|
J3391
|
HCPCS
|
Inj, Atidarsagene Autotemcel
|
7
|
7
|
—
|
—
|
$4,162,276.71
|
$4,323,918.52
|
$4,243,097.62
|
2025-12-15
|
|
J1414
|
HCPCS
|
Inj, Beqvez, Per Tx Dose
|
7
|
7
|
—
|
—
|
$3,527,594.88
|
$3,664,588.86
|
$3,596,091.87
|
2025-12-15
|
|
J1411
|
HCPCS
|
Inj, Hemgenix, Per Tx Dose
|
7
|
7
|
—
|
—
|
$3,504,077.59
|
$3,640,158.27
|
$3,572,117.93
|
2025-12-15
|
|
J1413
|
HCPCS
|
Inj Delandistrogene Mox Rokl
|
7
|
7
|
—
|
—
|
$3,161,116.66
|
$3,283,878.48
|
$3,222,497.57
|
2025-12-15
|
|
J3394
|
HCPCS
|
Inj, Lovotibeglogene Autotem
|
7
|
7
|
—
|
—
|
$3,101,007.87
|
$3,221,435.36
|
$3,161,221.62
|
2025-12-15
|
|
J3393
|
HCPCS
|
Inj, Betibeglogene Autotemce
|
11
|
7
|
—
|
—
|
$2,805,613.80
|
$4,864,551.99
|
$2,860,091.74
|
2025-12-15
|
|
J3399
|
HCPCS
|
Onasemnogene Abeparvovec Xioi 20 Trillion vg/mL Inj
|
30
|
16
|
—
|
$3,381,618.00
|
$1,933,158.29
|
$4,959,706.40
|
$2,818,015.00
|
2025-12-15
|
|
J3392
|
HCPCS
|
Inj, Exagamglogene Autotem
|
11
|
7
|
—
|
—
|
$2,217,345.35
|
$3,847,800.00
|
$2,260,400.60
|
2025-12-15
|
|
65128198_IP
|
CDM
|
Pharmacy Uh
|
5
|
1
|
—
|
—
|
$1,859,889.90
|
$2,536,213.50
|
$2,254,412.00
|
2025-12-15
|
|
5834
|
APR_DRG
|
Neonate With Ecmo
|
3
|
3
|
—
|
—
|
$1,252,089.48
|
$1,299,517.12
|
$1,252,089.48
|
2025-12-15
|
|
Q2042
|
HCPCS
|
Tisagenlecleucel (kymriah Dlbcl) Susp IV Infusion
|
59
|
16
|
$1,494,666.95
|
$896,800.17
40% off
|
$493,240.09
|
$1,674,988.70
|
$856,528.31
|
2025-12-15
|
|
5833
|
APR_DRG
|
Neonate With Ecmo
|
3
|
3
|
—
|
—
|
$755,979.43
|
$784,615.02
|
$755,979.43
|
2025-12-15
|
|
Q2057
|
HCPCS
|
Afamitresgene Autoleucel
|
11
|
7
|
—
|
—
|
$732,731.85
|
$1,271,523.00
|
$746,959.65
|
2025-12-15
|
|
Q2041
|
HCPCS
|
Axicabtagene Ciloleucel (yescarta) Susp 68 Ml IV Infusion
|
33
|
16
|
$1,484,000.00
|
$890,400.00
40% off
|
$489,720.00
|
$1,305,920.00
|
$727,160.00
|
2025-12-15
|
|
Q2053
|
HCPCS
|
Brexucabtagene (1 X T Cells) Susp 68 Ml IV Infusion
|
33
|
16
|
$1,484,000.00
|
$890,400.00
40% off
|
$465,642.52
|
$1,305,920.00
|
$727,160.00
|
2025-12-15
|
|
Q2056
|
HCPCS
|
Ciltacabtagene Car-pos T
|
14
|
7
|
—
|
—
|
$526,171.52
|
$1,465,898.64
|
$720,540.06
|
2025-12-15
|
|
Q2055
|
HCPCS
|
Idecabtagene Vicleucel (abecma) Susp
|
33
|
16
|
$1,435,000.00
|
$861,000.00
40% off
|
$473,550.00
|
$1,262,800.00
|
$703,150.00
|
2025-12-15
|
|
Q2054
|
HCPCS
|
Lisocabtagene Maraleucel (breyanzi) Susp
|
33
|
16
|
$1,435,000.00
|
$861,000.00
40% off
|
$473,550.00
|
$1,262,800.00
|
$703,150.00
|
2025-12-15
|
|
6094
|
APR_DRG
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
3
|
3
|
—
|
—
|
$556,492.66
|
$577,571.93
|
$556,492.66
|
2025-12-15
|
|
114
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
3
|
3
|
—
|
—
|
$546,442.37
|
$567,140.94
|
$546,442.37
|
2025-12-15
|
|
113
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
3
|
3
|
—
|
—
|
$546,442.37
|
$567,140.94
|
$546,442.37
|
2025-12-15
|
|
5914
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
3
|
3
|
—
|
—
|
$533,622.96
|
$553,835.95
|
$533,622.96
|
2025-12-15
|
|
5832
|
APR_DRG
|
Neonate With Ecmo
|
3
|
3
|
—
|
—
|
$474,393.84
|
$492,363.30
|
$474,393.84
|
2025-12-15
|
|
C9301
|
HCPCS
|
Obecabtagene Car Pos T
|
4
|
1
|
—
|
—
|
$449,930.25
|
$459,112.50
|
$459,112.50
|
2025-12-15
|
|
6314
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
3
|
3
|
—
|
—
|
$444,831.46
|
$461,681.14
|
$444,831.46
|
2025-12-15
|
|
112
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
3
|
3
|
—
|
—
|
$428,530.87
|
$444,763.10
|
$428,530.87
|
2025-12-15
|
|
5882
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
3
|
3
|
—
|
—
|
$401,522.84
|
$416,732.04
|
$401,522.84
|
2025-12-15
|
|
5883
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
3
|
3
|
—
|
—
|
$401,522.84
|
$416,732.04
|
$401,522.84
|
2025-12-15
|
|
5884
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
3
|
3
|
—
|
—
|
$401,522.84
|
$416,732.04
|
$401,522.84
|
2025-12-15
|
|
5934
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
3
|
3
|
—
|
—
|
$383,019.38
|
$397,527.69
|
$383,019.38
|
2025-12-15
|
|
5913
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
3
|
3
|
—
|
—
|
$363,748.11
|
$377,526.45
|
$363,748.11
|
2025-12-15
|
|
6304
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
3
|
3
|
—
|
—
|
$360,089.52
|
$373,729.27
|
$360,089.52
|
2025-12-15
|
|
5831
|
APR_DRG
|
Neonate With Ecmo
|
3
|
3
|
—
|
—
|
$346,532.58
|
$359,658.81
|
$346,532.58
|
2025-12-15
|
|
18
|
MS_DRG
|
Chimeric Antigen Receptor (car) T-cell Immunotherapy
|
15
|
9
|
—
|
—
|
$309,244.96
|
$473,861.33
|
$337,004.42
|
2025-12-15
|
|
5912
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
3
|
3
|
—
|
—
|
$335,942.49
|
$348,667.59
|
$335,942.49
|
2025-12-15
|
|
5881
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
3
|
3
|
—
|
—
|
$328,607.62
|
$341,054.88
|
$328,607.62
|
2025-12-15
|
|
1614
|
APR_DRG
|
Implantable Heart Assist Systems
|
3
|
3
|
—
|
—
|
$314,979.19
|
$326,910.22
|
$314,979.19
|
2025-12-15
|
|
94
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
