|
J1411
|
HCPCS
|
Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose
|
3
|
3
|
—
|
—
|
$3,994,116.00
|
$4,200,000.00
|
$4,111,590.00
|
2024-10-01
|
|
J1413
|
HCPCS
|
Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose
|
2
|
2
|
—
|
—
|
$3,651,763.20
|
$3,840,000.00
|
$3,745,881.60
|
2024-10-01
|
|
9138
|
OTHER
|
Inj, Hemgenix, Per Tx Dos
|
28
|
19
|
—
|
—
|
$3,232,152.00
|
$4,223,835.00
|
$3,709,629.00
|
2024-10-01
|
|
773
|
OTHER
|
Inj, Beqvez, Per Tx Dose
|
28
|
19
|
—
|
—
|
$3,172,400.00
|
$4,145,750.00
|
$3,641,050.00
|
2024-10-01
|
|
714
|
OTHER
|
Inj Delandistrogene Mox R
|
33
|
23
|
—
|
—
|
$4,461.14
|
$4,888,418.85
|
$3,358,709.55
|
2024-10-01
|
|
748
|
OTHER
|
Inj, Lovotibeglogene Auto
|
33
|
23
|
—
|
—
|
$7,358.63
|
$4,830,420.00
|
$3,318,860.00
|
2024-10-01
|
|
746
|
OTHER
|
Inj, Betibeglogene Autote
|
33
|
23
|
—
|
—
|
$6,535.93
|
$4,362,960.00
|
$2,997,680.00
|
2024-10-01
|
|
J3399
|
HCPCS
|
Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge…
|
2
|
2
|
—
|
—
|
$2,648,347.96
|
$2,649,861.29
|
$2,649,104.62
|
2024-10-01
|
|
9141
|
OTHER
|
Inj Onase Abepar-xioi Tre
|
31
|
22
|
—
|
—
|
$2,101,980.32
|
$3,511,262.58
|
$2,436,386.28
|
2024-10-01
|
|
Q2042
|
HCPCS
|
Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka…
|
6
|
3
|
—
|
—
|
$629,386.80
|
$1,387,149.28
|
$1,387,149.28
|
2024-10-01
|
|
Q2056
|
HCPCS
|
Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige…
|
7
|
4
|
—
|
—
|
$579,360.22
|
$1,345,370.55
|
$1,345,370.55
|
2024-10-01
|
|
Q2055
|
HCPCS
|
Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (…
|
7
|
4
|
—
|
—
|
$569,385.09
|
$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…
|
7
|
4
|
—
|
—
|
$556,654.68
|
$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…
|
7
|
4
|
—
|
—
|
$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…
|
7
|
4
|
—
|
—
|
$512,890.14
|
$1,191,016.00
|
$1,191,016.00
|
2024-10-01
|
|
9194
|
OTHER
|
Tisagenlecleucel Car-pos
|
31
|
22
|
—
|
—
|
$465,689.75
|
$777,913.56
|
$539,776.76
|
2024-10-01
|
|
9498
|
OTHER
|
Ciltacabtagene Car-pos T
|
31
|
22
|
—
|
—
|
$463,868.59
|
$774,871.40
|
$537,665.87
|
2024-10-01
|
|
9422
|
OTHER
|
Idecabtagene Vicleucel Ca
|
31
|
22
|
—
|
—
|
$463,397.09
|
$774,083.77
|
$537,119.35
|
2024-10-01
|
|
9413
|
OTHER
|
Lisocabtagene Car Pos T
|
31
|
22
|
—
|
—
|
$454,718.97
|
$759,587.37
|
$527,060.62
|
2024-10-01
|
|
9035
|
OTHER
|
Axicabtagene Ciloleucel C
|
31
|
22
|
—
|
—
|
$430,721.28
|
$719,500.32
|
$499,245.12
|
2024-10-01
|
|
9391
|
OTHER
|
Brexucabtagene Car Pos T
|
31
|
22
|
—
|
—
|
$405,266.75
|
$676,979.69
|
$469,741.01
|
2024-10-01
|
|
18
|
MS_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
47
|
28
|
—
|
—
|
$1,854.72
|
$1,249,829.16
|
$265,763.86
|
2024-10-01
|
|
1
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
53
|
28
|
—
|
—
|
$2,253.12
|
$933,519.00
|
$198,818.30
|
2024-10-01
|
|
1614
|
APR_DRG
|
Implantable Heart Assist Systems
|
1
|
1
|
—
|
—
|
$198,774.36
|
$198,774.36
|
$198,774.36
|
2024-10-01
|
|
J7330
|
HCPCS
|
Autologous Cultured Chondrocytes, Implant
|
5
|
2
|
—
|
—
|
$87,248.40
|
$192,914.70
|
$192,914.70
|
2024-10-01
|
|
5834
|
APR_DRG
|
Neonate With Ecmo
|
1
|
1
|
—
|
—
|
$189,844.81
|
$189,844.81
|
$189,844.81
|
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
|
|
94
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
