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Hospital

MEMORIAL HEALTH MEADOWS HOSPITAL

Vidalia, GA · CCN 110128 · Rates published

20,962 distinct procedures filed
28 distinct payers
297,544 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

178,936 of 297,544 rate rows are consumer-grade (60.1%)

118,608 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 111,650
per-diem day rate — not a per-procedure price 4,507
template filing: same amount across many unrelated codes — excluded 2,373
placeholder amount (≤ $0.02) — excluded from medians 69
exceeds 10× this hospital's gross charge — excluded from medians 9

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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://core.secure.ehc.com/src/util/json-detail-price-list/85-2556972_memorial-health-meadows-hospital_standardcharges.json
Found on page https://memorialhealth.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 1d12d47d42cbbbac… · 220,734,953 bytes · first seen 2026-05-05

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
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 12 $2,387,385.00 $3,856,545.00 $3,709,629.00 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 12 $2,343,250.00 $3,785,250.00 $3,641,050.00 nat. median
$3,605,000
1.0× median
J1411
HCPCS 		Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 4 $465,980.20 $4,111,590.00 $3,563,378.00 nat. median
$3,710,000
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 13 $5,320.60 $3,491,727.75 $3,358,709.55 nat. median
$13,041
outlier · 257.5×
748
OTHER 		Inj, Lovotibeglogene Auto 13 $8,776.31 $3,450,300.00 $3,318,860.00 nat. median
$17,963
outlier · 184.8×
746
OTHER 		Inj, Betibeglogene Autote 13 $7,795.11 $3,116,400.00 $2,997,680.00 nat. median
$21,896
outlier · 136.9×
J1413
HCPCS 		Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 3 $426,039.04 $3,651,763.20 $2,864,128.00 nat. median
$3,325,455
0.9× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 5 $309,150.46 $3,884,946.48 $2,648,347.96 nat. median
$2,469,189
1.1× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 12 $1,552,599.10 $2,508,044.70 $2,412,500.14 nat. median
$2,588,981
0.9× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 8 $73,428.36 $1,292,595.50 $657,793.40 nat. median
$754,974
0.9× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 8 $66,087.96 $1,198,462.58 $599,371.74 nat. median
$674,188
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 7 $67,592.00 $1,282,791.58 $595,823.34 nat. median
$675,122
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 8 $68,614.69 $1,136,715.72 $595,395.54 nat. median
$634,511
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 7 $67,028.42 $1,225,870.24 $574,529.28 nat. median
$625,184
0.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 12 $343,975.39 $555,652.55 $534,484.83 nat. median
$566,531
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 12 $342,630.21 $553,479.57 $532,394.63 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 12 $342,281.94 $552,916.98 $531,853.48 nat. median
$558,082
1.0× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 7 $59,837.13 $1,136,715.72 $527,975.14 nat. median
$620,080
0.9× median
9413
OTHER 		Lisocabtagene Car Pos T 12 $335,871.96 $542,562.41 $521,893.36 nat. median
$562,201
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 12 $318,146.40 $513,928.80 $494,350.56 nat. median
$532,192
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 12 $299,344.76 $483,556.92 $465,135.70 nat. median
$489,450
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 18 $9,933.00 $1,390,867.30 $252,336.47 nat. median
$370,174
0.7× median
1614
APR_DRG 		Implantable Heart Assist Systems 4 $164,800.80 $210,121.02 $206,001.00 nat. median
$207,730
1.0× median
5834
APR_DRG 		Neonate With Ecmo 4 $157,397.60 $200,681.94 $196,747.00 nat. median
$309,665
0.6× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 18 $11,919.00 $1,083,843.07 $189,092.80 nat. median
$265,286
0.7× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $180,346.21 $180,346.21 $180,346.21 nat. median
$263,894
0.7× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 4 $141,880.80 $180,898.02 $177,351.00 nat. median
$164,834
1.1× median
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 3 $108,036.36 $165,601.38 $162,221.76 nat. median
$62,507
outlier · 2.6×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 18 $11,919.00 $912,853.34 $159,646.42 nat. median
$206,368
0.8× median
5833
APR_DRG 		Neonate With Ecmo 4 $124,640.00 $158,916.00 $155,800.00 nat. median
