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 NORTHCREST MEDICAL CENTER

Springfield, TN · CCN 440065 · Rates published

22,684 distinct procedures filed
24 distinct payers
845,106 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

794,336 of 845,106 rate rows are consumer-grade (94.0%)

50,770 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 23,917
per-diem day rate — not a per-procedure price 18,234
template filing: same amount across many unrelated codes — excluded 4,864
exceeds 10× this hospital's gross charge — excluded from medians 3,260
placeholder amount (≤ $0.02) — excluded from medians 482
percent-of-charges filed in the dollar field — excluded from medians 13

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/85-4366763_TRISTAR-NORTHCREST-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 Latest re-check couldn't be parsed — showing last good data · 2026-06-08

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
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
$3,325,455
1.2× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 15 $3,489,255.00 $4,848,228.00 $3,709,629.00 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 15 $3,424,750.00 $4,758,600.00 $3,641,050.00 nat. median
$3,605,000
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 17 $3,159,182.25 $4,888,418.85 $3,408,591.38 nat. median
$13,041
outlier · 261.4×
748
OTHER 		Inj, Lovotibeglogene Auto 17 $3,121,700.00 $4,830,420.00 $3,368,150.00 nat. median
$17,963
outlier · 187.5×
746
OTHER 		Inj, Betibeglogene Autote 17 $2,819,600.00 $4,362,960.00 $3,042,200.00 nat. median
$21,896
outlier · 138.9×
9141
OTHER 		Inj Onase Abepar-xioi Tre 17 $2,269,183.30 $3,511,262.58 $2,448,329.35 nat. median
$2,588,981
0.9× 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
$753,246
1.8× median
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
$674,867
2.0× median
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
$625,184
outlier · 2.1×
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
$673,137
2.0× median
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
$634,303
outlier · 2.0×
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
$619,808
1.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 17 $502,733.26 $777,913.56 $542,422.72 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 17 $500,767.23 $774,871.40 $540,301.48 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 17 $500,258.22 $774,083.77 $539,752.29 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 17 $490,889.79 $759,587.37 $529,644.25 nat. median
$562,201
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 17 $464,983.20 $719,500.32 $501,692.40 nat. median
$532,192
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 17 $437,503.88 $676,979.69 $472,043.66 nat. median
$489,450
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 20 $1,854.72 $910,889.88 $265,640.74 nat. median
$370,174
0.7× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 20 $2,253.12 $680,359.39 $201,604.86 nat. median
$265,286
0.8× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 2 $87,248.40 $192,914.70 $192,914.70 nat. median
$76,329
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
$62,507
outlier · 2.8×
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 3 $72,000.00 $168,273.22 $168,273.22 nat. median
$69,774
outlier · 2.4×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 21 $2,253.12 $573,024.23 $165,865.23 nat. median
$206,474
0.8× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 22 $2,253.12 $517,646.48 $151,422.98 nat. median
$202,976
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
$66,682
outlier · 2.2×
1908
OTHER 		New Technology - Level 52 17 $133,131.86 $206,004.04 $141,540.19 nat. median
$152,962
0.9× median
1907
OTHER 		New Technology - Level 52 17 $133,131.86 $206,004.04 $141,540.19 nat. median
$153,199
0.9× median
1906
OTHER 		New Technology - Level 51 17 $120,036.96 $185,741.41 $127,618.25 nat. median
$138,020
0.9× median
1905
OTHER 		New Technology - Level 51 17 $120,036.96 $185,741.41 $127,618.25 nat. median
$137,903
0.9× median
A9699
HCPCS 		Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 $123,321.96 $123,321.96 $123,321.96 nat. median
$21,806
outlier · 5.7×
J9226
HCPCS 		Histrelin Implant (supprelin La), 50 Mg 3 $54,500.39 $117,019.36 $117,019.36 nat. median
$60,368
1.9× median
1904
OTHER 		New Technology - Level 50 17 $106,942.07 $165,478.78 $113,696.31 nat. median
$120,174
0.9× median
1903
OTHER 		New Technology - Level 50 17 $106,942.07 $165,478.78 $113,696.31 nat. median
$119,935
