Price Transparency Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

HCA FLORIDA WEST HOSPITAL

Pensacola, FL · CCN 100231 · Rates published

34,363 distinct procedures filed
78 distinct payers
1,456,526 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

1,148,971 of 1,456,526 rate rows are consumer-grade (78.9%)

307,555 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 259,724
template filing: same amount across many unrelated codes — excluded 22,723
per-diem day rate — not a per-procedure price 20,857
exceeds 10× this hospital's gross charge — excluded from medians 4,043
placeholder amount (≤ $0.02) — excluded from medians 208

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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/59-1525468_HCA-FLORIDA-WEST-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 27 $3,636,171.00 $4,407,480.00 $3,783,087.00 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 27 $3,568,950.00 $4,326,000.00 $3,713,150.00 nat. median
$3,605,000
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,562,713.00 $3,672,900.00 $3,562,713.00 nat. median
$3,574,709
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $3,496,850.00 $3,605,000.00 $3,496,850.00 nat. median
$3,496,850
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 27 $5,280.60 $3,990,546.00 $3,408,591.37 nat. median
$13,041
outlier · 261.4×
748
OTHER 		Inj, Lovotibeglogene Auto 27 $8,710.34 $3,943,200.00 $3,368,150.00 nat. median
$17,963
outlier · 187.5×
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,225,691.35 $3,325,455.00 $3,225,691.35 nat. median
$3,228,024
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,187,420.00 $3,286,000.00 $3,187,420.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 27 $7,736.51 $3,561,600.00 $3,042,200.00 nat. median
$21,896
outlier · 138.9×
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,878,960.00 $2,968,000.00 $2,878,960.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 27 $2,364,727.86 $2,866,336.80 $2,460,272.42 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,316,955.58 $2,388,614.00 $2,316,955.58 nat. median
$2,457,321
0.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 29 $523,900.97 $1,111,305.09 $555,652.55 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 29 $521,852.17 $1,106,959.14 $553,479.57 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 29 $521,321.72 $1,105,833.96 $552,916.98 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 29 $511,558.84 $1,085,124.81 $542,562.41 nat. median
$562,201
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 29 $484,561.44 $1,027,857.60 $513,928.80 nat. median
$532,192
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $513,317.11 $529,192.90 $513,317.11 nat. median
$538,205
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $511,309.70 $527,123.40 $511,309.70 nat. median
$554,552
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $510,789.97 $526,587.60 $510,789.97 nat. median
$530,178
1.0× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 $502,693.77 $1,125,423.00 $510,467.39 nat. median
$754,974
0.7× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $501,224.32 $516,726.10 $501,224.32 nat. median
$534,091
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $492,271.12 $1,091,527.05 $499,883.56 nat. median
$675,122
0.7× median
9391
OTHER 		Brexucabtagene Car Pos T 29 $455,925.10 $967,113.84 $483,556.92 nat. median
$489,450
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 $470,149.30 $1,082,427.24 $477,419.65 nat. median
$625,184
0.8× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $474,772.32 $489,456.00 $474,772.32 nat. median
$505,583
0.9× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 $459,839.17 $1,067,238.95 $466,950.09 nat. median
$674,188
0.7× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $445,599.57 $1,051,644.36 $452,490.28 nat. median
$634,511
0.7× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $446,714.49 $460,530.40 $446,714.49 nat. median
$464,978
1.0× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $435,956.80 $966,296.00 $442,698.40 nat. median
$620,080
0.7× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 43 $2,701.00 $1,658,155.20 $288,841.42 nat. median
$370,174
0.8× median
5834
APR_DRG 		Neonate With Ecmo 22 $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 43 $2,837.00 $1,238,504.77 $216,394.52 nat. median
$265,286
