Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

GUNDERSEN PALMER LUTHERAN HOSPITAL AND CLINICS

West Union, IA · CCN 161316 · Rates published

Your selected procedure

You selected 93350 (HCPCS)

STRESS TTE ONLY

This hospital’s price: $1,133 across 4 payers · range $202-$2,783

Source: https://bellin-ghs.pt.panaceainc.com/MRFDownload/bellin-ghs/gundersen-palmer · observed 2025-06-27

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

16,317 distinct procedures filed
16 distinct payers
128,248 rate rows
2025-06-27 last MRF observed · ⚠ 16 mo old
Data quality

102,686 of 128,248 rate rows are consumer-grade (80.1%)

25,562 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 13,876
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 9,939
template filing: same amount across many unrelated codes — excluded 1,710
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 19
placeholder amount (≤ $0.02) — excluded from medians 10
exceeds 10× this hospital's gross charge — excluded from medians 8

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 16 months old.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://bellin-ghs.pt.panaceainc.com/MRFDownload/bellin-ghs/gundersen-palmer
Found on page https://www.gundersenhealth.org/cost-estimates/charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-28
Content fingerprint 1d17dbecebcf277c… · 1,380,322 bytes · first seen 2026-05-09

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
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 2 $63,235.61 $777,866.81 $670,711.67 nat. median
$68,423
outlier · 9.8×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell Immunotherapy 2 $349,597.66 $690,785.36 $646,397.39 nat. median
$359,454
1.8× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 2 $261,120.14 $515,958.75 $482,804.66 nat. median
$249,036
1.9× median
5834
APR_DRG 		Neonate With Ecmo 2 $411,851.82 $411,851.82 $411,851.82 nat. median
$307,206
1.3× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 2 $219,910.36 $434,530.53 $406,608.79 nat. median
$198,418
outlier · 2.0×
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 $198,670.93 $392,562.62 $367,337.62 nat. median
$190,559
1.9× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $268,686.28 $268,686.28 $268,686.28 nat. median
$247,214
1.1× median
5833
APR_DRG 		Neonate With Ecmo 2 $266,810.37 $266,810.37 $266,810.37 nat. median
$244,017
1.1× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 $130,985.10 $258,819.21 $242,188.20 nat. median
$126,695
1.9× median
24
APR_DRG 		Heart And/or Lung Transplant 2 $237,946.25 $237,946.25 $237,946.25 nat. median
$241,437
1.0× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 2 $121,453.69 $239,985.67 $224,564.85 nat. median
$110,307
outlier · 2.0×
7
MS_DRG 		Lung Transplant 2 $121,147.78 $239,381.21 $223,999.23 nat. median
$117,974
1.9× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 $209,226.61 $209,226.61 $209,226.61 nat. median
$123,836
1.7× median
5832
APR_DRG 		Neonate With Ecmo 2 $204,861.54 $204,861.54 $204,861.54 nat. median
$159,249
1.3× median
1614
APR_DRG 		Implantable Heart Assist Systems 2 $203,918.48 $203,918.48 $203,918.48 nat. median
$202,993
1.0× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 $195,997.12 $195,997.12 $195,997.12 nat. median
$154,011
1.3× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 2 $193,312.43 $193,312.43 $193,312.43 nat. median
$155,939
1.2× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 $102,152.62 $201,847.84 $188,877.66 nat. median
$104,013
1.8× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 2 $100,986.45 $199,543.57 $186,721.45 nat. median
$97,323
1.9× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 2 $98,719.94 $195,065.06 $182,530.72 nat. median
$95,038
1.9× median
215
MS_DRG 		Other Heart Assist System Implant 2 $98,213.80 $194,064.95 $181,594.87 nat. median
$93,901
1.9× median
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 $176,662.50 $176,662.50 $176,662.50 nat. median
$165,000
1.1× median
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $174,746.55 $174,746.55 $174,746.55 nat. median
$175,204
1.0× median
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 $173,438.36 $173,438.36 $173,438.36 nat. median
$133,164
1.3× median
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 2 $170,686.93 $170,686.93 $170,686.93 nat. median
$162,342
1.1× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 $89,465.70 $176,779.20 $165,419.85 nat. median
$90,551
1.8× median
74
APR_DRG 		Allogeneic Bone Marrow Transplant 2 $162,015.68 $162,015.68 $162,015.68 nat. median
$170,082
1.0× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 2 $161,203.76 $161,203.76 $161,203.76 nat. median
$163,587
1.0× median
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 2 $158,270.15 $158,270.15 $158,270.15 nat. median
$151,838
1.0× median
5882
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $153,336.58 $153,336.58 $153,336.58 nat. median
$145,061
1.1× median
5831
APR_DRG 		Neonate With Ecmo 2 $148,907.12 $148,907.12 $148,907.12 nat. median
$146,500
1.0× median
6034
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 $146,394.39 $146,394.39 $146,394.39 nat. median
$107,681
1.4× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 2 $78,553.05 $155,216.43 $145,242.65 nat. median
$77,028
1.9× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 2 $78,509.48 $155,130.34 $145,162.09 nat. median
$77,632
1.9× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 2 $97,106.96 $191,877.90 $144,492.43 nat. median
$93,276
1.5× median
14
APR_DRG 		Liver Transplant And/or Intestinal Transplant 2 $144,084.26 $144,084.26 $144,084.26 nat. median
$136,566
1.1× median
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 2 $143,096.45 $143,096.45 $143,096.45 nat. median
$122,016
1.2× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 2 $74,726.40 $147,655.17 $138,167.25 nat. median
$74,370
1.9× median
1613
APR_DRG 		Implantable Heart Assist Systems 2 $137,976.77 $137,976.77 $137,976.77 nat. median
$120,517
1.1× median
10
MS_DRG 		Pancreas Transplant 2 $73,909.71 $146,041.44 $136,657.22 nat. median
$64,933
outlier · 2.1×
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 2 $73,486.07 $145,204.35 $135,873.92 nat. median
$66,715
outlier · 2.0×
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization With Mcc 2 $72,458.03 $143,173.00 $133,973.10 nat. median
$71,748
1.9× median
23
APR_DRG 		Heart And/or Lung Transplant 2 $133,605.42 $133,605.42 $133,605.42 nat. median
$110,944
1.2× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 2 $71,726.63 $141,727.79 $132,620.75 nat. median
$72,398
1.8× median
5881
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $131,431.13 $131,431.13 $131,431.13 nat. median
$120,208
1.1× median
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 2 $69,193.13 $136,721.75 $127,936.39 nat. median
$67,976
1.9× median
850
MS_DRG 		Acute Leukemia With Other Procedures 2 $85,394.31 $168,734.37 $127,064.34 nat. median
$78,268
1.6× median
5913
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 2 $126,689.93 $126,689.93 $126,689.93 nat. median
$101,406
1.2× median
113
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 $122,020.98 $122,020.98 $122,020.98 nat. median
$67,735
1.8× median
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 2 $65,511.09 $129,446.24 $121,128.38 nat. median
$66,649
1.8× median