0.9× median
Q0480
HCPCS 		Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 17 $94,999.90 $146,999.85 $100,999.90 nat. median
$111,989
0.9× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 22 $2,253.12 $341,288.41 $100,199.67 nat. median
$133,161
0.8× median
1902
OTHER 		New Technology - Level 49 17 $93,847.18 $145,216.17 $99,774.38 nat. median
$105,172
0.9× median
1901
OTHER 		New Technology - Level 49 17 $93,847.18 $145,216.17 $99,774.38 nat. median
$105,693
0.9× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 20 $1,854.72 $316,452.24 $92,985.98 nat. median
$117,357
0.8× median
7
MS_DRG 		Lung Transplant 20 $2,253.12 $315,655.12 $92,754.46 nat. median
$122,708
0.8× median
K1007
HCPCS 		Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 17 $86,480.30 $133,816.89 $91,942.22 nat. median
$96,983
0.9× median
1585
OTHER 		New Technology - Level 48 17 $82,934.77 $128,330.65 $88,172.76 nat. median
$95,360
0.9× median
1599
OTHER 		New Technology - Level 48 17 $82,934.77 $128,330.65 $88,172.76 nat. median
$95,288
0.9× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 20 $2,253.12 $529,787.00 $79,537.35 nat. median
$108,660
0.7× median
1598
OTHER 		New Technology - Level 47 17 $74,204.84 $114,822.23 $78,891.46 nat. median
$85,322
0.9× median
1584
OTHER 		New Technology - Level 47 17 $74,204.84 $114,822.23 $78,891.46 nat. median
$85,390
0.9× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 22 $2,253.12 $263,122.83 $77,496.43 nat. median
$102,358
0.8× median
215
MS_DRG 		Other Heart Assist System Implant 22 $2,253.12 $437,749.00 $76,877.82 nat. median
$99,019
0.8× median

Other procedures at this hospital

Browse this hospital's 22,684 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 2 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 2 1 — — $3,840,000.00 $3,840,000.00 $3,840,000.00 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 52 15 — — $3,489,255.00 $4,848,228.00 $3,709,629.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 52 15 — — $3,424,750.00 $4,758,600.00 $3,641,050.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 56 17 — — $3,159,182.25 $4,888,418.85 $3,408,591.38 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 56 17 — — $3,121,700.00 $4,830,420.00 $3,368,150.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 56 17 — — $2,819,600.00 $4,362,960.00 $3,042,200.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 56 17 — — $2,269,183.30 $3,511,262.58 $2,448,329.35 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 8 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… 10 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 (… 10 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… 10 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… 10 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… 10 2 — — $549,504.00 $1,191,016.00 $1,191,016.00 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 56 17 — — $502,733.26 $777,913.56 $542,422.72 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 56 17 — — $500,767.23 $774,871.40 $540,301.48 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 56 17 — — $500,258.22 $774,083.77 $539,752.29 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 56 17 — — $490,889.79 $759,587.37 $529,644.25 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 56 17 — — $464,983.20 $719,500.32 $501,692.40 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 56 17 — — $437,503.88 $676,979.69 $472,043.66 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 80 20 — — $1,854.72 $910,889.88 $265,640.74 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 92 20 — — $2,253.12 $680,359.39 $201,604.86 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 10 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… 12 3 — — $74,124.43 $173,512.94 $173,512.94 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 12 3 — — $72,000.00 $168,273.22 $168,273.22 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 82 21 — — $2,253.12 $573,024.23 $165,865.23 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 102 22 — — $2,253.12 $517,646.48 $151,422.98 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 12 3 — — $65,321.65 $147,108.87 $147,108.87 2024-10-01
1907 OTHER New Technology - Level 52 58 17 — — $133,131.86 $206,004.04 $141,540.19 2024-10-01
1908 OTHER New Technology - Level 52 58 17 — — $133,131.86 $206,004.04 $141,540.19 2024-10-01
1905 OTHER New Technology - Level 51 58 17 — — $120,036.96 $185,741.41 $127,618.25 2024-10-01
