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 RAULERSON HOSPITAL

Okeechobee, FL · CCN 100252 · Rates published

22,045 distinct procedures filed
44 distinct payers
483,889 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

301,632 of 483,889 rate rows are consumer-grade (62.3%)

182,257 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 159,757
per-diem day rate — not a per-procedure price 13,056
template filing: same amount across many unrelated codes — excluded 9,311
placeholder amount (≤ $0.02) — excluded from medians 88
exceeds 10× this hospital's gross charge — excluded from medians 45

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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/59-1833934_HCA-FLORIDA-RAULERSON-HOSPITAL_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.hcafloridahealthcare.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaCMS hospital list
Last fetch success · 2026-06-08

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,897,200.00 $4,897,200.00 $4,897,200.00 nat. median
$3,006,423
1.6× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $3,884,946.48 $3,884,946.48 $3,884,946.48 nat. median
$2,469,189
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 18 $3,672,900.00 $4,407,480.00 $3,746,358.00 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 18 $3,605,000.00 $4,326,000.00 $3,677,100.00 nat. median
$3,605,000
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,636,171.00 $3,636,171.00 $3,636,171.00 nat. median
$3,574,709
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 1 $3,568,950.00 $3,568,950.00 $3,568,950.00 nat. median
$3,496,850
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 19 $5,443.92 $3,990,546.00 $3,391,964.10 nat. median
$13,041
outlier · 260.1×
748
OTHER 		Inj, Lovotibeglogene Auto 19 $8,979.73 $3,943,200.00 $3,351,720.00 nat. median
$17,963
outlier · 186.6×
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,292,200.45 $3,292,200.45 $3,292,200.45 nat. median
$3,228,024
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $3,253,140.00 $3,253,140.00 $3,253,140.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 19 $7,975.79 $3,561,600.00 $3,027,360.00 nat. median
$21,896
outlier · 138.3×
00746
OTHER 		Inj, Betibeglogene Autote 1 $2,938,320.00 $2,938,320.00 $2,938,320.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 18 $2,388,614.00 $2,866,336.80 $2,436,386.28 nat. median
$2,588,981
0.9× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,364,727.86 $2,364,727.86 $2,364,727.86 nat. median
$2,457,321
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 18 $529,192.90 $635,031.48 $539,776.76 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 18 $527,123.40 $632,548.08 $537,665.87 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 18 $526,587.60 $631,905.12 $537,119.35 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 18 $516,726.10 $620,071.32 $527,060.62 nat. median
$562,201
0.9× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $523,900.97 $523,900.97 $523,900.97 nat. median
$538,205
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $521,852.17 $521,852.17 $521,852.17 nat. median
$554,552
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $521,321.72 $521,321.72 $521,321.72 nat. median
$530,178
1.0× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 $513,058.59 $863,696.72 $513,058.59 nat. median
$754,974
0.7× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $511,558.84 $511,558.84 $511,558.84 nat. median
$534,091
1.0× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $502,421.04 $837,683.55 $502,421.04 nat. median
$675,122
0.7× median
9035
OTHER 		Axicabtagene Ciloleucel C 18 $489,456.00 $587,347.20 $499,245.12 nat. median
$532,192
0.9× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $484,561.44 $484,561.44 $484,561.44 nat. median
$505,583
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $479,843.10 $830,699.97 $479,843.10 nat. median
$625,184
0.8× median
9391
OTHER 		Brexucabtagene Car Pos T 18 $460,530.40 $552,636.48 $469,741.01 nat. median
$489,450
1.0× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $469,320.39 $819,043.85 $469,320.39 nat. median
$674,188
0.7× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $455,925.10 $455,925.10 $455,925.10 nat. median
$464,978
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 3 $454,787.19 $807,075.90 $454,787.19 nat. median
$634,511
0.7× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $444,945.60 $741,576.00 $444,945.60 nat. median
$620,080
0.7× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 24 $5,348.00 $1,159,814.91 $283,885.37 nat. median
$370,174
0.8× median
