|
J1414
|
HCPCS
|
Inj, Beqvez, Per Tx Dose
|
12
|
5
|
—
|
—
|
$3,605,000.00
|
$4,565,876.22
|
$4,390,265.60
|
2025-09-05
|
|
J1411
|
HCPCS
|
Inj, Hemgenix, Per Tx Dose
|
12
|
5
|
—
|
—
|
$3,672,900.00
|
$4,535,437.05
|
$4,360,997.17
|
2025-09-05
|
|
J1413
|
HCPCS
|
Inj Delandistrogene Mox Rokl
|
14
|
6
|
—
|
—
|
$3,325,454.76
|
$4,722,145.76
|
$3,934,165.40
|
2025-09-05
|
|
J3394
|
HCPCS
|
Inj, Lovotibeglogene Autotem
|
14
|
6
|
—
|
—
|
$3,286,000.00
|
$4,666,120.00
|
$3,859,357.05
|
2025-09-05
|
|
J3393
|
HCPCS
|
Inj, Betibeglogene Autotemce
|
14
|
6
|
—
|
—
|
$2,968,000.00
|
$4,214,560.00
|
$3,491,724.58
|
2025-09-05
|
|
J3399
|
HCPCS
|
Inj Onase Abepar-xioi Treat
|
18
|
8
|
—
|
—
|
$2,388,614.23
|
$4,352,603.27
|
$2,901,735.52
|
2025-09-05
|
|
J3392
|
HCPCS
|
Inj, Exagamglogene Autotem
|
18
|
8
|
—
|
—
|
$2,332,000.00
|
$4,139,393.28
|
$2,759,595.52
|
2025-09-05
|
|
Q2057
|
HCPCS
|
Afamitresgene Autoleucel
|
60
|
16
|
—
|
—
|
$755,207.60
|
$1,823,841.77
|
$911,920.88
|
2025-09-05
|
|
Q2042
|
HCPCS
|
Tisagenlecleucel Car-pos T
|
62
|
16
|
—
|
—
|
$529,192.86
|
$1,368,732.35
|
$684,366.18
|
2025-09-05
|
|
Q2056
|
HCPCS
|
Ciltacabtagene Car-pos T
|
62
|
16
|
—
|
—
|
$527,123.43
|
$1,309,692.74
|
$654,846.37
|
2025-09-05
|
|
Q2054
|
HCPCS
|
Lisocabtagene Mara Car Pos T
|
62
|
16
|
—
|
—
|
$516,726.08
|
$1,281,899.95
|
$640,949.97
|
2025-09-05
|
|
Q2055
|
HCPCS
|
Idecabtagene Vicleucel Car
|
62
|
16
|
—
|
—
|
$526,587.59
|
$1,281,011.93
|
$640,505.97
|
2025-09-05
|
|
Q2041
|
HCPCS
|
Axicabtagene Ciloleucel Car+
|
62
|
16
|
—
|
—
|
$489,455.96
|
$1,261,642.77
|
$630,821.38
|
2025-09-05
|
|
Q2053
|
HCPCS
|
Brexucabtagene Car Pos T
|
62
|
16
|
—
|
—
|
$460,530.40
|
$1,159,030.12
|
$579,515.06
|
2025-09-05
|
|
18
|
MS_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
68
|
21
|
—
|
—
|
$17,861.00
|
$1,038,723.65
|
$500,220.35
|
2025-09-05
|
|
24
|
APR_DRG
|
Heart &/or Lung Transplant
|
110
|
12
|
—
|
—
|
$268,700.30
|
$1,845,804.48
|
$446,838.02
|
2025-09-05
|
|
1
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$775,839.49
|
$376,515.77
|
2025-09-05
|
|
5834
|
APR_DRG
|
Neonate W Ecmo
|
110
|
12
|
—
|
—
|
$198,080.78
|
$676,250.89
|
$330,511.63
|
2025-09-05
|
|
Q2058
|
HCPCS
|
Obecbtge Autol Up To 400 Mil
|
16
|
7
|
—
|
—
|
$319,950.96
|
$639,901.92
|
$326,349.98
|
2025-09-05
|
|
5884
|
APR_DRG
|
Neonate Bwt <1500g W Major Procedure
|
110
|
12
|
—
|
—
|
$194,617.95
|
$768,888.48
|
$324,807.56
|
2025-09-05
|
|
5883
|
APR_DRG
|
Neonate Bwt <1500g W Major Procedure
|
110
|
12
|
—
|
—
|
$194,617.95
|
$664,583.47
|
$324,807.56
|
2025-09-05
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
66
|
20
|
—
|
—
|
$17,861.00
|
$653,397.08
|
$319,419.04
|
2025-09-05
|
|
1614
|
APR_DRG
|
Cardiac Defibrillator & Heart Assist Implant
|
110
|
12
|
—
|
—
|
$178,102.20
|
$767,810.26
|
$297,602.37
|
2025-09-05
|
|
SUP24349
|
CDM
|
Sealer Tissue Da Vinci Slim Jaw Extend Disposable( - 480422)
|
86
|
19
|
$396,259.24
|
—
|
$79,251.85
|
$336,820.35
|
$297,194.43
|
2025-09-05
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
68
|
21
|
—
|
—
|
$17,861.00
|
$590,290.56
|
$292,166.47
|
2025-09-05
|
|
34
|
APR_DRG
|
Bone Marrow Transplant
|
110
|
12
|
—
|
—
|
$172,959.72
|
$1,748,446.96
|
$289,131.54
|
2025-09-05
|
|
1734
|
APR_DRG
|
Other Vascular Procedures
|
2
|
1
|
—
|
—
|
$250,985.11
|
$250,985.11
|
$250,985.11
|
2025-09-05
|
|
5914
|
APR_DRG
|
Neonate Birthwt 500-749g Without Major Procedure
|
110
|
12
|
—
|
—
|
$149,676.30
|
$513,160.31
|
$250,778.46
|
2025-09-05
|
|
5881
|
APR_DRG
|
Neonate Bwt <1500g W Major Procedure
|
110
|
12
|
—
|
—
|
$149,139.43
|
$560,588.72
|
$249,894.11
|
2025-09-05
|
|
5882
|
APR_DRG
|
Neonate Bwt <1500g W Major Procedure
|
110
|
12
|
—
|
—
|
$149,139.43
|
$560,588.72
|
$249,894.11
|
2025-09-05
|
|
8414
|
APR_DRG
|
Extensive 3rd Degree Burns W Skin Graft
|
110
|
12
|
—
|
—
|
$144,797.66
|
$1,262,494.22
|
$242,742.23
|
2025-09-05
|
|
44
|
APR_DRG
|
Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo
|
110
|
12
|
—
|
—
|
$139,687.39
|
$621,417.39
|
$234,324.45
|
2025-09-05
|
|
6934
|
APR_DRG
|
Chemotherapy
|
2
|
1
|
—
|
—
|
$232,361.31
|
$232,361.31
|
$232,361.31
|
2025-09-05
|
|
14
|
APR_DRG
|
Liver Transplant &/or Intestinal Transplant
|
110
|
12
|
—
|
—
|
$135,341.02
|
$1,445,653.04
|
$227,164.99
|
2025-09-05
|
|
5934
|
APR_DRG
|
Neonate Birthwt 750-999g Without Major Procedure
|
110
|
12
|
—
|
—
|
$134,807.98
|
$463,064.06
|
$226,286.96
|
2025-09-05
|
|
SUP24347
|
CDM
|
Tenodesis Disposable Kit( - 232426)
|
86
|
19
|
$301,494.38
|
—
|
$60,298.88
|
$256,270.22
|
$226,120.79
|
2025-09-05
|
|
6094
|
APR_DRG
|
Neonate Bwt 1500-2499g W Major Procedure
|
110
|
12
|
—
|
—
|
$123,520.61
|
$523,564.87
|
$207,694.09
|
2025-09-05
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
68
|
21
|
—
|
—
|
$17,861.00
|
$389,182.59
|
$197,683.46
|
2025-09-05
|
|