Other procedures at this hospital

Browse this hospital's 16,317 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J9029 HCPCS Instill Adstiladrin, Tx Dose 3 2 — — $63,235.61 $777,866.81 $670,711.67 2025-06-27
18 MS_DRG Chimeric Antigen Receptor (car) T-cell Immunotherapy 3 2 — — $349,597.66 $690,785.36 $646,397.39 2025-06-27
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 3 2 — — $261,120.14 $515,958.75 $482,804.66 2025-06-27
5834 APR_DRG Neonate With Ecmo 2 2 — — $411,851.82 $411,851.82 $411,851.82 2025-06-27
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 3 2 — — $219,910.36 $434,530.53 $406,608.79 2025-06-27
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 3 2 — — $198,670.93 $392,562.62 $367,337.62 2025-06-27
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $268,686.28 $268,686.28 $268,686.28 2025-06-27
5833 APR_DRG Neonate With Ecmo 2 2 — — $266,810.37 $266,810.37 $266,810.37 2025-06-27
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 3 2 — — $130,985.10 $258,819.21 $242,188.20 2025-06-27
24 APR_DRG Heart And/or Lung Transplant 2 2 — — $237,946.25 $237,946.25 $237,946.25 2025-06-27
14 MS_DRG Allogeneic Bone Marrow Transplant 3 2 — — $121,453.69 $239,985.67 $224,564.85 2025-06-27
7 MS_DRG Lung Transplant 3 2 — — $121,147.78 $239,381.21 $223,999.23 2025-06-27
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $209,226.61 $209,226.61 $209,226.61 2025-06-27
5832 APR_DRG Neonate With Ecmo 2 2 — — $204,861.54 $204,861.54 $204,861.54 2025-06-27
1614 APR_DRG Implantable Heart Assist Systems 2 2 — — $203,918.48 $203,918.48 $203,918.48 2025-06-27
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $195,997.12 $195,997.12 $195,997.12 2025-06-27
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $193,312.43 $193,312.43 $193,312.43 2025-06-27
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 3 2 — — $102,152.62 $201,847.84 $188,877.66 2025-06-27
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 3 2 — — $100,986.45 $199,543.57 $186,721.45 2025-06-27
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 3 2 — — $98,719.94 $195,065.06 $182,530.72 2025-06-27
215 MS_DRG Other Heart Assist System Implant 3 2 — — $98,213.80 $194,064.95 $181,594.87 2025-06-27
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $176,662.50 $176,662.50 $176,662.50 2025-06-27
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $174,746.55 $174,746.55 $174,746.55 2025-06-27
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $173,438.36 $173,438.36 $173,438.36 2025-06-27
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $170,686.93 $170,686.93 $170,686.93 2025-06-27
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 2 — — $89,465.70 $176,779.20 $165,419.85 2025-06-27
74 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $162,015.68 $162,015.68 $162,015.68 2025-06-27
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $161,203.76 $161,203.76 $161,203.76 2025-06-27
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $158,270.15 $158,270.15 $158,270.15 2025-06-27
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $153,336.58 $153,336.58 $153,336.58 2025-06-27
5831 APR_DRG Neonate With Ecmo 2 2 — — $148,907.12 $148,907.12 $148,907.12 2025-06-27
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $146,394.39 $146,394.39 $146,394.39 2025-06-27
231 MS_DRG Coronary Bypass With Ptca With Mcc 3 2 — — $78,553.05 $155,216.43 $145,242.65 2025-06-27
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 3 2 — — $78,509.48 $155,130.34 $145,162.09 2025-06-27
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 2 2 — — $97,106.96 $191,877.90 $144,492.43 2025-06-27
14 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $144,084.26 $144,084.26 $144,084.26 2025-06-27
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $143,096.45 $143,096.45 $143,096.45 2025-06-27
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 3 2 — — $74,726.40 $147,655.17 $138,167.25 2025-06-27
1613 APR_DRG Implantable Heart Assist Systems 2 2 — — $137,976.77 $137,976.77 $137,976.77 2025-06-27
10 MS_DRG Pancreas Transplant 3 2 — — $73,909.71 $146,041.44 $136,657.22 2025-06-27
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 3 2 — — $73,486.07 $145,204.35 $135,873.92 2025-06-27
233 MS_DRG Coronary Bypass With Cardiac Catheterization With Mcc 3 2 — — $72,458.03 $143,173.00 $133,973.10 2025-06-27
