $147,108.87 $100,449.43 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 44 23 — — $2,701.00 $576,059.67 $99,764.92 2024-10-01
7 MS_DRG Lung Transplant 44 23 — — $2,837.00 $574,608.63 $99,515.89 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 16 13 — — $82,446.00 $123,669.00 $98,935.20 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 16 13 — — $81,552.00 $122,328.00 $97,862.40 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 16 13 — — $80,942.00 $121,413.00 $97,130.40 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 3 1 — — $68,358.00 $96,349.00 $96,349.00 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 3 1 — — $68,358.00 $96,349.00 $96,349.00 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 16 13 — — $79,657.00 $119,485.50 $95,588.40 2024-10-01
1599 OTHER New Technology - Level 48 21 18 — — $89,949.97 $110,142.82 $93,621.39 2024-10-01
1585 OTHER New Technology - Level 48 21 18 — — $89,949.97 $110,142.82 $93,621.39 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 3 1 — — $66,124.00 $93,198.00 $93,198.00 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 3 1 — — $66,124.00 $93,198.00 $93,198.00 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 22 18 — — $88,300.94 $109,238.28 $92,852.54 2024-10-01
74 APR_DRG Allogeneic Bone Marrow Transplant 16 13 — — $75,611.00 $113,416.50 $90,733.20 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 16 13 — — $75,232.00 $112,848.00 $90,278.40 2024-10-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 3 1 — — $63,181.00 $89,052.00 $89,052.00 2024-10-01
247 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 3 1 — — $63,181.00 $89,052.00 $89,052.00 2024-10-01
01585 OTHER New Technology - Level 48 1 1 — — $89,032.11 $89,032.11 $89,032.11 2024-10-01
01599 OTHER New Technology - Level 48 1 1 — — $89,032.11 $89,032.11 $89,032.11 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 16 13 — — $73,863.00 $110,794.50 $88,635.60 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 3 1 — — $62,687.00 $88,354.00 $88,354.00 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 3 1 — — $62,687.00 $88,354.00 $88,354.00 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 16 13 — — $71,560.00 $107,340.00 $85,872.00 2024-10-01
215 MS_DRG Other Heart Assist System Implant 45 24 — — $10,799.00 $465,837.57 $84,380.21 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
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 45 23 — — $2,837.00 $484,547.23 $84,059.06 2024-10-01
1584 OTHER New Technology - Level 47 21 18 — — $80,481.61 $98,548.91 $83,766.57 2024-10-01
1598 OTHER New Technology - Level 47 21 18 — — $80,481.61 $98,548.91 $83,766.57 2024-10-01
5831 APR_DRG Neonate With Ecmo 16 13 — — $69,493.00 $104,239.50 $83,391.60 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 45 24 — — $2,837.00 $478,980.50 $83,103.68 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 16 13 — — $68,321.00 $102,481.50 $81,985.20 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 44 23 — — $2,837.00 $468,229.59 $81,258.55 2024-10-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 16 13 — — $67,242.00 $100,863.00 $80,690.40 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 16 13 — — $66,782.00 $100,173.00 $80,138.40 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 45 24 — — $10,799.00 $460,886.43 $79,998.28 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
1613 APR_DRG Implantable Heart Assist Systems 16 13 — — $64,392.00 $96,588.00 $77,270.40 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 43 24 — — $10,799.00 $185,584.09 $76,588.73 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
0207 RC — 10 9 — — $11,700.00 $75,194.50 $75,194.50 2024-10-01
23 APR_DRG Heart And/or Lung Transplant 16 13 — — $62,352.00 $93,528.00 $74,822.40 2024-10-01
1583 OTHER New Technology - Level 46 21 18 — — $71,013.23 $86,954.98 $73,911.73 2024-10-01
1597 OTHER New Technology - Level 46 21 18 — — $71,013.23 $86,954.98 $73,911.73 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 16 13 — — $61,338.00 $92,007.00 $73,605.60 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 16 13 — — $59,125.00 $88,687.50 $70,950.00 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 47 24 — — $2,837.00 $405,030.07 $70,411.91 2024-10-01
