|
001
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
1
|
1
|
—
|
—
|
$219,442.42
|
$219,442.42
|
$219,442.42
|
2024-10-01
|
|
002
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
1
|
1
|
—
|
—
|
$82,703.63
|
$82,703.63
|
$82,703.63
|
2024-10-01
|
|
003
|
OTHER
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
1
|
1
|
—
|
—
|
$146,982.55
|
$146,982.55
|
$146,982.55
|
2024-10-01
|
|
004
|
OTHER
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
1
|
1
|
—
|
—
|
$103,347.00
|
$103,347.00
|
$103,347.00
|
2024-10-01
|
|
005
|
OTHER
|
Liver Transplant With Mcc Or Intestinal Transplant
|
1
|
1
|
—
|
—
|
$67,982.36
|
$67,982.36
|
$67,982.36
|
2024-10-01
|
|
006
|
OTHER
|
Liver Transplant Without Mcc
|
1
|
1
|
—
|
—
|
$44,356.06
|
$44,356.06
|
$44,356.06
|
2024-10-01
|
|
007
|
OTHER
|
Lung Transplant
|
1
|
1
|
—
|
—
|
$82,853.93
|
$82,853.93
|
$82,853.93
|
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
|
—
|
—
|
$96,027.12
|
$96,027.12
|
$96,027.12
|
2024-10-01
|
|
01580
|
OTHER
|
New Technology - Level 43
|
1
|
1
|
—
|
—
|
$42,173.35
|
$42,173.35
|
$42,173.35
|
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
|
|
01594
|
OTHER
|
New Technology - Level 43
|
1
|
1
|
—
|
—
|
$42,173.35
|
$42,173.35
|
$42,173.35
|
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
|
|
017
|
OTHER
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
1
|
1
|
—
|
—
|
$41,723.01
|
$41,723.01
|
$41,723.01
|
2024-10-01
|
|
018
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
1
|
1
|
—
|
—
|
$181,072.32
|
$181,072.32
|
$181,072.32
|
2024-10-01
|
|
019
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
1
|
1
|
—
|
—
|
$53,992.55
|
$53,992.55
|
$53,992.55
|
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
|
—
|
—
|
$70,543.01
|
$70,543.01
|
$70,543.01
|
2024-10-01
|
|
0207
|
RC
|
—
|
14
|
12
|
—
|
—
|
$8,000.00
|
$42,172.50
|
$42,172.50
|
2024-10-01
|
|
021
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
1
|
1
|
—
|
—
|
$55,352.58
|
$55,352.58
|
$55,352.58
|
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
|
|
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
|
53
|
31
|
—
|
—
|
$10,670.00
|
$622,167.61
|
$250,646.45
|
2024-10-01
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
51
|
30
|
—
|
—
|
$10,670.00
|
$178,156.54
|
$71,553.13
|
2024-10-01
|
|
11
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$119,183.41
|
$48,698.41
|
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
|
26
|
23
|
—
|
—
|
$45,350.21
|
$65,757.80
|
$47,164.22
|
2024-10-01
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
51
|
30
|
—
|
—
|
$7,387.00
|
$347,669.19
|
$117,034.66
|
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
|
26
|
23
|
—
|
—
|
$43,477.68
|
$63,042.64
|
$45,216.79
|
2024-10-01
|
|
1581
|
OTHER
|
New Technology - Level 44
|
26
|
23
|
—
|
—
|
$53,139.28
|
$77,051.96
|
$55,264.85
|
2024-10-01
|
|
1582
|
OTHER
|
New Technology - Level 45
|
26
|
23
|
—
|
—
|
$62,800.88
|
$91,061.28
|
$65,312.92
|
2024-10-01
|
|
1583
|
OTHER
|
New Technology - Level 46
|
