|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
5834
|
APR_DRG
|
Neonate With Ecmo
|
19
|
15
|
—
|
—
|
$192,207.00
|
$288,310.50
|
$230,648.40
|
2024-10-01
|
|
J7330
|
HCPCS
|
Autologous Cultured Chondrocytes, Implant
|
2
|
1
|
—
|
—
|
$156,515.70
|
$156,515.70
|
$156,515.70
|
2024-10-01
|
|
5884
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
19
|
15
|
—
|
—
|
$125,393.00
|
$188,089.50
|
$150,471.60
|
2024-10-01
|
|
5833
|
APR_DRG
|
Neonate With Ecmo
|
19
|
15
|
—
|
—
|
$124,517.00
|
$186,775.50
|
$149,420.40
|
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
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
15
|
9
|
—
|
—
|
$10,799.00
|
$320,066.00
|
$136,328.00
|
2024-10-01
|
|
24
|
APR_DRG
|
Heart And/or Lung Transplant
|
19
|
15
|
—
|
—
|
$111,047.00
|
$166,570.50
|
$133,256.40
|
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
|
|
114
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
19
|
15
|
—
|
—
|
$97,644.00
|
$146,466.00
|
$117,172.80
|
2024-10-01
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$187,168.93
|
$115,891.00
|
2024-10-01
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$183,631.00
|
$115,231.00
|
2024-10-01
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$173,239.00
|
$115,231.00
|
2024-10-01
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$233,623.00
|
$115,231.00
|
2024-10-01
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$178,437.00
|
$115,231.00
|
2024-10-01
|
|
267
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$177,122.00
|
$115,231.00
|
2024-10-01
|
|
5832
|
APR_DRG
|
Neonate With Ecmo
|
19
|
15
|
—
|
—
|
$95,607.00
|
$143,410.50
|
$114,728.40
|
2024-10-01
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$141,689.00
|
$114,496.00
|
2024-10-01
|
|
1614
|
APR_DRG
|
Implantable Heart Assist Systems
|
19
|
15
|
—
|
—
|
$95,167.00
|
$142,750.50
|
$114,200.40
|
2024-10-01
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
13
|
8
|
—
|
—
|
$10,799.00
|
$147,232.00
|
$112,640.00
|
2024-10-01
|
|
221
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
13
|
8
|
—
|
—
|
$10,799.00
|
$138,900.00
|
$112,640.00
|
2024-10-01
|
|
220
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
13
|
8
|
—
|
—
|
$10,799.00
|
$143,065.00
|
$112,640.00
|
2024-10-01
|
|
6304
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
19
|
15
|
—
|
—
|
$91,470.00
|
$137,205.00
|
$109,764.00
|
2024-10-01
|
|
8414
|
APR_DRG
|
Extensive Third Degree Burns With Skin Graft
|
19
|
15
|
—
|
—
|
$90,217.00
|
$135,325.50
|
$108,260.40
|
2024-10-01
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$156,091.92
|
$107,636.93
|
2024-10-01
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$121,395.00
|
$105,741.00
|
2024-10-01
|
|
228
|
MS_DRG
|
Other Cardiothoracic Procedures With Mcc
|
13
|
8
|
—
|
—
|
$10,799.00
|
$137,939.00
|
$104,697.00
|
2024-10-01
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$117,567.00
|
$104,245.00
|
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
|
|
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
|
|
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
|
|
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
|
|
A9699
|
HCPCS
|
Radiopharmaceutical, Therapeutic, Not Otherwise Classified
|
2
|
1
|
—
|
—
|
$100,053.67
|
$100,053.67
|
$100,053.67
|
2024-10-01
|
|
6094
|
APR_DRG
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
19
|
15
|
—
|
—
|
$82,446.00
|
$123,669.00
|
$98,935.20
|
2024-10-01
|
|
229
|
MS_DRG
|
Other Cardiothoracic Procedures Without Mcc
|
13
|
8
|
—
|
—
|
$10,799.00
|
$137,939.00
|
$98,814.00
|
2024-10-01
|
|
5883
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
19
|
15
|
—
|
—
|
$81,552.00
|
$122,328.00
|
$97,862.40
|
2024-10-01
|
|
6314
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
19
|
15
|
—
|
—
|
$80,942.00
|
$121,413.00
|
$97,130.40
|
2024-10-01
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$112,866.00
|
$97,000.00
|
2024-10-01
|
|
5914
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
19
|
15
|
—
|
—
|
$79,657.00
|
$119,485.50
|
$95,588.40
|
2024-10-01
|
|
236
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$112,866.00
|
$94,383.00
|
2024-10-01
|
|
74
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
19
|
15
|
—
|
—
|
$75,611.00
|
$113,416.50
|
$90,733.20
|
2024-10-01
|
|
94
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
19
|
15
|
—
|
—
|
$75,232.00
|
$112,848.00
|
$90,278.40
|
2024-10-01
|
|
5934
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
19
|
15
|
—
|
—
|
$73,863.00
|
$110,794.50
|
$88,635.60
|
2024-10-01
|
|
5882
