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

MAINEHEALTH PEN BAY HOSPITAL

Rockport, ME · CCN 200063 · Rates published

11,169 distinct procedures filed
10 distinct payers
289,211 rate rows
2025-09-09 last MRF observed · ⚠ 14 mo old
Data quality

153,348 of 289,211 rate rows are consumer-grade (53.0%)

135,863 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
professional (physician) fee — not the facility price 135,614
exceeds 10× this hospital's gross charge — excluded from medians 135
percent-of-charges filed in the dollar field — excluded from medians 51
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 32
placeholder amount (≤ $0.02) — excluded from medians 24
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 7

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 14 months old.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/7976/010238552-1982645305_mainehealth_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/penbaymedicalcenter/7976
Discovered viaDiscovered by HANK
Last fetch success · 2026-10-31
Content fingerprint 01df9743b73340c0… · 105,982,897 bytes · first seen 2026-10-31

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
J3391
HCPCS 		Apc 5 $4,377,500.00 $4,508,825.00 $4,421,275.00 nat. median
$4,505,000
1.0× median
J1414
HCPCS 		Fee Schedule 5 $3,710,000.00 $3,821,300.00 $3,747,100.00 nat. median
$3,710,000
1.0× median
J1411
HCPCS 		Apc 5 $0.03 $3,795,824.67 $3,703,693.00 nat. median
$3,705,478
1.0× median
J1413
HCPCS 		Apc 5 $0.03 $3,424,309.06 $3,341,194.76 nat. median
$3,324,572
1.0× median
J3394
HCPCS 		Apc 5 $0.03 $3,359,195.65 $3,277,661.77 nat. median
$3,286,000
1.0× median
J3393
HCPCS 		Apc 5 $0.03 $3,039,207.27 $2,965,440.10 nat. median
$2,994,107
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 5 $0.03 $2,525,679.06 $2,464,376.17 nat. median
$2,467,989
1.0× median
J3392
HCPCS 		Apc 5 $2,332,000.00 $2,401,960.00 $2,355,320.00 nat. median
$2,401,965
1.0× median
Q2057
HCPCS 		Apc 5 $770,620.00 $849,762.67 $782,179.30 nat. median
$813,967
1.0× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 5 $578,324.58 $637,718.51 $586,999.44 nat. median
$739,658
0.8× median
Q2056
HCPCS 		Apc 5 $553,378.83 $610,210.84 $561,679.52 nat. median
$646,415
0.9× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 5 $541,635.66 $597,261.64 $549,760.19 nat. median
$640,950
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 5 $541,260.45 $596,847.89 $549,379.35 nat. median
$623,527
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 5 $533,076.48 $587,823.43 $541,072.62 nat. median
$608,239
0.9× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 5 $489,720.00 $540,014.24 $497,065.80 nat. median
$592,235
0.8× median
J9355
HCPCS 		Trastuzumab 150 Mg IV Solr 9 $76.18 $528,886.05 $482,692.92 nat. median
$556
outlier · 867.8×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 5 $383,931.48 $765,461.23 $389,690.45 nat. median
$359,244
1.1× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 5 $286,764.61 $571,735.37 $291,066.08 nat. median
$248,541
1.2× median
Q2058
HCPCS 		Apc 5 $270,375.00 $298,142.51 $274,430.62 nat. median
$319,951
0.9× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 5 $241,507.64 $481,504.52 $245,130.26 nat. median
$198,115
1.2× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 5 $218,182.31 $434,999.76 $221,455.04 nat. median
$190,359
1.2× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And… 5 $143,849.09 $286,798.31 $146,006.83 nat. median
$126,461
1.2× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 5 $133,381.61 $265,928.81 $135,382.33 nat. median
$110,084
1.2× median
7
MS_DRG 		Lung Transplant 5 $133,045.64 $265,259.00 $135,041.33 nat. median
$117,977
1.1× median
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 5 $129,537.50 $142,841.00 $131,480.57 nat. median
$111,503
1.2× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 9 $55,945.97 $140,513.32 $129,227.41 nat. median
$65,720
2.0× median
J9043
HCPCS 		Cabazitaxel 60 Mg/6ml IV Soln 9 $227.10 $128,914.52 $118,560.21 nat. median
$738
outlier · 160.6×
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 5 $112,184.98 $223,668.17 $113,867.76 nat. median
$103,938
1.1× median
K1007
HCPCS 		Bil Hkaf Pc S/d Micro Sensor 5 $111,860.00 $123,348.02 $113,537.90 nat. median
$96,983
1.2× median
212
MS_DRG 		DRG 5 $110,904.29 $221,114.80 $112,567.86 nat. median
$97,137
1.2× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 5 $108,415.17 $216,152.15 $110,041.40 nat. median
$94,943
1.2× median
215
MS_DRG 		Other Heart Assist System Implant 5 $107,859.32 $215,043.93 $109,477.21 nat. median