$244,017
0.6× median
1613
APR_DRG 		Implantable Heart Assist Systems 4 $120,684.80 $153,873.12 $150,856.00 nat. median
$119,796
1.3× median
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $148,812.20 $148,812.20 $148,812.20 nat. median
$424,868
outlier · 0.4×
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 4 $118,757.60 $151,415.94 $148,447.00 nat. median
$105,658
1.4× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 $118,656.80 $151,287.42 $148,321.00 nat. median
$150,721
1.0× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 4 $116,324.00 $148,313.10 $145,405.00 nat. median
$246,434
0.6× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 18 $11,919.00 $778,723.61 $144,454.13 nat. median
$202,986
0.7× median
1907
OTHER 		New Technology - Level 52 12 $89,365.44 $144,359.57 $138,860.15 nat. median
$153,199
0.9× median
1908
OTHER 		New Technology - Level 52 12 $89,365.44 $144,359.57 $138,860.15 nat. median
$152,962
0.9× median
222
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 $126,562.11 $126,562.11 $126,562.11 nat. median
$63,570
2.0× median
1906
OTHER 		New Technology - Level 51 12 $80,575.43 $130,160.31 $125,201.82 nat. median
$138,020
0.9× median
1905
OTHER 		New Technology - Level 51 12 $80,575.43 $130,160.31 $125,201.82 nat. median
$137,903
0.9× median
003
OTHER 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 $120,795.89 $120,795.89 $120,795.89 nat. median
$218,232
0.6× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 1 $120,116.70 $120,116.70 $120,116.70 nat. median
$76,377
1.6× median
24
APR_DRG 		Heart And/or Lung Transplant 4 $93,556.00 $119,283.90 $116,945.00 nat. median
$234,738
outlier · 0.5×
5832
APR_DRG 		Neonate With Ecmo 4 $91,933.60 $117,215.34 $114,917.00 nat. median
$156,126
0.7× median
224
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 $113,119.68 $113,119.68 $113,119.68 nat. median
$54,196
outlier · 2.1×
1904
OTHER 		New Technology - Level 50 12 $71,785.42 $115,961.06 $111,543.49 nat. median
$120,174
0.9× median
1903
OTHER 		New Technology - Level 50 12 $71,785.42 $115,961.06 $111,543.49 nat. median
$119,935
0.9× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 4 $87,065.60 $111,008.64 $108,832.00 nat. median
$160,267
0.7× median

Other procedures at this hospital

Browse this hospital's 20,962 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
9138 OTHER Inj, Hemgenix, Per Tx Dos 15 12 — — $2,387,385.00 $3,856,545.00 $3,709,629.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 15 12 — — $2,343,250.00 $3,785,250.00 $3,641,050.00 2024-10-01
J1411 HCPCS Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 4 4 — — $465,980.20 $4,111,590.00 $3,563,378.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 16 13 — — $5,320.60 $3,491,727.75 $3,358,709.55 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 16 13 — — $8,776.31 $3,450,300.00 $3,318,860.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 16 13 — — $7,795.11 $3,116,400.00 $2,997,680.00 2024-10-01
J1413 HCPCS Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 3 3 — — $426,039.04 $3,651,763.20 $2,864,128.00 2024-10-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 5 5 — — $309,150.46 $3,884,946.48 $2,648,347.96 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 15 12 — — $1,552,599.10 $2,508,044.70 $2,412,500.14 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 8 8 — — $73,428.36 $1,292,595.50 $657,793.40 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 8 8 — — $66,087.96 $1,198,462.58 $599,371.74 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 7 7 — — $67,592.00 $1,282,791.58 $595,823.34 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 8 8 — — $68,614.69 $1,136,715.72 $595,395.54 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 7 7 — — $67,028.42 $1,225,870.24 $574,529.28 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 15 12 — — $343,975.39 $555,652.55 $534,484.83 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 15 12 — — $342,630.21 $553,479.57 $532,394.63 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 15 12 — — $342,281.94 $552,916.98 $531,853.48 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 7 7 — — $59,837.13 $1,136,715.72 $527,975.14 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 15 12 — — $335,871.96 $542,562.41 $521,893.36 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 15 12 — — $318,146.40 $513,928.80 $494,350.56 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 15 12 — — $299,344.76 $483,556.92 $465,135.70 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 22 18 — — $9,933.00 $1,390,867.30 $252,336.47 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 4 4 — — $164,800.80 $210,121.02 $206,001.00 2024-10-01