3
|
3
|
—
|
—
|
$287,845.75
|
$298,749.00
|
$287,845.75
|
2025-12-15
|
|
1613
|
APR_DRG
|
Implantable Heart Assist Systems
|
3
|
3
|
—
|
—
|
$273,950.70
|
$284,327.62
|
$273,950.70
|
2025-12-15
|
|
6024
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$273,822.60
|
$284,194.66
|
$273,822.60
|
2025-12-15
|
|
8414
|
APR_DRG
|
Extensive Third Degree Burns With Skin Graft
|
3
|
3
|
—
|
—
|
$269,464.36
|
$279,671.35
|
$269,464.36
|
2025-12-15
|
|
Q2058
|
HCPCS
|
Obecbtge Autol Up To 400 Mil
|
7
|
7
|
—
|
—
|
$257,081.80
|
$267,065.56
|
$262,073.68
|
2025-12-15
|
|
6074
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$261,914.49
|
$271,835.50
|
$261,914.49
|
2025-12-15
|
|
6034
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
3
|
3
|
—
|
—
|
$253,903.81
|
$263,521.38
|
$253,903.81
|
2025-12-15
|
|
5893
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
3
|
3
|
—
|
—
|
$251,886.99
|
$261,428.17
|
$251,886.99
|
2025-12-15
|
|
5891
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
3
|
3
|
—
|
—
|
$251,886.99
|
$261,428.17
|
$251,886.99
|
2025-12-15
|
|
5892
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
3
|
3
|
—
|
—
|
$251,886.99
|
$261,428.17
|
$251,886.99
|
2025-12-15
|
|
1
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
14
|
8
|
—
|
—
|
$225,930.13
|
$353,934.69
|
$249,831.53
|
2025-12-15
|
|
6023
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$246,406.18
|
$255,739.75
|
$246,406.18
|
2025-12-15
|
|
5933
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
3
|
3
|
—
|
—
|
$240,736.08
|
$249,854.87
|
$240,736.08
|
2025-12-15
|
|
5932
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
3
|
3
|
—
|
—
|
$239,014.71
|
$248,068.30
|
$239,014.71
|
2025-12-15
|
|
6334
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Anomaly
|
3
|
3
|
—
|
—
|
$226,956.23
|
$235,553.06
|
$226,956.23
|
2025-12-15
|
|
6093
|
APR_DRG
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
3
|
3
|
—
|
—
|
$220,721.77
|
$229,082.44
|
$220,721.77
|
2025-12-15
|
|
6114
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
3
|
3
|
—
|
—
|
$220,205.19
|
$228,546.29
|
$220,205.19
|
2025-12-15
|
|
44
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
3
|
3
|
—
|
—
|
$216,434.83
|
$224,633.12
|
$216,434.83
|
2025-12-15
|
|
8634
|
APR_DRG
|
Neonatal Aftercare
|
3
|
3
|
—
|
—
|
$210,096.30
|
$218,054.49
|
$210,096.30
|
2025-12-15
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
15
|
9
|
—
|
—
|
$124,852.05
|
$298,076.98
|
$208,708.66
|
2025-12-15
|
|
6073
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$191,624.68
|
$198,883.19
|
$191,624.68
|
2025-12-15
|
|
6124
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$191,037.33
|
$198,273.59
|
$191,037.33
|
2025-12-15
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
16
|
9
|
—
|
—
|
$166,044.30
|
$714,198.00
|
$190,526.18
|
2025-12-15
|
|
Q0480
|
HCPCS
|
Driver Pneumatic Vad, Rep
|
1
|
1
|
—
|
—
|
$173,999.90
|
$173,999.90
|
$173,999.90
|
2025-12-15
|
|
1611
|
APR_DRG
|
Implantable Heart Assist Systems
|
3
|
3
|
—
|
—
|
$171,305.03
|
$177,793.86
|
$171,305.03
|
2025-12-15
|
|
1612
|
APR_DRG
|
Implantable Heart Assist Systems
|
3
|
3
|
—
|
—
|
$171,305.03
|
$177,793.86
|
$171,305.03
|
2025-12-15
|
|
E0766
|
HCPCS
|
Elec Stim Cancer Treatment
|
1
|
1
|
—
|
—
|
$169,910.53
|
$169,910.53
|
$169,910.53
|
2025-12-15
|
|
1604
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
3
|
3
|
—
|
—
|
$166,530.43
|
$172,838.41
|
$166,530.43
|
2025-12-15
|
|
481S2045
|
CDM
|
Abiomed 1000100 Kit Impella 5.5 W/smart Asst Heart Pump-card
|
21
|
12
|
$270,000.00
|
$162,000.00
40% off
|
$4,500.00
|
$237,600.00
|
$165,240.00
|
2025-12-15
|
|
S0108341
|
CDM
|
Abiomed 1000100 Kit Impella 5.5 W/smart Assist Heart Pump
|
21
|
12
|
$270,000.00
|
$162,000.00
40% off
|
$4,500.00
|
$237,600.00
|
$165,240.00
|
2025-12-15
|
|
93
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
3
|
3
|
—
|
—
|
$163,985.99
|
$170,197.58
|
$163,985.99
|
2025-12-15
|
|
6022
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$159,932.26
|
$165,990.30
|
$159,932.26
|
2025-12-15
|
|
111
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
3
|
3
|
—
|
—
|
$152,255.25
|
$158,022.50
|
$152,255.25
|
2025-12-15
|
|
62002042
|
CDM
|
Kidney Acquisition Liv Donor
|
20
|
11
|
$234,101.78
|
$140,461.07
40% off
|
$4,500.00
|
$206,009.57
|
$152,166.16
|
2025-12-15
|
|
62002018
|
CDM
|
Kidney Acquisition Cadaveric
|
20
|
11
|
$234,101.78
|
$140,461.07
40% off
|
$4,500.00
|
$206,009.57
|
$152,166.16
|
2025-12-15
|
|
6214
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Major Anomaly
|
3
|
3
|
—
|
—
|
$150,766.33
|
$156,477.18
|
$150,766.33
|
2025-12-15
|
|
54
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
3
|
3
|
—
|
—
|
$147,632.87
|
$153,225.02
|
$147,632.87
|
2025-12-15
|
|
6303
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
3
|
3
|
—
|
—
|
$145,004.23
|
$150,496.82
|
$145,004.23
|
2025-12-15
|
|
8424
|
APR_DRG
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
