|
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
|
66
|
20
|
—
|
—
|
$17,861.00
|
$1,111,245.36
|
$475,027.85
|
2025-09-05
|
|
0024
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$264,199.63
|
$1,845,804.48
|
$410,285.95
|
2025-09-05
|
|
1
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$830,007.13
|
$356,571.81
|
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
|
|
5834
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$194,702.56
|
$625,227.37
|
$303,526.01
|
2025-09-05
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
64
|
19
|
—
|
—
|
$17,861.00
|
$699,016.02
|
$301,399.06
|
2025-09-05
|
|
5884
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$191,294.76
|
$768,888.48
|
$298,291.03
|
2025-09-05
|
|
5883
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$191,294.76
|
$614,519.44
|
$298,291.03
|
2025-09-05
|
|
1614
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$175,041.53
|
$767,810.26
|
$273,323.14
|
2025-09-05
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
66
|
20
|
—
|
—
|
$17,861.00
|
$631,503.53
|
$272,963.15
|
2025-09-05
|
|
0034
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$169,980.78
|
$1,748,446.96
|
$265,548.93
|
2025-09-05
|
|
1734
|
APR_DRG
|
—
|
2
|
1
|
—
|
—
|
$250,985.11
|
$250,985.11
|
$250,985.11
|
2025-09-05
|
|
6934
|
APR_DRG
|
—
|
2
|
1
|
—
|
—
|
$232,361.31
|
$232,361.31
|
$232,361.31
|
2025-09-05
|
|
5914
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$147,067.44
|
$475,549.02
|
$230,349.93
|
2025-09-05
|
|
5882
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$146,539.11
|
$560,588.72
|
$229,538.31
|
2025-09-05
|
|
5881
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$146,539.11
|
$560,588.72
|
$229,538.31
|
2025-09-05
|
|
8414
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$142,266.34
|
$1,262,494.22
|
$222,974.58
|
2025-09-05
|
|
0044
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$137,237.30
|
$621,417.39
|
$215,249.08
|
2025-09-05
|
|
0014
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$132,960.01
|
$1,445,653.04
|
$208,678.39
|
2025-09-05
|
|
5934
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$132,435.44
|
$429,572.59
|
$207,872.57
|
2025-09-05
|
|
6094
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$121,327.48
|
$523,564.87
|
$190,808.74
|
2025-09-05
|
|
C1833
|
HCPCS
|
Cardiac Monitor Sys
|
2
|
1
|
—
|
—
|
$187,725.00
|
$187,725.00
|
$187,725.00
|
2025-09-05
|
|
E0766NU
|
HCPCS
|
Elec Stim Cancer Treatment
|
6
|
1
|
—
|
—
|
$185,002.22
|
$185,002.22
|
$185,002.22
|
2025-09-05
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
66
|
20
|
—
|
—
|
$17,861.00
|
$416,354.58
|
$182,343.57
|
2025-09-05
|
|
6024
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$114,967.77
|
$374,685.93
|
$181,039.09
|
2025-09-05
|
|
0023
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$114,569.26
|
$1,150,464.12
|
$180,426.90
|
2025-09-05
|
|
8413
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$111,354.69
|
$456,306.76
|
$175,488.74
|
2025-09-05
|
|
5833
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$110,973.53
|
$418,910.78
|
$174,903.21
|
2025-09-05
|
|
5832
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$108,913.76
|
$417,124.62
|
$171,739.04
|
2025-09-05
|
|
5831
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$108,913.76
|
$417,124.62
|
$171,739.04
|
2025-09-05
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
66
|
20
|
—
|
—
|
$17,861.00
|
$386,057.64
|
$169,582.66
|
2025-09-05
|
|
7
|
MS_DRG
|
Lung Transplant
|
66
|
20
|
—
|
—
|
$17,861.00
|
$385,085.26
|
$169,173.10
|
2025-09-05
|
|
6034
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$105,972.41
|
$346,420.85
|
$167,220.60
|
2025-09-05
|
|
0054
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$104,913.47
|
$458,238.60
|
$165,593.88
|
2025-09-05
|
|
5933
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$103,619.04
|
$341,251.22
|
$163,605.40
|
2025-09-05
|
|
0022
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$97,790.69
|
$709,397.78
|
$154,652.01
|
2025-09-05
|
|
6074
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$94,015.33
