Hospital

HCA FLORIDA LARGO HOSPITAL

Largo, FL · CCN 100248 · Rates published

34,346 distinct procedures filed

59 distinct payers

984,340 rate rows

2024-10-01 last MRF observed · ⚠ 20 mo old

Data quality

423,057 of 984,340 rate rows are consumer-grade (43.0%)

561,283 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 — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	548,060
per-diem day rate — not a per-procedure price	12,482
template filing: same amount across many unrelated codes — excluded	596
placeholder amount (≤ $0.02) — excluded from medians	104
exceeds 10× this hospital's gross charge — excluded from medians	41

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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/62-1026428_HCA-FLORIDA-LARGO-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 via	CMS hospital list
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-06-08

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code	Description	Payers	Min $	Max $	Avg median	vs national
9138 OTHER	Inj, Hemgenix, Per Tx Dos	20	$3,672,900.00	$4,187,106.00	$3,856,545.00	nat. median $3,746,358 1.0× median
773 OTHER	Inj, Beqvez, Per Tx Dose	20	$3,605,000.00	$4,109,700.00	$3,785,250.00	nat. median $3,605,000 1.1× median
09138 OTHER	Inj, Hemgenix, Per Tx Dos	1	$3,562,713.00	$3,562,713.00	$3,562,713.00	nat. median $3,574,709 1.0× median
00773 OTHER	Inj, Beqvez, Per Tx Dose	1	$3,496,850.00	$3,496,850.00	$3,496,850.00	nat. median $3,496,850 1.0× median
714 OTHER	Inj Delandistrogene Mox R	22	$6,578.05	$4,821,909.75	$3,491,727.75	nat. median $13,041 outlier · 267.7×
748 OTHER	Inj, Lovotibeglogene Auto	22	$10,850.47	$4,764,700.00	$3,450,300.00	nat. median $17,963 outlier · 192.1×
00714 OTHER	Inj Delandistrogene Mox R	1	$3,225,691.35	$3,225,691.35	$3,225,691.35	nat. median $3,228,024 1.0× median
00748 OTHER	Inj, Lovotibeglogene Auto	1	$3,187,420.00	$3,187,420.00	$3,187,420.00	nat. median $3,187,420 1.0× median
746 OTHER	Inj, Betibeglogene Autote	22	$9,637.37	$4,303,600.00	$3,116,400.00	nat. median $21,896 outlier · 142.3×
00746 OTHER	Inj, Betibeglogene Autote	1	$2,878,960.00	$2,878,960.00	$2,878,960.00	nat. median $2,878,960 1.0× median
9141 OTHER	Inj Onase Abepar-xioi Tre	21	$2,388,614.00	$3,463,490.30	$2,508,044.70	nat. median $2,588,981 1.0× median
09141 OTHER	Inj Onase Abepar-xioi Tre	1	$2,316,955.58	$2,316,955.58	$2,316,955.58	nat. median $2,457,321 0.9× median
9194 OTHER	Tisagenlecleucel Car-pos	21	$529,192.90	$767,329.70	$555,652.55	nat. median $566,531 1.0× median
9498 OTHER	Ciltacabtagene Car-pos T	21	$527,123.40	$764,328.93	$553,479.57	nat. median $587,650 0.9× median
9422 OTHER	Idecabtagene Vicleucel Ca	21	$526,587.60	$763,552.02	$552,916.98	nat. median $558,082 1.0× median
9413 OTHER	Lisocabtagene Car Pos T	21	$516,726.10	$749,252.84	$542,562.41	nat. median $562,201 1.0× median
9035 OTHER	Axicabtagene Ciloleucel C	21	$489,456.00	$709,711.20	$513,928.80	nat. median $532,192 1.0× median
09194 OTHER	Tisagenlecleucel Car-pos	1	$513,317.11	$513,317.11	$513,317.11	nat. median $538,205 1.0× median
09498 OTHER	Ciltacabtagene Car-pos T	1	$511,309.70	$511,309.70	$511,309.70	nat. median $554,552 0.9× median
09422 OTHER	Idecabtagene Vicleucel Ca	1	$510,789.97	$510,789.97	$510,789.97	nat. median $530,178 1.0× median
Q2042 HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	3	$502,693.77	$1,125,423.00	$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
Q2056 HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	3	$492,271.12	$1,091,527.05	$492,271.12	nat. median $674,867 0.7× median
9391 OTHER	Brexucabtagene Car Pos T	21	$460,530.40	$667,769.08	$483,556.92	nat. median $489,450 1.0× median
09035 OTHER	Axicabtagene Ciloleucel C	1	$474,772.32	$474,772.32	$474,772.32	nat. median $505,583 0.9× median
Q2055 HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	3	$470,149.30	$1,082,427.24	$470,149.30	nat. median $625,184 0.8× median
Q2054 HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	3	$459,839.17	$1,067,238.95	$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	$1,051,644.36	$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	$966,296.00	$435,956.80	nat. median $619,808 0.7× median
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	32	$6,771.00	$832,980.61	$339,682.90	nat. median $370,174 0.9× median
02HA3RZ OTHER	Insertion Of External Heart Assist System Into Heart, Percutaneous Approach	1	$312,000.00	$312,000.00	$312,000.00	nat. median $18,377 outlier · 17.0×
02RK0JZ OTHER	Replacement Of Right Ventricle With Synthetic Substitute, Open Approach	1	$312,000.00	$312,000.00	$312,000.00	nat. median $18,261 outlier · 17.1×
02PA4RZ OTHER	Removal Of External Heart Assist System From Heart, Percutaneous Endoscopic Appr…	1	$312,000.00	$312,000.00	$312,000.00	nat. median $18,261 outlier · 17.1×