5834 APR_DRG Neonate With Ecmo 4 4 — — $157,397.60 $200,681.94 $196,747.00 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 23 18 — — $11,919.00 $1,083,843.07 $189,092.80 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $180,346.21 $180,346.21 $180,346.21 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 4 4 — — $141,880.80 $180,898.02 $177,351.00 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 3 3 — — $108,036.36 $165,601.38 $162,221.76 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 23 18 — — $11,919.00 $912,853.34 $159,646.42 2024-10-01
5833 APR_DRG Neonate With Ecmo 4 4 — — $124,640.00 $158,916.00 $155,800.00 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 4 4 — — $120,684.80 $153,873.12 $150,856.00 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $148,812.20 $148,812.20 $148,812.20 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $118,757.60 $151,415.94 $148,447.00 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 4 — — $118,656.80 $151,287.42 $148,321.00 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $116,324.00 $148,313.10 $145,405.00 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 23 18 — — $11,919.00 $778,723.61 $144,454.13 2024-10-01
1908 OTHER New Technology - Level 52 15 12 — — $89,365.44 $144,359.57 $138,860.15 2024-10-01
1907 OTHER New Technology - Level 52 15 12 — — $89,365.44 $144,359.57 $138,860.15 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $126,562.11 $126,562.11 $126,562.11 2024-10-01
1906 OTHER New Technology - Level 51 15 12 — — $80,575.43 $130,160.31 $125,201.82 2024-10-01
1905 OTHER New Technology - Level 51 15 12 — — $80,575.43 $130,160.31 $125,201.82 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $120,795.89 $120,795.89 $120,795.89 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 1 1 — — $120,116.70 $120,116.70 $120,116.70 2024-10-01
24 APR_DRG Heart And/or Lung Transplant 4 4 — — $93,556.00 $119,283.90 $116,945.00 2024-10-01
5832 APR_DRG Neonate With Ecmo 4 4 — — $91,933.60 $117,215.34 $114,917.00 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $113,119.68 $113,119.68 $113,119.68 2024-10-01
1903 OTHER New Technology - Level 50 15 12 — — $71,785.42 $115,961.06 $111,543.49 2024-10-01
1904 OTHER New Technology - Level 50 15 12 — — $71,785.42 $115,961.06 $111,543.49 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 4 4 — — $87,065.60 $111,008.64 $108,832.00 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 4 4 — — $85,240.00 $108,681.00 $106,550.00 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $83,160.80 $106,030.02 $103,951.00 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 1 1 — — $103,606.87 $103,606.87 $103,606.87 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 4 4 — — $82,349.60 $104,995.74 $102,937.00 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $81,436.80 $103,831.92 $101,796.00 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $81,183.20 $103,508.58 $101,479.00 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 4 — — $80,777.60 $102,991.44 $100,972.00 2024-10-01
5831 APR_DRG Neonate With Ecmo 4 4 — — $79,459.20 $101,310.48 $99,324.00 2024-10-01
1902 OTHER New Technology - Level 49 15 12 — — $62,995.40 $101,761.80 $97,885.16 2024-10-01
1901 OTHER New Technology - Level 49 15 12 — — $62,995.40 $101,761.80 $97,885.16 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 23 18 — — $11,919.00 $528,395.82 $96,072.10 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $95,122.15 $95,122.15 $95,122.15 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 4 4 — — $75,909.60 $96,784.74 $94,887.00 2024-10-01
74 APR_DRG Allogeneic Bone Marrow Transplant 4 4 — — $74,946.40 $95,556.66 $93,683.00 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 4 4 — — $72,106.40 $91,935.66 $90,133.00 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 23 18 — — $9,933.00 $504,122.63 $89,258.55 2024-10-01
7 MS_DRG Lung Transplant 23 18 — — $11,919.00 $502,852.79 $89,039.86 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 6 6 — — $8,454.12 $156,303.14 $88,618.88 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 4 4 — — $70,585.60 $89,996.64 $88,232.00 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 5 5 — — $82,554.24 $352,276.70 $87,080.98 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $87,002.91 $87,002.91 $87,002.91 2024-10-01