01597 OTHER New Technology - Level 46 1 1 — — $70,288.61 $70,288.61 $70,288.61 2024-10-01
01583 OTHER New Technology - Level 46 1 1 — — $70,288.61 $70,288.61 $70,288.61 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 16 13 — — $56,946.00 $85,419.00 $68,335.20 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 45 24 — — $10,799.00 $372,583.87 $67,676.28 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
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 22 18 — — $63,895.55 $79,046.04 $67,189.13 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 21 18 — — $64,167.05 $78,571.90 $66,786.11 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 43 24 — — $10,799.00 $372,372.81 $66,694.68 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 16 13 — — $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… 16 13 — — $54,849.00 $82,273.50 $65,818.80 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 45 24 — — $10,799.00 $366,718.14 $65,076.15 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 22 18 — — $12,654.78 $76,025.72 $64,621.87 2024-10-01
1582 OTHER New Technology - Level 45 21 18 — — $61,544.86 $75,361.06 $64,056.90 2024-10-01
1596 OTHER New Technology - Level 45 21 18 — — $61,544.86 $75,361.06 $64,056.90 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 45 24 — — $10,799.00 $354,428.25 $63,525.24 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $63,512.28 $63,512.28 $63,512.28 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 45 24 — — $10,799.00 $173,955.00 $62,496.87 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $62,431.63 $62,431.63 $62,431.63 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 1 1 — — $62,320.47 $62,320.47 $62,320.47 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 16 13 — — $51,688.00 $77,532.00 $62,025.60 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 43 24 — — $10,799.00 $173,965.00 $61,876.22 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 5 3 — — $61,600.24 $168,273.22 $61,600.24 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 16 13 — — $51,226.00 $76,839.00 $61,471.20 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $61,454.13 $61,454.13 $61,454.13 2024-10-01
10 MS_DRG Pancreas Transplant 44 23 — — $2,837.00 $350,563.19 $61,064.01 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
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 45 24 — — $2,837.00 $348,544.93 $60,717.62 2024-10-01
249 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc 3 1 — — $42,484.00 $59,879.00 $59,879.00 2024-10-01
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 3 1 — — $42,484.00 $59,879.00 $59,879.00 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 16 13 — — $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 16 13 — — $48,983.00 $73,474.50 $58,779.60 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 16 13 — — $48,895.00 $73,342.50 $58,674.00 2024-10-01
64 APR_DRG Pancreas Transplant 16 13 — — $48,372.00 $72,558.00 $58,046.40 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
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 47 24 — — $2,837.00 $328,186.35 $57,223.59 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 16 13 — — $47,538.00 $71,307.00 $57,045.60 2024-10-01
8514 APR_DRG Gender Related Procedures 16 13 — — $46,902.00 $70,353.00 $56,282.40 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 21 18 — — $53,914.93 $66,018.28 $56,115.53 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 45 24 — — $10,799.00 $312,136.94 $56,055.58 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 16 13 — — $46,525.00 $69,787.50 $55,830.00 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 43 24 — — $10,799.00 $310,721.07 $55,805.50 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
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 16 13 — — $46,203.00 $69,304.50 $55,443.60 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
22 APR_DRG Heart And/or Lung Transplant 16 13 — — $45,376.00 $68,064.00 $54,451.20 2024-10-01