26
|
23
|
—
|
—
|
$72,462.48
|
$105,070.60
|
$75,360.98
|
2024-10-01
|
|
1584
|
OTHER
|
New Technology - Level 47
|
26
|
23
|
—
|
—
|
$82,124.09
|
$119,079.93
|
$85,409.05
|
2024-10-01
|
|
1585
|
OTHER
|
New Technology - Level 48
|
26
|
23
|
—
|
—
|
$91,785.68
|
$133,089.24
|
$95,457.11
|
2024-10-01
|
|
1594
|
OTHER
|
New Technology - Level 43
|
26
|
23
|
—
|
—
|
$43,477.68
|
$63,042.64
|
$45,216.79
|
2024-10-01
|
|
1595
|
OTHER
|
New Technology - Level 44
|
26
|
23
|
—
|
—
|
$53,139.28
|
$77,051.96
|
$55,264.85
|
2024-10-01
|
|
1596
|
OTHER
|
New Technology - Level 45
|
26
|
23
|
—
|
—
|
$62,800.88
|
$91,061.28
|
$65,312.92
|
2024-10-01
|
|
1597
|
OTHER
|
New Technology - Level 46
|
26
|
23
|
—
|
—
|
$72,462.48
|
$105,070.60
|
$75,360.98
|
2024-10-01
|
|
1598
|
OTHER
|
New Technology - Level 47
|
26
|
23
|
—
|
—
|
$82,124.09
|
$119,079.93
|
$85,409.05
|
2024-10-01
|
|
1599
|
OTHER
|
New Technology - Level 48
|
26
|
23
|
—
|
—
|
$91,785.68
|
$133,089.24
|
$95,457.11
|
2024-10-01
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/mcc
|
51
|
30
|
—
|
—
|
$7,387.00
|
$347,669.19
|
$54,373.51
|
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
|
|
163
|
MS_DRG
|
Major Chest Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$101,805.99
|
$41,721.38
|
2024-10-01
|
|
1643
|
OTHER
|
Y90 Ibritumomab, Rx
|
26
|
23
|
—
|
—
|
$65,476.58
|
$94,941.04
|
$68,095.65
|
2024-10-01
|
|
17
|
MS_DRG
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
51
|
30
|
—
|
—
|
$7,387.00
|
$347,669.19
|
$54,373.51
|
2024-10-01
|
|
18
|
MS_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
52
|
31
|
—
|
—
|
$7,387.00
|
$832,980.61
|
$333,628.04
|
2024-10-01
|
|
19
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
52
|
31
|
—
|
—
|
$10,670.00
|
$179,965.44
|
$71,275.86
|
2024-10-01
|
|
1901
|
OTHER
|
New Technology - Level 49
|
26
|
23
|
—
|
—
|
$103,862.70
|
$150,600.91
|
$108,017.21
|
2024-10-01
|
|
1902
|
OTHER
|
New Technology - Level 49
|
26
|
23
|
—
|
—
|
$103,862.70
|
$150,600.91
|
$108,017.21
|
2024-10-01
|
|
1903
|
OTHER
|
New Technology - Level 50
|
26
|
23
|
—
|
—
|
$118,355.10
|
$171,614.89
|
$123,089.30
|
2024-10-01
|
|
1904
|
OTHER
|
New Technology - Level 50
|
26
|
23
|
—
|
—
|
$118,355.10
|
$171,614.89
|
$123,089.30
|
2024-10-01
|
|
1905
|
OTHER
|
New Technology - Level 51
|
26
|
23
|
—
|
—
|
$132,847.50
|
$192,628.88
|
$138,161.40
|
2024-10-01
|
|
1906
|
OTHER
|
New Technology - Level 51
|
26
|
23
|
—
|
—
|
$132,847.50
|
$192,628.88
|
$138,161.40
|
2024-10-01
|
|
1907
|
OTHER
|
New Technology - Level 52
|
26
|
23
|
—
|
—
|
$147,339.90
|
$213,642.85
|
$153,233.49
|
2024-10-01
|
|
1908
|
OTHER
|
New Technology - Level 52
|
26
|
23
|
—
|
—
|
$147,339.90
|
$213,642.85
|
$153,233.49
|
2024-10-01
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
53
|
31
|
—
|
—
|
$10,670.00
|
$397,791.42
|
$99,553.04
|
2024-10-01
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$222,506.93
|
$75,197.35
|
2024-10-01
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
55
|
33
|
—
|
—
|
$7,387.00
