Price Transparencybeta Hospital negotiated rates

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

TRISTAR HORIZON MEDICAL CENTER

Dickson, TN · CCN 440046 · Rates published

Your selected procedure

You selected 807 (MS_DRG)

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

This hospital’s price: $5,790 across 26 payers · range $1,855-$17,338

Source: https://www.hcadam.com/api/public/content/52f651596e02412da651c83fd3224f31?download=true · observed 2024-10-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

27,678 distinct procedures filed
37 distinct payers
637,478 rate rows
2026-07-31 last MRF observed
Data quality

596,577 of 637,478 rate rows are consumer-grade (93.6%)

40,901 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
per-diem day rate — not a per-procedure price 23,286
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 10,816
exceeds 10× this hospital's gross charge — excluded from medians 3,054
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 2,999
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 435
placeholder amount (≤ $0.02) — excluded from medians 243
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 37
percent-of-charges filed in the dollar field — excluded from medians 31
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1620866_TRISTAR-HORIZON-MEDICAL-CENTER_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.tristarhealth.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaCMS hospital list
Last fetch not_modified · 2026-08-11

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
J1411
HCPCS 		Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 1 $4,200,000.00 $4,200,000.00 $4,200,000.00 nat. median
$3,710,000
1.1× median
J1413
HCPCS 		Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 1 $3,840,000.00 $3,840,000.00 $3,840,000.00 nat. median
$3,324,572
1.2× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 16 $3,232,152.00 $4,223,835.00 $3,709,629.00 nat. median
$3,758,972
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 16 $3,172,400.00 $4,145,750.00 $3,641,050.00 nat. median
$3,646,097
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 19 $4,496.74 $4,888,418.85 $3,391,964.10 nat. median
$3,325,455
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 19 $7,417.36 $4,830,420.00 $3,351,720.00 nat. median
$3,252,508
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 19 $6,588.09 $4,362,960.00 $3,027,360.00 nat. median
$2,939,969
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 19 $2,101,980.32 $3,511,262.58 $2,460,272.42 nat. median
$2,588,981
1.0× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 1 $1,387,149.28 $1,387,149.28 $1,387,149.28 nat. median
$691,418
outlier · 2.0×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 2 $620,118.79 $1,345,370.55 $1,345,370.55 nat. median
$631,793
outlier · 2.1×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 2 $591,090.52 $1,334,154.50 $1,334,154.50 nat. median
$610,161
outlier · 2.2×
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 2 $579,352.98 $1,315,434.06 $1,315,434.06 nat. median
$624,417
outlier · 2.1×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 2 $549,504.00 $1,296,212.81 $1,296,212.81 nat. median
$588,565
outlier · 2.2×
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 2 $549,504.00 $1,191,016.00 $1,191,016.00 nat. median
$577,541
outlier · 2.1×
9194
OTHER 		Tisagenlecleucel Car-pos 19 $465,689.75 $777,913.56 $545,068.69 nat. median
$576,820
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 19 $463,868.59 $774,871.40 $542,937.10 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 19 $463,397.09 $774,083.77 $542,385.23 nat. median
$560,872
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 19 $454,718.97 $759,587.37 $532,227.88 nat. median
$562,201
