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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

LEHIGH VALLEY HOSPITAL - DICKSON CITY

Dickson City, PA · CCN 390338 · Rates published

21,643 distinct procedures filed
19 distinct payers
781,105 rate rows
2025-08-01 last MRF observed · ⚠ 12 mo old
Data quality

643,670 of 781,105 rate rows are consumer-grade (82.4%)

137,435 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
placeholder amount (≤ $0.02) — excluded from medians 129,402
template filing: same amount across many unrelated codes — excluded 6,418
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 771
exceeds 10× this hospital's gross charge — excluded from medians 560
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 160
percent-of-charges filed in the dollar field — excluded from medians 84
per-diem day rate — not a per-procedure price 40

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 12 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://lvhn.pt.panaceainc.com/MRFDownload/lvhn/dicksoncity
Found on page https://www.lvhn.org/get-price-quote
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-18
Content fingerprint 60316e15275df420… · 399,656,440 bytes · first seen 2026-05-08

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 14 $3,570,000.00 $4,683,875.00 $3,895,500.00 nat. median
$3,710,000
1.1× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 14 $3,570,000.00 $4,652,649.17 $3,869,530.00 nat. median
$3,710,000
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 14 $3,264,000.00 $4,194,622.54 $3,488,596.97 nat. median
$3,324,572
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 14 $3,162,000.00 $4,148,575.00 $3,450,300.00 nat. median
$3,286,000
1.1× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 14 $2,856,000.00 $3,722,119.33 $3,095,624.00 nat. median
$2,997,086
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 14 $2,368,485.25 $4,697,482.20 $2,556,403.45 nat. median
$2,460,273
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 14 $2,244,000.00 $4,520,815.20 $2,460,260.00 nat. median
$2,405,851
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 15 $756,178.89 $4,323,193.31 $820,025.22 nat. median
$809,151
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell Immunotherapy 8 $242,757.29 $1,140,020.23 $680,150.35 nat. median
$370,165
1.8× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 16 $565,623.84 $3,375,103.79 $630,860.52 nat. median
$691,418
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 16 $551,318.34 $3,225,806.77 $602,954.53 nat. median
$631,793
1.0× median
5957251501
NDC 		Idecabtagene Vicleucel 300 X 10exp6 To 460 X 10exp6 Cell IV Suspension 18 $527,622.46 $3,076,830.38 $580,384.71 nat. median
$606,766
1.0× median
7315390001
NDC 		Lisocabtagene Maraleucel 1.5 X 10exp6 To 70 X 10exp6 Cell/ml IV Susp 18 $516,442.29 $3,011,633.21 $568,086.52 nat. median
$618,487
0.9× median
7128711901
NDC 		Axicabtagene Ciloleucel Intravenous Suspension 18 $489,517.15 $2,932,315.72 $553,124.80 nat. median
$627,582
0.9× median
7128722001
NDC 		Brexucabtagene Autoleucel 1x 10exp6 To 1x 10exp8 Cell IV Suspension 18 $488,051.51 $2,853,931.20 $538,339.08 nat. median
$617,866
0.9× median
7128721901
NDC 		Brexucabtagene Autoleucel 2x 10exp6 To 2x 10exp8 Cell IV Suspension 18 $488,051.51 $2,853,931.20 $538,339.08 nat. median
$577,363
0.9× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 15 $194,418.67 $851,499.54 $356,244.49 nat. median
$261,939
1.4× median
C9098
HCPCS 		Ciltacabtagene Car Pos T 1 $335,983.43 $335,983.43 $335,983.43 nat. median
$30,221
outlier · 11.1×
C9301
HCPCS 		Obecabtagene Car Pos T 15 $278,250.00 $1,622,614.88 $303,292.50 nat. median
$459,112
0.7× median
5831
APR_DRG 		Neonate With Ecmo 8 $141,506.98 $484,571.75 $247,292.65 nat. median
$154,685
1.6× median
0-D
OTHER 		Kidney Transplant With Hemodialysis With Mcc - Deceased Donor 2 $145,141.00 $291,282.00 $218,211.50 nat. median
$147,318
1.5× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 14 $152,703.66 $717,116.52 $202,663.01 nat. median
$205,166
1.0× median
1-D
OTHER 		Kidney Transplant With Hemodialysis Without Mcc - Deceased Donor 2 $145,141.00 $238,389.00 $191,765.00 nat. median
$147,318
1.3× median
0-L
OTHER 		Kidney Transplant With Hemodialysis With Mcc - Living Donor 2 $122,004.00 $243,226.00 $182,615.00 nat. median
$122,004
1.5× median
2-D
OTHER 		Kidney Transplant - Deceased Donor 2 $145,141.00 $201,892.00 $173,516.50 nat. median
$147,318
1.2× median
5881
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 8 $124,900.26 $316,127.86 $170,016.21 nat. median
$120,928
1.4× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 15 $22,511.00 $647,855.84 $169,856.18 nat. median
$199,832
0.8× median
1-L
OTHER 		Kidney Transplant With Hemodialysis Without Mcc - Living Donor 2 $122,004.00 $199,061.00 $160,532.50 nat. median
$123,834
1.3× median
J7330
HCPCS 		Cultured Chondrocytes Implnt 2 $61,878.30 $232,043.63 $146,960.97 nat. median
$75,807
1.9× median
2-L
OTHER 		Kidney Transplant - Living Donor 2 $122,004.00 $171,483.00 $146,743.50 nat. median
$123,834