|
$142,865.03
|
$57,630.27
|
2024-10-01
|
|
207
|
OTHER
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
1
|
1
|
—
|
—
|
$40,219.97
|
$40,219.97
|
$40,219.97
|
2024-10-01
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$222,506.93
|
$52,627.61
|
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
|
56
|
33
|
—
|
—
|
$10,670.00
|
$331,909.89
|
$97,936.70
|
2024-10-01
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
57
|
33
|
—
|
—
|
$10,799.00
|
$358,941.69
|
$100,435.27
|
2024-10-01
|
|
215
|
OTHER
|
Other Heart Assist System Implant
|
1
|
1
|
—
|
—
|
$63,081.97
|
$63,081.97
|
$63,081.97
|
2024-10-01
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
57
|
33
|
—
|
—
|
$10,799.00
|
$225,422.12
|
$89,856.17
|
2024-10-01
|
|
216
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
1
|
1
|
—
|
—
|
$61,062.92
|
$61,062.92
|
$61,062.92
|
2024-10-01
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
57
|
33
|
—
|
—
|
$10,799.00
|
$225,422.12
|
$61,567.62
|
2024-10-01
|
|
217
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
1
|
1
|
—
|
—
|
$60,723.36
|
$60,723.36
|
$60,723.36
|
2024-10-01
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
57
|
33
|
—
|
—
|
$10,799.00
|
$225,422.12
|
$56,791.83
|
2024-10-01
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
55
|
32
|
—
|
—
|
$10,799.00
|
$195,336.46
|
$73,385.45
|
2024-10-01
|
|
219
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
1
|
1
|
—
|
—
|
$46,526.04
|
$46,526.04
|
$46,526.04
|
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…
|
55
|
32
|
—
|
—
|
$10,799.00
|
$195,336.46
|
$50,658.40
|
2024-10-01
|
|
221
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
55
|
32
|
—
|
—
|
$10,799.00
|
$195,336.46
|
$44,043.91
|
2024-10-01
|
|
222
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock…
|
3
|
1
|
—
|
—
|
$56,756.00
|
$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
|
—
|
—
|
$56,756.00
|
$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
|
—
|
—
|
$56,756.00
|
$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
|
—
|
—
|
$56,756.00
|
$102,063.00
|
$102,063.00
|
2024-10-01
|
|
226
|
MS_DRG
|
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc
|
3
|
1
|
—
|
—
|
$55,840.00
|
$100,416.00
|
$100,416.00
|
2024-10-01
|
|
227
|
MS_DRG
|
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc
|
3
|
1
|
—
|
—
|
$55,840.00
|
$100,416.00
|
$100,416.00
|
2024-10-01
|
|
228
|
MS_DRG
|
Other Cardiothoracic Procedures With Mcc
|
54
|
32
|
—
|
—
|
$10,799.00
|
$147,309.72
|
$47,713.83
|
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…
|
56
|
33
|
—
|
—
|
$10,799.00
|
$137,374.65
|
$54,302.32
|
2024-10-01
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$227,083.10
|
$80,439.65
|
2024-10-01
|
|
231
|
OTHER
|
Coronary Bypass With Ptca With Mcc
|
1
|
1
|
—
|
—
|
$54,814.65
|
$54,814.65
|
$54,814.65
|
2024-10-01
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$227,083.10
|
$58,287.62
|
2024-10-01
|
|
232
|
OTHER
|
Coronary Bypass With Ptca Without Mcc
|
1
|
1
|
—
|
—
|
$46,530.30
