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

LAFAYETTE REGIONAL HEALTH CENTER

Lexington, MO · CCN 261320 · Rates published

14,641 distinct procedures filed
33 distinct payers
363,166 rate rows
2025-01-01 last MRF observed · ⚠ 21 mo old
Data quality

294,421 of 363,166 rate rows are consumer-grade (81.1%)

68,745 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 38,756
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 20,802
per-diem day rate — not a per-procedure price 4,083
template filing: same amount across many unrelated codes — excluded 2,395
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 2,232
placeholder amount (≤ $0.02) — excluded from medians 310
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 104
percent-of-charges filed in the dollar field — excluded from medians 43
exceeds 10× this hospital's gross charge — excluded from medians 20

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 21 months old.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/1aff4dd8cf7a46a7b7873bc95a0315cd?download=true
Found on page https://hcamidwest.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-09-20
Content fingerprint 9277f0f92e830642… · 162,443,065 bytes · first seen 2026-05-08

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
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,897,200.00 $4,897,200.00 $4,897,200.00 nat. median
$2,968,000
1.6× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $3,884,946.48 $3,884,946.48 $3,884,946.48 nat. median
$2,455,111
1.6× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 6 $497,024.65 $837,683.55 $516,905.64 nat. median
$599,737
0.9× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 6 $484,623.49 $863,696.72 $504,008.43 nat. median
$621,313
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 6 $483,453.66 $830,699.97 $502,791.81 nat. median
$574,037
0.9× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 6 $473,458.43 $819,043.85 $492,396.77 nat. median
$579,571
0.8× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 6 $449,440.00 $741,576.00 $467,417.60 nat. median
$513,770
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 6 $449,341.85 $807,075.90 $467,315.52 nat. median
$562,501
0.8× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 1 $120,116.70 $120,116.70 $120,116.70 nat. median
$92,809
1.3× median
447
MS_DRG 		Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 1 $107,961.00 $116,715.00 $112,338.00 nat. median
$2,958
outlier · 38.0×
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 $108,036.36 $108,036.36 $108,036.36 nat. median
$65,477
1.7× median
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 1 $104,773.89 $104,773.89 $104,773.89 nat. median
$66,211
1.6× median
450
MS_DRG 		Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 1 $82,929.00 $89,653.00 $86,291.00 nat. median
$2,736
outlier · 31.5×
A9699
HCPCS 		Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 $76,785.37 $76,785.37 $76,785.37 nat. median
$7,098
outlier · 10.8×
J9226
HCPCS 		Histrelin Implant (supprelin La), 50 Mg 1 $72,861.11 $72,861.11 $72,861.11 nat. median
$57,036
1.3× median
448
MS_DRG 		Multiple Level Spinal Fusion Except Cervical Without Mcc 1 $65,754.00 $71,085.00 $68,419.50 nat. median
$29,826
outlier · 2.3×
222
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 $62,162.10 $62,162.10 $62,162.10 nat. median
$2,024
outlier · 30.7×
0515T
CPT 		Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including… 1 $57,458.00 $62,114.00 $59,786.00 nat. median
$22,512
outlier · 2.7×
0520T
CPT 		Removal And Replacement Of Pulse Generator For Wireless Cardiac Stimulator For L… 1 $57,458.00 $62,114.00 $59,786.00 nat. median
$11,241
outlier · 5.3×
0571T
CPT 		Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S… 1 $57,458.00 $62,114.00 $59,786.00 nat. median
$32,945
1.8× median
C9760
HCPCS 		Non-randomized, Non-blinded Procedure For Nyha Class Ii, Iii, IV Heart Failure;… 1 $57,458.00 $62,114.00 $59,786.00 nat. median
$28,845
outlier · 2.1×
0414T
CPT 		Removal And Replacement Of Permanent Cardiac Contractility Modulation System Pul… 1 $57,458.00 $62,114.00 $59,786.00 nat. median
$24,700
outlier · 2.4×
0100T
CPT 		Placement Of A Subconjunctival Retinal Prosthesis Receiver And Pulse Generator,… 1 $57,458.00 $62,114.00 $59,786.00 nat. median
$11,456
outlier · 5.2×
0614T
CPT 		Removal And Replacement Of Substernal Implantable Defibrillator Pulse Generator 1 $57,458.00 $62,114.00 $59,786.00 nat. median
$24,111
outlier · 2.5×
0409T
CPT 		Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 1 $57,458.00 $62,114.00 $59,786.00 nat. median
$24,700
outlier · 2.4×
0408T
CPT 		Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 1 $57,458.00 $62,114.00 $59,786.00 nat. median
$31,369
1.9× median
Q2043
HCPCS 		Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 6 $53,472.87 $91,596.09 $55,611.78 nat. median
$63,499
0.9× median
224
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 $53,780.76 $53,780.76 $53,780.76 nat. median
$2,024
outlier · 26.6×
451
MS_DRG 		Single Level Spinal Fusion Except Cervical Without Mcc 1 $49,692.00 $53,721.00 $51,706.50 nat. median
$21,019
outlier · 2.5×
226
MS_DRG 		Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 1 $49,797.00 $49,797.00 $49,797.00 nat. median
$2,024
outlier · 24.6×
223
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 $47,193.30 $47,193.30 $47,193.30 nat. median
$2,024
outlier · 23.3×
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 7 $43,120.35 $142,470.00 $44,845.16 nat. median
$69,822
0.6× median
33276