02RL0JZ OTHER	Replacement Of Left Ventricle With Synthetic Substitute, Open Approach	1	$312,000.00	$312,000.00	$312,000.00	nat. median $18,261 outlier · 17.1×
02PA0RZ OTHER	Removal Of External Heart Assist System From Heart, Open Approach	1	$312,000.00	$312,000.00	$312,000.00	nat. median $18,261 outlier · 17.1×
02PA3RZ OTHER	Removal Of External Heart Assist System From Heart, Percutaneous Approach	1	$312,000.00	$312,000.00	$312,000.00	nat. median $18,261 outlier · 17.1×
1 MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	33	$9,780.00	$421,414.16	$256,521.64	nat. median $265,286 1.0× median
5834 APR_DRG	Neonate With Ecmo	13	$192,207.00	$288,310.50	$226,804.26	nat. median $309,665 0.7× median
001 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	1	$222,968.47	$222,968.47	$222,968.47	nat. median $263,894 0.8× median
927 MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	29	$8,000.00	$524,012.93	$211,995.80	nat. median $206,474 1.0× median
02HA4QZ OTHER	Insertion Of Implantable Heart Assist System Into Heart, Percutaneous Endoscopic…	2	$105,000.00	$312,000.00	$208,500.00	nat. median $25,848 outlier · 8.1×
02HA0QZ OTHER	Insertion Of Implantable Heart Assist System Into Heart, Open Approach	2	$105,000.00	$312,000.00	$208,500.00	nat. median $25,848 outlier · 8.1×
02HA0RZ OTHER	Insertion Of External Heart Assist System Into Heart, Open Approach	2	$105,000.00	$312,000.00	$208,500.00	nat. median $18,493 outlier · 11.3×
02WA4QZ OTHER	Revision Of Implantable Heart Assist System In Heart, Percutaneous Endoscopic Ap…	2	$105,000.00	$312,000.00	$208,500.00	nat. median $18,493 outlier · 11.3×
02WA3RZ OTHER	Revision Of External Heart Assist System In Heart, Percutaneous Approach	2	$105,000.00	$312,000.00	$208,500.00	nat. median $18,493 outlier · 11.3×
02HA3QZ OTHER	Insertion Of Implantable Heart Assist System Into Heart, Percutaneous Approach	2	$105,000.00	$312,000.00	$208,500.00	nat. median $25,848 outlier · 8.1×
02WA3QZ OTHER	Revision Of Implantable Heart Assist System In Heart, Percutaneous Approach	2	$105,000.00	$312,000.00	$208,500.00	nat. median $18,493 outlier · 11.3×
02WA4RZ OTHER	Revision Of External Heart Assist System In Heart, Percutaneous Endoscopic Appro…	2	$105,000.00	$312,000.00	$208,500.00	nat. median $18,493 outlier · 11.3×
02WA0QZ OTHER	Revision Of Implantable Heart Assist System In Heart, Open Approach	2	$105,000.00	$312,000.00	$208,500.00	nat. median $18,493 outlier · 11.3×

Other procedures at this hospital

Browse this hospital's 34,346 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	1	1	—	—	$222,968.47	$222,968.47	$222,968.47	2024-10-01
002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	1	1	—	—	$84,032.55	$84,032.55	$84,032.55	2024-10-01
003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	1	1	—	—	$149,344.30	$149,344.30	$149,344.30	2024-10-01
004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	1	1	—	—	$105,007.64	$105,007.64	$105,007.64	2024-10-01
005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	1	1	—	—	$69,074.75	$69,074.75	$69,074.75	2024-10-01
006	OTHER	Liver Transplant Without Mcc	1	1	—	—	$45,068.80	$45,068.80	$45,068.80	2024-10-01
007	OTHER	Lung Transplant	1	1	—	—	$84,185.27	$84,185.27	$84,185.27	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
00717	OTHER	Instill Adstiladrin, Tx D	1	1	—	—	$61,454.13	$61,454.13	$61,454.13	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
00748	OTHER	Inj, Lovotibeglogene Auto	1	1	—	—	$3,187,420.00	$3,187,420.00	$3,187,420.00	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
01142	OTHER	Supprelin La Implant	1	1	—	—	$43,989.70	$43,989.70	$43,989.70	2024-10-01
014	OTHER	Allogeneic Bone Marrow Transplant	1	1	—	—	$97,570.17	$97,570.17	$97,570.17	2024-10-01
01581	OTHER	New Technology - Level 44	1	1	—	—	$51,545.10	$51,545.10	$51,545.10	2024-10-01
01582	OTHER	New Technology - Level 45	1	1	—	—	$60,916.85	$60,916.85	$60,916.85	2024-10-01
01583	OTHER	New Technology - Level 46	1	1	—	—	$70,288.61	$70,288.61	$70,288.61	2024-10-01
01584	OTHER	New Technology - Level 47	1	1	—	—	$79,660.37	$79,660.37	$79,660.37	2024-10-01
01585	OTHER	New Technology - Level 48	1	1	—	—	$89,032.11	$89,032.11	$89,032.11	2024-10-01
01595	OTHER	New Technology - Level 44	1	1	—	—	$51,545.10	$51,545.10	$51,545.10	2024-10-01
01596	OTHER	New Technology - Level 45	1	1	—	—	$60,916.85	$60,916.85	$60,916.85	2024-10-01
01597	OTHER	New Technology - Level 46	1	1	—	—	$70,288.61	$70,288.61	$70,288.61	2024-10-01
01598	OTHER	New Technology - Level 47	1	1	—	—	$79,660.37	$79,660.37	$79,660.37	2024-10-01
01599	OTHER	New Technology - Level 48	1	1	—	—	$89,032.11	$89,032.11	$89,032.11	2024-10-01
01643	OTHER	Y90 Ibritumomab, Rx	1	1	—	—	$63,512.28	$63,512.28	$63,512.28	2024-10-01
018	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$183,981.84	$183,981.84	$183,981.84	2024-10-01
019	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	1	1	—	—	$54,860.13	$54,860.13	$54,860.13	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