|
$46,530.30
|
$46,530.30
|
2024-10-01
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$190,898.96
|
$74,231.72
|
2024-10-01
|
|
233
|
OTHER
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
1
|
1
|
—
|
—
|
$45,826.85
|
$45,826.85
|
$45,826.85
|
2024-10-01
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$145,445.36
|
$50,880.14
|
2024-10-01
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$157,099.97
|
$55,993.07
|
2024-10-01
|
|
239
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$111,251.25
|
$45,063.02
|
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
|
56
|
33
|
—
|
—
|
$10,799.00
|
$107,937.90
|
$44,402.07
|
2024-10-01
|
|
246
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar…
|
3
|
1
|
—
|
—
|
$30,928.00
|
$55,615.00
|
$55,615.00
|
2024-10-01
|
|
247
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc
|
3
|
1
|
—
|
—
|
$30,928.00
|
$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
|
—
|
—
|
$29,705.00
|
$53,419.00
|
$53,419.00
|
2024-10-01
|
|
249
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc
|
3
|
1
|
—
|
—
|
$29,705.00
|
$53,419.00
|
$53,419.00
|
2024-10-01
|
|
25
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$117,442.86
|
$42,713.09
|
2024-10-01
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
57
|
33
|
—
|
—
|
$10,799.00
|
$277,097.47
|
$57,179.88
|
2024-10-01
|
|
267
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
57
|
33
|
—
|
—
|
$10,799.00
|
$208,060.39
|
$45,097.16
|
2024-10-01
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$109,888.00
|
$59,975.88
|
2024-10-01
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$109,723.00
|
$48,204.05
|
2024-10-01
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$216,815.21
|
$66,661.59
|
2024-10-01
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
56
|
33
|
—
|
—
|
$10,799.00
|
$153,787.25
|
$57,988.28
|
2024-10-01
|
|
277
|
MS_DRG
|
Cardiac Defibrillator Implant Without Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$153,787.25
|
$43,949.53
|
2024-10-01
|
|
278
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures
|
56
|
33
|
—
|
—
|
$10,799.00
|
$137,451.69
|
$46,334.86
|
2024-10-01
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$134,281.24
|
$54,760.18
|
2024-10-01
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
54
|
31
|
—
|
—
|
$10,670.00
|
$617,595.78
|
$191,850.03
|
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
|
56
|
33
|
—
|
—
|
$10,670.00
|
$190,627.78
|
$55,923.00
|
2024-10-01
|
|
326
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$112,183.40
|
$45,503.60
|
2024-10-01
|
|
329
|
MS_DRG
|
Major Small And Large Bowel Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$101,426.06
|
$41,568.83
|
2024-10-01
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
54
|
31
|
—
|
—
|
$10,670.00
|
$370,673.34
|
$126,153.44
|
2024-10-01
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$137,448.60
|
$48,989.30
|
2024-10-01
|
|
405
|
OTHER
|
Pancreas, Liver And Shunt Procedures With Mcc
|
1
|
1
|
—
|
—
|
$41,657.29