0.8× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 41 $2,837.00 $1,043,115.24 $182,282.07 nat. median
$206,368
0.9× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $178,990.51 $182,033.40 $180,511.96 nat. median
$263,894
0.7× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 43 $2,837.00 $942,307.32 $166,464.61 nat. median
$202,986
0.8× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 1 $156,515.70 $156,515.70 $156,515.70 nat. median
$76,377
outlier · 2.0×
1907
OTHER 		New Technology - Level 52 29 $145,866.50 $353,615.76 $154,706.89 nat. median
$153,199
1.0× median
1908
OTHER 		New Technology - Level 52 29 $145,866.50 $353,615.76 $154,706.89 nat. median
$152,962
1.0× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 22 $125,393.00 $188,089.50 $150,471.60 nat. median
$246,434
0.6× median
5833
APR_DRG 		Neonate With Ecmo 22 $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 $150,204.40 $148,948.98 nat. median
$424,868
outlier · 0.4×
01907
OTHER 		New Technology - Level 52 2 $142,919.70 $147,339.90 $142,919.70 nat. median
$84,819
1.7× median
01908
OTHER 		New Technology - Level 52 2 $142,919.70 $147,339.90 $142,919.70 nat. median
$82,736
1.7× median
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 $140,774.65 $140,774.65 $140,774.65 nat. median
$62,507
outlier · 2.3×
1905
OTHER 		New Technology - Level 51 29 $131,519.02 $318,834.00 $139,489.88 nat. median
$137,903
1.0× median
1906
OTHER 		New Technology - Level 51 29 $131,519.02 $318,834.00 $139,489.88 nat. median
$138,020
1.0× median
24
APR_DRG 		Heart And/or Lung Transplant 22 $111,047.00 $166,570.50 $133,256.40 nat. median
$234,738
0.6× median
01906
OTHER 		New Technology - Level 51 2 $128,862.07 $132,847.50 $128,862.07 nat. median
$82,736
1.6× median
01905
OTHER 		New Technology - Level 51 2 $128,862.07 $132,847.50 $128,862.07 nat. median
$82,736
1.6× median

Other procedures at this hospital

Browse this hospital's 34,363 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
             
A9604 HCPCS Sm153 Lexidron Tx 150mci 3 1 $58,328.00 $58,328.00 $37,108.68 $37,108.68 $37,108.68 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 43 27 — — $3,636,171.00 $4,407,480.00 $3,783,087.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 43 27 — — $3,568,950.00 $4,326,000.00 $3,713,150.00 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 3 2 — — $3,562,713.00 $3,672,900.00 $3,562,713.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 3 2 — — $3,496,850.00 $3,605,000.00 $3,496,850.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 45 27 — — $5,280.60 $3,990,546.00 $3,408,591.37 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 45 27 — — $8,710.34 $3,943,200.00 $3,368,150.00 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 3 2 — — $3,225,691.35 $3,325,455.00 $3,225,691.35 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 3 2 — — $3,187,420.00 $3,286,000.00 $3,187,420.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 45 27 — — $7,736.51 $3,561,600.00 $3,042,200.00 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 3 2 — — $2,878,960.00 $2,968,000.00 $2,878,960.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 43 27 — — $2,364,727.86 $2,866,336.80 $2,460,272.42 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 3 2 — — $2,316,955.58 $2,388,614.00 $2,316,955.58 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 45 29 — — $523,900.97 $1,111,305.09 $555,652.55 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 45 29 — — $521,852.17 $1,106,959.14 $553,479.57 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 45 29 — — $521,321.72 $1,105,833.96 $552,916.98 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 45 29 — — $511,558.84 $1,085,124.81 $542,562.41 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 45 29 — — $484,561.44 $1,027,857.60 $513,928.80 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 3 2 — — $513,317.11 $529,192.90 $513,317.11 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 3 2 — — $511,309.70 $527,123.40 $511,309.70 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 3 2 — — $510,789.97 $526,587.60 $510,789.97 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 12 4 — — $502,693.77 $1,125,423.00 $510,467.39 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 3 2 — — $501,224.32 $516,726.10 $501,224.32 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 12 4 — — $492,271.12 $1,091,527.05 $499,883.56 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 