1.2× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 15 $76,058.38 $371,351.90 $139,366.15 nat. median
$108,240
1.3× median
7
MS_DRG 		Lung Transplant 14 $90,201.35 $395,056.76 $138,463.70 nat. median
$122,690
1.1× median
1611
APR_DRG 		Implantable Heart Assist Systems 8 $100,280.52 $239,924.76 $130,716.29 nat. median
$82,164
1.6× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 16 $22,511.00 $427,135.77 $120,712.07 nat. median
$132,706
0.9× median
21
APR_DRG 		Heart And/or Lung Transplant 8 $84,974.85 $279,960.14 $120,682.88 nat. median
$74,854
1.6× median
5911
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 8 $54,880.49 $200,824.52 $116,714.60 nat. median
$37,247
outlier · 3.1×
8
MS_DRG 		Simultaneous Pancreas/kidney Transplant 8 $68,813.59 $275,556.00 $114,139.04 nat. median
$53,073
outlier · 2.2×
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 14 $73,502.56 $321,920.71 $112,830.19 nat. median
$99,646
1.1× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 15 $67,430.15 $316,660.87 $110,986.67 nat. median
$96,835
1.1× median
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 16 $52,470.33 $583,149.48 $107,999.90 nat. median
$111,503
1.0× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve?procedures 16 $70,124.03 $329,311.70 $107,246.00 nat. median
$100,978
1.1× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 16 $62,124.13 $291,743.10 $107,246.00 nat. median
$92,900
1.2× median
5931
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 8 $18,489.11 $186,215.34 $105,044.61 nat. median
$29,157
outlier · 3.6×
270006206-10806601-31409
CDM 		Hb Kit Protek Duo Dl31 9 $2.00 $149,438.03 $104,977.12 nat. median
$104,977
1.0× median
K1007
HCPCS 		Bil Hkaf Pc S/d Micro Sensor 15 $95,081.03 $543,593.19 $102,538.37 nat. median
$97,404
1.1× median
111
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 17 $35,223.87 $588,241.58 $102,421.08 nat. median
$34,746
outlier · 2.9×
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 8 $14,791.42 $123,492.17 $101,232.80 nat. median
$96,420
1.0× median
215
MS_DRG 		Other Heart Assist System Implant 16 $68,198.73 $320,270.21 $100,586.19 nat. median
$98,002
1.0× median
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 16 $51,028.03 $338,268.00 $100,256.56 nat. median
$69,153
1.4× median
270006205-10806601-31410
CDM 		Hb Kit Protek Duo Dl29 9 $2.00 $140,977.10 $99,033.50 nat. median
$99,034
1.0× median

Other procedures at this hospital

Browse this hospital's 21,643 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
             
J3399 HCPCS Inj Onase Abepar-xioi Treat 18 14 — — $2,368,485.25 $4,697,482.20 $2,556,403.45 2025-08-01
J1414 HCPCS Inj, Beqvez, Per Tx Dose 16 14 — — $3,570,000.00 $4,683,875.00 $3,895,500.00 2025-08-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 16 14 — — $3,570,000.00 $4,652,649.17 $3,869,530.00 2025-08-01
J3392 HCPCS Inj, Exagamglogene Autotem 18 14 — — $2,244,000.00 $4,520,815.20 $2,460,260.00 2025-08-01
Q2057 HCPCS Afamitresgene Autoleucel 26 15 — — $756,178.89 $4,323,193.31 $820,025.22 2025-08-01
J1413 HCPCS Inj Delandistrogene Mox Rokl 16 14 — — $3,264,000.00 $4,194,622.54 $3,488,596.97 2025-08-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 16 14 — — $3,162,000.00 $4,148,575.00 $3,450,300.00 2025-08-01
J3393 HCPCS Inj, Betibeglogene Autotemce 16 14 — — $2,856,000.00 $3,722,119.33 $3,095,624.00 2025-08-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 32 16 — — $565,623.84 $3,375,103.79 $630,860.52 2025-08-01
Q2056 HCPCS Ciltacabtagene Car-pos T 32 16 — — $551,318.34 $3,225,806.77 $602,954.53 2025-08-01
5957251501 NDC Idecabtagene Vicleucel 300 X 10exp6 To 460 X 10exp6 Cell IV Suspension 35 18 $3,962,343.23 $1,981,171.62 50% off $527,622.46 $3,076,830.38 $580,384.71 2025-08-01
7315390001 NDC Lisocabtagene Maraleucel 1.5 X 10exp6 To 70 X 10exp6 Cell/ml IV Susp 35 18 $3,985,128.00 $1,992,564.00 50% off $516,442.29 $3,011,633.21 $568,086.52 2025-08-01
7128711901 NDC Axicabtagene Ciloleucel Intravenous Suspension 35 18 $3,776,850.00 $1,888,425.00 50% off $489,517.15 $2,932,315.72 $553,124.80 2025-08-01
7128721901 NDC Brexucabtagene Autoleucel 2x 10exp6 To 2x 10exp8 Cell IV Suspension 35 18 $3,465,000.00 $1,732,500.00 50% off $488,051.51 $2,853,931.20 $538,339.08 2025-08-01
7128722001 NDC Brexucabtagene Autoleucel 1x 10exp6 To 1x 10exp8 Cell IV Suspension 35 18 $3,465,000.00 $1,732,500.00 50% off $488,051.51 $2,853,931.20 $538,339.08 2025-08-01
C9301 HCPCS Obecabtagene Car Pos T 26 15 — — $278,250.00 $1,622,614.88 $303,292.50 2025-08-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell Immunotherapy 13 8 — — $242,757.29 $1,140,020.23 $680,150.35 2025-08-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 27 15 — — $194,418.67 $851,499.54 $356,244.49 2025-08-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 27 14 — — $152,703.66 $717,116.52 $202,663.01 2025-08-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 28 15 — — $22,511.00 $647,855.84 $169,856.18 2025-08-01
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 51 17 — — $35,223.87 $588,241.58 $102,421.08 2025-08-01