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
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
01907	OTHER	New Technology - Level 52	1	1	—	—	$142,919.70	$142,919.70	$142,919.70	2024-10-01
01908	OTHER	New Technology - Level 52	1	1	—	—	$142,919.70	$142,919.70	$142,919.70	2024-10-01
020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	1	1	—	—	$71,676.53	$71,676.53	$71,676.53	2024-10-01
021	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	1	1	—	—	$56,242.02	$56,242.02	$56,242.02	2024-10-01
0294T	CPT	HInsertion Of Left Atrial Hemodynamic Monitor; Pressure Sensor Lead At Time Of I…	3	1	—	—	$19,926.00	$49,364.00	$45,326.00	2024-10-01
02HA0QZ	OTHER	Insertion Of Implantable Heart Assist System Into Heart, Open Approach	2	2	—	—	$105,000.00	$312,000.00	$208,500.00	2024-10-01
02HA0RS	OTHER	Insertion Of Biventricular External Heart Assist System Into Heart, Open Approac…	1	1	—	—	$105,000.00	$105,000.00	$105,000.00	2024-10-01
02HA0RZ	OTHER	Insertion Of External Heart Assist System Into Heart, Open Approach	2	2	—	—	$105,000.00	$312,000.00	$208,500.00	2024-10-01
02HA3QZ	OTHER	Insertion Of Implantable Heart Assist System Into Heart, Percutaneous Approach	2	2	—	—	$105,000.00	$312,000.00	$208,500.00	2024-10-01
02HA3RS	OTHER	Insertion Of Biventricular External Heart Assist System Into Heart, Percutaneous…	1	1	—	—	$105,000.00	$105,000.00	$105,000.00	2024-10-01
02HA3RZ	OTHER	Insertion Of External Heart Assist System Into Heart, Percutaneous Approach	1	1	—	—	$312,000.00	$312,000.00	$312,000.00	2024-10-01
02HA4QZ	OTHER	Insertion Of Implantable Heart Assist System Into Heart, Percutaneous Endoscopic…	2	2	—	—	$105,000.00	$312,000.00	$208,500.00	2024-10-01
02HA4RS	OTHER	Insertion Of Biventricular External Heart Assist System Into Heart, Percutaneous…	1	1	—	—	$105,000.00	$105,000.00	$105,000.00	2024-10-01
02HA4RZ	OTHER	Insertion Of External Heart Assist System Into Heart, Percutaneous Endoscopic Ap…	1	1	—	—	$105,000.00	$105,000.00	$105,000.00	2024-10-01
02PA0RZ	OTHER	Removal Of External Heart Assist System From Heart, Open Approach	1	1	—	—	$312,000.00	$312,000.00	$312,000.00	2024-10-01
02PA3RZ	OTHER	Removal Of External Heart Assist System From Heart, Percutaneous Approach	1	1	—	—	$312,000.00	$312,000.00	$312,000.00	2024-10-01
02PA4RZ	OTHER	Removal Of External Heart Assist System From Heart, Percutaneous Endoscopic Appr…	1	1	—	—	$312,000.00	$312,000.00	$312,000.00	2024-10-01
02RK0JZ	OTHER	Replacement Of Right Ventricle With Synthetic Substitute, Open Approach	1	1	—	—	$312,000.00	$312,000.00	$312,000.00	2024-10-01
02RL0JZ	OTHER	Replacement Of Left Ventricle With Synthetic Substitute, Open Approach	1	1	—	—	$312,000.00	$312,000.00	$312,000.00	2024-10-01
02WA0QZ	OTHER	Revision Of Implantable Heart Assist System In Heart, Open Approach	2	2	—	—	$105,000.00	$312,000.00	$208,500.00	2024-10-01
02WA0RZ	OTHER	Revision Of External Heart Assist System In Heart, Open Approach	2	2	—	—	$105,000.00	$312,000.00	$208,500.00	2024-10-01
02WA3QZ	OTHER	Revision Of Implantable Heart Assist System In Heart, Percutaneous Approach	2	2	—	—	$105,000.00	$312,000.00	$208,500.00	2024-10-01
02WA3RZ	OTHER	Revision Of External Heart Assist System In Heart, Percutaneous Approach	2	2	—	—	$105,000.00	$312,000.00	$208,500.00	2024-10-01
02WA4QZ	OTHER	Revision Of Implantable Heart Assist System In Heart, Percutaneous Endoscopic Ap…	2	2	—	—	$105,000.00	$312,000.00	$208,500.00	2024-10-01
02WA4RZ	OTHER	Revision Of External Heart Assist System In Heart, Percutaneous Endoscopic Appro…	2	2	—	—	$105,000.00	$312,000.00	$208,500.00	2024-10-01
02YA0Z0	OTHER	Transplantation Of Heart, Allogeneic, Open Approach	2	1	—	—	$105,000.00	$290,000.00	$197,500.00	2024-10-01
02YA0Z1	OTHER	Transplantation Of Heart, Syngeneic, Open Approach	2	1	—	—	$105,000.00	$290,000.00	$197,500.00	2024-10-01
02YA0Z2	OTHER	Transplantation Of Heart, Zooplastic, Open Approach	2	1	—	—	$105,000.00	$290,000.00	$197,500.00	2024-10-01
05244	OTHER	Level 4 Blood Product Exc	1	1	—	—	$48,795.12	$48,795.12	$48,795.12	2024-10-01
09035	OTHER	Axicabtagene Ciloleucel C	1	1	—	—	$474,772.32	$474,772.32	$474,772.32	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
09141	OTHER	Inj Onase Abepar-xioi Tre	1	1	—	—	$2,316,955.58	$2,316,955.58	$2,316,955.58	2024-10-01
09194	OTHER	Tisagenlecleucel Car-pos	1	1	—	—	$513,317.11	$513,317.11	$513,317.11	2024-10-01
09273	OTHER	Sipuleucel-t Auto Cd54+	1	1	—	—	$53,364.77	$53,364.77	$53,364.77	2024-10-01
09391	OTHER	Brexucabtagene Car Pos T	1	1	—	—	$446,714.49	$446,714.49	$446,714.49	2024-10-01
09413	OTHER	Lisocabtagene Car Pos T	1	1	—	—	$501,224.32	$501,224.32	$501,224.32	2024-10-01
09422	OTHER	Idecabtagene Vicleucel Ca	1	1	—	—	$510,789.97	$510,789.97	$510,789.97	2024-10-01
09498	OTHER	Ciltacabtagene Car-pos T	1	1	—	—	$511,309.70	$511,309.70	$511,309.70	2024-10-01