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 19 $430,721.28 $719,500.32 $504,139.68 nat. median
$533,230
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 19 $405,266.75 $676,979.69 $474,346.31 nat. median
$492,768
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 24 $1,854.72 $910,889.88 $272,044.30 nat. median
$370,165
0.7× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 25 $2,253.12 $706,817.00 $205,482.12 nat. median
$261,939
0.8× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 2 $87,248.40 $192,914.70 $192,914.70 nat. median
$75,807
outlier · 2.5×
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 3 $74,124.43 $173,512.94 $173,512.94 nat. median
$63,643
outlier · 2.7×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 25 $2,253.12 $573,024.23 $171,566.96 nat. median
$205,166
0.8× median
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 3 $72,000.00 $168,273.22 $168,273.22 nat. median
$69,291
outlier · 2.4×
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 26 $2,253.12 $517,646.48 $156,618.81 nat. median
$199,832
0.8× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $152,420.78 $152,420.78 $152,420.78 nat. median
$214,447
0.7× median
Q2043
HCPCS 		Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 3 $65,321.65 $147,108.87 $147,108.87 nat. median
$65,655
outlier · 2.2×
1908
OTHER 		New Technology - Level 52 19 $123,322.14 $206,004.04 $144,342.96 nat. median
$155,877
0.9× median
1907
OTHER 		New Technology - Level 52 19 $123,322.14 $206,004.04 $144,342.96 nat. median
$155,877
0.9× median
1906
OTHER 		New Technology - Level 51 19 $111,192.14 $185,741.41 $130,145.34 nat. median
$140,545
0.9× median
1905
OTHER 		New Technology - Level 51 19 $111,192.14 $185,741.41 $130,145.34 nat. median
$140,545
0.9× median
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $125,769.64 $125,769.64 $125,769.64 nat. median
$292,434
outlier · 0.4×
A9699
HCPCS 		Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 $123,321.96 $123,321.96 $123,321.96 nat. median
$4,125
outlier · 29.9×
J9226
HCPCS 		Histrelin Implant (supprelin La), 50 Mg 3 $54,500.39 $117,019.36 $117,019.36 nat. median
$55,200
outlier · 2.1×
1903
OTHER 		New Technology - Level 50 19 $99,062.13 $165,478.78 $115,947.72 nat. median
$122,500
0.9× median
1904
OTHER 		New Technology - Level 50 19 $99,062.13 $165,478.78 $115,947.72 nat. median
$122,500
0.9× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 26 $2,253.12 $341,288.41 $103,154.57 nat. median
$132,706
0.8× median
Q0480
HCPCS 		Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 19 $87,999.91 $146,999.85 $102,999.90 nat. median
$111,503
0.9× median
003
OTHER 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 $102,091.46 $102,091.46 $102,091.46 nat. median
$163,765
0.6× median
1902
OTHER 		New Technology - Level 49 19 $86,932.13 $145,216.17 $101,750.11 nat. median
$107,500
0.9× median
1901
OTHER 		New Technology - Level 49 19 $86,932.13 $145,216.17 $101,750.11 nat. median
$107,500
0.9× median
7
MS_DRG 		Lung Transplant 25 $2,253.12 $315,655.12 $95,494.15 nat. median
$122,690
0.8× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 25 $1,854.72 $316,452.24 $95,265.38 nat. median
$114,305
0.8× median
K1007
HCPCS 		Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 19 $80,108.07 $133,816.89 $93,762.86 nat. median
$97,404
1.0× median
1585
OTHER 		New Technology - Level 48 19 $76,823.79 $128,330.65 $89,918.75 nat. median
$97,104
0.9× median
1599
OTHER 		New Technology - Level 48 19 $76,823.79 $128,330.65 $89,918.75 nat. median
$97,104
0.9× median
30230X2
OTHER 		Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Op… 1 $83,298.00 $83,298.00 $83,298.00 nat. median
$221,450
outlier · 0.4×
30230X3
OTHER 		Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein,… 1 $83,298.00 $83,298.00 $83,298.00 nat. median
$265,174
outlier · 0.3×