CPT 		Insertion Of Phrenic Nerve Stimulator System (pulse Generator And Stimulating Le… 3 $2,550.00 $62,114.00 $43,335.00 nat. median
$44,163
1.0× median
64565
CPT 		HPercutaneous Implantation Of Neurostimulator Electrode Array; Neuromuscular 1 $41,199.00 $44,539.00 $42,869.00 nat. median
$3,236
outlier · 13.2×
0266T
CPT 		Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Total… 1 $40,759.00 $44,064.00 $42,411.50 nat. median
$41,318
1.0× median
0308T
CPT 		Insertion Of Ocular Telescope Prosthesis Including Removal Of Crystalline Lens O… 1 $40,759.00 $44,064.00 $42,411.50 nat. median
$16,465
outlier · 2.6×
0268T
CPT 		Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Pulse… 1 $40,759.00 $44,064.00 $42,411.50 nat. median
$30,474
1.4× median
225
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 $41,473.08 $41,473.08 $41,473.08 nat. median
$2,024
outlier · 20.5×
227
MS_DRG 		Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 1 $39,596.04 $39,596.04 $39,596.04 nat. median
$2,024
outlier · 19.6×
0888T
CPT 		Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 1 $39,376.13 $39,376.13 $39,376.13 nat. median
$18,205
outlier · 2.2×
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 7 $37,441.95 $71,363.16 $38,939.63 nat. median
$2,106
outlier · 18.5×
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 7 $36,057.84 $136,412.00 $37,500.15 nat. median
$60,505
0.6× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 7 $35,631.96 $134,787.00 $37,057.24 nat. median
$59,651
0.6× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 7 $34,638.24 $100,167.00 $36,023.77 nat. median
$55,935
0.6× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 7 $34,247.85 $85,824.00 $35,617.76 nat. median
$55,923
0.6× median
266
MS_DRG 		Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 7 $32,792.76 $163,642.00 $34,104.47 nat. median
$44,036
0.8× median
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 6 $31,266.69 $123,801.00 $32,517.36 nat. median
$51,518
0.6× median
268
MS_DRG 		Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 7 $30,450.42 $66,993.00 $31,668.44 nat. median
$49,569
0.6× median
69715
CPT 		$2,139.23 1 $30,431.61 $30,431.61 $30,431.61 nat. median
$6,484
outlier · 4.7×
217
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 7 $28,285.53 $142,470.00 $29,416.95 nat. median
$47,458
0.6× median

Other procedures at this hospital

Browse this hospital's 14,641 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
             
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 2 1 — — $4,897,200.00 $4,897,200.00 $4,897,200.00 2025-01-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 2 1 — — $3,884,946.48 $3,884,946.48 $3,884,946.48 2025-01-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 8 6 — — $497,024.65 $837,683.55 $516,905.64 2025-01-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 8 6 — — $484,623.49 $863,696.72 $504,008.43 2025-01-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 8 6 — — $483,453.66 $830,699.97 $502,791.81 2025-01-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 8 6 — — $473,458.43 $819,043.85 $492,396.77 2025-01-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 8 6 — — $449,440.00 $741,576.00 $467,417.60 2025-01-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 8 6 — — $449,341.85 $807,075.90 $467,315.52 2025-01-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 2 1 — — $120,116.70 $120,116.70 $120,116.70 2025-01-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 2 1 — — $108,036.36 $108,036.36 $108,036.36 2025-01-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 2 1 — — $107,961.00 $116,715.00 $112,338.00 2025-01-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 2 1 — — $104,773.89 $104,773.89 $104,773.89 2025-01-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 2 1 — — $82,929.00 $89,653.00 $86,291.00 2025-01-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $76,785.37 $76,785.37 $76,785.37 2025-01-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 2 1 — — $72,861.11 $72,861.11 $72,861.11 2025-01-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 2 1 — — $65,754.00 $71,085.00 $68,419.50 2025-01-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $62,162.10 $62,162.10 $62,162.10 2025-01-01
0571T CPT Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S… 2 1 — — $57,458.00 $62,114.00 $59,786.00 2025-01-01
0414T CPT Removal And Replacement Of Permanent Cardiac Contractility Modulation System Pul… 2 1 — — $57,458.00 $62,114.00 $59,786.00 2025-01-01
0408T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 2 1 — — $57,458.00 $62,114.00 $59,786.00 2025-01-01
0520T CPT Removal And Replacement Of Pulse Generator For Wireless Cardiac Stimulator For L… 2 1 — — $57,458.00 $62,114.00 $59,786.00 2025-01-01
0515T CPT Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including … 2 1 — — $57,458.00 $62,114.00 $59,786.00 2025-01-01
C9760 HCPCS Non-randomized, Non-blinded Procedure For Nyha Class Ii, Iii, IV Heart Failure; … 2 1 — — $57,458.00 $62,114.00 $59,786.00 2025-01-01
0614T CPT Removal And Replacement Of Substernal Implantable Defibrillator Pulse Generator 2 1 — — $57,458.00 $62,114.00 $59,786.00 2025-01-01
0100T CPT Placement Of A Subconjunctival Retinal Prosthesis Receiver And Pulse Generator, … 2 1 — — $57,458.00 $62,114.00 $59,786.00 2025-01-01