$93,787
1.2× median
426
MS_DRG 		DRG 5 $106,643.79 $212,620.45 $108,243.45 nat. median
$93,226
1.2× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 5 $98,252.08 $195,889.53 $99,725.86 nat. median
$90,512
1.1× median
850
MS_DRG 		DRG 5 $93,780.86 $186,975.04 $95,187.57 nat. median
$78,164
1.2× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 5 $86,267.71 $171,995.77 $87,561.73 nat. median
$76,979
1.1× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 5 $86,219.87 $171,900.37 $87,513.17 nat. median
$77,487
1.1× median
429
MS_DRG 		DRG 5 $84,910.67 $169,290.16 $86,184.33 nat. median
$77,936
1.1× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 5 $82,065.25 $163,617.11 $83,296.23 nat. median
$74,298
1.1× median
10
MS_DRG 		Pancreas Transplant 5 $81,168.34 $161,828.94 $82,385.87 nat. median
$64,851
1.3× median
L8702
HCPCS 		Ewhf S/d Uprt Micro Sensor 5 $80,943.19 $89,256.06 $82,157.33 nat. median
$70,178
1.2× median
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 5 $80,703.10 $160,901.36 $81,913.65 nat. median
$66,623
1.2× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 5 $79,574.11 $158,650.41 $80,767.72 nat. median
$71,737
1.1× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 5 $78,770.86 $157,048.97 $79,952.43 nat. median
$72,247
1.1× median
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 5 $75,988.55 $151,501.76 $77,128.38 nat. median
$67,908
1.1× median
427
MS_DRG 		DRG 5 $72,308.33 $144,164.35 $73,392.96 nat. median
$63,564
1.2× median
J9228
HCPCS 		Ipilimumab 5 Mg/ml IV Soln (combined) 9 $183.41 $79,700.46 $73,298.99 nat. median
$9,011
outlier · 8.1×
275
MS_DRG 		DRG 5 $71,944.89 $143,439.75 $73,024.07 nat. median
$66,584
1.1× median
870
MS_DRG 		Septicemia Or Severe Sepsis With Mv >96 Hours 5 $70,819.96 $141,196.92 $71,882.26 nat. median
$62,577
1.1× median
955
MS_DRG 		Craniotomy For Multiple Significant Trauma 5 $69,514.84 $138,594.82 $70,557.57 nat. median
$61,660
1.1× median

Other procedures at this hospital

Browse this hospital's 11,169 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
             
288 MS_DRG Acute And Subacute Endocarditis With Mcc 12 5 — — $27,807.77 $55,441.58 $28,224.89 2025-09-09
834 MS_DRG Acute Leukemia Without Major O.r. Procedures With Mcc 12 5 — — $56,270.14 $112,188.27 $57,114.19 2025-09-09
245 MS_DRG Aicd Generator Procedures 12 5 — — $49,749.59 $99,187.97 $50,495.83 2025-09-09
265 MS_DRG Aicd Lead Procedures 12 5 — — $36,315.54 $72,403.89 $36,860.27 2025-09-09
14 MS_DRG Allogeneic Bone Marrow Transplant 12 5 — — $133,381.61 $265,928.81 $135,382.33 2025-09-09
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 12 5 — — $29,647.37 $59,109.27 $30,092.08 2025-09-09
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 12 5 — — $51,277.67 $102,234.56 $52,046.83 2025-09-09
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 12 5 — — $45,656.04 $91,026.49 $46,340.88 2025-09-09
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 12 5 — — $39,347.26 $78,448.37 $39,937.47 2025-09-09
L5973 HCPCS Ank-foot Sys Dors-plant Flex 12 5 — — $25,092.86 $27,669.90 $25,469.26 2025-09-09
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 12 5 — — $67,878.85 $135,333.08 $68,897.04 2025-09-09
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 12 5 — — $42,357.60 $84,450.23 $42,992.96 2025-09-09
J3391 HCPCS Apc 10 5 — — $4,377,500.00 $4,508,825.00 $4,421,275.00 2025-09-09
J1411 HCPCS Apc 12 5 — — $0.03 $3,795,824.67 $3,703,693.00 2025-09-09
J1413 HCPCS Apc 12 5 — — $0.03 $3,424,309.06 $3,341,194.76 2025-09-09
J3394 HCPCS Apc 12 5 — — $0.03 $3,359,195.65 $3,277,661.77 2025-09-09
J3393 HCPCS Apc 12 5 — — $0.03 $3,039,207.27 $2,965,440.10 2025-09-09
J3392 HCPCS Apc 10 5 — — $2,332,000.00 $2,401,960.00 $2,355,320.00 2025-09-09
Q2057 HCPCS Apc 12 5 — — $770,620.00 $849,762.67 $782,179.30 2025-09-09
Q2056 HCPCS Apc 12 5 — — $553,378.83 $610,210.84 $561,679.52 2025-09-09
Q2058 HCPCS Apc 12 5 — — $270,375.00 $298,142.51 $274,430.62 2025-09-09
J9029 HCPCS Apc 12 5 — — $63,431.05 $192,561.72 $64,382.51 2025-09-09
33276 CPT Apc 10 5 — — $43,553.28 $44,859.88 $43,988.82 2025-09-09
L6700 HCPCS Apc 12 5 — — $34,717.87 $38,283.40 $35,238.64 2025-09-09
0915T CPT Apc 12 5 — — $31,030.48 $150,684.28 $31,495.93 2025-09-09
33287 CPT Apc 12 5 — — $29,493.56 $143,220.97 $29,935.96 2025-09-09
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 12 5 — — $61,447.90 $122,511.39 $62,369.62 2025-09-09
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 12 5 — — $61,447.90 $122,511.39 $62,369.62 2025-09-09