3
|
3
|
—
|
—
|
$144,100.82
|
$149,559.19
|
$144,100.82
|
2025-12-15
|
|
6134
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
3
|
3
|
—
|
—
|
$140,547.77
|
$145,871.54
|
$140,547.77
|
2025-12-15
|
|
1624
|
APR_DRG
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$138,473.91
|
$143,719.14
|
$138,473.91
|
2025-12-15
|
|
6021
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$133,862.18
|
$138,932.71
|
$133,862.18
|
2025-12-15
|
|
43
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
3
|
3
|
—
|
—
|
$132,671.13
|
$137,696.55
|
$132,671.13
|
2025-12-15
|
|
5931
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
3
|
3
|
—
|
—
|
$132,342.47
|
$137,355.45
|
$132,342.47
|
2025-12-15
|
|
6084
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
3
|
3
|
—
|
—
|
$127,963.85
|
$132,810.96
|
$127,963.85
|
2025-12-15
|
|
6083
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
3
|
3
|
—
|
—
|
$127,963.85
|
$132,810.96
|
$127,963.85
|
2025-12-15
|
|
6113
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
3
|
3
|
—
|
—
|
$127,323.42
|
$132,146.28
|
$127,323.42
|
2025-12-15
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
15
|
9
|
—
|
—
|
$101,754.36
|
$177,543.45
|
$125,056.82
|
2025-12-15
|
|
214
|
APR_DRG
|
Open Craniotomy Except Trauma
|
3
|
3
|
—
|
—
|
$123,249.92
|
$127,918.48
|
$123,249.92
|
2025-12-15
|
|
6032
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
3
|
3
|
—
|
—
|
$122,247.75
|
$126,878.34
|
$122,247.75
|
2025-12-15
|
|
6033
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
3
|
3
|
—
|
—
|
$122,247.75
|
$126,878.34
|
$122,247.75
|
2025-12-15
|
|
7
|
MS_DRG
|
Lung Transplant
|
14
|
8
|
—
|
—
|
$85,939.58
|
$164,209.47
|
$116,905.74
|
2025-12-15
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
15
|
9
|
—
|
—
|
$105,395.82
|
$164,624.12
|
$116,090.64
|
2025-12-15
|
|
3034
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
3
|
3
|
—
|
—
|
$114,729.94
|
$119,075.77
|
$114,729.94
|
2025-12-15
|
|
J7330
|
HCPCS
|
Cultured Chondrocytes Implnt
|
8
|
3
|
—
|
—
|
$84,549.68
|
$130,327.56
|
$114,195.34
|
2025-12-15
|
|
6123
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$113,005.75
|
$117,286.28
|
$113,005.75
|
2025-12-15
|
|
6213
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Major Anomaly
|
3
|
3
|
—
|
—
|
$112,538.70
|
$116,801.53
|
$112,538.70
|
2025-12-15
|
|
6072
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$112,220.25
|
$116,471.02
|
$112,220.25
|
2025-12-15
|
|
6092
|
APR_DRG
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
3
|
3
|
—
|
—
|
$109,430.31
|
$113,575.40
|
$109,430.31
|
2025-12-15
|
|
1634
|
APR_DRG
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$109,182.11
|
$113,317.80
|
$109,182.11
|
2025-12-15
|
|
6344
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…
|
3
|
3
|
—
|
—
|
$108,614.73
|
$112,728.93
|
$108,614.73
|
2025-12-15
|
|
6814
|
APR_DRG
|
Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
3
|
3
|
—
|
—
|
$108,424.51
|
$112,531.50
|
$108,424.51
|
2025-12-15
|
|
8514
|
APR_DRG
|
Gender Related Procedures
|
3
|
3
|
—
|
—
|
$108,404.74
|
$112,510.98
|
$108,404.74
|
2025-12-15
|
|
1304
|
APR_DRG
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
3
|
3
|
—
|
—
|
$107,377.42
|
$111,444.75
|
$107,377.42
|
2025-12-15
|
|
6144
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition
|
3
|
3
|
—
|
—
|
$106,389.16
|
$110,419.05
|
$106,389.16
|
2025-12-15
|
|
6313
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
3
|
3
|
—
|
—
|
$105,532.89
|
$109,530.35
|
$105,532.89
|
2025-12-15
|
|
2994
|
APR_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical
|
3
|
3
|
—
|
—
|
$104,335.70
|
$108,287.81
|
$104,335.70
|
2025-12-15
|
|
6133
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
3
|
3
|
—
|
—
|
$103,641.67
|
$107,567.50
|
$103,641.67
|
2025-12-15
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
14
|
8
|
—
|
—
|
$90,361.54
|
$138,462.53
|
$103,321.71
|
2025-12-15
|
|
3044
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
3
|
3
|
—
|
—
|
$102,689.36
|
$106,579.11
|
$102,689.36
|
2025-12-15
|
|
1784
|
APR_DRG
|
External Heart Assist Devices
|
3
|
3
|
—
|
—
|
$101,922.39
|
$105,783.08
|
$101,922.39
|
2025-12-15
|
|
90288
|
HCPCS
|
Botulism Ig IV
|
1
|
1
|
—
|
—
|
$99,702.00
|
$99,702.00
|
$99,702.00
|
2025-12-15
|
|
7524
|
APR_DRG
|
Personality Disorders
|
4
|
4
|
—
|
—
|
$75,465.76
|
$103,388.09
|
$99,614.80
|
2025-12-15
|
|
630407788
|
CDM
|
Abiomed 4000021 Kit Cath Impella C9 W/smrt Assist-jclb
|
21
|
12
|
$162,000.00
|
$97,200.00
40% off
|
$4,500.00
|
$142,560.00
|
$99,144.00
|
2025-12-15
|
|
S0112039
|
CDM
|
Abiomed 1000323 Set Rp Flex W/smart Assist Impella
|
21
|
12
|
$162,000.00
|
$97,200.00
40% off
|
$4,500.00
|
$142,560.00
|
$99,144.00
|
2025-12-15
|
|
48107788
|
CDM
|
Abiomed 4000021 Kit Cath Impella C9 W/smrt Assist-card
|
21
|
12
|
$162,000.00
|
$97,200.00
40% off
|
$4,500.00
|
$142,560.00
|
$99,144.00
|
2025-12-15
|
|
48108435
|
CDM
|