|
$331,604.20
|
$148,852.37
|
2025-09-05
|
|
6304
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$93,139.04
|
$390,628.80
|
$147,506.24
|
2025-09-05
|
|
5892
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$92,455.22
|
$303,947.33
|
$146,455.77
|
2025-09-05
|
|
5891
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$92,455.22
|
$303,947.33
|
$146,455.77
|
2025-09-05
|
|
0021
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$92,162.37
|
$679,146.78
|
$146,005.89
|
2025-09-05
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$324,706.48
|
$143,741.88
|
2025-09-05
|
|
0033
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$90,071.65
|
$878,468.76
|
$142,794.18
|
2025-09-05
|
|
5913
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$90,009.00
|
$327,548.53
|
$142,697.94
|
2025-09-05
|
|
212
|
MS_DRG
|
Concomitant Aortic And Mitral Valve?procedures
|
66
|
20
|
—
|
—
|
$17,861.00
|
$320,999.66
|
$142,180.59
|
2025-09-05
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
66
|
20
|
—
|
—
|
$17,861.00
|
$313,795.22
|
$139,146.11
|
2025-09-05
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
66
|
20
|
—
|
—
|
$17,861.00
|
$312,186.38
|
$138,468.48
|
2025-09-05
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
56
|
17
|
—
|
—
|
$127,397.55
|
$308,668.14
|
$136,986.61
|
2025-09-05
|
|
0904
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$85,598.12
|
$282,401.06
|
$135,922.04
|
2025-09-05
|
|
6023
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$85,082.61
|
$304,618.44
|
$135,130.13
|
2025-09-05
|
|
5932
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$84,931.65
|
$317,697.19
|
$134,898.24
|
2025-09-05
|
|
5912
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$84,024.42
|
$277,456.21
|
$133,504.56
|
2025-09-05
|
|
3034
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$83,062.84
|
$367,626.46
|
$132,027.40
|
2025-09-05
|
|
5931
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$82,370.72
|
$315,579.28
|
$130,964.17
|
2025-09-05
|
|
6314
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$80,186.41
|
$308,285.24
|
$127,608.68
|
2025-09-05
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
70
|
21
|
—
|
—
|
$17,861.00
|
$284,379.31
|
$126,756.29
|
2025-09-05
|
|
4404
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$79,210.49
|
$765,586.90
|
$126,109.50
|
2025-09-05
|
|
B0407
|
OTHER
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$123,357.87
|
$178,743.04
|
$125,875.38
|
2025-09-05
|
|
1733
|
APR_DRG
|
—
|
2
|
1
|
—
|
—
|
$122,809.26
|
$122,809.26
|
$122,809.26
|
2025-09-05
|
|
0043
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$76,844.28
|
$369,344.26
|
$122,474.57
|
2025-09-05
|
|
850
|
MS_DRG
|
Acute Leukemia With Other Procedures
|
56
|
17
|
—
|
—
|
$112,814.04
|
$271,437.85
|
$121,305.42
|
2025-09-05
|
|
1604
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$75,887.99
|
$364,565.79
|
$121,005.53
|
2025-09-05
|
|
1613
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$75,100.76
|
$375,323.48
|
$119,796.22
|
2025-09-05
|
|
3614
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$73,296.10
|
$588,059.16
|
$117,023.94
|
2025-09-05
|
|
B1904
|
OTHER
|
Guillain-barr? M <38.50
|
34
|
11
|
—
|
—
|
$114,098.87
|
$165,326.94
|
$116,427.42
|
2025-09-05
|
|
6022
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$72,416.80
|
$242,671.83
|
$115,673.16
|
2025-09-05
|
|
1624
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$71,667.31
|
$377,847.50
|
$114,521.81
|
2025-09-05
|
|
0053
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$70,520.06
|
$321,429.63
|
$112,759.43
|
2025-09-05
|
|
3044
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$70,138.90
|
$324,536.87
|
$112,173.90
|
2025-09-05
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
70
|
21
|
—
|
—
|
$17,861.00
|
$249,691.94
|
$112,146.16
|
2025-09-05
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
66
|
20
|
—
|
—
|
$17,861.00
|
$249,553.45
|
$112,087.82
|
2025-09-05
|
|
6073
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$69,889.07
|
$236,869.56
|
$111,790.12
|
2025-09-05
