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

WESLEY MEDICAL CENTER

Wichita, KS · CCN 170123 · Rates published

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You selected 93306 (CPT)

ECHO2D COMP W CF DOP

This hospital’s price: $1,595 across 13 payers · range $291-$7,678

Source: https://www.hcadam.com/api/public/content/8cf802df1ca74002bc905804324caf05?download=true · observed 2024-10-01

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.

30,623 distinct procedures filed
20 distinct payers
615,099 rate rows
2024-10-01 last MRF observed · ⚠ 24 mo old
Data quality

595,439 of 615,099 rate rows are consumer-grade (96.8%)

19,660 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 9,218
per-diem day rate — not a per-procedure price 5,709
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 4,380
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 187
percent-of-charges filed in the dollar field — excluded from medians 91
placeholder amount (≤ $0.02) — excluded from medians 38
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 27
exceeds 10× this hospital's gross charge — excluded from medians 10

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 24 months old.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://www.hcadam.com/api/public/content/8cf802df1ca74002bc905804324caf05?download=true
Found on page https://www.wesleymc.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-01
Content fingerprint 90557678809faba3… · 382,792,886 bytes · first seen 2026-07-17

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
J1411
HCPCS 		Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 5 $3,848,460.00 $3,848,460.00 $3,848,460.00 nat. median
$3,703,693
1.0× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 5 $3,672,900.00 $3,856,545.00 $3,672,900.00 nat. median
$3,758,972
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 5 $3,605,000.00 $3,785,250.00 $3,605,000.00 nat. median
$3,646,097
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 6 $3,325,455.00 $4,988,182.50 $3,325,455.00 nat. median
$3,325,455
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 6 $3,286,000.00 $4,929,000.00 $3,286,000.00 nat. median
$3,252,508
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 6 $2,968,000.00 $4,452,000.00 $2,968,000.00 nat. median
$2,939,969
1.0× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $2,528,750.00 $2,528,750.00 $2,528,750.00 nat. median
$2,466,282
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 6 $2,388,614.00 $3,582,921.00 $2,388,614.00 nat. median
$2,588,981
0.9× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 5 $523,452.00 $1,989,119.73 $544,390.08 nat. median
$738,272
0.7× median
9194
OTHER 		Tisagenlecleucel Car-pos 6 $529,192.90 $793,789.35 $529,192.90 nat. median
$577,003
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 6 $527,123.40 $790,685.10 $527,123.40 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 6 $526,587.60 $789,881.40 $526,587.60 nat. median
$562,826
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 6 $474,810.00 $1,929,210.60 $525,456.04 nat. median
$646,415
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 6 $474,810.00 $1,913,127.21 $521,074.89 nat. median
$622,245
0.8× median
9413
OTHER 		Lisocabtagene Car Pos T 6 $516,726.10 $775,089.15 $516,726.10 nat. median
$562,201
0.9× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 6 $474,810.00 $1,886,282.80 $513,763.65 nat. median
$640,950
0.8× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 6 $438,724.44 $1,858,720.26 $506,255.76 nat. median
$608,101
0.8× median
9035
OTHER 		Axicabtagene Ciloleucel C 6 $489,456.00 $734,184.00 $489,456.00 nat. median