23 APR_DRG Heart And/or Lung Transplant 2 2 — — $133,605.42 $133,605.42 $133,605.42 2025-06-27
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 2 — — $71,726.63 $141,727.79 $132,620.75 2025-06-27
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $131,431.13 $131,431.13 $131,431.13 2025-06-27
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 3 2 — — $69,193.13 $136,721.75 $127,936.39 2025-06-27
850 MS_DRG Acute Leukemia With Other Procedures 2 2 — — $85,394.31 $168,734.37 $127,064.34 2025-06-27
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $126,689.93 $126,689.93 $126,689.93 2025-06-27
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $122,020.98 $122,020.98 $122,020.98 2025-06-27
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 3 2 — — $65,511.09 $129,446.24 $121,128.38 2025-06-27
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 3 2 — — $64,486.76 $127,422.21 $119,234.41 2025-06-27
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $118,972.73 $118,972.73 $118,972.73 2025-06-27
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $117,527.92 $117,527.92 $117,527.92 2025-06-27
955 MS_DRG Craniotomy For Multiple Significant Trauma 3 2 — — $63,298.34 $125,073.97 $117,037.06 2025-06-27
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 2 2 — — $77,317.36 $152,774.77 $115,046.07 2025-06-27
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 3 2 — — $61,913.40 $122,337.41 $114,476.35 2025-06-27
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 3 2 — — $61,808.65 $122,130.43 $114,282.66 2025-06-27
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 3 2 — — $59,950.94 $118,459.70 $110,847.81 2025-06-27
1612 APR_DRG Implantable Heart Assist Systems 2 2 — — $110,756.13 $110,756.13 $110,756.13 2025-06-27
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 2 — — $59,864.73 $118,289.35 $110,688.41 2025-06-27
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $109,765.96 $109,765.96 $109,765.96 2025-06-27
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 3 2 — — $58,626.26 $115,842.20 $108,398.50 2025-06-27
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 3 2 — — $57,422.09 $113,462.82 $106,172.02 2025-06-27
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 3 2 — — $57,086.51 $112,799.75 $105,551.55 2025-06-27
1611 APR_DRG Implantable Heart Assist Systems 2 2 — — $105,524.17 $105,524.17 $105,524.17 2025-06-27
461 MS_DRG Bilateral Or Multiple Major Joint Procs Of Lower Extremity W Mcc 3 2 — — $56,887.21 $112,405.93 $105,183.04 2025-06-27
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 2 2 — — $104,959.59 $104,959.59 $104,959.59 2025-06-27
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $104,771.13 $104,771.13 $104,771.13 2025-06-27
232 MS_DRG Coronary Bypass With Ptca Without Mcc 3 2 — — $56,627.65 $111,893.06 $104,703.12 2025-06-27
28 MS_DRG Spinal Procedures With Mcc 3 2 — — $56,356.97 $111,358.20 $104,202.63 2025-06-27
64 APR_DRG Pancreas Transplant 2 2 — — $103,649.83 $103,649.83 $103,649.83 2025-06-27
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 3 2 — — $55,952.79 $110,559.58 $103,455.33 2025-06-27
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 3 2 — — $55,952.79 $110,559.58 $103,455.33 2025-06-27
266 MS_DRG Endovascular Cardiac Valve Replacement W Mcc 3 2 — — $55,534.72 $109,733.48 $102,682.31 2025-06-27
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 2 — — $55,150.01 $108,973.33 $101,971.00 2025-06-27
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 3 2 — — $55,108.30 $108,890.90 $101,893.87 2025-06-27
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 2 2 — — $101,863.44 $101,863.44 $101,863.44 2025-06-27
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 3 2 — — $54,546.53 $107,780.89 $100,855.19 2025-06-27
8514 APR_DRG Gender Related Procedures 2 2 — — $100,501.08 $100,501.08 $100,501.08 2025-06-27
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 3 2 — — $53,972.72 $106,647.07 $99,794.22 2025-06-27
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 2 2 — — $99,693.08 $99,693.08 $99,693.08 2025-06-27
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 2 2 — — $99,002.08 $99,002.08 $99,002.08 2025-06-27
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 3 2 — — $53,204.24 $105,128.59 $98,373.32 2025-06-27
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 2 2 — — $65,842.03 $130,100.16 $97,971.10 2025-06-27
