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 ORANGE PARK HOSPITAL

Orange Park, FL · CCN 100226 · Rates published

Your selected procedure

You selected 45378 (CPT)

Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

This hospital’s price: $2,730 across 12 payers · range $1,161-$14,343

Source: https://www.hcadam.com/api/public/content/32b081c08103459ea754d05492d4b3ca?download=true · observed 2026-03-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

31,553 distinct procedures filed
57 distinct payers
1,930,141 rate rows
2024-10-01 last MRF observed · ⚠ 24 mo old
Data quality

1,856,718 of 1,930,141 rate rows are consumer-grade (96.2%)

73,423 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
per-diem day rate — not a per-procedure price 19,607
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 16,963
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 16,741
exceeds 10× this hospital's gross charge — excluded from medians 11,133
template filing: same amount across many unrelated codes — excluded 7,554
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 989
placeholder amount (≤ $0.02) — excluded from medians 213
percent-of-charges filed in the dollar field — excluded from medians 165
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 58

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 24 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.hcadam.com/api/public/content/32b081c08103459ea754d05492d4b3ca?download=true
Found on page https://www.hcafloridahealthcare.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-09-21
Content fingerprint 25aeb2e97d23788e… · 464,888,548 bytes · first seen 2026-05-09

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
$2,968,000
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
$2,455,111
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 20 $2,938,320.00 $4,591,125.00 $3,691,264.50 nat. median
$3,765,001
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,672,900.00 $3,672,900.00 $3,672,900.00 nat. median
$3,562,713
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 20 $2,884,000.00 $4,506,250.00 $3,623,025.00 nat. median
$3,677,100
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $3,605,000.00 $3,605,000.00 $3,605,000.00 nat. median
$3,496,850
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 20 $5,015.74 $4,156,818.75 $3,342,082.27 nat. median
$3,391,964
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,325,455.00 $3,325,455.00 $3,325,455.00 nat. median
$3,225,691
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 20 $8,273.46 $4,107,500.00 $3,302,430.00 nat. median
$3,351,720
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,286,000.00 $3,286,000.00 $3,286,000.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 20 $7,348.47 $3,710,000.00 $2,982,840.00 nat. median
$3,001,835
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,968,000.00 $2,968,000.00 $2,968,000.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 20 $1,910,891.20 $2,985,767.50 $2,400,557.07 nat. median
$2,508,045
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,388,614.00 $2,388,614.00 $2,388,614.00 nat. median
$2,316,956
1.0× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 $518,241.00 $863,696.72 $690,968.86 nat. median
$621,313
1.1× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $507,496.00 $837,683.55 $672,589.78 nat. median
$599,737
1.1× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $484,690.00 $830,699.97 $657,694.98 nat. median
$574,037
1.1× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $474,061.00 $819,043.85 $646,552.43 nat. median
$579,571
1.1× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 3 $459,381.00 $807,075.90 $633,228.45 nat. median
$562,501
1.1× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $449,440.00 $741,576.00 $595,508.00 nat. median
$513,770
1.2× median
9194
OTHER 		Tisagenlecleucel Car-pos 20 $423,354.32 $661,491.13 $531,838.86 nat. median
$555,653
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 20 $421,698.72 $658,904.25 $529,759.02 nat. median
$553,480
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 20 $421,270.08 $658,234.50 $529,220.54 nat. median