Other procedures at this hospital

Browse this hospital's 27,678 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
             
J1411 HCPCS Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 1 1 — — $4,200,000.00 $4,200,000.00 $4,200,000.00 2024-10-01
J1413 HCPCS Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 1 1 — — $3,840,000.00 $3,840,000.00 $3,840,000.00 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 26 16 — — $3,232,152.00 $4,223,835.00 $3,709,629.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 26 16 — — $3,172,400.00 $4,145,750.00 $3,641,050.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 30 19 — — $4,496.74 $4,888,418.85 $3,391,964.10 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 30 19 — — $7,417.36 $4,830,420.00 $3,351,720.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 30 19 — — $6,588.09 $4,362,960.00 $3,027,360.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 29 19 — — $2,101,980.32 $3,511,262.58 $2,460,272.42 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 1 — — $1,387,149.28 $1,387,149.28 $1,387,149.28 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 5 2 — — $620,118.79 $1,345,370.55 $1,345,370.55 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 5 2 — — $591,090.52 $1,334,154.50 $1,334,154.50 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 5 2 — — $579,352.98 $1,315,434.06 $1,315,434.06 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 5 2 — — $549,504.00 $1,296,212.81 $1,296,212.81 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 5 2 — — $549,504.00 $1,191,016.00 $1,191,016.00 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 29 19 — — $465,689.75 $777,913.56 $545,068.69 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 29 19 — — $463,868.59 $774,871.40 $542,937.10 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 29 19 — — $463,397.09 $774,083.77 $542,385.23 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 29 19 — — $454,718.97 $759,587.37 $532,227.88 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 29 19 — — $430,721.28 $719,500.32 $504,139.68 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 29 19 — — $405,266.75 $676,979.69 $474,346.31 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 45 24 — — $1,854.72 $910,889.88 $272,044.30 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 52 25 — — $2,253.12 $706,817.00 $205,482.12 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 5 2 — — $87,248.40 $192,914.70 $192,914.70 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 6 3 — — $74,124.43 $173,512.94 $173,512.94 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 46 25 — — $2,253.12 $573,024.23 $171,566.96 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 6 3 — — $72,000.00 $168,273.22 $168,273.22 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 56 26 — — $2,253.12 $517,646.48 $156,618.81 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $152,420.78 $152,420.78 $152,420.78 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 6 3 — — $65,321.65 $147,108.87 $147,108.87 2024-10-01
1907 OTHER New Technology - Level 52 29 19 — — $123,322.14 $206,004.04 $144,342.96 2024-10-01
1908 OTHER New Technology - Level 52 29 19 — — $123,322.14 $206,004.04 $144,342.96 2024-10-01
1905 OTHER New Technology - Level 51 29 19 — — $111,192.14 $185,741.41 $130,145.34 2024-10-01
1906 OTHER New Technology - Level 51 29 19 — — $111,192.14 $185,741.41 $130,145.34 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $125,769.64 $125,769.64 $125,769.64 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 4 1 — — $123,321.96 $123,321.96 $123,321.96 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 6 3 — — $54,500.39 $117,019.36 $117,019.36 2024-10-01
1903 OTHER New Technology - Level 50 29 19 — — $99,062.13 $165,478.78 $115,947.72 2024-10-01
1904 OTHER New Technology - Level 50 29 19 — — $99,062.13 $165,478.78 $115,947.72 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 56 26 — — $2,253.12 $341,288.41 $103,154.57 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 29 19 — — $87,999.91 $146,999.85 $102,999.90 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $102,091.46 $102,091.46 $102,091.46 2024-10-01
1901 OTHER New Technology - Level 49 29 19 — — $86,932.13 $145,216.17 $101,750.11 2024-10-01
1902 OTHER New Technology - Level 49 29 19 — — $86,932.13 $145,216.17 $101,750.11 2024-10-01
7 MS_DRG Lung Transplant 46 25 — — $2,253.12 $315,655.12 $95,494.15 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 46 25 — — $1,854.72 $316,452.24 $95,265.38 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 29 19 — — $80,108.07 $133,816.89 $93,762.86 2024-10-01
1585 OTHER New Technology - Level 48 29 19 — — $76,823.79 $128,330.65 $89,918.75 2024-10-01
1599 OTHER New Technology - Level 48 29 19 — — $76,823.79 $128,330.65 $89,918.75 2024-10-01
