Price Transparency Hospital negotiated rates

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

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Hospital

Bob Wilson Memorial Hospital

Ulysses, KS · CCN 170110 · Rates published

12,733 distinct procedures filed
9 distinct payers
227,706 rate rows
2024-12-02 last MRF observed · ⚠ 18 mo old
Data quality

227,456 of 227,706 rate rows are consumer-grade (99.9%)

250 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
per-diem day rate — not a per-procedure price 236
exceeds 10× this hospital's gross charge — excluded from medians 10
placeholder amount (≤ $0.02) — excluded from medians 4

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 18 months old.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://sthpiprd.blob.core.windows.net/machine-readable-files/8265/480543721_commonspirit-health-bob-wilson_standardcharges.csv
Found on page https://www.mountain.commonspirit.org/price-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-18
Content fingerprint c02b65b6ec9bc6c7… · 129,374,559 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
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 1 $3,519,387.81 $3,519,387.81 $3,519,387.81 nat. median
$2,469,189
1.4× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $660,816.82 $660,816.82 $660,816.82 nat. median
$634,511
1.0× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 1 $660,816.82 $660,816.82 $660,816.82 nat. median
$674,188
1.0× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 1 $660,816.82 $660,816.82 $660,816.82 nat. median
$675,122
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 1 $660,816.82 $660,816.82 $660,816.82 nat. median
$625,184
1.1× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 1 $660,816.82 $660,816.82 $660,816.82 nat. median
$620,080
1.1× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 5 $366,527.69 $585,042.32 $366,527.69 nat. median
$370,174
1.0× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 5 $269,589.02 $416,543.90 $269,589.02 nat. median
$265,286
1.0× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 5 $141,117.02 $262,228.16 $262,228.16 nat. median
$206,368
1.3× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 5 $197,826.03 $212,103.89 $212,103.89 nat. median
$202,986
1.0× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And… 5 $123,450.36 $146,242.19 $146,242.19 nat. median
$133,176
1.1× median
7
MS_DRG 		Lung Transplant 5 $118,527.08 $122,031.65 $122,031.65 nat. median
$122,708
1.0× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 5 $121,809.79 $248,300.81 $121,809.79 nat. median
$108,660
1.1× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 5 $114,018.18 $178,917.56 $114,018.18 nat. median
$117,303
1.0× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 4 $107,151.76 $107,151.76 $107,151.76 nat. median
$102,358
1.0× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 5 $102,966.44 $157,882.18 $102,966.44 nat. median
$100,136
1.0× median
215
MS_DRG 		Other Heart Assist System Implant 5 $101,621.41 $123,765.84 $101,621.41 nat. median
$99,019
1.0× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 5 $96,552.67 $103,950.95 $96,552.67 nat. median
$93,672
1.0× median
90288
CPT 		Botulism Ig IV 1 $95,776.06 $95,776.06 $95,776.06 nat. median
$55,037
1.7× median
222
MS_DRG 		DRG 1 $94,922.12 $94,922.12 $94,922.12 nat. median
$63,570
1.5× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 1 $92,442.86 $92,442.86 $92,442.86 nat. median
$66,682
1.4× median
453
MS_DRG 		DRG 5 $88,157.17 $95,136.24 $88,157.17 nat. median
$87,411
1.0× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 5 $84,088.26 $85,689.89 $84,088.26 nat. median
$77,576
1.1× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 5 $83,859.45 $89,047.85 $83,859.45 nat. median
$81,118
1.0× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 5 $80,733.65 $86,097.64 $80,733.65 nat. median
$79,312
1.0× median
224
MS_DRG 		DRG 1 $79,590.58 $79,590.58 $79,590.58 nat. median
$54,196
1.5× median
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 5 $79,522.92 $100,028.67 $79,522.92 nat. median
$71,240
1.1× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 5 $77,593.92 $83,918.99 $77,593.92 nat. median
$73,807
1.1× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 5 $76,714.48 $83,431.62 $76,714.48 nat. median
$74,915
1.0× median
223
MS_DRG 		DRG 1 $75,468.73 $75,468.73 $75,468.73 nat. median
$44,728
1.7× median
J9226
HCPCS 		Supprelin La Implant 1 $74,705.93 $74,705.93 $74,705.93 nat. median
$60,368
1.2× median
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 5 $71,952.15 $72,417.08 $71,952.15 nat. median
$72,138
1.0× median
226
MS_DRG 		DRG 1 $71,684.45 $71,684.45 $71,684.45 nat. median
$49,935
1.4× median
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 4 $69,995.30 $69,995.30 $69,995.30 nat. median