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 3 2 — — $52,886.28 $104,500.32 $97,785.41 2025-06-27
22 APR_DRG Heart And/or Lung Transplant 2 2 — — $97,231.39 $97,231.39 $97,231.39 2025-06-27
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $96,071.62 $96,071.62 $96,071.62 2025-06-27
653 MS_DRG Major Bladder Procedures With Mcc 3 2 — — $51,676.54 $102,109.95 $95,548.64 2025-06-27
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 3 2 — — $51,238.07 $101,243.55 $94,737.92 2025-06-27
834 MS_DRG Acute Leukemia Without Major O.r. Procedures With Mcc 3 2 — — $51,238.07 $101,243.55 $94,737.92 2025-06-27
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $93,588.73 $93,588.73 $93,588.73 2025-06-27
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $93,338.24 $93,338.24 $93,338.24 2025-06-27
8 MS_DRG Simultaneous Pancreas/kidney Transplant 3 2 — — $50,439.00 $99,664.63 $93,260.45 2025-06-27
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 3 2 — — $50,324.05 $99,437.50 $93,047.92 2025-06-27
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 3 2 — — $50,067.27 $98,930.12 $92,573.14 2025-06-27
Q2053 HCPCS Brexucabtagene Car Pos T 6 5 — — $16,507.81 $4,747,210.00 $92,543.15 2025-06-27
11 MS_DRG Tracheostomy For Face,mouth & Neck Diagnoses W Mcc 3 2 — — $50,019.99 $98,836.70 $92,485.73 2025-06-27
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 2 2 — — $62,152.57 $122,809.99 $92,481.28 2025-06-27
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 3 2 — — $50,014.43 $98,825.71 $92,475.44 2025-06-27
234 MS_DRG Coronary Bypass With Cardiac Catheterization Without Mcc 3 2 — — $49,318.25 $97,450.10 $91,188.23 2025-06-27
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 2 — — $49,100.41 $97,019.65 $90,785.44 2025-06-27
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $90,070.92 $90,070.92 $90,070.92 2025-06-27
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $89,903.67 $89,903.67 $89,903.67 2025-06-27
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $89,730.92 $89,730.92 $89,730.92 2025-06-27
21 APR_DRG Heart And/or Lung Transplant 2 2 — — $89,418.40 $89,418.40 $89,418.40 2025-06-27
Q2055 HCPCS Idecabtagene Vicleucel Car 5 4 — — $16,507.81 $527,622.46 $88,219.97 2025-06-27
Q2056 HCPCS Ciltacabtagene Car-pos T 5 4 — — $16,507.81 $553,169.30 $88,219.97 2025-06-27
Q2054 HCPCS Lisocabtagene Mara Car Pos T 5 4 — — $16,507.81 $516,442.29 $88,219.97 2025-06-27
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 5 4 — — $16,507.81 $502,840.73 $88,219.97 2025-06-27
Q2042 HCPCS Tisagenlecleucel Car-pos T 5 4 — — $16,507.81 $578,771.12 $88,219.97 2025-06-27
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 3 2 — — $47,582.91 $94,021.16 $87,979.62 2025-06-27
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 3 2 — — $47,226.94 $93,317.79 $87,321.44 2025-06-27
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 3 2 — — $47,082.33 $93,032.04 $87,054.06 2025-06-27
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 3 2 — — $46,692.06 $92,260.90 $86,332.47 2025-06-27
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 3 2 — — $46,416.74 $91,716.88 $85,823.41 2025-06-27
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 3 2 — — $46,380.59 $91,645.45 $85,756.56 2025-06-27
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 3 2 — — $46,362.05 $91,608.81 $85,722.28 2025-06-27
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $85,449.08 $85,449.08 $85,449.08 2025-06-27
228 MS_DRG Other Cardiothoracic Procedures With Mcc 3 2 — — $46,195.19 $91,279.11 $85,413.76 2025-06-27
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 2 2 — — $57,347.93 $113,316.29 $85,332.11 2025-06-27
245 MS_DRG Aicd Generator Procedures 3 2 — — $45,300.64 $89,511.52 $83,759.75 2025-06-27
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $83,366.66 $83,366.66 $83,366.66 2025-06-27
471 MS_DRG Cervical Spinal Fusion With Mcc 3 2 — — $45,027.17 $88,971.16 $83,254.12 2025-06-27
6 MS_DRG Liver Transplant Without Mcc 3 2 — — $44,952.08 $88,822.80 $83,115.29 2025-06-27
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 3 2 — — $44,268.89 $87,472.83 $81,852.07 2025-06-27
799 MS_DRG Splenic Procedures With Mcc 3 2 — — $44,077.00 $87,093.67 $81,497.27 2025-06-27
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 3 2 — — $44,068.65 $87,077.19 $81,481.85 2025-06-27
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $81,220.64 $81,220.64 $81,220.64 2025-06-27