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	63	33	—	—	$9,780.00	$421,414.16	$256,521.64	2024-10-01
10	MS_DRG	Pancreas Transplant	48	31	—	—	$9,780.00	$188,736.32	$73,443.67	2024-10-01
11	MS_DRG	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	54	34	—	—	$8,000.00	$119,183.41	$49,555.02	2024-10-01
112	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	16	13	—	—	$48,895.00	$73,342.50	$57,696.10	2024-10-01
113	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	16	13	—	—	$56,946.00	$85,419.00	$67,196.28	2024-10-01
114	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	16	13	—	—	$97,644.00	$146,466.00	$115,219.92	2024-10-01
1142	OTHER	Supprelin La Implant	24	21	—	—	$45,350.21	$65,757.80	$47,617.72	2024-10-01
14	MS_DRG	Allogeneic Bone Marrow Transplant	48	31	—	—	$6,771.00	$368,315.44	$120,344.71	2024-10-01
14	APR_DRG	Liver Transplant And/or Intestinal Transplant	16	13	—	—	$67,242.00	$100,863.00	$79,345.56	2024-10-01
1580	OTHER	New Technology - Level 43	24	21	—	—	$43,477.68	$63,042.64	$45,651.56	2024-10-01
1581	OTHER	New Technology - Level 44	24	21	—	—	$53,139.28	$77,051.96	$55,796.24	2024-10-01
1582	OTHER	New Technology - Level 45	24	21	—	—	$62,800.88	$91,061.28	$65,940.92	2024-10-01
1583	OTHER	New Technology - Level 46	24	21	—	—	$72,462.48	$105,070.60	$76,085.60	2024-10-01
1584	OTHER	New Technology - Level 47	24	21	—	—	$82,124.09	$119,079.93	$86,230.29	2024-10-01
1585	OTHER	New Technology - Level 48	24	21	—	—	$91,785.68	$133,089.24	$96,374.96	2024-10-01
1594	OTHER	New Technology - Level 43	24	21	—	—	$43,477.68	$63,042.64	$45,651.56	2024-10-01
1595	OTHER	New Technology - Level 44	24	21	—	—	$53,139.28	$77,051.96	$55,796.24	2024-10-01
1596	OTHER	New Technology - Level 45	24	21	—	—	$62,800.88	$91,061.28	$65,940.92	2024-10-01
1597	OTHER	New Technology - Level 46	24	21	—	—	$72,462.48	$105,070.60	$76,085.60	2024-10-01
1598	OTHER	New Technology - Level 47	24	21	—	—	$82,124.09	$119,079.93	$86,230.29	2024-10-01
1599	OTHER	New Technology - Level 48	24	21	—	—	$91,785.68	$133,089.24	$96,374.96	2024-10-01
16	MS_DRG	Autologous Bone Marrow Transplant With Cc/mcc	47	30	—	—	$6,771.00	$368,315.44	$55,881.84	2024-10-01
1604	APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	16	13	—	—	$55,523.00	$83,284.50	$65,517.14	2024-10-01
1611	APR_DRG	Implantable Heart Assist Systems	16	13	—	—	$49,247.00	$73,870.50	$58,111.46	2024-10-01
1612	APR_DRG	Implantable Heart Assist Systems	16	13	—	—	$51,688.00	$77,532.00	$60,991.84	2024-10-01
1613	APR_DRG	Implantable Heart Assist Systems	16	13	—	—	$64,392.00	$96,588.00	$75,982.56	2024-10-01
1614	APR_DRG	Implantable Heart Assist Systems	16	13	—	—	$95,167.00	$142,750.50	$112,297.06	2024-10-01
1624	APR_DRG	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	16	13	—	—	$37,904.00	$56,856.00	$44,726.72	2024-10-01
1643	OTHER	Y90 Ibritumomab, Rx	24	21	—	—	$65,476.58	$94,941.04	$68,750.41	2024-10-01
17	MS_DRG	Autologous Bone Marrow Transplant Without Cc/mcc	48	31	—	—	$6,771.00	$368,315.44	$56,155.77	2024-10-01
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	50	32	—	—	$6,771.00	$832,980.61	$339,682.90	2024-10-01
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	51	33	—	—	$9,780.00	$190,652.64	$73,027.54	2024-10-01
1901	OTHER	New Technology - Level 49	24	21	—	—	$103,862.70	$150,600.91	$109,055.84	2024-10-01
1902	OTHER	New Technology - Level 49	24	21	—	—	$103,862.70	$150,600.91	$109,055.84	2024-10-01
1903	OTHER	New Technology - Level 50	24	21	—	—	$118,355.10	$171,614.89	$124,272.86	2024-10-01
1904	OTHER	New Technology - Level 50	24	21	—	—	$118,355.10	$171,614.89	$124,272.86	2024-10-01
1905	OTHER	New Technology - Level 51	24	21	—	—	$132,847.50	$192,628.88	$139,489.88	2024-10-01
1906	OTHER	New Technology - Level 51	24	21	—	—	$132,847.50	$192,628.88	$139,489.88	2024-10-01
1907	OTHER	New Technology - Level 52	24	21	—	—	$147,339.90	$213,642.85	$154,706.89	2024-10-01
1908	OTHER	New Technology - Level 52	24	21	—	—	$147,339.90	$213,642.85	$154,706.89	2024-10-01
2	MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	63	33	—	—	$9,780.00	$421,414.16	$105,032.32	2024-10-01
20	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	54	34	—	—	$10,799.00	$235,720.44	$76,438.98	2024-10-01
207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	53	34	—	—	$6,000.00	$142,865.03	$58,627.63	2024-10-01
21	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	54	34	—	—	$10,799.00	$235,720.44	$53,285.24	2024-10-01
21	APR_DRG	Heart And/or Lung Transplant	16	13	—	—	$41,730.00	$62,595.00	$49,241.40	2024-10-01
212	MS_DRG	Concomitant Aortic And Mitral Valve Procedures	54	34	—	—	$8,000.00	$351,620.27	$102,859.92	2024-10-01
215	MS_DRG	Other Heart Assist System Implant	55	34	—	—	$10,799.00	$380,257.34	$101,023.43	2024-10-01
215	OTHER	Other Heart Assist System Implant	1	1	—	—	$64,095.61	$64,095.61	$64,095.61	2024-10-01
216	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	55	34	—	—	$10,799.00	$238,808.75	$91,534.04	2024-10-01