$68,887
1.0× median
J9269
HCPCS 		Tagraxofusp-erzs 1,000 Mcg/ml Intravenous Solution 9 $547.96 $101,702.72 $69,785.38 nat. median
$509
outlier · 137.0×
870
MS_DRG 		Septicemia Or Severe Sepsis With Mv >96 Hours 5 $66,672.00 $69,289.95 $69,289.95 nat. median
$66,526
1.0× median
928
MS_DRG 		Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 5 $48,842.21 $68,840.27 $68,840.27 nat. median
$64,027
1.1× median
207
MS_DRG 		Respiratory System Diagnosis With Ventilator Support >96 Hours 5 $68,723.88 $72,395.83 $68,723.88 nat. median
$62,134
1.1× median
969
MS_DRG 		HIV With Extensive O.r. Procedures With Mcc 5 $66,507.40 $68,371.70 $68,371.70 nat. median
$60,185
1.1× median
268
MS_DRG 		Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 5 $68,193.63 $72,100.81 $68,193.63 nat. median
$65,950
1.0× median
461
MS_DRG 		Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 5 $62,972.36 $67,833.50 $67,833.50 nat. median
$55,736
1.2× median
459
MS_DRG 		DRG 5 $65,981.10 $69,721.37 $65,981.10 nat. median
$65,381
1.0× median
J2507
HCPCS 		Pegloticase 8 Mg/ml Intravenous Solution 9 $5,720.08 $94,197.96 $64,635.83 nat. median
$8,558
outlier · 7.6×
217
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 5 $63,324.87 $67,132.77 $63,324.87 nat. median
$64,510
1.0× median
J3357
HCPCS 		Ustekinumab 90 Mg/ml Subcutaneous Syringe 9 $265.43 $91,602.98 $62,855.24 nat. median
$14,306
outlier · 4.4×
225
MS_DRG 		DRG 1 $62,436.40 $62,436.40 $62,436.40 nat. median
$48,649
1.3× median
266
MS_DRG 		Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 5 $62,139.00 $73,478.36 $62,139.00 nat. median
$60,726
1.0× median
573
MS_DRG 		Skin Graft For Skin Ulcer Or Cellulitis With Mcc 5 $33,645.06 $61,860.45 $61,860.45 nat. median
$59,793
1.0× median
276
MS_DRG 		Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 4 $61,781.85 $61,781.85 $61,781.85 nat. median
$59,099
1.0× median
A9543
HCPCS 		Y-90 Zevalin 9 $24,783.65 $66,561.81 $61,605.08 nat. median
$62,507
1.0× median

Other procedures at this hospital

Browse this hospital's 12,733 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
             
J2327 HCPCS Risankizumab-rzaa 60 Mg/ml Intravenous Solution 24 9 $34,320.72 $13,728.29 60% off $27.06 $32,261.48 $22,136.87 2024-12-02
J9119 HCPCS Cemiplimab-rwlc 50 Mg/ml Intravenous Solution 24 9 $34,992.60 $13,997.04 60% off $46.63 $32,893.04 $22,570.22 2024-12-02
J0896 HCPCS Luspatercept-aamt 75 Mg Subcutaneous Solution 36 9 $40,696.85 $16,278.74 60% off $65.88 $38,255.04 $26,249.47 2024-12-02
J9144 HCPCS Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln 24 9 $33,925.77 $13,570.31 60% off $82.56 $31,890.22 $21,882.12 2024-12-02
J1930 HCPCS Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe 72 9 $29,512.00 $11,804.80 60% off $98.33 $31,458.98 $22,408.89 2024-12-02
J2350 HCPCS Ocrelizumab 30 Mg/ml Intravenous Solution 24 9 $69,000.33 $27,600.13 60% off $100.98 $64,860.31 $44,505.21 2024-12-02
J9022 HCPCS Atezolizumab 1,200 Mg/20 Ml (60 Mg/ml) Intravenous Solution 24 9 $37,120.72 $14,848.29 60% off $138.82 $34,893.48 $23,942.87 2024-12-02
J3245 HCPCS Tildrakizumab-asmn 100 Mg/ml Subcutaneous Syringe 24 9 $60,331.15 $24,132.46 60% off $239.38 $56,711.28 $38,913.59 2024-12-02
J3357 HCPCS Ustekinumab 90 Mg/ml Subcutaneous Syringe 24 9 $97,449.98 $38,979.99 60% off $265.43 $91,602.98 $62,855.24 2024-12-02
J9228 HCPCS Ipilimumab 50 Mg/10 Ml (5 Mg/ml) Intravenous Solution 36 9 $29,863.72 $11,945.49 60% off $283.88 $112,287.31 $26,145.69 2024-12-02
A9604 HCPCS Samarium-153 Lexidronam 26 9 $34,492.50 $13,797.00 60% off $299.41 $32,422.95 $30,008.47 2024-12-02
J9298 HCPCS Nivolumab 240 Mg-relatlimab-rmbw 80 Mg/20 Ml Intravenous Solution 24 9 $50,863.68 $20,345.47 60% off $310.47 $47,811.86 $32,807.07 2024-12-02
J9043 HCPCS Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution 24 9 $37,845.70 $15,138.28 60% off $341.78 $35,574.96 $24,410.48 2024-12-02
J9042 HCPCS Brentuximab Vedotin 50 Mg Intravenous Solution 24 9 $39,557.00 $15,822.80 60% off $366.13 $37,183.58 $25,514.26 2024-12-02
J9203 HCPCS Gemtuzumab Ozogamicin 4.5 Mg (1 Mg/ml Initial Concentration) IV Soln 24 9 $34,126.09 $13,650.44 60% off $372.35 $32,078.52 $22,011.33 2024-12-02
J9281 HCPCS Mitomycin 40 Mg X 2 Intra-pyelocalyceal Kit 24 9 $82,845.00 $33,138.00 60% off $497.14 $77,874.30 $53,435.03 2024-12-02
J9269 HCPCS Tagraxofusp-erzs 1,000 Mcg/ml Intravenous Solution 24 9 $108,194.38 $43,277.75 60% off $547.96 $101,702.72 $69,785.38 2024-12-02
J3241 HCPCS Teprotumumab-trbw 500 Mg Intravenous Solution 24 9 $55,721.05 $22,288.42 60% off $561.70 $52,377.79 $35,940.08 2024-12-02
J7311 HCPCS Fluocinolone 0.59 Mg Intravitreal Implant 24 9 $66,587.50 $26,635.00 60% off $575.42 $62,592.25 $42,948.94 2024-12-02