5834
APR_DRG 		Neonate With Ecmo 12 $192,207.00 $288,310.50 $225,843.22 nat. median
$309,665
0.7× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 26 $7,000.00 $866,285.80 $212,038.94 nat. median
$265,286
0.8× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $184,526.30 $184,526.30 $184,526.30 nat. median
$263,894
0.7× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 24 $8,403.00 $729,618.44 $178,587.14 nat. median
$206,368
0.9× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 25 $7,000.00 $745,680.37 $158,613.58 nat. median
$202,986
0.8× median
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $152,261.40 $152,261.40 $152,261.40 nat. median
$424,868
outlier · 0.4×
1908
OTHER 		New Technology - Level 52 18 $147,339.90 $176,807.88 $150,286.70 nat. median
$152,962
1.0× median
1907
OTHER 		New Technology - Level 52 18 $147,339.90 $176,807.88 $150,286.70 nat. median
$153,199
1.0× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 12 $125,393.00 $188,089.50 $147,336.78 nat. median
$246,434
0.6× median
5833
APR_DRG 		Neonate With Ecmo 12 $124,517.00 $186,775.50 $146,307.48 nat. median
$244,017
0.6× median
01908
OTHER 		New Technology - Level 52 1 $145,866.50 $145,866.50 $145,866.50 nat. median
$82,736
1.8× median
01907
OTHER 		New Technology - Level 52 1 $145,866.50 $145,866.50 $145,866.50 nat. median
$84,819
1.7× median
1906
OTHER 		New Technology - Level 51 18 $132,847.50 $159,417.00 $135,504.45 nat. median
$138,020
1.0× median
1905
OTHER 		New Technology - Level 51 18 $132,847.50 $159,417.00 $135,504.45 nat. median
$137,903
1.0× median
01905
OTHER 		New Technology - Level 51 1 $131,519.02 $131,519.02 $131,519.02 nat. median
$82,736
1.6× median
01906
OTHER 		New Technology - Level 51 1 $131,519.02 $131,519.02 $131,519.02 nat. median
$82,736
1.6× median
24
APR_DRG 		Heart And/or Lung Transplant 12 $111,047.00 $166,570.50 $130,480.23 nat. median
$234,738
0.6× median

Other procedures at this hospital

Browse this hospital's 22,045 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 1 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… 1 1 — — $3,884,946.48 $3,884,946.48 $3,884,946.48 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 22 18 — — $3,672,900.00 $4,407,480.00 $3,746,358.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 22 18 — — $3,605,000.00 $4,326,000.00 $3,677,100.00 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,636,171.00 $3,636,171.00 $3,636,171.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 1 1 — — $3,568,950.00 $3,568,950.00 $3,568,950.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 23 19 — — $5,443.92 $3,990,546.00 $3,391,964.10 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 23 19 — — $8,979.73 $3,943,200.00 $3,351,720.00 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,292,200.45 $3,292,200.45 $3,292,200.45 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,253,140.00 $3,253,140.00 $3,253,140.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 23 19 — — $7,975.79 $3,561,600.00 $3,027,360.00 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,938,320.00 $2,938,320.00 $2,938,320.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 22 18 — — $2,388,614.00 $2,866,336.80 $2,436,386.28 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,364,727.86 $2,364,727.86 $2,364,727.86 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 22 18 — — $529,192.90 $635,031.48 $539,776.76 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 22 18 — — $527,123.40 $632,548.08 $537,665.87 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 22 18 — — $526,587.60 $631,905.12 $537,119.35 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 22 18 — — $516,726.10 $620,071.32 $527,060.62 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $523,900.97 $523,900.97 $523,900.97 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $521,852.17 $521,852.17 $521,852.17 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $521,321.72 $521,321.72 $521,321.72 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 5 3 — — $513,058.59 $863,696.72 $513,058.59 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $511,558.84 $511,558.84 $511,558.84 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 5 3 — — $502,421.04 $837,683.55 $502,421.04 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 22 18 — — $489,456.00 $587,347.20 $499,245.12 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $484,561.44 $484,561.44 $484,561.44 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 3 — — $479,843.10 $830,699.97 $479,843.10 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 22 18 — — $460,530.40 $552,636.48 $469,741.01 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 5 3 — — $469,320.39 $819,043.85 $469,320.39 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $455,925.10 $455,925.10 $455,925.10 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 5 3 — — $454,787.19 $807,075.90 $454,787.19 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 5 3 — — $444,945.60 $741,576.00 $444,945.60 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 49 24 — — $5,348.00 $1,159,814.91 $283,885.37 2024-10-01