6024
|
APR_DRG
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
110
|
12
|
—
|
—
|
$117,058.19
|
$403,259.20
|
$197,049.03
|
2025-09-05
|
|
23
|
APR_DRG
|
Heart &/or Lung Transplant
|
110
|
12
|
—
|
—
|
$116,653.24
|
$1,150,464.12
|
$196,381.97
|
2025-09-05
|
|
8413
|
APR_DRG
|
Extensive 3rd Degree Burns W Skin Graft
|
110
|
12
|
—
|
—
|
$113,386.75
|
$456,306.76
|
$191,001.32
|
2025-09-05
|
|
5833
|
APR_DRG
|
Neonate W Ecmo
|
110
|
12
|
—
|
—
|
$112,999.43
|
$418,910.78
|
$190,363.33
|
2025-09-05
|
|
C1833
|
HCPCS
|
Cardiac Monitor Sys
|
2
|
1
|
—
|
—
|
$187,725.00
|
$187,725.00
|
$187,725.00
|
2025-09-05
|
|
5831
|
APR_DRG
|
Neonate W Ecmo
|
110
|
12
|
—
|
—
|
$110,906.39
|
$417,124.62
|
$186,915.62
|
2025-09-05
|
|
5832
|
APR_DRG
|
Neonate W Ecmo
|
110
|
12
|
—
|
—
|
$110,906.39
|
$417,124.62
|
$186,915.62
|
2025-09-05
|
|
E0766NU
|
OTHER
|
Elec Stim Cancer Treatment
|
6
|
1
|
—
|
—
|
$185,002.22
|
$185,002.22
|
$185,002.22
|
2025-09-05
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
68
|
21
|
—
|
—
|
$17,861.00
|
$360,862.88
|
$183,005.97
|
2025-09-05
|
|
7
|
MS_DRG
|
Lung Transplant
|
68
|
21
|
—
|
—
|
$17,861.00
|
$359,953.96
|
$182,582.12
|
2025-09-05
|
|
6034
|
APR_DRG
|
Neonate Birthwt 1000-1249g W Or Without Other Significant Condition
|
110
|
12
|
—
|
—
|
$107,917.54
|
$372,461.36
|
$181,992.31
|
2025-09-05
|
|
5933
|
APR_DRG
|
Neonate Birthwt 750-999g Without Major Procedure
|
110
|
12
|
—
|
—
|
$105,526.15
|
$364,403.99
|
$178,053.15
|
2025-09-05
|
|
22
|
APR_DRG
|
Heart &/or Lung Transplant
|
110
|
12
|
—
|
—
|
$99,603.68
|
$709,397.78
|
$168,297.48
|
2025-09-05
|
|
54
|
APR_DRG
|
Tracheostomy W Mv 96+ Hours Without Extensive Procedure
|
130
|
12
|
—
|
—
|
$2,548.00
|
$458,238.60
|
$167,112.91
|
2025-09-05
|
|
6074
|
APR_DRG
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
110
|
12
|
—
|
—
|
$95,767.33
|
$331,604.20
|
$161,978.16
|
2025-09-05
|
|
6304
|
APR_DRG
|
Neonate Birthwt >2499g W Major Cardiovascular Procedure
|
110
|
12
|
—
|
—
|
$94,876.89
|
$390,628.80
|
$160,511.40
|
2025-09-05
|
|
5891
|
APR_DRG
|
Neonate Bwt <500g Or Ga <24 Weeks
|
110
|
12
|
—
|
—
|
$94,182.02
|
$326,181.89
|
$159,366.79
|
2025-09-05
|
|
5892
|
APR_DRG
|
Neonate Bwt <500g Or Ga <24 Weeks
|
110
|
12
|
—
|
—
|
$94,182.02
|
$326,181.89
|
$159,366.79
|
2025-09-05
|
|
21
|
APR_DRG
|
Heart &/or Lung Transplant
|
110
|
12
|
—
|
—
|
$93,884.44
|
$679,146.78
|
$158,876.61
|
2025-09-05
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$303,515.60
|
$157,436.05
|
2025-09-05
|
|
212
|
MS_DRG
|
Concomitant Aortic And Mitral Valve?procedures
|
68
|
21
|
—
|
—
|
$17,861.00
|
$300,050.69
|
$155,808.19
|
2025-09-05
|
|
33
|
APR_DRG
|
Bone Marrow Transplant
|
110
|
12
|
—
|
—
|
$91,759.96
|
$878,468.76
|
$155,377.10
|
2025-09-05
|
|
5913
|
APR_DRG
|
Neonate Birthwt 500-749g Without Major Procedure
|
110
|
12
|
—
|
—
|
$91,696.30
|
$327,548.53
|
$155,272.24
|
2025-09-05
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
68
|
21
|
—
|
—
|
$17,861.00
|
$293,316.42
|
$152,285.00
|
2025-09-05
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
68
|
21
|
—
|
—
|
$17,861.00
|
$291,812.58
|
$151,045.69
|
2025-09-05
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
58
|
18
|
—
|
—
|
$138,824.11
|
$288,523.94
|
$149,273.24
|
2025-09-05
|
|
904
|
APR_DRG
|
Major Larynx & Trachea Procedures
|
110
|
12
|
—
|
—
|
$87,214.18
|
$302,704.92
|
$147,889.16
|
2025-09-05
|
|
6023
|
APR_DRG
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
110
|
12
|
—
|
—
|
$86,690.34
|
$304,618.44
|
$147,026.29
|
2025-09-05
|
|
5932
|
APR_DRG
|
Neonate Birthwt 750-999g Without Major Procedure
|
110
|
12
|
—
|
—
|
$86,536.95
|
$317,697.19
|
$146,773.62
|
2025-09-05
|
|
5912
|
APR_DRG
|
Neonate Birthwt 500-749g Without Major Procedure
|
110
|
12
|
—
|
—
|
$85,615.06
|
$297,316.98
|
$145,255.06
|
2025-09-05
|
|
3034
|
APR_DRG
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
110
|
12
|
—
|
—
|
$84,637.95
|
$367,626.46
|
$143,645.54
|
2025-09-05
|
|
5931
|
APR_DRG
|
Neonate Birthwt 750-999g Without Major Procedure
|
110
|
12
|
—
|
—
|
$83,934.65
|
$315,579.28
|
$142,487.04
|
2025-09-05
|
|
6314
|
APR_DRG
|
Neonate Birthwt >2499g W Other Major Procedure
|
110
|
12
|
—
|
—
|
$81,715.07
|
$308,285.24
|
$138,830.88
|
2025-09-05
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
72
|
22
|
—
|
—
|
$17,861.00
|
$265,820.25
|
$138,686.16
|
2025-09-05
|
|
4404
|
APR_DRG
|
Kidney Transplant
|
110
|
12
|
—
|
—
|
$80,723.38
|
$765,586.90
|
$137,197.35
|
2025-09-05
|
|
43
|
APR_DRG
|
Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo
|
110
|
12
|
—
|
—
|
$78,318.96
|
$369,344.26
|
$133,236.72
|
2025-09-05
|
|
850
|
MS_DRG
|
Acute Leukemia With Other Procedures
|
58
|
18
|
—
|
—
|
$123,732.05
|
$253,723.36
|
$133,045.21
|
2025-09-05
|
|
1604
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
110
