|
J3391
|
HCPCS
|
Inj, Atidarsagene Autotemcel
|
14
|
6
|
—
|
$4,377,500.00
|
$4,377,500.00
|
$4,596,375.00
|
$4,377,500.00
|
2025-12-31
|
|
J1414
|
HCPCS
|
Inj, Beqvez, Per Tx Dose
|
14
|
6
|
—
|
$3,710,000.00
|
$3,710,000.00
|
$3,895,500.00
|
$3,710,000.00
|
2025-12-31
|
|
J1411
|
HCPCS
|
Inj, Hemgenix, Per Tx Dose
|
14
|
6
|
—
|
$3,685,266.67
|
$3,685,266.67
|
$3,869,530.00
|
$3,685,266.67
|
2025-12-31
|
|
J1413
|
HCPCS
|
Inj Delandistrogene Mox Rokl
|
14
|
6
|
—
|
$3,324,571.90
|
$3,324,571.90
|
$3,490,800.50
|
$3,324,571.90
|
2025-12-31
|
|
J3394
|
HCPCS
|
Inj, Lovotibeglogene Autotem
|
14
|
6
|
—
|
$3,261,355.00
|
$3,261,355.00
|
$3,424,422.75
|
$3,261,355.00
|
2025-12-31
|
|
J3393
|
HCPCS
|
Inj, Betibeglogene Autotemce
|
14
|
6
|
—
|
$2,950,686.67
|
$2,950,686.67
|
$3,098,221.00
|
$2,950,686.67
|
2025-12-31
|
|
J3399
|
HCPCS
|
Inj Onase Abepar-xioi Treat
|
14
|
6
|
—
|
$2,452,115.60
|
$2,452,115.60
|
$2,574,721.38
|
$2,452,115.60
|
2025-12-31
|
|
J3392
|
HCPCS
|
Inj, Exagamglogene Autotem
|
14
|
6
|
—
|
$2,332,000.00
|
$2,332,000.00
|
$2,448,600.00
|
$2,332,000.00
|
2025-12-31
|
|
Q2057
|
HCPCS
|
Afamitresgene Autoleucel
|
16
|
6
|
—
|
$770,620.00
|
$655,027.00
|
$809,151.00
|
$770,620.00
|
2025-12-31
|
|
Q2042
|
HCPCS
|
Tisagenlecleucel Car-pos T
|
24
|
10
|
—
|
$578,324.58
|
$491,575.89
|
$922,082.02
|
$578,324.58
|
2025-12-31
|
|
Q2056
|
HCPCS
|
Ciltacabtagene Car-pos T
|
18
|
7
|
—
|
$553,378.83
|
$470,372.01
|
$674,570.57
|
$553,378.83
|
2025-12-31
|
|
Q2054
|
HCPCS
|
Lisocabtagene Mara Car Pos T
|
22
|
9
|
—
|
$541,635.66
|
$460,390.31
|
$933,986.41
|
$541,635.66
|
2025-12-31
|
|
Q2055
|
HCPCS
|
Idecabtagene Vicleucel Car
|
22
|
9
|
—
|
$541,260.45
|
$460,071.38
|
$954,928.83
|
$541,260.45
|
2025-12-31
|
|
Q2041
|
HCPCS
|
Axicabtagene Ciloleucel Car+
|
24
|
10
|
—
|
$533,076.48
|
$453,115.01
|
$884,589.61
|
$533,076.48
|
2025-12-31
|
|
Q2053
|
HCPCS
|
Brexucabtagene Car Pos T
|
22
|
9
|
—
|
$489,720.00
|
$416,262.00
|
$878,671.10
|
$489,720.00
|
2025-12-31
|
|
18
|
MS_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
56
|
14
|
—
|
$326,207.42
|
$4,529.00
|
$1,303,203.52
|
$340,242.79
|
2025-12-31
|
|
0100T
|
OTHER
|
Prosth Retina Receive&gen
|
2
|
1
|
—
|
—
|
$315,676.04
|
$315,676.04
|
$315,676.04
|
2025-12-31
|
|
Q2058
|
HCPCS
|
Obecbtge Autol Up To 400 Mil
|
14
|
6
|
—
|
$270,375.00
|
$270,375.00
|
$283,893.75
|
$270,375.00
|
2025-12-31
|
|
1
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
52
|
13
|
—
|
$245,924.75
|
$143,947.00
|
$973,383.77
|
$254,379.79
|
2025-12-31
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
65
|
16
|
—
|
$207,113.09
|
$5,095.00
|
$896,271.11
|
$221,818.51
|
2025-12-31
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
52
|
13
|
—
|
$187,109.66
|
$98,732.00
|
$740,590.37
|
$193,775.97
|
2025-12-31
|
|
Q0480
|
HCPCS
|
Driver Pneumatic Vad, Rep
|
2
|
1
|
—
|
—
|
$132,999.99
|
$132,999.99
|
$132,999.99
|
2025-12-31
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
52
|
13
|
—
|
$123,362.67
|
$60,132.00
|
$488,276.28
|
$128,090.27
|
2025-12-31
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
62
|
15
|
—
|
$113,327.69
|
$4,529.00
|
$458,724.00
|
$125,977.61
|
2025-12-31
|
|
7
|
MS_DRG
|
Lung Transplant
|
63
|
15
|
—
|
$113,042.24
|
$5,095.00
|
$451,605.45
|
$118,543.64
|
2025-12-31
|
|
212
|
MS_DRG
|
Concomitant Aortic And Mitral Valve?procedures
|
54
|
14
|
—
|
$95,109.74
|
$5,095.00
|
$411,582.44
|
$100,628.43
|
2025-12-31
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
52
|
13
|
—
|
$96,208.04
|
$72,998.00
|
$380,796.75
|
$100,109.78
|
2025-12-31
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
62
|
15
|
—
|
$92,114.97
|
$5,095.00
|
$393,629.00
|
$98,389.52
|
2025-12-31
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
66
|
16
|
—
|
$92,498.43
|
$5,095.00
|
$494,646.00
|
$97,889.55
|
2025-12-31
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
54
|
14
|
—
|
$91,456.00
|
$5,095.00
|
$395,771.09
|
$96,796.20
|
2025-12-31
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
64
|
16
|
—
|
$84,259.41
|
$52,311.00
|
$376,985.00
|
$91,562.15
|
2025-12-31
|
|
B0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
6
|
2
|
—
|
—
|
$89,793.99
|
$89,793.99
|
$89,793.99
|
2025-12-31
|
|
Sx00000069838-74820
|
CDM
|
Jts Implant Set
|
56
|
14
|
$172,360.00
|
—
|
$31,024.80
|
$146,506.00
|
$86,180.00
|
2025-12-31
|
|
850
|
MS_DRG
|
Acute Leukemia With Other Procedures
|
54
|
14
|
—
|
$80,424.95
|
$5,095.00
|
$348,034.79
|
$85,226.29
|
2025-12-31
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
64
|
16
|
—
|
$73,981.81
|
$42,774.00
|
$322,400.00
|
$80,488.52
|
2025-12-31
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
66
|
18
|
—
|
$73,940.77
|
$42,400.00
|
$350,280.00
|
$80,444.31
|
2025-12-31
|
|
C0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
6
|
2
|
—
|
—
|
$79,852.04
|
$79,852.04
|
$79,852.04
|
2025-12-31
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
65
|
16
|
—
|
$69,726.74
|
$5,095.00
|
$400,186.00
|
$78,393.62
