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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

JEFFERSON HEALTH- NORTHEAST

Philadelphia, PA · CCN 390115 · Rates published

24,099 distinct procedures filed
49 distinct payers
749,108 rate rows
2026-09-15 last MRF observed
Data quality

741,623 of 749,108 rate rows are consumer-grade (99.0%)

7,485 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 6,095
placeholder amount (≤ $0.02) — excluded from medians 911
per-diem day rate — not a per-procedure price 247
template filing: same amount across many unrelated codes — excluded 135
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 97
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://use2webtechstgpricelist.blob.core.windows.net/pricelist/Complete%20File/230596940_jefferson-torresdale-hospital_standardcharges.csv
Found on page https://www.jeffersonhealth.org/pay-my-bill/charge-description
Discovered viaDiscovered by HANK
Last fetch success · 2026-09-23
Content fingerprint ab1090ade64746bc… · 261,185,085 bytes · first seen 2026-09-23

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J3391
HCPCS 		Injection Atidarsagene Autotemcel Per Treatment-1 Dose 1 $4,233,000.00 $4,233,000.00 $4,233,000.00 nat. median
$4,505,000
0.9× median
J1411
HCPCS 		Injection Etranacogene Dezaparvovec-drlb Per Therapeutic Dose-1 Dose 1 $3,486,000.00 $3,486,000.00 $3,486,000.00 nat. median
$3,685,267
0.9× median
J1414
HCPCS 		Injection Fidanacogene Elaparvovec-dzkt Per Therapeutic Dose-1 Dose 1 $3,486,000.00 $3,486,000.00 $3,486,000.00 nat. median
$3,508,750
1.0× median
J1413
HCPCS 		Injection Delandistrogene Moxeparvovec-rokl Per Therapeutic Dose-1 Dose 2 $3,187,200.00 $4,825,396.61 $3,187,200.00 nat. median
$3,325,455
1.0× median
J3389
HCPCS 		Topical Administration Prademagene Zamikeracel Per Treatment-1 Ea 2 $3,134,412.00 $4,836,939.00 $3,134,412.00 nat. median
$3,335,820
0.9× median
J3394
HCPCS 		Injection Lovotibeglogene Autotemcel Per Treatment-1 Dose 2 $3,087,600.00 $4,716,136.72 $3,087,600.00 nat. median
$3,248,446
1.0× median
J3387
HCPCS 		Injection Elivaldogene Autotemcel Per Treatment-1 Ea 2 $2,988,000.00 $4,611,000.00 $2,988,000.00 nat. median
$3,180,000
0.9× median
J3393
HCPCS 		Injection Betibeglogene Autotemcel Per Treatment-1 Dose 2 $2,788,800.00 $4,262,954.89 $2,788,800.00 nat. median
$2,968,000
0.9× median
J3399
HCPCS 		High Cost Drugs 2 $2,576,283.18 $3,754,022.78 $2,576,283.18 nat. median
$2,455,111
1.0× median
C9309
HCPCS 		Injection Onasemnogene Abeparvovec-brve Per Treatment-1 Ea 1 $2,576,283.18 $2,576,283.18 $2,576,283.18 nat. median
$2,664,229
1.0× median
J3392
HCPCS 		Injection Exagamglogene Autotemcel Per Treatment-1 Ea 2 $2,191,200.00 $3,381,400.00 $2,191,200.00 nat. median
$2,332,000
0.9× median
Q2057
HCPCS 		Afamitresgene autoleucel__PER Therapeutic Dose 38 $767,896.82 $3,316,917.05 $846,526.07 nat. median
$813,967
1.0× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T__up To 600 Million Car-positive Viable T Cells 38 $312,500.00 $2,492,649.67 $623,927.03 nat. median
$621,313
1.0× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T__up To 100 Million Autologous B-cell Maturation Antigen… 38 $310,000.00 $2,396,009.35 $599,737.31 nat. median
$599,737
1.0× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos t__Up To 110 Million Car-positive Viable T Cells Per… 38 $328,240.00 $2,361,750.25 $591,162.03 nat. median
$579,571
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel car__UP To 510 Million Autologous Anti-bcma Car-positive… 38 $335,600.00 $2,314,509.45 $579,337.34 nat. median
$574,037
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel car+__UP To 200 Million Car T Cells 38 $245,394.70 $2,292,191.13 $573,750.91 nat. median
$562,501
1.0× median
5834
APR_DRG 		Neonate With Ecmo 6 $492,137.68 $624,827.37 $539,007.94 nat. median
$390,362
1.4× median
Q2058
HCPCS 		Obecabtagene Autoleucel 10 Up To 400 Million Cd19 Car-positive Viable T Cells… 3 $403,462.50 $697,515.53 $522,900.00 nat. median
$286,598
1.8× median
Q2053
HCPCS 		Brexucabtagene Car Pos T__up To 200 Million Autologous Anti-cd19 Car Positive Vi… 38 $308,800.00 $2,078,673.47 $520,306.00 nat. median
$513,770
1.0× median
C9081
HCPCS 		Idecabtagene Vicleucel 1 $422,856.00 $422,856.00 $422,856.00 nat. median
$422,856
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 34 $263,318.13 $1,182,145.43 $403,443.00 nat. median
$168,055
outlier · 2.4×
24
APR_DRG 		Heart And-or Lung Transplant 6 $346,716.38 $440,197.72 $379,736.99 nat. median
$225,531
1.7× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 6 $329,061.81 $417,783.14 $360,401.02 nat. median
$286,698
1.3× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 6 $309,722.42 $393,229.48 $339,219.79 nat. median
$135,803
outlier · 2.5×
5833
APR_DRG 		Neonate With Ecmo 6 $297,579.26 $377,812.30 $325,920.15 nat. median
$268,208
1.2× median
1614
APR_DRG 		Implantable Heart Assist Systems 6 $247,907.14 $314,747.62 $271,517.34 nat. median
$202,242
1.3× median
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 6 $242,167.67 $307,460.68 $265,231.25 nat. median
$198,578