0409T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 2 1 — — $57,458.00 $62,114.00 $59,786.00 2025-01-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $53,780.76 $53,780.76 $53,780.76 2025-01-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 8 6 — — $53,472.87 $91,596.09 $55,611.78 2025-01-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 1 1 — — $49,797.00 $49,797.00 $49,797.00 2025-01-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 2 1 — — $49,692.00 $53,721.00 $51,706.50 2025-01-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $47,193.30 $47,193.30 $47,193.30 2025-01-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 9 7 — — $43,120.35 $142,470.00 $44,845.16 2025-01-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $41,473.08 $41,473.08 $41,473.08 2025-01-01
64565 CPT HPercutaneous Implantation Of Neurostimulator Electrode Array; Neuromuscular 2 1 — — $41,199.00 $44,539.00 $42,869.00 2025-01-01
0266T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Total… 2 1 — — $40,759.00 $44,064.00 $42,411.50 2025-01-01
0308T CPT Insertion Of Ocular Telescope Prosthesis Including Removal Of Crystalline Lens O… 2 1 — — $40,759.00 $44,064.00 $42,411.50 2025-01-01
0268T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Pulse… 2 1 — — $40,759.00 $44,064.00 $42,411.50 2025-01-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 1 1 — — $39,596.04 $39,596.04 $39,596.04 2025-01-01
0888T CPT Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 2 1 — — $39,376.13 $39,376.13 $39,376.13 2025-01-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 7 7 — — $37,441.95 $71,363.16 $38,939.63 2025-01-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 9 7 — — $36,057.84 $136,412.00 $37,500.15 2025-01-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 9 7 — — $35,631.96 $134,787.00 $37,057.24 2025-01-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 9 7 — — $34,638.24 $100,167.00 $36,023.77 2025-01-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 9 7 — — $34,247.85 $85,824.00 $35,617.76 2025-01-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 9 7 — — $32,792.76 $163,642.00 $34,104.47 2025-01-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 8 6 — — $31,266.69 $123,801.00 $32,517.36 2025-01-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 9 7 — — $30,450.42 $66,993.00 $31,668.44 2025-01-01
69715 CPT $2,139.23 1 1 — — $30,431.61 $30,431.61 $30,431.61 2025-01-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 9 7 — — $28,285.53 $142,470.00 $29,416.95 2025-01-01
0686T CPT Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 2 1 — — $28,126.13 $28,126.13 $28,126.13 2025-01-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 7 7 — — $28,037.10 $44,234.19 $29,158.58 2025-01-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 8 6 — — $27,575.73 $101,985.00 $28,678.76 2025-01-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 9 7 — — $26,440.05 $136,412.00 $27,497.65 2025-01-01
C9608 HCPCS Percutaneous Transluminal Revascularization Of Chronic Total Occlusion, Coronary… 2 1 — — $26,383.00 $28,522.00 $27,452.50 2025-01-01
C9605 HCPCS Percutaneous Transluminal Revascularization Of Or Through Coronary Artery Bypass… 2 1 — — $26,383.00 $28,522.00 $27,452.50 2025-01-01
C9606 HCPCS Percutaneous Transluminal Revascularization Of Acute Total/subtotal Occlusion Du… 2 1 — — $26,383.00 $28,522.00 $27,452.50 2025-01-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 9 7 — — $26,120.64 $84,047.00 $27,165.47 2025-01-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 7 7 — — $25,836.72 $47,595.24 $26,870.19 2025-01-01
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 8 6 — — $25,781.46 $44,574.52 $26,812.72 2025-01-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 9 7 — — $25,659.27 $134,787.00 $26,685.64 2025-01-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 9 7 — — $25,304.37 $142,470.00 $26,316.54 2025-01-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 1 1 — — $23,518.44 $23,518.44 $23,518.44 2025-01-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 9 7 — — $23,281.44 $85,824.00 $24,212.70 2025-01-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 9 7 — — $23,103.99 $100,167.00 $24,028.15 2025-01-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 9 7 — — $22,465.17 $66,993.00 $23,363.78 2025-01-01
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 1 1 — — $22,326.48 $22,326.48 $22,326.48 2025-01-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 9 7 — — $21,684.39 $122,872.00 $22,551.77 2025-01-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 8 6 — — $21,258.51 $101,985.00 $22,108.85 2025-01-01
471 MS_DRG Cervical Spinal Fusion With Mcc 9 7 — — $20,797.14 $36,034.02 $21,629.03 2025-01-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 9 7 — — $20,655.18 $85,824.00 $21,481.39 2025-01-01
338 MS_DRG Appendectomy With Complicated Principal Diagnosis With Mcc 1 1 — — $20,247.48 $20,247.48 $20,247.48 2025-01-01
69718 CPT $2,139.23 1 1 — — $20,041.56 $20,041.56 $20,041.56 2025-01-01
J1412 HCPCS Injection, Valoctocogene Roxaparvovec-rvox, Per Ml, Containing Nominal 2 X 10°13… 2 1 — — $19,812.89 $19,812.89 $19,812.89 2025-01-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 7 7 — — $19,448.52 $37,202.22 $20,226.46 2025-01-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 9 7 — — $19,129.11 $134,787.00 $19,894.27 2025-01-01
131 MS_DRG Cranial/facial Procedures W Cc/mcc 1 1 — — $18,835.74 $18,835.74 $18,835.74 2025-01-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 9 7 — — $18,490.29 $66,993.00 $19,229.90 2025-01-01
341 MS_DRG Appendectomy Without Complicated Principal Diagnosis With Mcc 1 1 — — $18,226.89 $18,226.89 $18,226.89 2025-01-01
61797 CPT Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); Eac… 4 2 — — $18,000.00 $39,154.00 $27,108.50 2025-01-01