1906 OTHER New Technology - Level 51 58 17 — — $120,036.96 $185,741.41 $127,618.25 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 8 1 — — $123,321.96 $123,321.96 $123,321.96 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 12 3 — — $54,500.39 $117,019.36 $117,019.36 2024-10-01
1904 OTHER New Technology - Level 50 58 17 — — $106,942.07 $165,478.78 $113,696.31 2024-10-01
1903 OTHER New Technology - Level 50 58 17 — — $106,942.07 $165,478.78 $113,696.31 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 58 17 — — $94,999.90 $146,999.85 $100,999.90 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 102 22 — — $2,253.12 $341,288.41 $100,199.67 2024-10-01
1901 OTHER New Technology - Level 49 58 17 — — $93,847.18 $145,216.17 $99,774.38 2024-10-01
1902 OTHER New Technology - Level 49 58 17 — — $93,847.18 $145,216.17 $99,774.38 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 80 20 — — $1,854.72 $316,452.24 $92,985.98 2024-10-01
7 MS_DRG Lung Transplant 80 20 — — $2,253.12 $315,655.12 $92,754.46 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 58 17 — — $86,480.30 $133,816.89 $91,942.22 2024-10-01
1599 OTHER New Technology - Level 48 58 17 — — $82,934.77 $128,330.65 $88,172.76 2024-10-01
1585 OTHER New Technology - Level 48 58 17 — — $82,934.77 $128,330.65 $88,172.76 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 92 20 — — $2,253.12 $529,787.00 $79,537.35 2024-10-01
1584 OTHER New Technology - Level 47 58 17 — — $74,204.84 $114,822.23 $78,891.46 2024-10-01
1598 OTHER New Technology - Level 47 58 17 — — $74,204.84 $114,822.23 $78,891.46 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 102 22 — — $2,253.12 $263,122.83 $77,496.43 2024-10-01
215 MS_DRG Other Heart Assist System Implant 102 22 — — $2,253.12 $437,749.00 $76,877.82 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 80 20 — — $2,253.12 $257,216.93 $75,781.06 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 12 3 — — $2,253.12 $92,326.93 $75,756.11 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 90 20 — — $11,362.05 $253,183.05 $75,340.87 2024-10-01
C9150 HCPCS Xenon Xe-129 Hyperpolarized Gas, Diagnostic, Per Study Dose 2 1 — — $74,786.40 $74,786.40 $74,786.40 2024-10-01
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 12 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… 102 22 — — $2,253.12 $233,105.41 $70,126.44 2024-10-01
1583 OTHER New Technology - Level 46 58 17 — — $65,474.91 $101,313.81 $69,610.17 2024-10-01
1597 OTHER New Technology - Level 46 58 17 — — $65,474.91 $101,313.81 $69,610.17 2024-10-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 2 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… 58 17 — — $62,578.11 $96,831.40 $66,530.42 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 58 17 — — $62,202.75 $96,250.57 $66,131.35 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 90 20 — — $8,481.00 $222,498.95 $65,697.20 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 56 17 — — $60,187.03 $93,131.51 $64,938.64 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 12 3 — — $26,766.00 $62,320.47 $62,320.47 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 102 22 — — $2,253.12 $213,260.00 $61,706.88 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 102 22 — — $2,253.12 $117,901.00 $61,672.55 2024-10-01
1596 OTHER New Technology - Level 45 58 17 — — $56,744.98 $87,805.39 $60,328.88 2024-10-01
1582 OTHER New Technology - Level 45 58 17 — — $56,744.98 $87,805.39 $60,328.88 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 90 20 — — $9,040.56 $201,452.70 $60,168.46 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 102 22 — — $2,253.12 $194,701.38 $57,623.38 2024-10-01
10 MS_DRG Pancreas Transplant 80 20 — — $2,253.12 $192,578.15 $56,727.25 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 12 3 — — $2,253.12 $69,101.93 $56,699.54 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 82 20 — — $2,253.12 $191,469.44 $56,684.66 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 102 22 — — $2,253.12 $186,887.24 $56,439.13 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 56 17 — — $52,264.47 $80,872.39 $56,390.61 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 102 22 — — $2,253.12 $188,790.65 $55,906.60 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 102 22 — — $2,253.12 $180,285.67 $53,436.32 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 12 3 — — $2,253.12 $63,725.73 $52,288.25 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 102 22 — — $2,253.12 $250,475.00 $51,642.77 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 90 20 — — $7,694.99 $171,469.10 $51,374.33 2024-10-01