30230Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Peripheral Vein,… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30230X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein, … 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30233G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Percutaneous… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30230X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Op… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30230U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30240G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Central Vein, Open Approach 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30233Y3 OTHER Transfusion Of Allogeneic Unrelated Hamatopoietic Stem Cells Into Peripheral Vei… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30243X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Central Vein, Percu… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30240Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein, … 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30240U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30233U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30233U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30230U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30243Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Central Vein, … 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30243Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Central Vein, Pe… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30233X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Peripheral Vein, Pe… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30243X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Per… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30240X2 OTHER Transfusion Of Allogeneic Related Cord Blood Stem Cells Into Central Vein, Open … 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30240Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Central Vein, Op… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30243G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Percutaneous … 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30233G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Peripheral Vein, Percutaneo… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30243G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Central Vein, Percutaneous Ap… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30233Y2 OTHER Transfusion Of Allogeneic Related Hematopoietic Stem Cells Into Peripheral Vein,… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30240G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Central Vein, Open Approach… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30243U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30230Y3 OTHER Transfusion Of Allogeneic Unrelated Hematopoietic Stem Cells Into Peripheral Vei… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30230G2 OTHER Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Open Approac… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30233X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Peripheral Vein, … 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30243U3 OTHER Transfusion Of Allogeneic Unrelated T-cell Depleted Hematopoietic Stem Cells Int… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30230G3 OTHER Transfusion Of Allogeneic Unrelated Bone Marrow Into Peripheral Vein, Open Appro… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30240U2 OTHER Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into … 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
30240X3 OTHER Transfusion Of Allogeneic Unrelated Cord Blood Stem Cells Into Central Vein, Ope… 1 1 — — $83,298.00 $83,298.00 $83,298.00 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 52 25 — — $2,253.12 $706,817.00 $81,102.65 2024-10-01
1598 OTHER New Technology - Level 47 29 19 — — $68,737.12 $114,822.23 $80,453.67 2024-10-01
1584 OTHER New Technology - Level 47 29 19 — — $68,737.12 $114,822.23 $80,453.67 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 56 26 — — $2,253.12 $263,122.83 $79,795.07 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 63 32 — — $21,031.00 $253,183.05 $78,698.37 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 46 25 — — $2,253.12 $257,216.93 $78,030.11 2024-10-01
215 MS_DRG Other Heart Assist System Implant 56 26 — — $2,253.12 $494,733.00 $78,016.13 2024-10-01
C9150 HCPCS Xenon Xe-129 Hyperpolarized Gas, Diagnostic, Per Study Dose 1 1 — — $74,786.40 $74,786.40 $74,786.40 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 7 4 — — $2,253.12 $92,326.93 $74,471.21 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $71,782.97 $71,782.97 $71,782.97 2024-10-01
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 6 3 — — $31,521.48 $71,589.38 $71,589.38 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 56 26 — — $2,253.12 $233,105.41 $71,169.96 2024-10-01
1597 OTHER New Technology - Level 46 29 19 — — $60,650.44 $101,313.81 $70,988.59 2024-10-01