|
12
|
—
|
—
|
$77,347.21
|
$364,565.79
|
$131,636.04
|
2025-09-05
|
|
1613
|
APR_DRG
|
Cardiac Defibrillator & Heart Assist Implant
|
110
|
12
|
—
|
—
|
$76,547.28
|
$375,323.48
|
$130,318.35
|
2025-09-05
|
|
3614
|
APR_DRG
|
Skin Graft For Skin & Subcutaneous Tissue Diagnoses
|
110
|
12
|
—
|
—
|
$74,713.47
|
$588,059.16
|
$127,297.67
|
2025-09-05
|
|
6022
|
APR_DRG
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
110
|
12
|
—
|
—
|
$73,819.96
|
$257,575.41
|
$125,825.84
|
2025-09-05
|
|
1624
|
APR_DRG
|
Cardiac Valve Procedures W Ami Or Complex Pdx
|
110
|
12
|
—
|
—
|
$73,058.37
|
$377,847.50
|
$124,571.33
|
2025-09-05
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
68
|
21
|
—
|
—
|
$17,861.00
|
$233,267.18
|
$124,432.48
|
2025-09-05
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
72
|
22
|
—
|
—
|
$17,861.00
|
$233,396.63
|
$123,566.55
|
2025-09-05
|
|
1733
|
APR_DRG
|
Other Vascular Procedures
|
2
|
1
|
—
|
—
|
$122,809.26
|
$122,809.26
|
$122,809.26
|
2025-09-05
|
|
3044
|
APR_DRG
|
Dorsal & Lumbar Fusion Proc Except For Curvature Of Back
|
110
|
12
|
—
|
—
|
$71,505.27
|
$324,536.87
|
$122,013.02
|
2025-09-05
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
58
|
18
|
—
|
—
|
$113,324.67
|
$229,725.15
|
$121,854.48
|
2025-09-05
|
|
6073
|
APR_DRG
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
110
|
12
|
—
|
—
|
$71,251.41
|
$248,921.12
|
$121,594.86
|
2025-09-05
|
|
B0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$117,562.53
|
$170,345.71
|
$119,961.77
|
2025-09-05
|
|
3124
|
APR_DRG
|
Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses
|
110
|
12
|
—
|
—
|
$70,125.50
|
$750,086.22
|
$119,740.25
|
2025-09-05
|
|
6033
|
APR_DRG
|
Neonate Birthwt 1000-1249g W Or Without Other Significant Condition
|
110
|
12
|
—
|
—
|
$69,942.97
|
$259,331.68
|
$119,439.56
|
2025-09-05
|
|
6814
|
APR_DRG
|
Other O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms
|
110
|
12
|
—
|
—
|
$69,886.98
|
$282,701.93
|
$119,347.34
|
2025-09-05
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$222,026.88
|
$119,151.65
|
2025-09-05
|
|
6804
|
APR_DRG
|
Major O.r. Procedures For Lymphatic/hematopoietic/other Neoplasms
|
110
|
12
|
—
|
—
|
$69,696.01
|
$374,497.66
|
$119,032.76
|
2025-09-05
|
|
5911
|
APR_DRG
|
Neonate Birthwt 500-749g Without Major Procedure
|
110
|
12
|
—
|
—
|
$69,259.61
|
$242,210.09
|
$118,313.91
|
2025-09-05
|
|
19
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
68
|
21
|
—
|
—
|
$17,861.00
|
$218,341.62
|
$117,420.26
|
2025-09-05
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
68
|
21
|
—
|
—
|
$17,861.00
|
$219,600.34
|
$117,133.13
|
2025-09-05
|
|
6904
|
APR_DRG
|
Acute Leukemia
|
110
|
12
|
—
|
—
|
$68,214.24
|
$316,969.72
|
$116,591.95
|
2025-09-05
|
|
8424
|
APR_DRG
|
Burns With Skin Graft Except Extensive 3rd Degree Burns
|
110
|
12
|
—
|
—
|
$67,329.17
|
$578,689.80
|
$115,134.03
|
2025-09-05
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
72
|
22
|
—
|
—
|
$17,861.00
|
$215,287.11
|
$115,121.80
|
2025-09-05
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
72
|
22
|
—
|
—
|
$17,861.00
|
$213,113.96
|
$114,108.44
|
2025-09-05
|
|
53
|
APR_DRG
|
Tracheostomy W Mv 96+ Hours Without Extensive Procedure
|
130
|
12
|
—
|
—
|
$2,548.00
|
$321,429.63
|
$113,730.95
|
2025-09-05
|
|
6124
|
APR_DRG
|
Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond
|
110
|
12
|
—
|
—
|
$66,070.58
|
$231,465.22
|
$113,060.86
|
2025-09-05
|
|
4054
|
APR_DRG
|
Other Procedures For Endocrine, Nutritional & Metabolic Disorders
|
110
|
12
|
—
|
—
|
$65,414.82
|
$272,468.64
|
$111,980.68
|
2025-09-05
|
|
13
|
APR_DRG
|
Liver Transplant &/or Intestinal Transplant
|
110
|
12
|
—
|
—
|
$65,249.16
|
$739,895.52
|
$111,707.81
|
2025-09-05
|
|
B1904
|
HCPCS
|
Guillain-barr? M <38.50
|
34
|
11
|
—
|
—
|
$108,715.59
|
$157,526.68
|
$110,934.28
|
2025-09-05
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$205,586.46
|
$110,598.25
|
2025-09-05
|
|
6114
|
APR_DRG
|
Neonate Birthwt 1500-1999g W Major Anomaly
|
110
|
12
|
—
|
—
|
$64,077.24
|
$296,902.58
|
$109,777.38
|
2025-09-05
|
|
9504
|
APR_DRG
|
Extensive Procedure Unrelated To Principal Diagnosis
|
110
|
12
|
—
|
—
|
$63,314.89
|
$283,187.13
|
$108,521.61
|
2025-09-05
|
|
234
|
APR_DRG
|
Spinal Procedures
|
110
|
12
|
—
|
—
|
$63,067.93
|
$294,042.85
|
$108,114.81
|
2025-09-05
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$194,646.38
|
$106,287.95
|
2025-09-05
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
58
|
18
|
—
|
—
|
$98,538.38
|
$195,629.67
|
$105,955.25
|
2025-09-05
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
68
|
21
|
—
|
—
|
$17,861.00
|
$191,602.88
|
$104,858.08
|
2025-09-05
|
|
32
|
APR_DRG
|
Bone Marrow Transplant
|
110
|
12
|
—
|
—
|
$60,602.14
|
$656,510.92
|
$104,053.10
|
2025-09-05
|
|
64
|
APR_DRG
|
Pancreas Transplant
|