45 29 — — $455,925.10 $967,113.84 $483,556.92 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 11 4 — — $470,149.30 $1,082,427.24 $477,419.65 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 3 2 — — $474,772.32 $489,456.00 $474,772.32 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 12 4 — — $459,839.17 $1,067,238.95 $466,950.09 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 12 4 — — $445,599.57 $1,051,644.36 $452,490.28 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 3 2 — — $446,714.49 $460,530.40 $446,714.49 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 12 4 — — $435,956.80 $966,296.00 $442,698.40 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 98 43 — — $2,701.00 $1,658,155.20 $288,841.42 2024-10-01
5834 APR_DRG Neonate With Ecmo 36 22 — — $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 101 43 — — $2,837.00 $1,238,504.77 $216,394.52 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 99 41 — — $2,837.00 $1,043,115.24 $182,282.07 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 1 — — $178,990.51 $182,033.40 $180,511.96 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 101 43 — — $2,837.00 $942,307.32 $166,464.61 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 3 1 — — $156,515.70 $156,515.70 $156,515.70 2024-10-01
1907 OTHER New Technology - Level 52 47 29 — — $145,866.50 $353,615.76 $154,706.89 2024-10-01
1908 OTHER New Technology - Level 52 47 29 — — $145,866.50 $353,615.76 $154,706.89 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 36 22 — — $125,393.00 $188,089.50 $150,471.60 2024-10-01
5833 APR_DRG Neonate With Ecmo 36 22 — — $124,517.00 $186,775.50 $149,420.40 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 1 — — $147,693.56 $150,204.40 $148,948.98 2024-10-01
01907 OTHER New Technology - Level 52 3 2 — — $142,919.70 $147,339.90 $142,919.70 2024-10-01
01908 OTHER New Technology - Level 52 3 2 — — $142,919.70 $147,339.90 $142,919.70 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 3 1 — — $140,774.65 $140,774.65 $140,774.65 2024-10-01
1905 OTHER New Technology - Level 51 47 29 — — $131,519.02 $318,834.00 $139,489.88 2024-10-01
1906 OTHER New Technology - Level 51 47 29 — — $131,519.02 $318,834.00 $139,489.88 2024-10-01
24 APR_DRG Heart And/or Lung Transplant 36 22 — — $111,047.00 $166,570.50 $133,256.40 2024-10-01
01906 OTHER New Technology - Level 51 3 2 — — $128,862.07 $132,847.50 $128,862.07 2024-10-01
01905 OTHER New Technology - Level 51 3 2 — — $128,862.07 $132,847.50 $128,862.07 2024-10-01
1903 OTHER New Technology - Level 50 47 29 — — $117,171.55 $284,052.24 $124,272.86 2024-10-01
1904 OTHER New Technology - Level 50 47 29 — — $117,171.55 $284,052.24 $124,272.86 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 1 — — $119,887.93 $121,925.99 $120,906.96 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 36 22 — — $97,644.00 $146,466.00 $117,172.80 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 5 3 — — $11,430.00 $184,270.00 $116,024.00 2024-10-01
01904 OTHER New Technology - Level 50 3 2 — — $114,804.45 $118,355.10 $114,804.45 2024-10-01
01903 OTHER New Technology - Level 50 3 2 — — $114,804.45 $118,355.10 $114,804.45 2024-10-01
5832 APR_DRG Neonate With Ecmo 36 22 — — $95,607.00 $143,410.50 $114,728.40 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 36 22 — — $95,167.00 $142,750.50 $114,200.40 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 101 43 — — $2,837.00 $621,270.66 $110,276.08 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 36 22 — — $91,470.00 $137,205.00 $109,764.00 2024-10-01
1902 OTHER New Technology - Level 49 47 29 — — $102,824.07 $249,270.48 $109,055.84 2024-10-01
1901 OTHER New Technology - Level 49 47 29 — — $102,824.07 $249,270.48 $109,055.84 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 36 22 — — $90,217.00 $135,325.50 $108,260.40 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 98 43 — — $2,701.00 $576,059.67 $105,227.80 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 50 30 — — $96,999.90 $239,999.76 $103,999.90 2024-10-01
7 MS_DRG Lung Transplant 98 43 — — $2,837.00 $574,608.63 $101,994.47 2024-10-01
01902 OTHER New Technology - Level 49 3 2 — — $100,746.82 $103,862.70 $100,746.82 2024-10-01