Abiomed 1000323 Set Pump Heart Impella Rp Flex-card
|
21
|
12
|
$162,000.00
|
$97,200.00
40% off
|
$4,500.00
|
$142,560.00
|
$99,144.00
|
2025-12-15
|
|
9114
|
APR_DRG
|
Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma
|
3
|
3
|
—
|
—
|
$99,015.79
|
$102,766.39
|
$99,015.79
|
2025-12-15
|
|
6091
|
APR_DRG
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
3
|
3
|
—
|
—
|
$98,265.25
|
$101,987.42
|
$98,265.25
|
2025-12-15
|
|
8633
|
APR_DRG
|
Neonatal Aftercare
|
3
|
3
|
—
|
—
|
$97,256.85
|
$100,940.82
|
$97,256.85
|
2025-12-15
|
|
6223
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$97,110.00
|
$100,788.41
|
$97,110.00
|
2025-12-15
|
|
6224
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$97,110.00
|
$100,788.41
|
$97,110.00
|
2025-12-15
|
|
6333
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Anomaly
|
3
|
3
|
—
|
—
|
$96,949.01
|
$100,621.32
|
$96,949.01
|
2025-12-15
|
|
212
|
MS_DRG
|
Concomitant Aortic And Mitral Valve Procedures
|
18
|
10
|
—
|
—
|
$51,646.00
|
$136,881.85
|
$96,837.14
|
2025-12-15
|
|
6143
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition
|
3
|
3
|
—
|
—
|
$96,708.41
|
$100,371.61
|
$96,708.41
|
2025-12-15
|
|
4284
|
APR_DRG
|
Genetic Disorders
|
3
|
3
|
—
|
—
|
$96,520.88
|
$100,176.98
|
$96,520.88
|
2025-12-15
|
|
53
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
3
|
3
|
—
|
—
|
$96,333.97
|
$99,982.98
|
$96,333.97
|
2025-12-15
|
|
C1824
|
HCPCS
|
Impulse 10-b501-3-xx Generator Pulse Mini Optimizer-card
|
44
|
12
|
$169,000.00
|
$101,400.00
40% off
|
$43,316.00
|
$148,720.00
|
$95,940.00
|
2025-12-15
|
|
42
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
3
|
3
|
—
|
—
|
$95,733.50
|
$99,359.77
|
$95,733.50
|
2025-12-15
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
14
|
8
|
—
|
—
|
$87,325.08
|
$133,809.71
|
$95,606.99
|
2025-12-15
|
|
6071
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$95,602.69
|
$99,224.00
|
$95,602.69
|
2025-12-15
|
|
C1822
|
HCPCS
|
Nevro Hf10-c Kit Ipg Senza Omnia Charger Pt Remote Control
|
44
|
12
|
$175,500.00
|
$105,300.00
40% off
|
$39,780.00
|
$154,440.00
|
$95,062.50
|
2025-12-15
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
19
|
10
|
—
|
—
|
$39,657.00
|
$133,123.66
|
$94,228.91
|
2025-12-15
|
|
92
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
3
|
3
|
—
|
—
|
$94,105.90
|
$97,670.52
|
$94,105.90
|
2025-12-15
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
12
|
7
|
—
|
—
|
$31,903.00
|
$131,623.40
|
$93,187.71
|
2025-12-15
|
|
J9029
|
HCPCS
|
Nadofaragene Firadenovec Vncg (adstiladrin)
|
27
|
16
|
$210,000.00
|
$126,000.00
40% off
|
$60,312.41
|
$184,800.00
|
$92,610.00
|
2025-12-15
|
|
1834
|
APR_DRG
|
Percutaneous Structural Cardiac Procedures
|
3
|
3
|
—
|
—
|
$92,269.11
|
$95,764.15
|
$92,269.11
|
2025-12-15
|
|
6804
|
APR_DRG
|
Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
3
|
3
|
—
|
—
|
$91,068.17
|
$94,517.72
|
$91,068.17
|
2025-12-15
|
|
6904
|
APR_DRG
|
Acute Leukemia
|
3
|
3
|
—
|
—
|
$90,860.04
|
$94,301.70
|
$90,860.04
|
2025-12-15
|
|
6234
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection
|
3
|
3
|
—
|
—
|
$90,594.25
|
$94,025.85
|
$90,594.25
|
2025-12-15
|
|
1654
|
APR_DRG
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$90,402.14
|
$93,826.46
|
$90,402.14
|
2025-12-15
|
|
6954
|
APR_DRG
|
Chemotherapy For Acute Leukemia
|
3
|
3
|
—
|
—
|
$90,118.04
|
$93,531.60
|
$90,118.04
|
2025-12-15
|
|
6122
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…
|
3
|
3
|
—
|
—
|
$90,100.67
|
$93,513.57
|
$90,100.67
|
2025-12-15
|
|
3033
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
3
|
3
|
—
|
—
|
$90,017.10
|
$93,426.83
|
$90,017.10
|
2025-12-15
|
|
S0097351_IP
|
CDM
|
Edwards 9600ct20a Kit Valve Certitude Transcath Sapien3 20mm
|
1
|
1
|
—
|
—
|
$89,375.00
|
$89,375.00
|
$89,375.00
|
2025-12-15
|
|
6082
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
3
|
3
|
—
|
—
|
$89,025.02
|
$92,397.18
|
$89,025.02
|
2025-12-15
|
|
2604
|
APR_DRG
|
Major Pancreas, Liver And Shunt Procedures
|
3
|
3
|
—
|
—
|
$86,151.00
|
$89,414.30
|
$86,151.00
|
2025-12-15
|
|
6254
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Other Significant Condition
|
3
|
3
|
—
|
—
|
$86,056.40
|
$89,316.11
|
$86,056.40
|
2025-12-15
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
20
|
11
|
—
|
—
|
$39,657.00
|
$121,266.07
|
$85,999.59
|
2025-12-15
|
|
1674
|
APR_DRG
|
Other Cardiothoracic And Thoracic Circulatory Procedures
|
3
|
3
|
—
|
—
|
$84,625.37
|
$87,830.88
|
$84,625.37
|
2025-12-15
|
|
1623
|
APR_DRG
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$84,576.47
|
$87,780.12
|
$84,576.47
|
2025-12-15
|
|
914
|
APR_DRG
|
Other Major Head And Neck Procedures
|
3
|
3
|
—
|
—
|
$83,861.51
|
$87,038.09
|
$83,861.51
|
2025-12-15
|
|
1794
|
APR_DRG
|
Defibrillator Implants
|
3
|
3
|
—
|
—
|
$82,845.83
|
$85,983.93
|
$82,845.83
|
2025-12-15
|
|
9104
|
APR_DRG
|
Craniotomy For Multiple Significant Trauma
|
3
|
3
|
—
|
—
|
$82,676.19
|
$85,807.87
|
$82,676.19