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
56
|
17
|
—
|
—
|
$102,757.36
|
$245,764.12
|
$110,491.78
|
2025-09-05
|
|
3124
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$68,781.06
|
$750,086.22
|
$110,088.02
|
2025-09-05
|
|
6033
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$68,601.43
|
$259,331.68
|
$109,812.08
|
2025-09-05
|
|
6814
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$68,546.33
|
$282,701.93
|
$109,727.43
|
2025-09-05
|
|
6804
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$68,358.39
|
$374,497.66
|
$109,438.73
|
2025-09-05
|
|
5911
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$67,928.92
|
$226,881.18
|
$108,778.99
|
2025-09-05
|
|
6904
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$66,900.17
|
$316,969.72
|
$107,198.64
|
2025-09-05
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$237,528.37
|
$107,022.93
|
2025-09-05
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
66
|
20
|
—
|
—
|
$17,861.00
|
$234,932.42
|
$105,929.52
|
2025-09-05
|
|
8424
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$66,029.17
|
$578,689.80
|
$105,860.62
|
2025-09-05
|
|
19
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
66
|
20
|
—
|
—
|
$17,861.00
|
$233,585.82
|
$105,362.35
|
2025-09-05
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
70
|
21
|
—
|
—
|
$17,861.00
|
$230,318.04
|
$103,985.97
|
2025-09-05
|
|
6124
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$64,790.59
|
$231,152.96
|
$103,957.94
|
2025-09-05
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
70
|
21
|
—
|
—
|
$17,861.00
|
$227,993.18
|
$103,006.75
|
2025-09-05
|
|
4054
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$64,145.25
|
$272,468.64
|
$102,966.60
|
2025-09-05
|
|
0013
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$63,982.22
|
$739,895.52
|
$102,716.15
|
2025-09-05
|
|
6114
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$62,828.93
|
$296,902.58
|
$100,944.49
|
2025-09-05
|
|
C0407
|
OTHER
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$98,899.79
|
$143,303.77
|
$100,918.15
|
2025-09-05
|
|
9504
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$62,078.69
|
$283,187.13
|
$99,791.99
|
2025-09-05
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
64
|
19
|
—
|
—
|
$17,861.00
|
$219,940.12
|
$99,614.85
|
2025-09-05
|
|
0234
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$61,835.66
|
$294,042.85
|
$99,418.64
|
2025-09-05
|
|
D0407
|
OTHER
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$96,355.55
|
$139,617.23
|
$98,321.99
|
2025-09-05
|
|
Q0480
|
HCPCS
|
Driver Pneumatic Vad, Rep
|
16
|
3
|
—
|
—
|
$35,858.53
|
$122,219.08
|
$97,904.99
|
2025-09-05
|
|
B1806
|
OTHER
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
34
|
11
|
—
|
—
|
$94,824.76
|
$137,399.14
|
$96,759.96
|
2025-09-05
|
|
0032
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$59,409.07
|
$656,510.92
|
$95,690.97
|
2025-09-05
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
56
|
17
|
—
|
—
|
$88,469.32
|
$209,288.16
|
$95,128.30
|
2025-09-05
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$208,236.22
|
$94,685.23
|
2025-09-05
|
|
0064
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$58,490.51
|
$622,852.88
|
$94,279.90
|
2025-09-05
|
|
4474
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$58,427.87
|
$244,542.75
|
$94,183.66
|
2025-09-05
|
|
8504
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$58,398.43
|
$232,304.95
|
$94,138.44
|
2025-09-05
|
|
9124
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$58,020.29
|
$252,842.59
|
$93,557.55
|
2025-09-05
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
66
|
20
|
—
|
—
|
$17,861.00
|
$204,980.23
|
$93,313.82
|
2025-09-05
|
|
5124
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$57,467.80
|
$194,010.39
|
$92,708.83
|
2025-09-05
|
|
6072
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$57,279.10
|
$193,623.81
|
$92,418.95
|
2025-09-05
|
|
B0406
|
OTHER
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$90,394.24
|
$130,979.41
|
$92,239.02
|
2025-09-05
|
|
2604