$533,230
0.9× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 6 $449,440.00 $1,707,872.00 $471,113.80 nat. median
$591,650
0.8× median
9391
OTHER 		Brexucabtagene Car Pos T 6 $460,530.40 $690,795.60 $460,530.40 nat. median
$492,768
0.9× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 13 $4,153.00 $423,747.30 $282,498.20 nat. median
$359,358
0.8× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 1 $276,632.40 $276,632.40 $276,632.40 nat. median
$75,037
outlier · 3.7×
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 $248,811.00 $248,811.00 $248,811.00 nat. median
$63,643
outlier · 3.9×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 15 $14,070.00 $316,848.45 $211,232.30 nat. median
$249,124
0.8× median
J2326
HCPCS 		Nusinersen 12 Mg Inj 12 $1,106.19 $771,989.81 $184,848.67 nat. median
$2,487
outlier · 74.3×
A9699
HCPCS 		Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 $176,839.04 $176,839.04 $176,839.04 nat. median
$1,683
outlier · 105.1×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 15 $6,067.00 $267,076.20 $164,110.26 nat. median
$198,433
0.8× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 15 $8,942.00 $282,813.00 $160,931.30 nat. median
$190,557
0.8× median
90288
CPT 		Botulism Ig Human IV 9 $55,711.59 $311,431.23 $155,715.61 nat. median
$51,570
outlier · 3.0×
1907
OTHER 		New Technology - Level 52 6 $138,867.00 $208,300.50 $138,867.00 nat. median
$155,877
0.9× median
1908
OTHER 		New Technology - Level 52 6 $138,867.00 $208,300.50 $138,867.00 nat. median
$155,833
0.9× median
J9226
HCPCS 		Supprelin La 50 Mg Imp 9 $46,079.19 $257,585.54 $138,809.98 nat. median
$55,159
outlier · 2.5×
551981
CDM 		Pump Heart 21fr 85mm 11 $76,287.76 $426,453.30 $133,550.96 nat. median
$60,543
outlier · 2.2×
578762
CDM 		Kit Cath Rt Heart 11 $76,287.76 $426,453.30 $133,550.96 nat. median
$69,526
1.9× median
1905
OTHER 		New Technology - Level 51 6 $125,208.00 $187,812.00 $125,208.00 nat. median
$140,530
0.9× median
1906
OTHER 		New Technology - Level 51 6 $125,208.00 $187,812.00 $125,208.00 nat. median
$140,545
0.9× median
J9999
HCPCS 		Carmustine Wafers 8/box 8 $37,678.01 $210,622.41 $113,502.08 nat. median
$2,702
outlier · 42.0×
1903
OTHER 		New Technology - Level 50 6 $111,549.00 $167,323.50 $111,549.00 nat. median
$120,722
0.9× median
1904
OTHER 		New Technology - Level 50 6 $111,549.00 $167,323.50 $111,549.00 nat. median
$120,722
0.9× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 15 $6,067.00 $159,618.30 $105,454.49 nat. median
$126,722
0.8× median
Q0480
HCPCS 		Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 6 $99,999.90 $149,999.85 $99,999.90 nat. median
$111,503
0.9× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 14 $4,153.00 $148,101.51 $98,734.34 nat. median
$110,192
0.9× median
1901
OTHER 		New Technology - Level 49 6 $97,889.95 $146,834.92 $97,889.95 nat. median
$105,940
0.9× median
1902
OTHER 		New Technology - Level 49 6 $97,889.95 $146,834.92 $97,889.95 nat. median
$105,940
0.9× median
7
MS_DRG 		Lung Transplant 14 $8,942.00 $147,731.86 $96,274.60 nat. median
$117,894
0.8× median
K1007
HCPCS 		Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 6 $91,031.90 $136,547.85 $91,031.90 nat. median
$97,020
0.9× median
1585
OTHER 		New Technology - Level 48 6 $86,507.45 $129,761.17 $86,507.45 nat. median
$96,908
0.9× median
1599
OTHER 		New Technology - Level 48 6 $86,507.45 $129,761.17 $86,507.45 nat. median
$97,104
0.9× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 15 $14,070.00 $297,020.00 $83,193.48 nat. median
$103,967
0.8× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 14 $6,067.00 $123,372.18 $82,248.12 nat. median
$97,414
0.8× median