Q0480 HCPCS Driver Pneumatic Vad, Rep 27 16 — — $52,470.33 $583,149.48 $107,999.90 2025-08-01
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 25 15 — — $95,081.03 $543,593.19 $102,538.37 2025-08-01
5831 APR_DRG Neonate With Ecmo 36 8 — — $141,506.98 $484,571.75 $247,292.65 2025-08-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 29 16 — — $22,511.00 $427,135.77 $120,712.07 2025-08-01
71 APR_DRG Allogeneic Bone Marrow Transplant 64 18 — — $57,323.70 $396,054.31 $93,088.80 2025-08-01
7 MS_DRG Lung Transplant 26 14 — — $90,201.35 $395,056.76 $138,463.70 2025-08-01
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 25 15 — — $68,801.71 $393,350.19 $74,197.93 2025-08-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 27 15 — — $76,058.38 $371,351.90 $139,366.15 2025-08-01
J9029 HCPCS Instill Adstiladrin, Tx Dose 34 17 — — $56,912.05 $368,758.46 $68,926.82 2025-08-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 29 16 — — $51,028.03 $338,268.00 $100,256.56 2025-08-01
C9098 HCPCS Ciltacabtagene Car Pos T 2 1 — — $335,983.43 $335,983.43 $335,983.43 2025-08-01
3023789006 NDC Sipuleucel-t In Lactated Ringers 50 Million Cell/250 Ml IV Suspension 35 18 $73,946.00 $36,973.00 50% off $10,352.44 $332,495.22 $61,008.30 2025-08-01
560000237-10806601-28791 CDM Hb Trnsplj Allogeneic Hematopoietic Cells Per Donor 30 16 $180,430.00 $90,215.00 50% off $130.04 $331,789.61 $62,934.00 2025-08-01
A9543 HCPCS Y90 Ibritumomab, Rx 29 15 — — $41,945.39 $331,372.36 $61,370.51 2025-08-01
212 MS_DRG Concomitant Aortic And Mitral Valve?procedures 29 16 — — $70,124.03 $329,311.70 $107,246.00 2025-08-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 26 14 — — $73,502.56 $321,920.71 $112,830.19 2025-08-01
215 MS_DRG Other Heart Assist System Implant 29 16 — — $68,198.73 $320,270.21 $100,586.19 2025-08-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 28 15 — — $67,430.15 $316,660.87 $110,986.67 2025-08-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 36 8 — — $124,900.26 $316,127.86 $170,016.21 2025-08-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 29 16 — — $62,124.13 $291,743.10 $107,246.00 2025-08-01
0-D OTHER Kidney Transplant With Hemodialysis With Mcc - Deceased Donor 2 2 — — $145,141.00 $291,282.00 $218,211.50 2025-08-01
21 APR_DRG Heart And/or Lung Transplant 36 8 — — $84,974.85 $279,960.14 $120,682.88 2025-08-01
850 MS_DRG Acute Leukemia With Other Procedures 28 15 — — $59,297.00 $278,466.53 $97,599.91 2025-08-01
8 MS_DRG Simultaneous Pancreas/kidney Transplant 12 8 — — $68,813.59 $275,556.00 $114,139.04 2025-08-01
L7181 HCPCS Electronic Elbo Simultaneous 27 16 — — $23,653.04 $275,312.52 $50,988.17 2025-08-01
6797900201 NDC Histrelin 50 Mg (65 Mcg/day) Implant Kit 36 19 $48,781.77 $24,390.89 50% off $9,527.08 $263,654.01 $48,579.32 2025-08-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 29 16 — — $54,546.49 $256,157.52 $73,021.00 2025-08-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 29 16 — — $22,511.00 $256,015.45 $72,352.06 2025-08-01
33276 HCPCS Insj Phrnc Nrv Stim Sys 26 15 — — $44,157.21 $252,453.68 $47,885.53 2025-08-01
0266T OTHER Implt/rpl Crtd Sns Dev Total 28 15 — — $21,089.53 $252,453.68 $47,187.60 2025-08-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 28 15 — — $53,688.44 $252,128.00 $88,368.51 2025-08-01
L7180 HCPCS Electronic Elbow Sequential 27 16 — — $20,995.68 $244,381.90 $45,259.79 2025-08-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 29 16 — — $22,511.00 $243,678.99 $68,865.68 2025-08-01
0-L OTHER Kidney Transplant With Hemodialysis With Mcc - Living Donor 2 2 — — $122,004.00 $243,226.00 $182,615.00 2025-08-01
61 APR_DRG Pancreas Transplant 63 19 — — $41,902.30 $241,015.82 $69,975.27 2025-08-01
1611 APR_DRG Implantable Heart Assist Systems 36 8 — — $100,280.52 $239,924.76 $130,716.29 2025-08-01
1-D OTHER Kidney Transplant With Hemodialysis Without Mcc - Deceased Donor 2 2 — — $145,141.00 $238,389.00 $191,765.00 2025-08-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 29 16 — — $50,314.17 $236,281.96 $73,021.00 2025-08-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 29 16 — — $49,806.29 $233,896.89 $85,980.03 2025-08-01
J7330 HCPCS Cultured Chondrocytes Implnt 2 2 — — $61,878.30 $232,043.63 $146,960.97 2025-08-01
6301 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 36 8 — — $24,284.20 $230,604.13 $75,975.67 2025-08-01
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 27 8 — — $39,888.43 $227,445.24 $61,589.29 2025-08-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 29 16 — — $22,511.00 $225,635.30 $63,766.39 2025-08-01
L2006 HCPCS Kaf Sng/dbl Swg/stn Mcpr Cus 25 15 — — $38,584.77 $220,595.21 $41,611.03 2025-08-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 28 15 — — $45,720.08 $214,707.52 $75,252.98 2025-08-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 29 16 — — $45,490.28 $213,628.34 $89,376.35 2025-08-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 29 16 — — $14,754.00 $210,288.04 $59,429.12 2025-08-01
6091 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 36 8 — — $32,855.30 $207,855.27 $52,751.32 2025-08-01