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$56,887.38
|
$268,442.47
|
$91,817.20
|
2025-09-05
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
64
|
19
|
—
|
—
|
$17,861.00
|
$201,202.69
|
$91,722.74
|
2025-09-05
|
|
6954
|
APR_DRG
|
—
|
108
|
12
|
—
|
—
|
$56,587.74
|
$191,245.07
|
$91,356.89
|
2025-09-05
|
|
4604
|
APR_DRG
|
—
|
2
|
1
|
—
|
—
|
$91,324.90
|
$91,324.90
|
$91,324.90
|
2025-09-05
|
|
0924
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$56,335.64
|
$190,452.94
|
$90,969.63
|
2025-09-05
|
|
0063
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$56,039.77
|
$561,783.04
|
$90,515.12
|
2025-09-05
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
56
|
17
|
—
|
—
|
$83,875.54
|
$197,560.69
|
$90,188.75
|
2025-09-05
|
|
6093
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$55,805.03
|
$213,284.76
|
$90,154.53
|
2025-09-05
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
64
|
19
|
—
|
—
|
$17,861.00
|
$196,800.47
|
$89,868.55
|
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
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$196,467.50
|
$89,728.31
|
2025-09-05
|
|
0214
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$55,490.30
|
$267,344.65
|
$89,671.03
|
2025-09-05
|
|
B0404
|
OTHER
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
34
|
11
|
—
|
—
|
$87,507.77
|
$126,796.97
|
$89,293.64
|
2025-09-05
|
|
0041
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$55,091.77
|
$264,416.30
|
$89,058.83
|
2025-09-05
|
|
0042
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$55,091.77
|
$264,840.24
|
$89,058.83
|
2025-09-05
|
|
1694
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$55,048.76
|
$257,005.99
|
$88,992.74
|
2025-09-05
|
|
9104
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$55,045.74
|
$242,349.55
|
$88,988.11
|
2025-09-05
|
|
6084
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$55,044.99
|
$214,956.68
|
$88,986.94
|
2025-09-05
|
|
A0407
|
OTHER
|
Traumatic Spinal Cord Injury M <24.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$87,040.84
|
$126,120.40
|
$88,817.18
|
2025-09-05
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
70
|
21
|
—
|
—
|
$17,861.00
|
$190,288.48
|
$88,427.47
|
2025-09-05
|
|
2204
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$54,330.22
|
$261,926.59
|
$87,888.93
|
2025-09-05
|
|
8412
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$54,286.44
|
$452,737.48
|
$87,821.68
|
2025-09-05
|
|
1654
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$54,246.43
|
$294,910.32
|
$87,760.23
|
2025-09-05
|
|
3214
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$54,152.84
|
$277,501.97
|
$87,616.46
|
2025-09-05
|
|
1634
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$54,023.02
|
$352,293.68
|
$87,417.03
|
2025-09-05
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
66
|
20
|
—
|
—
|
$17,861.00
|
$190,562.52
|
$87,241.16
|
2025-09-05
|
|
3033
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$53,577.71
|
$231,138.51
|
$86,732.94
|
2025-09-05
|
|
4014
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$53,575.44
|
$306,976.59
|
$86,729.47
|
2025-09-05
|
|
6032
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$52,902.18
|
$202,082.26
|
$85,695.23
|
2025-09-05
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
64
|
19
|
—
|
—
|
$17,861.00
|
$186,351.82
|
$85,467.64
|
2025-09-05
|
|
B0505
|
OTHER
|
Non-traumatic Spinal Cord Injury M <39.50
|
34
|
11
|
—
|
—
|
$83,361.11
|
$120,788.55
|
$85,062.36
|
2025-09-05
|
|
3104
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$52,477.25
|
$205,513.63
|
$85,042.45
|
2025-09-05
|
|
6083
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$52,336.86
|
$200,249.96
|
$84,826.79
|
2025-09-05
|
|
0894
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$52,299.12
|
$213,720.36
|
$84,768.82
|
2025-09-05
|
|
0244
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$52,110.44
|
$243,574.80
|
$84,478.94
|
2025-09-05
|
|
6214
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$52,099.11
|
$180,285.82
|
$84,461.55
|
2025-09-05
|
|
4414
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$51,881.73