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	1	1	—	—	$62,044.10	$62,044.10	$62,044.10	2024-10-01
217	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	55	34	—	—	$10,799.00	$238,808.75	$62,048.24	2024-10-01
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	1	1	—	—	$61,699.10	$61,699.10	$61,699.10	2024-10-01
218	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	55	34	—	—	$10,799.00	$238,808.75	$57,799.44	2024-10-01
219	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	53	33	—	—	$10,799.00	$206,936.46	$73,405.00	2024-10-01
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	1	1	—	—	$47,273.64	$47,273.64	$47,273.64	2024-10-01
22	APR_DRG	Heart And/or Lung Transplant	16	13	—	—	$45,376.00	$68,064.00	$53,543.68	2024-10-01
220	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	53	33	—	—	$10,799.00	$206,936.46	$51,108.85	2024-10-01
221	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	53	33	—	—	$10,799.00	$206,936.46	$44,476.06	2024-10-01
222	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock…	3	1	—	—	$68,499.00	$102,063.00	$102,063.00	2024-10-01
223	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock…	3	1	—	—	$68,499.00	$102,063.00	$102,063.00	2024-10-01
224	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh…	3	1	—	—	$68,499.00	$102,063.00	$102,063.00	2024-10-01
225	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh…	3	1	—	—	$68,499.00	$102,063.00	$102,063.00	2024-10-01
226	MS_DRG	Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc	3	1	—	—	$67,393.00	$100,416.00	$100,416.00	2024-10-01
227	MS_DRG	Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc	3	1	—	—	$67,393.00	$100,416.00	$100,416.00	2024-10-01
228	MS_DRG	Other Cardiothoracic Procedures With Mcc	52	33	—	—	$10,799.00	$156,057.67	$48,156.13	2024-10-01
23	APR_DRG	Heart And/or Lung Transplant	16	13	—	—	$62,352.00	$93,528.00	$73,575.36	2024-10-01
23	MS_DRG	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	54	34	—	—	$10,799.00	$145,532.60	$54,438.17	2024-10-01
231	MS_DRG	Coronary Bypass With Ptca With Mcc	54	34	—	—	$10,799.00	$240,568.37	$80,323.89	2024-10-01
231	OTHER	Coronary Bypass With Ptca With Mcc	1	1	—	—	$55,695.44	$55,695.44	$55,695.44	2024-10-01
232	MS_DRG	Coronary Bypass With Ptca Without Mcc	54	34	—	—	$10,799.00	$240,568.37	$58,759.17	2024-10-01
232	OTHER	Coronary Bypass With Ptca Without Mcc	1	1	—	—	$47,277.97	$47,277.97	$47,277.97	2024-10-01
233	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	54	34	—	—	$10,799.00	$202,235.44	$74,164.21	2024-10-01
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	1	1	—	—	$46,563.22	$46,563.22	$46,563.22	2024-10-01
234	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	54	34	—	—	$10,799.00	$154,082.59	$51,089.07	2024-10-01
235	MS_DRG	Coronary Bypass Without Cardiac Catheterization With Mcc	54	34	—	—	$10,799.00	$166,429.31	$56,376.85	2024-10-01
239	MS_DRG	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	54	34	—	—	$8,000.00	$111,251.25	$45,906.72	2024-10-01
24	APR_DRG	Heart And/or Lung Transplant	16	13	—	—	$111,047.00	$166,570.50	$131,035.46	2024-10-01
245	MS_DRG	Aicd Generator Procedures	54	34	—	—	$10,799.00	$107,937.90	$45,464.95	2024-10-01
246	MS_DRG	Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar…	3	1	—	—	$37,326.00	$55,615.00	$55,615.00	2024-10-01
247	MS_DRG	Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc	3	1	—	—	$37,326.00	$55,615.00	$55,615.00	2024-10-01
248	MS_DRG	Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4…	3	1	—	—	$35,851.00	$53,419.00	$53,419.00	2024-10-01
249	MS_DRG	Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc	3	1	—	—	$35,851.00	$53,419.00	$53,419.00	2024-10-01
25	MS_DRG	Craniotomy And Endovascular Intracranial Procedures With Mcc	54	34	—	—	$10,799.00	$124,417.17	$42,933.75	2024-10-01
266	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	55	34	—	—	$10,799.00	$293,552.83	$58,192.22	2024-10-01
267	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	55	34	—	—	$10,799.00	$220,416.00	$45,961.78	2024-10-01
268	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	54	34	—	—	$10,799.00	$109,888.00	$62,423.62	2024-10-01
270	MS_DRG	Other Major Cardiovascular Procedures With Mcc	54	34	—	—	$10,799.00	$109,723.00	$49,100.79	2024-10-01
275	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	54	34	—	—	$10,799.00	$229,690.73	$67,786.93	2024-10-01
276	MS_DRG	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	54	34	—	—	$10,799.00	$162,919.86	$59,004.66	2024-10-01
277	MS_DRG	Cardiac Defibrillator Implant Without Mcc	54	34	—	—	$10,799.00	$162,919.86	$44,827.96	2024-10-01
278	MS_DRG	Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures	54	34	—	—	$10,799.00	$145,614.22	$47,739.66	2024-10-01
28	MS_DRG	Spinal Procedures With Mcc	54	34	—	—	$10,799.00	$134,281.24	$56,001.24	2024-10-01
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	53	33	—	—	$8,000.00	$654,271.54	$195,450.87	2024-10-01