61800 CPT Application Of Stereotactic Headframe For Stereotactic Radiosurgery (List Separa… 4 2 — — $18,000.00 $39,154.00 $27,108.50 2025-01-01
61798 CPT Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); 1 C… 4 2 — — $18,000.00 $39,154.00 $27,108.50 2025-01-01
61796 CPT Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); 1 S… 4 2 — — $18,000.00 $39,154.00 $27,108.50 2025-01-01
61799 CPT Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); Eac… 4 2 — — $18,000.00 $39,154.00 $27,108.50 2025-01-01
63621 CPT Stereotactic Radiosurgery (particle Beam, Gamma Ray, Or Linear Accelerator); Eac… 4 2 — — $18,000.00 $39,154.00 $27,108.50 2025-01-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 9 7 — — $17,957.94 $84,047.00 $18,676.26 2025-01-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 9 7 — — $17,319.12 $65,835.00 $18,011.88 2025-01-01
129 MS_DRG Major Head & Neck Procedures W Cc/mcc Or Major Device 1 1 — — $16,793.37 $16,793.37 $16,793.37 2025-01-01
0410T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0516T CPT Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including … 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0527T CPT Insertion Or Replacement Of Intracardiac Ischemia Monitoring System, Including T… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0802T CPT Transcatheter Removal And Replacement Of Permanent Dual-chamber Leadless Pacemak… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0505T CPT Endovenous Femoral-popliteal Arterial Revascularization, With Transcatheter Plac… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0238T CPT Transluminal Peripheral Atherectomy, Open Or Percutaneous, Including Radiologica… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0796T CPT Transcatheter Insertion Of Permanent Dual-chamber Leadless Pacemaker, Including … 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0803T CPT Transcatheter Removal And Replacement Of Permanent Dual-chamber Leadless Pacemak… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0620T CPT Endovascular Venous Arterialization, Tibial Or Peroneal Vein, With Transcatheter… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0793T CPT Percutaneous Transcatheter Thermal Ablation Of Nerves Innervating The Pulmonary … 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0795T CPT Transcatheter Insertion Of Permanent Dual-chamber Leadless Pacemaker, Including … 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0786T CPT Insertion Or Replacement Of Percutaneous Electrode Array, Sacral, With Integrate… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0411T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0234T CPT Transluminal Peripheral Atherectomy, Open Or Percutaneous, Including Radiologica… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0526T CPT Insertion Or Replacement Of Intracardiac Ischemia Monitoring System, Including T… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0817T CPT Open Insertion Or Replacement Of Integrated Neurostimulation System For Bladder … 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0237T CPT Transluminal Peripheral Atherectomy, Open Or Percutaneous, Including Radiologica… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0825T CPT Transcatheter Removal And Replacement Of Permanent Single-chamber Leadless Pacem… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0801T CPT Transcatheter Removal And Replacement Of Permanent Dual-chamber Leadless Pacemak… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0572T CPT Insertion Of Substernal Implantable Defibrillator Electrode 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0784T CPT Insertion Or Replacement Of Percutaneous Electrode Array, Spinal, With Integrate… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0236T CPT Transluminal Peripheral Atherectomy, Open Or Percutaneous, Including Radiologica… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0398T CPT Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS), Ster… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0645T CPT Transcatheter Implantation Of Coronary Sinus Reduction Device Including Vascular… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0797T CPT Transcatheter Insertion Of Permanent Dual-chamber Leadless Pacemaker, Including … 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0823T CPT Transcatheter Insertion Of Permanent Single-chamber Leadless Pacemaker, Right At… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0525T CPT Insertion Or Replacement Of Intracardiac Ischemia Monitoring System, Including T… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0816T CPT Open Insertion Or Replacement Of Integrated Neurostimulation System For Bladder … 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0632T CPT Percutaneous Transcatheter Ultrasound Ablation Of Nerves Innervating The Pulmona… 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
0517T CPT Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including … 2 1 — — $16,651.00 $18,002.00 $17,326.50 2025-01-01
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 4 2 — — $16,154.32 $28,478.75 $22,782.53 2025-01-01
247 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 1 1 — — $15,498.45 $15,498.45 $15,498.45 2025-01-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 9 7 — — $15,438.15 $29,940.00 $16,055.68 2025-01-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 9 7 — — $15,367.17 $66,993.00 $15,981.86 2025-01-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 9 7 — — $15,331.68 $67,996.00 $15,944.95 2025-01-01