1595 OTHER New Technology - Level 44 21 18 — — $52,076.49 $63,767.14 $54,202.07 2024-10-01
1581 OTHER New Technology - Level 44 21 18 — — $52,076.49 $63,767.14 $54,202.07 2024-10-01
B0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 5 4 — — $44,083.60 $56,482.11 $54,002.41 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 16 13 — — $44,835.00 $67,252.50 $53,802.00 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 45 24 — — $10,799.00 $173,955.00 $53,450.21 2024-10-01
B0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 5 4 — — $43,630.84 $55,902.02 $53,447.78 2024-10-01
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $53,364.77 $53,364.77 $53,364.77 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 45 24 — — $10,799.00 $164,024.96 $52,991.75 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 47 24 — — $2,837.00 $300,229.59 $52,425.50 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 16 13 — — $43,677.00 $65,515.50 $52,412.40 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 16 13 — — $43,560.00 $65,340.00 $52,272.00 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 45 24 — — $10,799.00 $90,407.00 $51,840.75 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 43 24 — — $10,799.00 $185,584.09 $51,797.78 2024-10-01
01595 OTHER New Technology - Level 44 1 1 — — $51,545.10 $51,545.10 $51,545.10 2024-10-01
01581 OTHER New Technology - Level 44 1 1 — — $51,545.10 $51,545.10 $51,545.10 2024-10-01
B0106 OTHER Stroke; M > 30.05 & M < 34.25 5 4 — — $42,041.14 $53,865.21 $51,500.39 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $51,453.49 $51,453.49 $51,453.49 2024-10-01
5244 OTHER Level 4 Blood Product Exc 21 18 — — $49,298.17 $60,365.10 $51,310.33 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 46 23 — — $2,837.00 $293,660.32 $51,173.53 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 16 13 — — $42,035.00 $63,052.50 $50,442.00 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 16 13 — — $41,957.00 $62,935.50 $50,348.40 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 16 13 — — $41,876.00 $62,814.00 $50,251.20 2024-10-01
21 APR_DRG Heart And/or Lung Transplant 16 13 — — $41,730.00 $62,595.00 $50,076.00 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
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 47 24 — — $2,701.00 $284,391.24 $49,707.23 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
232 MS_DRG Coronary Bypass With Ptca Without Mcc 45 24 — — $10,799.00 $268,588.06 $49,048.19 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 45 24 — — $10,799.00 $269,836.84 $49,042.70 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 45 24 — — $10,799.00 $267,304.11 $48,818.20 2024-10-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $48,795.12 $48,795.12 $48,795.12 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
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 47 24 — — $2,837.00 $278,068.21 $48,622.04 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 45 24 — — $10,799.00 $272,356.37 $48,566.83 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 22 18 — — $46,068.21 $56,991.60 $48,442.86 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 43 24 — — $10,799.00 $228,127.04 $48,119.57 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 47 24 — — $2,837.00 $272,004.61 $48,043.32 2024-10-01
C0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 5 4 — — $39,203.10 $50,228.97 $48,023.80 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 16 13 — — $39,878.00 $59,817.00 $47,853.60 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 43 24 — — $10,799.00 $185,584.09 $47,794.29 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 45 24 — — $10,799.00 $173,955.00 $47,279.96 2024-10-01
B0205 OTHER Traumatic Brain Injury; M > 28.75 & M < 40.65 5 4 — — $38,165.96 $48,900.13 $46,753.30 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 16 13 — — $38,906.00 $58,359.00 $46,687.20 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 31 20 — — $42,697.00 $140,902.44 $46,651.25 2024-10-01