267 MS_DRG Endovascular Cardiac Valve Replacement Without Mcc 3 2 — — $43,612.57 $86,175.99 $80,638.56 2025-06-27
84 APR_DRG Autologous Bone Marrow Transplant 2 2 — — $80,301.92 $80,301.92 $80,301.92 2025-06-27
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 3 2 — — $43,378.97 $85,714.40 $80,206.63 2025-06-27
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 3 2 — — $43,123.11 $85,208.85 $79,733.57 2025-06-27
73 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $79,182.98 $79,182.98 $79,182.98 2025-06-27
163 MS_DRG Major Chest Procedures With Mcc 3 2 — — $42,727.28 $84,426.72 $79,001.69 2025-06-27
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 3 2 — — $42,709.67 $84,391.91 $78,969.12 2025-06-27
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 2 — — $42,573.40 $84,122.65 $78,717.16 2025-06-27
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 3 2 — — $42,566.91 $84,109.83 $78,705.17 2025-06-27
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 3 2 — — $41,822.53 $82,638.98 $77,328.82 2025-06-27
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 3 2 — — $41,573.17 $82,146.25 $76,867.76 2025-06-27
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 3 2 — — $41,458.22 $81,919.12 $76,655.22 2025-06-27
901 MS_DRG Wound Debridements For Injuries With Mcc 3 2 — — $41,070.74 $81,153.47 $75,938.77 2025-06-27
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 2 2 — — $51,023.01 $100,818.60 $75,920.81 2025-06-27
4404 APR_DRG Kidney Transplant 2 2 — — $75,902.30 $75,902.30 $75,902.30 2025-06-27
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 2 2 — — $50,711.54 $100,203.15 $75,457.35 2025-06-27
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 3 2 — — $40,721.26 $80,462.92 $75,292.59 2025-06-27
8634 APR_DRG Neonatal Aftercare 2 2 — — $75,015.78 $75,015.78 $75,015.78 2025-06-27
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 3 2 — — $40,110.36 $79,255.83 $74,163.07 2025-06-27
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 3 2 — — $40,027.86 $79,092.81 $74,010.52 2025-06-27
63 APR_DRG Pancreas Transplant 2 2 — — $73,634.57 $73,634.57 $73,634.57 2025-06-27
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 2 2 — — $73,344.03 $73,344.03 $73,344.03 2025-06-27
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 3 2 — — $39,543.04 $78,134.83 $73,114.10 2025-06-27
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 3 2 — — $39,484.64 $78,019.43 $73,006.12 2025-06-27
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 2 2 — — $73,000.89 $73,000.89 $73,000.89 2025-06-27
140 MS_DRG Major Head And Neck Procedures With Mcc 3 2 — — $39,204.68 $77,466.26 $72,488.49 2025-06-27
31 MS_DRG Ventricular Shunt Procedures With Mcc 3 2 — — $38,846.86 $76,759.22 $71,826.88 2025-06-27
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 3 2 — — $38,837.59 $76,740.90 $71,809.74 2025-06-27
793 MS_DRG Full Term Neonate With Major Problems 3 2 — — $38,660.54 $76,391.05 $71,482.37 2025-06-27
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 3 2 — — $38,569.69 $76,211.54 $71,314.40 2025-06-27
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 2 2 — — $47,741.43 $94,334.38 $71,037.90 2025-06-27
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 3 2 — — $38,119.17 $75,321.34 $70,481.39 2025-06-27
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 3 2 — — $38,097.85 $75,279.21 $70,441.97 2025-06-27
12 MS_DRG Tracheostomy For Face,mouth & Neck Diagnoses W Cc 3 2 — — $38,041.30 $75,167.47 $70,337.42 2025-06-27
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 3 2 — — $37,704.80 $74,502.57 $69,715.24 2025-06-27
791 MS_DRG Prematurity With Major Problems 3 2 — — $37,635.27 $74,365.19 $69,586.69 2025-06-27
Q0224 HCPCS Inj, Pemivibart, 4500 Mg 3 2 — — $6,583.50 $80,647.88 $69,538.24 2025-06-27
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $69,473.66 $69,473.66 $69,473.66 2025-06-27
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 3 2 — — $36,928.90 $72,969.43 $68,280.62 2025-06-27
739 MS_DRG Uterine,adnexa Proc For Non-ovarian/adnexal Malig W Mcc 3 2 — — $36,902.94 $72,918.15 $68,232.63 2025-06-27
1674 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 2 2 — — $68,116.00 $68,116.00 $68,116.00 2025-06-27
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $67,655.86 $67,655.86 $67,655.86 2025-06-27