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 12 5 — — $533,076.48 $587,823.43 $541,072.62 2025-09-09
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 12 5 — — $36,486.56 $72,744.88 $37,033.86 2025-09-09
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 12 5 — — $24,404.47 $48,656.26 $24,770.53 2025-09-09
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 12 5 — — $37,145.24 $74,058.10 $37,702.42 2025-09-09
96 MS_DRG Bacterial And Tuberculous Infections Of Nervous System Without Cc/mcc 12 5 — — $24,404.47 $48,656.26 $24,770.53 2025-09-09
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 12 5 — — $111,860.00 $123,348.02 $113,537.90 2025-09-09
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 12 5 — — $62,474.08 $124,557.34 $63,411.19 2025-09-09
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 12 5 — — $29,154.65 $58,126.89 $29,591.97 2025-09-09
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 12 5 — — $35,644.64 $71,066.31 $36,179.31 2025-09-09
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 12 5 — — $35,010.40 $69,801.80 $35,535.56 2025-09-09
J9042 HCPCS Brentuximab Vedotin 50 Mg IV Solr 42 9 $29,131.16 $29,131.16 $258.52 $27,383.29 $25,183.89 2025-09-09
Q2053 HCPCS Brexucabtagene Car Pos T 12 5 — — $489,720.00 $540,014.24 $497,065.80 2025-09-09
J9043 HCPCS Cabazitaxel 60 Mg/6ml IV Soln 42 9 $137,143.11 $137,143.11 $227.10 $128,914.52 $118,560.21 2025-09-09
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 12 5 — — $28,561.12 $56,943.57 $28,989.53 2025-09-09
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 12 5 — — $34,676.47 $69,136.05 $35,196.62 2025-09-09
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 5 — — $98,252.08 $195,889.53 $99,725.86 2025-09-09
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 5 — — $65,744.02 $131,076.77 $66,730.18 2025-09-09
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 5 — — $60,566.26 $120,753.66 $61,474.75 2025-09-09
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 5 — — $78,770.86 $157,048.97 $79,952.43 2025-09-09
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 5 — — $53,922.53 $107,507.76 $54,731.37 2025-09-09
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 5 — — $46,754.51 $93,216.55 $47,455.83 2025-09-09
34 MS_DRG Carotid Artery Stent Procedures With Mcc 12 5 — — $39,588.52 $78,929.41 $40,182.35 2025-09-09
472 MS_DRG Cervical Spinal Fusion With Cc 12 5 — — $29,494.66 $58,804.82 $29,937.08 2025-09-09
471 MS_DRG Cervical Spinal Fusion With Mcc 12 5 — — $49,449.28 $98,589.20 $50,191.02 2025-09-09
473 MS_DRG Cervical Spinal Fusion Without Cc/mcc 12 5 — — $24,101.08 $48,051.40 $24,462.60 2025-09-09
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 12 5 — — $50,975.32 $101,631.74 $51,739.95 2025-09-09
846 MS_DRG Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc 12 5 — — $25,998.72 $51,834.79 $26,388.70 2025-09-09
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 5 — — $383,931.48 $765,461.23 $389,690.45 2025-09-09
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 12 5 — — $35,670.11 $71,117.05 $36,205.16 2025-09-09
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 12 5 — — $27,857.66 $55,541.04 $28,275.53 2025-09-09
L8614 HCPCS Cochlear Device 12 5 — — $27,812.64 $30,669.00 $28,229.83 2025-09-09
545 MS_DRG Connective Tissue Disorders With Mcc 12 5 — — $25,724.86 $51,288.79 $26,110.74 2025-09-09
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 12 5 — — $79,574.11 $158,650.41 $80,767.72 2025-09-09
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 12 5 — — $54,161.78 $107,984.74 $54,974.21 2025-09-09
231 MS_DRG Coronary Bypass With Ptca With Mcc 12 5 — — $86,267.71 $171,995.77 $87,561.73 2025-09-09
232 MS_DRG Coronary Bypass With Ptca Without Mcc 12 5 — — $62,189.02 $123,989.02 $63,121.86 2025-09-09
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 12 5 — — $59,903.54 $119,432.31 $60,802.10 2025-09-09
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 12 5 — — $41,862.85 $83,463.79 $42,490.79 2025-09-09
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 12 5 — — $31,137.77 $62,080.77 $31,604.84 2025-09-09
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 12 5 — — $45,529.81 $90,774.81 $46,212.76 2025-09-09
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc 12 5 — — $25,123.18 $50,089.23 $25,500.03 2025-09-09
955 MS_DRG Craniotomy For Multiple Significant Trauma 12 5 — — $69,514.84 $138,594.82 $70,557.57 2025-09-09
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 12 5 — — $58,080.23 $115,797.10 $58,951.43 2025-09-09