01901 OTHER New Technology - Level 49 3 2 — — $100,746.82 $103,862.70 $100,746.82 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 3 1 — — $100,053.67 $100,053.67 $100,053.67 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 36 22 — — $82,446.00 $123,669.00 $98,935.20 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 36 22 — — $81,552.00 $122,328.00 $97,862.40 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 36 22 — — $80,942.00 $121,413.00 $97,130.40 2024-10-01
1585 OTHER New Technology - Level 48 47 29 — — $90,867.82 $220,285.63 $96,374.96 2024-10-01
1599 OTHER New Technology - Level 48 47 29 — — $90,867.82 $220,285.63 $96,374.96 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 4 2 — — $11,430.00 $110,589.00 $96,207.00 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 36 22 — — $79,657.00 $119,485.50 $95,588.40 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 50 30 — — $88,300.94 $218,476.56 $94,673.18 2024-10-01
74 APR_DRG Allogeneic Bone Marrow Transplant 36 22 — — $75,611.00 $113,416.50 $90,733.20 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 36 22 — — $75,232.00 $112,848.00 $90,278.40 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 101 43 — — $2,837.00 $484,547.23 $89,361.01 2024-10-01
01599 OTHER New Technology - Level 48 3 2 — — $89,032.11 $91,785.68 $89,032.11 2024-10-01
01585 OTHER New Technology - Level 48 3 2 — — $89,032.11 $91,785.68 $89,032.11 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 36 22 — — $73,863.00 $110,794.50 $88,635.60 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 105 45 — — $2,837.00 $478,980.50 $88,343.98 2024-10-01
215 MS_DRG Other Heart Assist System Implant 105 46 — — $10,799.00 $465,837.57 $87,966.78 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 7 2 — — $58,610.00 $102,063.00 $87,610.00 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 7 2 — — $56,474.00 $102,063.00 $87,610.00 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 6 3 — — $53,789.99 $119,352.48 $87,403.04 2024-10-01
1598 OTHER New Technology - Level 47 47 29 — — $81,302.85 $197,097.82 $86,230.29 2024-10-01
1584 OTHER New Technology - Level 47 47 29 — — $81,302.85 $197,097.82 $86,230.29 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 36 22 — — $71,560.00 $107,340.00 $85,872.00 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 98 43 — — $2,837.00 $468,229.59 $85,759.51 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 7 2 — — $55,557.00 $102,063.00 $85,547.00 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 7 2 — — $57,389.00 $102,063.00 $85,547.00 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 103 45 — — $10,799.00 $460,886.43 $85,038.25 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 1 — — $84,296.07 $85,729.10 $85,012.59 2024-10-01
5831 APR_DRG Neonate With Ecmo 36 22 — — $69,493.00 $104,239.50 $83,391.60 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 36 22 — — $68,321.00 $102,481.50 $81,985.20 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 9 4 — — $11,430.00 $124,225.00 $81,308.00 2024-10-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 36 22 — — $67,242.00 $100,863.00 $80,690.40 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 36 22 — — $66,782.00 $100,173.00 $80,138.40 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 7 2 — — $51,894.00 $100,416.00 $79,989.00 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 7 2 — — $53,727.00 $100,416.00 $79,989.00 2024-10-01
01584 OTHER New Technology - Level 47 3 2 — — $79,660.37 $82,124.09 $79,660.37 2024-10-01
01598 OTHER New Technology - Level 47 3 2 — — $79,660.37 $82,124.09 $79,660.37 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 105 46 — — $10,799.00 $238,808.75 $79,535.04 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 2 1 — — $78,325.54 $79,657.08 $78,991.31 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 36 22 — — $64,392.00 $96,588.00 $77,270.40 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 2 1 — — $76,277.63 $77,574.34 $76,925.99 2024-10-01
1597 OTHER New Technology - Level 46 47 29 — — $71,737.86 $173,909.95 $76,085.60 2024-10-01
1583 OTHER New Technology - Level 46 47 29 — — $71,737.86 $173,909.95 $76,085.60 2024-10-01
23 APR_DRG Heart And/or Lung Transplant 36 22 — — $62,352.00 $93,528.00 $74,822.40 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 36 22 — — $61,338.00 $92,007.00 $73,605.60 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 105 45 — — $2,837.00 $405,030.07 $72,440.17 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 104 46 — — $10,799.00 $372,583.87 $71,425.29 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 36 22 — — $59,125.00 $88,687.50 $70,950.00 2024-10-01