|
2025-12-15
|
|
S0097141_IP
|
CDM
|
Medtronic Evolutpro-29-US Valve Aortic Corevalve 29mm Ster
|
1
|
1
|
—
|
—
|
$82,500.00
|
$82,500.00
|
$82,500.00
|
2025-12-15
|
|
48108086_IP
|
CDM
|
Medtronic Evolutpro-29-US Valve Aortic Evolutpro 29mm
|
1
|
1
|
—
|
—
|
$82,500.00
|
$82,500.00
|
$82,500.00
|
2025-12-15
|
|
2204
|
APR_DRG
|
Major Stomach, Esophageal And Duodenal Procedures
|
3
|
3
|
—
|
—
|
$82,369.20
|
$85,489.25
|
$82,369.20
|
2025-12-15
|
|
850
|
MS_DRG
|
Acute Leukemia With Other Procedures
|
10
|
7
|
—
|
—
|
$80,604.51
|
$115,747.52
|
$82,169.65
|
2025-12-15
|
|
3124
|
APR_DRG
|
Skin Graft For Musculoskeletal And Connective Tissue Diagnoses
|
3
|
3
|
—
|
—
|
$81,999.76
|
$85,105.81
|
$81,999.76
|
2025-12-15
|
|
L7181
|
HCPCS
|
Electronic Elbo Simultaneous
|
1
|
1
|
—
|
—
|
$81,788.63
|
$81,788.63
|
$81,788.63
|
2025-12-15
|
|
8413
|
APR_DRG
|
Extensive Third Degree Burns With Skin Graft
|
3
|
3
|
—
|
—
|
$81,485.66
|
$84,572.24
|
$81,485.66
|
2025-12-15
|
|
1783
|
APR_DRG
|
External Heart Assist Devices
|
3
|
3
|
—
|
—
|
$80,816.51
|
$83,877.74
|
$80,816.51
|
2025-12-15
|
|
1664
|
APR_DRG
|
Coronary Bypass Without Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$80,088.04
|
$83,121.68
|
$80,088.04
|
2025-12-15
|
|
7754
|
APR_DRG
|
Alcohol Abuse And Dependence
|
4
|
4
|
—
|
—
|
$60,416.50
|
$82,770.61
|
$79,749.78
|
2025-12-15
|
|
3214
|
APR_DRG
|
Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures
|
3
|
3
|
—
|
—
|
$79,528.17
|
$82,540.60
|
$79,528.17
|
2025-12-15
|
|
6302
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
3
|
3
|
—
|
—
|
$79,140.82
|
$82,138.58
|
$79,140.82
|
2025-12-15
|
|
481S1319
|
CDM
|
Livanova 5820-2916 Kit Pump W/29f Vv Cannula Protekduo-card
|
21
|
12
|
$129,000.00
|
$77,400.00
40% off
|
$4,500.00
|
$113,520.00
|
$78,948.00
|
2025-12-15
|
|
481S1320
|
CDM
|
Livanova 5820-3118 Kit Pump W/31f Vv Cannula Protekduo-card
|
21
|
12
|
$129,000.00
|
$77,400.00
40% off
|
$4,500.00
|
$113,520.00
|
$78,948.00
|
2025-12-15
|
|
3004
|
APR_DRG
|
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical
|
3
|
3
|
—
|
—
|
$78,893.35
|
$81,881.74
|
$78,893.35
|
2025-12-15
|
|
1694
|
APR_DRG
|
Major Abdominal Vascular Procedures
|
3
|
3
|
—
|
—
|
$78,502.06
|
$81,475.63
|
$78,502.06
|
2025-12-15
|
|
B0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
7
|
7
|
—
|
—
|
$76,710.78
|
$79,689.84
|
$78,200.31
|
2025-12-15
|
|
6394
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
3
|
3
|
—
|
—
|
$78,066.95
|
$81,024.03
|
$78,066.95
|
2025-12-15
|
|
52
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
3
|
3
|
—
|
—
|
$77,828.74
|
$80,776.80
|
$77,828.74
|
2025-12-15
|
|
2304
|
APR_DRG
|
Major Small Bowel Procedures
|
3
|
3
|
—
|
—
|
$77,599.79
|
$80,539.18
|
$77,599.79
|
2025-12-15
|
|
1603
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
3
|
3
|
—
|
—
|
$76,621.56
|
$79,523.90
|
$76,621.56
|
2025-12-15
|
|
91
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
3
|
3
|
—
|
—
|
$76,139.73
|
$79,023.81
|
$76,139.73
|
2025-12-15
|
|
7924
|
APR_DRG
|
Extensive O.r. Procedures For Other Complications Of Treatment
|
3
|
3
|
—
|
—
|
$76,136.61
|
$79,020.57
|
$76,136.61
|
2025-12-15
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
20
|
11
|
—
|
—
|
$39,657.00
|
$106,474.55
|
$75,734.09
|
2025-12-15
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
20
|
11
|
—
|
—
|
$21,740.00
|
$106,415.50
|
$75,693.10
|
2025-12-15
|
|
9504
|
APR_DRG
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis
|
3
|
3
|
—
|
—
|
$75,283.26
|
$78,134.89
|
$75,283.26
|
2025-12-15
|
|
A9699
|
HCPCS
|
Radiopharm Rx Agent Noc
|
5
|
2
|
—
|
—
|
$73,122.44
|
$75,510.15
|
$74,614.73
|
2025-12-15
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
11
|
7
|
—
|
—
|
$36,688.00
|
$104,799.64
|
$74,571.67
|
2025-12-15
|
|
7104
|
APR_DRG
|
Infectious And Parasitic Diseases Including HIV With O.r. Procedure
|
3
|
3
|
—
|
—
|
$74,529.81
|
$77,352.91
|
$74,529.81
|
2025-12-15
|
|
6112
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
3
|
3
|
—
|
—
|
$74,116.46
|
$76,923.90
|
$74,116.46
|
2025-12-15
|
|
L7180
|
HCPCS
|
Electronic Elbow Sequential
|
1
|
1
|
—
|
—
|
$73,700.17
|
$73,700.17
|
$73,700.17
|
2025-12-15
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
15
|
9
|
—
|
—
|
$66,101.02
|
$101,287.72
|
$73,508.35
|
2025-12-15
|
|
8504
|
APR_DRG
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…
|
3
|
3
|
—
|
—
|
$73,448.55
|
$76,230.69
|
$73,448.55
|
2025-12-15
|
|
48107556
|
CDM
|
Abiomed 005042 Catheter Impella 2.5
|
21
|
12
|
$120,000.00
|
$72,000.00
40% off
|
$4,500.00
|
$105,600.00
|
$73,440.00
|
2025-12-15
|
|
C1736
|
HCPCS
|
Recor Prds-ppp System Prds Denervation Renal Ultrasound-card
|
21
|
12
|
$120,000.00
|
$72,000.00
40% off
|
$32,640.00
|
$105,600.00
|
$73,440.00
|
2025-12-15
|
|
444
|
APR_DRG
|
Intracranial Hemorrhage
|
3
|
3
|
—
|
—
|
$73,270.60
|
$76,046.00
|
$73,270.60
|
2025-12-15
|
|
1303
|
APR_DRG
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