1.3× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 34 $196,761.67 $794,677.52 $264,220.00 nat. median
$186,516
1.4× median
113
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 6 $238,641.09 $302,983.27 $261,368.81 nat. median
$68,335
outlier · 3.8×
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 6 $238,631.55 $302,971.16 $261,358.36 nat. median
$152,792
1.7× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 6 $229,170.40 $290,959.10 $250,996.15 nat. median
$173,018
1.5× median
5832
APR_DRG 		Neonate With Ecmo 6 $228,486.24 $290,090.48 $250,246.83 nat. median
$201,678
1.2× median
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 6 $226,231.73 $287,228.11 $247,777.60 nat. median
$181,762
1.4× median
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 6 $213,198.90 $270,681.39 $233,503.56 nat. median
$171,497
1.4× median
453
MS_DRG 		Combined Anterior-posterior Spinal Fusion W Mcc 2 $97,642.64 $368,168.17 $232,905.40 nat. median
$2,106
outlier · 110.6×
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 6 $203,279.05 $258,086.95 $222,638.96 nat. median
$187,567
1.2× median
112
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 6 $202,492.57 $257,088.42 $221,777.58 nat. median
$63,564
outlier · 3.5×
74
APR_DRG 		Allogeneic Bone Marrow Transplant 6 $201,977.50 $256,434.48 $221,213.45 nat. median
$149,836
1.5× median
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 6 $198,215.06 $251,657.62 $217,092.69 nat. median
$168,439
1.3× median
5831
APR_DRG 		Neonate With Ecmo 6 $194,912.20 $247,464.24 $213,475.27 nat. median
$173,909
1.2× median
J3403
HCPCS 		Revakinagene Taroretcel-lwey Per Implant 2 $166,667.00 $249,000.00 $207,833.50 nat. median
$264,195
0.8× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ td__Per Therapeutic Dose 37 $129,333.00 $829,913.53 $207,732.96 nat. median
$207,733
1.0× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 35 $165,761.97 $515,748.28 $201,301.00 nat. median
$131,925
1.5× median
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 6 $182,879.17 $232,186.88 $200,296.24 nat. median
$173,134
1.2× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face Mouth… 35 $149,784.78 $552,846.27 $200,119.00 nat. median
$145,435
1.4× median
14
APR_DRG 		Liver Transplant And-or Intestinal Transplant 6 $181,829.09 $230,853.67 $199,146.14 nat. median
$136,566
1.5× median
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 6 $179,033.49 $227,304.33 $196,084.30 nat. median
$135,630
1.4× median
1613
APR_DRG 		Implantable Heart Assist Systems 6 $174,714.37 $221,820.69 $191,353.83 nat. median
$155,539
1.2× median
5882
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 6 $171,922.24 $218,275.75 $188,295.78 nat. median
$152,383
1.2× median

Other procedures at this hospital

Browse this hospital's 24,099 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 43 34 — — $196,761.67 $794,677.52 $264,220.00 2026-09-15
10 MS_DRG Pancreas Transplant 43 34 — — $41,271.06 $270,400.00 $66,425.20 2026-09-15
11 APR_DRG Liver Transplant And-or Intestinal Transplant 7 6 — — $62,728.36 $79,641.12 $68,702.49 2026-09-15
11 MS_DRG Tracheostomy For Face Mouth And Neck Diagnoses Or Laryngectomy With Mcc 45 35 — — $37,963.39 $148,097.31 $51,423.40 2026-09-15
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 6 — — $93,436.56 $118,628.84 $102,335.28 2026-09-15
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 6 — — $202,492.57 $257,088.42 $221,777.58 2026-09-15
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 6 — — $238,641.09 $302,983.27 $261,368.81 2026-09-15
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 6 — — $309,722.42 $393,229.48 $339,219.79 2026-09-15
12 APR_DRG Liver Transplant And-or Intestinal Transplant 7 6 — — $67,160.21 $85,267.89 $73,556.42 2026-09-15
1204 APR_DRG Major Respiratory And Chest Procedures 7 6 — — $58,434.38 $74,189.40 $63,999.56 2026-09-15
1214 APR_DRG Other Respiratory And Chest Procedures 7 6 — — $45,801.30 $58,150.21 $50,163.33 2026-09-15
13 APR_DRG Liver Transplant And-or Intestinal Transplant 7 6 — — $85,440.85 $108,477.33 $93,578.07 2026-09-15
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 7 6 — — $52,652.42 $66,848.52 $57,666.94 2026-09-15
14 APR_DRG Liver Transplant And-or Intestinal Transplant 7 6 — — $181,829.09 $230,853.67 $199,146.14 2026-09-15
14 MS_DRG Allogeneic Bone Marrow Transplant 43 34 — — $91,698.78 $400,192.00 $113,309.00 2026-09-15
16 MS_DRG Autologous Bone Marrow Transplant With Cc-mcc 43 34 — — $42,426.29 $400,192.00 $55,907.50 2026-09-15
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 7 6 — — $57,772.77 $73,349.41 $63,274.94 2026-09-15
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 7 6 — — $145,123.01 $184,250.94 $158,944.25 2026-09-15
1611 APR_DRG Implantable Heart Assist Systems 7 6 — — $128,555.81 $163,216.90 $140,799.22 2026-09-15
1612 APR_DRG Implantable Heart Assist Systems 7 6 — — $132,688.51 $168,463.85 $145,325.51 2026-09-15
1613 APR_DRG Implantable Heart Assist Systems 7 6 — — $174,714.37 $221,820.69 $191,353.83 2026-09-15
1614 APR_DRG Implantable Heart Assist Systems 7 6 — — $247,907.14 $314,747.62 $271,517.34 2026-09-15