C2616 HCPCS Brachytherapy Source, Non-stranded, Yttrium-90, Per Source 4 2 — — $15,260.96 $19,824.00 $17,239.20 2025-01-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 9 7 — — $15,118.74 $22,066.11 $15,723.49 2025-01-01
49655 CPT $2,108.02 1 1 — — $15,037.11 $15,037.11 $15,037.11 2025-01-01
49654 CPT $2,108.02 1 1 — — $15,037.11 $15,037.11 $15,037.11 2025-01-01
49656 CPT $2,108.02 1 1 — — $15,037.11 $15,037.11 $15,037.11 2025-01-01
49657 CPT $2,108.02 1 1 — — $15,037.11 $15,037.11 $15,037.11 2025-01-01
252 MS_DRG Other Vascular Procedures With Mcc 9 7 — — $14,905.80 $42,180.00 $15,502.03 2025-01-01
C9607 HCPCS Percutaneous Transluminal Revascularization Of Chronic Total Occlusion, Coronary… 4 2 — — $14,843.92 $28,522.00 $21,041.65 2025-01-01
C9773 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Tibial/peroneal Artery(i… 4 2 — — $14,843.92 $18,002.00 $16,175.65 2025-01-01
C9775 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Tibial/peroneal Artery(ie… 4 2 — — $14,843.92 $18,002.00 $16,175.65 2025-01-01
C9765 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Lower Extremity Artery(ie… 4 2 — — $14,843.92 $18,002.00 $16,175.65 2025-01-01
C9766 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Lower Extremity Artery(ie… 4 2 — — $14,843.92 $18,002.00 $16,175.65 2025-01-01
C9774 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Tibial/peroneal Artery(ie… 4 2 — — $14,843.92 $18,002.00 $16,175.65 2025-01-01
C9797 HCPCS Vascular Embolization Or Occlusion Procedure With Use Of A Pressure-generating C… 4 2 — — $14,843.92 $18,002.00 $16,175.65 2025-01-01
C9767 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Lower Extremity Artery(ie… 4 2 — — $14,843.92 $18,002.00 $16,175.65 2025-01-01
19324 CPT $2,550.00 1 1 — — $14,626.26 $14,626.26 $14,626.26 2025-01-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 9 7 — — $14,621.88 $24,603.00 $15,206.76 2025-01-01
33282 CPT $453.51 1 1 — — $14,592.60 $14,592.60 $14,592.60 2025-01-01
133 MS_DRG Other Ear, Nose, Mouth & Throat O.r. Procedures W Cc/mcc 1 1 — — $14,547.06 $14,547.06 $14,547.06 2025-01-01
264 MS_DRG Other Circulatory System O.r. Procedures 9 7 — — $14,515.41 $31,650.00 $15,096.03 2025-01-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 9 7 — — $14,408.94 $44,875.00 $14,985.30 2025-01-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 9 7 — — $14,373.45 $34,955.00 $14,948.39 2025-01-01
249 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc 1 1 — — $14,334.21 $14,334.21 $14,334.21 2025-01-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 9 7 — — $14,054.04 $41,606.00 $14,616.20 2025-01-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 9 7 — — $13,357.00 $29,768.31 $26,058.18 2025-01-01
653 MS_DRG Major Bladder Procedures With Mcc 9 7 — — $13,357.00 $40,512.78 $24,212.70 2025-01-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 9 7 — — $13,357.00 $33,316.47 $21,924.30 2025-01-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 9 7 — — $13,357.00 $35,994.42 $21,629.03 2025-01-01
799 MS_DRG Splenic Procedures With Mcc 9 7 — — $13,357.00 $35,728.11 $20,743.20 2025-01-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 9 7 — — $13,357.00 $38,734.74 $20,226.46 2025-01-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 9 7 — — $13,357.00 $27,742.77 $14,357.83 2025-01-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 9 7 — — $13,357.00 $21,680.01 $14,284.02 2025-01-01
500 MS_DRG Soft Tissue Procedures With Mcc 9 7 — — $13,357.00 $21,679.02 $14,247.11 2025-01-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 9 7 — — $13,357.00 $25,984.53 $14,210.20 2025-01-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 9 7 — — $13,357.00 $23,843.16 $14,025.65 2025-01-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 9 7 — — $13,357.00 $19,491.12 $13,988.74 2025-01-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 8 6 — — $13,357.00 $14,441.00 $13,951.83 2025-01-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 9 7 — — $13,344.24 $34,594.00 $13,878.01 2025-01-01
662 MS_DRG Minor Bladder Procedures With Mcc 9 7 — — $12,882.87 $22,311.63 $13,398.18 2025-01-01
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 8 6 — — $12,634.44 $41,606.00 $13,139.82 2025-01-01
472 MS_DRG Cervical Spinal Fusion With Cc 9 7 — — $12,492.48 $32,729.00 $12,992.18 2025-01-01
339 MS_DRG Appendectomy With Complicated Principal Diagnosis With Cc 1 1 — — $12,490.83 $12,490.83 $12,490.83 2025-01-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 9 7 — — $12,456.99 $25,983.54 $12,955.27 2025-01-01
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 9 7 — — $12,279.54 $24,603.00 $12,770.72 2025-01-01
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 9 7 — — $12,137.58 $22,050.27 $12,623.08 2025-01-01
668 MS_DRG Transurethral Procedures With Mcc 9 7 — — $12,102.09 $19,304.01 $12,586.17 2025-01-01
654 MS_DRG Major Bladder Procedures With Cc 9 7 — — $11,782.68 $20,311.83 $12,253.99 2025-01-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 7 7 — — $11,711.70 $29,412.90 $12,180.17 2025-01-01
691 MS_DRG Urinary Stones W Esw Lithotripsy W Cc/mcc 1 1 — — $11,707.74 $11,707.74 $11,707.74 2025-01-01
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 9 7 — — $11,498.76 $23,630.00 $11,958.71 2025-01-01
132 MS_DRG Cranial/facial Procedures Without Cc/mcc 1 1 — — $11,395.89 $11,395.89 $11,395.89 2025-01-01
800 MS_DRG Splenic Procedures With Cc 9 7 — — $11,356.80 $19,684.17 $11,811.07 2025-01-01