5834 APR_DRG Neonate With Ecmo 14 12 — — $192,207.00 $288,310.50 $225,843.22 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 54 26 — — $7,000.00 $866,285.80 $212,038.94 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $184,526.30 $184,526.30 $184,526.30 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 51 24 — — $8,403.00 $729,618.44 $178,587.14 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 54 25 — — $7,000.00 $745,680.37 $158,613.58 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $152,261.40 $152,261.40 $152,261.40 2024-10-01
1907 OTHER New Technology - Level 52 22 18 — — $147,339.90 $176,807.88 $150,286.70 2024-10-01
1908 OTHER New Technology - Level 52 22 18 — — $147,339.90 $176,807.88 $150,286.70 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 12 — — $125,393.00 $188,089.50 $147,336.78 2024-10-01
5833 APR_DRG Neonate With Ecmo 14 12 — — $124,517.00 $186,775.50 $146,307.48 2024-10-01
01908 OTHER New Technology - Level 52 1 1 — — $145,866.50 $145,866.50 $145,866.50 2024-10-01
01907 OTHER New Technology - Level 52 1 1 — — $145,866.50 $145,866.50 $145,866.50 2024-10-01
1905 OTHER New Technology - Level 51 22 18 — — $132,847.50 $159,417.00 $135,504.45 2024-10-01
1906 OTHER New Technology - Level 51 22 18 — — $132,847.50 $159,417.00 $135,504.45 2024-10-01
01905 OTHER New Technology - Level 51 1 1 — — $131,519.02 $131,519.02 $131,519.02 2024-10-01
01906 OTHER New Technology - Level 51 1 1 — — $131,519.02 $131,519.02 $131,519.02 2024-10-01
24 APR_DRG Heart And/or Lung Transplant 14 12 — — $111,047.00 $166,570.50 $130,480.23 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $123,595.80 $123,595.80 $123,595.80 2024-10-01
1904 OTHER New Technology - Level 50 22 18 — — $118,355.10 $142,026.12 $120,722.20 2024-10-01
1903 OTHER New Technology - Level 50 22 18 — — $118,355.10 $142,026.12 $120,722.20 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 1 1 — — $120,116.70 $120,116.70 $120,116.70 2024-10-01
01904 OTHER New Technology - Level 50 1 1 — — $117,171.55 $117,171.55 $117,171.55 2024-10-01
01903 OTHER New Technology - Level 50 1 1 — — $117,171.55 $117,171.55 $117,171.55 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 14 12 — — $97,644.00 $146,466.00 $114,731.70 2024-10-01
5832 APR_DRG Neonate With Ecmo 14 12 — — $95,607.00 $143,410.50 $112,338.23 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 14 12 — — $95,167.00 $142,750.50 $111,821.23 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 1 — — $108,036.36 $108,036.36 $108,036.36 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 14 12 — — $91,470.00 $137,205.00 $107,477.25 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 14 12 — — $90,217.00 $135,325.50 $106,004.98 2024-10-01
1902 OTHER New Technology - Level 49 22 18 — — $103,862.70 $124,635.24 $105,939.95 2024-10-01
1901 OTHER New Technology - Level 49 22 18 — — $103,862.70 $124,635.24 $105,939.95 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 54 25 — — $7,000.00 $447,548.12 $104,575.17 2024-10-01
01901 OTHER New Technology - Level 49 1 1 — — $102,824.07 $102,824.07 $102,824.07 2024-10-01
01902 OTHER New Technology - Level 49 1 1 — — $102,824.07 $102,824.07 $102,824.07 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 50 25 — — $5,348.00 $419,773.09 $98,624.62 2024-10-01
7 MS_DRG Lung Transplant 53 26 — — $7,000.00 $401,916.33 $98,376.19 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 14 12 — — $82,446.00 $123,669.00 $96,874.05 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 12 — — $81,552.00 $122,328.00 $95,823.60 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 14 12 — — $80,942.00 $121,413.00 $95,106.85 2024-10-01
1599 OTHER New Technology - Level 48 22 18 — — $91,785.68 $110,142.82 $93,621.39 2024-10-01
1585 OTHER New Technology - Level 48 22 18 — — $91,785.68 $110,142.82 $93,621.39 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 14 12 — — $79,657.00 $119,485.50 $93,596.98 2024-10-01
01599 OTHER New Technology - Level 48 1 1 — — $90,867.82 $90,867.82 $90,867.82 2024-10-01
01585 OTHER New Technology - Level 48 1 1 — — $90,867.82 $90,867.82 $90,867.82 2024-10-01