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
19
|
15
|
—
|
—
|
$71,560.00
|
$107,340.00
|
$85,872.00
|
2024-10-01
|
|
5831
|
APR_DRG
|
Neonate With Ecmo
|
19
|
15
|
—
|
—
|
$69,493.00
|
$104,239.50
|
$83,391.60
|
2024-10-01
|
|
6034
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
19
|
15
|
—
|
—
|
$68,321.00
|
$102,481.50
|
$81,985.20
|
2024-10-01
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$109,723.00
|
$81,795.00
|
2024-10-01
|
|
14
|
APR_DRG
|
Liver Transplant And/or Intestinal Transplant
|
19
|
15
|
—
|
—
|
$67,242.00
|
$100,863.00
|
$80,690.40
|
2024-10-01
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$109,888.00
|
$80,660.00
|
2024-10-01
|
|
44
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
19
|
15
|
—
|
—
|
$66,782.00
|
$100,173.00
|
$80,138.40
|
2024-10-01
|
|
272
|
MS_DRG
|
Other Major Cardiovascular Procedures Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$109,723.00
|
$77,639.00
|
2024-10-01
|
|
271
|
MS_DRG
|
Other Major Cardiovascular Procedures With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$109,723.00
|
$77,639.00
|
2024-10-01
|
|
269
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$109,723.00
|
$77,639.00
|
2024-10-01
|
|
1613
|
APR_DRG
|
Implantable Heart Assist Systems
|
19
|
15
|
—
|
—
|
$64,392.00
|
$96,588.00
|
$77,270.40
|
2024-10-01
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$178,048.38
|
$74,994.00
|
2024-10-01
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$187,062.91
|
$74,994.00
|
2024-10-01
|
|
23
|
APR_DRG
|
Heart And/or Lung Transplant
|
19
|
15
|
—
|
—
|
$62,352.00
|
$93,528.00
|
$74,822.40
|
2024-10-01
|
|
5881
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
19
|
15
|
—
|
—
|
$61,338.00
|
$92,007.00
|
$73,605.60
|
2024-10-01
|
|
5913
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
19
|
15
|
—
|
—
|
$59,125.00
|
$88,687.50
|
$70,950.00
|
2024-10-01
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$146,695.00
|
$68,861.00
|
2024-10-01
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$184,222.26
|
$68,861.00
|
2024-10-01
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$231,528.06
|
$68,861.00
|
2024-10-01
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$126,768.77
|
$68,861.00
|
2024-10-01
|
|
113
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
19
|
15
|
—
|
—
|
$56,946.00
|
$85,419.00
|
$68,335.20
|
2024-10-01
|
|
1604
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
19
|
15
|
—
|
—
|
$55,523.00
|
$83,284.50
|
$66,627.60
|
2024-10-01
|
|
6024
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
19
|
15
|
—
|
—
|
$54,849.00
|
$82,273.50
|
$65,818.80
|
2024-10-01
|
|
458
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$114,078.00
|
$65,767.21
|
2024-10-01
|
|
1612
|
APR_DRG
|
Implantable Heart Assist Systems
|
19
|
15
|
—
|
—
|
$51,688.00
|
$77,532.00
|
$62,025.60
|
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
|
|
5933
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
19
|
15
|
—
|
—
|
$51,226.00
|
$76,839.00
|
$61,471.20
|
2024-10-01
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$156,803.18
|
$60,317.65
|
2024-10-01
|
|
23
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$126,011.12
|
$59,983.00
|
2024-10-01
|
|
22
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$142,424.00
|
$59,983.00
|
2024-10-01
|
|
1611
|
APR_DRG
|
Implantable Heart Assist Systems
|
19
|
15
|
—
|
—
|
$49,247.00
|
$73,870.50
|
$59,096.40
|
2024-10-01
|
|
5891
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational
|
19
|
15
|
—
|
—
|
$48,983.00
|
$73,474.50
|
$58,779.60
|
2024-10-01
|
|
112
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
19
|
15
|
—
|
—
|
$48,895.00
|
$73,342.50
|
$58,674.00
|
2024-10-01
|
|
64
|
APR_DRG
|
Pancreas Transplant
|
19
|
15
|
—
|
—
|
$48,372.00
|
$72,558.00
|
$58,046.40
|
2024-10-01
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$135,553.57
|
$58,039.00
|
2024-10-01
|
|
27
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$81,505.00
|
$57,946.00
|
2024-10-01
|
|
26
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$81,505.00
|
$57,946.00
|
2024-10-01
|
|
25
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$81,505.00
|
$57,946.00
|
2024-10-01
|
|
24
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$105,716.00
|
$57,902.92
|
2024-10-01
|
|
5892
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational
|
19
|
15
|
—
|
—
|
$47,538.00
|
$71,307.00
|
$57,045.60
|
2024-10-01
|
|
34
|
MS_DRG
|
Carotid Artery Stent Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$78,377.00
|
$56,993.00
|