D0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 5 4 — — $38,056.02 $48,759.28 $46,618.63 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 47 24 — — $2,837.00 $270,764.62 $46,448.78 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 44 23 — — $2,701.00 $286,226.88 $46,445.61 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 44 23 — — $2,701.00 $286,226.88 $46,445.61 2024-10-01
1142 OTHER Supprelin La Implant 21 18 — — $44,443.21 $54,420.25 $46,257.21 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 43 24 — — $10,799.00 $252,349.57 $46,139.48 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 45 24 — — $10,799.00 $250,841.36 $45,869.34 2024-10-01
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 1 1 — — $45,738.60 $45,738.60 $45,738.60 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 16 13 — — $37,904.00 $56,856.00 $45,484.80 2024-10-01
B0105 OTHER Stroke; M > 34.25 & M < 38.85 5 4 — — $36,962.47 $47,358.16 $45,279.02 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
84 APR_DRG Autologous Bone Marrow Transplant 16 13 — — $37,476.00 $56,214.00 $44,971.20 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 47 24 — — $2,837.00 $255,994.76 $44,833.68 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
C0106 OTHER Stroke; M > 30.05 & M < 34.25 5 4 — — $36,460.53 $46,715.06 $44,664.15 2024-10-01
B1903 OTHER Guillian Barre; M < 18.05 5 4 — — $36,327.45 $46,544.55 $44,501.13 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 45 24 — — $10,799.00 $243,040.91 $44,472.08 2024-10-01
1594 OTHER New Technology - Level 43 21 18 — — $42,608.13 $52,173.22 $44,347.23 2024-10-01
1580 OTHER New Technology - Level 43 21 18 — — $42,608.13 $52,173.22 $44,347.23 2024-10-01
73 APR_DRG Allogeneic Bone Marrow Transplant 16 13 — — $36,953.00 $55,429.50 $44,343.60 2024-10-01
B0604 OTHER Neurological; M < 25.85 5 4 — — $36,023.69 $46,155.35 $44,129.02 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 45 24 — — $10,799.00 $242,069.15 $44,091.98 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
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 45 24 — — $10,799.00 $240,525.77 $43,816.81 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
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 5 3 — — $43,241.44 $117,019.36 $43,241.44 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 47 24 — — $2,837.00 $245,103.15 $42,964.40 2024-10-01
B0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 5 4 — — $35,057.42 $44,917.33 $42,945.34 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 45 24 — — $10,799.00 $173,955.00 $42,838.56 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
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 43 24 — — $10,799.00 $173,965.00 $42,652.68 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 47 24 — — $2,701.00 $243,023.32 $42,607.44 2024-10-01
4404 APR_DRG Kidney Transplant 16 13 — — $35,422.00 $53,133.00 $42,506.40 2024-10-01
A0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 5 4 — — $34,580.08 $44,305.73 $42,360.60 2024-10-01
A5104 OTHER Expired, Not Orthopedic, Length Of Stay Is 16 Days 5 4 — — $34,475.93 $44,172.29 $42,233.02 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
8634 APR_DRG Neonatal Aftercare 16 13 — — $35,009.00 $52,513.50 $42,010.80 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 44 23 — — $2,837.00 $239,237.42 $41,957.69 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 47 24 — — $2,837.00 $238,692.18 $41,864.11 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 47 24 — — $2,837.00 $237,474.18 $41,655.07 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 47 24 — — $2,837.00 $237,249.93 $41,616.58 2024-10-01
C0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 5 4 — — $33,943.62 $43,490.26 $41,580.93 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 45 24 — — $10,799.00 $173,955.00 $41,364.91 2024-10-01
B0704 OTHER Fracture Of Lower Extremity; M < 28.15 5 4 — — $33,664.44 $43,132.57 $41,238.94 2024-10-01
63 APR_DRG Pancreas Transplant 16 13 — — $34,364.00 $51,546.00 $41,236.80 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
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 16 13 — — $34,228.00 $51,342.00 $41,073.60 2024-10-01