1583 OTHER New Technology - Level 46 29 19 — — $60,650.44 $101,313.81 $70,988.59 2024-10-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 1 1 — — $68,674.05 $68,674.05 $68,674.05 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 29 19 — — $57,967.10 $96,831.40 $67,847.85 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 29 19 — — $57,619.39 $96,250.57 $67,440.88 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 49 23 — — $9,270.00 $222,498.95 $67,324.75 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $66,698.72 $66,698.72 $66,698.72 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $64,954.81 $64,954.81 $64,954.81 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 30 19 — — $10,776.28 $93,131.51 $64,621.87 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 56 26 — — $2,253.12 $173,945.04 $62,901.24 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 63 32 — — $21,031.00 $201,452.70 $62,861.88 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 56 26 — — $2,253.12 $241,121.00 $62,632.19 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 6 3 — — $26,766.00 $62,320.47 $62,320.47 2024-10-01
1596 OTHER New Technology - Level 45 29 19 — — $52,563.77 $87,805.39 $61,523.51 2024-10-01
1582 OTHER New Technology - Level 45 29 19 — — $52,563.77 $87,805.39 $61,523.51 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 56 26 — — $2,253.12 $194,701.38 $59,637.07 2024-10-01
10 MS_DRG Pancreas Transplant 46 25 — — $2,253.12 $192,578.15 $58,426.65 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 47 25 — — $2,253.12 $191,469.44 $58,096.93 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 56 26 — — $2,253.12 $188,790.65 $57,581.17 2024-10-01
007 OTHER Lung Transplant 1 1 — — $57,548.86 $57,548.86 $57,548.86 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $57,444.46 $57,444.46 $57,444.46 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 56 26 — — $2,253.12 $186,887.24 $57,290.45 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 29 19 — — $48,413.40 $80,872.39 $56,665.69 2024-10-01
B0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $56,363.91 $56,363.91 $56,363.91 2024-10-01
B0505 HCPCS Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 3 1 — — $55,785.03 $55,785.03 $55,785.03 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 7 4 — — $2,253.12 $69,101.93 $55,737.85 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 56 26 — — $2,253.12 $180,285.67 $55,307.97 2024-10-01
B0106 HCPCS Stroke; M > 30.05 & M < 34.25 3 1 — — $53,752.48 $53,752.48 $53,752.48 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 63 32 — — $21,031.00 $171,469.10 $53,682.86 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $53,164.13 $53,164.13 $53,164.13 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 56 26 — — $2,253.12 $283,196.00 $52,426.75 2024-10-01
1595 OTHER New Technology - Level 44 29 19 — — $44,477.10 $74,296.98 $52,058.42 2024-10-01
1581 OTHER New Technology - Level 44 29 19 — — $44,477.10 $74,296.98 $52,058.42 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 7 4 — — $2,253.12 $63,725.73 $51,401.39 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 56 26 — — $1,854.72 $168,034.26 $51,127.57 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 63 32 — — $21,031.00 $161,939.95 $50,765.64 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 56 26 — — $2,253.12 $164,927.92 $50,695.98 2024-10-01
C0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $50,123.85 $50,123.85 $50,123.85 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 56 26 — — $2,253.12 $161,046.22 $49,530.29 2024-10-01
5244 OTHER Level 4 Blood Product Exc 29 19 — — $42,104.21 $70,333.16 $49,281.06 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 46 25 — — $2,253.12 $161,319.17 $49,130.58 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $48,997.92 $48,997.92 $48,997.92 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 29 19 — — $41,793.84 $69,814.71 $48,917.79 2024-10-01
B0205 HCPCS Traumatic Brain Injury; M > 28.75 & M < 40.65 3 1 — — $48,797.80 $48,797.80 $48,797.80 2024-10-01
D0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $48,657.24 $48,657.24 $48,657.24 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 56 26 — — $2,253.12 $155,978.50 $48,008.43 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 56 26 — — $1,854.72 $156,227.29 $47,616.32 2024-10-01
B0105 HCPCS Stroke; M > 34.25 & M < 38.85 3 1 — — $47,259.05 $47,259.05 $47,259.05 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $47,219.35 $47,219.35 $47,219.35 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $47,111.56 $47,111.56 $47,111.56 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 63 32 — — $19,567.31 $149,422.83 $46,933.71 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 56 26 — — $2,253.12 $152,753.80 $46,811.70 2024-10-01
1142 OTHER Supprelin La Implant 29 19 — — $39,908.18 $66,664.81 $46,710.72 2024-10-01
C0106 HCPCS Stroke; M > 30.05 & M < 34.25 3 1 — — $46,617.29 $46,617.29 $46,617.29 2024-10-01
B1903 HCPCS Guillian Barre; M < 18.05 3 1 — — $46,447.14 $46,447.14 $46,447.14 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 56 26 — — $2,253.12 $184,165.00 $46,097.77 2024-10-01