Other procedures at this hospital

Browse this hospital's 30,623 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
             
J1411 HCPCS Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 6 5 — — $3,848,460.00 $3,848,460.00 $3,848,460.00 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 10 5 — — $3,672,900.00 $3,856,545.00 $3,672,900.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 10 5 — — $3,605,000.00 $3,785,250.00 $3,605,000.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 12 6 — — $3,325,455.00 $4,988,182.50 $3,325,455.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 12 6 — — $3,286,000.00 $4,929,000.00 $3,286,000.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 12 6 — — $2,968,000.00 $4,452,000.00 $2,968,000.00 2024-10-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 2 1 — — $2,528,750.00 $2,528,750.00 $2,528,750.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 12 6 — — $2,388,614.00 $3,582,921.00 $2,388,614.00 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 6 5 — — $523,452.00 $1,989,119.73 $544,390.08 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 12 6 — — $529,192.90 $793,789.35 $529,192.90 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 12 6 — — $527,123.40 $790,685.10 $527,123.40 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 12 6 — — $526,587.60 $789,881.40 $526,587.60 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 8 6 — — $474,810.00 $1,929,210.60 $525,456.04 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 8 6 — — $474,810.00 $1,913,127.21 $521,074.89 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 12 6 — — $516,726.10 $775,089.15 $516,726.10 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 8 6 — — $474,810.00 $1,886,282.80 $513,763.65 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 8 6 — — $438,724.44 $1,858,720.26 $506,255.76 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 12 6 — — $489,456.00 $734,184.00 $489,456.00 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 8 6 — — $449,440.00 $1,707,872.00 $471,113.80 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 12 6 — — $460,530.40 $690,795.60 $460,530.40 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 27 13 — — $4,153.00 $423,747.30 $282,498.20 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 2 1 — — $276,632.40 $276,632.40 $276,632.40 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 2 1 — — $248,811.00 $248,811.00 $248,811.00 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 28 15 — — $14,070.00 $316,848.45 $211,232.30 2024-10-01
J2326 HCPCS Nusinersen 12 Mg Inj 20 12 $857,766.46 $857,766.46 $1,106.19 $771,989.81 $184,848.67 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $176,839.04 $176,839.04 $176,839.04 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 32 15 — — $6,067.00 $267,076.20 $164,110.26 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 32 15 — — $8,942.00 $282,813.00 $160,931.30 2024-10-01
90288 CPT Botulism Ig Human IV 15 9 $346,034.70 $346,034.70 $55,711.59 $311,431.23 $155,715.61 2024-10-01
1907 OTHER New Technology - Level 52 12 6 — — $138,867.00 $208,300.50 $138,867.00 2024-10-01
1908 OTHER New Technology - Level 52 12 6 — — $138,867.00 $208,300.50 $138,867.00 2024-10-01
J9226 HCPCS Supprelin La 50 Mg Imp 17 9 $286,206.15 $286,206.15 $46,079.19 $257,585.54 $138,809.98 2024-10-01
551981 CDM Pump Heart 21fr 85mm 20 11 $473,837.00 $473,837.00 $76,287.76 $426,453.30 $133,550.96 2024-10-01
578762 CDM Kit Cath Rt Heart 20 11 $473,837.00 $473,837.00 $76,287.76 $426,453.30 $133,550.96 2024-10-01
1905 OTHER New Technology - Level 51 12 6 — — $125,208.00 $187,812.00 $125,208.00 2024-10-01
1906 OTHER New Technology - Level 51 12 6 — — $125,208.00 $187,812.00 $125,208.00 2024-10-01
J9999 HCPCS Carmustine Wafers 8/box 13 8 $234,024.90 $234,024.90 $37,678.01 $210,622.41 $113,502.08 2024-10-01
1903 OTHER New Technology - Level 50 12 6 — — $111,549.00 $167,323.50 $111,549.00 2024-10-01
1904 OTHER New Technology - Level 50 12 6 — — $111,549.00 $167,323.50 $111,549.00 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 32 15 — — $6,067.00 $159,618.30 $105,454.49 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 12 6 — — $99,999.90 $149,999.85 $99,999.90 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 29 14 — — $4,153.00 $148,101.51 $98,734.34 2024-10-01
1902 OTHER New Technology - Level 49 12 6 — — $97,889.95 $146,834.92 $97,889.95 2024-10-01
1901 OTHER New Technology - Level 49 12 6 — — $97,889.95 $146,834.92 $97,889.95 2024-10-01
7 MS_DRG Lung Transplant 29 14 — — $8,942.00 $147,731.86 $96,274.60 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 12 6 — — $91,031.90 $136,547.85 $91,031.90 2024-10-01
1599 OTHER New Technology - Level 48 12 6 — — $86,507.45 $129,761.17 $86,507.45 2024-10-01