110
|
12
|
—
|
—
|
$59,668.75
|
$622,852.88
|
$102,515.59
|
2025-09-05
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
66
|
20
|
—
|
—
|
$17,861.00
|
$188,071.87
|
$102,430.93
|
2025-09-05
|
|
4474
|
APR_DRG
|
Other Kidney, Urinary Tract & Related Procedures
|
110
|
12
|
—
|
—
|
$59,605.10
|
$244,542.75
|
$102,410.74
|
2025-09-05
|
|
8504
|
APR_DRG
|
Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service
|
110
|
12
|
—
|
—
|
$59,575.18
|
$232,304.95
|
$102,361.47
|
2025-09-05
|
|
9124
|
APR_DRG
|
Musculoskeletal & Other Procedures For Multiple Significant Trauma
|
110
|
12
|
—
|
—
|
$59,190.94
|
$252,842.59
|
$101,728.52
|
2025-09-05
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$183,645.71
|
$101,119.70
|
2025-09-05
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
58
|
18
|
—
|
—
|
$93,784.41
|
$184,667.55
|
$100,843.45
|
2025-09-05
|
|
5124
|
APR_DRG
|
Uterine & Adnexa Procedures For Non-ovarian & Non-adnexal Malig
|
110
|
12
|
—
|
—
|
$58,629.52
|
$206,393.83
|
$100,803.74
|
2025-09-05
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$183,956.94
|
$100,512.08
|
2025-09-05
|
|
6072
|
APR_DRG
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
110
|
12
|
—
|
—
|
$58,437.78
|
$205,747.81
|
$100,487.90
|
2025-09-05
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
72
|
22
|
—
|
—
|
$17,861.00
|
$177,869.94
|
$99,871.27
|
2025-09-05
|
|
2604
|
APR_DRG
|
Major Pancreas, Liver & Shunt Procedures
|
110
|
12
|
—
|
—
|
$58,039.73
|
$268,442.47
|
$99,832.22
|
2025-09-05
|
|
6954
|
APR_DRG
|
Chemotherapy For Acute Leukemia #
|
108
|
12
|
—
|
—
|
$57,735.24
|
$203,380.72
|
$99,330.66
|
2025-09-05
|
|
924
|
APR_DRG
|
Facial Bone Procedures Except Major Cranial/facial Bone Procedures
|
110
|
12
|
—
|
—
|
$57,479.08
|
$202,517.62
|
$98,908.70
|
2025-09-05
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
68
|
21
|
—
|
—
|
$17,861.00
|
$178,126.09
|
$98,526.52
|
2025-09-05
|
|
63
|
APR_DRG
|
Pancreas Transplant
|
110
|
12
|
—
|
—
|
$57,178.43
|
$561,783.04
|
$98,413.47
|
2025-09-05
|
|
6093
|
APR_DRG
|
Neonate Bwt 1500-2499g W Major Procedure
|
110
|
12
|
—
|
—
|
$56,939.90
|
$213,284.76
|
$98,020.56
|
2025-09-05
|
|
Q0480
|
HCPCS
|
Driver Pneumatic Vad, Rep
|
16
|
3
|
—
|
—
|
$35,858.53
|
$122,219.08
|
$97,904.99
|
2025-09-05
|
|
214
|
APR_DRG
|
Craniotomy Except For Trauma
|
110
|
12
|
—
|
—
|
$56,620.08
|
$267,344.65
|
$97,493.74
|
2025-09-05
|
|
42
|
APR_DRG
|
Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo
|
110
|
12
|
—
|
—
|
$56,215.13
|
$264,840.24
|
$96,826.69
|
2025-09-05
|
|
41
|
APR_DRG
|
Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo
|
110
|
12
|
—
|
—
|
$56,215.13
|
$264,416.30
|
$96,826.69
|
2025-09-05
|
|
1694
|
APR_DRG
|
Major Abdominal Vascular Procedures
|
110
|
12
|
—
|
—
|
$56,171.41
|
$257,005.99
|
$96,754.67
|
2025-09-05
|
|
9104
|
APR_DRG
|
Craniotomy For Multiple Significant Trauma
|
110
|
12
|
—
|
—
|
$56,168.34
|
$242,349.55
|
$96,749.62
|
2025-09-05
|
|
6084
|
APR_DRG
|
Neonate Bwt 1250-1499g W Or Without Other Significant Condition
|
110
|
12
|
—
|
—
|
$56,167.57
|
$214,956.68
|
$96,748.36
|
2025-09-05
|
|
C0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$94,192.93
|
$136,483.63
|
$96,115.23
|
2025-09-05
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$174,190.19
|
$95,957.70
|
2025-09-05
|
|
2204
|
APR_DRG
|
Major Stomach, Esophageal & Duodenal Procedures
|
110
|
12
|
—
|
—
|
$55,441.26
|
$261,926.59
|
$95,551.95
|
2025-09-05
|
|
8412
|
APR_DRG
|
Extensive 3rd Degree Burns W Skin Graft
|
110
|
12
|
—
|
—
|
$55,396.78
|
$452,737.48
|
$95,478.68
|
2025-09-05
|
|
1654
|
APR_DRG
|
Coronary Bypass W Ami Or Complex Pdx
|
110
|
12
|
—
|
—
|
$55,356.13
|
$294,910.32
|
$95,411.72
|
2025-09-05
|
|
3214
|
APR_DRG
|
Cervical Spinal Fusion & Other Back/neck Proc Exc Disc Excis/decomp
|
110
|
12
|
—
|
—
|
$55,261.03
|
$277,501.97
|
$95,255.06
|
2025-09-05
|
|
1634
|
APR_DRG
|
Cardiac Valve Procedures Without Ami Or Complex Pdx
|
110
|
12
|
—
|
—
|
$55,129.11
|
$352,293.68
|
$95,037.77
|
2025-09-05
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$170,612.36
|
$94,996.47
|
2025-09-05
|
|
573
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$169,615.30
|
$94,528.04
|
2025-09-05
|
|
3033
|
APR_DRG
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
110
|
12
|
—
|
—
|
$54,676.60
|
$231,138.51
|
$94,292.39
|
2025-09-05
|
|
4014
|
APR_DRG
|
Pituitary & Adrenal Procedures
|
110
|
12
|
—
|
—
|
$54,674.30
|
$306,976.59
|
$94,288.59
|
2025-09-05
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$169,023.13
|
$94,249.83
|
2025-09-05
|
|
317
|
MS_DRG
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
58
|
18
|
—
|
—
|
$87,593.49
|
$170,392.02
|
$94,186.55
|
2025-09-05
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$168,251.92
|
$93,887.51
|
2025-09-05
|
|
D0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$91,761.92