1595 OTHER New Technology - Level 44 58 17 — — $48,015.05 $74,296.98 $51,047.58 2024-10-01
1581 OTHER New Technology - Level 44 58 17 — — $48,015.05 $74,296.98 $51,047.58 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 102 22 — — $1,854.72 $168,034.26 $49,877.90 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 102 22 — — $2,253.12 $164,927.92 $48,975.66 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 90 20 — — $7,267.35 $161,939.95 $48,579.45 2024-10-01
5244 OTHER Level 4 Blood Product Exc 58 17 — — $45,453.41 $70,333.16 $48,324.15 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 102 22 — — $2,253.12 $161,046.22 $48,317.32 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 58 17 — — $45,118.35 $69,814.71 $47,967.93 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 82 21 — — $2,253.12 $161,319.17 $47,457.62 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 102 22 — — $2,253.12 $155,978.50 $47,285.63 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 102 22 — — $1,854.72 $156,227.29 $46,448.56 2024-10-01
1142 OTHER Supprelin La Implant 58 17 — — $43,082.70 $66,664.81 $45,803.71 2024-10-01
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 12 3 — — $19,539.46 $45,738.60 $45,738.60 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 102 22 — — $2,253.12 $152,753.80 $45,439.68 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 102 22 — — $2,253.12 $162,886.00 $45,401.43 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 102 22 — — $2,253.12 $213,260.00 $44,788.38 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 90 20 — — $6,705.62 $149,422.83 $44,472.19 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 102 22 — — $2,253.12 $148,741.66 $44,274.35 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 102 22 — — $2,253.12 $148,231.99 $44,126.31 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 102 22 — — $2,253.12 $163,432.00 $43,944.99 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 102 22 — — $2,253.12 $146,840.66 $43,722.21 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 102 22 — — $2,253.12 $143,700.51 $43,649.56 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 80 20 — — $1,854.72 $145,787.50 $43,416.31 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 80 20 — — $1,854.72 $145,787.50 $43,416.31 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 76 19 — — $1,854.72 $74,716.76 $42,781.38 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 102 22 — — $2,253.12 $142,123.19 $42,352.01 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 102 22 — — $2,253.12 $106,112.00 $42,146.63 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 98 22 — — $2,253.12 $314,996.79 $41,917.73 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 102 22 — — $2,253.12 $137,797.03 $41,901.27 2024-10-01
1594 OTHER New Technology - Level 43 58 17 — — $39,285.12 $60,788.56 $41,766.29 2024-10-01
1580 OTHER New Technology - Level 43 58 17 — — $39,285.12 $60,788.56 $41,766.29 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 102 22 — — $2,253.12 $133,511.93 $40,632.26 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 102 22 — — $2,253.12 $134,644.80 $40,179.91 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 90 20 — — $5,967.64 $132,978.11 $40,084.98 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 102 22 — — $1,854.72 $133,502.27 $39,848.06 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 90 20 — — $5,929.59 $132,130.27 $39,836.32 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 12 3 — — $2,253.12 $47,985.75 $39,373.27 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 102 22 — — $2,253.12 $130,453.91 $39,344.65 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 80 20 — — $2,253.12 $131,422.52 $39,243.99 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 102 22 — — $2,253.12 $131,123.00 $39,156.99 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 102 22 — — $2,253.12 $127,932.13 $38,979.82 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 102 22 — — $2,253.12 $130,330.72 $38,926.88 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 102 22 — — $2,253.12 $130,313.81 $38,921.97 2024-10-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 58 17 — — $36,375.03 $56,285.57 $38,672.39 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 102 22 — — $2,253.12 $128,502.18 $38,395.78 2024-10-01