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 12 5 — — $38,702.83 $77,163.56 $39,283.38 2025-09-09
56 MS_DRG Degenerative Nervous System Disorders With Mcc 12 5 — — $25,492.76 $50,826.02 $25,875.15 2025-09-09
212 MS_DRG DRG 12 5 — — $110,904.29 $221,114.80 $112,567.86 2025-09-09
426 MS_DRG DRG 12 5 — — $106,643.79 $212,620.45 $108,243.45 2025-09-09
850 MS_DRG DRG 12 5 — — $93,780.86 $186,975.04 $95,187.57 2025-09-09
429 MS_DRG DRG 12 5 — — $84,910.67 $169,290.16 $86,184.33 2025-09-09
427 MS_DRG DRG 12 5 — — $72,308.33 $144,164.35 $73,392.96 2025-09-09
275 MS_DRG DRG 12 5 — — $71,944.89 $143,439.75 $73,024.07 2025-09-09
447 MS_DRG DRG 12 5 — — $68,256.54 $136,086.10 $69,280.39 2025-09-09
276 MS_DRG DRG 12 5 — — $63,061.49 $125,728.48 $64,007.41 2025-09-09
317 MS_DRG DRG 12 5 — — $62,980.03 $125,566.10 $63,924.73 2025-09-09
428 MS_DRG DRG 12 5 — — $56,033.95 $111,717.38 $56,874.46 2025-09-09
430 MS_DRG DRG 12 5 — — $55,691.88 $111,035.39 $56,527.26 2025-09-09
450 MS_DRG DRG 12 5 — — $52,430.09 $104,532.20 $53,216.54 2025-09-09
278 MS_DRG DRG 12 5 — — $50,935.61 $101,552.58 $51,699.65 2025-09-09
277 MS_DRG DRG 12 5 — — $47,358.22 $94,420.17 $48,068.59 2025-09-09
323 MS_DRG DRG 12 5 — — $43,362.41 $86,453.55 $44,012.85 2025-09-09
448 MS_DRG DRG 12 5 — — $41,571.67 $82,883.29 $42,195.24 2025-09-09
402 MS_DRG DRG 12 5 — — $39,827.78 $79,406.39 $40,425.20 2025-09-09
279 MS_DRG DRG 12 5 — — $32,622.07 $65,040.09 $33,111.40 2025-09-09
324 MS_DRG DRG 12 5 — — $32,527.40 $64,851.33 $33,015.31 2025-09-09
451 MS_DRG DRG 12 5 — — $31,416.72 $62,636.91 $31,887.97 2025-09-09
173 MS_DRG DRG 12 5 — — $31,239.59 $62,283.74 $31,708.19 2025-09-09
325 MS_DRG DRG 12 5 — — $29,137.33 $58,092.39 $29,574.39 2025-09-09
321 MS_DRG DRG 12 5 — — $28,981.56 $57,781.84 $29,416.28 2025-09-09
397 MS_DRG DRG 12 5 — — $25,225.01 $50,292.20 $25,603.38 2025-09-09
Q0480 HCPCS Driver Pneumatic Vad, Rep 12 5 — — $129,537.50 $142,841.00 $131,480.57 2025-09-09
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 12 5 — — $218,182.31 $434,999.76 $221,455.04 2025-09-09
J9334 HCPCS Efgartigimod Alfa-hyalur-qvfc 180-2000 Mg-unit/ml Sc Soln 42 9 $38,416.02 $38,416.02 $33.74 $36,111.06 $33,210.65 2025-09-09
L6880 HCPCS Elec Hand Ind Art Digits 12 5 — — $34,363.97 $37,893.15 $34,879.43 2025-09-09
L5856 HCPCS Elec Knee-shin Swing/stance 12 5 — — $34,568.35 $38,118.52 $35,086.88 2025-09-09
L7181 HCPCS Electronic Elbo Simultaneous 12 5 — — $57,614.51 $63,531.52 $58,478.73 2025-09-09
L7180 HCPCS Electronic Elbow Sequential 12 5 — — $52,277.90 $57,646.84 $53,062.07 2025-09-09
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 12 5 — — $60,988.76 $121,595.99 $61,903.60 2025-09-09
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 12 5 — — $47,895.74 $95,491.86 $48,614.18 2025-09-09
0620T CPT Evasc Ven Artlz Tibl/prnl Vn 10 5 — — $33,874.88 $34,891.13 $34,213.63 2025-09-09
L8701 HCPCS Ewh S/d Uprt Micro Sensor 12 5 — — $41,141.33 $45,366.54 $41,758.45 2025-09-09
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 12 5 — — $80,943.19 $89,256.06 $82,157.33 2025-09-09
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 12 5 — — $241,507.64 $481,504.52 $245,130.26 2025-09-09
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 12 5 — — $44,049.59 $87,823.61 $44,710.33 2025-09-09
982 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 12 5 — — $24,924.68 $49,693.44 $25,298.55 2025-09-09
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 12 5 — — $48,396.62 $96,490.48 $49,122.57 2025-09-09
37 MS_DRG Extracranial Procedures With Mcc 12 5 — — $33,808.10 $67,404.71 $34,315.22 2025-09-09
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 12 5 — — $60,520.47 $120,662.32 $61,428.27 2025-09-09
J1414 HCPCS Fee Schedule 10 5 — — $3,710,000.00 $3,821,300.00 $3,747,100.00 2025-09-09
37226 CPT Fem/popl Revasc W/stent 42 9 $30,622.00 $30,622.00 $10,975.86 $53,298.85 $26,472.72 2025-09-09
503 MS_DRG Foot Procedures With Mcc 12 5 — — $26,943.44 $53,718.36 $27,347.59 2025-09-09
793 MS_DRG Full Term Neonate With Major Problems 12 5 — — $42,457.38 $84,649.14 $43,094.24 2025-09-09
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 12 5 — — $67,993.89 $135,562.43 $69,013.80 2025-09-09
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc 12 5 — — $32,377.75 $64,552.96 $32,863.42 2025-09-09
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 12 5 — — $286,764.61 $571,735.37 $291,066.08 2025-09-09
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 12 5 — — $112,184.98 $223,668.17 $113,867.76 2025-09-09
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 12 5 — — $35,931.72 $71,638.69 $36,470.69 2025-09-09