9101 APR_DRG Craniotomy For Multiple Significant Trauma 65 19 — — $19,882.59 $206,412.68 $47,591.23 2025-08-01
6311 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 36 8 — — $6,325.78 $204,062.25 $44,642.18 2025-08-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 28 15 — — $43,158.15 $202,676.38 $71,036.18 2025-08-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 27 14 — — $42,539.76 $201,896.47 $47,905.78 2025-08-01
2-D OTHER Kidney Transplant - Deceased Donor 2 2 — — $145,141.00 $201,892.00 $173,516.50 2025-08-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 29 16 — — $22,511.00 $201,554.88 $56,961.06 2025-08-01
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 36 8 — — $54,880.49 $200,824.52 $116,714.60 2025-08-01
L8701 HCPCS Ewh S/d Uprt Micro Sensor 25 15 — — $34,970.13 $199,929.71 $37,712.88 2025-08-01
1-L OTHER Kidney Transplant With Hemodialysis Without Mcc - Living Donor 2 2 — — $122,004.00 $199,061.00 $160,532.50 2025-08-01
834 MS_DRG Acute Leukemia Without Major O.r. Procedures With Mcc 29 16 — — $22,511.00 $197,247.42 $47,219.52 2025-08-01
0620T OTHER Evasc Ven Artlz Tibl/prnl Vn 28 15 — — $11,506.22 $196,353.49 $36,701.59 2025-08-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 29 16 — — $14,754.00 $195,496.99 $55,249.05 2025-08-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 29 16 — — $41,569.50 $195,215.86 $79,568.45 2025-08-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 29 16 — — $22,511.00 $191,177.26 $54,028.26 2025-08-01
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 36 8 — — $37,839.64 $189,667.56 $57,667.21 2025-08-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc 29 16 — — $39,873.35 $187,250.52 $78,340.58 2025-08-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 28 15 — — $39,821.86 $187,008.69 $65,544.79 2025-08-01
5931 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 36 8 — — $18,489.11 $186,215.34 $105,044.61 2025-08-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 29 16 — — $22,511.00 $186,156.23 $52,609.27 2025-08-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 29 16 — — $22,511.00 $185,506.30 $52,425.60 2025-08-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 29 16 — — $39,321.70 $184,659.89 $73,021.00 2025-08-01
28 MS_DRG Spinal Procedures With Mcc 29 16 — — $22,511.00 $183,777.21 $51,936.94 2025-08-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 28 15 — — $38,853.09 $182,459.22 $54,139.07 2025-08-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 28 15 — — $38,853.09 $182,459.22 $44,823.81 2025-08-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 29 16 — — $38,562.78 $181,095.89 $75,765.65 2025-08-01
481000370-10806601-29333 CDM Hb 0915t Insj Perm Ccm-d Sys Pg&dual Transvns Eltrds/lds 30 16 $161,270.00 $80,635.00 50% off $31,460.76 $179,866.09 $34,117.08 2025-08-01
481000034-10806621-29619 CDM Hb Icd Removal/rplcmnt Pace With Mult Lead 33264 30 16 $157,220.00 $78,610.00 50% off $892.40 $179,866.09 $34,117.08 2025-08-01
0408T OTHER Insj/rplc Cardiac Modulj Sys 28 15 — — $16,520.92 $179,866.09 $34,117.08 2025-08-01
481000211-10806621-29458 CDM Hb 33270 Insert Subq Defib W/eltrd 30 16 $116,270.00 $58,135.00 50% off $22,707.53 $179,866.09 $34,117.08 2025-08-01
0571T OTHER Insj/rplcmt Icds Ss Eltrd 28 15 — — $23,533.24 $179,866.09 $34,117.08 2025-08-01
481000031-10806621-29622 CDM Hb Icd Insert Generator, Leads Single/dual 33249 30 16 $41,735.00 $20,867.50 50% off $892.40 $179,866.09 $33,619.83 2025-08-01
481000024-10806621-29629 CDM Hb Icd Gen Insertion With Multiple Lead 33231 30 16 $47,045.00 $23,522.50 50% off $892.40 $179,866.09 $33,619.83 2025-08-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 29 16 — — $38,295.64 $179,841.39 $71,896.16 2025-08-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 27 15 — — $38,266.68 $179,705.36 $50,786.21 2025-08-01
69930 HCPCS Implant Cochlear Device 35 18 — — $853.60 $178,442.50 $32,435.75 2025-08-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 29 16 — — $37,876.60 $177,873.48 $67,105.48 2025-08-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 29 16 — — $22,511.00 $176,002.31 $49,739.70 2025-08-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 29 16 — — $22,511.00 $173,496.32 $49,031.49 2025-08-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 29 16 — — $22,511.00 $172,459.47 $48,738.46 2025-08-01
6031 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 36 8 — — $15,795.28 $172,243.71 $51,936.32 2025-08-01
2-L OTHER Kidney Transplant - Living Donor 2 2 — — $122,004.00 $171,483.00 $146,743.50 2025-08-01
0674T OTHER Laps Insj Nw/rpcmt Prm Isdss 26 15 — — $29,902.52 $170,957.42 $34,809.22 2025-08-01
33287 HCPCS Rmv&rplcmt Phrnc Nrv Stim Pg 26 15 — — $29,902.52 $170,957.42 $34,809.22 2025-08-01
64582 HCPCS Opn Mpltj Hpglsl Nstm Ary Pg 28 15 — — $21,089.53 $170,957.42 $32,427.28 2025-08-01
0268T OTHER Implt/rpl Crtd Sns Dev Gen 28 15 — — $21,089.53 $170,957.42 $32,427.28 2025-08-01
761001320-10806601-27195 CDM Hb 63685 Insj/rplcmt Spi Npg Rcvr With Pocket 37 19 $136,325.00 $68,162.50 50% off $331.10 $170,957.42 $31,075.17 2025-08-01