$552,917
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $529,192.90 $529,192.90 $529,192.90 nat. median
$513,317
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $527,123.40 $527,123.40 $527,123.40 nat. median
$511,310
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $526,587.60 $526,587.60 $526,587.60 nat. median
$510,790
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 20 $413,380.88 $645,907.63 $519,309.73 nat. median
$542,562
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $516,726.10 $516,726.10 $516,726.10 nat. median
$501,224
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 20 $391,564.80 $611,820.00 $491,903.28 nat. median
$513,929
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $489,456.00 $489,456.00 $489,456.00 nat. median
$474,772
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 20 $368,424.32 $575,663.00 $462,833.05 nat. median
$483,557
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $460,530.40 $460,530.40 $460,530.40 nat. median
$446,714
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 28 $6,604.00 $426,229.75 $340,983.80 nat. median
$168,055
outlier · 2.0×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 29 $8,700.00 $582,560.00 $256,314.90 nat. median
$186,516
1.4× median
5834
APR_DRG 		Neonate With Ecmo 14 $192,207.00 $288,310.50 $230,648.40 nat. median
$390,362
0.6× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 27 $8,700.00 $353,785.88 $216,099.22 nat. median
$131,925
1.6× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 28 $8,700.00 $502,317.65 $196,322.49 nat. median
$145,435
1.3× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $170,012.99 $170,012.99 $170,012.99 nat. median
$177,883
1.0× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 14 $125,393.00 $188,089.50 $150,471.60 nat. median
$286,698
0.5× median
5833
APR_DRG 		Neonate With Ecmo 14 $124,517.00 $186,775.50 $149,420.40 nat. median
$268,208
0.6× median
1907
OTHER 		New Technology - Level 52 21 $117,871.92 $184,174.88 $148,076.60 nat. median
$149,948
1.0× median
1908
OTHER 		New Technology - Level 52 21 $117,871.92 $184,174.88 $148,076.60 nat. median
$149,948
1.0× median
01908
OTHER 		New Technology - Level 52 2 $147,339.90 $147,339.90 $147,339.90 nat. median
$145,788
1.0× median
01907
OTHER 		New Technology - Level 52 2 $147,339.90 $147,339.90 $147,339.90 nat. median
$145,788
1.0× median
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $140,285.74 $140,285.74 $140,285.74 nat. median
$149,977
0.9× median
1905
OTHER 		New Technology - Level 51 21 $106,278.00 $166,059.38 $133,511.74 nat. median
$135,199
1.0× median
1906
OTHER 		New Technology - Level 51 21 $106,278.00 $166,059.38 $133,511.74 nat. median
$135,199
1.0× median
24
APR_DRG 		Heart And/or Lung Transplant 14 $111,047.00 $166,570.50 $133,256.40 nat. median
$225,531
0.6× median
01906
OTHER 		New Technology - Level 51 2 $132,847.50 $132,847.50 $132,847.50 nat. median
$131,449
1.0× median
01905
OTHER 		New Technology - Level 51 2 $132,847.50 $132,847.50 $132,847.50 nat. median
$131,449
1.0× median

Other procedures at this hospital

Browse this hospital's 31,553 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 27 20 — — $2,938,320.00 $4,591,125.00 $3,691,264.50 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $3,672,900.00 $3,672,900.00 $3,672,900.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 27 20 — — $2,884,000.00 $4,506,250.00 $3,623,025.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 2 2 — — $3,605,000.00 $3,605,000.00 $3,605,000.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 28 20 — — $5,015.74 $4,156,818.75 $3,342,082.27 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $3,325,455.00 $3,325,455.00 $3,325,455.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 28 20 — — $8,273.46 $4,107,500.00 $3,302,430.00 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 2 2 — — $3,286,000.00 $3,286,000.00 $3,286,000.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 28 20 — — $7,348.47 $3,710,000.00 $2,982,840.00 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 2 2 — — $2,968,000.00 $2,968,000.00 $2,968,000.