|
$132,961.15
|
$93,634.61
|
2025-09-05
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$167,447.67
|
$93,509.66
|
2025-09-05
|
|
6032
|
APR_DRG
|
Neonate Birthwt 1000-1249g W Or Without Other Significant Condition
|
110
|
12
|
—
|
—
|
$53,990.17
|
$202,082.26
|
$93,161.67
|
2025-09-05
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$166,246.79
|
$92,945.47
|
2025-09-05
|
|
17
|
MS_DRG
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$166,246.79
|
$92,945.47
|
2025-09-05
|
|
3104
|
APR_DRG
|
Intervertebral Disc Excision & Decompression
|
110
|
12
|
—
|
—
|
$53,558.37
|
$205,513.63
|
$92,450.40
|
2025-09-05
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$165,004.60
|
$92,361.88
|
2025-09-05
|
|
6083
|
APR_DRG
|
Neonate Bwt 1250-1499g W Or Without Other Significant Condition
|
110
|
12
|
—
|
—
|
$53,415.72
|
$200,249.96
|
$92,215.42
|
2025-09-05
|
|
B1806
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
34
|
11
|
—
|
—
|
$90,299.26
|
$130,841.78
|
$92,142.10
|
2025-09-05
|
|
6214
|
APR_DRG
|
Neonate Bwt 2000-2499g W Major Anomaly
|
110
|
12
|
—
|
—
|
$53,174.12
|
$188,012.81
|
$91,817.46
|
2025-09-05
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
68
|
21
|
—
|
—
|
$17,861.00
|
$163,861.57
|
$91,515.21
|
2025-09-05
|
|
4414
|
APR_DRG
|
Major Bladder Procedures
|
110
|
12
|
—
|
—
|
$52,953.24
|
$267,445.12
|
$91,453.62
|
2025-09-05
|
|
4604
|
APR_DRG
|
Renal Failure
|
2
|
1
|
—
|
—
|
$91,324.90
|
$91,324.90
|
$91,324.90
|
2025-09-05
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
58
|
19
|
—
|
—
|
$17,861.00
|
$129,338.58
|
$91,083.51
|
2025-09-05
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
72
|
22
|
—
|
—
|
$17,861.00
|
$162,068.52
|
$90,305.18
|
2025-09-05
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$160,363.61
|
$90,181.49
|
2025-09-05
|
|
1674
|
APR_DRG
|
Other Cardiothoracic & Thoracic Vascular Procedures
|
110
|
12
|
—
|
—
|
$51,940.08
|
$237,666.64
|
$89,784.72
|
2025-09-05
|
|
K1007
|
HCPCS
|
Bil Hkaf Pc S/d Micro Sensor
|
4
|
1
|
—
|
—
|
$67,727.85
|
$111,750.95
|
$89,739.40
|
2025-09-05
|
|
31
|
APR_DRG
|
Bone Marrow Transplant
|
110
|
12
|
—
|
—
|
$51,897.13
|
$579,899.84
|
$89,713.97
|
2025-09-05
|
|
1814
|
APR_DRG
|
Lower Extremity Arterial Procedures #
|
108
|
12
|
—
|
—
|
$51,827.34
|
$183,475.06
|
$89,599.00
|
2025-09-05
|
|
7914
|
APR_DRG
|
O.r. Procedure For Other Complications Of Treatment
|
110
|
12
|
—
|
—
|
$51,782.86
|
$225,624.89
|
$89,525.72
|
2025-09-05
|
|
2214
|
APR_DRG
|
Major Small & Large Bowel Procedures
|
110
|
12
|
—
|
—
|
$51,764.45
|
$228,884.05
|
$89,495.41
|
2025-09-05
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
68
|
21
|
—
|
—
|
$17,861.00
|
$158,080.29
|
$89,108.75
|
2025-09-05
|
|
4034
|
APR_DRG
|
Procedures For Obesity
|
110
|
12
|
—
|
—
|
$51,522.09
|
$247,292.21
|
$89,096.18
|
2025-09-05
|
|
23
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
68
|
21
|
—
|
—
|
$17,861.00
|
$157,135.57
|
$88,664.90
|
2025-09-05
|
|
6021
|
APR_DRG
|
Neonate Bwt 1000-1249g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
110
|
12
|
—
|
—
|
$50,877.84
|
$238,693.07
|
$88,034.96
|
2025-09-05
|
|
9114
|
APR_DRG
|
Extensive Abdominal/thoracic Procedures For Mult Significant Trauma
|
110
|
12
|
—
|
—
|
$50,859.43
|
$231,959.43
|
$88,004.64
|
2025-09-05
|
|
B0406
|
HCPCS
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$86,065.90
|
$124,707.74
|
$87,822.35
|
2025-09-05
|
|
3134
|
APR_DRG
|
Knee & Lower Leg Procedures Except Foot
|
110
|
12
|
—
|
—
|
$50,713.71
|
$245,868.47
|
$87,764.60
|
2025-09-05
|
|
5104
|
APR_DRG
|
Pelvic Evisceration, Radical Hysterectomy & Other Radical GYN Procs
|
110
|
12
|
—
|
—
|
$50,238.19
|
$193,577.25
|
$86,981.32
|
2025-09-05
|
|
653
|
MS_DRG
|
Major Bladder Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$153,541.21
|
$86,976.24
|
2025-09-05
|
|
4424
|
APR_DRG
|
Kidney & Urinary Tract Procedures For Malignancy
|
110
|
12
|
—
|
—
|
$49,982.03
|
$226,347.78
|
$86,559.36
|
2025-09-05
|
|
834
|
MS_DRG
|
Acute Leukemia Without Major O.r. Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$152,238.42
|
$86,364.17
|
2025-09-05
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$152,238.42
|
$86,364.17
|
2025-09-05
|
|
6123
|
APR_DRG
|
Neonate Bwt 1500-1999g W Resp Dist Synd/oth Maj Resp Cond
|
110
|
12
|
—
|
—
|
$49,729.70
|
$176,407.43
|
$86,143.72
|
2025-09-05
|
|
1774
|
APR_DRG
|
Cardiac Pacemaker & Defibrillator Revision Except Device Replacement
|
110
|
12
|
—
|
—
|
$49,665.27
|
$248,534.61
|
$86,037.59
|
2025-09-05
|
|
6914
|
APR_DRG
|
Lymphoma, Myeloma & Non-acute Leukemia
|
110
|
12
|
—
|
—
|
$49,651.47
|
$210,069.11
|
$86,014.85
|
2025-09-05
|
|
7104
|
APR_DRG
|
Infectious & Parasitic Diseases Including HIV W O.r. Procedure
|
110
|
12
|
—
|
—
|
$49,556.36
|
$235,929.24
|
$85,858.19
|
2025-09-05
|
|
3174