|
2025-12-31
|
|
B1904
|
HCPCS
|
Guillain-barr? M <38.50
|
6
|
2
|
—
|
—
|
$77,698.42
|
$77,698.42
|
$77,698.42
|
2025-12-31
|
|
D0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
6
|
2
|
—
|
—
|
$77,515.76
|
$77,515.76
|
$77,515.76
|
2025-12-31
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
54
|
14
|
—
|
$72,818.03
|
$5,095.00
|
$315,116.21
|
$77,247.76
|
2025-12-31
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
60
|
15
|
—
|
$68,964.70
|
$5,095.00
|
$275,514.99
|
$75,776.68
|
2025-12-31
|
|
8010000021-108078
|
CDM
|
Cadaver Donor Kidney Acquisit
|
26
|
7
|
$93,500.00
|
—
|
$19,261.00
|
$90,003.10
|
$74,800.00
|
2025-12-31
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
64
|
16
|
—
|
$68,241.47
|
$40,469.00
|
$295,311.41
|
$74,303.58
|
2025-12-31
|
|
453
|
MS_DRG
|
Combined Anterior/posterior Spinal Fusion W Mcc
|
2
|
1
|
—
|
—
|
$74,055.37
|
$74,055.37
|
$74,055.37
|
2025-12-31
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
64
|
16
|
—
|
$67,552.63
|
$40,840.00
|
$295,250.00
|
$73,561.39
|
2025-12-31
|
|
B1806
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
6
|
2
|
—
|
—
|
$73,087.44
|
$73,087.44
|
$73,087.44
|
2025-12-31
|
|
19
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
56
|
15
|
—
|
$68,569.40
|
$5,095.00
|
$299,501.32
|
$72,290.34
|
2025-12-31
|
|
A0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
6
|
2
|
—
|
—
|
$70,434.70
|
$70,434.70
|
$70,434.70
|
2025-12-31
|
|
8010000020-108079
|
CDM
|
Live Donor Kidney Acquisition
|
26
|
7
|
$88,000.00
|
—
|
$18,128.00
|
$84,708.80
|
$70,400.00
|
2025-12-31
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
65
|
16
|
—
|
$65,166.57
|
$5,095.00
|
$291,676.00
|
$70,320.81
|
2025-12-31
|
|
C1827
|
HCPCS
|
Generator Neurostimulator Vagal Nerve Stimulator Permanent Pulse
|
56
|
14
|
$136,290.00
|
—
|
$24,532.20
|
$115,846.50
|
$68,145.00
|
2025-12-31
|
|
222
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock…
|
2
|
1
|
—
|
—
|
$67,832.80
|
$67,832.80
|
$67,832.80
|
2025-12-31
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
52
|
14
|
—
|
$61,698.80
|
$61,128.00
|
$266,998.33
|
$67,254.17
|
2025-12-31
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
67
|
16
|
—
|
$60,734.07
|
$4,529.00
|
$262,823.53
|
$66,839.39
|
2025-12-31
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
54
|
14
|
—
|
$62,010.48
|
$5,095.00
|
$268,347.11
|
$65,912.26
|
2025-12-31
|
|
B0406
|
HCPCS
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
6
|
2
|
—
|
—
|
$65,681.42
|
$65,681.42
|
$65,681.42
|
2025-12-31
|
|
B0404
|
HCPCS
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
6
|
2
|
—
|
—
|
$64,727.79
|
$64,727.79
|
$64,727.79
|
2025-12-31
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
65
|
16
|
—
|
$59,614.81
|
$5,095.00
|
$257,980.00
|
$64,395.48
|
2025-12-31
|
|
8010000023-108076
|
CDM
|
Cadaver Kidney/pancreas Acquis
|
26
|
7
|
$80,453.00
|
—
|
$16,573.32
|
$77,444.06
|
$64,362.40
|
2025-12-31
|
|
B0505
|
HCPCS
|
Non-traumatic Spinal Cord Injury M <39.50
|
6
|
2
|
—
|
—
|
$64,063.02
|
$64,063.02
|
$64,063.02
|
2025-12-31
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
52
|
14
|
—
|
$58,535.72
|
$57,994.18
|
$253,310.27
|
$63,846.10
|
2025-12-31
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
64
|
16
|
—
|
$58,211.82
|
$35,331.00
|
$257,328.00
|
$63,497.12
|
2025-12-31
|
|
J9029
|
HCPCS
|
Instill Adstiladrin, Tx Dose
|
16
|
6
|
—
|
$63,431.05
|
$53,916.39
|
$66,602.60
|
$63,431.05
|
2025-12-31
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
65
|
16
|
—
|
$58,310.47
|
$5,095.00
|
$252,335.52
|
$63,003.38
|
2025-12-31
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
67
|
16
|
—
|
$56,462.21
|
$4,529.00
|
$244,337.28
|
$62,193.25
|
2025-12-31
|
|
B0106
|
HCPCS
|
Stroke M <41.50 And A <84.50
|
6
|
2
|
—
|
—
|
$61,728.86
|
$61,728.86
|
$61,728.86
|
2025-12-31
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
65
|
16
|
—
|
$56,381.02
|
$11,842.00
|
$244,242.00
|
$60,944.10
|
2025-12-31
|
|
C1605
|
HCPCS
|
System Leadless Pacemaker Aveir Dr
|
54
|
16
|
$118,965.00
|
—
|
$21,413.70
|
$118,965.00
|
$59,839.40
|
2025-12-31
|
|
C1904
|
HCPCS
|
Guillain-barr? M <38.50
|
6
|
2
|
—
|
—
|
$59,734.52
|
$59,734.52
|
$59,734.52
|
2025-12-31
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
65
|
16
|
—
|
$55,214.62
|
$5,095.00
|
$238,938.38
|
$59,699.21
|
2025-12-31
|
|
224
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh…
|
2
|
1
|
—
|
—
|
$59,303.26
|
$59,303.26
|
$59,303.26
|
2025-12-31
|
|
E0194NU
|
OTHER
|
Air Fluidized Bed
|
2
|
1
|
—
|
—
|
$59,056.79
|
$59,056.79
|
$59,056.79
|
2025-12-31
|
|
573
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
64
|
16
|
—
|
$53,764.47
|
$11,842.00
|
$232,662.95
|
$58,705.32
|
2025-12-31
|
|
17
|
MS_DRG
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
62
|
15
|
—
|
$52,209.21
|
$4,529.00
|
$208,576.56
|
$58,529.01
|
2025-12-31
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/mcc
|
62
|
15
|
—
|
$52,209.21
|
$4,529.00
|
$251,021.00