|
$267,445.12
|
$84,127.63
|
2025-09-05
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$182,524.19
|
$83,855.46
|
2025-09-05
|
|
317
|
MS_DRG
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
56
|
17
|
—
|
—
|
$77,893.24
|
$182,288.46
|
$83,756.17
|
2025-09-05
|
|
573
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$181,457.52
|
$83,406.18
|
2025-09-05
|
|
0204
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$51,328.49
|
$233,873.27
|
$83,277.74
|
2025-09-05
|
|
1732
|
APR_DRG
|
—
|
2
|
1
|
—
|
—
|
$83,245.94
|
$83,245.94
|
$83,245.94
|
2025-09-05
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$180,824.00
|
$83,139.35
|
2025-09-05
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$179,998.95
|
$82,791.84
|
2025-09-05
|
|
1674
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$50,884.68
|
$237,666.64
|
$82,595.98
|
2025-09-05
|
|
0031
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$50,842.41
|
$579,899.84
|
$82,531.05
|
2025-09-05
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$179,138.55
|
$82,429.44
|
2025-09-05
|
|
1814
|
APR_DRG
|
—
|
108
|
12
|
—
|
—
|
$50,773.73
|
$172,976.40
|
$82,425.54
|
2025-09-05
|
|
7914
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$50,729.95
|
$225,624.89
|
$82,358.29
|
2025-09-05
|
|
2214
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$50,711.84
|
$228,884.05
|
$82,330.46
|
2025-09-05
|
|
4034
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$50,473.33
|
$247,292.21
|
$81,964.07
|
2025-09-05
|
|
C1904
|
OTHER
|
Guillain-barr? M <38.50
|
34
|
11
|
—
|
—
|
$80,299.54
|
$116,352.40
|
$81,938.31
|
2025-09-05
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$177,853.83
|
$81,888.33
|
2025-09-05
|
|
17
|
MS_DRG
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$177,853.83
|
$81,888.33
|
2025-09-05
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$176,524.91
|
$81,328.60
|
2025-09-05
|
|
6021
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$49,839.33
|
$238,693.07
|
$80,990.12
|
2025-09-05
|
|
9114
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$49,821.21
|
$231,959.43
|
$80,962.30
|
2025-09-05
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
66
|
20
|
—
|
—
|
$17,861.00
|
$175,302.07
|
$80,813.54
|
2025-09-05
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
58
|
19
|
—
|
—
|
$17,861.00
|
$132,462.03
|
$80,757.69
|
2025-09-05
|
|
3134
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$49,677.80
|
$245,868.47
|
$80,742.00
|
2025-09-05
|
|
5104
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$49,209.85
|
$193,577.25
|
$80,023.13
|
2025-09-05
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
70
|
21
|
—
|
—
|
$17,861.00
|
$173,383.84
|
$80,005.59
|
2025-09-05
|
|
C1806
|
OTHER
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
34
|
11
|
—
|
—
|
$78,129.38
|
$113,207.88
|
$79,723.86
|
2025-09-05
|
|
4424
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$48,957.76
|
$226,347.78
|
$79,635.86
|
2025-09-05
|
|
6123
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$48,709.44
|
$167,145.56
|
$79,254.41
|
2025-09-05
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$171,559.89
|
$79,237.36
|
2025-09-05
|
|
1774
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$48,646.03
|
$248,534.61
|
$79,157.01
|
2025-09-05
|
|
6914
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$48,632.45
|
$210,069.11
|
$79,136.15
|
2025-09-05
|
|
7104
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$48,538.85
|
$235,929.24
|
$78,992.36
|
2025-09-05
|
|
3174
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$48,520.74
|
$240,242.12
|
$78,964.53
|
2025-09-05
|
|
3054
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$48,398.46
|
$247,823.97
|
$78,776.71
|
2025-09-05
|
|
0264
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$48,202.98
|
$229,619.20
|
$78,476.41
|
2025-09-05
|
|
9514
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$48,196.94
|
$230,802.79
|
$78,467.13
|
2025-09-05
|
|
1824
|
APR_DRG
|
—
|
108
|
12
|
—
|
—
|
$48,173.54
|
$164,806.13
|
$78,431.19
|
2025-09-05
|
|
6113