74 APR_DRG Allogeneic Bone Marrow Transplant 14 12 — — $75,611.00 $113,416.50 $88,842.92 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 14 12 — — $75,232.00 $112,848.00 $88,397.60 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $86,903.16 $86,903.16 $86,903.16 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 14 12 — — $73,863.00 $110,794.50 $86,789.02 2024-10-01
215 MS_DRG Other Heart Assist System Implant 56 26 — — $7,000.00 $433,383.42 $84,355.17 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 12 — — $71,560.00 $107,340.00 $84,083.00 2024-10-01
1584 OTHER New Technology - Level 47 22 18 — — $82,124.09 $98,548.91 $83,766.57 2024-10-01
1598 OTHER New Technology - Level 47 22 18 — — $82,124.09 $98,548.91 $83,766.57 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 54 26 — — $7,000.00 $480,290.28 $82,957.18 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 55 26 — — $7,000.00 $400,745.43 $82,004.12 2024-10-01
5831 APR_DRG Neonate With Ecmo 14 12 — — $69,493.00 $104,239.50 $81,654.27 2024-10-01
01584 OTHER New Technology - Level 47 1 1 — — $81,302.85 $81,302.85 $81,302.85 2024-10-01
01598 OTHER New Technology - Level 47 1 1 — — $81,302.85 $81,302.85 $81,302.85 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $80,747.98 $80,747.98 $80,747.98 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 14 12 — — $68,321.00 $102,481.50 $80,277.18 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 53 26 — — $7,000.00 $426,660.11 $80,163.51 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 2 1 — — $72,221.00 $87,033.00 $79,627.00 2024-10-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 14 12 — — $67,242.00 $100,863.00 $79,009.35 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 52 25 — — $11,098.00 $389,988.89 $78,906.32 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $78,636.73 $78,636.73 $78,636.73 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 14 12 — — $66,782.00 $100,173.00 $78,468.85 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 1 — — $76,785.37 $76,785.37 $76,785.37 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 56 26 — — $7,000.00 $272,172.93 $76,256.64 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 14 12 — — $64,392.00 $96,588.00 $75,660.60 2024-10-01
1583 OTHER New Technology - Level 46 22 18 — — $72,462.48 $86,954.98 $73,911.73 2024-10-01
1597 OTHER New Technology - Level 46 22 18 — — $72,462.48 $86,954.98 $73,911.73 2024-10-01
23 APR_DRG Heart And/or Lung Transplant 14 12 — — $62,352.00 $93,528.00 $73,263.60 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 2 2 — — $54,899.06 $91,596.09 $73,247.57 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 14 12 — — $61,338.00 $92,007.00 $72,072.15 2024-10-01
01597 OTHER New Technology - Level 46 1 1 — — $71,737.86 $71,737.86 $71,737.86 2024-10-01
01583 OTHER New Technology - Level 46 1 1 — — $71,737.86 $71,737.86 $71,737.86 2024-10-01
007 OTHER Lung Transplant 1 1 — — $69,670.81 $69,670.81 $69,670.81 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $69,544.43 $69,544.43 $69,544.43 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 14 12 — — $59,125.00 $88,687.50 $69,471.88 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 52 25 — — $8,403.00 $342,724.84 $69,343.40 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 2 1 — — $61,112.00 $74,071.00 $67,591.50 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 56 26 — — $7,000.00 $274,178.38 $67,468.53 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 14 12 — — $56,946.00 $85,419.00 $66,911.55 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 22 18 — — $65,476.58 $78,571.90 $66,786.11 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 14 12 — — $55,523.00 $83,284.50 $65,239.52 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $64,821.81 $64,821.81 $64,821.81 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 23 19 — — $13,046.17 $76,025.72 $64,621.87 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 14 12 — — $54,849.00 $82,273.50 $64,447.57 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 52 25 — — $11,098.00 $260,460.26 $64,365.30 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $64,362.50 $64,362.50 $64,362.50 2024-10-01
1582 OTHER New Technology - Level 45 22 18 — — $62,800.88 $75,361.06 $64,056.90 2024-10-01
1596 OTHER New Technology - Level 45 22 18 — — $62,800.88 $75,361.06 $64,056.90 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 52 25 — — $11,098.00 $310,306.38 $63,086.04 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 5 3 — — $62,870.35 $104,773.89 $62,870.35 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $62,721.22 $62,721.22 $62,721.22 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 56 26 — — $7,000.00 $230,489.92 $62,232.47 2024-10-01