|
$58,529.01
|
2025-12-31
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
53
|
14
|
—
|
$54,080.52
|
$11,842.00
|
$234,030.63
|
$58,488.80
|
2025-12-31
|
|
C0406
|
HCPCS
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
6
|
2
|
—
|
—
|
$58,409.21
|
$58,409.21
|
$58,409.21
|
2025-12-31
|
|
C1806
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
6
|
2
|
—
|
—
|
$58,305.14
|
$58,305.14
|
$58,305.14
|
2025-12-31
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
65
|
15
|
—
|
$51,901.37
|
$4,529.00
|
$224,600.49
|
$58,086.00
|
2025-12-31
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
65
|
16
|
—
|
$53,332.31
|
$11,842.00
|
$236,473.00
|
$57,690.26
|
2025-12-31
|
|
C0404
|
HCPCS
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
6
|
2
|
—
|
—
|
$57,561.78
|
$57,561.78
|
$57,561.78
|
2025-12-31
|
|
317
|
MS_DRG
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
54
|
14
|
—
|
$54,010.67
|
$5,095.00
|
$233,728.38
|
$57,521.67
|
2025-12-31
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
64
|
16
|
—
|
$52,302.98
|
$11,842.00
|
$276,053.00
|
$57,419.13
|
2025-12-31
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
65
|
16
|
—
|
$52,586.34
|
$5,095.00
|
$229,689.59
|
$57,418.17
|
2025-12-31
|
|
Q2043
|
HCPCS
|
Sipuleucel-t Auto Cd54+
|
28
|
11
|
—
|
$55,945.97
|
$47,554.07
|
$112,575.34
|
$57,344.62
|
2025-12-31
|
|
0424T
|
OTHER
|
Insj/rplc Nstim Apnea Compl
|
2
|
1
|
—
|
—
|
$57,334.55
|
$57,334.55
|
$57,334.55
|
2025-12-31
|
|
0312T
|
OTHER
|
Laps Impltj Nstim Vagus
|
2
|
1
|
—
|
—
|
$57,334.55
|
$57,334.55
|
$57,334.55
|
2025-12-31
|
|
A9543
|
HCPCS
|
Y-90 Yttrium Ibrit To 40 Mci Tx
|
88
|
23
|
$129,984.00
|
$56,824.55
56% off
|
$10,098.00
|
$128,407.29
|
$56,824.55
|
2025-12-31
|
|
D0406
|
HCPCS
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
6
|
2
|
—
|
—
|
$56,699.47
|
$56,699.47
|
$56,699.47
|
2025-12-31
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
65
|
16
|
—
|
$51,940.66
|
$11,842.00
|
$226,681.00
|
$56,204.96
|
2025-12-31
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
69
|
18
|
—
|
$53,081.10
|
$5,095.00
|
$231,850.66
|
$56,181.97
|
2025-12-31
|
|
Sx00000102245-63204
|
CDM
|
Custom Pelvis IMPLaNT
|
56
|
14
|
$112,294.40
|
—
|
$20,212.99
|
$95,450.24
|
$56,147.20
|
2025-12-31
|
|
B0205
|
HCPCS
|
Traumatic Brain Injury M <35.50
|
6
|
2
|
—
|
—
|
$56,038.94
|
$56,038.94
|
$56,038.94
|
2025-12-31
|
|
D0404
|
HCPCS
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
6
|
2
|
—
|
—
|
$55,877.53
|
$55,877.53
|
$55,877.53
|
2025-12-31
|
|
D1904
|
HCPCS
|
Guillain-barr? M <38.50
|
6
|
2
|
—
|
—
|
$55,739.47
|
$55,739.47
|
$55,739.47
|
2025-12-31
|
|
B1705
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
6
|
2
|
—
|
—
|
$55,688.50
|
$55,688.50
|
$55,688.50
|
2025-12-31
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
65
|
16
|
—
|
$51,372.30
|
$11,842.00
|
$223,019.00
|
$55,598.36
|
2025-12-31
|
|
D1806
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
6
|
2
|
—
|
—
|
$55,352.93
|
$55,352.93
|
$55,352.93
|
2025-12-31
|
|
L8702
|
HCPCS
|
Ewhf S/d Uprt Micro Sensor
|
8
|
2
|
—
|
—
|
$26,348.70
|
$55,311.18
|
$55,311.18
|
2025-12-31
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
67
|
18
|
—
|
$50,108.12
|
$11,842.00
|
$251,221.00
|
$55,282.43
|
2025-12-31
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
65
|
16
|
—
|
$50,831.88
|
$5,095.00
|
$219,972.32
|
$55,021.58
|
2025-12-31
|
|
A1904
|
HCPCS
|
Guillain-barr? M <38.50
|
6
|
2
|
—
|
—
|
$54,775.23
|
$54,775.23
|
$54,775.23
|
2025-12-31
|
|
B0105
|
HCPCS
|
Stroke M <41.50 And A >=84.50
|
6
|
2
|
—
|
—
|
$54,271.86
|
$54,271.86
|
$54,271.86
|
2025-12-31
|
|
459
|
MS_DRG
|
Spinal Fusion Except Cervical With Mcc
|
2
|
1
|
—
|
—
|
$54,225.32
|
$54,225.32
|
$54,225.32
|
2025-12-31
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
65
|
16
|
—
|
$47,809.93
|
$5,095.00
|
$303,464.00
|
$54,079.76
|
2025-12-31
|
|
Sx00000065138-76399
|
CDM
|
Carticel Cs1000
|
56
|
14
|
$108,087.82
|
—
|
$19,455.81
|
$91,874.65
|
$54,043.91
|
2025-12-31
|
|
23
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
65
|
16
|
—
|
$49,347.86
|
$5,095.00
|
$215,544.38
|
$53,929.50
|
2025-12-31
|
|
C0106
|
HCPCS
|
Stroke M <41.50 And A <84.50
|
6
|
2
|
—
|
—
|
$53,534.87
|
$53,534.87
|
$53,534.87
|
2025-12-31
|
|
B1903
|
HCPCS
|
Guillain-barr? M >=38.50 And M <51.50
|
6
|
2
|
—
|
—
|
$53,339.47
|
$53,339.47
|
$53,339.47
|
2025-12-31
|
|
834
|
MS_DRG
|
Acute Leukemia Without Major O.r. Procedures With Mcc
|
67
|
16
|
—
|
$48,256.37
|
$4,529.00
|
$211,422.00
|
$53,268.43
|
2025-12-31
|
|
226
|
MS_DRG
|
Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc
|
2
|
1
|
—
|
—
|
$53,258.71
|
$53,258.71
|
$53,258.71
|
2025-12-31
|
|
653
|
MS_DRG
|
Major Bladder Procedures With Mcc
|
64
|
16
|
—
|
$48,669.32
|
$11,842.00
|
$210,701.00
|
$53,215.54
|
2025-12-31
|
|
B0604
|
HCPCS
|
Neurological M <43.50
|
6
|
2
|
—
|
—
|
$52,893.46
|
$52,893.46
|
$52,893.46
|
2025-12-31
|
|
8
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant
|
60
|
15
|
—
|
$47,064.32
|
$5,095.00
|
$201,488.00
|
$51,959.74
|
2025-12-31
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
64
|
16
|
—
|
$47,395.54
|
$11,842.00
|
$206,482.00
|
$51,843.10
|
2025-12-31
|
|
A0406
|
HCPCS
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
6
|
2
|
—
|
—
|
$51,521.42
|
$51,521.42
|
$51,521.42
|
2025-12-31
|
|
B0405
|
HCPCS
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
6
|
2
|
—
|
—
|
$51,474.69
|
$51,474.69
|
$51,474.69
|
2025-12-31
|
|
B1805
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
6
|
2
|
—
|
—
|
$51,464.08
|
$51,464.08
|
$51,464.08
|
2025-12-31
|
|
A1806
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
6
|
2
|
—
|
—
|
$51,321.77
|
$51,321.77
|
$51,321.77
|
2025-12-31
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
65
|
16
|
—
|
$46,448.27
|
$11,842.00
|
$201,002.48
|
$51,301.92
|
2025-12-31
|
|
428
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
54
|
14
|
—
|
$48,053.82
|
$5,095.00
|
$207,950.40
|
$51,273.82
|
2025-12-31
|
|
0187433001
|
NDC
|
Isoproterenol Hcl 0.2 Mg/ml Ij Soln
|
27
|
13
|
$65,582.32
|
—
|
$8,722.45
|
$63,352.52
|
$51,114.86
|
2025-12-31
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
65
|
16
|
—
|
$47,153.70
|
$5,095.00
|
$204,055.18
|
$51,095.90
|
2025-12-31
|
|
220
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
65
|
16
|
—
|
$46,243.10
|
$11,842.00
|
$200,114.62
|
$51,078.77
|
2025-12-31
|
|
11
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
65
|
16
|
—
|
$46,673.35
|
$5,095.00
|
$203,862.50
|
$51,048.38
|
2025-12-31
|
|
576
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
65
|
16
|
—
|
$47,103.94
|
$5,095.00
|
$203,839.83
|
$51,042.79
|
2025-12-31
|
|
430
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
54
|
14
|
—
|
$47,760.47
|
$5,095.00
|
$206,680.96
|
$50,966.15
|
2025-12-31
|
|
C1826
|
HCPCS
|
Generator Neurostimulator Pain Management Closed Loop Evoke 3042
|
112
|
14
|
$101,640.00
|
—
|
$17,672.33
|
$86,394.00
|
$50,820.00
|
2025-12-31
|
|
A0404
|
HCPCS
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
6
|
2
|
—
|
—
|
$50,773.81
|
$50,773.81
|
$50,773.81
|
2025-12-31
|
|
B0305
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
6
|
2
|
—
|
—
|
$50,644.25
|
$50,644.25
|
$50,644.25
|
2025-12-31
|
|
A5104
|
HCPCS
|
Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More
|
6
|
2
|
—
|
—
|
$50,620.89
|
$50,620.89
|
$50,620.89
|
2025-12-31
|
|
223
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock…
|
2
|
1
|
—
|
—
|
$50,039.09
|
$50,039.09
|
$50,039.09
|
2025-12-31
|
|
B1604
|
HCPCS
|
Pain Syndrome M <43.50
|
6
|
2
|
—
|
—
|
$49,858.41
|
$49,858.41
|
$49,858.41
|
2025-12-31
|
|
C0505
|
HCPCS
|
Non-traumatic Spinal Cord Injury M <39.50
|
6
|
2
|
—
|
—
|
$49,839.30
|
$49,839.30
|
$49,839.30
|
2025-12-31
|
|
Sx00000201156-24771
|
CDM
|
Repiphysis Total Femur
|
56
|
14
|
$99,200.00
|
—
|
$17,856.00
|
$84,320.00
|
$49,600.00
|
2025-12-31
|
|
B0704
|
HCPCS
|
Fracture Of Lower Extremity M <41.50
|
6
|
2
|
—
|
—
|
$49,429.38
|
$49,429.38
|
$49,429.38
|
2025-12-31
|
|
B2102
|
HCPCS
|
Burns M <52.50
|
6
|
2
|
—
|
—
|
$49,223.37
|
$49,223.37
|
$49,223.37
|
2025-12-31
|
|
454
|
MS_DRG
|
Combined Anterior/posterior Spinal Fusion W Cc
|
2
|
1
|
—
|
—
|
$49,120.81
|
$49,120.81
|
$49,120.81
|
2025-12-31
|
|
D0106
|
HCPCS
|
Stroke M <41.50 And A <84.50
|
6
|
2
|
—
|
—
|
$48,921.77
|
$48,921.77
|
$48,921.77
|
2025-12-31
|
|
B1004
|
HCPCS
|
Amputation Lower Extremity M <47.50
|
6
|
2
|
—
|
—
|
$48,872.92
|
$48,872.92
|
$48,872.92
|
2025-12-31
|
|
228
|
MS_DRG
|
Other Cardiothoracic Procedures With Mcc
|
66
|
16
|
—
|
$43,506.95
|
$5,095.00
|
$252,434.00
|
$48,859.63
|
2025-12-31
|
|
450
|
MS_DRG
|
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …
|
53
|
14
|
—
|
$44,963.21
|
$11,842.00
|
$194,575.93
|
$48,758.01
|
2025-12-31
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures With Mcc
|
65
|
16
|
—
|
$44,813.91
|
$11,842.00
|
$194,298.00
|
$48,598.67
|
2025-12-31
|
|
326
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
64
|
16
|
—
|
$44,342.46
|
$11,842.00
|
$201,753.00
|
$48,553.56
|
2025-12-31
|
|
837
|
MS_DRG
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
67
|
16
|
—
|
$43,715.61
|
$4,529.00
|
$206,290.00
|
$48,329.83
|
2025-12-31
|
|
B1504
|
HCPCS
|
Pulmonary M <45.50
|
6
|
2
|
—
|
—
|
$48,305.84
|
$48,305.84
|
$48,305.84
|
2025-12-31
|
|
239
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
65
|
16
|
—
|
$43,974.91
|
$5,095.00
|
$190,299.12
|
$47,703.21
|
2025-12-31
|
|
B1704
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
6
|
2
|
—
|
—
|
$47,454.16
|
$47,454.16
|
$47,454.16
|
2025-12-31
|
|
853
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
65
|
16
|
—
|
$43,664.10
|
$5,095.00
|
$194,122.00
|
$47,371.50
|
2025-12-31
|
|
B2005
|
HCPCS
|
Miscellaneous M <46.50 And A <77.50
|
6
|
2
|
—
|
—
|
$47,175.93
|
$47,175.93
|
$47,175.93
|
2025-12-31
|
|
D0505
|
HCPCS
|
Non-traumatic Spinal Cord Injury M <39.50
|
6
|
2
|
—
|
—
|
$47,084.61