J9307 HCPCS Pralatrexate 40 Mg/2 Ml (20 Mg/ml) Intravenous Solution 36 9 $47,512.64 $19,005.06 60% off $581.09 $44,661.88 $30,645.65 2024-12-02
0620T CPT Hc Revasc Venous Tib/per Arterialization 26 9 $28,074.61 $11,229.84 60% off $1,267.00 $26,390.13 $24,424.91 2024-12-02
J2507 HCPCS Pegloticase 8 Mg/ml Intravenous Solution 36 9 $100,210.60 $40,084.24 60% off $5,720.08 $94,197.96 $64,635.83 2024-12-02
80 MS_DRG Nontraumatic Stupor And Coma With Mcc 10 5 — — $12,413.90 $21,973.13 $21,973.13 2024-12-02
J2329 HCPCS Ublituximab-xiiy 25 Mg/ml Intravenous Solution 24 9 $36,653.76 $14,661.50 60% off $12,828.82 $34,454.53 $26,482.34 2024-12-02
849 MS_DRG Radiotherapy 10 5 — — $14,399.80 $26,775.25 $26,775.25 2024-12-02
113 MS_DRG Orbital Procedures With Cc/mcc 10 5 — — $16,889.67 $24,943.75 $24,943.75 2024-12-02
263 MS_DRG Vein Ligation And Stripping 10 5 — — $16,937.75 $28,106.35 $28,106.35 2024-12-02
135 MS_DRG Sinus And Mastoid Procedures With Cc/mcc 10 5 — — $17,378.82 $26,384.28 $26,384.28 2024-12-02
595 MS_DRG Major Skin Disorders With Mcc 10 5 — — $17,813.52 $21,637.87 $21,637.87 2024-12-02
85 MS_DRG Traumatic Stupor And Coma <1 Hour With Mcc 10 5 — — $17,941.48 $22,610.84 $22,610.84 2024-12-02
577 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 10 5 — — $17,979.57 $26,354.43 $26,354.43 2024-12-02
827 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 10 5 — — $18,415.62 $23,052.53 $23,052.53 2024-12-02
619 MS_DRG O.r. Procedures For Obesity With Mcc 12 6 — — $19,294.00 $29,848.01 $25,890.84 2024-12-02
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 10 5 — — $19,476.32 $25,975.41 $25,975.41 2024-12-02
35 MS_DRG Carotid Artery Stent Procedures With Cc 10 5 — — $20,064.15 $22,876.46 $22,876.46 2024-12-02
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 10 5 — — $20,742.96 $27,065.75 $27,065.75 2024-12-02
715 MS_DRG Other Male Reproductive System O.r. Procedures For Malignancy With Cc/mcc 10 5 — — $20,932.46 $21,961.20 $21,961.20 2024-12-02
503 MS_DRG Foot Procedures With Mcc 10 5 — — $21,179.48 $26,680.75 $26,680.75 2024-12-02
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc 10 5 — — $21,184.91 $31,989.24 $31,989.24 2024-12-02
734 MS_DRG Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/mcc 10 5 — — $21,623.94 $23,031.30 $21,623.94 2024-12-02
96 MS_DRG Bacterial And Tuberculous Infections Of Nervous System Without Cc/mcc 10 5 — — $21,684.63 $24,153.71 $21,684.63 2024-12-02
808 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 10 5 — — $21,788.10 $22,632.64 $21,788.10 2024-12-02
357 MS_DRG Other Digestive System O.r. Procedures With Cc 10 5 — — $21,854.76 $23,488.96 $21,854.76 2024-12-02
320 MS_DRG Other Endovascular Cardiac Valve Procedures Without Mcc 10 5 — — $22,145.24 $24,245.98 $22,145.24 2024-12-02
41 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe… 10 5 — — $22,192.00 $24,329.74 $22,192.00 2024-12-02
821 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Cc 10 5 — — $22,205.93 $25,996.71 $22,205.93 2024-12-02
824 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Cc 10 5 — — $22,213.90 $25,661.69 $22,213.90 2024-12-02
835 MS_DRG Acute Leukemia With Cc 10 5 — — $22,239.76 $25,237.09 $22,239.76 2024-12-02
397 MS_DRG Appendix Procedures With Mcc 8 4 — — $22,350.19 $22,350.19 $22,350.19 2024-12-02
614 MS_DRG Adrenal And Pituitary Procedures With Cc/mcc 10 5 — — $22,407.90 $30,804.27 $22,407.90 2024-12-02
629 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Cc 10 5 — — $22,511.34 $24,284.19 $22,511.34 2024-12-02
350 MS_DRG Inguinal And Femoral Hernia Procedures With Mcc 10 5 — — $22,565.59 $23,876.28 $23,876.28 2024-12-02
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 10 5 — — $22,593.38 $29,061.41 $29,061.41 2024-12-02
243 MS_DRG Permanent Cardiac Pacemaker Implant With Cc 10 5 — — $22,658.59 $34,709.83 $22,658.59 2024-12-02
82 MS_DRG Traumatic Stupor And Coma >1 Hour With Mcc 10 5 — — $22,665.54 $24,012.69 $22,665.54 2024-12-02
668 MS_DRG Transurethral Procedures With Mcc 10 5 — — $22,677.75 $28,034.73 $28,034.73 2024-12-02
56 MS_DRG Degenerative Nervous System Disorders With Mcc 10 5 — — $22,731.01 $23,816.58 $23,816.58 2024-12-02
J9266 HCPCS Pegaspargase 750 Unit/ml Injection Solution 24 9 $65,104.83 $26,041.93 60% off $22,786.69 $61,198.54 $41,992.61 2024-12-02
545 MS_DRG Connective Tissue Disorders With Mcc 10 5 — — $22,997.21 $24,803.47 $24,803.47 2024-12-02
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 10 5 — — $23,058.51 $25,102.17 $23,058.51 2024-12-02
30 MS_DRG Spinal Procedures Without Cc/mcc 10 5 — — $23,070.46 $24,403.25 $23,070.46 2024-12-02
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 10 5 — — $23,126.81 $30,163.69 $30,163.69 2024-12-02
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 10 5 — — $23,357.56 $33,084.55 $33,084.55 2024-12-02