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$48,126.75
|
$171,150.69
|
$78,359.30
|
2025-09-05
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
66
|
20
|
—
|
—
|
$17,861.00
|
$169,117.16
|
$78,208.49
|
2025-09-05
|
|
1664
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$47,865.60
|
$309,909.83
|
$77,958.12
|
2025-09-05
|
|
5114
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$47,829.37
|
$204,403.56
|
$77,902.47
|
2025-09-05
|
|
B0106
|
OTHER
|
Stroke M <41.50 And A <84.50
|
34
|
11
|
—
|
—
|
$76,243.09
|
$110,474.68
|
$77,799.07
|
2025-09-05
|
|
23
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
66
|
20
|
—
|
—
|
$17,861.00
|
$168,106.48
|
$77,782.80
|
2025-09-05
|
|
4444
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$47,523.68
|
$222,811.71
|
$77,432.88
|
2025-09-05
|
|
0012
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$47,353.11
|
$733,541.12
|
$77,170.85
|
2025-09-05
|
|
0011
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$47,353.11
|
$720,223.92
|
$77,170.85
|
2025-09-05
|
|
2644
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$47,287.45
|
$250,551.37
|
$77,069.97
|
2025-09-05
|
|
2614
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$47,181.78
|
$201,325.73
|
$76,907.66
|
2025-09-05
|
|
1612
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$47,083.65
|
$227,881.80
|
$76,756.92
|
2025-09-05
|
|
6933
|
APR_DRG
|
—
|
2
|
1
|
—
|
—
|
$76,394.34
|
$76,394.34
|
$76,394.34
|
2025-09-05
|
|
1204
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$46,805.90
|
$230,143.61
|
$76,330.23
|
2025-09-05
|
|
653
|
MS_DRG
|
Major Bladder Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$164,261.16
|
$76,163.17
|
2025-09-05
|
|
B1903
|
OTHER
|
Guillain-barr? M >=38.50 And M <51.50
|
34
|
11
|
—
|
—
|
$71,185.19
|
$108,141.28
|
$76,155.83
|
2025-09-05
|
|
1304
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$46,670.04
|
$211,343.37
|
$76,121.53
|
2025-09-05
|
|
6903
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$46,595.32
|
$182,069.70
|
$76,006.74
|
2025-09-05
|
|
1214
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$46,551.54
|
$219,523.14
|
$75,939.50
|
2025-09-05
|
|
3014
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$46,525.88
|
$193,322.40
|
$75,900.08
|
2025-09-05
|
|
2624
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$46,525.12
|
$175,629.79
|
$75,898.92
|
2025-09-05
|
|
5194
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$46,488.90
|
$159,512.65
|
$75,843.26
|
2025-09-05
|
|
6071
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$46,431.54
|
$166,350.25
|
$75,755.14
|
2025-09-05
|
|
7114
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$46,391.53
|
$234,458.94
|
$75,693.70
|
2025-09-05
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$162,867.42
|
$75,576.13
|
2025-09-05
|
|
834
|
MS_DRG
|
Acute Leukemia Without Major O.r. Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$162,867.42
|
$75,576.13
|
2025-09-05
|
|
428
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
56
|
17
|
—
|
—
|
$70,018.03
|
$162,183.81
|
$75,288.20
|
2025-09-05
|
|
J9029
|
HCPCS
|
Instill Adstiladrin, Tx Dose
|
64
|
17
|
—
|
—
|
$62,162.43
|
$150,123.53
|
$75,061.77
|
2025-09-05
|
|
5184
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$45,953.76
|
$157,831.16
|
$75,021.20
|
2025-09-05
|
|
0494
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$45,875.26
|
$178,366.99
|
$74,900.62
|
2025-09-05
|
|
430
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
56
|
17
|
—
|
—
|
$69,630.21
|
$161,193.75
|
$74,871.19
|
2025-09-05
|
|
1714
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$45,847.34
|
$207,123.61
|
$74,857.72
|
2025-09-05
|
|
69930
|
CPT
|
Implant Cochlear Device
|
10
|
3
|
—
|
—
|
$33,265.40
|
$74,847.15
|
$74,847.15
|
2025-09-05
|
|
8
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant
|
66
|
20
|
—
|
—
|
$17,861.00
|
$160,327.45
|
$74,506.31
|
2025-09-05
|
|
B0205
|
OTHER
|
Traumatic Brain Injury M <35.50
|
34
|
11
|
—
|
—
|
$73,006.42
|
$105,784.82
|
$74,496.35
|
2025-09-05
|
|
9524
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$45,604.30
|