|
$47,084.61
|
$47,084.61
|
2025-12-31
|
|
C0105
|
HCPCS
|
Stroke M <41.50 And A >=84.50
|
6
|
2
|
—
|
—
|
$47,067.61
|
$47,067.61
|
$47,067.61
|
2025-12-31
|
|
471
|
MS_DRG
|
Cervical Spinal Fusion With Mcc
|
67
|
18
|
—
|
$42,406.90
|
$11,842.00
|
$192,341.00
|
$46,906.46
|
2025-12-31
|
|
466
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Mcc
|
69
|
18
|
—
|
$44,067.17
|
$5,095.00
|
$196,275.00
|
$46,807.17
|
2025-12-31
|
|
278
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …
|
54
|
14
|
—
|
$43,681.56
|
$5,095.00
|
$189,029.68
|
$46,687.98
|
2025-12-31
|
|
A0106
|
HCPCS
|
Stroke M <41.50 And A <84.50
|
6
|
2
|
—
|
—
|
$46,621.60
|
$46,621.60
|
$46,621.60
|
2025-12-31
|
|
B1204
|
HCPCS
|
Osteoarthritis M <49.50 And A <74.50
|
6
|
2
|
—
|
—
|
$46,379.47
|
$46,379.47
|
$46,379.47
|
2025-12-31
|
|
33231
|
HCPCS
|
Ins Pacng Cvdfb Pls Gen Only W/exist Multi Leads
|
80
|
22
|
$75,878.00
|
$32,061.58
58% off
|
$104.00
|
$75,043.34
|
$46,209.70
|
2025-12-31
|
|
C0205
|
HCPCS
|
Traumatic Brain Injury M <35.50
|
6
|
2
|
—
|
—
|
$46,154.34
|
$46,154.34
|
$46,154.34
|
2025-12-31
|
|
B0504
|
HCPCS
|
Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50
|
6
|
2
|
—
|
—
|
$46,103.37
|
$46,103.37
|
$46,103.37
|
2025-12-31
|
|
B0304
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
6
|
2
|
—
|
—
|
$45,920.71
|
$45,920.71
|
$45,920.71
|
2025-12-31
|
|
J7330
|
HCPCS
|
Graft Cartilage Membrane Collagen Maci 3x5cm 81073
|
144
|
19
|
$139,304.08
|
—
|
$11,794.33
|
$118,408.47
|
$45,866.86
|
2025-12-31
|
|
C0405
|
HCPCS
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
6
|
2
|
—
|
—
|
$45,776.29
|
$45,776.29
|
$45,776.29
|
2025-12-31
|
|
K0606NU
|
OTHER
|
Aed Garment W Elec Analysis
|
2
|
1
|
—
|
—
|
$45,699.60
|
$45,699.60
|
$45,699.60
|
2025-12-31
|
|
J9226
|
HCPCS
|
Supprelin La Implant
|
28
|
11
|
—
|
$45,560.39
|
$38,726.33
|
$93,292.40
|
$45,654.58
|
2025-12-31
|
|
B1404
|
HCPCS
|
Cardiac M <45.50
|
6
|
2
|
—
|
—
|
$45,574.52
|
$45,574.52
|
$45,574.52
|
2025-12-31
|
|
799
|
MS_DRG
|
Splenic Procedures With Mcc
|
64
|
16
|
—
|
$41,512.02
|
$11,842.00
|
$180,476.00
|
$45,503.89
|
2025-12-31
|
|
B1304
|
HCPCS
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
6
|
2
|
—
|
—
|
$45,485.31
|
$45,485.31
|
$45,485.31
|
2025-12-31
|
|
B0904
|
HCPCS
|
Other Orthopedic M <44.5
|
6
|
2
|
—
|
—
|
$45,485.31
|
$45,485.31
|
$45,485.31
|
2025-12-31
|
|
225
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh…
|
2
|
1
|
—
|
—
|
$45,324.44
|
$45,324.44
|
$45,324.44
|
2025-12-31
|
|
267
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
64
|
16
|
—
|
$41,074.62
|
$11,842.00
|
$224,485.00
|
$45,286.62
|
2025-12-31
|
|
826
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …
|
65
|
16
|
—
|
$41,692.74
|
$5,095.00
|
$189,930.00
|
$45,267.48
|
2025-12-31
|
|
981
|
MS_DRG
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
65
|
16
|
—
|
$41,504.16
|
$5,095.00
|
$179,607.10
|
$45,066.22
|
2025-12-31
|
|
0266T
|
OTHER
|
Im/repl Cartd Sinus Baroreflx Activ Dev Tot Syst
|
42
|
13
|
$84,284.00
|
$45,000.50
47% off
|
$1,967.00
|
$71,641.40
|
$45,000.50
|
2025-12-31
|
|
33276
|
HCPCS
|
Insertion Phrenic Nerve Stimulator System
|
44
|
14
|
$150,200.00
|
$45,000.50
70% off
|
$1,202.82
|
$127,670.00
|
$45,000.50
|
2025-12-31
|
|
245
|
MS_DRG
|
Aicd Generator Procedures
|
67
|
17
|
—
|
$42,664.45
|
$5,095.00
|
$192,394.00
|
$44,937.78
|
2025-12-31
|
|
38240
|
HCPCS
|
Marrow/bld-drv Prph Stem Cell Trnsplj Allogeneic
|
72
|
15
|
$71,666.00
|
$59,142.33
|
$510.90
|
$64,262.90
|
$44,863.05
|
2025-12-31
|
|
B2004
|
HCPCS
|
Miscellaneous M <46.50 And A >=77.50
|
6
|
2
|
—
|
—
|
$44,756.82
|
$44,756.82
|
$44,756.82
|
2025-12-31
|
|
Sx00000066257-76056
|
CDM
|
Controller Impella Packaged
|
56
|
14
|
$89,280.00
|
—
|
$16,070.40
|
$75,888.00
|
$44,640.00
|
2025-12-31
|
|
6
|
MS_DRG
|
Liver Transplant Without Mcc
|
63
|
15
|
—
|
$41,944.51
|
$5,095.00
|
$186,767.00
|
$44,599.54
|
2025-12-31
|
|
D0405
|
HCPCS
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
6
|
2
|
—
|
—
|
$44,436.11
|
$44,436.11
|
$44,436.11
|
2025-12-31
|
|
221
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
65
|
16
|
—
|
$40,095.92
|
$11,842.00
|
$176,860.00
|
$44,393.01
|
2025-12-31
|
|
823
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Other Procedures With Mcc
|
65
|
16
|
—
|
$40,854.61
|
$5,095.00
|
$176,796.19
|
$44,372.96
|
2025-12-31
|
|
E0194UE
|
OTHER
|
Air Fluidized Bed
|
2
|
1
|
—
|
—
|
$44,292.59
|
$44,292.59
|
$44,292.59
|
2025-12-31
|
|
B1203
|
HCPCS
|
Osteoarthritis M <49.50 And A >=74.50
|
6
|
2
|
—
|
—
|
$44,227.97
|
$44,227.97
|
$44,227.97
|
2025-12-31
|
|
277
|
MS_DRG
|
Cardiac Defibrillator Implant Without Mcc
|
53
|
14
|
—
|
$40,613.65
|
$11,842.00
|
$175,753.43
|
$44,115.78
|
2025-12-31
|
|
329
|
MS_DRG
|
Major Small And Large Bowel Procedures With Mcc
|
64
|
16
|
—
|
$40,089.81
|
$11,842.00
|
$191,650.00
|
$43,971.52
|
2025-12-31
|
|
Sx00000075430-72870
|
CDM
|
Ligasure Kit
|
38
|
13
|
$87,094.62
|
—
|
$17,941.49
|
$87,094.62