01596 OTHER New Technology - Level 45 1 1 — — $62,172.87 $62,172.87 $62,172.87 2024-10-01
01582 OTHER New Technology - Level 45 1 1 — — $62,172.87 $62,172.87 $62,172.87 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 52 25 — — $11,098.00 $268,653.14 $61,847.01 2024-10-01
0515T CPT Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including … 1 1 — — $61,780.00 $61,780.00 $61,780.00 2024-10-01
0614T CPT Removal And Replacement Of Substernal Implantable Defibrillator Pulse Generator 1 1 — — $61,780.00 $61,780.00 $61,780.00 2024-10-01
0520T CPT Removal And Replacement Of Pulse Generator For Wireless Cardiac Stimulator For L… 1 1 — — $61,780.00 $61,780.00 $61,780.00 2024-10-01
0571T CPT Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S… 1 1 — — $61,780.00 $61,780.00 $61,780.00 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 54 25 — — $7,000.00 $235,847.73 $60,764.96 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 14 12 — — $51,688.00 $77,532.00 $60,733.40 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 14 12 — — $51,226.00 $76,839.00 $60,190.55 2024-10-01
10 MS_DRG Pancreas Transplant 50 25 — — $8,403.00 $245,205.29 $60,018.37 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 50 25 — — $8,403.00 $243,793.59 $59,672.83 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $59,318.72 $59,318.72 $59,318.72 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 14 12 — — $49,247.00 $73,870.50 $57,865.22 2024-10-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 14 12 — — $48,983.00 $73,474.50 $57,555.02 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 14 12 — — $48,895.00 $73,342.50 $57,451.62 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $57,165.51 $57,165.51 $57,165.51 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $57,035.03 $57,035.03 $57,035.03 2024-10-01
64 APR_DRG Pancreas Transplant 14 12 — — $48,372.00 $72,558.00 $56,837.10 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 52 25 — — $11,098.00 $261,781.01 $56,266.24 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 52 25 — — $8,403.00 $229,553.56 $56,187.33 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 22 18 — — $55,015.23 $66,018.28 $56,115.53 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 14 12 — — $47,538.00 $71,307.00 $55,857.15 2024-10-01
8514 APR_DRG Gender Related Procedures 14 12 — — $46,902.00 $70,353.00 $55,109.85 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 52 25 — — $11,098.00 $264,121.33 $54,724.18 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 14 12 — — $46,525.00 $69,787.50 $54,666.88 2024-10-01
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $54,465.08 $54,465.08 $54,465.08 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 14 12 — — $46,203.00 $69,304.50 $54,288.53 2024-10-01
1595 OTHER New Technology - Level 44 22 18 — — $53,139.28 $63,767.14 $54,202.07 2024-10-01
1581 OTHER New Technology - Level 44 22 18 — — $53,139.28 $63,767.14 $54,202.07 2024-10-01
C9782 HCPCS Blinded Procedure For New York Heart Association (nyha) Class Ii Or Iii Heart Fa… 1 1 — — $54,105.00 $54,105.00 $54,105.00 2024-10-01
0266T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Total… 1 1 — — $54,105.00 $54,105.00 $54,105.00 2024-10-01
22 APR_DRG Heart And/or Lung Transplant 14 12 — — $45,376.00 $68,064.00 $53,316.80 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 55 26 — — $7,000.00 $174,152.00 $53,086.86 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $53,044.83 $53,044.83 $53,044.83 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 14 12 — — $44,835.00 $67,252.50 $52,681.12 2024-10-01
01595 OTHER New Technology - Level 44 1 1 — — $52,607.89 $52,607.89 $52,607.89 2024-10-01
01581 OTHER New Technology - Level 44 1 1 — — $52,607.89 $52,607.89 $52,607.89 2024-10-01
5244 OTHER Level 4 Blood Product Exc 22 18 — — $50,304.25 $65,395.53 $51,561.85 2024-10-01
247 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 4 2 — — $6,300.00 $115,429.00 $51,524.50 2024-10-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 4 2 — — $6,300.00 $115,429.00 $51,524.50 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 56 26 — — $7,000.00 $272,172.93 $51,416.35 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 52 25 — — $8,403.00 $260,344.82 $51,400.98 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $51,347.03 $51,347.03 $51,347.03 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 14 12 — — $43,677.00 $65,515.50 $51,320.47 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 14 12 — — $43,560.00 $65,340.00 $51,183.00 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 52 25 — — $9,535.00 $76,841.50 $51,110.21 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $51,061.50 $51,061.50 $51,061.50 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 52 25 — — $11,098.00 $249,443.17 $50,955.04 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 51 24 — — $8,403.00 $205,403.95 $50,276.28 2024-10-01