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 27 20 — — $1,910,891.20 $2,985,767.50 $2,400,557.07 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $2,388,614.00 $2,388,614.00 $2,388,614.00 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 3 — — $518,241.00 $863,696.72 $690,968.86 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 3 — — $507,496.00 $837,683.55 $672,589.78 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 3 — — $484,690.00 $830,699.97 $657,694.98 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 3 — — $474,061.00 $819,043.85 $646,552.43 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 3 — — $459,381.00 $807,075.90 $633,228.45 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 3 — — $449,440.00 $741,576.00 $595,508.00 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 27 20 — — $423,354.32 $661,491.13 $531,838.86 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 27 20 — — $421,698.72 $658,904.25 $529,759.02 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 27 20 — — $421,270.08 $658,234.50 $529,220.54 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $529,192.90 $529,192.90 $529,192.90 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 2 2 — — $527,123.40 $527,123.40 $527,123.40 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 2 2 — — $526,587.60 $526,587.60 $526,587.60 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 27 20 — — $413,380.88 $645,907.63 $519,309.73 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 2 2 — — $516,726.10 $516,726.10 $516,726.10 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 27 20 — — $391,564.80 $611,820.00 $491,903.28 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $489,456.00 $489,456.00 $489,456.00 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 27 20 — — $368,424.32 $575,663.00 $462,833.05 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $460,530.40 $460,530.40 $460,530.40 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 49 28 — — $6,604.00 $426,229.75 $340,983.80 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 51 29 — — $8,700.00 $582,560.00 $256,314.90 2024-10-01
5834 APR_DRG Neonate With Ecmo 17 14 — — $192,207.00 $288,310.50 $230,648.40 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 50 27 — — $8,700.00 $353,785.88 $216,099.22 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 51 28 — — $8,700.00 $502,317.65 $196,322.49 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $170,012.99 $170,012.99 $170,012.99 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
1907 OTHER New Technology - Level 52 28 21 — — $117,871.92 $184,174.88 $148,076.60 2024-10-01
1908 OTHER New Technology - Level 52 28 21 — — $117,871.92 $184,174.88 $148,076.60 2024-10-01
01908 OTHER New Technology - Level 52 2 2 — — $147,339.90 $147,339.90 $147,339.90 2024-10-01
01907 OTHER New Technology - Level 52 2 2 — — $147,339.90 $147,339.90 $147,339.90 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $140,285.74 $140,285.74 $140,285.74 2024-10-01
1906 OTHER New Technology - Level 51 28 21 — — $106,278.00 $166,059.38 $133,511.74 2024-10-01
1905 OTHER New Technology - Level 51 28 21 — — $106,278.00 $166,059.38 $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
01905 OTHER New Technology - Level 51 2 2 — — $132,847.50 $132,847.50 $132,847.50 2024-10-01
01906 OTHER New Technology - Level 51 2 2 — — $132,847.50 $132,847.50 $132,847.50 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 51 28 — — $8,700.00 $301,484.83 $129,273.75 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
429019 CDM Tavr Cardio Bypass Supp 23 17 $245,238.84 $245,238.84 $12,997.66 $245,238.84 $122,619.42 2024-10-01
429868 CDM Ins Perm Subq Defib 23 17 $240,995.52 $240,995.52 $12,772.76 $240,995.52 $120,497.76 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 2 1 — — $120,116.70 $120,116.70 $120,116.70 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 49 29 — — $6,604.00 $282,774.55 $119,968.26 2024-10-01
7 MS_DRG Lung Transplant 49 29 — — $8,700.00 $238,536.59 $119,669.67 2024-10-01
1903 OTHER New Technology - Level 50 28 21 — — $94,684.08 $147,943.88 $118,946.88 2024-10-01
1904 OTHER New Technology - Level 50 28 21 — — $94,684.08 $147,943.88 $118,946.88 2024-10-01