2024-10-01
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$147,486.00
|
$56,965.59
|
2024-10-01
|
|
8514
|
APR_DRG
|
Gender Related Procedures
|
19
|
15
|
—
|
—
|
$46,902.00
|
$70,353.00
|
$56,282.40
|
2024-10-01
|
|
5893
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational
|
19
|
15
|
—
|
—
|
$46,525.00
|
$69,787.50
|
$55,830.00
|
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
|
|
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
|
|
8424
|
APR_DRG
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
19
|
15
|
—
|
—
|
$46,203.00
|
$69,304.50
|
$55,443.60
|
2024-10-01
|
|
35
|
MS_DRG
|
Carotid Artery Stent Procedures With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$78,377.00
|
$55,378.00
|
2024-10-01
|
|
22
|
APR_DRG
|
Heart And/or Lung Transplant
|
19
|
15
|
—
|
—
|
$45,376.00
|
$68,064.00
|
$54,451.20
|
2024-10-01
|
|
5912
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
19
|
15
|
—
|
—
|
$44,835.00
|
$67,252.50
|
$53,802.00
|
2024-10-01
|
|
36
|
MS_DRG
|
Carotid Artery Stent Procedures Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$78,377.00
|
$53,766.00
|
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
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
15
|
9
|
—
|
—
|
$10,799.00
|
$136,819.27
|
$52,630.42
|
2024-10-01
|
|
319
|
MS_DRG
|
Other Endovascular Cardiac Valve Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$127,238.00
|
$52,472.00
|
2024-10-01
|
|
6303
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
19
|
15
|
—
|
—
|
$43,677.00
|
$65,515.50
|
$52,412.40
|
2024-10-01
|
|
54
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
19
|
15
|
—
|
—
|
$43,560.00
|
$65,340.00
|
$52,272.00
|
2024-10-01
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$134,281.24
|
$50,895.00
|
2024-10-01
|
|
J9600
|
HCPCS
|
Injection, Porfimer Sodium, 75 Mg
|
2
|
1
|
—
|
—
|
$50,561.89
|
$50,561.89
|
$50,561.89
|
2024-10-01
|
|
6074
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
19
|
15
|
—
|
—
|
$42,035.00
|
$63,052.50
|
$50,442.00
|
2024-10-01
|
|
5932
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
19
|
15
|
—
|
—
|
$41,957.00
|
$62,935.50
|
$50,348.40
|
2024-10-01
|
|
43
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
19
|
15
|
—
|
—
|
$41,876.00
|
$62,814.00
|
$50,251.20
|
2024-10-01
|
|
21
|
APR_DRG
|
Heart And/or Lung Transplant
|
19
|
15
|
—
|
—
|
$41,730.00
|
$62,595.00
|
$50,076.00
|
2024-10-01
|
|
40
|
MS_DRG
|
Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$74,994.00
|
$49,076.00
|
2024-10-01
|
|
466
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$65,833.00
|
$48,319.44
|
2024-10-01
|
|
3034
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
19
|
15
|
—
|
—
|
$39,878.00
|
$59,817.00
|
$47,853.60
|
2024-10-01
|
|
0294T
|
CPT
|
HInsertion Of Left Atrial Hemodynamic Monitor; Pressure Sensor Lead At Time Of I…
|
2
|
1
|
—
|
—
|
$45,326.00
|
$49,364.00
|
$47,345.00
|
2024-10-01
|
|
320
|
MS_DRG
|
Other Endovascular Cardiac Valve Procedures Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$127,238.00
|
$47,032.00
|
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
|
|
428
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$121,604.36
|
$46,777.68
|
2024-10-01
|
|
6023
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
19
|
15
|
—
|
—
|
$38,906.00
|
$58,359.00
|
$46,687.20
|
2024-10-01
|
|
471
|
MS_DRG
|
Cervical Spinal Fusion With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$78,377.00
|
$46,489.00
|
2024-10-01
|
|
473
|
MS_DRG
|
Cervical Spinal Fusion Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$74,994.00
|
$46,489.00
|
2024-10-01
|
|
472
|
MS_DRG
|
Cervical Spinal Fusion With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$78,377.00
|
$46,489.00
|
2024-10-01
|
|
430
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$120,829.04
|
$46,479.44
|
2024-10-01
|
|
245
|
MS_DRG
|
Aicd Generator Procedures
|
15
|
9
|
—
|
—
|
$10,799.00
|
$107,937.90
|
$46,348.45
|
2024-10-01
|
|
1624
|
APR_DRG
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
19
|
15
|
—
|
—
|
$37,904.00
|
$56,856.00
|
$45,484.80
|
2024-10-01
|
|
242
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$81,795.00
|
$45,326.00
|
2024-10-01
|
|
265
|
MS_DRG
|
Aicd Lead Procedures
|
15
|
9
|
—
|
—
|
$10,799.00
|
$99,972.00
|
$45,326.00
|
2024-10-01
|
|
84
|
APR_DRG
|
Autologous Bone Marrow Transplant
|
19
|
15
|
—
|
—
|
$37,476.00
|
$56,214.00
|
$44,971.20
|
2024-10-01
|
|
73
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
19
|
15
|
—
|
—
|
$36,953.00
|
$55,429.50
|
$44,343.60
|
2024-10-01
|
|
462