B0604 HCPCS Neurological; M < 25.85 3 1 — — $46,058.76 $46,058.76 $46,058.76 2024-10-01
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 6 3 — — $19,539.46 $45,738.60 $45,738.60 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 56 26 — — $2,253.12 $148,231.99 $45,682.13 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 56 26 — — $2,253.12 $148,741.66 $45,612.68 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 56 26 — — $2,253.12 $241,121.00 $45,476.12 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 56 26 — — $2,253.12 $146,840.66 $45,044.58 2024-10-01
B0405 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 3 1 — — $44,823.32 $44,823.32 $44,823.32 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 56 26 — — $2,253.12 $184,780.00 $44,620.89 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 46 25 — — $1,854.72 $145,787.50 $44,511.65 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 46 25 — — $1,854.72 $145,787.50 $44,511.65 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 56 26 — — $2,253.12 $143,700.51 $44,321.30 2024-10-01
A0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 3 1 — — $44,213.00 $44,213.00 $44,213.00 2024-10-01
A5104 HCPCS Expired, Not Orthopedic, Length Of Stay Is 16 Days 3 1 — — $44,079.84 $44,079.84 $44,079.84 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 43 23 — — $1,854.72 $122,110.30 $43,861.55 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 56 26 — — $2,253.12 $142,123.19 $43,847.63 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $43,815.62 $43,815.62 $43,815.62 2024-10-01
C0505 HCPCS Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 3 1 — — $43,399.25 $43,399.25 $43,399.25 2024-10-01
B0704 HCPCS Fracture Of Lower Extremity; M < 28.15 3 1 — — $43,042.30 $43,042.30 $43,042.30 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 56 26 — — $2,253.12 $119,975.00 $43,005.02 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 54 26 — — $2,253.12 $314,996.79 $42,977.26 2024-10-01
B2102 HCPCS Burns; M=12-45 3 1 — — $42,862.90 $42,862.90 $42,862.90 2024-10-01
D0106 HCPCS Stroke; M > 30.05 & M < 34.25 3 1 — — $42,600.28 $42,600.28 $42,600.28 2024-10-01
1594 OTHER New Technology - Level 43 29 19 — — $36,390.43 $60,788.56 $42,593.34 2024-10-01
1580 OTHER New Technology - Level 43 29 19 — — $36,390.43 $60,788.56 $42,593.34 2024-10-01
B1004 HCPCS Amputation, Lower Extremity; M=39-45 3 1 — — $42,557.74 $42,557.74 $42,557.74 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 56 26 — — $2,253.12 $137,797.03 $42,548.47 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $42,413.21 $42,413.21 $42,413.21 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $42,177.37 $42,177.37 $42,177.37 2024-10-01
B1504 HCPCS Pulmonary; M < 29.15 3 1 — — $42,063.94 $42,063.94 $42,063.94 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 63 32 — — $17,413.83 $132,978.11 $41,899.41 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 63 32 — — $17,302.80 $132,130.27 $41,639.85 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 56 26 — — $2,253.12 $134,644.80 $41,399.88 2024-10-01
B1704 HCPCS Major Multiple Trauma,no Brain Or Spinal Cord Inju 3 1 — — $41,322.31 $41,322.31 $41,322.31 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 56 26 — — $2,253.12 $133,511.93 $41,261.64 2024-10-01
B2005 HCPCS Miscellaneous; M=12-32 And A Tm81 3 1 — — $41,080.03 $41,080.03 $41,080.03 2024-10-01
D0505 HCPCS Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 3 1 — — $41,000.51 $41,000.51 $41,000.51 2024-10-01
C0105 HCPCS Stroke; M > 34.25 & M < 38.85 3 1 — — $40,985.71 $40,985.71 $40,985.71 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 56 26 — — $1,854.72 $133,502.27 $40,858.16 2024-10-01
A0106 HCPCS Stroke; M > 30.05 & M < 34.25 3 1 — — $40,597.33 $40,597.33 $40,597.33 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 46 25 — — $2,253.12 $131,422.52 $40,436.92 2024-10-01
B1204 HCPCS Osteoarthritis; M=39-47 3 1 — — $40,386.49 $40,386.49 $40,386.49 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 56 26 — — $2,253.12 $131,123.00 $40,347.40 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 56 26 — — $2,253.12 $130,453.91 $40,343.30 2024-10-01
C0205 HCPCS Traumatic Brain Injury; M > 28.75 & M < 40.65 3 1 — — $40,190.45 $40,190.45 $40,190.45 2024-10-01
B0504 HCPCS Nontraumatic Spinal Cord Injury; M > 29.25 & M < 3 3 1 — — $40,146.06 $40,146.06 $40,146.06 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 56 26 — — $2,253.12 $130,330.72 $40,110.64 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 56 26 — — $2,253.12 $130,313.81 $40,105.58 2024-10-01
B0304 HCPCS Nontraumatic Brain Injury; M < 26.15 3 1 — — $39,987.01 $39,987.01 $39,987.01 2024-10-01
C0405 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 3 1 — — $39,861.24 $39,861.24 $39,861.24 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 56 26 — — $2,253.12 $128,502.18 $39,757.19 2024-10-01
B1404 HCPCS Cardiac; M < 31.15 3 1 — — $39,685.55 $39,685.55 $39,685.55 2024-10-01