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 12 5 — — $29,859.12 $59,531.45 $30,307.00 2025-09-09
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 12 5 — — $29,940.56 $59,693.83 $30,389.67 2025-09-09
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 12 5 — — $29,672.82 $59,160.02 $30,117.92 2025-09-09
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 12 5 — — $64,383.92 $128,365.08 $65,349.68 2025-09-09
970 MS_DRG HIV With Extensive O.r. Procedures Without Mcc 12 5 — — $27,011.67 $53,854.35 $27,416.85 2025-09-09
974 MS_DRG HIV With Major Related Condition With Mcc 12 5 — — $30,400.71 $60,611.26 $30,856.72 2025-09-09
Q2055 HCPCS Idecabtagene Vicleucel Car 12 5 — — $541,260.45 $596,847.89 $549,379.35 2025-09-09
69930 CPT Implant Cochlear Device 12 5 — — $30,784.88 $149,491.66 $31,246.65 2025-09-09
61886 CPT Implant Neurostim Arrays 12 5 — — $29,493.56 $143,220.97 $29,935.96 2025-09-09
0268T CPT Implt/rpl Crtd Sns Dev Gen 12 5 — — $29,493.56 $143,220.97 $29,935.96 2025-09-09
0266T CPT Implt/rpl Crtd Sns Dev Total 10 5 — — $43,553.28 $44,859.88 $43,988.82 2025-09-09
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 12 5 — — $50,915.25 $101,511.99 $51,678.98 2025-09-09
350 MS_DRG Inguinal And Femoral Hernia Procedures With Mcc 12 5 — — $24,623.34 $49,092.64 $24,992.69 2025-09-09
J3399 HCPCS Inj Onase Abepar-xioi Treat 12 5 — — $0.03 $2,525,679.06 $2,464,376.17 2025-09-09
33270 CPT Ins/rep Subq Defibrillator 12 5 — — $31,030.48 $150,684.28 $31,495.93 2025-09-09
33206 CPT Insert Heart Pm Atrial 42 9 $37,630.20 $37,630.20 $10,128.77 $49,185.37 $32,531.31 2025-09-09
33207 CPT Insert Heart Pm Ventricular 42 9 $37,630.20 $37,630.20 $10,128.77 $49,185.37 $32,531.31 2025-09-09
33213 CPT Insert Pulse Gen Dual Leads 42 9 $36,341.60 $36,341.60 $10,128.77 $49,185.37 $31,417.31 2025-09-09
33212 CPT Insert Pulse Gen Sngl Lead 42 9 $34,525.55 $34,525.55 $8,009.82 $38,895.78 $29,847.34 2025-09-09
0408T CPT Insj/rplc Cardiac Modulj Sys 12 5 — — $31,030.48 $150,684.28 $31,495.93 2025-09-09
33249 CPT Insj/rplcmt Defib W/lead(s) 12 5 — — $31,030.48 $150,684.28 $31,495.93 2025-09-09
0571T CPT Insj/rplcmt Icds Ss Eltrd 12 5 — — $31,030.48 $150,684.28 $31,495.93 2025-09-09
33208 CPT Insrt Heart Pm Atrial & Vent 42 9 $41,076.90 $41,076.90 $10,128.77 $49,185.37 $35,510.98 2025-09-09
33231 CPT Insrt Pulse Gen W/mult Leads 12 5 — — $31,030.48 $150,684.28 $31,495.93 2025-09-09
63685 CPT Insrt/redo Spine N Generator 12 5 — — $29,493.56 $143,220.97 $29,935.96 2025-09-09
L6975 HCPCS Interscap-thor Myoelectronic 12 5 — — $25,573.88 $28,200.32 $25,957.49 2025-09-09
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 12 5 — — $56,270.14 $112,188.27 $57,114.19 2025-09-09
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 12 5 — — $82,065.25 $163,617.11 $83,296.23 2025-09-09
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 12 5 — — $35,940.90 $71,656.95 $36,480.01 2025-09-09
J9228 HCPCS Ipilimumab 5 Mg/ml IV Soln (combined) 42 9 $84,787.72 $84,787.72 $183.41 $79,700.46 $73,298.99 2025-09-09
61 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 12 5 — — $27,521.70 $54,871.23 $27,934.53 2025-09-09
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 12 5 — — $33,167.75 $66,128.02 $33,665.27 2025-09-09
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 12 5 — — $26,309.23 $52,453.85 $26,703.86 2025-09-09
652 MS_DRG Kidney Transplant 12 5 — — $31,268.08 $62,340.57 $31,737.10 2025-09-09
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 12 5 — — $46,904.16 $93,514.92 $47,607.72 2025-09-09
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 12 5 — — $35,351.44 $70,481.75 $35,881.71 2025-09-09
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 12 5 — — $32,773.79 $65,342.52 $33,265.40 2025-09-09
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 12 5 — — $24,193.73 $48,236.11 $24,556.63 2025-09-09
0674T CPT Laps Insj Nw/rpcmt Prm Isdss 12 5 — — $29,493.56 $143,220.97 $29,935.96 2025-09-09
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 12 5 — — $38,913.57 $77,583.71 $39,497.27 2025-09-09
Q2054 HCPCS Lisocabtagene Mara Car Pos T 12 5 — — $541,635.66 $597,261.64 $549,760.19 2025-09-09
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 12 5 — — $108,415.17 $216,152.15 $110,041.40 2025-09-09
6 MS_DRG Liver Transplant Without Mcc 12 5 — — $49,366.81 $98,424.79 $50,107.32 2025-09-09
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 12 5 — — $35,841.12 $71,458.04 $36,378.74 2025-09-09
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 12 5 — — $25,704.50 $51,248.20 $26,090.07 2025-09-09