64568 HCPCS Opn Impltj Crnl Nrv Nea&pg 35 18 — — $853.60 $170,957.42 $31,075.17 2025-08-01
61886 HCPCS Implant Neurostim Arrays 37 18 — — $853.60 $170,957.42 $31,075.17 2025-08-01
11 APR_DRG Liver Transplant And/or Intestinal Transplant 36 8 — — $44,740.62 $169,524.82 $63,880.47 2025-08-01
L6700 HCPCS Ue Add Ext Power Myoel 25 15 — — $29,510.19 $168,714.39 $31,824.72 2025-08-01
653 MS_DRG Major Bladder Procedures With Mcc 29 16 — — $22,511.00 $168,514.58 $47,623.60 2025-08-01
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 36 8 — — $46,694.22 $168,363.35 $75,209.52 2025-08-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 29 16 — — $22,511.00 $167,084.75 $47,219.52 2025-08-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 28 15 — — $35,429.89 $166,383.44 $58,315.84 2025-08-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 28 15 — — $35,213.61 $165,367.74 $57,959.85 2025-08-01
L5856 HCPCS Elec Knee-shin Swing/stance 27 16 — — $14,171.16 $164,947.01 $30,548.36 2025-08-01
L6880 HCPCS Elec Hand Ind Art Digits 27 16 — — $13,418.56 $164,168.15 $30,404.12 2025-08-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 29 16 — — $22,511.00 $164,104.17 $46,377.18 2025-08-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 29 16 — — $22,511.00 $163,266.83 $46,140.54 2025-08-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 29 16 — — $22,511.00 $163,112.66 $46,096.97 2025-08-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 29 16 — — $22,511.00 $163,094.52 $46,091.84 2025-08-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 29 16 — — $34,246.13 $160,824.33 $67,284.57 2025-08-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 29 16 — — $34,094.86 $160,113.94 $66,727.27 2025-08-01
481000292-10806601-29403 CDM Hb Tcat Impl Wrls P-art Prs Snr 30 16 $138,070.00 $69,035.00 50% off $20,666.19 $159,483.48 $30,250.90 2025-08-01
7269495401 NDC Pegaspargase 750 Unit/ml Injection Solution 36 19 $26,402.24 $13,201.12 50% off $3,696.31 $157,861.80 $26,402.24 2025-08-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 28 15 — — $33,151.19 $155,682.37 $54,565.21 2025-08-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 29 16 — — $22,511.00 $155,165.46 $43,851.03 2025-08-01
C9760 HCPCS Non-blind Interatrial Shunt 28 15 — — $19,291.61 $154,278.34 $28,837.07 2025-08-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 29 16 — — $32,793.94 $154,004.66 $43,522.98 2025-08-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 29 16 — — $22,511.00 $153,533.09 $43,389.70 2025-08-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 29 16 — — $22,511.00 $152,260.45 $43,030.05 2025-08-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 29 16 — — $14,754.00 $151,362.65 $42,776.33 2025-08-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 29 16 — — $32,206.24 $151,244.76 $42,743.01 2025-08-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 29 16 — — $22,511.00 $151,184.30 $42,725.92 2025-08-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 29 16 — — $32,077.50 $150,640.18 $63,023.80 2025-08-01
270006206-10806601-31409 CDM Hb Kit Protek Duo Dl31 12 9 $247,005.00 $123,502.50 50% off $2.00 $149,438.03 $104,977.12 2025-08-01
245 MS_DRG Aicd Generator Procedures 29 16 — — $31,456.33 $147,723.08 $41,747.74 2025-08-01
471 MS_DRG Cervical Spinal Fusion With Mcc 29 16 — — $22,511.00 $146,831.32 $41,495.74 2025-08-01
6 MS_DRG Liver Transplant Without Mcc 26 14 — — $33,469.36 $146,586.47 $51,377.18 2025-08-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 29 16 — — $22,511.00 $144,358.59 $40,796.92 2025-08-01
799 MS_DRG Splenic Procedures With Mcc 29 16 — — $22,511.00 $143,732.85 $40,620.08 2025-08-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 29 16 — — $22,511.00 $143,705.64 $40,612.39 2025-08-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 29 16 — — $30,284.15 $142,218.38 $59,500.34 2025-08-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 29 16 — — $22,511.00 $141,456.61 $39,976.80 2025-08-01
270006205-10806601-31410 CDM Hb Kit Protek Duo Dl29 12 9 $233,020.00 $116,510.00 50% off $2.00 $140,977.10 $99,033.50 2025-08-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 29 16 — — $29,944.28 $140,622.29 $58,832.58 2025-08-01
1601 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 36 8 — — $22,522.32 $139,980.06 $40,625.85 2025-08-01
163 MS_DRG Major Chest Procedures With Mcc 29 16 — — $22,511.00 $139,331.51 $39,376.23 2025-08-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 27 15 — — $29,657.19 $139,274.07 $39,359.99 2025-08-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 29 16 — — $29,562.57 $138,829.71 $53,579.93 2025-08-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 29 16 — — $22,511.00 $138,808.55 $39,228.43 2025-08-01
6021 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 36 8 — — $18,804.79 $138,279.39 $78,832.33 2025-08-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 29 16 — — $22,511.00 $136,381.16 $38,542.43 2025-08-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 29 16 — — $22,511.00 $135,568.00 $38,312.62 2025-08-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 29 16 — — $22,511.00 $135,193.16 $38,206.70 2025-08-01