|
$41,657.29
|
$41,657.29
|
2024-10-01
|
|
423
|
OTHER
|
Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc
|
1
|
1
|
—
|
—
|
$50,378.56
|
$50,378.56
|
$50,378.56
|
2024-10-01
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
56
|
33
|
—
|
—
|
$10,799.00
|
$323,000.99
|
$94,269.15
|
2024-10-01
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
56
|
33
|
—
|
—
|
$10,799.00
|
$218,753.54
|
$66,329.58
|
2024-10-01
|
|
428
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
56
|
33
|
—
|
—
|
$10,799.00
|
$169,648.24
|
$51,637.56
|
2024-10-01
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$257,005.44
|
$75,273.11
|
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
|
56
|
33
|
—
|
—
|
$10,799.00
|
$168,566.60
|
$51,313.95
|
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
|
|
4404
|
APR_DRG
|
Kidney Transplant
|
16
|
13
|
—
|
—
|
$35,422.00
|
$53,133.00
|
$41,797.96
|
2024-10-01
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
56
|
33
|
—
|
—
|
$10,799.00
|
$206,596.63
|
$62,692.31
|
2024-10-01
|
|
450
|
MS_DRG
|
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically
|
56
|
33
|
—
|
—
|
$10,670.00
|
$158,693.16
|
$46,747.88
|
2024-10-01
|
|
453
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion With Mcc
|
1
|
1
|
—
|
—
|
$67,827.20
|
$67,827.20
|
$67,827.20
|
2024-10-01
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
56
|
33
|
—
|
—
|
$9,472.00
|
$187,062.91
|
$75,952.02
|
2024-10-01
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
56
|
33
|
—
|
—
|
$9,472.00
|
$156,357.30
|
$54,305.51
|
2024-10-01
|
|
458
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
56
|
33
|
—
|
—
|
$9,472.00
|
$156,357.30
|
$41,014.88
|
2024-10-01
|
|
459
|
MS_DRG
|
Spinal Fusion Except Cervical With Mcc
|
3
|
2
|
—
|
—
|
$9,472.00
|
$75,435.00
|
$75,435.00
|
2024-10-01
|
|
460
|
MS_DRG
|
Spinal Fusion Except Cervical Without Mcc
|
3
|
2
|
—
|
—
|
$9,472.00
|
$62,710.00
|
$62,710.00
|
2024-10-01
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$135,553.57
|
$56,875.49
|
2024-10-01
|
|
461
|
OTHER
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
1
|
1
|
—
|
—
|
$46,055.65
|
$46,055.65
|
$46,055.65
|
2024-10-01
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective
|
56
|
33
|
—
|
—
|
$10,670.00
|
$119,296.06
|
$48,261.03
|
2024-10-01
|
|
466
|
OTHER
|
Revision Of Hip Or Knee Replacement With Mcc
|
1
|
1
|
—
|
—
|
$46,345.91
|
$46,345.91
|
$46,345.91
|
2024-10-01
|
|
466
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$76,506.88
|
$46,026.26
|
2024-10-01
|
|
471
|
MS_DRG
|
Cervical Spinal Fusion With Mcc
|
56
|
33
|
—
|
—
|
$10,799.00
|
$78,377.00
|
$46,096.05
|
2024-10-01
|
|
474
|
MS_DRG
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$99,055.91
|
$40,215.07
|
2024-10-01
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
51
|
30
|
—
|
—
|
$10,670.00
|
$353,373.24
|
$95,285.84
|
2024-10-01
|
|
5244
|
OTHER
|
Level 4 Blood Product Exc
|
26
|
23
|
—
|
—
|
$50,304.25
|
$72,941.16
|
$52,316.42
|
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