250 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc 10 5 — — $23,386.81 $28,319.91 $23,386.81 2024-12-02
330 MS_DRG Major Small And Large Bowel Procedures With Cc 10 5 — — $23,598.72 $30,245.28 $23,598.72 2024-12-02
674 MS_DRG Other Kidney And Urinary Tract Procedures With Cc 10 5 — — $23,699.20 $24,676.61 $23,699.20 2024-12-02
478 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Cc 10 5 — — $23,714.12 $24,419.83 $23,714.12 2024-12-02
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 10 5 — — $23,719.09 $25,961.59 $23,719.09 2024-12-02
347 MS_DRG Anal And Stomal Procedures With Mcc 10 5 — — $23,800.36 $25,359.59 $25,359.59 2024-12-02
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 10 5 — — $23,865.71 $33,882.42 $33,882.42 2024-12-02
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 10 5 — — $23,893.19 $24,082.25 $23,893.19 2024-12-02
341 MS_DRG DRG 2 1 — — $24,047.06 $24,047.06 $24,047.06 2024-12-02
792 MS_DRG Prematurity Without Major Problems 10 5 — — $24,202.36 $24,597.53 $24,597.53 2024-12-02
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc 10 5 — — $24,203.58 $26,034.08 $24,203.58 2024-12-02
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/mcc 10 5 — — $24,269.24 $27,835.73 $24,269.24 2024-12-02
846 MS_DRG Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc 10 5 — — $24,314.01 $27,676.27 $24,314.01 2024-12-02
L5973 HCPCS Ank-foot Sys Dors-plant Flex 2 1 — — $24,383.89 $24,383.89 $24,383.89 2024-12-02
L5858 HCPCS Stance Phase Only 2 1 — — $24,383.89 $24,383.89 $24,383.89 2024-12-02
473 MS_DRG Cervical Spinal Fusion Without Cc/mcc 10 5 — — $24,479.14 $26,289.83 $24,479.14 2024-12-02
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 10 5 — — $24,713.94 $24,925.64 $24,713.94 2024-12-02
982 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 10 5 — — $24,731.84 $26,264.97 $24,731.84 2024-12-02
A9543 HCPCS Y-90 Zevalin 26 9 $70,810.44 $28,324.18 60% off $24,783.65 $66,561.81 $61,605.08 2024-12-02
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 10 5 — — $24,845.26 $31,815.58 $24,845.26 2024-12-02
C7540 HCPCS Rmv&rplc Pm Dul W/l Vnt Lead 2 1 — — $24,856.42 $24,856.42 $24,856.42 2024-12-02
C7539 HCPCS Insrt A & V Pm W/l Vent Lead 2 1 — — $24,856.42 $24,856.42 $24,856.42 2024-12-02
C7538 HCPCS Insrt Vent Pm W/l Vent Lead 2 1 — — $24,856.42 $24,856.42 $24,856.42 2024-12-02
C7537 HCPCS Insrt Atril Pm W/l Vent Lead 2 1 — — $24,856.42 $24,856.42 $24,856.42 2024-12-02
749 MS_DRG Other Female Reproductive System O.r. Procedures With Cc/mcc 10 5 — — $25,042.23 $28,099.78 $25,042.23 2024-12-02
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/mcc 10 5 — — $25,193.44 $30,947.17 $25,193.44 2024-12-02
164 MS_DRG Major Chest Procedures With Cc 10 5 — — $25,372.52 $30,805.21 $25,372.52 2024-12-02
253 MS_DRG Other Vascular Procedures With Cc 10 5 — — $25,379.48 $28,381.20 $25,379.48 2024-12-02
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 10 5 — — $25,755.54 $27,630.37 $25,755.54 2024-12-02
288 MS_DRG Acute And Subacute Endocarditis With Mcc 10 5 — — $25,796.32 $27,805.70 $25,796.32 2024-12-02
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 10 5 — — $26,251.51 $27,332.37 $27,332.37 2024-12-02
C9601 HCPCS Perc Drug-el Cor Stent Bran 2 1 — — $26,276.15 $26,276.15 $26,276.15 2024-12-02
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 8 4 — — $26,306.68 $26,306.68 $26,306.68 2024-12-02
C9600 HCPCS Perc Drug-el Cor Stent Sing 2 1 — — $26,510.69 $26,510.69 $26,510.69 2024-12-02
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 10 5 — — $26,558.38 $30,424.52 $26,558.38 2024-12-02
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc 10 5 — — $26,718.55 $28,203.32 $26,718.55 2024-12-02
249 MS_DRG DRG 2 1 — — $26,816.50 $26,816.50 $26,816.50 2024-12-02
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 10 5 — — $26,898.61 $41,395.07 $26,898.61 2024-12-02
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 10 5 — — $26,946.37 $29,485.25 $26,946.37 2024-12-02
817 MS_DRG Other Antepartum Diagnoses With O.r. Procedures With Mcc 10 5 — — $27,106.03 $28,022.78 $28,022.78 2024-12-02
963 MS_DRG Other Multiple Significant Trauma With Mcc 10 5 — — $27,202.04 $28,907.45 $27,202.04 2024-12-02
654 MS_DRG Major Bladder Procedures With Cc 10 5 — — $27,233.87 $30,056.76 $27,233.87 2024-12-02
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 10 5 — — $27,262.73 $29,182.85 $27,262.73 2024-12-02
662 MS_DRG Minor Bladder Procedures With Mcc 10 5 — — $27,263.43 $29,812.51 $29,812.51 2024-12-02
970 MS_DRG HIV With Extensive O.r. Procedures Without Mcc 10 5 — — $27,652.71 $29,555.67 $27,652.71 2024-12-02
61 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 10 5 — — $27,883.52 $31,124.08 $27,883.52 2024-12-02
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 10 5 — — $27,947.18 $33,382.05 $27,947.18 2024-12-02