901 MS_DRG Wound Debridements For Injuries With Mcc 29 16 — — $22,511.00 $133,929.58 $37,849.60 2025-08-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 29 16 — — $21,439.00 $132,789.95 $37,527.52 2025-08-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 29 16 — — $22,511.00 $132,777.78 $32,654.61 2025-08-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 28 15 — — $27,852.26 $130,797.86 $44,515.82 2025-08-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 29 16 — — $22,511.00 $130,528.82 $36,888.51 2025-08-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 29 16 — — $22,511.00 $128,947.85 $36,441.71 2025-08-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 29 16 — — $27,417.76 $128,757.40 $53,868.63 2025-08-01
140 MS_DRG Major Head And Neck Procedures With Mcc 29 16 — — $22,511.00 $127,844.49 $36,129.90 2025-08-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 29 16 — — $22,511.00 $126,677.65 $35,800.13 2025-08-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 29 16 — — $22,511.00 $126,647.42 $35,791.60 2025-08-01
793 MS_DRG Full Term Neonate With Major Problems 27 15 — — $8,743.00 $126,070.04 $29,631.56 2025-08-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 29 16 — — $22,511.00 $125,773.80 $35,544.70 2025-08-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 29 16 — — $26,469.59 $124,304.67 $52,005.73 2025-08-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 29 16 — — $22,511.00 $124,235.14 $35,109.87 2025-08-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 29 16 — — $22,511.00 $124,050.75 $35,057.76 2025-08-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 36 8 — — $14,791.42 $123,492.17 $101,232.80 2025-08-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 28 15 — — $26,285.49 $123,440.12 $43,264.60 2025-08-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 29 16 — — $22,511.00 $122,953.43 $34,747.65 2025-08-01
791 MS_DRG Prematurity With Major Problems 27 15 — — $26,133.58 $122,726.72 $34,683.58 2025-08-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 29 16 — — $22,511.00 $120,423.27 $34,032.59 2025-08-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 29 16 — — $22,511.00 $120,338.63 $34,008.68 2025-08-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 29 16 — — $22,511.00 $119,693.32 $30,160.08 2025-08-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 29 16 — — $22,511.00 $119,274.57 $33,707.97 2025-08-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 29 16 — — $22,511.00 $119,029.71 $33,638.77 2025-08-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 29 16 — — $22,511.00 $118,787.88 $33,570.42 2025-08-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 28 15 — — $25,182.83 $118,261.89 $41,449.68 2025-08-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 29 16 — — $25,170.60 $118,204.46 $49,453.56 2025-08-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 29 16 — — $22,511.00 $117,551.51 $33,221.02 2025-08-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 29 16 — — $22,511.00 $116,835.09 $33,018.55 2025-08-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 29 16 — — $22,511.00 $116,717.19 $32,985.24 2025-08-01
8421 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 36 8 — — $12,539.26 $116,482.61 $28,691.74 2025-08-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 29 16 — — $22,511.00 $116,390.72 $32,892.97 2025-08-01
810000001-10806601-26776 CDM Hb Organ Processing 12 9 $191,370.00 $95,685.00 50% off $2.00 $115,778.85 $81,332.25 2025-08-01
810000002-10806601-26775 CDM Hb Organ Processing - Lrd 12 9 $191,370.00 $95,685.00 50% off $2.00 $115,778.85 $81,332.25 2025-08-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 29 16 — — $22,511.00 $114,921.59 $32,477.77 2025-08-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 29 16 — — $22,511.00 $114,026.81 $32,224.91 2025-08-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 29 16 — — $22,511.00 $113,116.92 $31,967.76 2025-08-01
810000003-10806601-26774 CDM Hb Pancreas Organ Processing 12 9 $184,995.00 $92,497.50 50% off $2.00 $111,921.98 $78,622.88 2025-08-01
4401 APR_DRG Kidney Transplant 63 18 — — $19,770.60 $111,371.95 $43,712.80 2025-08-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 29 16 — — $14,754.00 $110,296.55 $31,170.71 2025-08-01
51 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 36 8 — — $31,411.15 $109,818.96 $55,679.57 2025-08-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 29 16 — — $22,511.00 $109,531.76 $30,954.57 2025-08-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 29 16 — — $22,511.00 $108,364.92 $30,624.82 2025-08-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 29 16 — — $14,754.00 $108,358.87 $30,623.10 2025-08-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 29 16 — — $22,511.00 $108,340.74 $30,617.97 2025-08-01
332 MS_DRG Rectal Resection With Mcc 29 16 — — $22,328.02 $108,037.79 $29,632.97 2025-08-01