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 58 17 — — $35,816.42 $55,421.21 $38,078.51 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 102 22 — — $2,253.12 $123,982.78 $37,810.24 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 90 20 — — $5,582.27 $124,391.00 $37,566.41 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 102 22 — — $2,253.12 $120,845.05 $36,881.01 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 102 22 — — $2,253.12 $123,052.82 $36,813.01 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 102 22 — — $2,253.12 $120,361.95 $36,737.95 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 102 22 — — $2,253.12 $122,676.00 $36,703.56 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 102 22 — — $2,253.12 $121,656.66 $36,407.49 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 102 22 — — $1,854.72 $120,939.25 $36,199.13 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 102 22 — — $2,253.12 $120,811.23 $36,161.94 2024-10-01
245 MS_DRG Aicd Generator Procedures 102 22 — — $2,253.12 $118,033.41 $36,048.36 2024-10-01
C1767 HCPCS Ipg Nrstm 44mm 51mm 14 5 $78,745.00 $78,745.00 $5,512.15 $66,684.86 $36,015.30 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 102 22 — — $2,253.12 $69,561.00 $35,837.33 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 80 20 — — $2,253.12 $117,125.18 $35,091.33 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 102 22 — — $2,253.12 $122,711.00 $34,745.72 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 98 22 — — $2,253.12 $241,075.40 $34,574.26 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 102 22 — — $2,253.12 $114,844.95 $34,429.03 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 102 22 — — $2,253.12 $114,840.12 $34,427.62 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 102 22 — — $2,253.12 $162,886.00 $34,372.31 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 102 22 — — $2,253.12 $112,457.00 $33,943.82 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 98 22 — — $2,253.12 $234,521.98 $33,900.74 2024-10-01
L8701 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand With S… 58 17 — — $31,806.85 $49,216.92 $33,815.71 2024-10-01
C1820 HCPCS Ipg Nrstm 17mm 47mm 14 5 $74,995.00 $74,995.00 $5,247.41 $61,495.90 $33,740.55 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 102 22 — — $2,253.12 $111,327.98 $33,407.52 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 82 20 — — $2,253.12 $111,282.09 $33,394.19 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 102 22 — — $2,253.12 $110,912.51 $33,286.85 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 102 22 — — $2,253.12 $108,021.16 $33,083.27 2024-10-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 102 22 — — $2,253.12 $108,970.45 $32,722.77 2024-10-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 102 22 — — $2,253.12 $108,320.68 $32,534.05 2024-10-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 102 22 — — $2,253.12 $106,100.84 $32,514.58 2024-10-01
1579 OTHER New Technology - Level 42 58 17 — — $30,555.19 $47,280.14 $32,484.99 2024-10-01
1593 OTHER New Technology - Level 42 58 17 — — $30,555.19 $47,280.14 $32,484.99 2024-10-01
901 MS_DRG Wound Debridements For Injuries With Mcc 102 22 — — $2,253.12 $107,011.48 $32,153.80 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 102 22 — — $2,253.12 $106,112.00 $31,979.50 2024-10-01
J1412 HCPCS Injection, Valoctocogene Roxaparvovec-rvox, Per Ml, Containing Nominal 2 X 10°13… 10 2 — — $13,593.76 $31,820.70 $31,820.70 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 12 3 — — $2,253.12 $38,111.66 $31,271.39 2024-10-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 82 21 — — $1,854.72 $104,511.44 $31,119.54 2024-10-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 102 22 — — $2,253.12 $101,216.70 $31,068.16 2024-10-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 102 22 — — $2,253.12 $103,030.74 $30,997.59 2024-10-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 102 22 — — $2,253.12 $102,880.98 $30,954.08 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 102 22 — — $2,253.12 $100,494.46 $30,854.27 2024-10-01
140 MS_DRG Major Head And Neck Procedures With Mcc 102 22 — — $2,253.12 $102,151.49 $30,742.21 2024-10-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 102 22 — — $2,253.12 $101,209.45 $30,468.59 2024-10-01
793 MS_DRG Full Term Neonate With Major Problems 76 19 — — $1,854.72 $52,416.10 $30,332.48 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 102 22 — — $2,253.12 $99,320.53 $30,213.29 2024-10-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 90 20 — — $4,426.19 $98,629.70 $30,010.67 2024-10-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 102 22 — — $2,253.12 $99,264.97 $29,903.82 2024-10-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 102 22 — — $2,253.12 $99,117.63 $29,861.02 2024-10-01