420812 CDM Ins/rep Aicd Sngl/dual 23 17 $236,885.04 $236,885.04 $12,554.91 $236,885.04 $118,442.52 2024-10-01
01903 OTHER New Technology - Level 50 2 2 — — $118,355.10 $118,355.10 $118,355.10 2024-10-01
01904 OTHER New Technology - Level 50 2 2 — — $118,355.10 $118,355.10 $118,355.10 2024-10-01
425446 CDM Rem/repl Aicd Sing Ld 23 17 $236,348.28 $236,348.28 $12,526.46 $236,348.28 $118,174.14 2024-10-01
425445 CDM Insrt Aicd Only Mult Ld 23 17 $236,348.28 $236,348.28 $12,526.46 $236,348.28 $118,174.14 2024-10-01
425447 CDM Rem/repl Aicd Dual Ld 23 17 $236,348.28 $236,348.28 $12,526.46 $236,348.28 $118,174.14 2024-10-01
425448 CDM Rem/repl Aicd Mult Ld 23 17 $236,348.28 $236,348.28 $12,526.46 $236,348.28 $118,174.14 2024-10-01
425444 CDM Insrt Aicd Only Dual Ld 23 17 $236,348.28 $236,348.28 $12,526.46 $236,348.28 $118,174.14 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
1614 APR_DRG Implantable Heart Assist Systems 17 14 — — $95,167.00 $142,750.50 $114,200.40 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $113,874.68 $113,874.68 $113,874.68 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
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
1901 OTHER New Technology - Level 49 28 21 — — $83,090.16 $129,828.38 $104,382.01 2024-10-01
1902 OTHER New Technology - Level 49 28 21 — — $83,090.16 $129,828.38 $104,382.01 2024-10-01
01902 OTHER New Technology - Level 49 2 2 — — $103,862.70 $103,862.70 $103,862.70 2024-10-01
01901 OTHER New Technology - Level 49 2 2 — — $103,862.70 $103,862.70 $103,862.70 2024-10-01
428992 CDM Tavr/tavi/trans Exposure 23 17 $204,741.00 $204,741.00 $10,851.27 $204,741.00 $102,370.50 2024-10-01
429021 CDM Tavr/tavi Transaortic 23 17 $204,741.00 $204,741.00 $10,851.27 $204,741.00 $102,370.50 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 51 29 — — $8,700.00 $323,541.15 $101,636.10 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 29 21 — — $79,999.92 $124,999.88 $100,499.90 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 53 30 — — $8,700.00 $269,956.82 $100,484.60 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
215 MS_DRG Other Heart Assist System Implant 53 30 — — $10,799.00 $307,959.00 $98,734.00 2024-10-01
420809 CDM Ins/rep Aicd Sngl/dual 23 17 $196,956.36 $196,956.36 $10,438.69 $196,956.36 $98,478.18 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 49 29 — — $8,700.00 $287,413.90 $98,260.80 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
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 53 30 — — $10,799.00 $262,710.82 $96,741.89 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
429917 CDM Ins Icd Gen W/sngl Lead 23 17 $187,565.76 $187,565.76 $9,940.99 $187,565.76 $93,782.88 2024-10-01
1585 OTHER New Technology - Level 48 28 21 — — $73,428.54 $114,732.10 $92,244.61 2024-10-01
1599 OTHER New Technology - Level 48 28 21 — — $73,428.54 $114,732.10 $92,244.61 2024-10-01
969170 CDM Kit Cath Rt Heart 40 23 $352,887.00 $352,887.00 $15,000.00 $352,887.00 $92,103.51 2024-10-01
959463 CDM Pump Heart 21fr 85mm 40 23 $352,887.00 $352,887.00 $15,000.00 $352,887.00 $92,103.51 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
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 51 28 — — $57,011.00 $238,995.00 $91,830.87 2024-10-01
01585 OTHER New Technology - Level 48 2 2 — — $91,785.68 $91,785.68 $91,785.68 2024-10-01
01599 OTHER New Technology - Level 48 2 2 — — $91,785.68 $91,785.68 $91,785.68 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 29 21 — — $72,825.52 $113,789.88 $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
428541 CDM Tavr Pros Valve Faa 23 17 $173,242.80 $173,242.80 $9,181.87 $173,242.80 $86,621.40 2024-10-01
429022 CDM Tavr/tavi Perc Fem Aprch 23 17 $173,242.80 $173,242.80 $9,181.87 $173,242.80 $86,621.40 2024-10-01
429018 CDM Tavr/tavi Op Axl Art Apr 23 17 $173,242.80 $173,242.80 $9,181.87 $173,242.80 $86,621.40 2024-10-01
429020 CDM Tavr/tavi Opn Ili Art 23 17 $173,242.80 $173,242.80 $9,181.87 $173,242.80 $86,621.40 2024-10-01
432907 CDM Tmvi W/prosth Valve 22 16 $173,242.80 $173,242.80 $9,181.87 $173,242.80 $86,621.40 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