01597 OTHER New Technology - Level 46 3 2 — — $70,288.61 $72,462.48 $70,288.61 2024-10-01
01583 OTHER New Technology - Level 46 3 2 — — $70,288.61 $72,462.48 $70,288.61 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 113 52 — — $10,799.00 $372,372.81 $69,342.78 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 47 29 — — $64,821.81 $157,143.79 $68,750.41 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 50 30 — — $63,895.55 $158,092.08 $68,506.57 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 36 22 — — $56,946.00 $85,419.00 $68,335.20 2024-10-01
007 OTHER Lung Transplant 2 1 — — $67,580.69 $68,729.56 $68,155.12 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 1 — — $67,458.10 $68,604.88 $68,031.49 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 103 45 — — $10,799.00 $366,718.14 $67,833.93 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 36 22 — — $55,523.00 $83,284.50 $66,627.60 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 104 46 — — $10,799.00 $354,428.25 $66,455.31 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 113 52 — — $10,799.00 $202,235.44 $66,323.80 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 112 52 — — $10,799.00 $206,936.46 $66,222.30 2024-10-01
1582 OTHER New Technology - Level 45 47 29 — — $62,172.87 $150,722.11 $65,940.92 2024-10-01
1596 OTHER New Technology - Level 45 47 29 — — $62,172.87 $150,722.11 $65,940.92 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 36 22 — — $54,849.00 $82,273.50 $65,818.80 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 47 29 — — $12,654.78 $133,045.02 $65,255.41 2024-10-01
10 MS_DRG Pancreas Transplant 107 49 — — $2,837.00 $350,563.19 $64,760.30 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 108 50 — — $2,837.00 $348,544.93 $64,455.26 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 3 2 — — $63,512.28 $65,476.58 $63,512.28 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 2 1 — — $62,431.63 $63,492.96 $62,962.29 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 9 4 — — $11,430.00 $99,130.00 $62,710.00 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 12 4 — — $61,600.24 $136,523.56 $62,552.82 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 36 22 — — $51,688.00 $77,532.00 $62,025.60 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 36 22 — — $51,226.00 $76,839.00 $61,471.20 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 3 2 — — $61,454.13 $63,354.77 $61,454.13 2024-10-01
01582 OTHER New Technology - Level 45 3 2 — — $60,916.85 $62,800.88 $60,916.85 2024-10-01
01596 OTHER New Technology - Level 45 3 2 — — $60,916.85 $62,800.88 $60,916.85 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 116 51 — — $2,837.00 $328,186.35 $59,607.72 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 36 22 — — $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 36 22 — — $48,983.00 $73,474.50 $58,779.60 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 103 45 — — $10,555.00 $310,721.07 $58,690.27 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 36 22 — — $48,895.00 $73,342.50 $58,674.00 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 103 45 — — $10,799.00 $312,136.94 $58,389.91 2024-10-01
64 APR_DRG Pancreas Transplant 36 22 — — $48,372.00 $72,558.00 $58,046.40 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 2 1 — — $57,539.16 $58,517.33 $58,028.25 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 45 29 — — $54,465.08 $115,531.98 $57,765.99 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 36 22 — — $47,538.00 $71,307.00 $57,045.60 2024-10-01
8514 APR_DRG Gender Related Procedures 36 22 — — $46,902.00 $70,353.00 $56,282.40 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 2 1 — — $55,450.54 $56,393.20 $55,921.87 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 36 22 — — $46,525.00 $69,787.50 $55,830.00 2024-10-01
1595 OTHER New Technology - Level 44 47 29 — — $52,607.89 $127,534.27 $55,796.24 2024-10-01
1581 OTHER New Technology - Level 44 47 29 — — $52,607.89 $127,534.27 $55,796.24 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 2 1 — — $55,323.98 $56,264.48 $55,794.23 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 113 52 — — $10,799.00 $173,955.00 $55,458.21 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 36 22 — — $46,203.00 $69,304.50 $55,443.60 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 103 45 — — $10,799.00 $218,865.31 $55,208.89 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 105 46 — — $10,799.00 $238,808.75 $54,947.97 2024-10-01