C2616 HCPCS Yttrium-90 Brachytx Src Non-stranded 24 9 $79,875.00 $31,950.00 60% off $27,956.25 $75,082.50 $57,709.69 2024-12-02
800 MS_DRG Splenic Procedures With Cc 10 5 — — $28,031.74 $28,619.62 $28,031.74 2024-12-02
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 10 5 — — $28,316.27 $38,992.02 $28,316.27 2024-12-02
C9604 HCPCS Perc D-e Cor Revasc T Cabg S 2 1 — — $28,560.52 $28,560.52 $28,560.52 2024-12-02
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 8 4 — — $28,598.81 $28,598.81 $28,598.81 2024-12-02
665 MS_DRG Prostatectomy With Mcc 10 5 — — $28,663.71 $30,731.75 $30,731.75 2024-12-02
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 10 5 — — $28,711.80 $33,516.32 $33,516.32 2024-12-02
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 10 5 — — $28,725.14 $31,810.04 $28,725.14 2024-12-02
247 MS_DRG DRG 2 1 — — $28,740.48 $28,740.48 $28,740.48 2024-12-02
338 MS_DRG DRG 2 1 — — $28,964.37 $28,964.37 $28,964.37 2024-12-02
974 MS_DRG HIV With Major Related Condition With Mcc 10 5 — — $29,014.65 $30,187.11 $29,014.65 2024-12-02
570 MS_DRG Skin Debridement With Mcc 10 5 — — $29,071.35 $29,424.10 $29,071.35 2024-12-02
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 10 5 — — $29,092.25 $31,321.03 $29,092.25 2024-12-02
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 10 5 — — $29,336.98 $33,536.04 $29,336.98 2024-12-02
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 10 5 — — $29,378.77 $31,705.17 $29,378.77 2024-12-02
472 MS_DRG Cervical Spinal Fusion With Cc 10 5 — — $29,401.64 $31,619.23 $29,401.64 2024-12-02
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 8 4 — — $29,532.97 $29,532.97 $29,532.97 2024-12-02
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 10 5 — — $29,787.64 $34,817.68 $29,787.64 2024-12-02
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 10 5 — — $29,859.28 $33,390.89 $29,859.28 2024-12-02
652 MS_DRG Kidney Transplant 10 5 — — $29,889.11 $50,665.67 $29,889.11 2024-12-02
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 10 5 — — $30,160.07 $38,769.10 $38,769.10 2024-12-02
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 10 5 — — $30,247.27 $32,907.24 $30,247.27 2024-12-02
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 10 5 — — $30,431.54 $37,122.64 $37,122.64 2024-12-02
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 8 4 — — $30,591.48 $30,591.48 $30,591.48 2024-12-02
C9606 HCPCS Perc D-e Cor Revasc W Ami S 2 1 — — $30,831.91 $30,831.91 $30,831.91 2024-12-02
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 10 5 — — $31,090.89 $33,346.35 $31,090.89 2024-12-02
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 10 5 — — $31,214.25 $34,074.99 $31,214.25 2024-12-02
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 10 5 — — $31,375.41 $37,605.14 $31,375.41 2024-12-02
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 10 5 — — $31,452.03 $33,378.28 $31,452.03 2024-12-02
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 10 5 — — $31,632.09 $50,192.12 $31,632.09 2024-12-02
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 8 4 — — $31,841.01 $31,841.01 $31,841.01 2024-12-02
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 10 5 — — $31,842.99 $36,411.26 $31,842.99 2024-12-02
61889 CPT Ins Sk-mnt Crnl Nstm Pg/rcvr 2 1 — — $31,951.62 $31,951.62 $31,951.62 2024-12-02
61891 CPT Rev/rplcmt Sk-mnt Crnl Nstm 2 1 — — $31,951.62 $31,951.62 $31,951.62 2024-12-02
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 10 5 — — $31,987.25 $34,941.97 $31,987.25 2024-12-02
C7534 HCPCS Fem/pop Revasc W/arthr & US 2 1 — — $32,043.60 $32,043.60 $32,043.60 2024-12-02
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 10 5 — — $32,240.93 $34,030.78 $32,240.93 2024-12-02
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 10 5 — — $32,257.47 $35,070.27 $35,070.27 2024-12-02
500 MS_DRG Soft Tissue Procedures With Mcc 10 5 — — $32,260.83 $33,025.35 $32,260.83 2024-12-02
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 10 5 — — $32,394.14 $38,590.86 $32,394.14 2024-12-02
264 MS_DRG Other Circulatory System O.r. Procedures 10 5 — — $32,491.63 $33,689.08 $32,491.63 2024-12-02
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 10 5 — — $32,563.55 $33,249.71 $33,249.71 2024-12-02
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 10 5 — — $32,770.18 $35,304.37 $32,770.18 2024-12-02
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 10 5 — — $32,981.09 $36,937.26 $32,981.09 2024-12-02
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 10 5 — — $33,126.34 $35,340.66 $33,126.34 2024-12-02
252 MS_DRG Other Vascular Procedures With Mcc 10 5 — — $33,365.11 $36,447.27 $33,365.11 2024-12-02
37 MS_DRG Extracranial Procedures With Mcc 10 5 — — $33,581.99 $33,937.59 $33,581.99 2024-12-02