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$69,981.00
|
$43,618.36
|
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
|
|
G0448
|
HCPCS
|
Insertion Or Replacement Of A Permanent Pacing Cardioverter-defibrillator System…
|
11
|
5
|
—
|
—
|
$5,395.00
|
$55,286.00
|
$42,950.00
|
2024-10-01
|
|
29
|
MS_DRG
|
Spinal Procedures With Cc Or Spinal Neurostimulators
|
15
|
9
|
—
|
—
|
$10,799.00
|
$74,994.00
|
$42,798.00
|
2024-10-01
|
|
278
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures
|
15
|
9
|
—
|
—
|
$10,799.00
|
$110,509.06
|
$42,509.64
|
2024-10-01
|
|
4404
|
APR_DRG
|
Kidney Transplant
|
19
|
15
|
—
|
—
|
$35,422.00
|
$53,133.00
|
$42,506.40
|
2024-10-01
|
|
0207
|
RC
|
—
|
13
|
12
|
—
|
—
|
$8,000.00
|
$42,172.50
|
$42,172.50
|
2024-10-01
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
14
|
9
|
—
|
—
|
$6,000.00
|
$65,982.40
|
$42,021.50
|
2024-10-01
|
|
8634
|
APR_DRG
|
Neonatal Aftercare
|
19
|
15
|
—
|
—
|
$35,009.00
|
$52,513.50
|
$42,010.80
|
2024-10-01
|
|
0208
|
RC
|
—
|
22
|
18
|
—
|
—
|
$7,500.00
|
$41,922.50
|
$41,922.50
|
2024-10-01
|
|
37
|
MS_DRG
|
Extracranial Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$74,994.00
|
$41,813.00
|
2024-10-01
|
|
39
|
MS_DRG
|
Extracranial Procedures Without Cc/mcc
|
15
|
9
|
—
|
—
|
$9,671.29
|
$74,994.00
|
$41,813.00
|
2024-10-01
|
|
38
|
MS_DRG
|
Extracranial Procedures With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$74,994.00
|
$41,813.00
|
2024-10-01
|
|
481
|
MS_DRG
|
Hip And Femur Procedures Except Major Joint With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$55,248.00
|
$41,807.00
|
2024-10-01
|
|
482
|
MS_DRG
|
Hip And Femur Procedures Except Major Joint Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$55,248.00
|
$41,807.00
|
2024-10-01
|
|
480
|
MS_DRG
|
Hip And Femur Procedures Except Major Joint With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$55,248.00
|
$41,807.00
|
2024-10-01
|
|
515
|
MS_DRG
|
Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$68,303.61
|
$41,478.00
|
2024-10-01
|
|
30
|
MS_DRG
|
Spinal Procedures Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$74,994.00
|
$41,406.00
|
2024-10-01
|
|
63
|
APR_DRG
|
Pancreas Transplant
|
19
|
15
|
—
|
—
|
$34,364.00
|
$51,546.00
|
$41,236.80
|
2024-10-01
|
|
6134
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
19
|
15
|
—
|
—
|
$34,228.00
|
$51,342.00
|
$41,073.60
|
2024-10-01
|
|
467
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$65,833.00
|
$40,937.00
|
2024-10-01
|
|
6114
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
19
|
15
|
—
|
—
|
$34,068.00
|
$51,102.00
|
$40,881.60
|
2024-10-01
|
|
31
|
MS_DRG
|
Ventricular Shunt Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$78,377.00
|
$39,745.00
|
2024-10-01
|
|
279
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures
|
15
|
9
|
—
|
—
|
$10,799.00
|
$81,795.00
|
$39,666.00
|
2024-10-01
|
|
277
|
MS_DRG
|
Cardiac Defibrillator Implant Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$127,287.00
|
$39,529.74
|
2024-10-01
|
|
0888T
|
CPT
|
Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant…
|
2
|
1
|
—
|
—
|
$39,376.13
|
$39,376.13
|
$39,376.13
|
2024-10-01
|
|
93
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
19
|
15
|
—
|
—
|
$32,422.00
|
$48,633.00
|
$38,906.40
|
2024-10-01
|
|
253
|
MS_DRG
|
Other Vascular Procedures With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$70,533.00
|
$38,363.00
|
2024-10-01
|
|
252
|
MS_DRG
|
Other Vascular Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$70,533.00
|
$38,363.00
|
2024-10-01
|
|
254
|
MS_DRG
|
Other Vascular Procedures Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$70,533.00
|
$38,363.00
|
2024-10-01
|
|
1674
|
APR_DRG
|
Other Cardiothoracic And Thoracic Circulatory Procedures
|
19
|
15
|
—
|
—
|
$31,789.00
|
$47,683.50
|
$38,146.80
|
2024-10-01
|
|
1634
|
APR_DRG
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
19
|
15
|
—
|
—
|
$31,574.00
|
$47,361.00
|
$37,888.80
|
2024-10-01
|
|
13
|
APR_DRG
|
Liver Transplant And/or Intestinal Transplant
|
19
|
15
|
—
|
—
|
$31,456.00
|
$47,184.00
|
$37,747.20
|
2024-10-01
|
|
273
|
MS_DRG
|
Percutaneous And Other Intracardiac Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$57,147.00
|
$37,532.00
|
2024-10-01
|
|
468
|
MS_DRG
|
Revision Of Hip Or Knee Replacement Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$65,833.00
|
$37,478.00
|
2024-10-01
|
|
6022
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
19
|
15
|
—
|
—
|
$31,113.00
|
$46,669.50
|
$37,335.60
|
2024-10-01
|
|
A9604
|
HCPCS
|
Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri…
|
2
|
1
|
—
|
—
|
$37,108.68
|
$37,108.68
|
$37,108.68
|
2024-10-01
|
|
6093
|
APR_DRG
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
19
|
15
|
—
|
—
|
$30,783.00
|
$46,174.50
|
$36,939.60
|
2024-10-01
|
|
41
|
MS_DRG
|
Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$68,978.00
|
$36,645.00
|
2024-10-01
|
|
1784
|
APR_DRG
|
External Heart Assist Devices
|
19
|
15
|
—
|
—
|
$30,258.00
|
$45,387.00
|
$36,309.60
|
2024-10-01
|
|
6033
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
19
|
15
|
—
|
—
|
$30,178.00
|
$45,267.00
|
$36,213.60
|
2024-10-01
|
|
53
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
19
|
15
|
—
|
—
|
$30,089.00
|
$45,133.50
|
$36,106.80
|
2024-10-01
|
|
6124
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
19
|
15
|
—
|
—
|
$30,025.00
|
$45,037.50
|
$36,030.00
|
2024-10-01
|
|
8504
|
APR_DRG
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…
|
19
|
15
|
—
|
—
|
$29,751.00
|
$44,626.50
|
$35,701.20
|
2024-10-01
|
|
72
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
19
|
15
|
—
|
—
|
$29,633.00
|
$44,449.50
|
$35,559.60
|
2024-10-01
|
|
1654
|
APR_DRG
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
19
|
15
|
—
|
—
|
$29,487.00
|
$44,230.50
|
$35,384.40
|
2024-10-01
|
|
42
|
MS_DRG
|
Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$68,978.00
|
$35,237.00
|
2024-10-01
|
|
6073
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
19
|
15
|
—
|
—
|
$29,098.00
|
$43,647.00
|
$34,917.60
|
2024-10-01
|
|
448
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$101,893.00
|
$34,694.95
|
2024-10-01
|
|
8413
|
APR_DRG
|
Extensive Third Degree Burns With Skin Graft
|
19
|
15
|
—
|
—
|
$28,871.00
|
$43,306.50
|
$34,645.20
|
2024-10-01
|
|
6214
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Major Anomaly
|
19
|
15
|
—
|
—
|
$28,840.00
|
$43,260.00
|
$34,608.00
|
2024-10-01
|
|
6804
|
APR_DRG
|
Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
19
|
15
|
—
|
—
|
$28,815.00
|
$43,222.50
|
$34,578.00
|
2024-10-01
|
|
0515T
|
CPT
|
Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including …
|
2
|
1
|
—
|
—
|
$29,476.00
|
$39,443.00
|
$34,459.50
|
2024-10-01
|
|
0520T
|
CPT
|
Removal And Replacement Of Pulse Generator For Wireless Cardiac Stimulator For L…
|
2
|
1
|
—
|
—
|
$29,476.00
|
$39,443.00
|
$34,459.50
|
2024-10-01
|
|
0614T
|
CPT
|
Removal And Replacement Of Substernal Implantable Defibrillator Pulse Generator
|
2
|
1
|
—
|
—
|
$29,476.00
|
$39,443.00
|
$34,459.50
|
2024-10-01
|
|
0571T
|
CPT
|
Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S…
|
2
|
1
|
—
|
—
|
$29,476.00
|
$39,443.00
|
$34,459.50
|
2024-10-01
|
|
243
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$81,795.00
|
$34,313.13
|
2024-10-01
|
|
6334
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Anomaly
|
19
|
15
|
—
|
—
|
$28,549.00
|
$42,823.50
|
$34,258.80
|
2024-10-01
|
|
518
|
MS_DRG
|
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$74,994.00
|
$33,992.34
|
2024-10-01
|
|
71
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
19
|
15
|
—
|
—
|
$28,151.00
|
$42,226.50
|
$33,781.20
|
2024-10-01
|
|
274
|
MS_DRG
|
Percutaneous And Other Intracardiac Procedures Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$57,147.00
|
$33,621.00
|
2024-10-01
|
|
3044
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
19
|
15
|
—
|
—
|
$27,960.00
|
$41,940.00
|
$33,552.00
|
2024-10-01
|
|
299
|
MS_DRG
|
Peripheral Vascular Disorders With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$70,533.00
|
$33,493.00
|
2024-10-01
|
|
301
|
MS_DRG
|
Peripheral Vascular Disorders Without Cc/mcc
|
15
|
9
|
—
|
—
|
$6,060.91
|
$70,533.00
|
$33,493.00
|
2024-10-01
|
|
300
|
MS_DRG
|
Peripheral Vascular Disorders With Cc
|
15
|
9
|
—
|
—
|
$9,096.04
|
$70,533.00
|
$33,493.00
|
2024-10-01
|
|
250
|
MS_DRG
|
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$57,147.00
|
$33,474.00
|
2024-10-01
|
|
402
|
MS_DRG
|
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical
|
15
|
9
|
—
|
—
|
$10,799.00
|
$86,792.10
|
$33,386.41
|
2024-10-01
|
|
62
|
APR_DRG
|
Pancreas Transplant
|
19
|
15
|
—
|
—
|
$27,515.00
|
$41,272.50
|
$33,018.00
|
2024-10-01
|
|
3033
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
19
|
15
|
—
|
—
|
$27,175.00
|
$40,762.50
|
$32,610.00
|
2024-10-01
|
|
5911
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
19
|
15
|
—
|
—
|
$26,951.00
|
$40,426.50
|
$32,341.20
|
2024-10-01
|
|
470
|
MS_DRG
|
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without
|
15
|
9
|
—
|
—
|
$10,799.00
|
$65,833.00