22 APR_DRG Heart And/or Lung Transplant 36 22 — — $45,376.00 $68,064.00 $54,451.20 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 105 45 — — $2,837.00 $300,229.59 $54,103.07 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 36 22 — — $44,835.00 $67,252.50 $53,802.00 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 114 51 — — $2,837.00 $293,660.32 $53,634.79 2024-10-01
09273 OTHER Sipuleucel-t Auto Cd54+ 3 2 — — $53,364.77 $55,015.23 $53,364.77 2024-10-01
5244 OTHER Level 4 Blood Product Exc 47 29 — — $49,801.21 $120,730.20 $52,819.46 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 114 52 — — $8,000.00 $128,422.06 $52,789.45 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 36 22 — — $43,677.00 $65,515.50 $52,412.40 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 36 22 — — $43,560.00 $65,340.00 $52,272.00 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 114 51 — — $10,555.00 $272,356.37 $52,121.71 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 104 46 — — $10,799.00 $268,588.06 $51,900.98 2024-10-01
215 OTHER Other Heart Assist System Implant 2 1 — — $51,453.49 $52,328.19 $51,890.84 2024-10-01
01581 OTHER New Technology - Level 44 3 2 — — $51,545.10 $53,139.28 $51,545.10 2024-10-01
01595 OTHER New Technology - Level 44 3 2 — — $51,545.10 $53,139.28 $51,545.10 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 115 52 — — $10,799.00 $269,836.84 $51,079.89 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 104 45 — — $10,799.00 $293,552.83 $50,983.74 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 113 52 — — $10,799.00 $173,955.00 $50,825.10 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 104 45 — — $2,701.00 $284,391.24 $50,814.69 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 105 46 — — $10,799.00 $238,808.75 $50,691.25 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 116 51 — — $2,837.00 $278,068.21 $50,688.07 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 3 1 — — $50,561.89 $50,561.89 $50,561.89 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 105 45 — — $2,837.00 $272,004.61 $50,530.01 2024-10-01
B0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 5 4 — — $40,802.07 $52,277.66 $50,492.57 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 36 22 — — $42,035.00 $63,052.50 $50,442.00 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 36 22 — — $41,957.00 $62,935.50 $50,348.40 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 36 22 — — $41,876.00 $62,814.00 $50,251.20 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 1 — — $49,806.62 $50,653.33 $50,229.98 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 115 52 — — $10,799.00 $267,304.11 $50,139.84 2024-10-01
21 APR_DRG Heart And/or Lung Transplant 36 22 — — $41,730.00 $62,595.00 $50,076.00 2024-10-01
B0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 5 4 — — $40,383.02 $51,740.74 $49,973.99 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 1 — — $49,529.65 $50,371.66 $49,950.65 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 107 49 — — $2,701.00 $368,315.44 $49,889.22 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 107 49 — — $2,701.00 $368,315.44 $49,889.22 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 50 30 — — $46,068.21 $113,983.20 $49,392.72 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 113 52 — — $10,799.00 $252,349.57 $48,863.46 2024-10-01
05244 OTHER Level 4 Blood Product Exc 3 2 — — $48,795.12 $50,304.25 $48,795.12 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 115 52 — — $10,799.00 $250,841.36 $48,472.84 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 116 51 — — $2,837.00 $270,764.62 $48,467.67 2024-10-01
B0106 OTHER Stroke; M > 30.05 & M < 34.25 5 4 — — $38,911.65 $49,855.55 $48,153.17 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 36 22 — — $39,878.00 $59,817.00 $47,853.60 2024-10-01