850 MS_DRG Acute Leukemia With Other Procedures 53 30 — — $8,700.00 $230,872.02 $84,766.43 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 4 3 — — $63,505.40 $104,773.89 $84,139.65 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 28 21 — — $65,699.27 $102,655.11 $82,534.71 2024-10-01
1598 OTHER New Technology - Level 47 28 21 — — $65,699.27 $102,655.11 $82,534.71 2024-10-01
932521 CDM Kit Vlv Aor 14fr 26mm 19 12 $105,300.00 $105,300.00 $5,580.90 $105,300.00 $82,134.00 2024-10-01
932522 CDM Kit Aor Vlv 14fr 29mm 19 12 $105,300.00 $105,300.00 $5,580.90 $105,300.00 $82,134.00 2024-10-01
957486 CDM Valve Heart Trnscth 20mm 19 12 $105,300.00 $105,300.00 $5,580.90 $105,300.00 $82,134.00 2024-10-01
962844 CDM Valve Heart Trnscth 20mm 19 12 $105,300.00 $105,300.00 $5,580.90 $105,300.00 $82,134.00 2024-10-01
934198 CDM Kit Aor Vlv 14fr 20mm 19 12 $105,300.00 $105,300.00 $5,580.90 $105,300.00 $82,134.00 2024-10-01
955702 CDM Valve Heart Trnscth 26mm 19 12 $105,300.00 $105,300.00 $5,580.90 $105,300.00 $82,134.00 2024-10-01
955592 CDM Valve Heart Trnscth 23mm 19 12 $105,300.00 $105,300.00 $5,580.90 $105,300.00 $82,134.00 2024-10-01
932520 CDM Valve 23mm Thv 19 12 $105,300.00 $105,300.00 $5,580.90 $105,300.00 $82,134.00 2024-10-01
939201 CDM Valve Hrt W Cert Sys 26a 19 12 $105,300.00 $105,300.00 $5,580.90 $105,300.00 $82,134.00 2024-10-01
01584 OTHER New Technology - Level 47 2 2 — — $82,124.09 $82,124.09 $82,124.09 2024-10-01
01598 OTHER New Technology - Level 47 2 2 — — $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
974863 CDM System Trcsd 1clip 1cath 19 12 $103,680.00 $103,680.00 $5,495.04 $103,680.00 $80,870.40 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
231 MS_DRG Coronary Bypass With Ptca With Mcc 50 28 — — $15,603.00 $184,696.62 $80,419.24 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
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $80,068.05 $80,068.05 $80,068.05 2024-10-01
975910 CDM Valve Tavr 29mm 19 12 $102,060.00 $102,060.00 $5,409.18 $102,060.00 $79,606.80 2024-10-01
975909 CDM Valve Tavr 34mm 19 12 $102,060.00 $102,060.00 $5,409.18 $102,060.00 $79,606.80 2024-10-01
975895 CDM Valve Tavr 26mm 19 12 $102,060.00 $102,060.00 $5,409.18 $102,060.00 $79,606.80 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 48 28 — — $15,603.00 $204,884.00 $78,433.09 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 17 14 — — $64,392.00 $96,588.00 $77,270.40 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 53 30 — — $10,799.00 $209,167.00 $77,263.43 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $76,785.37 $76,785.37 $76,785.37 2024-10-01
C1823 HCPCS Generator Pulse N-rechg 15 9 $95,580.00 $95,580.00 $12,425.40 $95,580.00 $76,464.00 2024-10-01
939548 CDM Valve Tavr 26mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
966990 CDM Valve Tavr Size 34mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
936629 CDM Valve Tavr 23mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
936627 CDM Valve Tavr 29mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
966992 CDM Valve Tavr Sz 26mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
936628 CDM Valve Tavr 26mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
939549 CDM Valve Tavr 29mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
936578 CDM Valve Tavr 34mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
966993 CDM Valve Tavr Sz 23mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
966991 CDM Valve Tavr Sz 29mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
939547 CDM Valve Tavr 23mm 19 12 $97,200.00 $97,200.00 $5,151.60 $97,200.00 $75,816.00 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 51 28 — — $51,800.00 $166,196.00 $75,366.81 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
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 51 30 — — $10,799.00 $197,802.00 $74,721.30 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $74,396.99 $74,396.99 $74,396.99 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 49 28 — — $52,805.03 $185,954.00 $73,911.03 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