|
$32,167.00
|
2024-10-01
|
|
521
|
MS_DRG
|
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$64,380.60
|
$32,167.00
|
2024-10-01
|
|
522
|
MS_DRG
|
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$55,248.00
|
$32,167.00
|
2024-10-01
|
|
469
|
MS_DRG
|
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$65,833.00
|
$32,167.00
|
2024-10-01
|
|
9104
|
APR_DRG
|
Craniotomy For Multiple Significant Trauma
|
19
|
15
|
—
|
—
|
$26,692.00
|
$40,038.00
|
$32,030.40
|
2024-10-01
|
|
6084
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
19
|
15
|
—
|
—
|
$26,558.00
|
$39,837.00
|
$31,869.60
|
2024-10-01
|
|
519
|
MS_DRG
|
Back And Neck Procedures Except Spinal Fusion With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$74,994.00
|
$31,811.00
|
2024-10-01
|
|
520
|
MS_DRG
|
Back And Neck Procedures Except Spinal Fusion Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$74,994.00
|
$31,811.00
|
2024-10-01
|
|
251
|
MS_DRG
|
Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$57,147.00
|
$31,811.00
|
2024-10-01
|
|
133
|
MS_DRG
|
Other Ear, Nose, Mouth & Throat O.r. Procedures W Cc/mcc
|
2
|
1
|
—
|
—
|
$27,401.00
|
$36,060.00
|
$31,730.50
|
2024-10-01
|
|
1834
|
APR_DRG
|
Percutaneous Structural Cardiac Procedures
|
19
|
15
|
—
|
—
|
$26,369.00
|
$39,553.50
|
$31,642.80
|
2024-10-01
|
|
6814
|
APR_DRG
|
Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
19
|
15
|
—
|
—
|
$26,256.00
|
$39,384.00
|
$31,507.20
|
2024-10-01
|
|
3124
|
APR_DRG
|
Skin Graft For Musculoskeletal And Connective Tissue Diagnoses
|
19
|
15
|
—
|
—
|
$26,183.00
|
$39,274.50
|
$31,419.60
|
2024-10-01
|
|
7404
|
APR_DRG
|
Mental Illness Diagnosis With O.r. Procedure
|
19
|
15
|
—
|
—
|
$26,149.00
|
$39,223.50
|
$31,378.80
|
2024-10-01
|
|
6904
|
APR_DRG
|
Acute Leukemia
|
19
|
15
|
—
|
—
|
$26,010.00
|
$39,015.00
|
$31,212.00
|
2024-10-01
|
|
42
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
19
|
15
|
—
|
—
|
$25,840.00
|
$38,760.00
|
$31,008.00
|
2024-10-01
|
|
1664
|
APR_DRG
|
Coronary Bypass Without Ami Or Complex Principal Diagnosis
|
19
|
15
|
—
|
—
|
$25,822.00
|
$38,733.00
|
$30,986.40
|
2024-10-01
|
|
64
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction With Mcc
|
14
|
9
|
—
|
—
|
$6,000.00
|
$74,994.00
|
$30,901.00
|
2024-10-01
|
|
65
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours
|
14
|
9
|
—
|
—
|
$6,000.00
|
$74,994.00
|
$30,901.00
|
2024-10-01
|
|
69
|
MS_DRG
|
Transient Ischemia Without Thrombolytic
|
14
|
9
|
—
|
—
|
$6,000.00
|
$74,994.00
|
$30,901.00
|
2024-10-01
|
|
67
|
MS_DRG
|
Nonspecific Cva And Precerebral Occlusion Without Infarction With Mcc
|
14
|
9
|
—
|
—
|
$6,000.00
|
$74,994.00
|
$30,901.00
|
2024-10-01
|
|
66
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc
|
14
|
9
|
—
|
—
|
$5,848.49
|
$74,994.00
|
$30,901.00
|
2024-10-01
|
|
68
|
MS_DRG
|
Nonspecific Cva And Precerebral Occlusion Without Infarction Without Mcc
|
14
|
9
|
—
|
—
|
$6,000.00
|
$74,994.00
|
$30,901.00
|
2024-10-01
|
|
516
|
MS_DRG
|
Other Musculoskeletal System And Connective Tissue O.r. Procedures With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$51,391.00
|
$30,640.69
|
2024-10-01
|
|
3614
|
APR_DRG
|
Skin Graft For Skin And Subcutaneous Tissue Diagnoses
|
19
|
15
|
—
|
—
|
$25,369.00
|
$38,053.50
|
$30,442.80
|
2024-10-01
|
|
914
|
APR_DRG
|
Other Major Head And Neck Procedures
|
19
|
15
|
—
|
—
|
$25,293.00
|
$37,939.50
|
$30,351.60
|
2024-10-01
|
|
12
|
APR_DRG
|
Liver Transplant And/or Intestinal Transplant
|
19
|
15
|
—
|
—
|
$25,269.00
|
$37,903.50
|
$30,322.80
|
2024-10-01
|
|
32
|
MS_DRG
|
Ventricular Shunt Procedures With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$78,377.00
|
$30,124.00
|
2024-10-01
|
|
9114
|
APR_DRG
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
19
|
15
|
—
|
—
|
$25,033.00
|
$37,549.50
|
$30,039.60
|
2024-10-01
|
|
6302
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
19
|
15
|
—
|
—
|
$24,994.00
|
$37,491.00
|
$29,992.80
|
2024-10-01
|
|
214
|
APR_DRG
|
Open Craniotomy Except Trauma
|
19
|
15
|
—
|
—
|
$24,880.00
|
$37,320.00
|
$29,856.00
|
2024-10-01
|
|
872
|
MS_DRG
|
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc
|
14
|
9
|
—
|
—
|
$6,000.00
|
$54,860.00
|
$29,737.00
|
2024-10-01
|
|
871
|
MS_DRG
|
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc
|
14
|
9
|
—
|
—
|
$6,000.00
|
$54,860.00
|
$29,737.00
|
2024-10-01
|
|
0120
|
EAPG
|
Car T-cell Immunotherapy
|
19
|
15
|
—
|
—
|
$24,610.00
|
$36,915.00
|
$29,532.00
|
2024-10-01
|
|
0409T
|
CPT
|
Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I…
|
3
|
2