34 MS_DRG Carotid Artery Stent Procedures With Mcc 10 5 — — $33,585.14 $38,812.88 $38,812.88 2024-12-02
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 10 5 — — $33,592.93 $33,919.98 $33,592.93 2024-12-02
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 10 5 — — $33,645.06 $61,860.45 $61,860.45 2024-12-02
L5856 HCPCS Elec Knee-shin Swing/stance 2 1 — — $33,764.93 $33,764.93 $33,764.93 2024-12-02
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 10 5 — — $34,105.28 $34,136.40 $34,105.28 2024-12-02
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 10 5 — — $34,131.14 $38,000.27 $34,131.14 2024-12-02
265 MS_DRG Aicd Lead Procedures 10 5 — — $34,302.85 $35,158.82 $35,158.82 2024-12-02
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 10 5 — — $34,372.88 $48,812.82 $34,372.88 2024-12-02
271 MS_DRG Other Major Cardiovascular Procedures With Cc 10 5 — — $34,383.83 $36,917.58 $34,383.83 2024-12-02
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 10 5 — — $34,405.71 $55,464.05 $34,405.71 2024-12-02
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 10 5 — — $34,442.52 $35,929.76 $34,442.52 2024-12-02
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 10 5 — — $34,683.28 $38,653.41 $34,683.28 2024-12-02
335 MS_DRG Peritoneal Adhesiolysis With Mcc 10 5 — — $35,565.70 $40,521.95 $35,565.70 2024-12-02
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 10 5 — — $35,627.38 $37,709.70 $35,627.38 2024-12-02
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 10 5 — — $35,912.18 $36,789.36 $36,789.36 2024-12-02
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 10 5 — — $35,976.57 $39,595.23 $35,976.57 2024-12-02
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 10 5 — — $36,040.25 $37,668.27 $36,040.25 2024-12-02
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 10 5 — — $36,181.51 $38,936.69 $36,181.51 2024-12-02
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 10 5 — — $36,329.75 $37,140.20 $36,329.75 2024-12-02
332 MS_DRG Rectal Resection With Mcc 10 5 — — $36,354.62 $42,696.57 $36,354.62 2024-12-02
460 MS_DRG DRG 10 5 — — $36,390.43 $44,912.36 $36,390.43 2024-12-02
J9600 HCPCS Porfimer Sodium Injection 2 1 — — $36,573.48 $36,573.48 $36,573.48 2024-12-02
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 10 5 — — $37,003.26 $40,881.26 $37,003.26 2024-12-02
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 10 5 — — $37,030.12 $38,859.02 $37,030.12 2024-12-02
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 10 5 — — $37,430.12 $38,058.79 $38,058.79 2024-12-02
140 MS_DRG Major Head And Neck Procedures With Mcc 10 5 — — $37,586.24 $42,190.74 $37,586.24 2024-12-02
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 10 5 — — $37,591.80 $56,538.02 $56,538.02 2024-12-02
31 MS_DRG Ventricular Shunt Procedures With Mcc 10 5 — — $37,655.32 $40,953.79 $40,953.79 2024-12-02
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 10 5 — — $37,692.68 $40,785.98 $37,692.68 2024-12-02
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 10 5 — — $38,080.03 $38,907.39 $38,907.39 2024-12-02
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 10 5 — — $38,097.98 $39,938.04 $39,938.04 2024-12-02
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 10 5 — — $38,306.50 $40,017.69 $38,306.50 2024-12-02
248 MS_DRG DRG 2 1 — — $38,327.66 $38,327.66 $38,327.66 2024-12-02
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 10 5 — — $38,554.61 $40,368.82 $40,368.82 2024-12-02
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 10 5 — — $38,582.07 $50,144.17 $38,582.07 2024-12-02
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 10 5 — — $38,671.61 $44,116.99 $38,671.61 2024-12-02
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 10 5 — — $39,024.78 $49,582.43 $39,024.78 2024-12-02
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 10 5 — — $39,372.97 $41,067.63 $39,372.97 2024-12-02
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 10 5 — — $39,842.54 $42,213.59 $39,842.54 2024-12-02
791 MS_DRG Prematurity With Major Problems 10 5 — — $40,110.87 $40,765.76 $40,765.76 2024-12-02
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 10 5 — — $40,203.67 $50,327.72 $40,203.67 2024-12-02
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 10 5 — — $40,239.49 $43,547.50 $40,239.49 2024-12-02
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 8 4 — — $41,186.57 $41,186.57 $41,186.57 2024-12-02
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 10 5 — — $41,371.62 $44,680.28 $41,371.62 2024-12-02
793 MS_DRG Full Term Neonate With Major Problems 10 5 — — $41,876.00 $43,249.10 $41,876.00 2024-12-02
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 10 5 — — $42,205.57 $42,806.19 $42,806.19 2024-12-02
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 10 5 — — $42,350.19 $43,394.13 $43,394.13 2024-12-02