1142 OTHER Supprelin La Implant 47 29 — — $44,896.71 $108,840.50 $47,617.72 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 84 46 — — $11,098.00 $140,902.44 $47,088.22 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 104 46 — — $10,799.00 $243,040.91 $46,955.50 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 36 22 — — $38,906.00 $58,359.00 $46,687.20 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 114 51 — — $10,799.00 $242,069.15 $46,510.59 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 113 52 — — $10,799.00 $173,955.00 $46,459.45 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 116 51 — — $2,837.00 $255,994.76 $46,363.24 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 114 51 — — $10,799.00 $240,525.77 $46,224.65 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 112 52 — — $10,799.00 $206,936.46 $46,049.65 2024-10-01
1580 OTHER New Technology - Level 43 47 29 — — $43,042.90 $104,346.43 $45,651.56 2024-10-01
1594 OTHER New Technology - Level 43 47 29 — — $43,042.90 $104,346.43 $45,651.56 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 2 1 — — $45,148.93 $45,916.45 $45,532.69 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 36 22 — — $37,904.00 $56,856.00 $45,484.80 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 107 49 — — $2,837.00 $239,237.42 $45,134.38 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 2 1 — — $44,710.16 $45,470.23 $45,090.20 2024-10-01
84 APR_DRG Autologous Bone Marrow Transplant 36 22 — — $37,476.00 $56,214.00 $44,971.20 2024-10-01
C0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 5 4 — — $36,284.87 $46,489.99 $44,902.53 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 116 51 — — $2,837.00 $238,692.18 $44,527.14 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 116 51 — — $2,837.00 $245,103.15 $44,457.53 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 2 1 — — $44,039.60 $44,788.28 $44,413.94 2024-10-01
73 APR_DRG Allogeneic Bone Marrow Transplant 36 22 — — $36,953.00 $55,429.50 $44,343.60 2024-10-01
01142 OTHER Supprelin La Implant 3 2 — — $43,989.70 $45,350.21 $43,989.70 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 12 4 — — $43,241.44 $94,940.24 $43,910.12 2024-10-01
B0205 OTHER Traumatic Brain Injury; M > 28.75 & M < 40.65 5 4 — — $35,324.93 $45,260.07 $43,714.61 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 2 1 — — $43,339.76 $44,076.53 $43,708.15 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 115 51 — — $2,701.00 $243,023.32 $43,661.32 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 113 52 — — $10,799.00 $173,955.00 $43,656.76 2024-10-01
D0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 5 4 — — $35,223.18 $45,129.70 $43,588.69 2024-10-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 2 1 — — $42,827.53 $43,555.60 $43,191.57 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 111 52 — — $10,799.00 $173,955.00 $43,178.15 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 116 51 — — $2,837.00 $237,249.93 $43,083.43 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 116 51 — — $2,837.00 $237,474.18 $42,730.57 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 116 51 — — $2,837.00 $168,117.11 $42,705.04 2024-10-01
4404 APR_DRG Kidney Transplant 36 22 — — $35,422.00 $53,133.00 $42,506.40 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 112 51 — — $10,555.00 $219,982.52 $42,418.73 2024-10-01
834 OTHER Acute Leukemia With Mcc 2 1 — — $42,052.24 $42,767.13 $42,409.68 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 116 51 — — $2,837.00 $237,219.15 $42,370.60 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 115 52 — — $10,799.00 $94,550.86 $42,363.97 2024-10-01
B0105 OTHER Stroke; M > 34.25 & M < 38.85 5 4 — — $34,211.03 $43,832.88 $42,336.15 2024-10-01
01594 OTHER New Technology - Level 43 3 2 — — $42,173.35 $43,477.68 $42,173.35 2024-10-01
01580 OTHER New Technology - Level 43 3 2 — — $42,173.35 $43,477.68 $42,173.35 2024-10-01
0207 RC — 25 14 — — $8,000.00 $55,381.00 $42,172.50 2024-10-01
8634 APR_DRG Neonatal Aftercare 36 22 — — $35,009.00 $52,513.50 $42,010.80 2024-10-01
C0106 OTHER Stroke; M > 30.05 & M < 34.25 5 4 — — $33,746.46 $43,237.65 $41,761.24 2024-10-01
B1903 OTHER Guillian Barre; M < 18.05 5 4 — — $33,623.29 $43,079.83 $41,608.82 2024-10-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 2 1 — — $41,091.81 $41,790.37 $41,441.09 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 115 52 — — $10,799.00 $90,234.65 $41,357.55 2024-10-01
B0604 OTHER Neurological; M < 25.85 5 4 — — $33,342.13 $42,719.61 $41,260.89 2024-10-01
63 APR_DRG Pancreas Transplant 36 22 — — $34,364.00 $51,546.00 $41,236.80 2024-10-01