|
APR_DRG
|
Tendon, Muscle & Other Soft Tissue Procedures
|
110
|
12
|
—
|
—
|
$49,537.96
|
$240,242.12
|
$85,827.87
|
2025-09-05
|
|
3054
|
APR_DRG
|
Amputation Of Lower Limb Except Toes
|
110
|
12
|
—
|
—
|
$49,413.71
|
$247,823.97
|
$85,623.21
|
2025-09-05
|
|
894
|
APR_DRG
|
Major Cranial/facial Bone Procedures
|
130
|
12
|
—
|
—
|
$2,548.00
|
$213,720.36
|
$85,450.27
|
2025-09-05
|
|
428
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
58
|
18
|
—
|
—
|
$79,443.66
|
$151,599.43
|
$85,423.29
|
2025-09-05
|
|
264
|
APR_DRG
|
Other Nervous System & Related Procedures
|
110
|
12
|
—
|
—
|
$49,215.06
|
$229,619.20
|
$85,296.00
|
2025-09-05
|
|
9514
|
APR_DRG
|
Moderately Extensive Procedure Unrelated To Principal Diagnosis
|
110
|
12
|
—
|
—
|
$49,208.93
|
$230,802.79
|
$85,285.89
|
2025-09-05
|
|
8
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant
|
68
|
21
|
—
|
—
|
$17,861.00
|
$149,864.22
|
$85,248.74
|
2025-09-05
|
|
1824
|
APR_DRG
|
Other Peripheral Vascular Procedures #
|
108
|
12
|
—
|
—
|
$49,185.16
|
$174,572.66
|
$85,246.72
|
2025-09-05
|
|
6113
|
APR_DRG
|
Neonate Birthwt 1500-1999g W Major Anomaly
|
110
|
12
|
—
|
—
|
$49,137.60
|
$174,412.46
|
$85,168.40
|
2025-09-05
|
|
244
|
APR_DRG
|
Extracranial Vascular Procedures
|
130
|
12
|
—
|
—
|
$2,548.00
|
$243,574.80
|
$85,157.40
|
2025-09-05
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$149,522.68
|
$85,088.28
|
2025-09-05
|
|
B0404
|
HCPCS
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
34
|
11
|
—
|
—
|
$83,307.89
|
$120,711.43
|
$85,008.05
|
2025-09-05
|
|
430
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
58
|
18
|
—
|
—
|
$79,042.32
|
$150,673.98
|
$84,991.74
|
2025-09-05
|
|
1664
|
APR_DRG
|
Coronary Bypass Without Ami Or Complex Pdx
|
110
|
12
|
—
|
—
|
$48,872.24
|
$309,909.83
|
$84,731.27
|
2025-09-05
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
68
|
21
|
—
|
—
|
$17,861.00
|
$148,759.74
|
$84,729.85
|
2025-09-05
|
|
5114
|
APR_DRG
|
Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy
|
110
|
12
|
—
|
—
|
$48,835.42
|
$204,403.56
|
$84,670.63
|
2025-09-05
|
|
576
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$148,602.75
|
$84,656.08
|
2025-09-05
|
|
220
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
72
|
22
|
—
|
—
|
$17,861.00
|
$145,887.01
|
$84,621.59
|
2025-09-05
|
|
A0407
|
HCPCS
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$82,861.74
|
$120,064.98
|
$84,552.80
|
2025-09-05
|
|
11
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$148,619.27
|
$84,409.28
|
2025-09-05
|
|
4444
|
APR_DRG
|
Renal Dialysis Access Device Procedure Only
|
110
|
12
|
—
|
—
|
$48,524.80
|
$222,811.71
|
$84,158.98
|
2025-09-05
|
|
204
|
APR_DRG
|
Craniotomy For Trauma
|
130
|
12
|
—
|
—
|
$2,548.00
|
$233,873.27
|
$83,943.75
|
2025-09-05
|
|
11
|
APR_DRG
|
Liver Transplant &/or Intestinal Transplant
|
110
|
12
|
—
|
—
|
$48,351.47
|
$720,223.92
|
$83,873.46
|
2025-09-05
|
|
12
|
APR_DRG
|
Liver Transplant &/or Intestinal Transplant
|
110
|
12
|
—
|
—
|
$48,351.47
|
$733,541.12
|
$83,873.46
|
2025-09-05
|
|
2644
|
APR_DRG
|
Other Hepatobiliary, Pancreas & Abdominal Procedures
|
110
|
12
|
—
|
—
|
$48,284.74
|
$250,551.37
|
$83,763.54
|
2025-09-05
|
|
2614
|
APR_DRG
|
Major Biliary Tract Procedures
|
110
|
12
|
—
|
—
|
$48,177.37
|
$201,325.73
|
$83,586.67
|
2025-09-05
|
|
1612
|
APR_DRG
|
Cardiac Defibrillator & Heart Assist Implant
|
110
|
12
|
—
|
—
|
$48,077.67
|
$227,881.80
|
$83,422.44
|
2025-09-05
|
|
1732
|
APR_DRG
|
Other Vascular Procedures
|
2
|
1
|
—
|
—
|
$83,245.94
|
$83,245.94
|
$83,245.94
|
2025-09-05
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
72
|
22
|
—
|
—
|
$17,861.00
|
$146,534.27
|
$83,061.33
|
2025-09-05
|
|
1204
|
APR_DRG
|
Major Respiratory & Chest Procedures
|
110
|
12
|
—
|
—
|
$47,795.42
|
$230,143.61
|
$82,957.52
|
2025-09-05
|
|
1304
|
APR_DRG
|
Respiratory System Diagnosis W Ventilator Support 96+ Hours
|
110
|
12
|
—
|
—
|
$47,657.37
|
$211,343.37
|
$82,730.11
|
2025-09-05
|
|
6903
|
APR_DRG
|
Acute Leukemia
|
110
|
12
|
—
|
—
|
$47,581.43
|
$182,069.70
|
$82,605.04
|
2025-09-05
|
|
1214
|
APR_DRG
|
Other Respiratory & Chest Procedures
|
110
|
12
|
—
|
—
|
$47,536.96
|
$219,523.14
|
$82,531.77
|
2025-09-05
|
|
3014
|
APR_DRG
|
Hip Joint Replacement
|
110
|
12
|
—
|
—
|
$47,510.88
|
$193,322.40
|
$82,488.81
|
2025-09-05
|
|
2624
|
APR_DRG
|
Cholecystectomy Except Laparoscopic
|
110
|
12
|
—
|
—
|
$47,510.11
|
$175,629.79
|
$82,487.55
|
2025-09-05
|
|
5194
|
APR_DRG
|
Uterine & Adnexa Procedures For Leiomyoma
|
110
|
12
|
—
|
—
|
$47,473.30
|
$168,804.86
|
$82,426.91
|
2025-09-05
|
|
6071
|
APR_DRG
|
Neonate Bwt 1250-1499g W Resp Dist Synd/oth Maj Resp Or Maj Anom
|
110
|
12
|
—
|
—
|
$47,415.00
|
$168,608.48
|
$82,330.90
|
2025-09-05
|
|
7114
|
APR_DRG
|
Post-op, Post-trauma, Other Device Infections W O.r. Procedure