|
—
|
—
|
$14,841.00
|
$39,443.00
|
$29,476.00
|
2024-10-01
|
|
0414T
|
CPT
|
Removal And Replacement Of Permanent Cardiac Contractility Modulation System Pul…
|
3
|
2
|
—
|
—
|
$14,841.00
|
$39,443.00
|
$29,476.00
|
2024-10-01
|
|
7594
|
APR_DRG
|
Eating Disorders
|
19
|
15
|
—
|
—
|
$24,554.00
|
$36,831.00
|
$29,464.80
|
2024-10-01
|
|
1794
|
APR_DRG
|
Defibrillator Implants
|
19
|
15
|
—
|
—
|
$24,521.00
|
$36,781.50
|
$29,425.20
|
2024-10-01
|
|
6144
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition…
|
19
|
15
|
—
|
—
|
$24,513.00
|
$36,769.50
|
$29,415.60
|
2024-10-01
|
|
6313
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
19
|
15
|
—
|
—
|
$24,305.00
|
$36,457.50
|
$29,166.00
|
2024-10-01
|
|
258
|
MS_DRG
|
Cardiac Pacemaker Device Replacement With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$61,968.48
|
$29,083.00
|
2024-10-01
|
|
1623
|
APR_DRG
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
19
|
15
|
—
|
—
|
$24,215.00
|
$36,322.50
|
$29,058.00
|
2024-10-01
|
|
260
|
MS_DRG
|
Cardiac Pacemaker Revision Except Device Replacement With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$75,252.81
|
$28,947.58
|
2024-10-01
|
|
6254
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Other Significant Condition
|
19
|
15
|
—
|
—
|
$23,982.00
|
$35,973.00
|
$28,778.40
|
2024-10-01
|
|
33
|
MS_DRG
|
Ventricular Shunt Procedures Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$78,377.00
|
$28,706.00
|
2024-10-01
|
|
1204
|
APR_DRG
|
Major Respiratory And Chest Procedures
|
19
|
15
|
—
|
—
|
$23,868.00
|
$35,802.00
|
$28,641.60
|
2024-10-01
|
|
2604
|
APR_DRG
|
Major Pancreas, Liver And Shunt Procedures
|
19
|
15
|
—
|
—
|
$23,677.00
|
$35,515.50
|
$28,412.40
|
2024-10-01
|
|
0686T
|
CPT
|
Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant…
|
2
|
1
|
—
|
—
|
$28,126.13
|
$28,126.13
|
$28,126.13
|
2024-10-01
|
|
321
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A…
|
15
|
9
|
—
|
—
|
$10,799.00
|
$72,105.00
|
$28,103.00
|
2024-10-01
|
|
9124
|
APR_DRG
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
19
|
15
|
—
|
—
|
$23,409.00
|
$35,113.50
|
$28,090.80
|
2024-10-01
|
|
143
|
MS_DRG
|
Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc
|
15
|
9
|
—
|
—
|
$8,000.00
|
$72,931.25
|
$28,054.54
|
2024-10-01
|
|
274
|
APR_DRG
|
Other Open Craniotomy
|
19
|
15
|
—
|
—
|
$23,321.00
|
$34,981.50
|
$27,985.20
|
2024-10-01
|
|
0246
|
EAPG
|
Class IV Therapeutic Radiopharmaceuticals
|
19
|
15
|
—
|
—
|
$23,186.00
|
$34,779.00
|
$27,823.20
|
2024-10-01
|
|
2324
|
APR_DRG
|
Gastric Fundoplication
|
19
|
15
|
—
|
—
|
$23,163.00
|
$34,744.50
|
$27,795.60
|
2024-10-01
|
|
6954
|
APR_DRG
|
Chemotherapy For Acute Leukemia
|
19
|
15
|
—
|
—
|
$23,049.00
|
$34,573.50
|
$27,658.80
|
2024-10-01
|
|
41
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
19
|
15
|
—
|
—
|
$22,931.00
|
$34,396.50
|
$27,517.20
|
2024-10-01
|
|
244
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$61,663.00
|
$27,489.19
|
2024-10-01
|
|
2204
|
APR_DRG
|
Major Stomach, Esophageal And Duodenal Procedures
|
19
|
15
|
—
|
—
|
$22,906.00
|
$34,359.00
|
$27,487.20
|
2024-10-01
|
|
234
|
APR_DRG
|
Spinal Procedures
|
19
|
15
|
—
|
—
|
$22,843.00
|
$34,264.50
|
$27,411.60
|
2024-10-01
|
|
707
|
MS_DRG
|
Major Male Pelvic Procedures With Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$39,188.00
|
$27,410.00
|
2024-10-01
|
|
1694
|
APR_DRG
|
Major Abdominal Vascular Procedures
|
19
|
15
|
—
|
—
|
$22,756.00
|
$34,134.00
|
$27,307.20
|
2024-10-01
|
|
619
|
MS_DRG
|
O.r. Procedures For Obesity With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$50,760.00
|
$27,266.00
|
2024-10-01
|
|
621
|
MS_DRG
|
O.r. Procedures For Obesity Without Cc/mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$50,760.00
|
$27,266.00
|
2024-10-01
|
|
620
|
MS_DRG
|
O.r. Procedures For Obesity With Cc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$50,760.00
|
$27,266.00
|
2024-10-01
|
|
510
|
MS_DRG
|
Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$63,130.36
|
$27,108.13
|
2024-10-01
|
|
1603
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
19
|
15
|
—
|
—
|
$22,487.00
|
$33,730.50
|
$26,984.40
|
2024-10-01
|
|
33230
|
CPT
|
Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Dual …
|
28
|
15
|
—
|
—
|
$9.50
|
$77,816.00
|
$26,767.00
|
2024-10-01
|
|
111
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
19
|
15
|
—
|
—
|
$22,296.00
|
$33,444.00
|
$26,755.20
|
2024-10-01
|
|
204
|
APR_DRG
|
Open Craniotomy For Trauma
|
19
|
15
|
—
|
—
|
$22,290.00
|
$33,435.00
|
$26,748.00
|
2024-10-01