|
56
|
33
|
—
|
—
|
$10,670.00
|
$136,019.64
|
$54,909.06
|
2024-10-01
|
|
573
|
OTHER
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
1
|
1
|
—
|
—
|
$42,000.50
|
$42,000.50
|
$42,000.50
|
2024-10-01
|
|
576
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$119,167.95
|
$48,210.10
|
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
|
51
|
30
|
—
|
—
|
$10,670.00
|
$353,373.24
|
$43,849.87
|
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
|
|
6114
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
16
|
13
|
—
|
—
|
$34,068.00
|
$51,102.00
|
$40,200.24
|
2024-10-01
|
|
6134
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
16
|
13
|
—
|
—
|
$34,228.00
|
$51,342.00
|
$40,389.04
|
2024-10-01
|
|
63
|
APR_DRG
|
Pancreas Transplant
|
16
|
13
|
—
|
—
|
$34,364.00
|
$51,546.00
|
$40,549.52
|
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
|
52
|
31
|
—
|
—
|
$10,670.00
|
$142,576.39
|
$41,910.99
|
2024-10-01
|
|
651
|
OTHER
|
Kidney Transplant With Hemodialysis Without Mcc
|
1
|
1
|
—
|
—
|
$93,516.37
|
$93,516.37
|
$93,516.37
|
2024-10-01
|
|
653
|
MS_DRG
|
Major Bladder Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$123,128.50
|
$50,282.37
|
2024-10-01
|
|
7
|
MS_DRG
|
Lung Transplant
|
51
|
30
|
—
|
—
|
$10,670.00
|
$293,278.95
|
$116,741.96
|
2024-10-01
|
|
714
|
OTHER
|
Inj Delandistrogene Mox R
|
27
|
24
|
—
|
—
|
$6,474.02
|
$4,821,909.75
|
$3,425,218.65
|
2024-10-01
|
|
717
|
OTHER
|
Instill Adstiladrin, Tx D
|
27
|
24
|
—
|
—
|
$15,514.76
|
$91,864.42
|
$65,255.41
|
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
|
27
|
24
|
—
|
—
|
$9,484.96
|
$4,303,600.00
|
$3,057,040.00
|
2024-10-01
|
|
748
|
OTHER
|
Inj, Lovotibeglogene Auto
|
27
|
24
|
—
|
—
|
$10,678.88
|
$4,764,700.00
|
$3,384,580.00
|
2024-10-01
|
|
773
|
OTHER
|
Inj, Beqvez, Per Tx Dose
|
25
|
22
|
—
|
—
|
$3,605,000.00
|
$4,109,700.00
|
$3,713,150.00
|
2024-10-01
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
41
|
27
|
—
|
—
|
$11,098.00
|
$66,300.60
|
$53,570.88
|
2024-10-01
|
|
799
|
MS_DRG
|
Splenic Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$105,022.15
|
$43,012.67
|
2024-10-01
|
|
8
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant
|
51
|
30
|
—
|
—
|
$10,670.00
|
$179,965.44
|
$49,099.27
|
2024-10-01
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$128,599.95
|
$52,479.15
|
2024-10-01
|
|
823
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Other Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$103,358.85
|
$41,925.59
|
2024-10-01
|
|
826
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r.
|
56
|
33
|
—
|
—
|
$10,670.00
|
$105,479.39
|
$42,836.58
|
2024-10-01
|
|
834
|
OTHER
|
Acute Leukemia With Mcc
|
1
|
1
|
—
|
—
|
$51,556.04
|
$51,556.04
|
$51,556.04
|
2024-10-01
|
|
834
|
MS_DRG
|
Acute Leukemia With Mcc
|
55
|
33
|
—
|
—
|
$7,387.00
|
$122,083.69
|
$49,369.18
|
2024-10-01
|
|
837
|
MS_DRG
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
55
|
33
|
—
|
—
|
$7,387.00
|
$110,595.21
|
$44,802.22
|