1622 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 7 6 — — $47,815.62 $60,707.63 $52,369.49 2026-09-15
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 7 6 — — $62,453.48 $79,292.13 $68,401.43 2026-09-15
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 7 6 — — $90,928.85 $115,445.00 $99,588.74 2026-09-15
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 7 6 — — $53,790.08 $68,292.91 $58,912.95 2026-09-15
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 7 6 — — $81,191.09 $103,081.75 $88,923.57 2026-09-15
1653 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 7 6 — — $51,748.88 $65,701.37 $56,677.35 2026-09-15
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 7 6 — — $70,678.99 $89,735.39 $77,410.32 2026-09-15
1663 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 7 6 — — $44,778.97 $56,852.23 $49,043.63 2026-09-15
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 7 6 — — $61,311.49 $77,842.23 $67,150.67 2026-09-15
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 7 6 — — $72,150.49 $91,603.64 $79,021.97 2026-09-15
1694 APR_DRG Major Abdominal Vascular Procedures 7 6 — — $54,704.03 $69,453.28 $59,913.94 2026-09-15
17 MS_DRG Autologous Bone Marrow Transplant Without Cc-mcc 43 34 — — $42,426.29 $400,192.00 $50,286.60 2026-09-15
1704 APR_DRG Permanent Cardiac Pacemaker Implant With Ami Heart Failure Or Shock 7 6 — — $54,236.65 $68,859.88 $59,402.05 2026-09-15
1764 APR_DRG Insertion Revision And Replacements Of Pacemaker And Other Cardiac Devices 7 6 — — $45,339.99 $57,564.52 $49,658.09 2026-09-15
1782 APR_DRG External Heart Assist Devices 7 6 — — $49,295.80 $62,586.88 $53,990.64 2026-09-15
1783 APR_DRG External Heart Assist Devices 7 6 — — $60,189.43 $76,417.65 $65,921.76 2026-09-15
1784 APR_DRG External Heart Assist Devices 7 6 — — $78,176.98 $99,254.98 $85,622.40 2026-09-15
1793 APR_DRG Defibrillator Implants 7 6 — — $45,343.46 $57,568.92 $49,661.89 2026-09-15
1794 APR_DRG Defibrillator Implants 7 6 — — $59,517.41 $75,564.44 $65,185.74 2026-09-15
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 42 34 — — $263,318.13 $1,182,145.43 $403,443.00 2026-09-15
1814 APR_DRG Lower Vascular Procedures 7 6 — — $45,530.76 $57,806.72 $49,867.02 2026-09-15
1833 APR_DRG Percutaneous Structural Cardiac Procedures 7 6 — — $47,384.66 $60,160.47 $51,897.49 2026-09-15
1834 APR_DRG Percutaneous Structural Cardiac Procedures 7 6 — — $66,654.68 $84,626.05 $73,002.75 2026-09-15
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 42 34 — — $55,615.55 $248,489.15 $66,656.25 2026-09-15
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 43 34 — — $77,179.72 $478,772.53 $106,841.00 2026-09-15
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 45 35 — — $56,548.58 $294,329.54 $74,190.10 2026-09-15
204 APR_DRG Open Craniotomy For Trauma 7 6 — — $51,033.51 $64,793.11 $55,893.84 2026-09-15
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 45 35 — — $45,433.87 $164,742.04 $60,668.90 2026-09-15
209 MS_DRG Complex Aortic Arch Procedures 41 33 — — $92,033.20 $256,699.00 $106,718.00 2026-09-15
21 APR_DRG Heart And-or Lung Transplant 7 6 — — $113,131.47 $143,633.87 $123,905.90 2026-09-15
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 45 35 — — $38,879.69 $202,050.05 $49,912.00 2026-09-15
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 44 35 — — $76,302.47 $341,480.19 $102,525.00 2026-09-15
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 41 33 — — $46,402.80 $129,427.00 $53,806.90 2026-09-15
214 APR_DRG Open Craniotomy Except Trauma 7 6 — — $61,185.75 $77,682.60 $67,012.97 2026-09-15
215 MS_DRG Other Heart Assist System Implant 45 35 — — $74,216.77 $463,262.53 $93,878.50 2026-09-15
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 45 35 — — $67,636.08 $297,163.21 $92,236.10 2026-09-15
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 45 35 — — $45,369.01 $196,962.59 $61,994.50 2026-09-15
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 45 35 — — $41,822.41 $170,089.67 $61,994.50 2026-09-15
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 45 35 — — $54,292.03 $248,232.11 $72,394.00 2026-09-15
22 APR_DRG Heart And-or Lung Transplant 7 6 — — $121,127.19 $153,785.39 $132,663.11 2026-09-15
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 45 35 — — $37,271.64 $165,873.63 $50,279.70 2026-09-15
2204 APR_DRG Major Stomach Esophageal And Duodenal Procedures 7 6 — — $51,805.24 $65,772.92 $56,739.08 2026-09-15
222 MS_DRG Cardiac Defib Implant W Cardiac Cath W Ami-hf-shock W Mcc 2 2 — — $86,615.16 $276,368.28 $181,491.72 2026-09-15
223 MS_DRG Cardiac Defib Implant W Cardiac Cath W Ami-hf-shock W-o Mcc 2 2 — — $62,308.81 $201,419.99 $131,864.40 2026-09-15
224 MS_DRG Cardiac Defib Implant W Cardiac Cath W-o Ami-hf-shock W Mcc 2 2 — — $76,770.97 $242,066.35 $159,418.66 2026-09-15
224 APR_DRG Ventricular Shunt Procedures 7 6 — — $48,472.03 $61,541.02 $53,088.42 2026-09-15
225 MS_DRG Cardiac Defib Implant W Cardiac Cath W-o Ami-hf-shock W-o Mcc 2 2 — — $58,633.33 $185,587.13 $122,110.23 2026-09-15