|
$43,808.59
|
2025-12-31
|
|
B0805
|
HCPCS
|
Replacement Of Lower-extremity Joint M <42.50
|
6
|
2
|
—
|
—
|
$43,779.83
|
$43,779.83
|
$43,779.83
|
2025-12-31
|
|
B0204
|
HCPCS
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
6
|
2
|
—
|
—
|
$43,747.97
|
$43,747.97
|
$43,747.97
|
2025-12-31
|
|
163
|
MS_DRG
|
Major Chest Procedures With Mcc
|
65
|
16
|
—
|
$40,240.85
|
$5,095.00
|
$188,832.00
|
$43,717.91
|
2025-12-31
|
|
B1305
|
HCPCS
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
6
|
2
|
—
|
—
|
$43,558.94
|
$43,558.94
|
$43,558.94
|
2025-12-31
|
|
B0104
|
HCPCS
|
Stroke M >=41.50 And M <50.50
|
6
|
2
|
—
|
—
|
$43,401.77
|
$43,401.77
|
$43,401.77
|
2025-12-31
|
|
Sx00000021859-89968
|
CDM
|
Implant Orthopedic Repiphysis Proximal Tibial Lf
|
56
|
14
|
$86,800.00
|
—
|
$15,624.00
|
$73,780.00
|
$43,400.00
|
2025-12-31
|
|
C1825
|
HCPCS
|
Neo System Barostim
|
56
|
14
|
$86,800.00
|
—
|
$15,624.00
|
$73,780.00
|
$43,400.00
|
2025-12-31
|
|
A0505
|
HCPCS
|
Non-traumatic Spinal Cord Injury M <39.50
|
6
|
2
|
—
|
—
|
$43,389.03
|
$43,389.03
|
$43,389.03
|
2025-12-31
|
|
C1705
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
6
|
2
|
—
|
—
|
$43,287.08
|
$43,287.08
|
$43,287.08
|
2025-12-31
|
|
D0105
|
HCPCS
|
Stroke M <41.50 And A >=84.50
|
6
|
2
|
—
|
—
|
$43,010.98
|
$43,010.98
|
$43,010.98
|
2025-12-31
|
|
856
|
MS_DRG
|
Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc
|
65
|
16
|
—
|
$39,388.75
|
$5,095.00
|
$172,288.00
|
$42,808.47
|
2025-12-31
|
|
B1103
|
HCPCS
|
Amputation Non-lower Extremity M <52.50
|
6
|
2
|
—
|
—
|
$42,596.82
|
$42,596.82
|
$42,596.82
|
2025-12-31
|
|
474
|
MS_DRG
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc
|
65
|
16
|
—
|
$39,153.90
|
$5,095.00
|
$169,436.45
|
$42,557.81
|
2025-12-31
|
|
Sx00000294250-6580
|
CDM
|
Kit Tkr Osteotomy Femoral Distal My3d C240548
|
56
|
14
|
$85,014.40
|
—
|
$15,302.59
|
$72,262.24
|
$42,507.20
|
2025-12-31
|
|
B1804
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50
|
6
|
2
|
—
|
—
|
$42,448.14
|
$42,448.14
|
$42,448.14
|
2025-12-31
|
|
25
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
65
|
16
|
—
|
$38,684.41
|
$5,095.00
|
$168,967.97
|
$42,442.27
|
2025-12-31
|
|
650
|
MS_DRG
|
Kidney Transplant With Hemodialysis With Mcc
|
56
|
15
|
—
|
$40,224.26
|
$5,095.00
|
$174,068.40
|
$42,423.38
|
2025-12-31
|
|
227
|
MS_DRG
|
Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc
|
2
|
1
|
—
|
—
|
$42,304.58
|
$42,304.58
|
$42,304.58
|
2025-12-31
|
|
8010000022-108077
|
CDM
|
Cadaver Pancreas Acquisition
|
26
|
7
|
$52,859.00
|
—
|
$10,888.95
|
$50,882.07
|
$42,287.20
|
2025-12-31
|
|
B0603
|
HCPCS
|
Neurological M >=43.50 And M <52.50
|
6
|
2
|
—
|
—
|
$42,176.29
|
$42,176.29
|
$42,176.29
|
2025-12-31
|
|
458
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
68
|
18
|
—
|
$37,524.13
|
$11,842.00
|
$196,582.00
|
$42,130.54
|
2025-12-31
|
|
901
|
MS_DRG
|
Wound Debridements For Injuries With Mcc
|
65
|
16
|
—
|
$38,680.70
|
$5,095.00
|
$171,390.00
|
$42,052.77
|
2025-12-31
|
|
B1703
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50
|
6
|
2
|
—
|
—
|
$41,925.67
|
$41,925.67
|
$41,925.67
|
2025-12-31
|
|
D0205
|
HCPCS
|
Traumatic Brain Injury M <35.50
|
6
|
2
|
—
|
—
|
$41,921.42
|
$41,921.42
|
$41,921.42
|
2025-12-31
|
|
933
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft
|
67
|
16
|
—
|
$37,776.22
|
$4,529.00
|
$163,474.61
|
$41,870.05
|
2025-12-31
|
|
B0403
|
HCPCS
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
6
|
2
|
—
|
—
|
$41,456.29
|
$41,456.29
|
$41,456.29
|
2025-12-31
|
|
793
|
MS_DRG
|
Full Term Neonate With Major Problems
|
65
|
15
|
—
|
$36,410.76
|
$4,529.00
|
$157,565.66
|
$41,060.16
|
2025-12-31
|
|
C1805
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
6
|
2
|
—
|
—
|
$41,054.87
|
$41,054.87
|
$41,054.87
|
2025-12-31
|
|
C1903
|
HCPCS
|
Guillain-barr? M >=38.50 And M <51.50
|
6
|
2
|
—
|
—
|
$41,006.02
|
$41,006.02
|
$41,006.02
|
2025-12-31
|
|
A0105
|
HCPCS
|
Stroke M <41.50 And A >=84.50
|
6
|
2
|
—
|
—
|
$40,991.15
|
$40,991.15
|
$40,991.15
|
2025-12-31
|
|
C0305
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
6
|
2
|
—
|
—
|
$40,517.52
|
$40,517.52
|
$40,517.52
|
2025-12-31
|
|
356
|
MS_DRG
|
Other Digestive System O.r. Procedures With Mcc
|
65
|
16
|
—
|
$37,241.91
|
$5,095.00
|
$161,162.41
|
$40,517.17
|
2025-12-31
|
|
B0703
|
HCPCS
|
Fracture Of Lower Extremity M >=41.50 And M <52.50
|
6
|
2
|
—
|
—
|
$40,462.30
|
$40,462.30
|
$40,462.30
|
2025-12-31
|
|
C1004
|
HCPCS
|
Amputation Lower Extremity M <47.50
|
6
|
2
|
—
|
—
|
$40,419.83
|
$40,419.83
|
$40,419.83
|
2025-12-31
|
|
A0405
|
HCPCS
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
6
|
2
|
—
|
—
|
$40,377.35
|
$40,377.35
|
$40,377.35
|
2025-12-31
|
|
Sx00000033383-82905
|
CDM
|
Tavr Vavle Transapical 26mm
|
56
|
14
|
$80,600.00
|
—
|
$14,508.00
|
$68,510.00
|
$40,300.00
|
2025-12-31
|
|
269
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc
|
65
|
16
|
—
|
$36,325.20
|
$11,842.00
|
$159,336.00