0601T CPT Ablation, Irreversible Electroporation; 1 Or More Tumors Per Organ, Including Fl… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0600T CPT Ablation, Irreversible Electroporation; 1 Or More Tumors Per Organ, Including Im… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0594T CPT Osteotomy, Humerus, With Insertion Of An Externally Controlled Intramedullary Le… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0220T CPT Placement Of A Posterior Intrafacet Implant(s), Unilateral Or Bilateral, Includi… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0274T CPT Percutaneous Laminotomy/laminectomy (interlaminar Approach) For Decompression Of… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0629T CPT Percutaneous Injection Of Allogeneic Cellular And/or Tissue-based Product, Inter… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0867T CPT Transperineal Laser Ablation Of Benign Prostatic Hyperplasia, Including Imaging … 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
G0412 HCPCS Open Treatment Of Iliac Spine(s), Tuberosity Avulsion, Or Iliac Wing Fracture(s)… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0275T CPT Percutaneous Laminotomy/laminectomy (interlaminar Approach) For Decompression Of… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
G0415 HCPCS Open Treatment Of Posterior Pelvic Bone Fracture And/or Dislocation, For Fractur… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
G0414 HCPCS Open Treatment Of Anterior Pelvic Bone Fracture And/or Dislocation For Fracture … 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0744T CPT Insertion Of Bioprosthetic Valve, Open, Femoral Vein, Including Duplex Ultrasoun… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0219T CPT Placement Of A Posterior Intrafacet Implant(s), Unilateral Or Bilateral, Includi… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0644T CPT Transcatheter Removal Or Debulking Of Intracardiac Mass (eg, Vegetations, Thromb… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
G0276 HCPCS Blinded Procedure For Lumbar Stenosis, Percutaneous Image-guided Lumbar Decompre… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0202T CPT Posterior Vertebral Joint(s) Arthroplasty (eg, Facet Jointºs» Replacement), Incl… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0269T CPT Revision Or Removal Of Carotid Sinus Baroreflex Activation Device; Total System … 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
0627T CPT Percutaneous Injection Of Allogeneic Cellular And/or Tissue-based Product, Inter… 2 1 — — $11,334.00 $12,254.00 $11,794.00 2025-01-01
253 MS_DRG Other Vascular Procedures With Cc 9 7 — — $11,321.31 $42,180.00 $11,774.16 2025-01-01
81416 CPT Exome (eg, Unexplained Constitutional Or Heritable Disorder Or Syndrome); Sequen… 6 4 — — $11,232.00 $21,413.70 $11,940.00 2025-01-01
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 9 7 — — $11,143.86 $47,373.00 $11,589.61 2025-01-01
C9781 HCPCS Arthroscopy, Shoulder, Surgical; With Implantation Of Subacromial Spacer (e.g., … 4 2 — — $11,140.48 $12,254.00 $11,558.60 2025-01-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 8 6 — — $10,895.43 $51,354.00 $11,331.25 2025-01-01
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/mcc 9 7 — — $10,824.45 $66,993.00 $11,257.43 2025-01-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 9 7 — — $10,753.47 $24,163.92 $11,183.61 2025-01-01
347 MS_DRG Anal And Stomal Procedures With Mcc 9 7 — — $10,576.02 $19,264.41 $10,999.06 2025-01-01
C9604 HCPCS Percutaneous Transluminal Revascularization Of Or Through Coronary Artery Bypass… 4 2 — — $9,312.16 $28,522.00 $18,116.20 2025-01-01
C9772 HCPCS Revascularization, Endovascular, Open Or Percutaneous, Tibial/peroneal Artery(ie… 4 2 — — $9,312.16 $18,002.00 $13,250.20 2025-01-01
C9783 HCPCS Blinded Procedure For Transcatheter Implantation Of Coronary Sinus Reduction Dev… 4 2 — — $9,312.16 $18,002.00 $13,250.20 2025-01-01
C9901 HCPCS Endoscopic Defect Closure Within The Entire Gastrointestinal Tract, Including Up… 4 2 — — $8,714.16 $18,002.00 $12,933.95 2025-01-01
93657 CPT Additional Linear Or Focal Intracardiac Catheter Ablation Of The Left Or Right A… 4 2 — — $7,950.00 $37,794.00 $21,454.50 2025-01-01
93655 CPT Intracardiac Catheter Ablation Of A Discrete Mechanism Of Arrhythmia Which Is Di… 4 2 — — $7,950.00 $37,794.00 $21,454.50 2025-01-01
37215 CPT Transcatheter Placement Of Intravascular Stent(s), Cervical Carotid Artery, Open… 4 2 — — $7,950.00 $30,767.00 $18,204.50 2025-01-01
92921 CPT Percutaneous Transluminal Coronary Angioplasty; Each Additional Branch Of A Majo… 4 2 — — $7,950.00 $29,198.00 $17,479.00 2025-01-01
C9603 HCPCS Percutaneous Transluminal Coronary Atherectomy, With Drug-eluting Intracoronary … 4 2 — — $7,950.00 $28,522.00 $17,166.50 2025-01-01
C9601 HCPCS Percutaneous Transcatheter Placement Of Drug-eluting Intracoronary Stent(s), Wit… 4 2 — — $7,950.00 $28,522.00 $17,166.50 2025-01-01
C9602 HCPCS Percutaneous Transluminal Coronary Atherectomy, With Drug Eluting Intracoronary … 6 3 — — $7,950.00 $28,522.00 $15,272.11 2025-01-01
93581 CPT Percutaneous Transcatheter Closure Of A Congenital Ventricular Septal Defect Wit… 6 3 — — $7,950.00 $27,126.00 $15,272.11 2025-01-01
93580 CPT Percutaneous Transcatheter Closure Of Congenital Interatrial Communication (ie, … 6 3 — — $7,950.00 $27,126.00 $15,272.11 2025-01-01
93613 CPT Intracardiac Electrophysiologic 3-dimensional Mapping (List Separately In Additi… 4 2 — — $7,950.00 $24,307.00 $15,217.00 2025-01-01
93631 CPT Intra-operative Epicardial And Endocardial Pacing And Mapping To Localize The Si… 4 2 — — $7,950.00 $24,307.00 $15,217.00 2025-01-01
92998 CPT Percutaneous Transluminal Pulmonary Artery Balloon Angioplasty; Each Additional … 4 2 — — $7,950.00 $20,093.00 $13,268.00 2025-01-01