|
110
|
12
|
—
|
—
|
$47,374.36
|
$234,458.94
|
$82,263.93
|
2025-09-05
|
|
5184
|
APR_DRG
|
Other Female Reproductive System & Related Procedures
|
110
|
12
|
—
|
—
|
$46,929.53
|
$166,972.70
|
$81,531.19
|
2025-09-05
|
|
494
|
APR_DRG
|
Bacterial & Tuberculous Infections Of Nervous System
|
110
|
12
|
—
|
—
|
$46,849.75
|
$178,366.99
|
$81,399.79
|
2025-09-05
|
|
1714
|
APR_DRG
|
Perm Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock
|
110
|
12
|
—
|
—
|
$46,821.38
|
$207,123.61
|
$81,353.05
|
2025-09-05
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$141,378.22
|
$81,261.90
|
2025-09-05
|
|
B0505
|
HCPCS
|
Non-traumatic Spinal Cord Injury M <39.50
|
34
|
11
|
—
|
—
|
$79,345.78
|
$114,970.41
|
$80,965.08
|
2025-09-05
|
|
9524
|
APR_DRG
|
Nonextensive Procedure Unrelated To Principal Diagnosis
|
110
|
12
|
—
|
—
|
$46,574.42
|
$208,706.63
|
$80,946.25
|
2025-09-05
|
|
450
|
MS_DRG
|
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …
|
58
|
18
|
—
|
—
|
$75,215.25
|
$141,849.20
|
$80,876.61
|
2025-09-05
|
|
6303
|
APR_DRG
|
Neonate Birthwt >2499g W Major Cardiovascular Procedure
|
110
|
12
|
—
|
—
|
$46,527.64
|
$184,583.15
|
$80,869.18
|
2025-09-05
|
|
434
|
APR_DRG
|
Multiple Sclerosis & Other Demyelinating Diseases
|
110
|
12
|
—
|
—
|
$46,467.81
|
$165,417.05
|
$80,770.65
|
2025-09-05
|
|
466
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$140,320.57
|
$80,765.02
|
2025-09-05
|
|
3814
|
APR_DRG
|
Major Skin Disorders
|
110
|
12
|
—
|
—
|
$46,353.53
|
$165,032.01
|
$80,582.40
|
2025-09-05
|
|
326
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$139,890.90
|
$80,563.14
|
2025-09-05
|
|
228
|
MS_DRG
|
Other Cardiothoracic Procedures With Mcc
|
72
|
22
|
—
|
—
|
$17,861.00
|
$137,255.03
|
$80,505.80
|
2025-09-05
|
|
239
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$138,731.34
|
$79,806.54
|
2025-09-05
|
|
853
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$137,750.81
|
$79,557.71
|
2025-09-05
|
|
837
|
MS_DRG
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
68
|
21
|
—
|
—
|
$17,861.00
|
$137,913.31
|
$79,285.86
|
2025-09-05
|
|
2294
|
APR_DRG
|
Other Digestive System & Abdominal Procedures
|
110
|
12
|
—
|
—
|
$45,463.86
|
$208,674.78
|
$79,116.91
|
2025-09-05
|
|
278
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …
|
68
|
21
|
—
|
—
|
$17,861.00
|
$137,805.89
|
$78,991.15
|
2025-09-05
|
|
3084
|
APR_DRG
|
Hip And Femur Fracture Repair
|
110
|
12
|
—
|
—
|
$45,325.80
|
$166,339.94
|
$78,889.50
|
2025-09-05
|
|
3094
|
APR_DRG
|
Other Significant Hip And Femur Surgery
|
110
|
12
|
—
|
—
|
$45,144.04
|
$196,802.11
|
$78,590.08
|
2025-09-05
|
|
1623
|
APR_DRG
|
Cardiac Valve Procedures W Ami Or Complex Pdx
|
110
|
12
|
—
|
—
|
$45,079.61
|
$200,759.66
|
$78,483.97
|
2025-09-05
|
|
6504
|
APR_DRG
|
Splenectomy
|
110
|
12
|
—
|
—
|
$44,821.14
|
$229,852.00
|
$78,058.21
|
2025-09-05
|
|
C1904
|
HCPCS
|
Guillain-barr? M <38.50
|
34
|
11
|
—
|
—
|
$76,420.46
|
$110,731.69
|
$77,980.06
|
2025-09-05
|
|
51
|
APR_DRG
|
Tracheostomy W Mv 96+ Hours Without Extensive Procedure
|
110
|
12
|
—
|
—
|
$44,768.23
|
$214,293.77
|
$77,971.04
|
2025-09-05
|
|
6082
|
APR_DRG
|
Neonate Bwt 1250-1499g W Or Without Other Significant Condition
|
110
|
12
|
—
|
—
|
$44,690.76
|
$165,592.28
|
$77,843.44
|
2025-09-05
|
|
471
|
MS_DRG
|
Cervical Spinal Fusion With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$133,784.61
|
$77,694.34
|
2025-09-05
|
|
4403
|
APR_DRG
|
Kidney Transplant
|
110
|
12
|
—
|
—
|
$44,586.45
|
$528,757.06
|
$77,671.62
|
2025-09-05
|
|
6
|
MS_DRG
|
Liver Transplant Without Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$133,561.52
|
$77,589.53
|
2025-09-05
|
|
245
|
MS_DRG
|
Aicd Generator Procedures
|
72
|
22
|
—
|
—
|
$17,861.00
|
$134,597.13
|
$77,494.86
|
2025-09-05
|
|
2234
|
APR_DRG
|
Other Small & Large Bowel Procedures
|
110
|
12
|
—
|
—
|
$43,866.28
|
$207,535.30
|
$76,485.32
|
2025-09-05
|
|
6933
|
APR_DRG
|
Chemotherapy
|
2
|
1
|
—
|
—
|
$76,394.34
|
$76,394.34
|
$76,394.34
|
2025-09-05
|
|
799
|
MS_DRG
|
Splenic Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$130,961.46
|
$76,367.99
|
2025-09-05
|
|
2244
|
APR_DRG
|
Peritoneal Adhesiolysis
|
110
|
12
|
—
|
—
|
$43,790.35
|
$156,567.35
|
$76,360.25
|
2025-09-05
|
|
826
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …
|
68
|
21
|
—
|
—
|
$17,861.00
|
$131,531.60
|
$76,065.36
|
2025-09-05
|
|
2224
|
APR_DRG
|
Other Stomach, Esophageal & Duodenal Procedures
|
110
|
12
|
—
|
—
|
$43,524.98
|
$178,827.69
|
$75,923.13
|
2025-09-05
|
|
C1806
|
HCPCS
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
34
|
11
|
—
|
—
|
$74,346.88
|
$107,727.11
|
$75,864.16
|
2025-09-05
|
|
981
|
MS_DRG
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$130,936.67
|
$75,787.93
|
2025-09-05
|
|
267
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$129,581.55