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 12 5 — — $24,443.15 $48,733.39 $24,809.79 2025-09-09
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 12 5 — — $36,152.64 $72,079.13 $36,694.93 2025-09-09
7 MS_DRG Lung Transplant 12 5 — — $133,045.64 $265,259.00 $135,041.33 2025-09-09
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 12 5 — — $59,273.36 $118,175.92 $60,162.46 2025-09-09
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 12 5 — — $32,465.30 $64,727.52 $32,952.28 2025-09-09
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 12 5 — — $47,639.19 $94,980.37 $48,353.78 2025-09-09
654 MS_DRG Major Bladder Procedures With Cc 12 5 — — $28,730.11 $57,280.50 $29,161.06 2025-09-09
653 MS_DRG Major Bladder Procedures With Mcc 12 5 — — $56,751.66 $113,148.33 $57,602.93 2025-09-09
164 MS_DRG Major Chest Procedures With Cc 12 5 — — $25,624.07 $51,087.85 $26,008.43 2025-09-09
163 MS_DRG Major Chest Procedures With Mcc 12 5 — — $46,923.51 $93,553.49 $47,627.37 2025-09-09
140 MS_DRG Major Head And Neck Procedures With Mcc 12 5 — — $43,054.96 $85,840.58 $43,700.79 2025-09-09
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 12 5 — — $33,276.69 $66,345.20 $33,775.84 2025-09-09
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 12 5 — — $25,941.70 $51,721.12 $26,330.82 2025-09-09
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 12 5 — — $46,747.39 $93,202.35 $47,448.60 2025-09-09
662 MS_DRG Minor Bladder Procedures With Mcc 12 5 — — $31,758.78 $63,318.90 $32,235.17 2025-09-09
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 12 5 — — $27,431.09 $54,690.59 $27,842.56 2025-09-09
Q0483 HCPCS Monitor Elec Vad, Rep 12 5 — — $26,966.90 $29,736.40 $27,371.40 2025-09-09
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 12 5 — — $48,616.52 $96,928.90 $49,345.77 2025-09-09
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 12 5 — — $31,394.31 $62,592.26 $31,865.22 2025-09-09
J9298 HCPCS Nivolumab-relatlimab-rmbw 240-80 Mg/20ml IV Soln 42 9 $36,102.53 $36,102.53 $197.65 $33,936.38 $31,210.64 2025-09-09
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 12 5 — — $36,492.67 $72,757.06 $37,040.06 2025-09-09
C9760 HCPCS Non-blind Interatrial Shunt 10 5 — — $26,616.08 $27,414.57 $26,882.24 2025-09-09
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 12 5 — — $35,658.89 $71,094.72 $36,193.78 2025-09-09
619 MS_DRG O.r. Procedures For Obesity With Mcc 12 5 — — $27,756.86 $55,340.10 $28,173.22 2025-09-09
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 12 5 — — $32,312.60 $64,423.06 $32,797.29 2025-09-09
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 12 5 — — $40,004.89 $79,759.56 $40,604.96 2025-09-09
J2350 HCPCS Ocrelizumab 300 Mg/10ml IV Soln 42 9 $49,286.49 $49,286.49 $59.70 $46,329.30 $42,608.17 2025-09-09
37236 CPT Open/perq Place Stent 1st 42 9 $30,622.00 $30,622.00 $10,975.86 $53,298.85 $26,472.72 2025-09-09
37238 CPT Open/perq Place Stent Same 42 9 $31,540.80 $31,540.80 $10,975.86 $53,298.85 $27,267.02 2025-09-09
64568 CPT Opn Impltj Crnl Nrv Nea&pg 12 5 — — $29,493.56 $143,220.97 $29,935.96 2025-09-09
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 12 5 — — $29,493.56 $143,220.97 $29,935.96 2025-09-09
817 MS_DRG Other Antepartum Diagnoses With O.r. Procedures With Mcc 12 5 — — $25,808.34 $51,455.23 $26,195.46 2025-09-09
228 MS_DRG Other Cardiothoracic Procedures With Mcc 12 5 — — $50,732.00 $101,146.64 $51,492.98 2025-09-09
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 12 5 — — $31,623.40 $63,048.94 $32,097.75 2025-09-09
264 MS_DRG Other Circulatory System O.r. Procedures 12 5 — — $35,581.52 $70,940.46 $36,115.24 2025-09-09
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 12 5 — — $43,426.54 $86,581.42 $44,077.94 2025-09-09
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 12 5 — — $33,614.68 $67,019.06 $34,118.90 2025-09-09
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 12 5 — — $40,168.81 $80,086.35 $40,771.35 2025-09-09
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 12 5 — — $44,720.47 $89,161.19 $45,391.27 2025-09-09
749 MS_DRG Other Female Reproductive System O.r. Procedures With Cc/mcc 12 5 — — $26,352.99 $52,541.12 $26,748.28 2025-09-09
215 MS_DRG Other Heart Assist System Implant 12 5 — — $107,859.32 $215,043.93 $109,477.21 2025-09-09
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 12 5 — — $41,407.76 $82,556.51 $42,028.88 2025-09-09
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 12 5 — — $42,651.81 $85,036.81 $43,291.59 2025-09-09