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 3 2 — — $36,576.64 $72,273.39 $67,629.30 2025-06-27
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 3 2 — — $36,501.55 $72,125.02 $67,490.46 2025-06-27
13 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $67,403.01 $67,403.01 $67,403.01 2025-06-27
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 3 2 — — $36,427.39 $71,978.48 $67,353.34 2025-06-27
273 MS_DRG Percutaneous Intracardiac Procedures W Mcc 3 2 — — $36,248.48 $71,624.97 $67,022.54 2025-06-27
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $66,668.83 $66,668.83 $66,668.83 2025-06-27
34 MS_DRG Carotid Artery Stent Procedures With Mcc 3 2 — — $36,048.25 $71,229.32 $66,652.32 2025-06-27
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 3 2 — — $35,828.55 $70,795.21 $66,246.10 2025-06-27
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 3 2 — — $35,792.40 $70,723.77 $66,179.25 2025-06-27
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 3 2 — — $35,692.28 $70,525.95 $65,994.14 2025-06-27
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $65,962.12 $65,962.12 $65,962.12 2025-06-27
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 3 2 — — $35,433.65 $70,014.90 $65,515.94 2025-06-27
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 3 2 — — $35,241.76 $69,635.74 $65,161.14 2025-06-27
1784 APR_DRG External Heart Assist Systems 2 2 — — $64,835.33 $64,835.33 $64,835.33 2025-06-27
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $64,664.15 $64,664.15 $64,664.15 2025-06-27
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 3 2 — — $34,967.37 $69,093.56 $64,653.79 2025-06-27
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $64,474.91 $64,474.91 $64,474.91 2025-06-27
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $64,337.49 $64,337.49 $64,337.49 2025-06-27
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 3 2 — — $34,688.34 $68,542.21 $64,137.88 2025-06-27
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 2 2 — — $63,749.36 $63,749.36 $63,749.36 2025-06-27
72 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $63,495.73 $63,495.73 $63,495.73 2025-06-27
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $63,184.00 $63,184.00 $63,184.00 2025-06-27
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 3 2 — — $33,823.45 $66,833.24 $62,538.72 2025-06-27
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $62,350.87 $62,350.87 $62,350.87 2025-06-27
335 MS_DRG Peritoneal Adhesiolysis With Mcc 3 2 — — $33,588.92 $66,369.82 $62,105.08 2025-06-27
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $61,864.03 $61,864.03 $61,864.03 2025-06-27
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 2 2 — — $61,797.29 $61,797.29 $61,797.29 2025-06-27
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 2 2 — — $61,744.68 $61,744.68 $61,744.68 2025-06-27
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 3 2 — — $33,231.10 $65,662.78 $61,443.47 2025-06-27
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 3 2 — — $33,229.24 $65,659.12 $61,440.04 2025-06-27
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 3 2 — — $33,223.68 $65,648.13 $61,429.76 2025-06-27
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 2 2 — — $61,174.60 $61,174.60 $61,174.60 2025-06-27
265 MS_DRG Aicd Lead Procedures 3 2 — — $33,067.94 $65,340.40 $61,141.81 2025-06-27
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 3 2 — — $32,919.62 $65,047.33 $60,867.57 2025-06-27
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 3 2 — — $32,726.81 $64,666.34 $60,511.06 2025-06-27
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 3 2 — — $32,718.47 $64,649.85 $60,495.63 2025-06-27
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 3 2 — — $32,635.96 $64,486.83 $60,343.08 2025-06-27
71 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $60,321.06 $60,321.06 $60,321.06 2025-06-27
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 3 2 — — $32,480.23 $64,179.10 $60,055.13 2025-06-27
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 3 2 — — $32,470.03 $64,158.96 $60,036.28 2025-06-27
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 3 2 — — $32,457.05 $64,133.31 $60,012.28 2025-06-27
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 2 2 — — $59,911.17 $59,911.17 $59,911.17 2025-06-27
264 MS_DRG Other Circulatory System O.r. Procedures 3 2 — — $32,399.58 $64,019.75 $59,906.01 2025-06-27