B2102 OTHER Burns; M=12-45 5 4 — — $33,524.13 $42,952.79 $41,067.06 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 45 24 — — $10,799.00 $76,544.00 $41,061.68 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 16 13 — — $34,068.00 $51,102.00 $40,881.60 2024-10-01
D0106 OTHER Stroke; M > 30.05 & M < 34.25 5 4 — — $33,318.73 $42,689.62 $40,815.44 2024-10-01
B1004 OTHER Amputation, Lower Extremity; M=39-45 5 4 — — $33,285.46 $42,646.99 $40,774.69 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 47 24 — — $2,837.00 $237,219.15 $40,399.32 2024-10-01
B1504 OTHER Pulmonary; M < 29.15 5 4 — — $32,899.24 $42,152.16 $40,301.57 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 45 24 — — $10,799.00 $173,955.00 $40,184.26 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 47 24 — — $2,837.00 $127,286.00 $40,146.92 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 45 24 — — $10,799.00 $219,982.52 $39,778.87 2024-10-01
G0448 HCPCS Insertion Or Replacement Of A Permanent Pacing Cardioverter-defibrillator System… 11 5 — — $4,011.00 $46,059.00 $39,626.00 2024-10-01
4A020N8 OTHER Measurement Of Cardiac Sampling And Pressure, Bilateral, Open Approach 2 1 — — $39,620.00 $39,620.00 $39,620.00 2024-10-01
4A023N7 OTHER Measurement Of Cardiac Sampling And Pressure, Left Heart, Percutaneous Approach 2 1 — — $39,620.00 $39,620.00 $39,620.00 2024-10-01
4A020N7 OTHER Measurement Of Cardiac Sampling And Pressure, Left Heart, Open Approach 2 1 — — $39,620.00 $39,620.00 $39,620.00 2024-10-01
4A020N6 OTHER Measurement Of Cardiac Sampling And Pressure, Right Heart, Open Approach 2 1 — — $39,620.00 $39,620.00 $39,620.00 2024-10-01
4A023N6 OTHER Measurement Of Cardiac Sampling And Pressure, Right Heart, Percutaneous Approach… 2 1 — — $39,620.00 $39,620.00 $39,620.00 2024-10-01
4A023N8 OTHER Measurement Of Cardiac Sampling And Pressure, Bilateral, Percutaneous Approach 2 1 — — $39,620.00 $39,620.00 $39,620.00 2024-10-01
B1704 OTHER Major Multiple Trauma,no Brain Or Spinal Cord Inju 5 4 — — $32,319.20 $41,408.97 $39,591.02 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
B2005 OTHER Miscellaneous; M=12-32 And A Tm81 5 4 — — $32,129.70 $41,166.18 $39,358.89 2024-10-01
D0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 5 4 — — $32,067.50 $41,086.49 $39,282.69 2024-10-01
C0105 OTHER Stroke; M > 34.25 & M < 38.85 5 4 — — $32,055.93 $41,071.66 $39,268.52 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 47 24 — — $2,837.00 $223,315.52 $39,225.09 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 45 24 — — $10,799.00 $100,415.00 $39,192.64 2024-10-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 22 18 — — $37,140.82 $45,947.40 $39,055.29 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 47 24 — — $2,837.00 $221,459.94 $38,906.62 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 16 13 — — $32,422.00 $48,633.00 $38,906.40 2024-10-01
A0106 OTHER Stroke; M > 30.05 & M < 34.25 5 4 — — $31,752.17 $40,682.46 $38,896.40 2024-10-01
245 MS_DRG Aicd Generator Procedures 45 24 — — $10,799.00 $214,864.29 $38,874.87 2024-10-01
B1204 OTHER Osteoarthritis; M=39-47 5 4 — — $31,587.27 $40,471.18 $38,694.40 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 47 24 — — $2,701.00 $220,154.00 $38,682.49 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 47 24 — — $2,837.00 $219,920.96 $38,642.50 2024-10-01
C0205 OTHER Traumatic Brain Injury; M > 28.75 & M < 40.65 5 4 — — $31,433.94 $40,274.73 $38,506.57 2024-10-01
B0504 OTHER Nontraumatic Spinal Cord Injury; M > 29.25 & M < 3 5 4 — — $31,399.22 $40,230.25 $38,464.05 2024-10-01
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 22 18 — — $36,570.46 $45,241.80 $38,455.53 2024-10-01
B0304 OTHER Nontraumatic Brain Injury; M < 26.15 5 4 — — $31,274.82 $40,070.87 $38,311.66 2024-10-01
C0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 5 4 — — $31,176.46 $39,944.84 $38,191.16 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 16 13 — — $31,789.00 $47,683.50 $38,146.80 2024-10-01
B1404 OTHER Cardiac; M < 31.15 5 4 — — $31,039.04 $39,768.77 $38,022.83 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 43 24 — — $10,799.00 $173,965.00 $37,990.73 2024-10-01
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