271 MS_DRG Other Major Cardiovascular Procedures With Cc 12 5 — — $35,065.37 $69,911.40 $35,591.35 2025-09-09
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 12 5 — — $52,256.01 $104,185.12 $53,039.85 2025-09-09
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/mcc 12 5 — — $25,473.40 $50,787.45 $25,855.50 2025-09-09
963 MS_DRG Other Multiple Significant Trauma With Mcc 12 5 — — $27,657.10 $55,141.19 $28,071.96 2025-09-09
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 12 5 — — $31,481.88 $62,766.81 $31,954.11 2025-09-09
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 12 5 — — $40,555.67 $80,857.64 $41,164.01 2025-09-09
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 12 5 — — $41,839.42 $83,417.10 $42,467.01 2025-09-09
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 12 5 — — $75,988.55 $151,501.76 $77,128.38 2025-09-09
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/mcc 12 5 — — $26,915.98 $53,663.56 $27,319.72 2025-09-09
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 12 5 — — $36,494.70 $72,761.12 $37,042.12 2025-09-09
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 12 5 — — $39,197.61 $78,150.00 $39,785.57 2025-09-09
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 12 5 — — $33,182.02 $66,156.43 $33,679.75 2025-09-09
253 MS_DRG Other Vascular Procedures With Cc 12 5 — — $25,990.56 $51,818.55 $26,380.42 2025-09-09
252 MS_DRG Other Vascular Procedures With Mcc 12 5 — — $34,922.85 $69,627.24 $35,446.69 2025-09-09
J2427 HCPCS Paliperidone Palmitate ER 273 Mg/0.88ml IM Susy 112 9 $34,090.48 $34,090.48 $12.96 $48,066.43 $26,957.05 2025-09-09
10 MS_DRG Pancreas Transplant 12 5 — — $81,168.34 $161,828.94 $82,385.87 2025-09-09
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 12 5 — — $28,590.64 $57,002.43 $29,019.50 2025-09-09
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 12 5 — — $55,266.35 $110,186.98 $56,095.35 2025-09-09
J9266 HCPCS Pegaspargase Injection 12 5 — — $28,424.06 $81,922.56 $28,850.42 2025-09-09
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 12 5 — — $39,808.42 $79,367.83 $40,405.54 2025-09-09
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 12 5 — — $31,773.04 $63,347.31 $32,249.64 2025-09-09
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 12 5 — — $38,401.49 $76,562.77 $38,977.51 2025-09-09
335 MS_DRG Peritoneal Adhesiolysis With Mcc 12 5 — — $36,887.65 $73,544.58 $37,440.96 2025-09-09
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 12 5 — — $34,531.93 $68,847.83 $35,049.91 2025-09-09
J9306 HCPCS Pertuzumab 420 Mg/14ml IV Soln 42 9 $32,571.94 $32,571.94 $16.89 $30,617.62 $28,158.44 2025-09-09
J9600 HCPCS Porfimer Sodium Injection 12 5 — — $24,228.42 $71,315.79 $24,591.85 2025-09-09
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 12 5 — — $45,929.90 $91,572.49 $46,618.85 2025-09-09
791 MS_DRG Prematurity With Major Problems 12 5 — — $41,331.42 $82,404.28 $41,951.39 2025-09-09
792 MS_DRG Prematurity Without Major Problems 12 5 — — $24,938.94 $49,721.85 $25,313.03 2025-09-09
665 MS_DRG Prostatectomy With Mcc 12 5 — — $34,955.43 $69,692.19 $35,479.76 2025-09-09
849 MS_DRG Radiotherapy 12 5 — — $27,192.87 $54,215.64 $27,600.76 2025-09-09
332 MS_DRG Rectal Resection With Mcc 12 5 — — $35,312.76 $70,404.62 $35,842.46 2025-09-09
33227 CPT Remove&replace Pm Gen Singl 42 9 $34,525.55 $34,525.55 $8,009.82 $38,895.78 $29,847.34 2025-09-09
33228 CPT Remv&replc Pm Gen Dual Lead 42 9 $36,341.60 $36,341.60 $10,128.77 $49,185.37 $31,417.31 2025-09-09
33229 CPT Remv&replc Pm Gen Mult Leads 42 9 $48,269.95 $48,269.95 $18,457.83 $89,631.41 $41,729.37 2025-09-09
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 12 5 — — $65,838.71 $131,265.53 $66,826.29 2025-09-09
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 12 5 — — $27,322.15 $54,473.41 $27,731.98 2025-09-09
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 12 5 — — $34,869.90 $69,521.70 $35,392.95 2025-09-09
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 12 5 — — $51,865.07 $103,405.71 $52,643.04 2025-09-09
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 12 5 — — $26,706.25 $53,245.43 $27,106.85 2025-09-09
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 12 5 — — $31,030.48 $150,684.28 $31,495.93 2025-09-09
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 12 5 — — $70,819.96 $141,196.92 $71,882.26 2025-09-09
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 12 5 — — $29,096.62 $58,011.20 $29,533.07 2025-09-09
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 12 5 — — $55,392.59 $110,438.66 $56,223.48 2025-09-09