$208,706.63
|
$74,484.37
|
2025-09-05
|
|
6303
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$45,558.27
|
$184,583.15
|
$74,413.65
|
2025-09-05
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$159,962.07
|
$74,352.42
|
2025-09-05
|
|
0434
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$45,499.39
|
$156,403.44
|
$74,323.21
|
2025-09-05
|
|
3814
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$45,386.92
|
$156,050.08
|
$74,150.45
|
2025-09-05
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
66
|
20
|
—
|
—
|
$17,861.00
|
$159,145.87
|
$74,008.63
|
2025-09-05
|
|
C0406
|
OTHER
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$72,520.92
|
$105,081.33
|
$74,000.94
|
2025-09-05
|
|
11
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$158,995.59
|
$73,945.34
|
2025-09-05
|
|
576
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$158,977.91
|
$73,937.89
|
2025-09-05
|
|
220
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
70
|
21
|
—
|
—
|
$17,861.00
|
$156,072.56
|
$73,804.89
|
2025-09-05
|
|
0052
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$44,940.10
|
$220,371.01
|
$73,464.04
|
2025-09-05
|
|
D1806
|
OTHER
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
34
|
11
|
—
|
—
|
$71,549.92
|
$103,674.37
|
$73,010.12
|
2025-09-05
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
70
|
21
|
—
|
—
|
$17,861.00
|
$156,765.01
|
$73,005.83
|
2025-09-05
|
|
2294
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$44,511.40
|
$208,674.78
|
$72,805.47
|
2025-09-05
|
|
3084
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$44,375.54
|
$166,339.94
|
$72,596.77
|
2025-09-05
|
|
3094
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$44,196.65
|
$196,802.11
|
$72,321.98
|
2025-09-05
|
|
1623
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$44,133.26
|
$200,759.66
|
$72,224.58
|
2025-09-05
|
|
D0406
|
OTHER
|
Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50
|
34
|
11
|
—
|
—
|
$70,661.16
|
$102,386.57
|
$72,103.22
|
2025-09-05
|
|
6504
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$43,878.89
|
$229,852.00
|
$71,833.84
|
2025-09-05
|
|
D1904
|
OTHER
|
Guillain-barr? M <38.50
|
34
|
11
|
—
|
—
|
$70,382.59
|
$101,982.94
|
$71,818.97
|
2025-09-05
|
|
0051
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$43,826.82
|
$214,293.77
|
$71,753.84
|
2025-09-05
|
|
C0404
|
OTHER
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
34
|
11
|
—
|
—
|
$70,210.15
|
$101,733.07
|
$71,643.01
|
2025-09-05
|
|
6082
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$43,750.59
|
$165,592.28
|
$71,636.73
|
2025-09-05
|
|
4403
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$43,647.94
|
$528,757.06
|
$71,479.05
|
2025-09-05
|
|
A1904
|
OTHER
|
Guillain-barr? M <38.50
|
34
|
11
|
—
|
—
|
$69,913.01
|
$101,302.53
|
$71,339.81
|
2025-09-05
|
|
450
|
MS_DRG
|
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …
|
56
|
17
|
—
|
—
|
$65,932.10
|
$151,752.85
|
$70,894.73
|
2025-09-05
|
|
B0405
|
OTHER
|
Traumatic Spinal Cord Injury M >=31.50 And M <41.50
|
34
|
11
|
—
|
—
|
$69,318.74
|
$100,441.44
|
$70,733.41
|
2025-09-05
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$151,248.98
|
$70,682.51
|
2025-09-05
|
|
2234
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$42,939.20
|
$207,535.30
|
$70,390.31
|
2025-09-05
|
|
2244
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$42,864.48
|
$156,567.35
|
$70,275.51
|
2025-09-05
|
|
466
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$150,117.48
|
$70,205.93
|
2025-09-05
|
|
326
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$149,657.81
|
$70,012.32
|
2025-09-05
|
|
A9543
|
HCPCS
|
Y90 Ibritumomab, Rx
|
30
|
11
|
—
|
—
|
$14,774.74
|
$134,487.80
|
$69,933.66
|
2025-09-05
|
|
2224
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$42,603.33
|
$178,827.69
|
$69,874.34
|
2025-09-05
|
|
228
|
MS_DRG
|
Other Cardiothoracic Procedures With Mcc
|
70
|
21
|
—
|
—
|
$17,861.00
|
$146,837.92
|
$69,856.96
|
2025-09-05
|
|
B1705
|
OTHER
|
Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50
|
34
|
11
|
—
|
—
|
$68,432.64
|
$99,157.49
|