1
|
1
|
—
|
—
|
$171,129.43
|
$171,129.43
|
$171,129.43
|
2024-10-01
|
|
J9029
|
HCPCS
|
Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose
|
7
|
4
|
—
|
—
|
$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
|
50
|
30
|
—
|
—
|
$2,253.12
|
$786,244.76
|
$167,648.32
|
2024-10-01
|
|
001
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
2
|
2
|
—
|
—
|
$151,214.00
|
$182,499.66
|
$166,856.83
|
2024-10-01
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
57
|
30
|
—
|
—
|
$2,253.12
|
$710,261.12
|
$151,566.80
|
2024-10-01
|
|
5833
|
APR_DRG
|
Neonate With Ecmo
|
1
|
1
|
—
|
—
|
$150,334.58
|
$150,334.58
|
$150,334.58
|
2024-10-01
|
|
1613
|
APR_DRG
|
Implantable Heart Assist Systems
|
1
|
1
|
—
|
—
|
$145,563.99
|
$145,563.99
|
$145,563.99
|
2024-10-01
|
|
44
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
1
|
1
|
—
|
—
|
$143,239.86
|
$143,239.86
|
$143,239.86
|
2024-10-01
|
|
6304
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
1
|
1
|
—
|
—
|
$143,117.54
|
$143,117.54
|
$143,117.54
|
2024-10-01
|
|
1908
|
OTHER
|
New Technology - Level 52
|
31
|
22
|
—
|
—
|
$122,380.02
|
$204,430.25
|
$141,849.56
|
2024-10-01
|
|
1907
|
OTHER
|
New Technology - Level 52
|
31
|
22
|
—
|
—
|
$122,380.02
|
$204,430.25
|
$141,849.56
|
2024-10-01
|
|
5884
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
1
|
1
|
—
|
—
|
$140,304.12
|
$140,304.12
|
$140,304.12
|
2024-10-01
|
|
018
|
OTHER
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
2
|
2
|
—
|
—
|
$124,773.83
|
$150,589.11
|
$137,681.47
|
2024-10-01
|
|
1905
|
OTHER
|
New Technology - Level 51
|
31
|
22
|
—
|
—
|
$110,342.76
|
$184,322.57
|
$127,897.29
|
2024-10-01
|
|
1906
|
OTHER
|
New Technology - Level 51
|
31
|
22
|
—
|
—
|
$110,342.76
|
$184,322.57
|
$127,897.29
|
2024-10-01
|
|
A9699
|
HCPCS
|
Radiopharmaceutical, Therapeutic, Not Otherwise Classified
|
4
|
1
|
—
|
—
|
$123,321.96
|
$123,321.96
|
$123,321.96
|
2024-10-01
|
|
1903
|
OTHER
|
New Technology - Level 50
|
31
|
22
|
—
|
—
|
$98,305.42
|
$164,214.73
|
$113,944.91
|
2024-10-01
|
|
1904
|
OTHER
|
New Technology - Level 50
|
31
|
22
|
—
|
—
|
$98,305.42
|
$164,214.73
|
$113,944.91
|
2024-10-01
|
|
24
|
APR_DRG
|
Heart And/or Lung Transplant
|
1
|
1
|
—
|
—
|
$112,842.68
|
$112,842.68
|
$112,842.68
|
2024-10-01
|
|
Q2043
|
HCPCS
|
Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm…
|
8
|
5
|
—
|
—
|
$62,762.43
|
$147,108.87
|
$112,690.95
|
2024-10-01
|
|
003
|
OTHER
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
2
|
2
|
—
|
—
|
$101,283.23
|
$122,238.38
|
$111,760.80
|
2024-10-01
|
|
5832
|
APR_DRG
|
Neonate With Ecmo
|
1
|
1
|
—
|
—
|
$110,885.51
|
$110,885.51
|
$110,885.51
|
2024-10-01
|
|
8414
|
APR_DRG
|
Extensive Third Degree Burns With Skin Graft
|
1
|
1
|
—
|
—
|
$105,014.02
|
$105,014.02
|
$105,014.02
|
2024-10-01
|
|
5914
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
1
|
1
|
—
|
—
|
$102,812.22
|
$102,812.22
|
$102,812.22
|
2024-10-01
|
|
Q0480
|
HCPCS
|
Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only
|
31
|
22
|
—
|
—
|
$87,999.91
|
$146,999.85
|
$101,999.90
|
2024-10-01
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
58
|
30
|
—
|
—
|
$2,253.12
|
$468,280.76
|
$100,352.77
|
2024-10-01
|
|
5883
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
1
|
1
|
—
|
—
|
$100,304.60
|
$100,304.60