|
$75,719.69
|
2025-09-05
|
|
823
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Other Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$128,887.47
|
$75,393.61
|
2025-09-05
|
|
J9029
|
HCPCS
|
Instill Adstiladrin, Tx Dose
|
64
|
17
|
—
|
—
|
$62,162.43
|
$150,123.53
|
$75,061.77
|
2025-09-05
|
|
277
|
MS_DRG
|
Cardiac Defibrillator Implant Without Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$128,127.28
|
$75,036.45
|
2025-09-05
|
|
69930
|
CPT
|
Implant Cochlear Device
|
10
|
3
|
—
|
—
|
$33,287.01
|
$74,895.77
|
$74,895.77
|
2025-09-05
|
|
3024
|
APR_DRG
|
Knee Joint Replacement
|
110
|
12
|
—
|
—
|
$42,825.51
|
$209,931.88
|
$74,770.95
|
2025-09-05
|
|
4234
|
APR_DRG
|
Inborn Errors Of Metabolism
|
110
|
12
|
—
|
—
|
$42,790.99
|
$153,028.64
|
$74,714.09
|
2025-09-05
|
|
163
|
MS_DRG
|
Major Chest Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$126,951.20
|
$74,483.92
|
2025-09-05
|
|
650
|
MS_DRG
|
Kidney Transplant With Hemodialysis With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$126,898.86
|
$74,459.33
|
2025-09-05
|
|
221
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
68
|
21
|
—
|
—
|
$17,861.00
|
$126,493.98
|
$74,269.11
|
2025-09-05
|
|
329
|
MS_DRG
|
Major Small And Large Bowel Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$126,474.70
|
$74,260.05
|
2025-09-05
|
|
224
|
APR_DRG
|
Ventricular Shunt Procedures
|
110
|
12
|
—
|
—
|
$42,401.38
|
$250,901.79
|
$74,072.31
|
2025-09-05
|
|
52
|
APR_DRG
|
Tracheostomy W Mv 96+ Hours Without Extensive Procedure
|
130
|
12
|
—
|
—
|
$2,548.00
|
$220,371.01
|
$74,028.35
|
2025-09-05
|
|
B0106
|
HCPCS
|
Stroke M <41.50 And A <84.50
|
34
|
11
|
—
|
—
|
$72,544.54
|
$105,115.56
|
$74,025.04
|
2025-09-05
|
|
8411
|
APR_DRG
|
Extensive 3rd Degree Burns W Skin Graft
|
110
|
12
|
—
|
—
|
$42,242.61
|
$452,737.48
|
$73,810.79
|
2025-09-05
|
|
6334
|
APR_DRG
|
Neonate Birthwt >2499g W Major Anomaly
|
110
|
12
|
—
|
—
|
$42,143.68
|
$153,267.11
|
$73,647.82
|
2025-09-05
|
|
504
|
APR_DRG
|
Non-bacterial Infections Of Nervous System Exc Viral Meningitis
|
110
|
12
|
—
|
—
|
$42,086.93
|
$151,186.56
|
$73,554.33
|
2025-09-05
|
|
3043
|
APR_DRG
|
Dorsal & Lumbar Fusion Proc Except For Curvature Of Back
|
110
|
12
|
—
|
—
|
$41,941.97
|
$190,675.86
|
$73,315.56
|
2025-09-05
|
|
856
|
MS_DRG
|
Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$124,263.00
|
$73,220.97
|
2025-09-05
|
|
3644
|
APR_DRG
|
Other Skin, Subcutaneous Tissue & Related Procedures
|
110
|
12
|
—
|
—
|
$41,801.62
|
$149,695.11
|
$73,084.36
|
2025-09-05
|
|
8634
|
APR_DRG
|
Neonatal Aftercare
|
110
|
12
|
—
|
—
|
$41,722.62
|
$185,176.93
|
$72,954.23
|
2025-09-05
|
|
474
|
MS_DRG
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$123,522.09
|
$72,872.89
|
2025-09-05
|
|
3032
|
APR_DRG
|
Dorsal & Lumbar Fusion Proc For Curvature Of Back
|
110
|
12
|
—
|
—
|
$41,641.32
|
$176,835.43
|
$72,820.32
|
2025-09-05
|
|
25
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$123,180.56
|
$72,712.43
|
2025-09-05
|
|
2274
|
APR_DRG
|
Hernia Procedures Except Inguinal, Femoral & Umbilical
|
110
|
12
|
—
|
—
|
$41,528.58
|
$192,508.83
|
$72,634.61
|
2025-09-05
|
|
B1903
|
HCPCS
|
Guillain-barr? M >=38.50 And M <51.50
|
34
|
11
|
—
|
—
|
$71,005.83
|
$102,886.00
|
$72,454.93
|
2025-09-05
|
|
319
|
MS_DRG
|
Other Endovascular Cardiac Valve Procedures With Mcc
|
68
|
21
|
—
|
—
|
$17,861.00
|
$120,990.89
|
$71,683.70
|
2025-09-05
|
|
901
|
MS_DRG
|
Wound Debridements For Injuries With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$122,029.26
|
$71,634.28
|
2025-09-05
|
|
6134
|
APR_DRG
|
Neonate Birthwt 1500-1999g W Congenital/perinatal Infection
|
110
|
12
|
—
|
—
|
$40,795.37
|
$163,034.98
|
$71,426.83
|
2025-09-05
|
|
6031
|
APR_DRG
|
Neonate Birthwt 1000-1249g W Or Without Other Significant Condition
|
110
|
12
|
—
|
—
|
$40,765.45
|
$170,115.91
|
$71,377.56
|
2025-09-05
|
|
6224
|
APR_DRG
|
Neonate Bwt 2000-2499g W Resp Dist Synd/oth Maj Resp Cond
|
110
|
12
|
—
|
—
|
$40,725.57
|
$152,706.88
|
$71,311.87
|
2025-09-05
|
|
B0205
|
HCPCS
|
Traumatic Brain Injury M <35.50
|
34
|
11
|
—
|
—
|
$69,451.91
|
$100,634.41
|
$70,869.30
|
2025-09-05
|
|
3154
|
APR_DRG
|
Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement
|
110
|
12
|
—
|
—
|
$40,452.53
|
$170,814.55
|
$70,862.11
|
2025-09-05
|
|
458
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
68
|
21
|
—
|
—
|
$17,861.00
|
$118,930.67
|
$70,715.78
|
2025-09-05
|
|
C0406
|
HCPCS
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$68,988.01
|
$99,962.22
|
$70,395.93
|
2025-09-05
|
|
933
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft
|
66
|
20
|
—
|
—
|
$17,861.00
|
$119,175.81
|
$70,303.67
|
2025-09-05
|
|
8444
|
APR_DRG
|
Partial Thickness Burns Without Skin Graft
|
110
|
12
|
—
|
—
|
$40,040.68
|
$143,761.91
|
$70,183.69
|
2025-09-05
|