1585 OTHER New Technology - Level 48 12 6 — — $86,507.45 $129,761.17 $86,507.45 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 28 15 — — $14,070.00 $297,020.00 $83,193.48 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 30 14 — — $6,067.00 $123,372.18 $82,248.12 2024-10-01
766441 CDM Set Pump 21fr 5.0 20 11 $288,925.00 $288,925.00 $46,516.93 $260,032.50 $81,433.51 2024-10-01
706309 CDM Set Vntrc 17.4x13.8in 20 11 $288,925.00 $288,925.00 $46,516.93 $260,032.50 $81,433.51 2024-10-01
581224 CDM Kit Cath Rt Heart 20 11 $288,925.00 $288,925.00 $46,516.93 $260,032.50 $81,433.51 2024-10-01
835976 CDM Kit Pmp Rt Hrt 22f 170cm 20 11 $288,925.00 $288,925.00 $46,516.93 $260,032.50 $81,433.51 2024-10-01
573195 CDM Kit Cath Rt Heart 20 11 $288,925.00 $288,925.00 $46,516.93 $260,032.50 $81,433.51 2024-10-01
589193 CDM Kit Lo Prfl Comp Shth 7f 20 11 $288,925.00 $288,925.00 $46,516.93 $260,032.50 $81,433.51 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 29 14 — — $8,942.00 $120,633.57 $80,422.38 2024-10-01
215 MS_DRG Other Heart Assist System Implant 29 15 — — $14,070.00 $164,969.00 $80,016.16 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 26 10 — — $8,942.00 $136,718.40 $79,175.35 2024-10-01
1598 OTHER New Technology - Level 47 12 6 — — $77,401.45 $116,102.17 $77,401.45 2024-10-01
1584 OTHER New Technology - Level 47 12 6 — — $77,401.45 $116,102.17 $77,401.45 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 4 2 — — $62,162.10 $89,631.66 $75,896.88 2024-10-01
J7181 HCPCS Tretten 3125 U Inj 20 12 $350,828.16 $350,828.16 $17.00 $315,745.34 $75,603.47 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 28 15 — — $18,937.00 $109,452.86 $72,968.57 2024-10-01
C9293 HCPCS Glucarpidase 1000 U Inj 18 12 $248,649.79 $248,649.79 $347.71 $223,784.81 $72,357.09 2024-10-01
C1825 HCPCS System Generator Ipg 13 8 $144,760.00 $144,760.00 $23,306.36 $130,284.00 $70,208.60 2024-10-01
790455 CDM Tandem Lung Kit Size 29 20 11 $248,476.00 $248,476.00 $40,004.64 $223,628.40 $70,032.96 2024-10-01
44183 CDM Kit Bld Cann 31fr 20 11 $248,476.00 $248,476.00 $40,004.64 $223,628.40 $70,032.96 2024-10-01
558757 CDM Kit Pmp Oxyg Extrcpl 31f 20 11 $248,476.00 $248,476.00 $40,004.64 $223,628.40 $70,032.96 2024-10-01
558756 CDM Kit Pmp Oxyg Extrcpl 29f 20 11 $248,476.00 $248,476.00 $40,004.64 $223,628.40 $70,032.96 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 26 10 — — $6,067.00 $132,442.44 $69,689.70 2024-10-01
1583 OTHER New Technology - Level 46 12 6 — — $68,295.45 $102,443.17 $68,295.45 2024-10-01
1597 OTHER New Technology - Level 46 12 6 — — $68,295.45 $102,443.17 $68,295.45 2024-10-01
584925 CDM Valve Tavr 23mm 13 8 $140,624.00 $140,624.00 $22,640.46 $126,561.60 $68,202.64 2024-10-01
585067 CDM Valve Tavr 26mm 13 8 $140,624.00 $140,624.00 $22,640.46 $126,561.60 $68,202.64 2024-10-01
585066 CDM Valve Tavr 29mm 13 8 $140,624.00 $140,624.00 $22,640.46 $126,561.60 $68,202.64 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 4 2 — — $53,780.76 $79,446.79 $66,613.77 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 6 5 — — $63,499.00 $241,297.45 $66,038.96 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 12 6 — — $65,871.70 $98,807.55 $65,871.70 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 12 6 — — $65,476.58 $98,214.87 $65,476.58 2024-10-01
772862 CDM Valve Aor 15f W/23mm Edg 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
777386 CDM Valve Aor With Intro 25mm 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
90294 CDM Valve 23mm Thv 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
785937 CDM Kit Vlv Aor 18fr 29mm 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
772856 CDM Valve Aor 15f W/27mm Edg 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
294902 CDM Kit Aor Vlv 14fr 29mm 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
775845 CDM Valve Heart Trnscth 26mm 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
585068 CDM Valve Tavr 20mm 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
155463 CDM Valve 26mm Thv 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
772861 CDM Valve Aor 15f W/25mm Edg 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
784849 CDM Valve Hrt W/cert Sys 23a 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
775844 CDM Valve Heart Trnscth 23mm 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
777384 CDM Valve Aor With Intro 23mm 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
777390 CDM Valve Aor With Intro 27mm 13 8 $134,420.00 $134,420.00 $21,641.62 $120,978.00 $65,193.70 2024-10-01
961030 CDM Set Pump Asst 2.5in 20 11 $231,140.00 $231,140.00 $37,213.54 $208,026.00 $65,146.81 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 28 15 — — $18,937.00 $96,269.42 $64,179.61 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 29 15 — — $19,557.00 $97,364.83 $64,143.77 2024-10-01