1585 OTHER New Technology - Level 48 15 12 — — $55,670.39 $89,929.09 $86,503.22 2024-10-01
1599 OTHER New Technology - Level 48 15 12 — — $55,670.39 $89,929.09 $86,503.22 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $84,934.52 $84,934.52 $84,934.52 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 4 4 — — $67,695.20 $86,311.38 $84,619.00 2024-10-01
64 APR_DRG Pancreas Transplant 4 4 — — $67,238.40 $85,728.96 $84,048.00 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 1 1 — — $81,439.03 $81,439.03 $81,439.03 2024-10-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 4 4 — — $64,297.60 $81,979.44 $80,372.00 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $78,918.78 $78,918.78 $78,918.78 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 4 — — $62,674.40 $79,909.86 $78,343.00 2024-10-01
1598 OTHER New Technology - Level 47 15 12 — — $49,810.38 $80,462.92 $77,397.66 2024-10-01
1584 OTHER New Technology - Level 47 15 12 — — $49,810.38 $80,462.92 $77,397.66 2024-10-01
14 APR_DRG Liver Transplant And/or Intestinal Transplant 4 4 — — $61,812.80 $78,811.32 $77,266.00 2024-10-01
13 APR_DRG Liver Transplant And/or Intestinal Transplant 4 4 — — $61,812.80 $78,811.32 $77,266.00 2024-10-01
12 APR_DRG Liver Transplant And/or Intestinal Transplant 4 4 — — $61,812.80 $78,811.32 $77,266.00 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $76,855.36 $76,855.36 $76,855.36 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 1 — — $76,785.37 $76,785.37 $76,785.37 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 4 4 — — $60,950.40 $77,711.76 $76,188.00 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 23 18 — — $11,919.00 $424,038.06 $75,467.10 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 23 19 — — $11,919.00 $419,166.49 $74,628.17 2024-10-01
215 MS_DRG Other Heart Assist System Implant 27 20 — — $11,919.00 $396,467.14 $74,071.91 2024-10-01
338 MS_DRG Appendectomy With Complicated Principal Diagnosis With Mcc 2 2 — — $44,152.92 $102,222.12 $73,187.52 2024-10-01
23 APR_DRG Heart And/or Lung Transplant 4 4 — — $58,516.80 $74,608.92 $73,146.00 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 23 18 — — $11,919.00 $409,758.13 $73,007.94 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 4 4 — — $58,313.60 $74,349.84 $72,892.00 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 23 17 — — $11,919.00 $251,217.00 $71,196.36 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 4 4 — — $56,539.20 $72,087.48 $70,674.00 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 4 4 — — $56,133.60 $71,570.34 $70,167.00 2024-10-01
1583 OTHER New Technology - Level 46 15 12 — — $43,950.37 $70,996.75 $68,292.11 2024-10-01
1597 OTHER New Technology - Level 46 15 12 — — $43,950.37 $70,996.75 $68,292.11 2024-10-01
007 OTHER Lung Transplant 1 1 — — $68,092.54 $68,092.54 $68,092.54 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $67,969.02 $67,969.02 $67,969.02 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 27 20 — — $11,919.00 $371,347.39 $67,695.01 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $53,598.40 $68,337.96 $66,998.00 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 4 4 — — $53,293.60 $67,949.34 $66,617.00 2024-10-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 4 4 — — $52,989.60 $67,561.74 $66,237.00 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 15 12 — — $42,559.78 $68,750.41 $66,131.35 2024-10-01
247 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 2 2 — — $31,655.38 $100,200.00 $65,927.69 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 5 5 — — $61,787.52 $255,237.84 $65,175.61 2024-10-01
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 4 4 — — $52,127.20 $66,462.18 $65,159.00 2024-10-01
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 4 4 — — $51,721.60 $65,945.04 $64,652.00 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 16 13 — — $12,750.63 $66,522.51 $63,988.32 2024-10-01
230 MS_DRG Other Cardiothoracic Procedures Without Cc/mcc 1 1 — — $63,910.98 $63,910.98 $63,910.98 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 7 7 — — $7,390.73 $135,125.34 $63,349.14 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $62,904.47 $62,904.47 $62,904.47 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 20 16 — — $11,919.00 $354,450.82 $62,861.03 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $49,947.20 $63,682.68 $62,434.00 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $48,527.20 $61,872.18 $60,659.00 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 5 5 — — $56,979.84 $234,377.83 $60,104.88 2024-10-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 4 4 — — $48,071.20 $61,290.78 $60,089.00 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 36 22 — — $11,919.00 $139,744.55 $59,997.12 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 27 20 — — $11,919.00 $326,056.43 $59,742.49 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 4 4 — — $47,614.40 $60,708.36 $59,518.00 2024-10-01