226 MS_DRG Cardiac Defibrillator Implant W-o Cardiac Cath W Mcc 2 2 — — $69,416.89 $219,732.33 $144,574.61 2026-09-15
227 MS_DRG Cardiac Defibrillator Implant W-o Cardiac Cath W-o Mcc 2 2 — — $54,277.97 $173,647.44 $113,962.71 2026-09-15
23 APR_DRG Heart And-or Lung Transplant 7 6 — — $169,035.59 $214,610.81 $185,134.22 2026-09-15
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 45 35 — — $40,119.53 $161,704.61 $54,027.50 2026-09-15
230 MS_DRG Other Cardiothoracic Procedures W-o Cc-mcc 1 1 — — $114,942.65 $114,942.65 $114,942.65 2026-09-15
231 MS_DRG Coronary Bypass With Ptca With Mcc 45 35 — — $59,427.16 $244,994.07 $79,480.40 2026-09-15
232 MS_DRG Coronary Bypass With Ptca Without Mcc 45 35 — — $42,933.94 $175,992.12 $57,160.60 2026-09-15
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 45 35 — — $54,842.22 $231,606.19 $72,081.90 2026-09-15
234 APR_DRG Spinal Procedures 7 6 — — $57,156.24 $72,566.66 $62,599.70 2026-09-15
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 45 35 — — $37,435.51 $151,307.14 $51,504.50 2026-09-15
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 45 35 — — $41,368.44 $183,305.14 $55,331.40 2026-09-15
237 MS_DRG Major Cardiovasc Procedures W Mcc 1 1 — — $159,745.49 $159,745.49 $159,745.49 2026-09-15
238 MS_DRG Major Cardiovasc Procedures W-o Mcc 1 1 — — $105,247.33 $105,247.33 $105,247.33 2026-09-15
24 APR_DRG Heart And-or Lung Transplant 7 6 — — $346,716.38 $440,197.72 $379,736.99 2026-09-15
246 MS_DRG Perc Cardiovasc Proc W Drug-eluting Stent W Mcc Or 4+ Vessels-stents 2 2 — — $32,932.98 $99,774.32 $66,353.65 2026-09-15
248 MS_DRG Perc Cardiovasc Proc W Non-drug-eluting Stent W Mcc Or 4+ Ves-stents 2 2 — — $32,141.01 $92,404.87 $62,272.94 2026-09-15
2604 APR_DRG Major Pancreas Liver And Shunt Procedures 7 6 — — $55,435.88 $70,382.45 $60,715.48 2026-09-15
2614 APR_DRG Major Biliary Tract Procedures 7 6 — — $47,334.37 $60,096.62 $51,842.41 2026-09-15
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 45 35 — — $42,111.80 $281,863.23 $57,780.90 2026-09-15
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 45 35 — — $46,831.31 $196,874.82 $64,847.50 2026-09-15
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 45 35 — — $36,130.12 $148,420.18 $49,747.00 2026-09-15
274 APR_DRG Other Open Craniotomy 7 6 — — $49,816.94 $63,248.53 $54,561.41 2026-09-15
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 44 35 — — $49,616.44 $221,522.18 $67,228.20 2026-09-15
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 44 35 — — $43,531.55 $194,169.66 $56,632.60 2026-09-15
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 44 35 — — $35,225.69 $156,833.44 $52,480.30 2026-09-15
28 MS_DRG Spinal Procedures With Mcc 45 35 — — $42,730.33 $170,331.03 $56,648.60 2026-09-15
2993 APR_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 7 6 — — $60,158.22 $76,378.02 $65,887.57 2026-09-15
2994 APR_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 7 6 — — $79,222.73 $100,582.68 $86,767.75 2026-09-15
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face Mouth … 45 35 — — $149,784.78 $552,846.27 $200,119.00 2026-09-15
3004 APR_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 7 6 — — $53,617.53 $68,073.83 $58,723.96 2026-09-15
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 7 6 — — $58,844.53 $74,710.13 $64,448.77 2026-09-15
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 7 6 — — $92,239.07 $117,108.48 $101,023.74 2026-09-15
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 7 6 — — $45,091.13 $57,248.56 $49,385.52 2026-09-15
3043 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 7 6 — — $45,834.25 $58,192.04 $50,199.42 2026-09-15
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 7 6 — — $64,518.10 $81,913.40 $70,662.68 2026-09-15
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 7 6 — — $61,880.32 $78,564.43 $67,773.68 2026-09-15
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 44 35 — — $43,475.78 $193,918.89 $63,042.90 2026-09-15
3214 APR_DRG Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 7 6 — — $48,856.17 $62,028.72 $53,509.14 2026-09-15
338 MS_DRG Appendectomy W Complicated Principal Diag W Mcc 2 2 — — $30,206.21 $97,852.81 $64,029.51 2026-09-15
36033270 CDM Hc Insert Sq Icd W Electrode 21 17 $111,589.00 $37,084.82 67% off $17,965.83 $89,271.20 $57,356.75 2026-09-15
36133249 CDM Hc Icd Lead Insert/repos Sgl Cham 21 17 $137,653.00 $37,084.82 73% off $22,162.13 $110,122.40 $70,753.64 2026-09-15
36133276 CDM Hc Insertion Phrenic Nerve Stimulator System 21 17 $151,086.00 — $24,324.85 $120,868.80 $77,658.20 2026-09-15
36133287 CDM Hc Rmvl&rplcmt Phrenic Nrv Stimulator Pls Generator 21 17 $99,334.00 $36,457.27 63% off $15,992.77 $79,467.20 $51,057.68 2026-09-15
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 7 6 — — $56,023.79 $71,128.86 $61,359.38 2026-09-15
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face Mouth And Neck… 45 35 — — $98,868.70 $342,574.16 $130,596.00 2026-09-15
4014 APR_DRG Adrenal Procedures 7 6 — — $48,488.51 $61,561.93 $53,106.46 2026-09-15
4044 APR_DRG Thyroid Parathyroid And Thyroglossal Procedures 7 6 — — $51,338.73 $65,180.63 $56,228.14 2026-09-15