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 3 2 — — $32,190.08 $63,605.78 $59,518.65 2025-06-27
332 MS_DRG Rectal Resection With Mcc 3 2 — — $32,154.85 $63,536.18 $59,453.52 2025-06-27
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 3 2 — — $32,119.62 $63,466.57 $59,388.39 2025-06-27
271 MS_DRG Other Major Cardiovascular Procedures With Cc 3 2 — — $31,929.59 $63,091.07 $59,037.02 2025-06-27
62 APR_DRG Pancreas Transplant 2 2 — — $58,958.69 $58,958.69 $58,958.69 2025-06-27
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 3 2 — — $31,879.53 $62,992.16 $58,944.46 2025-06-27
665 MS_DRG Prostatectomy With Mcc 3 2 — — $31,829.47 $62,893.25 $58,851.90 2025-06-27
252 MS_DRG Other Vascular Procedures With Mcc 3 2 — — $31,799.81 $62,834.64 $58,797.06 2025-06-27
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 3 2 — — $31,751.60 $62,739.39 $58,707.93 2025-06-27
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 3 2 — — $31,575.47 $62,391.37 $58,382.27 2025-06-27
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $58,230.79 $58,230.79 $58,230.79 2025-06-27
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 3 2 — — $31,443.84 $62,131.26 $58,138.88 2025-06-27
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $57,751.02 $57,751.02 $57,751.02 2025-06-27
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 3 2 — — $31,116.61 $61,484.67 $57,533.84 2025-06-27
9104 APR_DRG Craniotomy For Multiple Significant Trauma 2 2 — — $57,195.08 $57,195.08 $57,195.08 2025-06-27
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 7 5 — — $10,330.37 $680,031.56 $57,017.10 2025-06-27
37 MS_DRG Extracranial Procedures With Mcc 3 2 — — $30,784.74 $60,828.93 $56,920.23 2025-06-27
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 2 2 — — $56,907.68 $56,907.68 $56,907.68 2025-06-27
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 3 2 — — $30,608.61 $60,480.90 $56,594.57 2025-06-27
1834 APR_DRG Percutaneous Structural Cardiac Procedures 2 2 — — $56,502.51 $56,502.51 $56,502.51 2025-06-27
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 2 2 — — $37,854.05 $74,797.47 $56,325.76 2025-06-27
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 2 2 — — $56,261.44 $56,261.44 $56,261.44 2025-06-27
3124 APR_DRG Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 2 2 — — $56,105.97 $56,105.97 $56,105.97 2025-06-27
7404 APR_DRG Mental Illness Diagnosis With O.r. Procedure 2 2 — — $56,031.37 $56,031.37 $56,031.37 2025-06-27
469 MS_DRG Major Joint Replacement Or Reattachment Of Lower Extremity W Mcc 3 2 — — $30,300.85 $59,872.78 $56,025.52 2025-06-27
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 3 2 — — $30,214.64 $59,702.43 $55,866.12 2025-06-27
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 3 2 — — $30,201.66 $59,676.79 $55,842.12 2025-06-27
6904 APR_DRG Acute Leukemia 2 2 — — $55,732.99 $55,732.99 $55,732.99 2025-06-27
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $55,370.21 $55,370.21 $55,370.21 2025-06-27
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 2 2 — — $55,330.95 $55,330.95 $55,330.95 2025-06-27
J9226 HCPCS Supprelin La Implant 7 5 — — $10,330.37 $540,938.58 $55,206.91 2025-06-27
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 3 2 — — $29,842.91 $58,967.92 $55,178.80 2025-06-27
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 3 2 — — $29,704.79 $58,694.99 $54,923.42 2025-06-27
0391U OTHER Onc Sld Tum Dna&rna 437 Gen 2 1 — — $51,984.00 $57,600.00 $54,792.00 2025-06-27
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 3 2 — — $29,618.58 $58,524.65 $54,764.01 2025-06-27
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 3 2 — — $29,562.03 $58,412.91 $54,659.46 2025-06-27
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc 3 2 — — $29,482.31 $58,255.39 $54,512.06 2025-06-27
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 3 2 — — $29,422.98 $58,138.16 $54,402.36 2025-06-27
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 2 2 — — $54,360.41 $54,360.41 $54,360.41 2025-06-27
500 MS_DRG Soft Tissue Procedures With Mcc 3 2 — — $29,373.85 $58,041.08 $54,311.52 2025-06-27
914 APR_DRG Other Major Head And Neck Procedures 2 2 — — $54,197.87 $54,197.87 $54,197.87 2025-06-27
12 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $54,146.83 $54,146.83 $54,146.83 2025-06-27
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 2 2 — — $36,266.09 $71,659.77 $53,962.93 2025-06-27