5166 OTHER Cochlear Implant Procedur 58 17 — — $27,893.35 $43,161.29 $29,655.03 2024-10-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 102 22 — — $2,253.12 $98,240.80 $29,606.35 2024-10-01
791 MS_DRG Prematurity With Major Problems 76 19 — — $1,854.72 $51,027.34 $29,557.23 2024-10-01
5232 OTHER Level 2 Icd And Similar P 58 17 — — $27,364.82 $42,343.45 $29,093.12 2024-10-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 102 22 — — $2,253.12 $96,221.44 $29,019.82 2024-10-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 102 22 — — $2,253.12 $80,722.00 $29,000.17 2024-10-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 90 20 — — $4,259.25 $94,909.83 $28,919.63 2024-10-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 102 22 — — $2,253.12 $93,926.72 $28,909.26 2024-10-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 102 22 — — $2,253.12 $94,446.05 $28,783.61 2024-10-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 102 22 — — $2,253.12 $95,322.88 $28,758.83 2024-10-01
L5856 HCPCS Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc… 58 17 — — $27,031.58 $41,827.82 $28,738.84 2024-10-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 102 22 — — $2,253.12 $95,105.48 $28,695.69 2024-10-01
L6880 HCPCS Electric Hand, Switch Or Myoelectric Controlled, Independently Articulating Digi… 58 17 — — $26,904.00 $41,630.40 $28,603.20 2024-10-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 102 21 — — $4,259.47 $49,384.70 $28,359.48 2024-10-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 102 22 — — $2,253.12 $95,211.00 $28,286.20 2024-10-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 102 22 — — $2,253.12 $93,356.66 $28,187.74 2024-10-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 102 22 — — $2,253.12 $93,260.04 $28,159.68 2024-10-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 102 22 — — $2,253.12 $93,020.90 $28,090.22 2024-10-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 102 22 — — $2,253.12 $92,325.24 $27,888.17 2024-10-01
5465 OTHER Level 5 Neurostimulator A 56 17 — — $25,828.63 $39,966.40 $27,867.73 2024-10-01
843 OTHER Pegaspargase Injection 56 17 — — $25,717.00 $39,793.68 $27,747.29 2024-10-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 102 22 — — $2,253.12 $91,107.83 $27,534.57 2024-10-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 102 22 — — $2,253.12 $90,436.32 $27,339.53 2024-10-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 102 22 — — $1,854.72 $88,127.10 $26,668.82 2024-10-01
265 MS_DRG Aicd Lead Procedures 102 22 — — $2,253.12 $86,158.47 $26,608.73 2024-10-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 102 22 — — $2,253.12 $87,535.30 $26,496.93 2024-10-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 102 22 — — $2,253.12 $85,276.81 $26,347.63 2024-10-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 102 22 — — $1,854.72 $86,590.84 $26,222.61 2024-10-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 102 22 — — $2,253.12 $86,586.01 $26,221.20 2024-10-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 102 22 — — $2,253.12 $86,566.69 $26,215.59 2024-10-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 102 22 — — $2,253.12 $85,774.40 $25,985.47 2024-10-01
J9216 HCPCS Injection, Interferon, Gamma 1-b, 3 Million Units 10 2 — — $11,709.97 $25,891.88 $25,891.88 2024-10-01
264 MS_DRG Other Circulatory System O.r. Procedures 102 22 — — $2,253.12 $84,419.31 $25,867.00 2024-10-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 102 22 — — $2,253.12 $85,247.83 $25,832.53 2024-10-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 102 22 — — $2,253.12 $85,032.85 $25,770.09 2024-10-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 106 22 — — $2,253.12 $83,199.48 $25,732.44 2024-10-01
5200 OTHER Implantation Wireless Pa 58 17 — — $24,175.33 $37,408.15 $25,702.20 2024-10-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 102 22 — — $2,253.12 $84,629.46 $25,652.92 2024-10-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 102 22 — — $2,253.12 $84,614.96 $25,648.72 2024-10-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 102 22 — — $2,253.12 $84,569.07 $25,635.38 2024-10-01
252 MS_DRG Other Vascular Procedures With Mcc 102 22 — — $2,253.12 $102,985.00 $25,630.86 2024-10-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 102 22 — — $2,253.12 $82,728.46 $25,592.94 2024-10-01
1578 OTHER New Technology - Level 41 58 17 — — $24,007.74 $37,148.83 $25,524.02 2024-10-01