0207 RC — 15 8 — — $7,500.00 $50,045.00 $50,045.00 2024-10-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $49,801.21 $49,801.21 $49,801.21 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 14 12 — — $42,035.00 $63,052.50 $49,391.12 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 14 12 — — $41,957.00 $62,935.50 $49,299.48 2024-10-01
0208 RC — 26 15 — — $6,000.00 $49,295.00 $49,295.00 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 14 12 — — $41,876.00 $62,814.00 $49,204.30 2024-10-01
21 APR_DRG Heart And/or Lung Transplant 14 12 — — $41,730.00 $62,595.00 $49,032.75 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 55 26 — — $7,000.00 $188,740.35 $48,862.81 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 52 25 — — $5,348.00 $198,920.58 $48,689.37 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 52 25 — — $11,098.00 $190,502.66 $48,646.53 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 56 26 — — $7,000.00 $274,178.38 $48,636.68 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 52 25 — — $11,098.00 $186,968.80 $47,744.12 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 55 26 — — $7,000.00 $334,565.34 $47,697.91 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 52 25 — — $8,403.00 $194,497.87 $47,606.82 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 56 26 — — $7,000.00 $272,172.93 $47,369.07 2024-10-01
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 4 2 — — $6,300.00 $54,530.00 $47,355.00 2024-10-01
249 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc 4 2 — — $6,300.00 $54,530.00 $47,355.00 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 52 25 — — $8,403.00 $230,162.50 $47,016.48 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 14 12 — — $39,878.00 $59,817.00 $46,856.65 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 53 25 — — $11,098.00 $189,681.29 $46,849.12 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $46,545.29 $46,545.29 $46,545.29 2024-10-01
1142 OTHER Supprelin La Implant 22 18 — — $45,350.21 $54,420.25 $46,257.21 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $46,092.95 $46,092.95 $46,092.95 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 14 12 — — $38,906.00 $58,359.00 $45,714.55 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 52 25 — — $11,098.00 $188,784.60 $45,696.17 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 55 26 — — $7,000.00 $189,389.30 $45,687.81 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 50 25 — — $5,348.00 $419,773.09 $45,435.73 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 50 25 — — $5,348.00 $419,773.09 $45,435.73 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 52 25 — — $11,098.00 $175,453.75 $45,423.06 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $45,401.65 $45,401.65 $45,401.65 2024-10-01
0120 EAPG Car T-cell Immunotherapy 13 11 — — $37,722.00 $56,583.00 $45,266.40 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 33 21 — — $10,959.00 $70,230.00 $45,184.77 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 52 25 — — $11,098.00 $268,653.14 $45,010.77 2024-10-01
01142 OTHER Supprelin La Implant 1 1 — — $44,896.71 $44,896.71 $44,896.71 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $44,680.16 $44,680.16 $44,680.16 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 14 12 — — $37,904.00 $56,856.00 $44,537.20 2024-10-01
1580 OTHER New Technology - Level 43 22 18 — — $43,477.68 $52,173.22 $44,347.23 2024-10-01
1594 OTHER New Technology - Level 43 22 18 — — $43,477.68 $52,173.22 $44,347.23 2024-10-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $44,152.09 $44,152.09 $44,152.09 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 5 3 — — $44,133.01 $72,861.11 $44,133.01 2024-10-01
84 APR_DRG Autologous Bone Marrow Transplant 14 12 — — $37,476.00 $56,214.00 $44,034.30 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 52 25 — — $11,098.00 $204,831.98 $43,834.56 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 52 25 — — $8,403.00 $179,058.36 $43,827.73 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 52 25 — — $11,098.00 $203,526.01 $43,555.08 2024-10-01
73 APR_DRG Allogeneic Bone Marrow Transplant 14 12 — — $36,953.00 $55,429.50 $43,419.78 2024-10-01