245 MS_DRG Aicd Generator Procedures 114 51 — — $10,555.00 $214,864.29 $41,086.52 2024-10-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 36 22 — — $34,228.00 $51,342.00 $41,073.60 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 36 22 — — $34,068.00 $51,102.00 $40,881.60 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 116 51 — — $2,837.00 $223,315.52 $40,452.61 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 116 51 — — $2,837.00 $219,920.96 $40,339.44 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 104 45 — — $10,799.00 $220,416.00 $40,267.59 2024-10-01
C2616 HCPCS Brachytherapy Source, Non-stranded, Yttrium-90, Per Source 3 1 — — $7,003.00 $53,804.00 $40,208.00 2024-10-01
B0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 5 4 — — $32,447.80 $41,573.74 $40,154.15 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 112 52 — — $10,799.00 $206,936.46 $40,101.43 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 116 51 — — $2,837.00 $221,459.94 $39,925.34 2024-10-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 50 30 — — $37,140.82 $91,894.80 $39,821.07 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 115 51 — — $2,701.00 $220,154.00 $39,699.08 2024-10-01
A0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 5 4 — — $32,005.98 $41,007.67 $39,607.40 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 98 43 — — $2,837.00 $374,358.21 $39,600.88 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 114 51 — — $10,555.00 $204,561.89 $39,545.79 2024-10-01
A5104 OTHER Expired, Not Orthopedic, Length Of Stay Is 16 Days 5 4 — — $31,909.59 $40,884.16 $39,488.12 2024-10-01
0888T CPT Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 3 1 — — $39,376.13 $39,376.13 $39,376.13 2024-10-01
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 50 30 — — $36,570.46 $90,483.60 $39,209.56 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 36 22 — — $32,422.00 $48,633.00 $38,906.40 2024-10-01
C0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 5 4 — — $31,416.90 $40,252.90 $38,878.41 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 115 52 — — $10,799.00 $124,417.17 $38,799.33 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 116 51 — — $2,837.00 $209,051.33 $38,747.00 2024-10-01
B0704 OTHER Fracture Of Lower Extremity; M < 28.15 5 4 — — $31,158.51 $39,921.84 $38,558.65 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 116 51 — — $2,837.00 $209,060.12 $38,406.51 2024-10-01
B2102 OTHER Burns; M=12-45 5 4 — — $31,028.64 $39,755.45 $38,397.94 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 108 50 — — $2,837.00 $202,574.40 $38,335.07 2024-10-01
232 OTHER Coronary Bypass With Ptca Without Mcc 2 1 — — $37,952.93 $38,598.13 $38,275.53 2024-10-01
219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 2 1 — — $37,949.46 $38,594.60 $38,272.03 2024-10-01
969 OTHER HIV With Extensive O.r. Procedures With Mcc 2 1 — — $37,864.09 $38,507.78 $38,185.93 2024-10-01
D0106 OTHER Stroke; M > 30.05 & M < 34.25 5 4 — — $30,838.53 $39,511.86 $38,162.68 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 36 22 — — $31,789.00 $47,683.50 $38,146.80 2024-10-01
B1004 OTHER Amputation, Lower Extremity; M=39-45 5 4 — — $30,807.73 $39,472.41 $38,124.57 2024-10-01
466 OTHER Revision Of Hip Or Knee Replacement With Mcc 2 1 — — $37,802.54 $38,445.18 $38,123.86 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 116 51 — — $2,837.00 $209,970.32 $38,122.49 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 36 22 — — $31,574.00 $47,361.00 $37,888.80 2024-10-01
461 OTHER Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 2 1 — — $37,565.78 $38,204.40 $37,885.09 2024-10-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 36 22 — — $31,456.00 $47,184.00 $37,747.20 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 117 52 — — $2,837.00 $201,901.64 $37,722.38 2024-10-01
233 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 2 1 — — $37,379.15 $38,014.61 $37,696.88 2024-10-01
B1504 OTHER Pulmonary; M < 29.15 5 4 — — $30,450.27 $39,014.40 $37,682.21 2024-10-01
870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 2 1 — — $37,248.13 $37,881.34 $37,564.74 2024-10-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 36 22 — — $31,113.00 $46,669.50 $37,335.60 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 116 51 — — $2,837.00 $205,749.10 $37,203.34 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 116 51 — — $2,837.00 $202,657.94 $37,195.38 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 113 52 — — $10,799.00 $189,853.59 $37,029.20 2024-10-01
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