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
|
56
|
33
|
—
|
—
|
$10,670.00
|
$283,855.42
|
$82,538.82
|
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
|
56
|
33
|
—
|
—
|
$10,670.00
|
$110,478.13
|
$45,203.24
|
2024-10-01
|
|
856
|
MS_DRG
|
Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$102,577.22
|
$40,855.79
|
2024-10-01
|
|
8634
|
APR_DRG
|
Neonatal Aftercare
|
16
|
13
|
—
|
—
|
$35,009.00
|
$52,513.50
|
$41,310.62
|
2024-10-01
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
55
|
33
|
—
|
—
|
$10,799.00
|
$77,402.97
|
$61,922.38
|
2024-10-01
|
|
870
|
OTHER
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
1
|
1
|
—
|
—
|
$45,666.20
|
$45,666.20
|
$45,666.20
|
2024-10-01
|
|
9035
|
OTHER
|
Axicabtagene Ciloleucel C
|
26
|
23
|
—
|
—
|
$489,456.00
|
$709,711.20
|
$509,034.24
|
2024-10-01
|
|
9138
|
OTHER
|
Inj, Hemgenix, Per Tx Dos
|
25
|
22
|
—
|
—
|
$3,672,900.00
|
$4,187,106.00
|
$3,783,087.00
|
2024-10-01
|
|
9141
|
OTHER
|
Inj Onase Abepar-xioi Tre
|
26
|
23
|
—
|
—
|
$2,388,614.00
|
$3,463,490.30
|
$2,484,158.56
|
2024-10-01
|
|
9194
|
OTHER
|
Tisagenlecleucel Car-pos
|
26
|
23
|
—
|
—
|
$529,192.90
|
$767,329.70
|
$550,360.62
|
2024-10-01
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
52
|
29
|
—
|
—
|
$10,670.00
|
$524,012.93
|
$210,191.63
|
2024-10-01
|
|
9273
|
OTHER
|
Sipuleucel-t Auto Cd54+
|
26
|
23
|
—
|
—
|
$55,015.23
|
$79,772.08
|
$57,215.84
|
2024-10-01
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
52
|
29
|
—
|
—
|
$10,670.00
|
$147,521.39
|
$59,778.69
|
2024-10-01
|
|
9391
|
OTHER
|
Brexucabtagene Car Pos T
|
26
|
23
|
—
|
—
|
$460,530.40
|
$667,769.08
|
$478,951.61
|
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
|
26
|
23
|
—
|
—
|
$516,726.10
|
$749,252.84
|
$537,395.15
|
2024-10-01
|
|
9422
|
OTHER
|
Idecabtagene Vicleucel Ca
|
26
|
23
|
—
|
—
|
$526,587.60
|
$763,552.02
|
$547,651.10
|
2024-10-01
|
|
9498
|
OTHER
|
Ciltacabtagene Car-pos T
|
26
|
23
|
—
|
—
|
$527,123.40
|
$764,328.93
|
$548,208.33
|
2024-10-01
|
|
955
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
1
|
1
|
—
|
—
|
$76,541.17
|
$76,541.17
|
$76,541.17
|
2024-10-01
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
56
|
33
|
—
|
—
|
$10,670.00
|
$215,625.72
|
$61,401.09
|
2024-10-01
|
|
956
|
OTHER
|
Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma
|
1
|
1
|
—
|
—
|
$53,134.54
|
$53,134.54
|
$53,134.54
|
2024-10-01
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$164,865.67
|
$67,039.83
|
2024-10-01
|
|
957
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
1
|
1
|
—
|
—
|
$52,506.55
|
$52,506.55
|
$52,506.55
|
2024-10-01
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$139,688.63
|
$56,931.25
|
2024-10-01
|
|
969
|
OTHER
|
HIV With Extensive O.r. Procedures With Mcc
|
1
|
1
|
—
|
—
|
$46,421.38
|
$46,421.38
|
$46,421.38
|
2024-10-01
|
|
981
|
MS_DRG
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
56
|
33
|
—
|
—
|
$10,670.00
|
$111,560.08
|
$43,010.89
|
2024-10-01
|
|
A0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