44326 CDM Kit Bl Pmp Cann 29fr 20 11 $225,362.00 $225,362.00 $36,283.28 $202,825.80 $63,518.28 2024-10-01
558209 CDM Kit Bld Pmp Cann 31fr 20 11 $225,362.00 $225,362.00 $36,283.28 $202,825.80 $63,518.28 2024-10-01
562681 CDM Kit Bld Pump Cann 29fr 20 11 $225,362.00 $225,362.00 $36,283.28 $202,825.80 $63,518.28 2024-10-01
44185 CDM Kit Bld Pump Cann 31fr 20 11 $225,362.00 $225,362.00 $36,283.28 $202,825.80 $63,518.28 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 12 6 — — $63,354.77 $95,032.15 $63,354.77 2024-10-01
595991 CDM Valve Tavr 29mm 13 8 $130,284.00 $130,284.00 $20,975.72 $117,255.60 $63,187.74 2024-10-01
596518 CDM Valve Tavr 26mm 13 8 $130,284.00 $130,284.00 $20,975.72 $117,255.60 $63,187.74 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 26 10 — — $8,942.00 $108,784.26 $63,183.48 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 32 15 — — $8,942.00 $97,762.43 $61,096.38 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 4 2 — — $49,797.00 $72,033.56 $60,915.28 2024-10-01
J9266 HCPCS Pegaspargase Singl Vial 20 12 $154,225.43 $154,225.43 $24,779.57 $138,802.89 $60,764.82 2024-10-01
780880 CDM Valve Aor Tavr 26mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
43727 CDM Valve Aor 23mm Evolutpro 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
43728 CDM Valve Tavr 26mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
780881 CDM Valve Aor Tavr 29mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
43696 CDM Valve Tavr 29mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
79123 CDM Valve Aor 18-20mm 0-34mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
43697 CDM Valve Tavr 34mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
575013 CDM Valve Tavr Sz 23mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
780879 CDM Valve Aor Tavr 23mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
43729 CDM Valve Tavr 29mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
43730 CDM Valve Tavr 23mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
575010 CDM Valve Tavr Size 34mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
575011 CDM Valve Tavr Sz 29mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
43695 CDM Valve Tavr 26mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
575012 CDM Valve Tavr Sz 26mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
780882 CDM Valve Aor Tavr 34mm 13 8 $124,080.00 $124,080.00 $19,976.88 $111,672.00 $60,178.80 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 27 13 — — $8,942.00 $90,145.89 $60,097.26 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 8 6 — — $40,786.00 $115,585.23 $59,619.53 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 8 6 — — $55,512.00 $210,948.56 $59,553.21 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 29 15 — — $14,070.00 $88,903.71 $59,269.14 2024-10-01
1582 OTHER New Technology - Level 45 12 6 — — $59,189.46 $88,784.19 $59,189.46 2024-10-01
1596 OTHER New Technology - Level 45 12 6 — — $59,189.46 $88,784.19 $59,189.46 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 29 15 — — $14,070.00 $88,021.08 $58,680.72 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 32 15 — — $8,942.00 $84,959.88 $56,639.92 2024-10-01
10 MS_DRG Pancreas Transplant 29 14 — — $8,942.00 $90,660.01 $56,198.86 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 4 2 — — $47,193.30 $65,149.42 $56,171.36 2024-10-01
J9118 HCPCS Calasparg 3750 Units Inj 17 9 $163,495.78 $163,495.78 $87.06 $147,146.20 $55,261.57 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 12 6 — — $55,015.23 $82,522.85 $55,015.23 2024-10-01
63708 CDM Tips Placement Init 16 9 $137,969.00 $137,969.00 $22,213.01 $124,172.10 $54,359.79 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 26 10 — — $8,942.00 $96,354.32 $53,914.38 2024-10-01
44182 CDM Kit Bld Cann 17fr 24fr 20 11 $190,691.00 $190,691.00 $30,701.25 $171,621.90 $53,746.26 2024-10-01
574855 CDM Kit Bld Cann 17fr 24fr 20 11 $190,691.00 $190,691.00 $30,701.25 $171,621.90 $53,746.26 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 27 14 — — $14,070.00 $86,141.00 $53,673.93 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 32 15 — — $4,153.00 $79,278.79 $52,376.85 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 32 15 — — $8,942.00 $80,936.00 $51,892.24 2024-10-01
27929 CDM Cas W/protect Device 16 9 $130,630.00 $130,630.00 $21,031.43 $117,567.00 $51,468.22 2024-10-01
38463 CDM Cas W/protect Device 16 9 $130,630.00 $130,630.00 $21,031.43 $117,567.00 $51,468.22 2024-10-01
27928 CDM Cas Without Protect Device 16 9 $130,630.00 $130,630.00 $21,031.43 $117,567.00 $51,468.22 2024-10-01
38464 CDM Cas Without Protect Device 16 9 $130,630.00 $130,630.00 $21,031.43 $117,567.00 $51,468.22 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 4 2 — — $41,473.08 $60,682.82 $51,077.95 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 24 10 — — $12,035.00 $76,452.81 $50,968.54 2024-10-01