|
$40,291.90
|
2025-12-31
|
|
B1603
|
HCPCS
|
Pain Syndrome M >=43.50 And M <58.50
|
6
|
2
|
—
|
—
|
$40,241.42
|
$40,241.42
|
$40,241.42
|
2025-12-31
|
|
0571T
|
OTHER
|
Insj/rplcmt Icds W/substernal Electrode
|
78
|
21
|
$66,076.00
|
$32,061.58
51% off
|
$104.00
|
$65,349.16
|
$40,240.28
|
2025-12-31
|
|
D1705
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
6
|
2
|
—
|
—
|
$40,088.50
|
$40,088.50
|
$40,088.50
|
2025-12-31
|
|
791
|
MS_DRG
|
Prematurity With Major Problems
|
65
|
15
|
—
|
$35,445.16
|
$4,529.00
|
$153,387.08
|
$39,998.86
|
2025-12-31
|
|
Sx00000076504-72681
|
CDM
|
Ligasure Kit Lf1744/gen
|
38
|
13
|
$79,401.17
|
—
|
$16,356.64
|
$79,401.17
|
$39,938.79
|
2025-12-31
|
|
323
|
MS_DRG
|
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc
|
54
|
14
|
—
|
$37,186.90
|
$5,095.00
|
$160,924.39
|
$39,876.06
|
2025-12-31
|
|
236
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization Without Mcc
|
65
|
16
|
—
|
$35,900.89
|
$11,842.00
|
$155,359.25
|
$39,830.42
|
2025-12-31
|
|
31
|
MS_DRG
|
Ventricular Shunt Procedures With Mcc
|
65
|
16
|
—
|
$36,247.77
|
$5,095.00
|
$160,565.00
|
$39,817.39
|
2025-12-31
|
|
673
|
MS_DRG
|
Other Kidney And Urinary Tract Procedures With Mcc
|
65
|
16
|
—
|
$36,577.51
|
$5,095.00
|
$158,287.28
|
$39,808.07
|
2025-12-31
|
|
319
|
MS_DRG
|
Other Endovascular Cardiac Valve Procedures With Mcc
|
59
|
15
|
—
|
$38,351.56
|
$5,095.00
|
$165,964.38
|
$39,722.42
|
2025-12-31
|
|
B0303
|
HCPCS
|
Non-traumatic Brain Injury M >=42.50 And M <52.50
|
6
|
2
|
—
|
—
|
$39,606.37
|
$39,606.37
|
$39,606.37
|
2025-12-31
|
|
C0604
|
HCPCS
|
Neurological M <43.50
|
6
|
2
|
—
|
—
|
$39,600.00
|
$39,600.00
|
$39,600.00
|
2025-12-31
|
|
A0205
|
HCPCS
|
Traumatic Brain Injury M <35.50
|
6
|
2
|
—
|
—
|
$39,468.32
|
$39,468.32
|
$39,468.32
|
2025-12-31
|
|
C1604
|
HCPCS
|
System Detour Cap Price Per Procedure
|
104
|
15
|
$115,500.00
|
—
|
$0.18
|
$98,175.00
|
$39,306.10
|
2025-12-31
|
|
C1504
|
HCPCS
|
Pulmonary M <45.50
|
6
|
2
|
—
|
—
|
$39,207.08
|
$39,207.08
|
$39,207.08
|
2025-12-31
|
|
958
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Cc
|
65
|
16
|
—
|
$35,880.81
|
$5,095.00
|
$160,446.00
|
$39,064.49
|
2025-12-31
|
|
423
|
MS_DRG
|
Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc
|
64
|
16
|
—
|
$35,510.64
|
$11,842.00
|
$153,670.44
|
$39,037.69
|
2025-12-31
|
|
140
|
MS_DRG
|
Major Head And Neck Procedures With Mcc
|
56
|
15
|
—
|
$36,923.24
|
$5,095.00
|
$159,783.41
|
$39,021.97
|
2025-12-31
|
|
12
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc
|
65
|
16
|
—
|
$35,496.10
|
$5,095.00
|
$155,041.89
|
$39,007.66
|
2025-12-31
|
|
B1503
|
HCPCS
|
Pulmonary M >=45.50 And M <56.50
|
6
|
2
|
—
|
—
|
$39,007.44
|
$39,007.44
|
$39,007.44
|
2025-12-31
|
|
D1805
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
6
|
2
|
—
|
—
|
$38,975.58
|
$38,975.58
|
$38,975.58
|
2025-12-31
|
|
448
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical Without Mcc
|
53
|
14
|
—
|
$35,651.20
|
$11,842.00
|
$154,278.71
|
$38,819.43
|
2025-12-31
|
|
B1803
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50
|
6
|
2
|
—
|
—
|
$38,816.29
|
$38,816.29
|
$38,816.29
|
2025-12-31
|
|
B0503
|
HCPCS
|
Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50
|
6
|
2
|
—
|
—
|
$38,784.43
|
$38,784.43
|
$38,784.43
|
2025-12-31
|
|
0426T
|
OTHER
|
Insj/rplc Nstim Apnea Stm Ld
|
2
|
1
|
—
|
—
|
$38,723.82
|
$38,723.82
|
$38,723.82
|
2025-12-31
|
|
0316T
|
OTHER
|
Replc Vagus Nerve Pls Gen
|
2
|
1
|
—
|
—
|
$38,723.82
|
$38,723.82
|
$38,723.82
|
2025-12-31
|
|
0427T
|
OTHER
|
Insj/rplc Nstim Apnea Pls Gn
|
2
|
1
|
—
|
—
|
$38,723.82
|
$38,723.82
|
$38,723.82
|
2025-12-31
|
|
0431T
|
OTHER
|
Rmvl/rplc Nstim Apnea Pls Gn
|
2
|
1
|
—
|
—
|
$38,723.82
|
$38,723.82
|
$38,723.82
|
2025-12-31
|
|
L7181
|
HCPCS
|
Electronic Elbo Simultaneous
|
16
|
5
|
—
|
—
|
$14,634.04
|
$74,831.36
|
$38,713.24
|
2025-12-31
|
|
455
|
MS_DRG
|
Combined Anterior/posterior Spinal Fusion Without Cc/mcc
|
2
|
1
|
—
|
—
|
$38,591.98
|
$38,591.98
|
$38,591.98
|
2025-12-31
|
|
876
|
MS_DRG
|
O.r. Procedures With Principal Diagnosis Of Mental Illness
|
62
|
16
|
—
|
$34,307.57
|
$1,270.18
|
$148,464.22
|
$38,423.01
|
2025-12-31
|
|
D1903
|
HCPCS
|
Guillain-barr? M >=38.50 And M <51.50
|
6
|
2
|
—
|
—
|
$38,264.07
|
$38,264.07
|
$38,264.07
|
2025-12-31
|
|
C0704
|
HCPCS
|
Fracture Of Lower Extremity M <41.50
|
6
|
2
|
—
|
—
|
$38,236.46
|
$38,236.46
|
$38,236.46
|
2025-12-31
|
|
B1003
|
HCPCS
|
Amputation Lower Extremity M >=47.50 And M <55.50
|
6
|
2
|
—
|
—
|
$38,174.87
|
$38,174.87
|
$38,174.87
|
2025-12-31
|
|
B0903
|
HCPCS
|
Other Orthopedic M >=44.50 And M <51.50
|
6
|
2
|
—
|
—
|
$37,960.36
|
$37,960.36
|
$37,960.36
|
2025-12-31
|
|
907
|
MS_DRG
|
Other O.r. Procedures For Injuries With Mcc
|
65
|
16
|
—
|
$34,779.89
|
$5,095.00
|
$161,839.00
|
$37,889.49
|
2025-12-31
|
|
739
|
MS_DRG
|
Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc…
|
65
|
16
|
—
|
$34,755.45
|
$5,095.00
|
$150,402.38
|