3034	APR_DRG	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	16	13	—	—	$39,878.00	$59,817.00	$47,056.04	2024-10-01
317	MS_DRG	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	54	34	—	—	$9,780.00	$201,948.16	$57,960.24	2024-10-01
326	MS_DRG	Stomach, Esophageal And Duodenal Procedures With Mcc	54	34	—	—	$8,000.00	$112,183.40	$46,281.81	2024-10-01
4	MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	52	32	—	—	$8,000.00	$392,685.68	$129,000.45	2024-10-01
405	MS_DRG	Pancreas, Liver And Shunt Procedures With Mcc	54	34	—	—	$8,000.00	$145,610.95	$50,130.89	2024-10-01
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	1	1	—	—	$51,188.07	$51,188.07	$51,188.07	2024-10-01
426	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	54	34	—	—	$10,799.00	$342,182.31	$99,019.52	2024-10-01
427	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	54	34	—	—	$10,799.00	$231,744.16	$67,447.95	2024-10-01
428	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	54	34	—	—	$10,799.00	$179,722.76	$52,576.29	2024-10-01
429	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	54	34	—	—	$10,799.00	$272,267.64	$79,032.62	2024-10-01
43	APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	16	13	—	—	$41,876.00	$62,814.00	$49,413.68	2024-10-01
430	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc	54	34	—	—	$10,799.00	$178,576.88	$52,248.71	2024-10-01
44	APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	16	13	—	—	$66,782.00	$100,173.00	$78,802.76	2024-10-01
447	MS_DRG	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	54	34	—	—	$10,799.00	$218,865.31	$61,944.30	2024-10-01
450	MS_DRG	Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically	54	34	—	—	$9,780.00	$168,117.11	$49,051.71	2024-10-01
453	OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	1	1	—	—	$68,917.07	$68,917.07	$68,917.07	2024-10-01
456	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	54	34	—	—	$10,799.00	$187,062.91	$77,940.43	2024-10-01
457	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	54	34	—	—	$10,799.00	$165,642.54	$54,758.28	2024-10-01
459	MS_DRG	Spinal Fusion Except Cervical With Mcc	3	2	—	—	$11,430.00	$75,435.00	$75,435.00	2024-10-01
460	MS_DRG	Spinal Fusion Except Cervical Without Mcc	3	2	—	—	$11,430.00	$62,710.00	$62,710.00	2024-10-01
461	MS_DRG	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	54	34	—	—	$10,799.00	$135,553.57	$56,799.32	2024-10-01
461	OTHER	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	1	1	—	—	$46,795.70	$46,795.70	$46,795.70	2024-10-01
463	MS_DRG	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective	54	34	—	—	$9,780.00	$119,296.06	$49,143.84	2024-10-01
466	MS_DRG	Revision Of Hip Or Knee Replacement With Mcc	54	34	—	—	$10,799.00	$81,050.22	$47,348.87	2024-10-01
466	OTHER	Revision Of Hip Or Knee Replacement With Mcc	1	1	—	—	$47,090.63	$47,090.63	$47,090.63	2024-10-01
471	MS_DRG	Cervical Spinal Fusion With Mcc	54	34	—	—	$10,799.00	$78,377.00	$46,526.84	2024-10-01
5	MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	62	32	—	—	$9,780.00	$374,358.21	$101,268.96	2024-10-01
5244	OTHER	Level 4 Blood Product Exc	24	21	—	—	$50,304.25	$72,941.16	$52,819.46	2024-10-01
54	APR_DRG	Tracheostomy With Mv >96 Hours Without Extensive Procedure	16	13	—	—	$43,560.00	$65,340.00	$51,400.80	2024-10-01
573	MS_DRG	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	54	34	—	—	$8,000.00	$136,019.64	$55,873.15	2024-10-01
576	MS_DRG	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc	54	34	—	—	$8,000.00	$119,167.95	$49,092.29	2024-10-01
5831	APR_DRG	Neonate With Ecmo	16	13	—	—	$69,493.00	$104,239.50	$82,001.74	2024-10-01
5832	APR_DRG	Neonate With Ecmo	16	13	—	—	$95,607.00	$143,410.50	$112,816.26	2024-10-01
5833	APR_DRG	Neonate With Ecmo	16	13	—	—	$124,517.00	$186,775.50	$146,930.06	2024-10-01
5834	APR_DRG	Neonate With Ecmo	16	13	—	—	$192,207.00	$288,310.50	$226,804.26	2024-10-01
5881	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	16	13	—	—	$61,338.00	$92,007.00	$72,378.84	2024-10-01
5882	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	16	13	—	—	$71,560.00	$107,340.00	$84,440.80	2024-10-01
5883	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	16	13	—	—	$81,552.00	$122,328.00	$96,231.36	2024-10-01
5884	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	16	13	—	—	$125,393.00	$188,089.50	$147,963.74	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	$57,799.94	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	$56,094.84	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	$54,899.50	2024-10-01
5912	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	16	13	—	—	$44,835.00	$67,252.50	$52,905.30	2024-10-01
5913	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	16	13	—	—	$59,125.00	$88,687.50	$69,767.50	2024-10-01
5914	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	16	13	—	—	$79,657.00	$119,485.50	$93,995.26	2024-10-01