J1246 HCPCS Dinutuximab 17.5 Mg Inj 13 8 $104,664.69 $104,664.69 $16,851.02 $94,198.22 $50,762.37 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 29 15 — — $14,070.00 $76,038.38 $50,692.25 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 32 15 — — $6,067.00 $76,164.94 $50,319.64 2024-10-01
1581 OTHER New Technology - Level 44 12 6 — — $50,083.46 $75,125.19 $50,083.46 2024-10-01
1595 OTHER New Technology - Level 44 12 6 — — $50,083.46 $75,125.19 $50,083.46 2024-10-01
69251 CDM Extcran Vertebral Stent 16 9 $124,960.00 $124,960.00 $20,118.56 $112,464.00 $49,234.24 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 29 15 — — $14,070.00 $103,810.00 $49,125.62 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 32 15 — — $4,153.00 $73,803.81 $48,759.71 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 4 2 — — $39,596.04 $56,420.25 $48,008.15 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 32 15 — — $6,067.00 $72,193.13 $47,695.59 2024-10-01
898580 CDM Trnscth Plc Vrt Stnt Ini 16 9 $120,536.00 $120,536.00 $19,406.30 $108,482.40 $47,491.18 2024-10-01
5244 OTHER Level 4 Blood Product Exc 12 6 — — $47,411.45 $71,117.17 $47,411.45 2024-10-01
576202 CDM Cannula Systm W Circuit 20 11 $167,577.00 $167,577.00 $26,979.90 $150,819.30 $47,231.57 2024-10-01
561694 CDM Cannula W Dltr Buble Trp 20 11 $167,577.00 $167,577.00 $26,979.90 $150,819.30 $47,231.57 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 27 14 — — $14,070.00 $87,123.00 $47,158.75 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 26 10 — — $8,942.00 $70,648.51 $47,099.01 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 12 6 — — $47,005.00 $70,507.50 $47,005.00 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 32 15 — — $8,942.00 $70,096.32 $46,730.88 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 29 15 — — $14,070.00 $76,796.00 $46,518.80 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 28 15 — — $12,035.00 $70,332.65 $46,466.43 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 29 15 — — $19,557.00 $69,451.14 $46,300.76 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 29 14 — — $4,153.00 $68,962.79 $45,975.19 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 29 15 — — $14,070.00 $99,595.00 $45,638.41 2024-10-01
1142 OTHER Supprelin La Implant 12 6 — — $45,350.21 $68,025.32 $45,350.21 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 29 15 — — $14,070.00 $103,810.00 $45,330.02 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 20 12 — — $4,241.69 $67,949.10 $45,299.40 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 29 15 — — $14,070.00 $67,263.62 $44,842.41 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 32 15 — — $6,067.00 $66,570.27 $43,980.76 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 29 15 — — $19,557.00 $90,420.00 $43,761.15 2024-10-01
63709 CDM Tips Revision 16 9 $110,617.00 $110,617.00 $17,809.34 $99,555.30 $43,583.10 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 32 15 — — $8,942.00 $65,257.53 $43,505.02 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 29 14 — — $4,153.00 $68,962.79 $43,074.37 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 29 15 — — $10,550.00 $63,795.81 $42,530.54 2024-10-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 12 6 — — $42,356.40 $63,534.60 $42,356.40 2024-10-01
779339 CDM Cannula Dual 31fr 51cm 20 11 $150,241.00 $150,241.00 $24,188.80 $135,216.90 $42,345.43 2024-10-01
779721 CDM Kit Prfsn Bypass Tube 20 11 $150,241.00 $150,241.00 $24,188.80 $135,216.90 $42,345.43 2024-10-01
899667 CDM Kit Bld Pmp Tndmhrt Acc 20 11 $150,241.00 $150,241.00 $24,188.80 $135,216.90 $42,345.43 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 32 15 — — $8,942.00 $76,510.00 $42,180.33 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 26 10 — — $8,942.00 $77,009.09 $42,015.30 2024-10-01
68280 CDM Dial Thromb&stent 16 9 $106,423.00 $106,423.00 $17,134.10 $95,780.70 $41,930.66 2024-10-01
68267 CDM Dial Thromb&stent 16 9 $106,423.00 $106,423.00 $17,134.10 $95,780.70 $41,930.66 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 32 15 — — $4,153.00 $63,266.01 $41,797.74 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 26 10 — — $8,942.00 $64,967.42 $41,753.20 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 29 14 — — $8,942.00 $62,301.62 $41,534.41 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 29 15 — — $10,550.00 $62,162.73 $41,441.82 2024-10-01
1580 OTHER New Technology - Level 43 12 6 — — $40,977.46 $61,466.19 $40,977.46 2024-10-01