10 MS_DRG Pancreas Transplant 49 29 — — $8,700.00 $144,902.50 $73,555.88 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 4 3 — — $55,453.60 $91,596.09 $73,524.85 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 50 29 — — $8,700.00 $146,373.76 $73,140.47 2024-10-01
1583 OTHER New Technology - Level 46 28 21 — — $57,969.98 $90,578.10 $72,824.79 2024-10-01
1597 OTHER New Technology - Level 46 28 21 — — $57,969.98 $90,578.10 $72,824.79 2024-10-01
01583 OTHER New Technology - Level 46 2 2 — — $72,462.48 $72,462.48 $72,462.48 2024-10-01
01597 OTHER New Technology - Level 46 2 2 — — $72,462.48 $72,462.48 $72,462.48 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $72,451.80 $72,451.80 $72,451.80 2024-10-01
C2642 HCPCS Brachytx Strnd Cesium131 90 9 $101,930.50 $101,930.50 $9,687.60 $168,480.00 $72,362.40 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
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 53 30 — — $8,700.00 $124,324.96 $68,950.21 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
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 50 28 — — $15,603.00 $179,140.00 $67,956.67 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… 29 21 — — $52,697.36 $82,339.63 $66,201.06 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 53 30 — — $10,799.00 $178,123.00 $65,973.47 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 28 21 — — $52,381.26 $81,845.73 $65,803.96 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 2 2 — — $65,476.58 $65,476.58 $65,476.58 2024-10-01
007 OTHER Lung Transplant 1 1 — — $64,191.07 $64,191.07 $64,191.07 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $64,074.62 $64,074.62 $64,074.62 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 53 30 — — $9,000.00 $80,049.65 $64,039.72 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 28 20 — — $12,020.06 $79,193.46 $63,671.54 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 53 30 — — $8,700.00 $175,377.82 $63,510.47 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 2 2 — — $63,354.77 $63,354.77 $63,354.77 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 51 28 — — $44,071.75 $183,345.67 $63,117.92 2024-10-01
1582 OTHER New Technology - Level 45 28 21 — — $50,240.70 $78,501.10 $63,114.88 2024-10-01
1596 OTHER New Technology - Level 45 28 21 — — $50,240.70 $78,501.10 $63,114.88 2024-10-01
489919 CDM Set Pump 21fr 5.0 40 23 $240,996.00 $240,996.00 $12,772.79 $240,996.00 $62,899.96 2024-10-01
01582 OTHER New Technology - Level 45 2 2 — — $62,800.88 $62,800.88 $62,800.88 2024-10-01
01596 OTHER New Technology - Level 45 2 2 — — $62,800.88 $62,800.88 $62,800.88 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 51 28 — — $34,816.95 $128,933.00 $62,663.20 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 51 28 — — $18,165.00 $168,142.00 $62,385.38 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 17 14 — — $51,688.00 $77,532.00 $62,025.60 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 50 27 — — $8,700.00 $106,466.86 $61,843.95 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
432992 CDM Transcath W Wir Sens Pa 23 17 $122,217.12 $122,217.12 $6,477.51 $122,217.12 $61,108.56 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 53 30 — — $6,604.00 $79,595.74 $59,637.96 2024-10-01
935485 CDM Strattice Tm 40x25cm 19 12 $76,361.00 $76,361.00 $4,047.13 $76,361.00 $59,561.58 2024-10-01
422893 CDM Cth Plc/inj R&lhc/grafts 22 16 $118,753.44 $118,753.44 $6,293.93 $118,753.44 $59,376.72 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $59,300.26 $59,300.26 $59,300.26 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
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 4 3 — — $44,578.80 $72,861.11 $58,719.96 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
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 53 30 — — $8,700.00 $112,983.50 $58,634.73 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 51 28 — — $40,602.61 $183,345.67 $58,265.93 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 53 30 — — $10,799.00 $225,375.49 $58,106.76 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 53 30 — — $10,799.00 $184,696.62 $58,093.52 2024-10-01