3
|
3
|
—
|
—
|
$73,194.53
|
$75,967.05
|
$73,194.53
|
2025-12-15
|
|
504
|
APR_DRG
|
Non-bacterial Infections Of Nervous System Except Viral Meningitis
|
3
|
3
|
—
|
—
|
$73,122.27
|
$75,892.05
|
$73,122.27
|
2025-12-15
|
|
J9226
|
HCPCS
|
Supprelin La Implant
|
15
|
8
|
—
|
—
|
$43,320.38
|
$83,642.27
|
$73,107.87
|
2025-12-15
|
|
234
|
APR_DRG
|
Spinal Procedures
|
3
|
3
|
—
|
—
|
$72,687.82
|
$75,441.15
|
$72,687.82
|
2025-12-15
|
|
B1904
|
HCPCS
|
Guillain-barr? M <38.50
|
7
|
7
|
—
|
—
|
$70,910.31
|
$73,664.11
|
$72,287.21
|
2025-12-15
|
|
4414
|
APR_DRG
|
Major Bladder Procedures
|
3
|
3
|
—
|
—
|
$72,258.03
|
$74,995.07
|
$72,258.03
|
2025-12-15
|
|
C1826
|
HCPCS
|
Medtronic 977118 Generator Neurostim Intellis Pro Recharge
|
22
|
12
|
$120,250.00
|
$72,150.00
40% off
|
$32,708.00
|
$105,820.00
|
$72,150.00
|
2025-12-15
|
|
C1882
|
HCPCS
|
Cardiovascular Lab
|
331
|
12
|
$120,218.00
|
$72,130.80
40% off
|
$29,172.00
|
$204,421.36
|
$72,130.80
|
2025-12-15
|
|
7504
|
APR_DRG
|
Schizophrenia And Other Severe Psychotic Disorders
|
4
|
4
|
—
|
—
|
$54,581.17
|
$74,776.20
|
$72,047.14
|
2025-12-15
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
14
|
8
|
—
|
—
|
$38,861.56
|
$100,180.75
|
$72,045.77
|
2025-12-15
|
|
7594
|
APR_DRG
|
Eating Disorders
|
4
|
4
|
—
|
—
|
$54,258.75
|
$74,334.49
|
$71,621.55
|
2025-12-15
|
|
894
|
APR_DRG
|
Major Cranial Or Facial Bone Procedures
|
3
|
3
|
—
|
—
|
$71,388.03
|
$74,092.12
|
$71,388.03
|
2025-12-15
|
|
19
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
15
|
9
|
—
|
—
|
$60,556.67
|
$99,606.52
|
$70,967.58
|
2025-12-15
|
|
7404
|
APR_DRG
|
Mental Illness Diagnosis With O.r. Procedure
|
4
|
4
|
—
|
—
|
$53,724.70
|
$73,602.84
|
$70,916.60
|
2025-12-15
|
|
9124
|
APR_DRG
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
3
|
3
|
—
|
—
|
$70,555.48
|
$73,228.03
|
$70,555.48
|
2025-12-15
|
|
4014
|
APR_DRG
|
Adrenal Procedures
|
3
|
3
|
—
|
—
|
$70,542.99
|
$73,215.07
|
$70,542.99
|
2025-12-15
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization With Mcc
|
20
|
11
|
—
|
—
|
$39,657.00
|
$98,213.07
|
$70,000.51
|
2025-12-15
|
|
2993
|
APR_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical
|
3
|
3
|
—
|
—
|
$69,895.70
|
$72,543.27
|
$69,895.70
|
2025-12-15
|
|
1782
|
APR_DRG
|
External Heart Assist Devices
|
3
|
3
|
—
|
—
|
$69,498.16
|
$72,130.66
|
$69,498.16
|
2025-12-15
|
|
1204
|
APR_DRG
|
Major Respiratory And Chest Procedures
|
3
|
3
|
—
|
—
|
$69,462.78
|
$72,093.95
|
$69,462.78
|
2025-12-15
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
21
|
11
|
—
|
—
|
$21,681.00
|
$97,221.69
|
$69,312.47
|
2025-12-15
|
|
C1767
|
HCPCS
|
Hospital Supplies
|
550
|
12
|
$117,325.00
|
$70,395.00
40% off
|
$2,176.00
|
$207,693.20
|
$69,094.32
|
2025-12-15
|
|
C2642
|
HCPCS
|
Hospital Supplies
|
177
|
19
|
$114,550.00
|
$68,730.00
40% off
|
$102.56
|
$163,372.00
|
$68,730.00
|
2025-12-15
|
|
6233
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection
|
3
|
3
|
—
|
—
|
$68,589.66
|
$71,187.75
|
$68,589.66
|
2025-12-15
|
|
7584
|
APR_DRG
|
Disorders Of Impulse Control & Development
|
4
|
4
|
—
|
—
|
$51,602.20
|
$70,695.01
|
$68,114.90
|
2025-12-15
|
|
41
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
3
|
3
|
—
|
—
|
$67,826.84
|
$70,396.04
|
$67,826.84
|
2025-12-15
|
|
7114
|
APR_DRG
|
Post-operative, Post-trauma, Other Device Infections With O.r. Procedure
|
3
|
3
|
—
|
—
|
$67,235.74
|
$69,782.55
|
$67,235.74
|
2025-12-15
|
|
5204
|
APR_DRG
|
Other GYN Procedures For Malignancy
|
3
|
3
|
—
|
—
|
$66,938.11
|
$69,473.65
|
$66,938.11
|
2025-12-15
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
15
|
9
|
—
|
—
|
$57,260.63
|
$103,000.00
|
$66,929.23
|
2025-12-15
|
|
6604
|
APR_DRG
|
Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula…
|
3
|
3
|
—
|
—
|
$66,333.13
|
$68,845.75
|
$66,333.13
|
2025-12-15
|
|
2644
|
APR_DRG
|
Other Hepatobiliary, Pancreas And Abdominal Procedures
|
3
|
3
|
—
|
—
|
$66,257.51
|
$68,767.26
|
$66,257.51
|
2025-12-15
|
|
8423
|
APR_DRG
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
3
|
3
|
—
|
—
|
$66,165.92
|
$68,672.21
|
$66,165.92
|
2025-12-15
|
|
L2006
|
HCPCS
|
Kaf Sng/dbl Swg/stn Mcpr Cus
|
1
|
1
|
—
|
—
|
$65,640.18
|
$65,640.18
|
$65,640.18
|
2025-12-15
|
|
1602
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
3
|
3
|
—
|
—
|
$65,603.96
|
$68,088.96
|
$65,603.96
|
2025-12-15
|
|
4234
|
APR_DRG
|
Inborn Errors Of Metabolism
|
3
|
3
|
—
|
—
|
$65,003.60
|
$67,465.86
|
$65,003.60
|
2025-12-15
|
|
1214
|
APR_DRG
|
Other Respiratory And Chest Procedures
|
3
|
3
|
—
|
—
|
$64,813.06
|
$67,268.10
|
$64,813.06
|
2025-12-15
|
|
2614
|
APR_DRG
|
Major Biliary Tract Procedures
|
3
|
3
|
—
|
—
|
$64,784.95
|
$67,238.93
|
$64,784.95
|
2025-12-15
|
|
4854
|
APR_DRG
|
Prostatectomy Procedures
|
3
|
3
|
—
|
—
|
$64,357.25
|
$66,795.02
|
$64,357.25
|
2025-12-15
|
|
C1891
|
HCPCS
|
Intera Onc Ap0300h Pump Infusion Heptic Artery Integra 3000
|
22
|
12
|
$107,228.00
|
$64,336.80