341 MS_DRG Appendectomy Without Complicated Principal Diagnosis With Mcc 2 2 — — $31,976.29 $86,926.32 $59,451.31 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 33 20 — — $11,919.00 $200,021.00 $59,299.00 2024-10-01
1596 OTHER New Technology - Level 45 15 12 — — $38,090.36 $61,530.58 $59,186.56 2024-10-01
1582 OTHER New Technology - Level 45 15 12 — — $38,090.36 $61,530.58 $59,186.56 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $57,974.96 $57,974.96 $57,974.96 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 35 22 — — $11,919.00 $238,345.12 $57,854.40 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 27 20 — — $11,919.00 $357,990.98 $56,952.68 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 4 4 — — $38,803.31 $57,735.72 $56,852.01 2024-10-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 4 4 — — $45,180.80 $57,605.52 $56,476.00 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $44,977.60 $57,346.44 $56,222.00 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 36 22 — — $11,919.00 $235,047.38 $55,995.19 2024-10-01
21 APR_DRG Heart And/or Lung Transplant 4 4 — — $44,724.00 $57,023.10 $55,905.00 2024-10-01
22 APR_DRG Heart And/or Lung Transplant 4 4 — — $44,724.00 $57,023.10 $55,905.00 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $55,870.52 $55,870.52 $55,870.52 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $55,743.00 $55,743.00 $55,743.00 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 15 12 — — $35,759.90 $57,765.99 $55,565.38 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 33 20 — — $11,919.00 $170,334.00 $55,369.86 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 4 4 — — $44,268.00 $56,441.70 $55,335.00 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 27 20 — — $11,919.00 $298,023.75 $55,299.34 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 36 22 — — $11,919.00 $120,000.00 $55,209.00 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 22 18 — — $11,919.00 $305,019.42 $54,970.79 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 27 20 — — $11,919.00 $297,719.76 $54,766.91 2024-10-01
10 MS_DRG Pancreas Transplant 23 18 — — $11,919.00 $306,785.65 $54,733.03 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $43,659.20 $55,665.48 $54,574.00 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 4 4 — — $43,557.60 $55,535.94 $54,447.00 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 36 22 — — $11,919.00 $228,921.37 $53,623.54 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 36 22 — — $11,919.00 $220,544.27 $53,360.67 2024-10-01
7114 APR_DRG Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 4 4 — — $42,594.40 $54,307.86 $53,243.00 2024-10-01
214 APR_DRG Open Craniotomy Except Trauma 4 4 — — $42,442.40 $54,114.06 $53,053.00 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 7 7 — — $5,879.08 $112,740.18 $52,365.14 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 24 19 — — $11,919.00 $285,156.04 $51,902.63 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $51,843.19 $51,843.19 $51,843.19 2024-10-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $41,377.60 $52,756.44 $51,722.00 2024-10-01
73 APR_DRG Allogeneic Bone Marrow Transplant 4 4 — — $41,174.40 $52,497.36 $51,468.00 2024-10-01
984 MS_DRG Prostatic O.r. Procedure Unrelated To Principal Diagnosis W Mcc 1 1 — — $50,281.35 $50,281.35 $50,281.35 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 26 20 — — $11,919.00 $271,918.92 $50,236.61 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $50,183.85 $50,183.85 $50,183.85 2024-10-01
83 APR_DRG Autologous Bone Marrow Transplant 4 4 — — $40,109.60 $51,139.74 $50,137.00 2024-10-01
84 APR_DRG Autologous Bone Marrow Transplant 4 4 — — $40,109.60 $51,139.74 $50,137.00 2024-10-01
1595 OTHER New Technology - Level 44 15 12 — — $32,230.35 $52,064.41 $50,081.00 2024-10-01
1581 OTHER New Technology - Level 44 15 12 — — $32,230.35 $52,064.41 $50,081.00 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $39,957.60 $50,945.94 $49,947.00 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $49,904.80 $49,904.80 $49,904.80 2024-10-01