B1304 HCPCS Rheumatoid, Other Arthritis; M=12-35 3 1 — — $39,607.87 $39,607.87 $39,607.87 2024-10-01
B0904 HCPCS Other Orthopedic; M < 24.15 3 1 — — $39,607.87 $39,607.87 $39,607.87 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 56 26 — — $2,253.12 $127,932.13 $39,585.99 2024-10-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 29 19 — — $33,694.76 $56,285.57 $39,438.18 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 63 32 — — $16,289.33 $124,391.00 $39,270.59 2024-10-01
B2004 HCPCS Miscellaneous; M < 27.85 3 1 — — $38,973.51 $38,973.51 $38,973.51 2024-10-01
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 29 19 — — $33,177.32 $55,421.21 $38,832.54 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 7 4 — — $2,253.12 $47,985.75 $38,705.46 2024-10-01
D0405 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 3 1 — — $38,694.24 $38,694.24 $38,694.24 2024-10-01
B1203 HCPCS Osteoarthritis; M < 30.75 3 1 — — $38,512.99 $38,512.99 $38,512.99 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $38,446.92 $38,446.92 $38,446.92 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 56 26 — — $2,253.12 $123,982.78 $38,399.99 2024-10-01
B0805 HCPCS Replacement Of Lower Extremity Joint; M > 22.05 & 3 1 — — $38,122.76 $38,122.76 $38,122.76 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 56 26 — — $2,253.12 $123,052.82 $38,120.71 2024-10-01
B0204 HCPCS Traumatic Brain Injury; M > 40.65 & M < 44.25 3 1 — — $38,095.02 $38,095.02 $38,095.02 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $38,073.28 $38,073.28 $38,073.28 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 56 26 — — $2,253.12 $122,676.00 $37,823.06 2024-10-01
B0104 HCPCS Stroke; M > 38.85 & M < 44.45 3 1 — — $37,793.56 $37,793.56 $37,793.56 2024-10-01
A0505 HCPCS Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 3 1 — — $37,782.46 $37,782.46 $37,782.46 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 56 26 — — $2,253.12 $121,656.66 $37,518.43 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $37,502.26 $37,502.26 $37,502.26 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 56 26 — — $2,253.12 $120,845.05 $37,457.71 2024-10-01
D0105 HCPCS Stroke; M > 34.25 & M < 38.85 3 1 — — $37,453.26 $37,453.26 $37,453.26 2024-10-01
677953 CDM Tacth Impl Wrls Pa Snsr 23 18 $120,934.87 $120,934.87 $15,000.00 $111,260.08 $37,368.87 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 56 26 — — $2,253.12 $120,361.95 $37,312.64 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 56 26 — — $2,253.12 $120,811.23 $37,265.77 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 56 26 — — $1,854.72 $120,939.25 $37,122.06 2024-10-01
B1103 HCPCS Amputation, Non-lower Extremity; M=12-37 3 1 — — $37,092.61 $37,092.61 $37,092.61 2024-10-01
B1804 HCPCS Major Multiple Trauma With Brain Or Spinal Code In 3 1 — — $36,963.15 $36,963.15 $36,963.15 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $36,906.30 $36,906.30 $36,906.30 2024-10-01
B0603 HCPCS Neurological; M > 25.85 & M < 37.35 3 1 — — $36,726.42 $36,726.42 $36,726.42 2024-10-01
815111 CDM Set Vntrc 17.4x13.8in 32 23 $122,475.00 $122,475.00 $15,000.00 $112,677.00 $36,681.26 2024-10-01
245 MS_DRG Aicd Generator Procedures 56 26 — — $2,253.12 $118,033.41 $36,613.37 2024-10-01
B1703 HCPCS Maj Mult Trauma No Brain Or Spinal Cord Injury; M 3 1 — — $36,508.19 $36,508.19 $36,508.19 2024-10-01
D0205 HCPCS Traumatic Brain Injury; M > 28.75 & M < 40.65 3 1 — — $36,504.49 $36,504.49 $36,504.49 2024-10-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $36,470.11 $36,470.11 $36,470.11 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 56 26 — — $2,253.12 $99,762.78 $36,399.38 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 46 25 — — $2,253.12 $117,125.18 $36,164.21 2024-10-01
B0403 HCPCS Traumatic Spinal Cord Injury; M > 16.05 & M < 30.3 3 1 — — $36,099.46 $36,099.46 $36,099.46 2024-10-01
834 OTHER Acute Leukemia With Mcc 1 1 — — $35,809.91 $35,809.91 $35,809.91 2024-10-01
C1903 HCPCS Guillian Barre; M < 18.05 3 1 — — $35,707.37 $35,707.37 $35,707.37 2024-10-01
A0105 HCPCS Stroke; M > 34.25 & M < 38.85 3 1 — — $35,694.43 $35,694.43 $35,694.43 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 56 26 — — $2,253.12 $114,844.95 $35,482.78 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 56 26 — — $2,253.12 $114,840.12 $35,481.33 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 54 26 — — $2,253.12 $241,075.40 $35,458.38 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 56 26 — — $2,253.12 $138,744.00 $35,292.45 2024-10-01
B0703 HCPCS Fracture Of Lower Extremity; M > 28.15 & M < 34.15 3 1 — — $35,233.91 $35,233.91 $35,233.91 2024-10-01
C1004 HCPCS Amputation, Lower Extremity; M=39-45 3 1 — — $35,196.93 $35,196.93 $35,196.93 2024-10-01
A0405 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 3 1 — — $35,159.94 $35,159.94 $35,159.94 2024-10-01
B1603 HCPCS Pain Syndrome: M < 26.75 3 1 — — $35,041.57 $35,041.57 $35,041.57 2024-10-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $34,992.05 $34,992.05 $34,992.05 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 56 26 — — $2,253.12 $184,165.00 $34,913.79 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 54 26 — — $2,253.12 $234,521.98 $34,768.78 2024-10-01