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 12 5 — — $80,703.10 $160,901.36 $81,913.65 2025-09-09
135 MS_DRG Sinus And Mastoid Procedures With Cc/mcc 12 5 — — $24,545.96 $48,938.39 $24,914.15 2025-09-09
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 42 9 $149,482.25 $149,482.25 $55,945.97 $140,513.32 $129,227.41 2025-09-09
570 MS_DRG Skin Debridement With Mcc 12 5 — — $30,645.05 $61,098.39 $31,104.72 2025-09-09
577 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 12 5 — — $27,108.38 $54,047.17 $27,515.00 2025-09-09
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 12 5 — — $54,926.33 $109,509.05 $55,750.22 2025-09-09
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 12 5 — — $35,274.07 $70,327.49 $35,803.18 2025-09-09
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 12 5 — — $62,692.95 $124,993.72 $63,633.35 2025-09-09
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 12 5 — — $38,095.07 $75,951.82 $38,666.49 2025-09-09
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 12 5 — — $39,307.55 $78,369.21 $39,897.16 2025-09-09
500 MS_DRG Soft Tissue Procedures With Mcc 12 5 — — $32,258.63 $64,315.48 $32,742.51 2025-09-09
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 12 5 — — $86,219.87 $171,900.37 $87,513.17 2025-09-09
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 12 5 — — $58,429.39 $116,493.29 $59,305.83 2025-09-09
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 12 5 — — $43,958.97 $87,642.96 $44,618.35 2025-09-09
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 12 5 — — $34,172.56 $68,131.34 $34,685.15 2025-09-09
28 MS_DRG Spinal Procedures With Mcc 12 5 — — $61,891.76 $123,396.34 $62,820.14 2025-09-09
800 MS_DRG Splenectomy With Cc 12 5 — — $29,663.66 $59,141.75 $30,108.61 2025-09-09
799 MS_DRG Splenectomy With Mcc 12 5 — — $48,405.78 $96,508.75 $49,131.87 2025-09-09
L5858 HCPCS Stance Phase Only 12 5 — — $26,723.96 $29,468.51 $27,124.82 2025-09-09
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 12 5 — — $24,719.04 $49,283.44 $25,089.82 2025-09-09
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 12 5 — — $51,706.27 $103,089.07 $52,481.87 2025-09-09
J9226 HCPCS Supprelin La Implant 12 5 — — $45,560.39 $133,909.89 $46,243.79 2025-09-09
33289 CPT Tcat Impl Wrls P-art Prs Snr 12 5 — — $27,514.07 $133,608.57 $27,926.79 2025-09-09
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 12 5 — — $29,188.24 $58,193.87 $29,626.06 2025-09-09
Q2042 HCPCS Tisagenlecleucel Car-pos T 12 5 — — $578,324.58 $637,718.51 $586,999.44 2025-09-09
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 12 5 — — $41,777.31 $83,293.29 $42,403.97 2025-09-09
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 12 5 — — $54,932.42 $109,521.23 $55,756.40 2025-09-09
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc 12 5 — — $26,978.06 $53,787.37 $27,382.73 2025-09-09
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And … 12 5 — — $143,849.09 $286,798.31 $146,006.83 2025-09-09
38240 CPT Transplt Allo Hct/donor 12 5 — — $57,240.31 $277,959.46 $58,098.92 2025-09-09
668 MS_DRG Transurethral Procedures With Mcc 12 5 — — $29,689.12 $59,192.49 $30,134.46 2025-09-09
J9355 HCPCS Trastuzumab 150 Mg IV Solr 56 9 $562,644.73 $562,644.73 $76.18 $528,886.05 $482,692.92 2025-09-09
33214 CPT Upgrade Of Pacemaker System 42 9 $41,076.90 $41,076.90 $10,128.77 $49,185.37 $35,510.98 2025-09-09
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 12 5 — — $26,637.02 $53,107.41 $27,036.57 2025-09-09
J3357 HCPCS Ustekinumab Sub Cu Inj, 1 Mg 42 9 $34,803.95 $34,803.95 $157.68 $32,715.71 $30,088.01 2025-09-09
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 12 5 — — $40,527.15 $80,800.81 $41,135.06 2025-09-09
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 12 5 — — $40,086.36 $79,921.94 $40,687.65 2025-09-09
37241 CPT Vasc Embolize/occlude Venous 42 9 $29,691.90 $29,691.90 $10,975.86 $53,298.85 $25,668.65 2025-09-09
263 MS_DRG Vein Ligation And Stripping 12 5 — — $27,304.84 $54,438.91 $27,714.42 2025-09-09
31 MS_DRG Ventricular Shunt Procedures With Mcc 12 5 — — $42,661.99 $85,057.11 $43,301.92 2025-09-09
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 12 5 — — $54,984.35 $109,624.75 $55,809.12 2025-09-09
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 12 5 — — $30,017.95 $59,848.09 $30,468.22 2025-09-09
901 MS_DRG Wound Debridements For Injuries With Mcc 12 5 — — $45,104.28 $89,926.39 $45,780.85 2025-09-09
A9543 HCPCS Y90 Ibritumomab, Rx 12 5 — — $56,824.55 $198,557.73 $57,676.92 2025-09-09
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