C9760 HCPCS Non-randomized, Non-blinded Procedure For Nyha Class Ii, Iii, IV Heart Failure; … 4 4 — — $19,000.00 $69,553.54 $49,462.04 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 36 22 — — $11,919.00 $203,801.62 $49,368.15 2024-10-01
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 4 4 — — $39,146.40 $49,911.66 $48,933.00 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 36 22 — — $11,919.00 $199,568.82 $48,928.74 2024-10-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 1 1 — — $48,275.69 $48,275.69 $48,275.69 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 27 20 — — $9,700.00 $261,313.83 $48,065.69 2024-10-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 4 4 — — $38,385.60 $48,941.64 $47,982.00 2024-10-01
1784 APR_DRG External Heart Assist Devices 4 4 — — $38,233.60 $48,747.84 $47,792.00 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 33 20 — — $11,919.00 $160,789.00 $47,788.69 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 24 19 — — $11,919.00 $259,201.28 $47,689.39 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 36 22 — — $11,919.00 $191,741.99 $47,430.09 2024-10-01
5244 OTHER Level 4 Blood Product Exc 15 12 — — $30,510.82 $49,286.72 $47,409.13 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 36 22 — — $11,919.00 $230,495.20 $47,029.00 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 23 18 — — $11,919.00 $256,988.68 $46,699.36 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 27 20 — — $11,919.00 $256,553.86 $46,624.49 2024-10-01
1303 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 4 4 — — $37,067.20 $47,260.68 $46,334.00 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 36 22 — — $11,919.00 $226,166.20 $46,198.00 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 27 20 — — $11,919.00 $248,480.75 $46,121.15 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 36 22 — — $11,919.00 $198,579.89 $45,938.23 2024-10-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $36,712.00 $46,807.80 $45,890.00 2024-10-01
1142 OTHER Supprelin La Implant 15 12 — — $29,477.64 $47,617.72 $45,803.71 2024-10-01
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 4 4 — — $36,509.60 $46,549.74 $45,637.00 2024-10-01
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 1 1 — — $45,604.43 $45,604.43 $45,604.43 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $45,490.88 $45,490.88 $45,490.88 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 24 19 — — $9,700.00 $252,655.83 $45,302.46 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 5 5 — — $42,906.24 $184,242.24 $45,259.23 2024-10-01
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 4 4 — — $36,204.80 $46,161.12 $45,256.00 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $45,048.79 $45,048.79 $45,048.79 2024-10-01
4404 APR_DRG Kidney Transplant 4 4 — — $35,799.20 $45,643.98 $44,749.00 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 35 22 — — $11,919.00 $179,016.66 $44,553.60 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 33 21 — — $11,919.00 $225,896.84 $44,520.88 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 30 19 — — $11,919.00 $238,037.28 $44,500.32 2024-10-01
339 MS_DRG Appendectomy With Complicated Principal Diagnosis With Cc 2 2 — — $26,286.14 $62,660.83 $44,473.49 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $44,373.15 $44,373.15 $44,373.15 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 24 19 — — $11,919.00 $278,887.65 $44,349.55 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $35,343.20 $45,062.58 $44,179.00 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 4 4 — — $35,241.60 $44,933.04 $44,052.00 2024-10-01
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 4 4 — — $35,241.60 $44,933.04 $44,052.00 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 4 4 — — $35,241.60 $44,933.04 $44,052.00 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 27 20 — — $11,919.00 $246,856.90 $43,954.30 2024-10-01
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $35,140.00 $44,803.50 $43,925.00 2024-10-01
3032 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $35,140.00 $44,803.50 $43,925.00 2024-10-01
3031 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $35,140.00 $44,803.50 $43,925.00 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 36 22 — — $11,919.00 $176,711.70 $43,757.67 2024-10-01