1592 OTHER New Technology - Level 41 58 17 — — $24,007.74 $37,148.83 $25,524.02 2024-10-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 82 20 — — $2,253.12 $83,870.99 $25,432.63 2024-10-01
332 MS_DRG Rectal Resection With Mcc 102 22 — — $2,253.12 $83,781.62 $25,406.67 2024-10-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 102 22 — — $2,253.12 $83,689.83 $25,380.01 2024-10-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 102 22 — — $2,253.12 $81,933.76 $25,357.60 2024-10-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 102 22 — — $2,253.12 $82,291.25 $25,218.63 2024-10-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 102 22 — — $2,253.12 $83,064.21 $25,198.29 2024-10-01
665 MS_DRG Prostatectomy With Mcc 102 22 — — $2,253.12 $82,933.78 $25,160.41 2024-10-01
64565 CPT HPercutaneous Implantation Of Neurostimulator Electrode Array; Neuromuscular 10 2 — — $9,885.00 $33,111.00 $24,833.00 2024-10-01
G0173 HCPCS Linear Accelerator Based Stereotactic Radiosurgery, Complete Course Of Therapy I… 2 1 — — $24,780.00 $24,780.00 $24,780.00 2024-10-01
G0251 HCPCS Linear Accelerator Based Stereotactic Radiosurgery, Delivery Including Collimato… 2 1 — — $24,780.00 $24,780.00 $24,780.00 2024-10-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 102 22 — — $2,253.12 $81,076.26 $24,620.89 2024-10-01
856 OTHER Porfimer Sodium Injection 56 17 — — $22,676.63 $35,089.11 $24,466.90 2024-10-01
37 MS_DRG Extracranial Procedures With Mcc 102 22 — — $2,253.12 $80,211.51 $24,369.73 2024-10-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 102 22 — — $2,253.12 $78,950.62 $24,238.83 2024-10-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 102 22 — — $2,253.12 $79,752.56 $24,236.42 2024-10-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 102 22 — — $2,253.12 $107,268.00 $24,014.19 2024-10-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 102 22 — — $2,253.12 $78,723.56 $23,937.55 2024-10-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 98 22 — — $2,253.12 $163,450.13 $23,927.73 2024-10-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 102 22 — — $2,253.12 $77,866.06 $23,688.49 2024-10-01
0888T CPT Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 12 2 — — $4,844.00 $23,625.68 $23,625.68 2024-10-01
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 102 22 — — $2,253.12 $77,175.22 $23,487.84 2024-10-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 102 22 — — $1,854.72 $77,039.96 $23,448.55 2024-10-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 102 22 — — $2,253.12 $76,663.14 $23,339.10 2024-10-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 102 22 — — $2,253.12 $90,016.00 $23,312.44 2024-10-01
500 MS_DRG Soft Tissue Procedures With Mcc 102 22 — — $2,253.12 $76,535.12 $23,301.92 2024-10-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 102 22 — — $2,253.12 $74,692.09 $23,213.01 2024-10-01
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc 82 21 — — $2,253.12 $76,817.73 $23,154.74 2024-10-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 102 22 — — $2,253.12 $79,407.00 $22,971.23 2024-10-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 102 22 — — $2,253.12 $75,382.92 $22,967.26 2024-10-01
662 MS_DRG Minor Bladder Procedures With Mcc 102 22 — — $2,253.12 $75,349.11 $22,957.44 2024-10-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 90 20 — — $3,345.01 $74,537.50 $22,944.47 2024-10-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 98 22 — — $2,253.12 $164,294.06 $22,706.27 2024-10-01
L8614 HCPCS Cochlear Device, Includes All Internal And External Components 58 17 — — $21,317.81 $32,986.51 $22,664.20 2024-10-01
652 MS_DRG Kidney Transplant 82 21 — — $2,253.12 $74,184.84 $22,619.28 2024-10-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 102 22 — — $2,253.12 $74,117.20 $22,599.63 2024-10-01
Q0483 HCPCS Monitor/display Module For Use With Electric Ventricular Assist Device, Replacem… 58 17 — — $21,112.71 $32,669.13 $22,446.14 2024-10-01
L5858 HCPCS Addition To Lower Extremity Prosthesis, Endoskeletal Knee Shin System, Microproc… 58 17 — — $20,927.74 $32,382.92 $22,249.49 2024-10-01
570 MS_DRG Skin Debridement With Mcc 102 22 — — $2,253.12 $72,716.21 $22,192.71 2024-10-01
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 102 22 — — $2,253.12 $71,223.43 $22,185.78 2024-10-01
974 MS_DRG HIV With Major Related Condition With Mcc 102 22 — — $1,854.72 $72,126.83 $22,021.52 2024-10-01
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 102 22 — — $2,253.12 $70,402.16 $21,942.56 2024-10-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 102 22 — — $2,253.12 $71,039.85 $21,918.62 2024-10-01