405 MS_DRG Pancreas Liver And Shunt Procedures With Mcc 45 35 — — $38,192.11 $170,312.22 $51,578.00 2026-09-15
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 6 — — $47,069.90 $59,760.84 $51,552.75 2026-09-15
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 6 — — $70,700.67 $89,762.91 $77,434.06 2026-09-15
4234 APR_DRG Inborn Errors Of Metabolism 7 6 — — $53,236.86 $67,590.53 $58,307.04 2026-09-15
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 44 35 — — $73,384.16 $328,361.89 $103,912.00 2026-09-15
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 44 35 — — $49,865.38 $222,641.23 $68,059.80 2026-09-15
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 44 35 — — $38,717.91 $172,531.52 $53,006.40 2026-09-15
4284 APR_DRG Genetic Disorders 7 6 — — $48,916.00 $62,104.68 $53,574.67 2026-09-15
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 44 35 — — $58,497.60 $261,444.45 $84,946.00 2026-09-15
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 6 — — $112,294.70 $142,571.49 $122,989.43 2026-09-15
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 44 35 — — $38,483.61 $171,478.29 $54,374.50 2026-09-15
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 6 — — $179,033.49 $227,304.33 $196,084.30 2026-09-15
4401 APR_DRG Kidney Transplant 7 6 — — $46,155.09 $58,599.38 $50,550.81 2026-09-15
4402 APR_DRG Kidney Transplant 7 6 — — $49,712.02 $63,115.32 $54,446.49 2026-09-15
4403 APR_DRG Kidney Transplant 7 6 — — $56,454.74 $71,676.02 $61,831.39 2026-09-15
4404 APR_DRG Kidney Transplant 7 6 — — $85,828.45 $108,969.43 $94,002.59 2026-09-15
4414 APR_DRG Major Bladder Procedures 7 6 — — $54,814.15 $69,593.09 $60,034.55 2026-09-15
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 44 35 — — $47,090.03 $210,165.53 $62,996.70 2026-09-15
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 44 35 — — $36,249.37 $161,435.03 $50,249.50 2026-09-15
453 MS_DRG Combined Anterior-posterior Spinal Fusion W Mcc 2 2 — — $97,642.64 $368,168.17 $232,905.40 2026-09-15
454 MS_DRG Combined Anterior-posterior Spinal Fusion W Cc 2 2 — — $63,576.18 $251,394.92 $157,485.55 2026-09-15
455 MS_DRG Combined Anterior-posterior Spinal Fusion W-o Cc-mcc 2 2 — — $49,961.02 $197,109.92 $123,535.47 2026-09-15
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature Malignancy Infection Or Exte… 45 35 — — $59,394.37 $300,517.24 $79,230.50 2026-09-15
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature Malignancy Infection Or Exte… 45 35 — — $40,358.71 $213,742.10 $56,222.40 2026-09-15
459 MS_DRG Spinal Fusion Except Cervical W Mcc 2 2 — — $71,122.29 $213,663.74 $142,393.02 2026-09-15
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 5 2 — — $48,695.00 $126,076.75 $60,809.00 2026-09-15
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 45 35 — — $43,129.19 $157,526.19 $52,073.00 2026-09-15
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 45 35 — — $37,998.95 $160,341.06 $53,737.10 2026-09-15
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 45 35 — — $35,862.34 $165,343.88 $49,078.50 2026-09-15
48133264 CDM Hc Remove/replace Aicd Gen Biv 21 17 $101,010.00 $37,084.82 63% off $16,262.61 $80,808.00 $51,919.14 2026-09-15
48133270 CDM Hc Insert Subq Defib W/electrod 21 17 $111,589.00 $37,084.82 67% off $17,965.83 $89,271.20 $57,356.75 2026-09-15
484 MS_DRG Major Joint & Limb Reattachment Proc Of Upper Extremity W-o Cc-mcc 1 1 — — $69,895.31 $69,895.31 $69,895.31 2026-09-15
4844 APR_DRG Other Male Reproductive System And Related Procedures 7 6 — — $45,746.67 $58,080.85 $50,103.50 2026-09-15
490 MS_DRG Back & Neck Proc Exc Spinal Fusion W Cc-mcc Or Disc Device-neurostim 1 1 — — $59,071.54 $59,071.54 $59,071.54 2026-09-15
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 43 34 — — $74,597.52 $465,088.00 $97,211.40 2026-09-15
5114 APR_DRG Gynecologic Procedures For Malignancy 7 6 — — $45,355.60 $57,584.34 $49,675.18 2026-09-15
5144 APR_DRG Female Reproductive System Reconstructive Procedures 7 6 — — $46,367.53 $58,869.10 $50,783.49 2026-09-15
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 6 — — $54,085.77 $68,668.32 $59,236.80 2026-09-15
5244 OTHER Level 4 Blood Product Exchange And Related Services 35 31 — — $35,542.20 $263,335.00 $67,853.20 2026-09-15
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 6 — — $81,328.09 $103,255.70 $89,073.63 2026-09-15
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 6 — — $122,382.78 $155,379.51 $134,038.28 2026-09-15
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 45 35 — — $43,279.12 $148,579.00 $61,769.20 2026-09-15
5831 APR_DRG Neonate With Ecmo 7 6 — — $194,912.20 $247,464.24 $213,475.27 2026-09-15
5832 APR_DRG Neonate With Ecmo 7 6 — — $228,486.24 $290,090.48 $250,246.83 2026-09-15
5833 APR_DRG Neonate With Ecmo 7 6 — — $297,579.26 $377,812.30 $325,920.15 2026-09-15
5834 APR_DRG Neonate With Ecmo 7 6 — — $492,137.68 $624,827.37 $539,007.94 2026-09-15
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 6 — — $160,964.44 $204,363.51 $176,294.38 2026-09-15
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 6 — — $171,922.24 $218,275.75 $188,295.78 2026-09-15