64 APR_DRG Pancreas Transplant 17 14 — — $48,372.00 $72,558.00 $58,046.40 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 53 30 — — $10,799.00 $153,422.00 $57,744.96 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 53 30 — — $8,700.00 $155,045.90 $57,672.20 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 53 30 — — $10,799.00 $106,913.00 $57,223.80 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 49 28 — — $11,933.00 $71,059.06 $57,131.49 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 53 30 — — $10,799.00 $133,362.00 $57,098.80 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
28 MS_DRG Spinal Procedures With Mcc 51 30 — — $10,799.00 $122,629.00 $56,699.93 2024-10-01
422892 CDM Cth Plc/inj R&lhc/l Vent 22 16 $112,642.40 $112,642.40 $5,970.05 $112,642.40 $56,321.20 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 49 29 — — $6,604.00 $282,774.55 $56,303.37 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 49 29 — — $6,604.00 $282,774.55 $56,303.37 2024-10-01
8514 APR_DRG Gender Related Procedures 17 14 — — $46,902.00 $70,353.00 $56,282.40 2024-10-01
974168 CDM Kit Lo Prfl Comp Shth 7f 40 23 $215,175.00 $215,175.00 $11,404.27 $215,175.00 $56,160.68 2024-10-01
967009 CDM Kit Cath Rt Heart 40 23 $215,175.00 $215,175.00 $11,404.27 $215,175.00 $56,160.68 2024-10-01
499252 CDM Set Vntrc 17.4x13.8in 40 23 $215,175.00 $215,175.00 $11,404.27 $215,175.00 $56,160.68 2024-10-01
974595 CDM Cath Vasc Assist Strl 40 23 $215,175.00 $215,175.00 $11,404.27 $215,175.00 $56,160.68 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
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 36 23 — — $33,409.00 $68,663.66 $55,480.24 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
9273 OTHER Sipuleucel-t Auto Cd54+ 27 20 — — $44,012.18 $68,769.04 $55,290.31 2024-10-01
09273 OTHER Sipuleucel-t Auto Cd54+ 2 2 — — $55,015.23 $55,015.23 $55,015.23 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $54,653.19 $54,653.19 $54,653.19 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
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 53 30 — — $8,700.00 $84,831.61 $54,091.50 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
B0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 4 2 — — $51,548.80 $54,804.52 $53,719.28 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 51 30 — — $10,799.00 $127,172.23 $53,606.62 2024-10-01
1595 OTHER New Technology - Level 44 28 21 — — $42,511.42 $66,424.10 $53,404.98 2024-10-01
1581 OTHER New Technology - Level 44 28 21 — — $42,511.42 $66,424.10 $53,404.98 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 51 30 — — $10,799.00 $115,791.00 $53,294.65 2024-10-01
B0505 HCPCS Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 4 2 — — $51,019.38 $54,241.65 $53,167.56 2024-10-01
01581 OTHER New Technology - Level 44 2 2 — — $53,139.28 $53,139.28 $53,139.28 2024-10-01
01595 OTHER New Technology - Level 44 2 2 — — $53,139.28 $53,139.28 $53,139.28 2024-10-01
412777 CDM Robotic Or First 60 Min 22 16 $106,091.70 $106,091.70 $5,622.86 $106,091.70 $53,045.85 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $52,669.33 $52,669.33 $52,669.33 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $52,549.11 $52,549.11 $52,549.11 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
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
653 MS_DRG Major Bladder Procedures With Mcc 52 30 — — $10,799.00 $83,856.62 $51,849.75 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 53 30 — — $10,799.00 $118,297.07 $51,766.86 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 51 30 — — $10,799.00 $180,974.61 $51,681.14 2024-10-01
428551 CDM Robotic Or First 60 Min 23 17 $103,205.88 $103,205.88 $5,469.91 $103,205.88 $51,602.94 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 51 30 — — $10,799.00 $158,875.68 $51,543.70 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 53 30 — — $10,799.00 $138,033.00 $51,480.13 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
B0106 HCPCS Stroke; M > 30.05 & M < 34.25 4 2 — — $49,160.47 $52,265.34 $51,230.38 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 53 30 — — $6,604.00 $63,957.31 $51,165.85 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 53 30 — — $10,799.00 $137,230.00 $51,160.89 2024-10-01