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 10 5 — — $42,566.42 $44,604.69 $42,566.42 2024-12-02
246 MS_DRG DRG 2 1 — — $42,812.87 $42,812.87 $42,812.87 2024-12-02
901 MS_DRG Wound Debridements For Injuries With Mcc 10 5 — — $43,054.89 $44,199.82 $43,054.89 2024-12-02
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 10 5 — — $43,932.35 $46,567.89 $43,932.35 2024-12-02
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 10 5 — — $44,055.71 $48,291.89 $44,055.71 2024-12-02
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 8 4 — — $44,374.07 $44,374.07 $44,374.07 2024-12-02
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 10 5 — — $44,743.14 $67,764.36 $44,743.14 2024-12-02
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 10 5 — — $44,786.92 $50,142.84 $44,786.92 2024-12-02
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 10 5 — — $44,935.15 $50,593.67 $44,935.15 2024-12-02
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 10 5 — — $45,076.43 $47,768.62 $45,076.43 2024-12-02
245 MS_DRG Aicd Generator Procedures 10 5 — — $45,080.40 $59,989.50 $45,080.40 2024-12-02
455 MS_DRG DRG 10 5 — — $45,818.57 $50,828.93 $45,818.57 2024-12-02
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 10 5 — — $46,038.44 $55,369.83 $46,038.44 2024-12-02
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 10 5 — — $46,246.36 $51,746.85 $46,246.36 2024-12-02
163 MS_DRG Major Chest Procedures With Mcc 10 5 — — $46,893.00 $51,842.42 $46,893.00 2024-12-02
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 10 5 — — $47,159.62 $47,780.39 $47,159.62 2024-12-02
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 8 4 — — $47,577.47 $47,577.47 $47,577.47 2024-12-02
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 10 5 — — $47,820.21 $50,349.00 $47,820.21 2024-12-02
10 MS_DRG Pancreas Transplant 10 5 — — $47,887.85 $59,025.41 $47,887.85 2024-12-02
6 MS_DRG Liver Transplant Without Mcc 10 5 — — $48,119.65 $73,922.02 $48,119.65 2024-12-02
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 10 5 — — $48,190.28 $59,012.83 $48,190.28 2024-12-02
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 10 5 — — $48,550.41 $63,515.94 $48,550.41 2024-12-02
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 10 5 — — $48,842.21 $68,840.27 $68,840.27 2024-12-02
471 MS_DRG Cervical Spinal Fusion With Mcc 10 5 — — $48,936.41 $51,975.99 $48,936.41 2024-12-02
799 MS_DRG Splenic Procedures With Mcc 10 5 — — $49,290.58 $53,298.25 $49,290.58 2024-12-02
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 10 5 — — $49,735.28 $51,438.60 $49,735.28 2024-12-02
228 MS_DRG Other Cardiothoracic Procedures With Mcc 10 5 — — $50,127.24 $68,426.08 $50,127.24 2024-12-02
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 10 5 — — $50,308.31 $53,708.28 $50,308.31 2024-12-02
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 10 5 — — $50,528.17 $55,047.10 $50,528.17 2024-12-02
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 10 5 — — $50,542.01 $56,673.32 $56,673.32 2024-12-02
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 10 5 — — $51,297.18 $56,604.24 $51,297.18 2024-12-02
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 10 5 — — $51,598.61 $55,351.52 $51,598.61 2024-12-02
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 10 5 — — $51,711.04 $67,677.42 $51,711.04 2024-12-02
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 10 5 — — $52,175.63 $56,769.71 $52,175.63 2024-12-02
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 10 5 — — $52,345.74 $84,325.96 $52,345.74 2024-12-02
653 MS_DRG Major Bladder Procedures With Mcc 10 5 — — $53,856.91 $56,526.75 $53,856.91 2024-12-02
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 10 5 — — $54,768.18 $59,409.41 $54,768.18 2024-12-02
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 10 5 — — $55,606.26 $56,345.03 $56,345.03 2024-12-02
834 MS_DRG Acute Leukemia With Mcc 10 5 — — $55,701.36 $64,047.32 $55,701.36 2024-12-02
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 10 5 — — $56,395.76 $58,729.13 $56,395.76 2024-12-02
227 MS_DRG DRG 2 1 — — $56,921.62 $56,921.62 $56,921.62 2024-12-02
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 10 5 — — $58,502.84 $68,646.79 $58,502.84 2024-12-02
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 10 5 — — $58,731.21 $59,691.69 $59,691.69 2024-12-02
232 MS_DRG Coronary Bypass With Ptca Without Mcc 10 5 — — $59,179.35 $60,834.14 $59,179.35 2024-12-02
28 MS_DRG Spinal Procedures With Mcc 10 5 — — $59,950.36 $60,294.70 $59,950.36 2024-12-02
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 10 5 — — $60,155.28 $72,557.71 $60,155.28 2024-12-02
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 10 5 — — $60,439.81 $62,685.40 $60,439.81 2024-12-02