63 APR_DRG Pancreas Transplant 4 4 — — $34,988.00 $44,609.70 $43,735.00 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $43,668.01 $43,668.01 $43,668.01 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 4 4 — — $34,886.40 $44,480.16 $43,608.00 2024-10-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 4 — — $34,734.40 $44,286.36 $43,418.00 2024-10-01
C9782 HCPCS Blinded Procedure For New York Heart Association (nyha) Class Ii Or Iii Heart Fa… 3 3 — — $21,170.00 $44,261.70 $43,358.40 2024-10-01
8634 APR_DRG Neonatal Aftercare 4 4 — — $34,532.00 $44,028.30 $43,165.00 2024-10-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $43,151.90 $43,151.90 $43,151.90 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 27 20 — — $11,919.00 $253,994.94 $42,965.81 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 33 20 — — $11,919.00 $131,997.00 $42,940.56 2024-10-01
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 4 4 — — $34,328.80 $43,769.22 $42,911.00 2024-10-01
1794 APR_DRG Defibrillator Implants 4 4 — — $34,278.40 $43,704.96 $42,848.00 2024-10-01
4403 APR_DRG Kidney Transplant 4 4 — — $34,227.20 $43,639.68 $42,784.00 2024-10-01
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 3 3 — — $28,478.75 $43,653.12 $42,762.24 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 33 20 — — $11,919.00 $131,191.00 $42,666.78 2024-10-01
1824 APR_DRG Other Peripheral Vascular And Related Procedures 4 4 — — $34,126.40 $43,511.16 $42,658.00 2024-10-01
245 MS_DRG Aicd Generator Procedures 36 22 — — $11,919.00 $188,032.52 $42,654.78 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 36 22 — — $11,919.00 $120,000.00 $42,650.90 2024-10-01
C2616 HCPCS Brachytherapy Source, Non-stranded, Yttrium-90, Per Source 3 3 — — $11,974.00 $43,443.40 $42,556.80 2024-10-01
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 4 4 — — $34,024.80 $43,381.62 $42,531.00 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 23 18 — — $9,933.00 $232,246.04 $42,438.42 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 23 18 — — $9,933.00 $232,246.04 $42,438.42 2024-10-01
834 OTHER Acute Leukemia With Mcc 1 1 — — $42,370.74 $42,370.74 $42,370.74 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 33 21 — — $11,919.00 $224,026.71 $42,229.51 2024-10-01
72 APR_DRG Allogeneic Bone Marrow Transplant 4 4 — — $33,720.80 $42,994.02 $42,151.00 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 33 21 — — $11,919.00 $201,696.77 $42,125.46 2024-10-01
914 APR_DRG Other Major Head And Neck Procedures 4 4 — — $33,568.00 $42,799.20 $41,960.00 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 19 15 — — $26,661.91 $77,701.06 $41,838.70 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 36 22 — — $11,919.00 $174,718.44 $41,568.38 2024-10-01
913 APR_DRG Other Major Head And Neck Procedures 4 4 — — $33,162.40 $42,282.06 $41,453.00 2024-10-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $41,403.04 $41,403.04 $41,403.04 2024-10-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 4 4 — — $33,061.60 $42,153.54 $41,327.00 2024-10-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 4 4 — — $32,960.00 $42,024.00 $41,200.00 2024-10-01
1580 OTHER New Technology - Level 43 15 12 — — $26,370.34 $42,598.24 $40,975.45 2024-10-01
1594 OTHER New Technology - Level 43 15 12 — — $26,370.34 $42,598.24 $40,975.45 2024-10-01
11 APR_DRG Liver Transplant And/or Intestinal Transplant 4 4 — — $32,756.80 $41,764.92 $40,946.00 2024-10-01
1834 APR_DRG Percutaneous Structural Cardiac Procedures 4 4 — — $32,706.40 $41,700.66 $40,883.00 2024-10-01
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 4 4 — — $32,604.80 $41,571.12 $40,756.00 2024-10-01
G0173 HCPCS Linear Accelerator Based Stereotactic Radiosurgery, Complete Course Of Therapy I… 5 3 — — $2,844.00 $40,688.00 $40,688.00 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 33 21 — — $11,919.00 $213,821.82 $40,539.81 2024-10-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $32,300.80 $41,183.52 $40,376.00 2024-10-01
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 4 4 — — $32,097.60 $40,924.44 $40,122.00 2024-10-01
1833 APR_DRG Percutaneous Structural Cardiac Procedures 4 4 — — $32,047.20 $40,860.18 $40,059.00 2024-10-01
71 APR_DRG Allogeneic Bone Marrow Transplant 4 4 — — $32,047.20 $40,860.18 $40,059.00 2024-10-01
G0299 HCPCS Direct Skilled Nursing Services Of A Registered Nurse (rn) In The Home Health Or… 3 1 — — $40,025.00 $40,025.00 $40,025.00 2024-10-01
G0300 HCPCS Direct Skilled Nursing Services Of A Licensed Practical Nurse (lpn) In The Home … 3 1 — — $40,025.00 $40,025.00 $40,025.00 2024-10-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 4 4 — — $31,945.60 $40,730.64 $39,932.00 2024-10-01