265 MS_DRG Aicd Lead Procedures 29 16 — — $22,962.07 $107,832.89 $39,990.00 2025-08-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 29 16 — — $22,511.00 $107,349.22 $30,337.76 2025-08-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 29 16 — — $22,511.00 $106,693.26 $30,152.39 2025-08-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 29 16 — — $22,511.00 $106,424.22 $30,076.35 2025-08-01
6071 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 36 8 — — $24,260.92 $105,974.22 $56,716.74 2025-08-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 29 16 — — $22,511.00 $105,916.37 $29,932.83 2025-08-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 29 16 — — $22,511.00 $105,883.12 $29,923.43 2025-08-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 29 16 — — $22,511.00 $105,840.80 $29,911.48 2025-08-01
264 MS_DRG Other Circulatory System O.r. Procedures 29 16 — — $22,497.96 $105,653.38 $29,858.50 2025-08-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 27 15 — — $22,352.48 $104,970.20 $29,665.43 2025-08-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 29 16 — — $22,303.56 $104,740.46 $29,600.51 2025-08-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 29 16 — — $22,171.60 $104,120.77 $29,425.38 2025-08-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 29 16 — — $22,136.84 $103,957.53 $29,379.25 2025-08-01
665 MS_DRG Prostatectomy With Mcc 29 16 — — $22,102.08 $103,794.29 $29,333.11 2025-08-01
252 MS_DRG Other Vascular Procedures With Mcc 29 16 — — $22,081.48 $103,697.56 $29,305.78 2025-08-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 29 16 — — $22,048.01 $103,540.37 $37,488.00 2025-08-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 29 16 — — $21,925.71 $102,966.02 $29,099.03 2025-08-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 29 16 — — $21,834.30 $102,536.77 $39,990.00 2025-08-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 29 16 — — $21,607.08 $101,469.68 $28,676.16 2025-08-01
3031 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 36 8 — — $30,914.02 $100,537.31 $51,706.53 2025-08-01
37 MS_DRG Extracranial Procedures With Mcc 29 16 — — $21,376.63 $100,387.49 $28,370.32 2025-08-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 29 16 — — $21,254.33 $99,813.14 $28,208.00 2025-08-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 29 16 — — $21,040.62 $98,809.53 $37,488.00 2025-08-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 29 16 — — $20,980.76 $98,528.40 $27,844.93 2025-08-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 29 16 — — $20,971.75 $98,486.08 $27,832.97 2025-08-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 29 16 — — $20,722.63 $97,316.22 $27,502.36 2025-08-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 29 16 — — $20,626.72 $96,865.81 $39,990.00 2025-08-01
270006137-10806601-31478 CDM Hb Set Usa Hls Advanced 7.0 12 9 $160,030.00 $80,015.00 50% off $2.00 $96,818.15 $68,012.75 2025-08-01
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 29 16 — — $20,566.86 $96,584.68 $40,408.43 2025-08-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 29 16 — — $20,527.59 $96,400.28 $27,243.50 2025-08-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 29 16 — — $20,431.04 $95,946.85 $27,115.36 2025-08-01
500 MS_DRG Soft Tissue Procedures With Mcc 29 16 — — $20,396.92 $95,786.63 $27,070.08 2025-08-01
1621 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 36 8 — — $31,547.42 $95,561.61 $47,358.65 2025-08-01
81 APR_DRG Autologous Bone Marrow Transplant 36 8 — — $23,009.87 $94,480.67 $39,774.68 2025-08-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 29 16 — — $20,089.88 $94,344.71 $39,471.29 2025-08-01
662 MS_DRG Minor Bladder Procedures With Mcc 29 16 — — $20,080.87 $94,302.39 $26,650.62 2025-08-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 29 16 — — $19,995.25 $93,900.34 $39,285.38 2025-08-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 29 16 — — $19,905.78 $93,480.16 $26,418.25 2025-08-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 28 15 — — $19,864.58 $93,286.69 $32,696.11 2025-08-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 29 16 — — $19,850.42 $93,220.19 $26,344.79 2025-08-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 29 16 — — $19,752.58 $92,760.71 $26,214.93 2025-08-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 29 16 — — $19,688.21 $92,458.42 $26,129.51 2025-08-01
270006272-10806601-31343 CDM Hb Protek Duo Cannula Veno-venous 29fr 12 9 $152,290.00 $76,145.00 50% off $2.00 $92,135.45 $64,723.25 2025-08-01
270006273-10806601-31342 CDM Hb Protek Duo Cannula Veno-venous 31fr 12 9 $152,290.00 $76,145.00 50% off $2.00 $92,135.45 $64,723.25 2025-08-01
5063321011 NDC Glucarpidase 1000 Unit Intravenous Solution 13 9 $160,331.12 $80,165.56 50% off $1,574.93 $89,785.43 $56,115.89 2025-08-01
8631 APR_DRG Neonatal Aftercare 36 8 — — $9,704.37 $88,261.26 $30,105.25 2025-08-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 29 16 — — $18,423.34 $86,518.42 $36,196.98 2025-08-01
6131 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 36 8 — — $16,192.44 $86,293.53 $34,874.85 2025-08-01