93582 CPT Percutaneous Transcatheter Closure Of Patent Ductus Arteriosus 12 8 — — $7,950.00 $27,073.00 $13,262.06 2025-01-01
C9780 HCPCS Insertion Of Central Venous Catheter Through Central Venous Occlusion Via Inferi… 4 2 — — $7,722.00 $18,002.00 $12,409.25 2025-01-01
54400 CPT Insertion Of Penile Prosthesis; Non-inflatable (semi-rigid) 5 3 — — $4,950.00 $31,079.07 $28,132.00 2025-01-01
54417 CPT Removal And Replacement Of Non-inflatable (semi-rigid) Or Inflatable (self-conta… 5 3 — — $4,950.00 $31,079.07 $28,132.00 2025-01-01
54410 CPT Removal And Replacement Of All Component(s) Of A Multi-component, Inflatable Pen… 5 3 — — $4,950.00 $31,079.07 $28,132.00 2025-01-01
54401 CPT Insertion Of Penile Prosthesis; Inflatable (self-contained) 5 3 — — $4,950.00 $31,079.07 $28,132.00 2025-01-01
54411 CPT Removal And Replacement Of All Components Of A Multi-component Inflatable Penile… 5 3 — — $4,950.00 $31,079.07 $28,132.00 2025-01-01
54416 CPT Removal And Replacement Of Non-inflatable (semi-rigid) Or Inflatable (self-conta… 5 3 — — $4,950.00 $31,079.07 $28,132.00 2025-01-01
54405 CPT Insertion Of Multi-component, Inflatable Penile Prosthesis, Including Placement … 5 3 — — $4,950.00 $31,079.07 $28,132.00 2025-01-01
63685 CPT Insertion Or Replacement Of Spinal Neurostimulator Pulse Generator Or Receiver, … 7 4 — — $4,950.00 $55,221.21 $27,802.50 2025-01-01
33249 CPT Insertion Or Replacement Of Permanent Implantable Defibrillator System, With Tra… 13 9 — — $4,950.00 $72,355.00 $26,090.04 2025-01-01
64568 CPT Open Implantation Of Cranial Nerve (eg, Vagus Nerve) Neurostimulator Electrode A… 15 9 — — $4,950.00 $55,221.21 $22,713.60 2025-01-01
64582 CPT Open Implantation Of Hypoglossal Nerve Neurostimulator Array, Pulse Generator, A… 14 8 — — $4,950.00 $44,064.00 $20,322.91 2025-01-01
64580 CPT Open Implantation Of Neurostimulator Electrode Array; Neuromuscular 7 4 — — $4,950.00 $44,539.00 $19,586.60 2025-01-01
63655 CPT Laminectomy For Implantation Of Neurostimulator Electrodes, Plate/paddle, Epidur… 7 4 — — $4,950.00 $44,539.00 $19,586.60 2025-01-01
33240 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Singl… 13 9 — — $4,950.00 $72,355.00 $19,429.55 2025-01-01
62360 CPT Implantation Or Replacement Of Device For Intrathecal Or Epidural Drug Infusion;… 7 4 — — $4,950.00 $32,550.21 $15,967.60 2025-01-01
62361 CPT Implantation Or Replacement Of Device For Intrathecal Or Epidural Drug Infusion;… 7 4 — — $4,950.00 $32,550.21 $15,967.60 2025-01-01
22633 CPT Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Inter… 7 4 — — $4,950.00 $27,073.00 $15,775.76 2025-01-01
67027 CPT Implantation Of Intravitreal Drug Delivery System (eg, Ganciclovir Implant), Inc… 9 4 — — $4,950.00 $21,198.10 $13,360.88 2025-01-01
50542 CPT Laparoscopy, Surgical; Ablation Of Renal Mass Lesion(s), Including Intraoperativ… 9 4 — — $4,950.00 $18,002.00 $13,070.72 2025-01-01
23472 CPT Arthroplasty, Glenohumeral Joint; Total Shoulder (glenoid And Proximal Humeral R… 18 10 — — $4,950.00 $36,887.00 $12,408.98 2025-01-01
64575 CPT Open Implantation Of Neurostimulator Electrode Array; Peripheral Nerve (excludes… 7 4 — — $4,950.00 $44,539.00 $12,196.80 2025-01-01
64553 CPT Percutaneous Implantation Of Neurostimulator Electrode Array; Cranial Nerve 7 4 — — $4,950.00 $44,539.00 $11,988.90 2025-01-01
23474 CPT Revision Of Total Shoulder Arthroplasty, Including Allograft When Performed; Hum… 8 4 — — $4,950.00 $14,000.00 $11,794.00 2025-01-01
23491 CPT Prophylactic Treatment (nailing, Pinning, Plating Or Wiring) With Or Without Met… 9 4 — — $4,950.00 $20,041.56 $11,783.20 2025-01-01
29867 CPT Arthroscopy, Knee, Surgical; Osteochondral Allograft (eg, Mosaicplasty) 9 4 — — $4,950.00 $20,041.56 $11,783.20 2025-01-01
29907 CPT Arthroscopy, Subtalar Joint, Surgical; With Subtalar Arthrodesis 9 4 — — $4,950.00 $20,041.56 $11,783.20 2025-01-01
27415 CPT Osteochondral Allograft, Knee, Open 9 4 — — $4,950.00 $20,041.56 $11,783.20 2025-01-01
19325 CPT Breast Augmentation With Implant 9 4 — — $4,950.00 $14,626.26 $11,729.00 2025-01-01
63664 CPT Revision Including Replacement, When Performed, Of Spinal Neurostimulator Electr… 7 4 — — $4,950.00 $36,367.65 $11,531.52 2025-01-01
23473 CPT Revision Of Total Shoulder Arthroplasty, Including Allograft When Performed; Hum… 18 10 — — $4,950.00 $36,887.00 $11,461.84 2025-01-01
64590 CPT Insertion Or Replacement Of Peripheral, Sacral, Or Gastric Neurostimulator Pulse… 13 9 — — $4,950.00 $44,539.00 $11,374.97 2025-01-01
135 MS_DRG Sinus And Mastoid Procedures With Cc/mcc 10 8 — — $3,906.86 $16,646.85 $11,109.79 2025-01-01
33262 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 13 9 — — $3,850.00 $72,355.00 $17,061.61 2025-01-01
33263 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 13 9 — — $3,850.00 $72,355.00 $17,061.61 2025-01-01
33264 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 13 9 — — $3,850.00 $72,355.00 $17,061.61 2025-01-01
33276 CPT Insertion Of Phrenic Nerve Stimulator System (pulse Generator And Stimulating Le… 6 3 — — $2,550.00 $62,114.00 $43,335.00 2025-01-01
61886 CPT Insertion Or Replacement Of Cranial Neurostimulator Pulse Generator Or Receiver,… 7 4 — — $2,550.00 $55,221.21 $27,802.50 2025-01-01
33287 CPT Removal And Replacement Of Phrenic Nerve Stimulator, Including Vessel Catheteriz… 6 3 — — $2,550.00 $44,064.00 $27,044.25 2025-01-01
33270 CPT Insertion Or Replacement Of Permanent Subcutaneous Implantable Defibrillator Sys… 13 9 — — $2,550.00 $72,355.00 $21,658.12 2025-01-01