$37,863.40
|
2025-12-31
|
|
0795T
|
OTHER
|
Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys
|
78
|
21
|
$62,030.00
|
$19,071.16
69% off
|
$104.00
|
$61,347.67
|
$37,776.27
|
2025-12-31
|
|
C2005
|
HCPCS
|
Miscellaneous M <46.50 And A <77.50
|
6
|
2
|
—
|
—
|
$37,682.13
|
$37,682.13
|
$37,682.13
|
2025-12-31
|
|
C0104
|
HCPCS
|
Stroke M >=41.50 And M <50.50
|
6
|
2
|
—
|
—
|
$37,639.65
|
$37,639.65
|
$37,639.65
|
2025-12-31
|
|
C1304
|
HCPCS
|
Rheumatoid Other Arthritis M <44.50 And A >=64.50
|
6
|
2
|
—
|
—
|
$37,607.79
|
$37,607.79
|
$37,607.79
|
2025-12-31
|
|
A1903
|
HCPCS
|
Guillain-barr? M >=38.50 And M <51.50
|
6
|
2
|
—
|
—
|
$37,601.42
|
$37,601.42
|
$37,601.42
|
2025-12-31
|
|
273
|
MS_DRG
|
Percutaneous And Other Intracardiac Procedures With Mcc
|
64
|
16
|
—
|
$34,139.07
|
$11,842.00
|
$147,735.04
|
$37,559.89
|
2025-12-31
|
|
628
|
MS_DRG
|
Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc
|
65
|
16
|
—
|
$34,448.13
|
$5,095.00
|
$149,072.49
|
$37,535.41
|
2025-12-31
|
|
736
|
MS_DRG
|
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc
|
65
|
16
|
—
|
$34,377.41
|
$5,095.00
|
$154,719.00
|
$37,459.94
|
2025-12-31
|
|
B2003
|
HCPCS
|
Miscellaneous M >=46.50 And M <55.50
|
6
|
2
|
—
|
—
|
$37,433.63
|
$37,433.63
|
$37,433.63
|
2025-12-31
|
|
D2102
|
HCPCS
|
Burns M <52.50
|
6
|
2
|
—
|
—
|
$37,403.90
|
$37,403.90
|
$37,403.90
|
2025-12-31
|
|
C2102
|
HCPCS
|
Burns M <52.50
|
6
|
2
|
—
|
—
|
$37,403.90
|
$37,403.90
|
$37,403.90
|
2025-12-31
|
|
D0305
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A <78.50
|
6
|
2
|
—
|
—
|
$37,219.12
|
$37,219.12
|
$37,219.12
|
2025-12-31
|
|
B1403
|
HCPCS
|
Cardiac M >=45.50 And M <55.50
|
6
|
2
|
—
|
—
|
$37,193.63
|
$37,193.63
|
$37,193.63
|
2025-12-31
|
|
34
|
MS_DRG
|
Carotid Artery Stent Procedures With Mcc
|
65
|
16
|
—
|
$33,636.40
|
$5,095.00
|
$146,918.97
|
$37,004.28
|
2025-12-31
|
|
166
|
MS_DRG
|
Other Respiratory System O.r. Procedures With Mcc
|
64
|
16
|
—
|
$33,615.24
|
$11,842.00
|
$145,468.18
|
$36,995.49
|
2025-12-31
|
|
D0604
|
HCPCS
|
Neurological M <43.50
|
8
|
3
|
—
|
—
|
$79.27
|
$36,968.50
|
$36,968.50
|
2025-12-31
|
|
C1735
|
HCPCS
|
Catheter Rnd Multi Electrode Rx Symplicity Spyral 4fr
|
56
|
14
|
$73,920.00
|
—
|
$13,305.60
|
$62,832.00
|
$36,960.00
|
2025-12-31
|
|
D1004
|
HCPCS
|
Amputation Lower Extremity M <47.50
|
6
|
2
|
—
|
—
|
$36,921.77
|
$36,921.77
|
$36,921.77
|
2025-12-31
|
|
C1704
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50
|
6
|
2
|
—
|
—
|
$36,885.67
|
$36,885.67
|
$36,885.67
|
2025-12-31
|
|
D1504
|
HCPCS
|
Pulmonary M <45.50
|
6
|
2
|
—
|
—
|
$36,872.92
|
$36,872.92
|
$36,872.92
|
2025-12-31
|
|
C0403
|
HCPCS
|
Traumatic Spinal Cord Injury M >=41.50 And M <47.50
|
6
|
2
|
—
|
—
|
$36,866.55
|
$36,866.55
|
$36,866.55
|
2025-12-31
|
|
616
|
MS_DRG
|
Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…
|
65
|
16
|
—
|
$33,743.58
|
$5,095.00
|
$158,734.00
|
$36,783.44
|
2025-12-31
|
|
904
|
MS_DRG
|
Skin Grafts For Injuries With Cc/mcc
|
65
|
16
|
—
|
$33,709.53
|
$5,095.00
|
$145,876.22
|
$36,747.10
|
2025-12-31
|
|
C0304
|
HCPCS
|
Non-traumatic Brain Injury M <42.50 And A >=78.50
|
6
|
2
|
—
|
—
|
$36,739.12
|
$36,739.12
|
$36,739.12
|
2025-12-31
|
|
402
|
MS_DRG
|
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical
|
54
|
14
|
—
|
$34,155.66
|
$5,095.00
|
$147,806.83
|
$36,696.74
|
2025-12-31
|
|
B0804
|
HCPCS
|
Replacement Of Lower-extremity Joint M >=42.50 And M <51.50
|
6
|
2
|
—
|
—
|
$36,503.36
|
$36,503.36
|
$36,503.36
|
2025-12-31
|
|
C0904
|
HCPCS
|
Other Orthopedic M <44.5
|
6
|
2
|
—
|
—
|
$36,431.15
|
$36,431.15
|
$36,431.15
|
2025-12-31
|
|
K1007
|
HCPCS
|
Bil Hkaf Pc S/d Micro Sensor
|
2
|
1
|
—
|
—
|
$36,412.77
|
$36,412.77
|
$36,412.77
|
2025-12-31
|
|
Sx00000046460-81161
|
CDM
|
Kit Starter Stapler Endowrist 45
|
38
|
13
|
$72,354.00
|
—
|
$14,904.92
|
$72,354.00
|
$36,394.06
|
2025-12-31
|
|
956
|
MS_DRG
|
Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma
|
65
|
16
|
—
|
$33,371.65
|
$5,095.00
|
$145,245.00
|
$36,386.50
|
2025-12-31
|
|
A1705
|
HCPCS
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
6
|
2
|
—
|
—
|
$36,369.56
|
$36,369.56
|
$36,369.56
|
2025-12-31
|
|
D0704
|
HCPCS
|
Fracture Of Lower Extremity M <41.50
|
6
|
2
|
—
|
—
|
$36,220.89
|
$36,220.89
|
$36,220.89
|
2025-12-31
|
|
24
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
65
|
16
|
—
|
$32,883.87
|
$5,095.00
|
$150,450.00
|
$36,193.62
|
2025-12-31
|
|
A1805
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
6
|
2
|
—
|
—
|
$36,138.05
|
$36,138.05
|
$36,138.05
|
2025-12-31
|
|
C0204
|
HCPCS
|
Traumatic Brain Injury M >=35.50 And M <49.50
|
6
|
2
|
—
|
—
|
$36,033.98
|
$36,033.98
|
$36,033.98
|
2025-12-31
|
|
B1303
|
HCPCS
|
Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50
|
6
|
2
|
—
|
—
|
$36,016.99
|
$36,016.99
|
$36,016.99
|
2025-12-31
|
|
C1305
|
HCPCS
|
Rheumatoid Other Arthritis M <51.50 And A <64.50
|
6
|
2
|
—
|
—
|
$36,014.87
|
$36,014.87
|
$36,014.87
|
2025-12-31
|