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 6 — — $182,879.17 $232,186.88 $200,296.24 2026-09-15
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 6 — — $329,061.81 $417,783.14 $360,401.02 2026-09-15
5891 APR_DRG Neonate Birth Weight < 500 Grams Or Birth Weight 500-999 Grams And Gestational A… 7 6 — — $151,614.28 $192,492.37 $166,053.73 2026-09-15
5892 APR_DRG Neonate Birth Weight < 500 Grams Or Birth Weight 500-999 Grams And Gestational A… 7 6 — — $151,502.42 $192,350.36 $165,931.22 2026-09-15
5893 APR_DRG Neonate Birth Weight < 500 Grams Or Birth Weight 500-999 Grams And Gestational A… 7 6 — — $151,392.29 $192,210.54 $165,810.61 2026-09-15
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 6 — — $119,609.73 $151,858.79 $131,001.13 2026-09-15
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 6 — — $155,089.70 $196,904.83 $169,860.14 2026-09-15
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 6 — — $213,198.90 $270,681.39 $233,503.56 2026-09-15
5931 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 6 — — $70,116.23 $89,020.90 $76,793.96 2026-09-15
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 6 — — $104,360.55 $132,498.14 $114,299.65 2026-09-15
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 6 — — $134,891.86 $171,261.27 $147,738.70 2026-09-15
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 6 — — $198,215.06 $251,657.62 $217,092.69 2026-09-15
6021 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 6 — — $58,177.71 $73,863.53 $63,718.45 2026-09-15
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 6 — — $84,786.17 $107,646.14 $92,861.04 2026-09-15
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 6 — — $109,587.55 $139,134.44 $120,024.46 2026-09-15
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 6 — — $145,765.55 $185,066.72 $159,647.98 2026-09-15
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 6 — — $49,699.01 $63,098.81 $54,432.25 2026-09-15
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 6 — — $65,924.57 $83,699.09 $72,203.10 2026-09-15
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 6 — — $107,567.16 $136,569.31 $117,811.65 2026-09-15
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 6 — — $58,452.59 $74,212.52 $64,019.50 2026-09-15
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 6 — — $80,529.48 $102,241.76 $88,198.95 2026-09-15
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 6 — — $102,648.85 $130,324.94 $112,424.93 2026-09-15
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 7 6 — — $58,909.56 $74,792.70 $64,520.00 2026-09-15
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 7 6 — — $63,484.49 $80,601.12 $69,530.63 2026-09-15
6092 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 6 — — $51,515.63 $65,405.22 $56,421.88 2026-09-15
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 6 — — $78,640.89 $99,843.97 $86,130.50 2026-09-15
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 6 — — $242,167.67 $307,460.68 $265,231.25 2026-09-15
61 APR_DRG Pancreas Transplant 7 6 — — $51,771.43 $65,729.99 $56,702.04 2026-09-15
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 7 6 — — $47,590.17 $60,421.39 $52,122.57 2026-09-15
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 7 6 — — $96,238.23 $122,185.89 $105,403.78 2026-09-15
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 7 6 — — $55,028.33 $69,865.02 $60,269.12 2026-09-15
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 7 6 — — $85,661.10 $108,756.96 $93,819.29 2026-09-15
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 7 6 — — $49,957.41 $63,426.88 $54,715.26 2026-09-15
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 7 6 — — $95,278.33 $120,967.18 $104,352.45 2026-09-15
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 7 6 — — $59,618.87 $75,693.25 $65,296.85 2026-09-15
62 APR_DRG Pancreas Transplant 7 6 — — $71,651.90 $90,970.61 $78,475.89 2026-09-15
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 7 6 — — $71,394.36 $90,643.64 $78,193.83 2026-09-15
6224 APR_DRG Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 7 6 — — $46,639.81 $59,214.79 $51,081.69 2026-09-15
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 7 6 — — $50,562.66 $64,195.32 $55,378.15 2026-09-15
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 7 6 — — $62,621.70 $79,505.71 $68,585.68 2026-09-15
63 APR_DRG Pancreas Transplant 7 6 — — $86,457.98 $109,768.70 $94,692.07 2026-09-15
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 6 — — $46,673.63 $59,257.72 $51,118.73 2026-09-15
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 6 — — $113,956.97 $144,681.94 $124,810.01 2026-09-15
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 6 — — $203,279.05 $258,086.95 $222,638.96 2026-09-15
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 6 — — $62,124.84 $78,874.89 $68,041.50 2026-09-15
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 6 — — $226,231.73 $287,228.11 $247,777.60 2026-09-15
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 7 6 — — $78,803.04 $100,049.84 $86,308.09 2026-09-15