5932	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	16	13	—	—	$41,957.00	$62,935.50	$49,509.26	2024-10-01
5933	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	16	13	—	—	$51,226.00	$76,839.00	$60,446.68	2024-10-01
5934	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	16	13	—	—	$73,863.00	$110,794.50	$87,158.34	2024-10-01
6	MS_DRG	Liver Transplant Without Mcc	62	32	—	—	$9,780.00	$374,358.21	$46,893.64	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	$45,909.08	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	$64,721.82	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	$80,618.78	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	$49,601.30	2024-10-01
6094	APR_DRG	Neonate Birth Weight 1500-2499 Grams With Major Procedure	16	13	—	—	$82,446.00	$123,669.00	$97,286.28	2024-10-01
6303	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	16	13	—	—	$43,677.00	$65,515.50	$51,538.86	2024-10-01
6304	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	16	13	—	—	$91,470.00	$137,205.00	$107,934.60	2024-10-01
6314	APR_DRG	Neonate Birth Weight > 2499 Grams With Other Major Procedure	16	13	—	—	$80,942.00	$121,413.00	$95,511.56	2024-10-01
64	APR_DRG	Pancreas Transplant	16	13	—	—	$48,372.00	$72,558.00	$57,078.96	2024-10-01
650	MS_DRG	Kidney Transplant With Hemodialysis With Mcc	59	34	—	—	$9,780.00	$309,000.00	$44,614.56	2024-10-01
651	OTHER	Kidney Transplant With Hemodialysis Without Mcc	1	1	—	—	$95,019.04	$95,019.04	$95,019.04	2024-10-01
653	MS_DRG	Major Bladder Procedures With Mcc	54	34	—	—	$8,000.00	$123,128.50	$50,764.31	2024-10-01
7	MS_DRG	Lung Transplant	47	30	—	—	$9,780.00	$310,695.25	$119,637.94	2024-10-01
714	OTHER	Inj Delandistrogene Mox R	25	22	—	—	$6,578.05	$4,821,909.75	$3,491,727.75	2024-10-01
717	OTHER	Instill Adstiladrin, Tx D	25	22	—	—	$15,764.06	$91,864.42	$66,522.51	2024-10-01
73	APR_DRG	Allogeneic Bone Marrow Transplant	16	13	—	—	$36,953.00	$55,429.50	$43,604.54	2024-10-01
74	APR_DRG	Allogeneic Bone Marrow Transplant	16	13	—	—	$75,611.00	$113,416.50	$89,220.98	2024-10-01
746	OTHER	Inj, Betibeglogene Autote	25	22	—	—	$9,637.37	$4,303,600.00	$3,116,400.00	2024-10-01
748	OTHER	Inj, Lovotibeglogene Auto	25	22	—	—	$10,850.47	$4,764,700.00	$3,450,300.00	2024-10-01
773	OTHER	Inj, Beqvez, Per Tx Dose	23	20	—	—	$3,605,000.00	$4,109,700.00	$3,785,250.00	2024-10-01
790	MS_DRG	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	39	27	—	—	$11,098.00	$67,477.16	$55,061.36	2024-10-01
799	MS_DRG	Splenic Procedures With Mcc	54	34	—	—	$8,000.00	$106,060.32	$44,051.23	2024-10-01
8	MS_DRG	Simultaneous Pancreas And Kidney Transplant	48	31	—	—	$9,780.00	$190,652.64	$50,737.77	2024-10-01
820	MS_DRG	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	54	34	—	—	$8,000.00	$128,599.95	$52,887.58	2024-10-01
826	MS_DRG	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r.	54	34	—	—	$8,000.00	$105,479.39	$43,584.21	2024-10-01
834	OTHER	Acute Leukemia With Mcc	1	1	—	—	$52,384.47	$52,384.47	$52,384.47	2024-10-01
834	MS_DRG	Acute Leukemia With Mcc	53	34	—	—	$6,000.00	$122,083.69	$50,265.54	2024-10-01
837	MS_DRG	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	53	34	—	—	$6,000.00	$110,595.21	$45,642.74	2024-10-01
84	APR_DRG	Autologous Bone Marrow Transplant	16	13	—	—	$37,476.00	$56,214.00	$44,221.68	2024-10-01
8414	APR_DRG	Extensive Third Degree Burns With Skin Graft	16	13	—	—	$90,217.00	$135,325.50	$106,456.06	2024-10-01
8424	APR_DRG	Burns With Skin Graft Except Extensive Third Degree Burns	16	13	—	—	$46,203.00	$69,304.50	$54,519.54	2024-10-01
850	MS_DRG	Acute Leukemia With Other Procedures	54	34	—	—	$8,000.00	$300,712.10	$84,673.79	2024-10-01
8514	APR_DRG	Gender Related Procedures	16	13	—	—	$46,902.00	$70,353.00	$55,344.36	2024-10-01
853	MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	54	34	—	—	$8,000.00	$110,478.13	$46,279.57	2024-10-01
870	MS_DRG	Septicemia Or Severe Sepsis With Mv >96 Hours	53	34	—	—	$6,000.00	$78,715.27	$61,712.78	2024-10-01
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	1	1	—	—	$46,399.99	$46,399.99	$46,399.99	2024-10-01
9035	OTHER	Axicabtagene Ciloleucel C	24	21	—	—	$489,456.00	$709,711.20	$513,928.80	2024-10-01
9138	OTHER	Inj, Hemgenix, Per Tx Dos	23	20	—	—	$3,672,900.00	$4,187,106.00	$3,856,545.00	2024-10-01
9141	OTHER	Inj Onase Abepar-xioi Tre	24	21	—	—	$2,388,614.00	$3,463,490.30	$2,508,044.70	2024-10-01
9194	OTHER	Tisagenlecleucel Car-pos	24	21	—	—	$529,192.90	$767,329.70	$555,652.55	2024-10-01
927	MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	49	29	—	—	$8,000.00	$524,012.93	$211,995.80	2024-10-01
9273	OTHER	Sipuleucel-t Auto Cd54+	24	21	—	—	$55,015.23	$79,772.08	$57,765.99	2024-10-01
928	MS_DRG	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	49	29	—	—	$8,000.00	$147,521.39	$60,590.62	2024-10-01
9391	OTHER	Brexucabtagene Car Pos T	24	21	—	—	$460,530.40	$667,769.08	$483,556.92	2024-10-01