894 APR_DRG Major Cranial Or Facial Bone Procedures 4 4 — — $31,895.20 $40,666.38 $39,869.00 2024-10-01
893 APR_DRG Major Cranial Or Facial Bone Procedures 4 4 — — $31,895.20 $40,666.38 $39,869.00 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 27 20 — — $11,919.00 $261,248.42 $39,836.83 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 33 21 — — $11,919.00 $213,252.31 $39,545.22 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 30 20 — — $11,919.00 $209,361.98 $39,441.09 2024-10-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 4 4 — — $31,540.00 $40,213.50 $39,425.00 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
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 33 21 — — $11,919.00 $198,756.90 $39,321.47 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 33 21 — — $11,919.00 $217,373.52 $39,316.69 2024-10-01
6903 APR_DRG Acute Leukemia 4 4 — — $31,336.80 $39,954.42 $39,171.00 2024-10-01
6904 APR_DRG Acute Leukemia 4 4 — — $31,336.80 $39,954.42 $39,171.00 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 24 19 — — $9,700.00 $212,675.11 $39,068.08 2024-10-01
1783 APR_DRG External Heart Assist Devices 4 4 — — $31,236.00 $39,825.90 $39,045.00 2024-10-01
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 4 4 — — $31,184.80 $39,760.62 $38,981.00 2024-10-01
61 APR_DRG Pancreas Transplant 4 4 — — $31,084.00 $39,632.10 $38,855.00 2024-10-01
62 APR_DRG Pancreas Transplant 4 4 — — $31,084.00 $39,632.10 $38,855.00 2024-10-01
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 4 4 — — $31,032.80 $39,566.82 $38,791.00 2024-10-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 36 22 — — $11,919.00 $158,576.08 $38,647.04 2024-10-01
1653 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 4 4 — — $30,677.60 $39,113.94 $38,347.00 2024-10-01
232 OTHER Coronary Bypass With Ptca Without Mcc 1 1 — — $38,240.39 $38,240.39 $38,240.39 2024-10-01
219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $38,236.88 $38,236.88 $38,236.88 2024-10-01
969 OTHER HIV With Extensive O.r. Procedures With Mcc 1 1 — — $38,150.87 $38,150.87 $38,150.87 2024-10-01
466 OTHER Revision Of Hip Or Knee Replacement With Mcc 1 1 — — $38,088.86 $38,088.86 $38,088.86 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 36 22 — — $11,919.00 $156,936.83 $38,040.49 2024-10-01
1302 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 4 4 — — $30,373.60 $38,726.34 $37,967.00 2024-10-01
461 OTHER Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 1 1 — — $37,850.31 $37,850.31 $37,850.31 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 32 21 — — $11,919.00 $192,511.59 $37,832.63 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 36 22 — — $11,919.00 $72,847.35 $37,828.00 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 36 22 — — $11,919.00 $201,831.45 $37,828.00 2024-10-01
342 MS_DRG Appendectomy Without Complicated Principal Diagnosis With Cc 2 2 — — $19,722.40 $55,919.14 $37,820.77 2024-10-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 4 4 — — $30,221.60 $38,532.54 $37,777.00 2024-10-01
233 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 1 — — $37,662.27 $37,662.27 $37,662.27 2024-10-01
870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 1 1 — — $37,530.24 $37,530.24 $37,530.24 2024-10-01
133 MS_DRG Other Ear, Nose, Mouth & Throat O.r. Procedures W Cc/mcc 4 2 — — $27,593.53 $37,482.00 $37,482.00 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 36 22 — — $11,919.00 $197,510.14 $37,350.06 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 33 20 — — $11,919.00 $123,508.00 $37,285.53 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 33 21 — — $11,919.00 $196,971.42 $37,159.71 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 33 21 — — $11,919.00 $178,935.85 $36,871.84 2024-10-01
7404 APR_DRG Mental Illness Diagnosis With O.r. Procedure 4 4 — — $29,410.40 $37,498.26 $36,763.00 2024-10-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 36 22 — — $11,919.00 $153,896.91 $36,724.20 2024-10-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 4 4 — — $29,359.20 $37,432.98 $36,699.00 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 33 21 — — $9,700.00 $192,661.66 $36,669.24 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 33 21 — — $11,919.00 $188,590.48 $36,633.08 2024-10-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 36 22 — — $11,919.00 $167,715.08 $36,630.24 2024-10-01
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