834 OTHER Acute Leukemia With Mcc 1 1 — — $43,352.82 $43,352.82 $43,352.82 2024-10-01
01580 OTHER New Technology - Level 43 1 1 — — $43,042.90 $43,042.90 $43,042.90 2024-10-01
01594 OTHER New Technology - Level 43 1 1 — — $43,042.90 $43,042.90 $43,042.90 2024-10-01
0246 EAPG Class IV Therapeutic Radiopharmaceuticals 13 11 — — $35,540.00 $53,310.00 $42,648.00 2024-10-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $42,362.69 $42,362.69 $42,362.69 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 56 26 — — $7,000.00 $175,609.60 $42,359.13 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 54 25 — — $7,000.00 $235,847.73 $42,171.22 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 52 25 — — $8,403.00 $171,440.10 $41,963.02 2024-10-01
4404 APR_DRG Kidney Transplant 14 12 — — $35,422.00 $53,133.00 $41,620.85 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 52 25 — — $5,348.00 $169,985.34 $41,606.95 2024-10-01
0786T CPT Insertion Or Replacement Of Percutaneous Electrode Array, Sacral, With Integrate… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0796T CPT Transcatheter Insertion Of Permanent Dual-chamber Leadless Pacemaker, Including … 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0803T CPT Transcatheter Removal And Replacement Of Permanent Dual-chamber Leadless Pacemak… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0823T CPT Transcatheter Insertion Of Permanent Single-chamber Leadless Pacemaker, Right At… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0825T CPT Transcatheter Removal And Replacement Of Permanent Single-chamber Leadless Pacem… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0797T CPT Transcatheter Insertion Of Permanent Dual-chamber Leadless Pacemaker, Including … 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0620T CPT Endovascular Venous Arterialization, Tibial Or Peroneal Vein, With Transcatheter… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0802T CPT Transcatheter Removal And Replacement Of Permanent Dual-chamber Leadless Pacemak… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9797 HCPCS Vascular Embolization Or Occlusion Procedure With Use Of A Pressure-generating C… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9901 HCPCS Endoscopic Defect Closure Within The Entire Gastrointestinal Tract, Including Up… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0572T CPT Insertion Of Substernal Implantable Defibrillator Electrode 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9792 HCPCS Blinded Or Nonblinded Procedure For Symptomatic New York Heart Association (nyha… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0517T CPT Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including … 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0816T CPT Open Insertion Or Replacement Of Integrated Neurostimulation System For Bladder … 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0398T CPT Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS), Ster… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0795T CPT Transcatheter Insertion Of Permanent Dual-chamber Leadless Pacemaker, Including … 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0645T CPT Transcatheter Implantation Of Coronary Sinus Reduction Device Including Vascular… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9767 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Lower Extremity Artery(ie… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0784T CPT Insertion Or Replacement Of Percutaneous Electrode Array, Spinal, With Integrate… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9774 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Tibial/peroneal Artery(ie… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0801T CPT Transcatheter Removal And Replacement Of Permanent Dual-chamber Leadless Pacemak… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0526T CPT Insertion Or Replacement Of Intracardiac Ischemia Monitoring System, Including T… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0525T CPT Insertion Or Replacement Of Intracardiac Ischemia Monitoring System, Including T… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0793T CPT Percutaneous Transcatheter Thermal Ablation Of Nerves Innervating The Pulmonary … 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0817T CPT Open Insertion Or Replacement Of Integrated Neurostimulation System For Bladder … 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9765 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Lower Extremity Artery(ie… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9772 