94	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	16	13	—	—	$75,232.00	$112,848.00	$88,773.76	2024-10-01
9413	OTHER	Lisocabtagene Car Pos T	24	21	—	—	$516,726.10	$749,252.84	$542,562.41	2024-10-01
9422	OTHER	Idecabtagene Vicleucel Ca	24	21	—	—	$526,587.60	$763,552.02	$552,916.98	2024-10-01
9498	OTHER	Ciltacabtagene Car-pos T	24	21	—	—	$527,123.40	$764,328.93	$553,479.57	2024-10-01
955	OTHER	Craniotomy For Multiple Significant Trauma	1	1	—	—	$77,771.07	$77,771.07	$77,771.07	2024-10-01
955	MS_DRG	Craniotomy For Multiple Significant Trauma	54	34	—	—	$8,000.00	$228,430.59	$63,065.77	2024-10-01
956	OTHER	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	1	1	—	—	$53,988.33	$53,988.33	$53,988.33	2024-10-01
957	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Mcc	54	34	—	—	$8,000.00	$164,865.67	$68,492.57	2024-10-01
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	1	1	—	—	$53,350.25	$53,350.25	$53,350.25	2024-10-01
969	MS_DRG	HIV With Extensive O.r. Procedures With Mcc	54	34	—	—	$8,000.00	$147,161.64	$58,209.74	2024-10-01
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	1	1	—	—	$47,167.30	$47,167.30	$47,167.30	2024-10-01
981	MS_DRG	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	54	34	—	—	$8,000.00	$118,185.05	$44,049.43	2024-10-01
A0404	OTHER	Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5	6	6	—	—	$34,497.40	$45,277.84	$43,121.75	2024-10-01
A5104	OTHER	Expired, Not Orthopedic, Length Of Stay Is 16 Days	6	6	—	—	$34,393.50	$45,141.47	$42,991.88	2024-10-01
A9543	HCPCS	Y90 Ibritum Tiu Tx 40mci	2	1	$104,070.64	$104,070.64	$140,774.65	$140,774.65	$140,774.65	2024-10-01
A9699	HCPCS	Radiopharmaceutical, Therapeutic, Not Otherwise Classified	2	1	—	—	$100,053.67	$100,053.67	$100,053.67	2024-10-01
B0105	OTHER	Stroke; M > 34.25 & M < 38.85	6	6	—	—	$36,874.10	$48,397.25	$46,092.62	2024-10-01
B0106	OTHER	Stroke; M > 30.05 & M < 34.25	6	6	—	—	$41,940.62	$55,047.07	$52,425.78	2024-10-01
B0205	OTHER	Traumatic Brain Injury; M > 28.75 & M < 40.65	6	6	—	—	$38,074.71	$49,973.05	$47,593.38	2024-10-01
B0404	OTHER	Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5	6	6	—	—	$43,978.20	$57,721.39	$54,972.75	2024-10-01
B0405	OTHER	Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5	6	6	—	—	$34,973.61	$45,902.86	$43,717.01	2024-10-01
B0505	OTHER	Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2	6	6	—	—	$43,526.53	$57,128.57	$54,408.16	2024-10-01
B0604	OTHER	Neurological; M < 25.85	6	6	—	—	$35,937.56	$47,168.05	$44,921.95	2024-10-01
B1903	OTHER	Guillian Barre; M < 18.05	6	6	—	—	$36,240.60	$47,565.79	$45,300.75	2024-10-01
C0106	OTHER	Stroke; M > 30.05 & M < 34.25	6	6	—	—	$36,373.36	$47,740.03	$45,466.70	2024-10-01
C0404	OTHER	Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5	6	6	—	—	$39,109.37	$51,331.05	$48,886.71	2024-10-01
C2616	HCPCS	Brachytx Ns Yttrium 90	2	1	$53,310.57	$53,310.57	$40,208.00	$53,804.00	$47,006.00	2024-10-01
D0404	OTHER	Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5	6	6	—	—	$37,965.04	$49,829.11	$47,456.30	2024-10-01
J7330	HCPCS	Autologous Cultured Chondrocytes, Implant	2	1	—	—	$156,515.70	$156,515.70	$156,515.70	2024-10-01
J9029	HCPCS	Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose	6	3	—	—	$61,600.24	$136,523.56	$61,600.24	2024-10-01
J9226	HCPCS	Histrelin Implant (supprelin La), 50 Mg	6	3	—	—	$43,241.44	$94,940.24	$43,241.44	2024-10-01
J9600	HCPCS	Injection, Porfimer Sodium, 75 Mg	2	1	—	—	$50,561.89	$50,561.89	$50,561.89	2024-10-01
K1007	HCPCS	Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin…	25	22	—	—	$88,300.94	$131,996.25	$95,583.49	2024-10-01
L7181	HCPCS	Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi…	25	22	—	—	$46,068.21	$68,864.85	$49,867.65	2024-10-01
L8702	HCPCS	Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge…	25	22	—	—	$63,895.55	$95,513.96	$69,165.29	2024-10-01
Q0480	HCPCS	Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only	25	22	—	—	$96,999.90	$144,999.85	$104,999.90	2024-10-01
Q2041	HCPCS	Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via…	6	3	—	—	$445,599.57	$1,051,644.36	$445,599.57	2024-10-01
Q2042	HCPCS	Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…	6	3	—	—	$502,693.77	$1,125,423.00	$502,693.77	2024-10-01
Q2043	HCPCS	Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…	3	2	—	—	$53,789.99	$119,352.48	$119,352.48	2024-10-01
Q2053	HCPCS	Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V…	6	3	—	—	$435,956.80	$966,296.00	$435,956.80	2024-10-01
Q2054	HCPCS	Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi…	6	3	—	—	$459,839.17	$1,067,238.95	$459,839.17	2024-10-01
Q2055	HCPCS	Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…	5	3	—	—	$470,149.30	$1,082,427.24	$470,149.30	2024-10-01
Q2056	HCPCS	Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…	6	3	—	—	$492,271.12	$1,091,527.05	$492,271.12	2024-10-01

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