40% off
|
$29,166.02
|
$94,360.64
|
$64,336.80
|
2025-12-15
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
18
|
10
|
—
|
—
|
$51,646.00
|
$88,796.86
|
$64,314.91
|
2025-12-15
|
|
1622
|
APR_DRG
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$64,157.44
|
$66,587.64
|
$64,157.44
|
2025-12-15
|
|
48107310_IP
|
CDM
|
Medtronic Dtba1d1 Generator Crt-d Viva Xt Df1
|
1
|
1
|
—
|
—
|
$64,075.00
|
$64,075.00
|
$64,075.00
|
2025-12-15
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
12
|
7
|
—
|
—
|
$31,903.00
|
$89,245.43
|
$63,776.84
|
2025-12-15
|
|
3614
|
APR_DRG
|
Skin Graft For Skin And Subcutaneous Tissue Diagnoses
|
3
|
3
|
—
|
—
|
$63,755.74
|
$66,170.73
|
$63,755.74
|
2025-12-15
|
|
1633
|
APR_DRG
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$63,280.14
|
$65,677.12
|
$63,280.14
|
2025-12-15
|
|
6081
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
3
|
3
|
—
|
—
|
$63,250.39
|
$65,646.24
|
$63,250.39
|
2025-12-15
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
18
|
10
|
—
|
—
|
$54,674.32
|
$83,778.39
|
$63,027.13
|
2025-12-15
|
|
C0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
7
|
7
|
—
|
—
|
$61,388.57
|
$63,772.59
|
$62,580.58
|
2025-12-15
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
15
|
9
|
—
|
—
|
$52,728.36
|
$87,408.42
|
$62,501.94
|
2025-12-15
|
|
1833
|
APR_DRG
|
Percutaneous Structural Cardiac Procedures
|
3
|
3
|
—
|
—
|
$62,423.67
|
$64,788.20
|
$62,423.67
|
2025-12-15
|
|
1302
|
APR_DRG
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
3
|
3
|
—
|
—
|
$62,281.47
|
$64,640.61
|
$62,281.47
|
2025-12-15
|
|
6903
|
APR_DRG
|
Acute Leukemia
|
3
|
3
|
—
|
—
|
$62,156.23
|
$64,510.63
|
$62,156.23
|
2025-12-15
|
|
204
|
APR_DRG
|
Open Craniotomy For Trauma
|
3
|
3
|
—
|
—
|
$62,152.05
|
$64,506.30
|
$62,152.05
|
2025-12-15
|
|
1781
|
APR_DRG
|
External Heart Assist Devices
|
3
|
3
|
—
|
—
|
$62,137.48
|
$64,491.17
|
$62,137.48
|
2025-12-15
|
|
6343
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…
|
3
|
3
|
—
|
—
|
$61,955.37
|
$64,302.17
|
$61,955.37
|
2025-12-15
|
|
1804
|
APR_DRG
|
Other Circulatory System Procedures
|
3
|
3
|
—
|
—
|
$61,832.58
|
$64,174.72
|
$61,832.58
|
2025-12-15
|
|
3032
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
3
|
3
|
—
|
—
|
$61,700.40
|
$64,037.54
|
$61,700.40
|
2025-12-15
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
15
|
9
|
—
|
—
|
$51,613.92
|
$103,000.00
|
$61,384.01
|
2025-12-15
|
|
1793
|
APR_DRG
|
Defibrillator Implants
|
3
|
3
|
—
|
—
|
$61,215.45
|
$63,534.22
|
$61,215.45
|
2025-12-15
|
|
1814
|
APR_DRG
|
Lower Extremity Vascular Procedures
|
3
|
3
|
—
|
—
|
$61,078.09
|
$63,391.65
|
$61,078.09
|
2025-12-15
|
|
924
|
APR_DRG
|
Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures
|
3
|
3
|
—
|
—
|
$61,022.93
|
$63,334.40
|
$61,022.93
|
2025-12-15
|
|
6993050
|
OTHER
|
Implant Cochlear Device
|
3
|
3
|
—
|
—
|
$61,010.04
|
$65,077.38
|
$61,010.04
|
2025-12-15
|
|
6393
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Other Significant Condition
|
3
|
3
|
—
|
—
|
$60,989.41
|
$63,299.62
|
$60,989.41
|
2025-12-15
|
|
D0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
7
|
7
|
—
|
—
|
$59,794.68
|
$62,116.81
|
$60,955.74
|
2025-12-15
|
|
274
|
APR_DRG
|
Other Open Craniotomy
|
3
|
3
|
—
|
—
|
$60,734.67
|
$63,035.22
|
$60,734.67
|
2025-12-15
|
|
3043
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back
|
3
|
3
|
—
|
—
|
$60,730.49
|
$63,030.89
|
$60,730.49
|
2025-12-15
|
|
6253
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Other Significant Condition
|
3
|
3
|
—
|
—
|
$60,609.05
|
$62,904.85
|
$60,609.05
|
2025-12-15
|
|
481S2080
|
CDM
|
Livanova 5840-0000 Kit Tandem Oxygentor/blood Pump-card
|
21
|
12
|
$99,000.00
|
$59,400.00
40% off
|
$4,500.00
|
$87,120.00
|
$60,588.00
|
2025-12-15
|
|
3134
|
APR_DRG
|
Knee And Lower Leg Procedures Except Foot
|
3
|
3
|
—
|
—
|
$60,571.28
|
$62,865.64
|
$60,571.28
|
2025-12-15
|
|
S0098883_IP
|
CDM
|
Boston Sci Db-1110-c Generator Pulse Vercise Implantbl
|
1
|
1
|
—
|
—
|
$60,500.00
|
$60,500.00
|
$60,500.00
|
2025-12-15
|
|
C1722
|
HCPCS
|
Cardiovascular Lab
|
266
|
12
|
$101,500.00
|
$60,900.00
40% off
|
$21,767.07
|
$152,810.24
|
$60,450.00
|
2025-12-15
|
|
1824
|
APR_DRG
|
Other Peripheral Vascular And Related Procedures
|
3
|
3
|
—
|
—
|
$60,312.15
|
$62,596.70
|
$60,312.15
|
2025-12-15
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
11
|
7
|
—
|
—
|
$31,903.00
|
$84,244.56
|
$60,306.17
|
2025-12-15
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
15
|
9
|
—
|
—
|
$48,224.26
|
$83,920.38
|
$60,081.20
|
2025-12-15
|
|
6514
|
APR_DRG
|
Other Procedures Of Blood And Blood-forming Organs
|
3
|
3
|
—
|
—
|
$59,997.87
|
$62,270.51
|
$59,997.87
|
2025-12-15
|
|
B1806
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
7
|
7
|
—
|
—
|
$58,835.70
|
$61,120.58
|
$59,978.14
|
2025-12-15
|
|
348S1438
|
CDM
|
Angiodynamics H965251960 Kit Cannula 180d Angiovac-perf
|
21
|
12
|
$97,875.00
|
$58,725.00