472 MS_DRG Cervical Spinal Fusion With Cc 102 22 — — $2,253.12 $69,561.00 $21,816.66 2024-10-01
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 102 22 — — $2,253.12 $70,841.78 $21,648.29 2024-10-01
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 102 22 — — $2,253.12 $69,170.26 $21,577.74 2024-10-01
668 MS_DRG Transurethral Procedures With Mcc 102 22 — — $2,253.12 $70,438.40 $21,531.12 2024-10-01
800 MS_DRG Splenic Procedures With Cc 102 22 — — $2,253.12 $70,378.01 $21,513.57 2024-10-01
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 102 22 — — $2,253.12 $70,339.36 $21,502.35 2024-10-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 102 22 — — $2,253.12 $68,762.04 $21,250.54 2024-10-01
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 102 22 — — $2,253.12 $69,249.97 $21,185.94 2024-10-01
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 102 22 — — $2,253.12 $67,764.44 $21,161.42 2024-10-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 102 22 — — $2,253.12 $69,131.61 $21,151.57 2024-10-01
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 102 22 — — $2,253.12 $69,034.99 $21,123.50 2024-10-01
5213 OTHER Level 3 Electrophysiologi 58 17 — — $19,755.13 $30,568.46 $21,002.82 2024-10-01
93656 CPT Comprehensive Electrophysiologic Evaluation With Transseptal Catheterizations, I… 30 6 — — $3,723.00 $34,632.00 $20,927.00 2024-10-01
93654 CPT Comprehensive Electrophysiologic Evaluation With Insertion And Repositioning Of … 30 6 — — $3,723.00 $34,632.00 $20,927.00 2024-10-01
93657 CPT Additional Linear Or Focal Intracardiac Catheter Ablation Of The Left Or Right A… 28 5 — — $226.00 $32,631.00 $20,927.00 2024-10-01
93653 CPT Comprehensive Electrophysiologic Evaluation With Insertion And Repositioning Of … 30 6 — — $3,723.00 $34,632.00 $20,927.00 2024-10-01
93655 CPT Intracardiac Catheter Ablation Of A Discrete Mechanism Of Arrhythmia Which Is Di… 28 5 — — $226.00 $32,631.00 $20,927.00 2024-10-01
1577 OTHER New Technology - Level 40 58 17 — — $19,642.78 $30,394.62 $20,883.38 2024-10-01
1591 OTHER New Technology - Level 40 58 17 — — $19,642.78 $30,394.62 $20,883.38 2024-10-01
654 MS_DRG Major Bladder Procedures With Cc 102 22 — — $2,253.12 $68,162.99 $20,870.23 2024-10-01
5231 OTHER Level 1 Icd And Similar P 58 17 — — $19,606.24 $30,338.08 $20,844.53 2024-10-01
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 102 22 — — $2,253.12 $67,832.07 $20,774.12 2024-10-01
L5973 HCPCS Endoskeletal Ankle Foot System, Microprocessor Controlled Feature, Dorsiflexion … 58 17 — — $19,373.26 $29,977.56 $20,596.83 2024-10-01
619 MS_DRG O.r. Procedures For Obesity With Mcc 102 22 — — $2,253.12 $65,856.19 $20,596.30 2024-10-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 102 22 — — $2,253.12 $66,097.74 $20,270.38 2024-10-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 102 22 — — $1,854.72 $65,974.55 $20,234.60 2024-10-01
963 MS_DRG Other Multiple Significant Trauma With Mcc 102 22 — — $1,854.72 $65,619.47 $20,131.45 2024-10-01
263 MS_DRG Vein Ligation And Stripping 102 22 — — $2,253.12 $64,781.29 $20,082.99 2024-10-01
61 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 102 22 — — $1,854.72 $65,295.80 $20,037.45 2024-10-01
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 102 22 — — $2,253.12 $65,083.23 $19,975.71 2024-10-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 102 22 — — $1,854.72 $64,834.44 $19,903.44 2024-10-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 102 22 — — $2,253.12 $63,363.40 $19,858.06 2024-10-01
23472 CPT Arthroplasty, Glenohumeral Joint; Total Shoulder (glenoid And Proximal Humeral R… 48 13 — — $4,013.00 $33,471.00 $19,844.00 2024-10-01
503 MS_DRG Foot Procedures With Mcc 102 22 — — $2,253.12 $63,926.21 $19,832.20 2024-10-01
849 MS_DRG Radiotherapy 102 22 — — $1,854.72 $64,515.59 $19,810.84 2024-10-01
577 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 102 22 — — $2,253.12 $64,315.10 $19,752.61 2024-10-01
970 MS_DRG HIV With Extensive O.r. Procedures Without Mcc 102 22 — — $2,253.12 $64,088.05 $19,686.65 2024-10-01
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc 102 22 — — $2,253.12 $64,005.92 $19,662.81 2024-10-01
5464 OTHER Level 4 Neurostimulator A 56 17 — — $18,195.65 $28,155.38 $19,632.15 2024-10-01
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/mcc 102 22 — — $2,253.12 $63,858.57 $19,620.01 2024-10-01
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 102 22 — — $2,253.12 $83,028.00 $19,579.08 2024-10-01
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