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 2 2 — — $53,639.57 $53,639.57 $53,639.57 2025-06-27
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $53,556.34 $53,556.34 $53,556.34 2025-06-27
274 MS_DRG Percutaneous Intracardiac Procedures Without Mcc 3 2 — — $28,931.67 $57,167.36 $53,493.94 2025-06-27
662 MS_DRG Minor Bladder Procedures With Mcc 3 2 — — $28,918.69 $57,141.71 $53,469.94 2025-06-27
214 APR_DRG Open Craniotomy Except Trauma 2 2 — — $53,312.92 $53,312.92 $53,312.92 2025-06-27
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 3 2 — — $28,795.40 $56,898.10 $53,241.98 2025-06-27
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 3 2 — — $28,666.55 $56,643.49 $53,003.74 2025-06-27
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 3 2 — — $28,586.83 $56,485.96 $52,856.33 2025-06-27
652 MS_DRG Kidney Transplant 3 2 — — $28,471.88 $56,258.83 $52,643.80 2025-06-27
7594 APR_DRG Eating Disorders 2 2 — — $52,614.85 $52,614.85 $52,614.85 2025-06-27
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 3 2 — — $28,445.92 $56,207.55 $52,595.80 2025-06-27
1794 APR_DRG Defibrillator Implants 2 2 — — $52,544.18 $52,544.18 $52,544.18 2025-06-27
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 2 2 — — $52,526.91 $52,526.91 $52,526.91 2025-06-27
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 3 2 — — $28,353.22 $56,024.38 $52,424.40 2025-06-27
C9073 HCPCS Brexucabtagene Autoleucel Ca 4 3 — — $16,507.81 $96,866.34 $52,363.89 2025-06-27
C9076 HCPCS Lisocabtagene Car Pos T 4 3 — — $16,507.81 $96,866.34 $52,363.89 2025-06-27
C9081 HCPCS Idecabtagene Car Pos T 4 3 — — $16,507.81 $96,866.34 $52,363.89 2025-06-27
C9098 HCPCS Ciltacabtagene Car Pos T 4 3 — — $16,507.81 $96,866.34 $52,363.89 2025-06-27
Q2040 HCPCS Tisagenlecleucel Car-pos T 4 3 — — $16,507.81 $96,866.34 $52,363.89 2025-06-27
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $52,079.33 $52,079.33 $52,079.33 2025-06-27
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $51,886.95 $51,886.95 $51,886.95 2025-06-27
570 MS_DRG Skin Debridement With Mcc 3 2 — — $27,904.55 $55,137.83 $51,594.83 2025-06-27
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 2 2 — — $51,388.33 $51,388.33 $51,388.33 2025-06-27
974 MS_DRG HIV With Major Related Condition With Mcc 3 2 — — $27,682.07 $54,698.23 $51,183.47 2025-06-27
1204 APR_DRG Major Respiratory And Chest Procedures 2 2 — — $51,144.13 $51,144.13 $51,144.13 2025-06-27
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 2 2 — — $50,733.45 $50,733.45 $50,733.45 2025-06-27
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 3 2 — — $27,333.52 $54,009.51 $50,539.00 2025-06-27
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 3 2 — — $27,263.07 $53,870.30 $50,408.74 2025-06-27
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 3 2 — — $27,188.91 $53,723.76 $50,271.62 2025-06-27
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 2 2 — — $50,161.81 $50,161.81 $50,161.81 2025-06-27
668 MS_DRG Transurethral Procedures With Mcc 3 2 — — $27,034.10 $53,417.87 $49,985.38 2025-06-27
274 APR_DRG Other Open Craniotomy 2 2 — — $49,973.35 $49,973.35 $49,973.35 2025-06-27
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 3 2 — — $27,019.27 $53,388.56 $49,957.96 2025-06-27
800 MS_DRG Splenic Procedures With Cc 3 2 — — $27,010.93 $53,372.07 $49,942.53 2025-06-27
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 3 2 — — $26,996.09 $53,342.77 $49,915.11 2025-06-27
472 MS_DRG Cervical Spinal Fusion With Cc 3 2 — — $26,857.04 $53,068.01 $49,658.01 2025-06-27
2324 APR_DRG Gastric Fundoplication 2 2 — — $49,634.14 $49,634.14 $49,634.14 2025-06-27
6954 APR_DRG Chemotherapy For Acute Leukemia 2 2 — — $49,389.93 $49,389.93 $49,389.93 2025-06-27
C9031 HCPCS Lutetium Lu 177 Dotatate, Tx 4 3 — — $15,552.92 $91,263.13 $49,334.92 2025-06-27
A9543 HCPCS Y90 Ibritumomab, Rx 4 3 — — $15,552.92 $91,263.13 $49,334.92 2025-06-27
A9513 HCPCS Lutetium Lu 177 Dotatat Ther 4 3 — — $15,552.92 $91,263.13 $49,334.92 2025-06-27
A9607 HCPCS Lutetium Lu 177 Vipivotide 4 3 — — $15,552.92 $91,263.13 $49,334.92 2025-06-27
J2350 HCPCS Ocrevus 30 Mg/ml IV Soln 32 16 $94,678.90 $53,493.58 43% off $57.81 $91,838.53 $49,233.03 2025-06-27
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 3 2 — — $26,578.02 $52,516.67 $49,142.09 2025-06-27
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