33289 CPT Transcatheter Implantation Of Wireless Pulmonary Artery Pressure Sensor For Long… 17 9 — — $2,550.00 $62,114.00 $19,452.90 2025-01-01
61891 CPT Revision Or Replacement Of Skull-mounted Cranial Neurostimulator Pulse Generator… 8 3 — — $2,550.00 $29,379.90 $18,260.12 2025-01-01
33230 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Dual … 13 9 — — $2,550.00 $72,355.00 $17,061.61 2025-01-01
33231 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multi… 13 9 — — $2,550.00 $72,355.00 $17,061.61 2025-01-01
27438 CPT Arthroplasty, Patella; With Prosthesis 9 4 — — $2,550.00 $36,887.00 $16,711.76 2025-01-01
25442 CPT Arthroplasty With Prosthetic Replacement; Distal Ulna 9 4 — — $2,550.00 $30,431.61 $16,685.90 2025-01-01
25446 CPT Arthroplasty With Prosthetic Replacement; Distal Radius And Partial Or Entire Ca… 9 4 — — $2,550.00 $30,431.61 $16,685.90 2025-01-01
27278 CPT Arthrodesis, Sacroiliac Joint, Percutaneous, With Image Guidance, Including Plac… 8 3 — — $2,550.00 $25,029.40 $16,668.45 2025-01-01
25441 CPT Arthroplasty With Prosthetic Replacement; Distal Radius 9 4 — — $2,550.00 $20,041.56 $16,651.00 2025-01-01
21243 CPT Arthroplasty, Temporomandibular Joint, With Prosthetic Joint Replacement 9 4 — — $2,550.00 $30,431.61 $15,775.76 2025-01-01
27132 CPT Conversion Of Previous Hip Surgery To Total Hip Arthroplasty, With Or Without Au… 8 4 — — $2,550.00 $36,887.00 $14,000.00 2025-01-01
27137 CPT Revision Of Total Hip Arthroplasty; Acetabular Component Only, With Or Without A… 8 4 — — $2,550.00 $36,887.00 $14,000.00 2025-01-01
27138 CPT Revision Of Total Hip Arthroplasty; Femoral Component Only, With Or Without Allo… 8 4 — — $2,550.00 $36,887.00 $14,000.00 2025-01-01
27134 CPT Revision Of Total Hip Arthroplasty; Both Components, With Or Without Autograft O… 8 4 — — $2,550.00 $36,887.00 $14,000.00 2025-01-01
27486 CPT Revision Of Total Knee Arthroplasty, With Or Without Allograft; 1 Component 8 4 — — $2,550.00 $36,887.00 $14,000.00 2025-01-01
27487 CPT Revision Of Total Knee Arthroplasty, With Or Without Allograft; Femoral And Enti… 8 4 — — $2,550.00 $36,887.00 $14,000.00 2025-01-01
53445 CPT Insertion Of Inflatable Urethral/bladder Neck Sphincter, Including Placement Of … 7 4 — — $2,550.00 $31,079.07 $12,949.00 2025-01-01
53444 CPT Insertion Of Tandem Cuff (dual Cuff) 7 4 — — $2,550.00 $31,079.07 $12,949.00 2025-01-01
43647 CPT Laparoscopy, Surgical; Implantation Or Replacement Of Gastric Neurostimulator El… 7 4 — — $2,550.00 $18,002.00 $11,988.90 2025-01-01
19296 CPT Placement Of Radiotherapy Afterloading Expandable Catheter (single Or Multichann… 9 4 — — $2,550.00 $15,882.00 $11,969.36 2025-01-01
33288 CPT Removal And Replacement Of Phrenic Nerve Stimulator, Including Vessel Catheteriz… 6 3 — — $2,550.00 $18,002.00 $11,864.16 2025-01-01
64596 CPT Insertion Or Replacement Of Percutaneous Electrode Array, Peripheral Nerve, With… 6 3 — — $2,550.00 $18,002.00 $11,864.16 2025-01-01
27871 CPT Arthrodesis, Tibiofibular Joint, Proximal Or Distal 9 4 — — $2,550.00 $20,041.56 $11,783.20 2025-01-01
25444 CPT Arthroplasty With Prosthetic Replacement; Lunate 9 4 — — $2,550.00 $20,041.56 $11,783.20 2025-01-01
24498 CPT Prophylactic Treatment (nailing, Pinning, Plating Or Wiring), With Or Without Me… 9 4 — — $2,550.00 $20,041.56 $11,783.20 2025-01-01
24587 CPT Open Treatment Of Periarticular Fracture And/or Dislocation Of The Elbow (fractu… 9 4 — — $2,550.00 $20,041.56 $11,783.20 2025-01-01
23680 CPT Open Treatment Of Shoulder Dislocation, With Surgical Or Anatomical Neck Fractur… 9 4 — — $2,550.00 $20,041.56 $11,783.20 2025-01-01
33902 CPT Percutaneous Pulmonary Artery Revascularization By Stent Placement, Initial; Abn… 12 8 — — $2,550.00 $18,002.00 $11,612.06 2025-01-01
61885 CPT Insertion Or Replacement Of Cranial Neurostimulator Pulse Generator Or Receiver,… 15 9 — — $2,550.00 $44,539.00 $11,521.24 2025-01-01
53440 CPT Sling Operation For Correction Of Male Urinary Incontinence (eg, Fascia Or Synth… 7 4 — — $2,550.00 $15,039.09 $11,492.80 2025-01-01
36836 CPT Percutaneous Arteriovenous Fistula Creation, Upper Extremity, Single Access Of B… 12 8 — — $2,550.00 $15,700.30 $11,444.58 2025-01-01
36837 CPT Percutaneous Arteriovenous Fistula Creation, Upper Extremity, Separate Access Si… 12 8 — — $2,550.00 $15,700.30 $11,444.58 2025-01-01
65770 CPT Keratoprosthesis 9 4 — — $2,550.00 $18,188.28 $11,334.00 2025-01-01
53451 CPT Periurethral Transperineal Adjustable Balloon Continence Device; Bilateral Inser… 6 3 — — $2,550.00 $18,002.00 $11,179.36 2025-01-01
24410 CPT Multiple Osteotomies With Realignment On Intramedullary Rod, Humeral Shaft (Sofi… 9 4 — — $2,550.00 $20,041.56 $11,140.48 2025-01-01
24365 CPT Arthroplasty, Radial Head; 9 4 — — $2,550.00 $20,041.56 $11,140.48 2025-01-01
25491 CPT Prophylactic Treatment (nailing, Pinning, Plating Or Wiring) With Or Without Met… 9 4 — — $2,550.00 $20,041.56 $11,140.48 2025-01-01
27447 CPT Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments With Or… 18 10 — — $572.00 $36,887.00 $11,461.84 2025-01-01
27446 CPT Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment 18 10 — — $572.00 $36,887.00 $11,461.84 2025-01-01
23470 CPT Arthroplasty, Glenohumeral Joint; Hemiarthroplasty 18 10 — — $468.00 $36,887.00 $11,461.84 2025-01-01
J9043 HCPCS Cabazitaxel 60 Mg Inj 44 21 $47,128.17 $47,128.17 $209.34 $42,415.35 $20,265.11 2025-01-01
J9022 HCPCS Atezolizumab 1200 Mg Inj 44 21 $36,215.31 $36,215.31 $82.62 $32,593.78 $15,572.58 2025-01-01
J9144 HCPCS Darat 1800mg/hyalu-fihj 44 21 $31,755.54 $31,755.54 $49.31 $28,579.99 $13,654.88 2025-01-01
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