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Tibial/peroneal Artery(ie… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9780 HCPCS Insertion Of Central Venous Catheter Through Central Venous Occlusion Via Inferi… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9766 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Lower Extremity Artery(ie… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0516T CPT Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including … 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0505T CPT Endovenous Femoral-popliteal Arterial Revascularization, With Transcatheter Plac… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9783 HCPCS Blinded Procedure For Transcatheter Implantation Of Coronary Sinus Reduction Dev… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9773 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Tibial/peroneal Artery(i… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
C9775 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Tibial/peroneal Artery(ie… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
0527T CPT Insertion Or Replacement Of Intracardiac Ischemia Monitoring System, Including T… 1 1 — — $41,512.00 $41,512.00 $41,512.00 2024-10-01
8634 APR_DRG Neonatal Aftercare 14 12 — — $35,009.00 $52,513.50 $41,135.57 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 53 26 — — $7,000.00 $217,288.88 $40,958.78 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 55 26 — — $7,000.00 $131,295.00 $40,869.37 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 52 25 — — $8,403.00 $166,955.87 $40,865.43 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 52 25 — — $8,403.00 $166,103.93 $40,656.91 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 52 25 — — $8,403.00 $165,947.07 $40,618.51 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 52 25 — — $11,098.00 $92,373.82 $40,562.82 2024-10-01
0414T CPT Removal And Replacement Of Permanent Cardiac Contractility Modulation System Pul… 2 2 — — $19,294.00 $61,780.00 $40,537.00 2024-10-01
0409T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 2 2 — — $19,294.00 $61,780.00 $40,537.00 2024-10-01
63 APR_DRG Pancreas Transplant 14 12 — — $34,364.00 $51,546.00 $40,377.70 2024-10-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 14 12 — — $34,228.00 $51,342.00 $40,217.90 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 14 12 — — $34,068.00 $51,102.00 $40,029.90 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 52 25 — — $11,098.00 $165,958.10 $39,835.05 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 55 26 — — $7,000.00 $177,860.62 $39,675.80 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 52 25 — — $8,403.00 $165,925.54 $39,636.96 2024-10-01
0888T CPT Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 1 1 — — $39,376.13 $39,376.13 $39,376.13 2024-10-01
G0448 HCPCS Insertion Or Replacement Of A Permanent Pacing Cardioverter-defibrillator System… 16 4 — — $18,208.00 $54,530.00 $39,178.00 2024-10-01
0294T CPT HInsertion Of Left Atrial Hemodynamic Monitor; Pressure Sensor Lead At Time Of I… 8 1 — — $18,208.00 $42,669.00 $39,178.00 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 52 25 — — $8,403.00 $191,604.89 $39,140.12 2024-10-01
232 OTHER Coronary Bypass With Ptca Without Mcc 1 1 — — $39,126.73 $39,126.73 $39,126.73 2024-10-01
219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $39,123.15 $39,123.15 $39,123.15 2024-10-01
969 OTHER HIV With Extensive O.r. Procedures With Mcc 1 1 — — $39,035.14 $39,035.14 $39,035.14 2024-10-01
466 OTHER Revision Of Hip Or Knee Replacement With Mcc 1 1 — — $38,971.69 $38,971.69 $38,971.69 2024-10-01
245 MS_DRG Aicd Generator Procedures 53 25 — — $2,900.00 $150,289.19 $38,908.23 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 1 1 — — $38,803.31 $38,803.31 $38,803.31 2024-10-01
461 OTHER Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 1 1 — — $38,727.61 $38,727.61 $38,727.61 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 55 26 — — $7,000.00 $88,887.00 $38,673.34 2024-10-01
233 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 1 — — $38,535.21 $38,535.21 $38,535.21 2024-10-01
0100T CPT Placement Of A Subconjunctival Retinal Prosthesis Receiver And Pulse Generator, … 2 2 — — $15,022.00 $61,780.00 $38,401.00 2024-10-01
870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 1 1 — — $38,400.13 $38,400.13 $38,400.13 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 52 25 — — $8,403.00 $156,200.50 $38,232.85 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 14 12 — — $32,422.00 $48,633.00 $38,095.85 2024-10-01
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