|
|
1783
|
APR_DRG
|
External Heart Assist Devices
|
19
|
15
|
—
|
—
|
$22,287.00
|
$33,430.50
|
$26,744.40
|
2024-10-01
|
|
259
|
MS_DRG
|
Cardiac Pacemaker Device Replacement Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$49,364.00
|
$26,501.00
|
2024-10-01
|
|
9504
|
APR_DRG
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis
|
19
|
15
|
—
|
—
|
$22,001.00
|
$33,001.50
|
$26,401.20
|
2024-10-01
|
|
11
|
APR_DRG
|
Liver Transplant And/or Intestinal Transplant
|
19
|
15
|
—
|
—
|
$21,971.00
|
$32,956.50
|
$26,365.20
|
2024-10-01
|
|
451
|
MS_DRG
|
Single Level Spinal Fusion Except Cervical Without Mcc
|
15
|
9
|
—
|
—
|
$10,799.00
|
$101,893.00
|
$26,220.04
|
2024-10-01
|
|
0408T
|
CPT
|
Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I…
|
7
|
4
|
—
|
—
|
$14,841.00
|
$39,443.00
|
$26,069.00
|
2024-10-01
|
|
C9760
|
HCPCS
|
Non-randomized, Non-blinded Procedure For Nyha Class Ii, Iii, IV Heart Failure; …
|
5
|
2
|
—
|
—
|
$17,497.00
|
$39,443.00
|
$26,069.00
|
2024-10-01
|
|
C9758
|
HCPCS
|
Blinded Procedure For Nyha Class Iii/iv Heart Failure; Transcatheter Implantatio…
|
5
|
2
|
—
|
—
|
$17,497.00
|
$29,000.00
|
$26,069.00
|
2024-10-01
|
|
J1412
|
HCPCS
|
Injection, Valoctocogene Roxaparvovec-rvox, Per Ml, Containing Nominal 2 X 10°13…
|
2
|
1
|
—
|
—
|
$25,816.79
|
$25,816.79
|
$25,816.79
|
2024-10-01
|
|
6072
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
19
|
15
|
—
|
—
|
$21,491.00
|
$32,236.50
|
$25,789.20
|
2024-10-01
|
|
4403
|
APR_DRG
|
Kidney Transplant
|
19
|
15
|
—
|
—
|
$21,467.00
|
$32,200.50
|
$25,760.40
|
2024-10-01
|
|
924
|
APR_DRG
|
Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures
|
19
|
15
|
—
|
—
|
$21,454.00
|
$32,181.00
|
$25,744.80
|
2024-10-01
|
|
1782
|
APR_DRG
|
External Heart Assist Devices
|
19
|
15
|
—
|
—
|
$21,425.00
|
$32,137.50
|
$25,710.00
|
2024-10-01
|
|
33212
|
CPT
|
Insertion Of Pacemaker Pulse Generator Only; With Existing Single Lead
|
28
|
15
|
—
|
—
|
$504.45
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
33208
|
CPT
|
Insertion Of New Or Replacement Of Permanent Pacemaker With Transvenous Electrod…
|
28
|
15
|
—
|
—
|
$975.00
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
33262
|
CPT
|
Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant…
|
28
|
15
|
—
|
—
|
$504.45
|
$77,816.00
|
$25,655.00
|
2024-10-01
|
|
33249
|
CPT
|
Insertion Or Replacement Of Permanent Implantable Defibrillator System, With Tra…
|
28
|
15
|
—
|
—
|
$504.45
|
$77,816.00
|
$25,655.00
|
2024-10-01
|
|
33207
|
CPT
|
Insertion Of New Or Replacement Of Permanent Pacemaker With Transvenous Electrod…
|
28
|
15
|
—
|
—
|
$504.45
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
33213
|
CPT
|
Insertion Of Pacemaker Pulse Generator Only; With Existing Dual Leads
|
28
|
15
|
—
|
—
|
$504.45
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
33214
|
CPT
|
Upgrade Of Implanted Pacemaker System, Conversion Of Single Chamber System To Du…
|
28
|
15
|
—
|
—
|
$504.45
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
33206
|
CPT
|
Insertion Of New Or Replacement Of Permanent Pacemaker With Transvenous Electrod…
|
28
|
15
|
—
|
—
|
$504.45
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
33227
|
CPT
|
Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pul…
|
28
|
15
|
—
|
—
|
$504.45
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
33228
|
CPT
|
Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pul…
|
28
|
15
|
—
|
—
|
$504.45
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
33229
|
CPT
|
Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pul…
|
28
|
15
|
—
|
—
|
$504.45
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
33224
|
CPT
|
Insertion Of Pacing Electrode, Cardiac Venous System, For Left Ventricular Pacin…
|
28
|
15
|
—
|
—
|
$504.45
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
33231
|
CPT
|
Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multi…
|
28
|
15
|
—
|
—
|
$504.45
|
$77,816.00
|
$25,655.00
|
2024-10-01
|
|
33221
|
CPT
|
Insertion Of Pacemaker Pulse Generator Only; With Existing Multiple Leads
|
28
|
15
|
—
|
—
|
$504.45
|
$55,286.00
|
$25,655.00
|
2024-10-01
|
|
92937
|
CPT
|
Percutaneous Transluminal Revascularization Of Or Through Coronary Artery Bypass…
|
20
|
12
|
—
|
—
|
$673.55
|
$41,854.15
|
$25,450.00
|
2024-10-01
|
|
6083
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
19
|
15
|
—
|
—
|
$21,147.00
|
$31,720.50
|
$25,376.40
|
2024-10-01
|
|
6113
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
19
|
15
|
—
|
—
|
$21,048.00
|
$31,572.00
|
$25,257.60
|
2024-10-01
|