40% off
|
$4,500.00
|
$86,130.00
|
$59,899.50
|
2025-12-15
|
|
S0104511
|
CDM
|
Angiodynamics H965251960 Kit Angvac Cann 180d Diltr Bbl Trp
|
21
|
12
|
$97,875.00
|
$58,725.00
40% off
|
$4,500.00
|
$86,130.00
|
$59,899.50
|
2025-12-15
|
|
5114
|
APR_DRG
|
Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy
|
3
|
3
|
—
|
—
|
$59,706.48
|
$61,968.09
|
$59,706.48
|
2025-12-15
|
|
1673
|
APR_DRG
|
Other Cardiothoracic And Thoracic Circulatory Procedures
|
3
|
3
|
—
|
—
|
$59,625.31
|
$61,883.85
|
$59,625.31
|
2025-12-15
|
|
5124
|
APR_DRG
|
Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy
|
3
|
3
|
—
|
—
|
$59,414.04
|
$61,664.58
|
$59,414.04
|
2025-12-15
|
|
6624
|
APR_DRG
|
Sickle Cell Anemia Crisis
|
3
|
3
|
—
|
—
|
$59,354.50
|
$61,602.78
|
$59,354.50
|
2025-12-15
|
|
C1735
|
HCPCS
|
Medtronic Rdn016 Catheter Denervation Renal Spyral-card
|
21
|
12
|
$96,000.00
|
$57,600.00
40% off
|
$26,112.00
|
$84,480.00
|
$58,752.00
|
2025-12-15
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
20
|
11
|
—
|
—
|
$39,657.00
|
$83,186.00
|
$58,707.86
|
2025-12-15
|
|
7934
|
APR_DRG
|
Moderately Extensive O.r. Procedures For Other Complications Of Treatment
|
3
|
3
|
—
|
—
|
$58,649.16
|
$60,870.72
|
$58,649.16
|
2025-12-15
|
|
6456850
|
OTHER
|
Opn Impltj Crnl Nrv Nea&pg
|
3
|
3
|
—
|
—
|
$58,450.86
|
$62,347.58
|
$58,450.86
|
2025-12-15
|
|
6458250
|
OTHER
|
Opn Mpltj Hpglsl Nstm Ary Pg
|
3
|
3
|
—
|
—
|
$58,450.86
|
$62,347.58
|
$58,450.86
|
2025-12-15
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
15
|
9
|
—
|
—
|
$47,068.02
|
$81,260.37
|
$58,235.11
|
2025-12-15
|
|
7574
|
APR_DRG
|
Organic Mental Health Conditions And Disturbances
|
4
|
4
|
—
|
—
|
$44,077.57
|
$60,386.27
|
$58,182.39
|
2025-12-15
|
|
4424
|
APR_DRG
|
Kidney And Urinary Tract Procedures For Malignancy
|
3
|
3
|
—
|
—
|
$58,164.20
|
$60,367.39
|
$58,164.20
|
2025-12-15
|
|
6364
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection
|
3
|
3
|
—
|
—
|
$58,061.48
|
$60,260.78
|
$58,061.48
|
2025-12-15
|
|
1653
|
APR_DRG
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$58,046.60
|
$60,245.34
|
$58,046.60
|
2025-12-15
|
|
7614
|
APR_DRG
|
Schizoaffective Disorders
|
3
|
3
|
—
|
—
|
$57,930.63
|
$60,124.97
|
$57,930.63
|
2025-12-15
|
|
S0090537_IP
|
CDM
|
Nuvasive P10.7-80d335 System Nail Troch Fem 10.7x80x335mm
|
1
|
1
|
—
|
—
|
$57,750.00
|
$57,750.00
|
$57,750.00
|
2025-12-15
|
|
3094
|
APR_DRG
|
Other Significant Hip And Femur Surgery
|
3
|
3
|
—
|
—
|
$57,648.03
|
$59,831.67
|
$57,648.03
|
2025-12-15
|
|
C1721
|
HCPCS
|
Cardiovascular Lab
|
135
|
12
|
$97,745.00
|
$58,647.00
40% off
|
$23,898.74
|
$163,660.64
|
$57,616.00
|
2025-12-15
|
|
4054
|
APR_DRG
|
Other Procedures For Endocrine, Nutritional And Metabolic Disorders
|
3
|
3
|
—
|
—
|
$57,205.74
|
$59,372.62
|
$57,205.74
|
2025-12-15
|
|
B0406
|
HCPCS
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
7
|
7
|
—
|
—
|
$56,060.12
|
$58,237.21
|
$57,148.67
|
2025-12-15
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
15
|
9
|
—
|
—
|
$50,062.26
|
$79,464.83
|
$56,988.98
|
2025-12-15
|
|
1663
|
APR_DRG
|
Coronary Bypass Without Ami Or Complex Principal Diagnosis
|
3
|
3
|
—
|
—
|
$56,978.87
|
$59,137.16
|
$56,978.87
|
2025-12-15
|
|
6132
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
3
|
3
|
—
|
—
|
$56,939.85
|
$59,096.66
|
$56,939.85
|
2025-12-15
|
|
1704
|
APR_DRG
|
Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock
|
3
|
3
|
—
|
—
|
$56,806.12
|
$58,957.87
|
$56,806.12
|
2025-12-15
|
|
4034
|
APR_DRG
|
Procedures For Obesity
|
3
|
3
|
—
|
—
|
$56,765.54
|
$58,915.75
|
$56,765.54
|
2025-12-15
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement W Mcc
|
18
|
10
|
—
|
—
|
$49,124.56
|
$83,186.00
|
$56,724.65
|
2025-12-15
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
18
|
10
|
—
|
—
|
$50,794.08
|
$83,181.00
|
$56,685.43
|
2025-12-15
|
|
7724
|
APR_DRG
|
Alcohol And Drug Dependence With Rehabilitation And/or Detoxification Therapy
|
4
|
4
|
—
|
—
|
$42,922.61
|
$58,803.98
|
$56,657.85
|
2025-12-15
|
|
48107336_IP
|
CDM
|
Medtronic Dtba1d4 Generator Crt-d Viva Xt Df4
|
1
|
1
|
—
|
—
|
$56,375.00
|
$56,375.00
|
$56,375.00
|
2025-12-15
|
|
48107431_IP
|
CDM
|
St Jude Cd3365-40q Generator Crt-d Quadra Assura
|
1
|
1
|
—
|
—
|
$56,375.00
|
$56,375.00
|
$56,375.00
|
2025-12-15
|
|
304
|
APR_DRG
|
Percutaneous Intracranial And Extracranial Vascular Procedures
|
3
|
3
|
—
|
—
|
$56,334.70
|
$58,468.59
|
$56,334.70
|
2025-12-15
|
|
38240
|
HCPCS
|
Transplt Allo Hct/donor
|
19
|
11
|
—
|
—
|
$1,017.00
|
$80,668.37
|
$56,234.55
|
2025-12-15
|
|
S0086943_IP
|
CDM
|
Allosource 33547002 Graft Condyle Left Whole
|
1
|
1
|
—
|
—
|
$55,825.00
|
$55,825.00
|
$55,825.00
|
2025-12-15
|
|
893
|
APR_DRG
|
Major Cranial Or Facial Bone Procedures
|
3
|
3
|
—
|
—
|
$55,811.24
|
$57,925.30
|
$55,811.24
|
2025-12-15
|
|
294
|
APR_DRG
|
Other Percutaneous Intracranial Procedures
|
3
|
3
|
—
|
—
|
$55,790.43
|
$57,903.71
|
$55,790.43
|
2025-12-15
|