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 7 6 — — $47,819.09 $60,712.03 $52,373.29 2026-09-15
64 APR_DRG Pancreas Transplant 7 6 — — $105,772.22 $134,290.42 $115,845.76 2026-09-15
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 7 6 — — $56,195.47 $71,346.85 $61,547.43 2026-09-15
6804 APR_DRG Major O.r. Procedures For Lymphatic Hematopoietic Or Other Neoplasms 7 6 — — $66,669.42 $84,644.77 $73,018.89 2026-09-15
6814 APR_DRG Other O.r. Procedures For Lymphatic Hematopoietic Or Other Neoplasms 7 6 — — $57,566.39 $73,087.39 $63,048.91 2026-09-15
6904 APR_DRG Acute Leukemia 7 6 — — $61,738.98 $78,384.98 $67,618.88 2026-09-15
6954 APR_DRG Chemotherapy For Acute Leukemia 7 6 — — $54,112.65 $68,702.45 $59,266.24 2026-09-15
7 MS_DRG Lung Transplant 43 34 — — $91,468.66 $594,880.00 $119,880.00 2026-09-15
71 APR_DRG Allogeneic Bone Marrow Transplant 7 6 — — $66,354.66 $84,245.14 $72,674.15 2026-09-15
72 APR_DRG Allogeneic Bone Marrow Transplant 7 6 — — $78,767.49 $100,004.70 $86,269.15 2026-09-15
73 APR_DRG Allogeneic Bone Marrow Transplant 7 6 — — $115,216.03 $146,280.46 $126,188.98 2026-09-15
74 APR_DRG Allogeneic Bone Marrow Transplant 7 6 — — $201,977.50 $256,434.48 $221,213.45 2026-09-15
7404 APR_DRG Mental Illness Diagnosis With O.r. Procedure 7 6 — — $55,820.01 $70,870.15 $61,136.20 2026-09-15
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome Neonate 45 35 — — $41,791.03 $157,717.40 $56,037.60 2026-09-15
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 7 6 — — $45,426.71 $57,674.61 $49,753.06 2026-09-15
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 43 34 — — $38,278.59 $161,516.53 $52,842.40 2026-09-15
81200005 CDM Hc Heart Trans Procurement Cadaver 21 17 $123,278.00 — $19,847.76 $98,622.40 $63,364.89 2026-09-15
81200007 CDM Hc Liver Acquisition Cadaver 21 17 $104,683.00 — $16,853.96 $83,746.40 $53,807.06 2026-09-15
81200011 CDM Hc Double Lung Procurement 21 17 $123,278.00 — $19,847.76 $98,622.40 $63,364.89 2026-09-15
81200012 CDM Hc Single Lung Procurement 21 17 $123,278.00 — $19,847.76 $98,622.40 $63,364.89 2026-09-15
81200013 CDM Hc Herat/lung Procurement 21 17 $140,000.00 — $22,540.00 $112,000.00 $71,960.00 2026-09-15
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 45 35 — — $40,936.80 $184,248.65 $55,295.60 2026-09-15
83 APR_DRG Autologous Bone Marrow Transplant 7 6 — — $53,427.63 $67,832.73 $58,515.97 2026-09-15
834 MS_DRG Acute Leukemia With Mcc 45 35 — — $38,879.69 $168,729.25 $51,760.90 2026-09-15
84 APR_DRG Autologous Bone Marrow Transplant 7 6 — — $88,209.56 $111,992.54 $96,610.47 2026-09-15
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 7 6 — — $51,228.61 $65,040.82 $56,107.52 2026-09-15
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 7 6 — — $53,925.35 $68,464.66 $59,061.10 2026-09-15
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 7 6 — — $85,983.66 $109,166.50 $94,172.58 2026-09-15
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 7 6 — — $229,170.40 $290,959.10 $250,996.15 2026-09-15
8423 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 7 6 — — $46,427.36 $58,945.06 $50,849.02 2026-09-15
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 7 6 — — $117,477.48 $149,151.64 $128,665.81 2026-09-15
850 MS_DRG Acute Leukemia With Other Procedures 44 35 — — $64,573.43 $288,756.22 $81,645.10 2026-09-15
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation Aftercare Or Other Contact With Healt… 7 6 — — $74,786.54 $94,950.41 $81,909.06 2026-09-15
8513 APR_DRG Gender Related Procedures 7 6 — — $109,194.74 $138,635.73 $119,594.24 2026-09-15
8514 APR_DRG Gender Related Procedures 7 6 — — $109,194.74 $138,635.73 $119,594.24 2026-09-15
8634 APR_DRG Neonatal Aftercare 7 6 — — $96,591.15 $122,633.96 $105,790.31 2026-09-15
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 45 35 — — $48,845.88 $185,527.57 $65,167.10 2026-09-15
894 APR_DRG Major Cranial Or Facial Bone Procedures 7 6 — — $55,754.98 $70,787.58 $61,064.98 2026-09-15
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 6 — — $52,720.06 $66,934.39 $57,741.01 2026-09-15
9104 APR_DRG Craniotomy For Multiple Significant Trauma 7 6 — — $66,600.92 $84,557.80 $72,943.87 2026-09-15
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 7 6 — — $67,163.68 $85,272.29 $73,560.22 2026-09-15
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 7 6 — — $60,283.95 $76,537.65 $66,025.28 2026-09-15
914 APR_DRG Other Major Head And Neck Procedures 7 6 — — $60,252.73 $76,498.02 $65,991.09 2026-09-15
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 6 — — $55,494.84 $70,457.31 $60,780.06 2026-09-15
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 7 6 — — $52,009.88 $66,032.74 $56,963.21 2026-09-15
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 45 35 — — $165,761.97 $515,748.28 $201,301.00 2026-09-15
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc-mcc 45 35 — — $46,910.11 $181,004.34 $67,627.00 2026-09-15
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 6 — — $134,075.03 $170,224.21 $146,844.08 2026-09-15
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 6 — — $238,631.55 $302,971.16 $261,358.36 2026-09-15