270006248-10806601-31367 CDM Hb Centrimag Blood Pump 17 12 $154,070.00 $77,035.00 50% off $14,390.14 $86,279.20 $53,924.50 2025-08-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 29 16 — — $18,324.85 $86,055.92 $36,003.48 2025-08-01
6111 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 36 8 — — $12,242.76 $85,890.83 $36,462.87 2025-08-01
619 MS_DRG O.r. Procedures For Obesity With Mcc 29 16 — — $17,550.48 $82,419.37 $34,482.05 2025-08-01
1671 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 36 8 — — $23,244.74 $80,142.79 $33,497.11 2025-08-01
1631 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 36 8 — — $27,030.76 $79,601.90 $39,586.93 2025-08-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 29 16 — — $16,886.18 $79,299.74 $30,689.14 2025-08-01
1781 APR_DRG External Heart Assist Systems 36 8 — — $37,012.46 $76,282.78 $47,544.73 2025-08-01
6121 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 36 8 — — $19,579.93 $75,697.80 $37,678.36 2025-08-01
1651 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 36 8 — — $27,999.01 $74,340.49 $39,541.86 2025-08-01
481000335-10806601-29361 CDM Hb 37231-50 Revasc Tibial/peroneal With Stent & Atherect Bilateral 20 14 $122,810.00 $61,405.00 50% off $700.94 $74,300.05 $33,484.15 2025-08-01
481000334-10806601-29362 CDM Hb 37230-50 Revasc Tibial/peroneal With Stent Bilateral 20 14 $118,545.00 $59,272.50 50% off $644.90 $71,719.73 $32,321.29 2025-08-01
481000331-10806601-29365 CDM Hb 37227-50 Revasc Femoral/popliteal With Stent & Atherect Bilater 20 14 $118,545.00 $59,272.50 50% off $690.34 $71,719.73 $32,321.29 2025-08-01
481000333-10806601-29363 CDM Hb 37229 -50 Revasc Tibial/peroneal With Atherectomy Bilateral 20 14 $118,545.00 $59,272.50 50% off $669.43 $71,719.73 $32,321.29 2025-08-01
3041 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 36 8 — — $20,288.65 $70,488.96 $33,797.20 2025-08-01
250 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc 29 16 — — $14,886.21 $69,907.59 $29,247.45 2025-08-01
243 MS_DRG Permanent Cardiac Pacemaker Implant With Cc 29 16 — — $14,501.27 $68,099.89 $28,491.16 2025-08-01
6081 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 36 8 — — $13,876.59 $66,955.36 $41,494.73 2025-08-01
1831 APR_DRG Percutaneous Structural Cardiac Procedures 36 8 — — $28,233.20 $66,478.89 $36,307.59 2025-08-01
6901 APR_DRG Acute Leukemia 36 8 — — $9,927.60 $65,574.30 $26,284.21 2025-08-01
1661 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 36 8 — — $23,251.59 $65,101.23 $33,497.54 2025-08-01
911 APR_DRG Other Major Head And Neck Procedures 36 8 — — $12,100.33 $63,767.65 $27,673.79 2025-08-01
J7310 HCPCS Ganciclovir Long Act Implant 1 1 — — $63,600.00 $63,600.00 $63,600.00 2025-08-01
211 APR_DRG Open Craniotomy Except Trauma 36 8 — — $16,070.54 $62,726.56 $28,487.86 2025-08-01
1791 APR_DRG Defibrillator Implants 36 8 — — $25,884.47 $61,821.97 $36,304.04 2025-08-01
6141 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 36 8 — — $10,046.75 $61,801.62 $28,921.78 2025-08-01
1691 APR_DRG Major Abdominal Vascular Procedures 36 8 — — $21,183.62 $57,371.90 $27,977.33 2025-08-01
201 APR_DRG Open Craniotomy For Trauma 36 8 — — $17,109.32 $56,196.86 $26,372.92 2025-08-01
560000345-10806601-28685 CDM Hb Nmdp Unreltd Donr Marrow Fee & Cryo 12 9 $91,695.00 $45,847.50 50% off $2.00 $55,475.48 $38,970.38 2025-08-01
891 APR_DRG Major Cranial Or Facial Bone Procedures 36 8 — — $13,712.24 $52,229.18 $26,735.24 2025-08-01
560000344-10806601-28686 CDM Hb Nmdp Unreltd Donr Marrow Fee 12 9 $85,695.00 $42,847.50 50% off $2.00 $51,845.48 $36,420.38 2025-08-01
560000347-10806601-28683 CDM Hb Nmdp Unreltd Donr Primary Pbsc Fee &cryo 12 9 $85,685.00 $42,842.50 50% off $2.00 $51,839.43 $36,416.12 2025-08-01
1301 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 36 8 — — $23,142.03 $50,698.06 $31,564.09 2025-08-01
560000346-10806601-28684 CDM Hb Nmdp Unreltd Donr Primary Pbsc Fee 12 9 $79,865.00 $39,932.50 50% off $2.00 $48,318.33 $33,942.62 2025-08-01
560000348-10806601-28682 CDM Hb Nmdp Unreltd Donr Total Sec. Pbsc 12 9 $79,685.00 $39,842.50 50% off $2.00 $48,209.43 $33,866.12 2025-08-01
481000340-10806601-29359 CDM Hb 37236-50 Open/perq Place Arterial Stent 1st Lesion Bilateral 13 9 $77,775.00 $38,887.50 50% off $15,189.46 $47,053.88 $27,221.25 2025-08-01
481000342-10806601-29358 CDM Hb 37238-50 Open/perq Place Venous Stent 1st Lesion Bilateral 13 9 $77,775.00 $38,887.50 50% off $15,189.46 $47,053.88 $27,221.25 2025-08-01
481000192-10806621-29475 CDM Hb C9602 Perc Arther W Drug Elud Stent Sgl 13 9 $76,875.00 $38,437.50 50% off $15,013.69 $46,509.38 $26,906.25 2025-08-01
301 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 36 8 — — $14,840.04 $46,255.63 $26,593.82 2025-08-01
895 MS_DRG Alcohol/drug Abuse Or Dependence W Rehabilitation Therapy 6 3 — — $23,858.50 $42,279.31 $27,793.32 2025-08-01
560000367-10806601-28665 CDM Hb Nmdp Unreltd Donr Licensed Cbu Shipment 12 9 $63,740.00 $31,870.00 50% off $2.00 $38,562.70 $27,089.50 2025-08-01
560000365-10806601-28667 CDM Hb Nmdp Unreltd Donr Unlicensed Cbu Shipment 1 12 9 $63,740.00 $31,870.00 50% off $2.00 $38,562.70 $27,089.50 2025-08-01
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