1594 OTHER New Technology - Level 43 12 6 — — $40,977.46 $61,466.19 $40,977.46 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 32 15 — — $8,942.00 $61,852.47 $40,863.87 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 32 15 — — $6,067.00 $61,795.33 $40,826.12 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 32 15 — — $6,067.00 $61,787.49 $40,820.93 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 29 15 — — $14,070.00 $60,947.43 $40,631.62 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 29 15 — — $14,070.00 $60,683.08 $40,455.39 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 8 6 — — $28,144.00 $83,019.84 $40,315.94 2024-10-01
784946 CDM Gft Stnt 185x40-46 Ff Tp 13 8 $82,700.00 $82,700.00 $13,314.70 $74,430.00 $40,109.50 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 8 6 — — $30,541.00 $69,044.47 $40,042.19 2024-10-01
63717 CDM Cath 1 Or M 2nd Od Rnlbi 16 9 $101,552.00 $101,552.00 $16,349.87 $91,396.80 $40,011.49 2024-10-01
63729 CDM Cath 1 Or M 2nd Od Rnlbi 16 9 $101,552.00 $101,552.00 $16,349.87 $91,396.80 $40,011.49 2024-10-01
J9269 HCPCS Tagraxf-erzs 1000mcg Inj 20 12 $182,948.06 $182,948.06 $326.00 $164,653.25 $39,425.31 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 25 10 — — $10,550.00 $59,041.05 $39,360.70 2024-10-01
64013 CDM Ins/rpl Icd W/lead 16 9 $99,836.00 $99,836.00 $16,073.60 $89,852.40 $39,335.38 2024-10-01
64015 CDM Rmvl + Rplc Icd Dual 16 9 $99,836.00 $99,836.00 $16,073.60 $89,852.40 $39,335.38 2024-10-01
67128 CDM Rmvl + Rplc Icd Mltp 16 9 $99,836.00 $99,836.00 $16,073.60 $89,852.40 $39,335.38 2024-10-01
67125 CDM Ins/rpl Icd W/lead 16 9 $99,836.00 $99,836.00 $16,073.60 $89,852.40 $39,335.38 2024-10-01
67129 CDM Ins/rpl Sq Icd W/lead 16 9 $99,836.00 $99,836.00 $16,073.60 $89,852.40 $39,335.38 2024-10-01
67127 CDM Rmvl + Rplc Icd Dual 16 9 $99,836.00 $99,836.00 $16,073.60 $89,852.40 $39,335.38 2024-10-01
67090 CDM Ins/rpl Sq Icd W/lead 16 9 $99,836.00 $99,836.00 $16,073.60 $89,852.40 $39,335.38 2024-10-01
64014 CDM Rmvl + Rplc Icd Sgl 16 9 $99,836.00 $99,836.00 $16,073.60 $89,852.40 $39,335.38 2024-10-01
64016 CDM Rmvl + Rplc Icd Mltp 16 9 $99,836.00 $99,836.00 $16,073.60 $89,852.40 $39,335.38 2024-10-01
67126 CDM Rmvl + Rplc Icd Sgl 16 9 $99,836.00 $99,836.00 $16,073.60 $89,852.40 $39,335.38 2024-10-01
67118 CDM Ins Icd Gen Only Mltp 16 9 $99,596.00 $99,596.00 $16,034.96 $89,636.40 $39,240.82 2024-10-01
64006 CDM Ins Icd Gen Only Mltp 16 9 $99,596.00 $99,596.00 $16,034.96 $89,636.40 $39,240.82 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 29 15 — — $14,070.00 $58,851.75 $39,234.50 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 30 15 — — $8,942.00 $58,245.78 $38,830.52 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 32 15 — — $8,942.00 $58,420.51 $38,596.49 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 32 15 — — $4,153.00 $66,916.78 $38,293.62 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 30 14 — — $8,942.00 $57,396.75 $38,264.50 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 32 15 — — $6,067.00 $57,773.10 $38,168.76 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 29 15 — — $14,070.00 $75,698.78 $38,115.16 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 32 15 — — $6,067.00 $57,381.08 $37,910.29 2024-10-01
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 12 6 — — $37,724.20 $56,586.30 $37,724.20 2024-10-01
64914 CDM Prc D-el Cor Stnt Ath Ld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64949 CDM Prc D-e Cor Revsc Chrnlm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64937 CDM Prc D-e Cor Revsc Ami Lc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64948 CDM Prc D-e Cor Revsc Chrnld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64913 CDM Prc D-el Cor Stnt Ath Lc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64930 CDM Ptca Rvs Gft Stnt Sgl Lc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64916 CDM Prc D-el Cor Stnt Ath Rc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64915 CDM Prc D-el Cor Stnt Ath Lm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64938 CDM Prc D-e Cor Revsc Ami Ld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64945 CDM Rvsc Ami Stn Thrm Sgl Rc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64910 CDM Ptca Stnt W Ang Sgl Ri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64947 CDM Prc D-e Cor Revsc Chrnlc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64908 CDM Ptca Stnt W Ang Sgl Lm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64946 CDM Rvsc Ami Stn Thrm Sgl Ri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64909 CDM Ptca Stnt W Ang Sgl Rc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64940 CDM Prc D-e Cor Revsc Ami Rc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64907 CDM Ptca Stnt W Ang Sgl Ld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64952 CDM Rvsc Chr Stn Thrm Sgl Lc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64921 CDM Ptca Stn W Ath Sgl Rc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64929 CDM Prc D-el Cor Rvsc Cabgri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64927 CDM Prc