B0303 HCPCS Nontraumatic Brain Injury; M > 26.15 & M < 35.05 3 1 — — $34,488.58 $34,488.58 $34,488.58 2024-10-01
L8701 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand With S… 29 19 — — $29,463.19 $49,216.92 $34,485.33 2024-10-01
C0604 HCPCS Neurological; M < 25.85 3 1 — — $34,483.04 $34,483.04 $34,483.04 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 56 26 — — $2,253.12 $127,146.00 $34,479.29 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 56 26 — — $2,253.12 $111,327.98 $34,431.74 2024-10-01
A0205 HCPCS Traumatic Brain Injury; M > 28.75 & M < 40.65 3 1 — — $34,368.37 $34,368.37 $34,368.37 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 56 26 — — $2,253.12 $110,912.51 $34,307.58 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 47 25 — — $2,253.12 $111,282.09 $34,250.13 2024-10-01
C1504 HCPCS Pulmonary; M < 29.15 3 1 — — $34,140.89 $34,140.89 $34,140.89 2024-10-01
B1503 HCPCS Pulmonary; M > 29.15 & M < 39.05 3 1 — — $33,967.04 $33,967.04 $33,967.04 2024-10-01
B1803 HCPCS Major Multiple Trauma With Brain Or Spinal Cord In 3 1 — — $33,800.59 $33,800.59 $33,800.59 2024-10-01
B0503 HCPCS Nontraumatic Spinal Cord Injury; M > 31.25 & M < 4 3 1 — — $33,772.85 $33,772.85 $33,772.85 2024-10-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 56 26 — — $2,253.12 $108,970.45 $33,727.21 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 56 26 — — $2,253.12 $108,021.16 $33,606.64 2024-10-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 56 26 — — $2,253.12 $108,320.68 $33,533.01 2024-10-01
D1903 HCPCS Guillian Barre; M < 18.05 3 1 — — $33,319.73 $33,319.73 $33,319.73 2024-10-01
C0704 HCPCS Fracture Of Lower Extremity; M < 28.15 3 1 — — $33,295.69 $33,295.69 $33,295.69 2024-10-01
B1003 HCPCS Amputation, Lower Extremity; M < 36.25 3 1 — — $33,242.05 $33,242.05 $33,242.05 2024-10-01
901 MS_DRG Wound Debridements For Injuries With Mcc 56 26 — — $2,253.12 $107,011.48 $33,141.76 2024-10-01
1579 OTHER New Technology - Level 42 29 19 — — $28,303.76 $47,280.14 $33,128.26 2024-10-01
1593 OTHER New Technology - Level 42 29 19 — — $28,303.76 $47,280.14 $33,128.26 2024-10-01
B0903 HCPCS Other Orthopedic; M > 24.15 & M < 34.35 3 1 — — $33,055.26 $33,055.26 $33,055.26 2024-10-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 56 26 — — $2,253.12 $106,100.84 $33,029.97 2024-10-01
C2005 HCPCS Miscellaneous; M=12-32 And A Tm81 3 1 — — $32,812.98 $32,812.98 $32,812.98 2024-10-01
C0104 HCPCS Stroke; M > 38.85 & M < 44.45 3 1 — — $32,775.99 $32,775.99 $32,775.99 2024-10-01
C1304 HCPCS Rheumatoid, Other Arthritis; M=12-35 3 1 — — $32,748.25 $32,748.25 $32,748.25 2024-10-01
A1903 HCPCS Guillian Barre; M < 18.05 3 1 — — $32,742.70 $32,742.70 $32,742.70 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 56 26 — — $2,253.12 $119,975.00 $32,645.08 2024-10-01
B2003 HCPCS Miscellaneous; M > 27.85 & M < 38.75 3 1 — — $32,596.60 $32,596.60 $32,596.60 2024-10-01
D2102 HCPCS Burns; M=12-45 3 1 — — $32,570.70 $32,570.70 $32,570.70 2024-10-01
C2102 HCPCS Burns; M=12-45 3 1 — — $32,570.70 $32,570.70 $32,570.70 2024-10-01
326651 CDM Rem/replace Icd Gen Mult 23 18 $105,334.02 $105,334.02 $15,000.00 $96,907.30 $32,548.21 2024-10-01
B1403 HCPCS Cardiac; M > 31.15 & M < 38.55 3 1 — — $32,387.61 $32,387.61 $32,387.61 2024-10-01
232 OTHER Coronary Bypass With Ptca Without Mcc 1 1 — — $32,319.12 $32,319.12 $32,319.12 2024-10-01
219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $32,316.16 $32,316.16 $32,316.16 2024-10-01
969 OTHER HIV With Extensive O.r. Procedures With Mcc 1 1 — — $32,243.46 $32,243.46 $32,243.46 2024-10-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 46 25 — — $1,854.72 $104,511.44 $32,236.62 2024-10-01
D0604 HCPCS Neurological; M < 25.85 3 1 — — $32,191.57 $32,191.57 $32,191.57 2024-10-01
466 OTHER Revision Of Hip Or Knee Replacement With Mcc 1 1 — — $32,191.04 $32,191.04 $32,191.04 2024-10-01
D1004 HCPCS Amputation, Lower Extremity; M=39-45 3 1 — — $32,150.88 $32,150.88 $32,150.88 2024-10-01
C1704 HCPCS Major Multiple Trauma,no Brain Or Spinal Cord Inju 3 1 — — $32,119.44 $32,119.44 $32,119.44 2024-10-01
D1504 HCPCS Pulmonary; M < 29.15 3 1 — — $32,108.34 $32,108.34 $32,108.34 2024-10-01
C0403 HCPCS Traumatic Spinal Cord Injury; M > 16.05 & M < 30.3 3 1 — — $32,102.79 $32,102.79 $32,102.79 2024-10-01
C0304 HCPCS Nontraumatic Brain Injury; M < 26.15 3 1 — — $31,991.82 $31,991.82 $31,991.82 2024-10-01
461 OTHER Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 1 1 — — $31,989.43 $31,989.43 $31,989.43 2024-10-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 56 26 — — $2,253.12 $103,030.74 $31,952.14 2024-10-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 56 26 — — $2,253.12 $102,880.98 $31,907.38 2024-10-01
233 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 1 — — $31,830.52 $31,830.52 $31,830.52 2024-10-01
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