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 7 6 — — $52,121.74 $66,174.76 $57,085.72 2026-09-15
955 MS_DRG Craniotomy For Multiple Significant Trauma 45 35 — — $47,951.92 $169,443.94 $63,463.40 2026-09-15
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 45 35 — — $52,386.23 $210,977.39 $71,843.40 2026-09-15
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 45 35 — — $44,437.38 $172,077.00 $57,714.00 2026-09-15
984 MS_DRG Prostatic O.r. Procedure Unrelated To Principal Diagnosis W Mcc 1 1 — — $107,024.65 $107,024.65 $107,024.65 2026-09-15
985 MS_DRG Prostatic O.r. Procedure Unrelated To Principal Diagnosis W Cc 1 1 — — $59,115.42 $59,115.42 $59,115.42 2026-09-15
A9543 HCPCS Y90 Ibritumomab Rx 5 3 — — $67,535.48 $115,501.94 $96,136.35 2026-09-15
A9699 HCPCS Radiopharm Rx Agent Noc 3 2 — — $55,449.60 $66,619.31 $66,619.31 2026-09-15
C1816 HCPCS Receiver And Or Transmitter 2 1 — — $55,116.72 $59,403.58 $57,260.15 2026-09-15
C9081 HCPCS Idecabtagene Vicleucel 1 1 — — $422,856.00 $422,856.00 $422,856.00 2026-09-15
C9309 HCPCS Injection Onasemnogene Abeparvovec-brve Per Treatment-1 Ea 2 1 — — $2,576,283.18 $2,576,283.18 $2,576,283.18 2026-09-15
J1411 HCPCS Injection Etranacogene Dezaparvovec-drlb Per Therapeutic Dose-1 Dose 2 1 — — $3,486,000.00 $3,486,000.00 $3,486,000.00 2026-09-15
J1413 HCPCS Injection Delandistrogene Moxeparvovec-rokl Per Therapeutic Dose-1 Dose 3 2 — — $3,187,200.00 $4,825,396.61 $3,187,200.00 2026-09-15
J1414 HCPCS Injection Fidanacogene Elaparvovec-dzkt Per Therapeutic Dose-1 Dose 2 1 — — $3,486,000.00 $3,486,000.00 $3,486,000.00 2026-09-15
J3387 HCPCS Injection Elivaldogene Autotemcel Per Treatment-1 Ea 3 2 — — $2,988,000.00 $4,611,000.00 $2,988,000.00 2026-09-15
J3389 HCPCS Topical Administration Prademagene Zamikeracel Per Treatment-1 Ea 3 2 — — $3,134,412.00 $4,836,939.00 $3,134,412.00 2026-09-15
J3391 HCPCS Injection Atidarsagene Autotemcel Per Treatment-1 Dose 2 1 — — $4,233,000.00 $4,233,000.00 $4,233,000.00 2026-09-15
J3392 HCPCS Injection Exagamglogene Autotemcel Per Treatment-1 Ea 3 2 — — $2,191,200.00 $3,381,400.00 $2,191,200.00 2026-09-15
J3393 HCPCS Injection Betibeglogene Autotemcel Per Treatment-1 Dose 3 2 — — $2,788,800.00 $4,262,954.89 $2,788,800.00 2026-09-15
J3394 HCPCS Injection Lovotibeglogene Autotemcel Per Treatment-1 Dose 3 2 — — $3,087,600.00 $4,716,136.72 $3,087,600.00 2026-09-15
J3399 HCPCS High Cost Drugs 3 2 — — $2,576,283.18 $3,754,022.78 $2,576,283.18 2026-09-15
J3402 HCPCS Inj. Remestemcel-l-rknd/ td__Per Therapeutic Dose 49 37 — — $129,333.00 $829,913.53 $207,732.96 2026-09-15
J3403 HCPCS Revakinagene Taroretcel-lwey Per Implant 4 2 — — $166,667.00 $249,000.00 $207,833.50 2026-09-15
J3404 HCPCS Injection Zopapogene Imadenovec-drba Suspension Per Therapeutic Dose-1 Dose 2 1 — — $114,540.00 $114,540.00 $114,540.00 2026-09-15
J7330 HCPCS Cultured Chondrocytes Implnt 5 3 — — $69,492.91 $118,849.06 $98,922.27 2026-09-15
J9029 HCPCS Instill Adstiladrin Tx dose__PER Therapeutic Dose 54 40 — — $60,690.44 $262,151.33 $67,226.54 2026-09-15
J9183 HCPCS Gemcitabine Intravesical Sys__225 Mg 46 36 — — $68,853.33 $297,410.78 $75,089.84 2026-09-15
K1007 HCPCS Bilateral Hip Knee Ankle Foot Device Powered Includes Pelvic Component Single Or… 34 30 — — $90,327.00 $387,455.00 $99,835.10 2026-09-15
L7181 HCPCS Electronic Elbow Microprocessor Simultaneous Control Of Elbow And Terminal Devic… 34 30 — — $45,747.70 $196,234.00 $50,563.30 2026-09-15
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device Elbow Wrist Hand Finger Si… 34 30 — — $65,361.60 $280,367.00 $72,241.80 2026-09-15
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device Replacement Only 36 31 — — $102,831.00 $441,092.00 $114,197.00 2026-09-15
Q2041 HCPCS Axicabtagene Ciloleucel car+__UP To 200 Million Car T Cells 53 38 — — $245,394.70 $2,292,191.13 $573,750.91 2026-09-15
Q2042 HCPCS Tisagenlecleucel Car-pos T__up To 600 Million Car-positive Viable T Cells 53 38 — — $312,500.00 $2,492,649.67 $623,927.03 2026-09-15
Q2043 HCPCS Sipuleucel-t Auto cd54+__Per Infusion (minimum 50 Million Cells) 54 40 — — $52,766.65 $227,924.64 $59,008.71 2026-09-15
Q2053 HCPCS Brexucabtagene Car Pos T__up To 200 Million Autologous Anti-cd19 Car Positive Vi… 51 38 — — $308,800.00 $2,078,673.47 $520,306.00 2026-09-15
Q2054 HCPCS Lisocabtagene Mara Car Pos t__Up To 110 Million Car-positive Viable T Cells Per … 53 38 — — $328,240.00 $2,361,750.25 $591,162.03 2026-09-15
Q2055 HCPCS Idecabtagene Vicleucel car__UP To 510 Million Autologous Anti-bcma Car-positive … 53 38 — — $335,600.00 $2,314,509.45 $579,337.34 2026-09-15
Q2056 HCPCS Ciltacabtagene Car-pos T__up To 100 Million Autologous B-cell Maturation Antigen… 53 38 — — $310,000.00 $2,396,009.35 $599,737.31 2026-09-15
Q2057 HCPCS Afamitresgene autoleucel__PER Therapeutic Dose 49 38 — — $767,896.82 $3,316,917.05 $846,526.07 2026-09-15
Q2058 HCPCS Obecabtagene Autoleucel 10 Up To 400 Million Cd19 Car-positive Viable T Cells … 5 3 — — $403,462.50 $697,515.53 $522,900.00 2026-09-15
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