955 MS_DRG Craniotomy For Multiple Significant Trauma 10 5 — — $60,588.04 $66,734.50 $60,588.04 2024-12-02
454 MS_DRG DRG 10 5 — — $60,847.70 $68,137.14 $60,847.70 2024-12-02
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 10 5 — — $61,097.40 $64,936.93 $61,097.40 2024-12-02
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 10 5 — — $61,451.57 $63,183.01 $61,451.57 2024-12-02
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 10 5 — — $61,451.57 $107,908.91 $61,451.57 2024-12-02
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 8 4 — — $61,781.85 $61,781.85 $61,781.85 2024-12-02
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 10 5 — — $62,139.00 $73,478.36 $62,139.00 2024-12-02
225 MS_DRG DRG 2 1 — — $62,436.40 $62,436.40 $62,436.40 2024-12-02
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 10 5 — — $62,972.36 $67,833.50 $67,833.50 2024-12-02
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 10 5 — — $63,324.87 $67,132.77 $63,324.87 2024-12-02
459 MS_DRG DRG 10 5 — — $65,981.10 $69,721.37 $65,981.10 2024-12-02
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 10 5 — — $66,507.40 $68,371.70 $68,371.70 2024-12-02
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 10 5 — — $66,672.00 $69,289.95 $69,289.95 2024-12-02
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 10 5 — — $68,193.63 $72,100.81 $68,193.63 2024-12-02
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 10 5 — — $68,723.88 $72,395.83 $68,723.88 2024-12-02
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 8 4 — — $69,995.30 $69,995.30 $69,995.30 2024-12-02
226 MS_DRG DRG 2 1 — — $71,684.45 $71,684.45 $71,684.45 2024-12-02
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 10 5 — — $71,952.15 $72,417.08 $71,952.15 2024-12-02
J9226 HCPCS Supprelin La Implant 2 1 — — $74,705.93 $74,705.93 $74,705.93 2024-12-02
223 MS_DRG DRG 2 1 — — $75,468.73 $75,468.73 $75,468.73 2024-12-02
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 10 5 — — $76,714.48 $83,431.62 $76,714.48 2024-12-02
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 10 5 — — $77,593.92 $83,918.99 $77,593.92 2024-12-02
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 10 5 — — $79,522.92 $100,028.67 $79,522.92 2024-12-02
224 MS_DRG DRG 2 1 — — $79,590.58 $79,590.58 $79,590.58 2024-12-02
231 MS_DRG Coronary Bypass With Ptca With Mcc 10 5 — — $80,733.65 $86,097.64 $80,733.65 2024-12-02
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 10 5 — — $83,859.45 $89,047.85 $83,859.45 2024-12-02
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 10 5 — — $84,088.26 $85,689.89 $84,088.26 2024-12-02
453 MS_DRG DRG 10 5 — — $88,157.17 $95,136.24 $88,157.17 2024-12-02
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 2 1 — — $92,442.86 $92,442.86 $92,442.86 2024-12-02
222 MS_DRG DRG 2 1 — — $94,922.12 $94,922.12 $94,922.12 2024-12-02
90288 CPT Botulism Ig IV 2 1 — — $95,776.06 $95,776.06 $95,776.06 2024-12-02
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 10 5 — — $96,552.67 $103,950.95 $96,552.67 2024-12-02
215 MS_DRG Other Heart Assist System Implant 10 5 — — $101,621.41 $123,765.84 $101,621.41 2024-12-02
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 10 5 — — $102,966.44 $157,882.18 $102,966.44 2024-12-02
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 8 4 — — $107,151.76 $107,151.76 $107,151.76 2024-12-02
14 MS_DRG Allogeneic Bone Marrow Transplant 10 5 — — $114,018.18 $178,917.56 $114,018.18 2024-12-02
7 MS_DRG Lung Transplant 10 5 — — $118,527.08 $122,031.65 $122,031.65 2024-12-02
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 10 5 — — $121,809.79 $248,300.81 $121,809.79 2024-12-02
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And … 10 5 — — $123,450.36 $146,242.19 $146,242.19 2024-12-02
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 10 5 — — $141,117.02 $262,228.16 $262,228.16 2024-12-02
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 10 5 — — $197,826.03 $212,103.89 $212,103.89 2024-12-02
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 10 5 — — $269,589.02 $416,543.90 $269,589.02 2024-12-02
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 10 5 — — $366,527.69 $585,042.32 $366,527.69 2024-12-02
Q2055 HCPCS Idecabtagene Vicleucel Car 2 1 — — $660,816.82 $660,816.82 $660,816.82 2024-12-02
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 2 1 — — $660,816.82 $660,816.82 $660,816.82 2024-12-02
Q2053 HCPCS Brexucabtagene Car Pos T 2 1 — — $660,816.82 $660,816.82 $660,816.82 2024-12-02
Q2054 HCPCS Lisocabtagene Mara Car Pos T 2 1 — — $660,816.82 $660,816.82 $660,816.82 2024-12-02
Q2056 HCPCS Ciltacabtagene Car-pos T 2 1 — — $660,816.82 $660,816.82 $660,816.82 2024-12-02
J3399 HCPCS Inj Onase Abepar-xioi Treat 2 1 — — $3,519,387.81 $3,519,387.81 $3,519,387.81 2024-12-02
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