D-el Cor Rvsc Cabglm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64904 CDM Perc Drug El Cor Stnt Rc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64941 CDM Prc D-e Cor Revsc Ami Ri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64926 CDM Prc D-el Cor Rvsc Cabgld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64905 CDM Perc Drug El Cor Stnt Ri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64942 CDM Rvsc Ami Stn Thrm Sgl Lc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64943 CDM Rvsc Ami Stn Thrm Sgl Ld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64903 CDM Perc Drug El Cor Stnt Lm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64918 CDM Ptca Stn W Ath Sgl Lc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64944 CDM Rvsc Ami Stn Thrm Sgl Lm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64901 CDM Perc Drug El Cor Stnt Lc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64902 CDM Perc Drug El Cor Stnt Ld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64953 CDM Rvsc Chr Stn Thrm Sgl Ld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64922 CDM Ptca Stn W Ath Sgl Ri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64933 CDM Ptca Rvs Gft Stnt Sgl Rc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64954 CDM Rvsc Chr Stn Thrm Sgl Lm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64934 CDM Ptca Rvs Gft Stnt Sgl Ri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64939 CDM Prc D-e Cor Revsc Ami Lm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64917 CDM Prc D-el Cor Stnt Ath Ri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64893 CDM Ptca Single Vessel Ri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64950 CDM Prc D-e Cor Revsc Chrnrc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64919 CDM Ptca Stn W Ath Sgl Ld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64892 CDM Ptca Single Vessel Rc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64951 CDM Prc D-e Cor Revsc Chrnri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64920 CDM Ptca Stn W Ath Sgl Lm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64925 CDM Prc D-el Cor Rvsc Cabglc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64890 CDM Ptca Single Vessel Ld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64955 CDM Rvsc Chr Stn Thrm Sgl Rc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64928 CDM Prc D-el Cor Rvsc Cabgrc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64931 CDM Ptca Rvs Gft Stnt Sgl Ld 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64932 CDM Ptca Rvs Gft Stnt Sgl Lm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64956 CDM Rvsc Chr Stn Thrm Sgl Ri 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64889 CDM Ptca Single Vessel Lc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64891 CDM Ptca Single Vessel Lm 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
64906 CDM Ptca Stnt W Ang Sgl Lc 16 9 $95,591.00 $95,591.00 $15,390.15 $86,031.90 $37,662.85 2024-10-01
897552 CDM Kit Device Guided 3cm 20 11 $132,906.00 $132,906.00 $21,397.87 $119,615.40 $37,459.56 2024-10-01
245 MS_DRG Aicd Generator Procedures 29 15 — — $14,070.00 $56,092.96 $37,395.31 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 29 14 — — $8,942.00 $55,671.81 $37,114.54 2024-10-01
122912 CDM Ins Leadless Ppm Atrial 16 9 $93,453.00 $93,453.00 $15,045.93 $84,107.70 $36,820.48 2024-10-01
122541 CDM Ins Leadless Ppm Atrial 16 9 $93,453.00 $93,453.00 $15,045.93 $84,107.70 $36,820.48 2024-10-01
122908 CDM Upgrd Leadless Ppm +atr 16 9 $93,453.00 $93,453.00 $15,045.93 $84,107.70 $36,820.48 2024-10-01
789172 CDM Insrt Perm Pcmkr Ldless 16 9 $93,453.00 $93,453.00 $15,045.93 $84,107.70 $36,820.48 2024-10-01
122895 CDM Upgrd Leadless Ppm +atr 16 9 $93,453.00 $93,453.00 $15,045.93 $84,107.70 $36,820.48 2024-10-01
122896 CDM Ins Leadless Ppm Dual 16 9 $93,453.00 $93,453.00 $15,045.93 $84,107.70 $36,820.48 2024-10-01
788898 CDM Insrt Perm Pcmkr Ldless 16 9 $93,453.00 $93,453.00 $15,045.93 $84,107.70 $36,820.48 2024-10-01
122909 CDM Ins Leadless Ppm Dual 16 9 $93,453.00 $93,453.00 $15,045.93 $84,107.70 $36,820.48 2024-10-01
22800 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; Up To 6 Vert… 12 6 — — $14,784.00 $57,176.00 $36,708.00 2024-10-01
22802 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 7 To 12 Vert… 12 6 — — $14,784.00 $57,176.00 $36,708.00 2024-10-01
22810 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 Verteb… 12 6 — — $14,784.00 $57,176.00 $36,708.00 2024-10-01
22812 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 8 Or More Ver… 12 6 — — $14,784.00 $57,176.00 $36,708.00 2024-10-01
22808 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 2 To 3 Verteb… 12 6 — — $14,784.00 $57,176.00 $36,708.00 2024-10-01
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