$69,829.22
|
2025-09-05
|
|
D0404
|
OTHER
|
Traumatic Spinal Cord Injury M <31.50 And A <61.50
|
34
|
11
|
—
|
—
|
$68,411.41
|
$99,126.74
|
$69,807.56
|
2025-09-05
|
|
239
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$148,417.30
|
$69,489.82
|
2025-09-05
|
|
837
|
MS_DRG
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
66
|
20
|
—
|
—
|
$17,861.00
|
$147,542.16
|
$69,121.21
|
2025-09-05
|
|
278
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …
|
66
|
20
|
—
|
—
|
$17,861.00
|
$147,427.24
|
$69,072.81
|
2025-09-05
|
|
B0105
|
OTHER
|
Stroke M <41.50 And A >=84.50
|
34
|
11
|
—
|
—
|
$67,684.48
|
$98,073.44
|
$69,065.80
|
2025-09-05
|
|
853
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$147,368.31
|
$69,047.99
|
2025-09-05
|
|
C0106
|
OTHER
|
Stroke M <41.50 And A <84.50
|
34
|
11
|
—
|
—
|
$67,618.16
|
$97,977.33
|
$68,998.12
|
2025-09-05
|
|
3024
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$41,914.98
|
$209,931.88
|
$68,816.91
|
2025-09-05
|
|
4234
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$41,881.02
|
$145,033.85
|
$68,764.74
|
2025-09-05
|
|
A1806
|
OTHER
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50
|
34
|
11
|
—
|
—
|
$67,270.61
|
$97,473.74
|
$68,643.48
|
2025-09-05
|
|
0224
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$41,497.60
|
$250,901.79
|
$68,175.72
|
2025-09-05
|
|
B1805
|
OTHER
|
Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50
|
34
|
11
|
—
|
—
|
$66,702.87
|
$96,651.09
|
$68,064.15
|
2025-09-05
|
|
B2102
|
OTHER
|
Burns M <52.50
|
34
|
11
|
—
|
—
|
$66,602.05
|
$96,505.02
|
$67,961.28
|
2025-09-05
|
|
8411
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$41,341.36
|
$452,737.48
|
$67,935.71
|
2025-09-05
|
|
6334
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$41,243.99
|
$153,267.11
|
$67,786.15
|
2025-09-05
|
|
0504
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$41,188.13
|
$151,186.56
|
$67,700.35
|
2025-09-05
|
|
245
|
MS_DRG
|
Aicd Generator Procedures
|
70
|
21
|
—
|
—
|
$17,861.00
|
$143,994.45
|
$67,626.94
|
2025-09-05
|
|
3043
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$41,045.48
|
$190,675.86
|
$67,481.21
|
2025-09-05
|
|
3644
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$40,907.36
|
$141,974.44
|
$67,269.03
|
2025-09-05
|
|
471
|
MS_DRG
|
Cervical Spinal Fusion With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$143,125.20
|
$67,260.82
|
2025-09-05
|
|
B0604
|
OTHER
|
Neurological M <43.50
|
34
|
11
|
—
|
—
|
$65,906.97
|
$95,497.85
|
$67,252.01
|
2025-09-05
|
|
6
|
MS_DRG
|
Liver Transplant Without Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$142,886.53
|
$67,160.29
|
2025-09-05
|
|
8634
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$40,829.62
|
$185,176.93
|
$67,149.60
|
2025-09-05
|
|
3032
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$40,749.61
|
$176,835.43
|
$67,026.70
|
2025-09-05
|
|
2274
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$40,638.66
|
$192,508.83
|
$66,856.26
|
2025-09-05
|
|
826
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …
|
66
|
20
|
—
|
—
|
$17,861.00
|
$140,714.88
|
$66,245.60
|
2025-09-05
|
|
Q2043
|
HCPCS
|
Sipuleucel-t Auto Cd54+
|
68
|
17
|
—
|
—
|
$54,827.05
|
$132,408.45
|
$66,204.22
|
2025-09-05
|
|
799
|
MS_DRG
|
Splenic Procedures With Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$140,104.94
|
$65,988.70
|
2025-09-05
|
|
981
|
MS_DRG
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
64
|
19
|
—
|
—
|
$17,861.00
|
$140,078.42
|
$65,977.53
|
2025-09-05
|
|
6134
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$39,917.10
|
$163,034.98
|
$65,747.81
|
2025-09-05
|
|
6031
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$39,887.67
|
$170,115.91
|
$65,702.59
|
2025-09-05
|
|
C0505
|
OTHER
|
Non-traumatic Spinal Cord Injury M <39.50
|
34
|
11
|
—
|
—
|
$64,357.61
|
$93,252.86
|
$65,671.03
|
2025-09-05
|
|
6224
|
APR_DRG
|
—
|
110
|
12
|
—
|
—
|
$39,848.42
|
$152,706.88
|
$65,642.30
|
2025-09-05
|
|
267
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
66
|
20
|
—
|
—
|
$17,861.00
|
$138,628.69
|
$65,366.91
|
2025-09-05
|