951702 CDM Stent Eprsth 40x40x20cm 19 12 $65,270.00 $65,270.00 $3,459.31 $65,270.00 $50,910.60 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 49 29 — — $8,700.00 $146,373.76 $50,894.40 2024-10-01
5244 OTHER Level 4 Blood Product Exc 28 21 — — $40,243.40 $62,880.31 $50,555.77 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 52 30 — — $10,799.00 $111,792.96 $50,530.22 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
05244 OTHER Level 4 Blood Product Exc 2 2 — — $50,304.25 $50,304.25 $50,304.25 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 53 30 — — $8,700.00 $124,284.00 $50,279.54 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
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 53 30 — — $8,700.00 $81,859.02 $50,233.38 2024-10-01
C1822 HCPCS Pulse Gen Imp 15 9 $62,626.00 $62,626.00 $8,141.38 $62,626.00 $50,100.80 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
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 53 30 — — $8,700.00 $62,471.45 $49,977.16 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 53 30 — — $10,799.00 $97,200.00 $49,521.57 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 53 30 — — $10,799.00 $176,730.00 $49,043.02 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $48,872.75 $48,872.75 $48,872.75 2024-10-01
434785 CDM Right Vad Venous Access 23 17 $96,928.92 $96,928.92 $5,137.23 $96,928.92 $48,464.46 2024-10-01
433864 CDM Vad Artery Access+h Cath 23 17 $96,928.92 $96,928.92 $5,137.23 $96,928.92 $48,464.46 2024-10-01
432994 CDM Tranc Ins Leadless Pacer 23 17 $96,531.48 $96,531.48 $5,116.17 $96,531.48 $48,265.74 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 52 30 — — $10,799.00 $129,155.00 $48,246.76 2024-10-01
412781 CDM Open Heart Or 1st 60 Min 22 16 $95,967.30 $95,967.30 $5,086.27 $95,967.30 $47,983.65 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
C0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 4 2 — — $45,841.83 $48,737.10 $47,772.01 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 53 30 — — $10,799.00 $109,455.00 $47,742.88 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 29 21 — — $37,994.40 $59,366.25 $47,730.46 2024-10-01
C2624 HCPCS System Mntr 2x15mm 4.5cm 15 9 $59,353.00 $59,353.00 $7,715.89 $59,353.00 $47,482.40 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 53 30 — — $8,700.00 $67,362.01 $47,365.35 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $47,308.48 $47,308.48 $47,308.48 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $47,045.41 $47,045.41 $47,045.41 2024-10-01
417627 CDM Per Cl Con Int Com W/imp 22 16 $93,998.32 $93,998.32 $4,981.91 $93,998.32 $46,999.16 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 53 30 — — $10,799.00 $111,795.47 $46,911.58 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 53 30 — — $8,700.00 $63,524.71 $46,749.68 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
422976 CDM Open Heart First 60 Min 22 16 $93,358.44 $93,358.44 $4,948.00 $93,358.44 $46,679.22 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 53 30 — — $8,700.00 $83,430.54 $46,666.67 2024-10-01
B0205 HCPCS Traumatic Brain Injury; M > 28.75 & M < 40.65 4 2 — — $44,629.06 $47,447.73 $46,508.18 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 53 30 — — $6,604.00 $64,504.71 $46,482.23 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 53 30 — — $10,799.00 $169,224.61 $46,384.59 2024-10-01
D0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 4 2 — — $44,500.51 $47,311.06 $46,374.21 2024-10-01
245 MS_DRG Aicd Generator Procedures 51 30 — — $10,799.00 $95,006.00 $45,852.89 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 51 30 — — $10,799.00 $108,244.00 $45,584.57 2024-10-01
1142 OTHER Supprelin La Implant 28 21 — — $36,280.17 $56,687.76 $45,576.96 2024-10-01
965755 CDM Occluder Cardiac Lt 20mm 19 12 $58,320.00 $58,320.00 $3,090.96 $58,320.00 $45,489.60 2024-10-01
965757 CDM Occluder Cardiac Lt 25mm 19 12 $58,320.00 $58,320.00 $3,090.96 $58,320.00 $45,489.60 2024-10-01
965754 CDM Occluder Cardiac Lt 18mm 19 12 $58,320.00 $58,320.00 $3,090.96 $58,320.00 $45,489.60 2024-10-01
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