7
|
7
|
—
|
—
|
$33,431.35
|
$43,878.64
|
$41,789.18
|
2024-10-01
|
|
A5104
|
OTHER
|
Expired, Not Orthopedic, Length Of Stay Is 16 Days
|
7
|
7
|
—
|
—
|
$33,330.66
|
$43,746.49
|
$41,663.32
|
2024-10-01
|
|
A9543
|
HCPCS
|
Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil…
|
2
|
1
|
—
|
—
|
$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
|
7
|
7
|
—
|
—
|
$35,734.59
|
$46,901.65
|
$44,668.24
|
2024-10-01
|
|
B0106
|
OTHER
|
Stroke; M > 30.05 & M < 34.25
|
7
|
7
|
—
|
—
|
$40,644.55
|
$53,345.97
|
$50,805.69
|
2024-10-01
|
|
B0205
|
OTHER
|
Traumatic Brain Injury; M > 28.75 & M < 40.65
|
7
|
7
|
—
|
—
|
$36,898.10
|
$48,428.76
|
$46,122.63
|
2024-10-01
|
|
B0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
7
|
7
|
—
|
—
|
$42,619.16
|
$55,937.65
|
$53,273.95
|
2024-10-01
|
|
B0405
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5
|
7
|
7
|
—
|
—
|
$33,892.84
|
$44,484.35
|
$42,366.04
|
2024-10-01
|
|
B0505
|
OTHER
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
7
|
7
|
—
|
—
|
$42,181.45
|
$55,363.15
|
$52,726.81
|
2024-10-01
|
|
B0604
|
OTHER
|
Neurological; M < 25.85
|
7
|
7
|
—
|
—
|
$34,827.00
|
$45,710.44
|
$43,533.75
|
2024-10-01
|
|
B0704
|
OTHER
|
Fracture Of Lower Extremity; M < 28.15
|
7
|
7
|
—
|
—
|
$32,546.13
|
$42,716.79
|
$40,682.66
|
2024-10-01
|
|
B1004
|
OTHER
|
Amputation, Lower Extremity; M=39-45
|
7
|
7
|
—
|
—
|
$32,179.73
|
$42,235.90
|
$40,224.67
|
2024-10-01
|
|
B1903
|
OTHER
|
Guillian Barre; M < 18.05
|
7
|
7
|
—
|
—
|
$35,120.67
|
$46,095.89
|
$43,900.84
|
2024-10-01
|
|
B2102
|
OTHER
|
Burns; M=12-45
|
7
|
7
|
—
|
—
|
$32,410.48
|
$42,538.75
|
$40,513.10
|
2024-10-01
|
|
C0106
|
OTHER
|
Stroke; M > 30.05 & M < 34.25
|
7
|
7
|
—
|
—
|
$35,249.33
|
$46,264.75
|
$44,061.67
|
2024-10-01
|
|
C0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
7
|
7
|
—
|
—
|
$37,900.79
|
$49,744.79
|
$47,375.99
|
2024-10-01
|
|
C0505
|
OTHER
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
7
|
7
|
—
|
—
|
$32,816.03
|
$43,071.04
|
$41,020.04
|
2024-10-01
|
|
C2616
|
HCPCS
|
Brachytherapy Source, Non-stranded, Yttrium-90, Per Source
|
2
|
1
|
—
|
—
|
$40,208.00
|
$53,804.00
|
$47,006.00
|
2024-10-01
|
|
D0106
|
OTHER
|
Stroke; M > 30.05 & M < 34.25
|
7
|
7
|
—
|
—
|
$32,211.90
|
$42,278.12
|
$40,264.87
|
2024-10-01
|
|
D0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
7
|
7
|
—
|
—
|
$36,791.82
|
$48,289.27
|
$45,989.78
|
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…
|
27
|
24
|
—
|
—
|
$88,300.94
|
$131,996.25
|
$93,762.86
|
2024-10-01
|
|
L7181
|
HCPCS
|
Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi…
|
27
|
24
|
—
|
—
|
$46,068.21
|
$68,864.85
|
$48,917.79
|
2024-10-01
|
|
L8702
|
HCPCS
|
Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge…
|
27
|
24
|
—
|
—
|
$63,895.55
|
$95,513.96
|
$67,847.85
|
2024-10-01
|
|
Q0480
|
HCPCS
|
Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only
|
27
|
24
|
—
|
—
|
$96,999.90
|
$144,999.85
|
$102,999.90
|
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
|