|
$100,304.60
|
2024-10-01
|
|
1901
|
OTHER
|
New Technology - Level 49
|
31
|
22
|
—
|
—
|
$86,268.04
|
$144,106.83
|
$99,992.50
|
2024-10-01
|
|
1902
|
OTHER
|
New Technology - Level 49
|
31
|
22
|
—
|
—
|
$86,268.04
|
$144,106.83
|
$99,992.50
|
2024-10-01
|
|
54
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
1
|
1
|
—
|
—
|
$99,326.02
|
$99,326.02
|
$99,326.02
|
2024-10-01
|
|
5882
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
1
|
1
|
—
|
—
|
$98,225.12
|
$98,225.12
|
$98,225.12
|
2024-10-01
|
|
114
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
1
|
1
|
—
|
—
|
$97,919.31
|
$97,919.31
|
$97,919.31
|
2024-10-01
|
|
6094
|
APR_DRG
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
1
|
1
|
—
|
—
|
$97,430.02
|
$97,430.02
|
$97,430.02
|
2024-10-01
|
|
5831
|
APR_DRG
|
Neonate With Ecmo
|
1
|
1
|
—
|
—
|
$95,839.82
|
$95,839.82
|
$95,839.82
|
2024-10-01
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
48
|
29
|
—
|
—
|
$1,854.72
|
$434,203.13
|
$93,140.40
|
2024-10-01
|
|
7
|
MS_DRG
|
Lung Transplant
|
48
|
29
|
—
|
—
|
$2,253.12
|
$433,109.41
|
$92,908.92
|
2024-10-01
|
|
K1007
|
HCPCS
|
Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin…
|
31
|
22
|
—
|
—
|
$80,108.07
|
$133,816.89
|
$92,852.54
|
2024-10-01
|
|
1612
|
APR_DRG
|
Implantable Heart Assist Systems
|
1
|
1
|
—
|
—
|
$91,558.53
|
$91,558.53
|
$91,558.53
|
2024-10-01
|
|
74
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
1
|
1
|
—
|
—
|
$90,396.46
|
$90,396.46
|
$90,396.46
|
2024-10-01
|
|
J9226
|
HCPCS
|
Histrelin Implant (supprelin La), 50 Mg
|
8
|
5
|
—
|
—
|
$50,392.33
|
$117,019.36
|
$89,641.24
|
2024-10-01
|
|
1585
|
OTHER
|
New Technology - Level 48
|
31
|
22
|
—
|
—
|
$76,236.92
|
$127,350.30
|
$88,365.52
|
2024-10-01
|
|
1599
|
OTHER
|
New Technology - Level 48
|
31
|
22
|
—
|
—
|
$76,236.92
|
$127,350.30
|
$88,365.52
|
2024-10-01
|
|
1611
|
APR_DRG
|
Implantable Heart Assist Systems
|
1
|
1
|
—
|
—
|
$86,971.43
|
$86,971.43
|
$86,971.43
|
2024-10-01
|
|
5934
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
1
|
1
|
—
|
—
|
$85,136.59
|
$85,136.59
|
$85,136.59
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
6034
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
1
|
1
|
—
|
—
|
$81,650.39
|
$81,650.39
|
$81,650.39
|
2024-10-01
|
|
64
|
APR_DRG
|
Pancreas Transplant
|
1
|
1
|
—
|
—
|
$81,099.94
|
$81,099.94
|
$81,099.94
|
2024-10-01
|
|
1584
|
OTHER
|
New Technology - Level 47
|
31
|
22
|
—
|
—
|
$68,212.02
|
$113,945.08
|
$79,063.93
|
2024-10-01
|
|
1598
|
OTHER
|
New Technology - Level 47
|
31
|
22
|
—
|
—
|
$68,212.02
|
$113,945.08
|
$79,063.93
|
2024-10-01
|
|
004
|
OTHER
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
2
|
2
|
—
|
—
|
$71,214.65
|
$85,948.72
|
$78,581.68
|
2024-10-01
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
53
|
28
|
—
|
—
|
$2,253.12
|
$676,929.00
|
$78,541.70
|
2024-10-01
|
|
212
|
MS_DRG
|
Concomitant Aortic And Mitral Valve Procedures
|
58
|
30
|
—
|
—
|
$2,253.12
|
$361,030.01
|
$77,653.66
|
2024-10-01
|
|
53
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
1
|
1
|
—
|
—
|
$77,552.58
|
$77,552.58
|
$77,552.58
|
2024-10-01
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
48
|
29
|
—
|
—
|
$2,253.12
|
$352,926.55
|
$75,938.60
|
2024-10-01
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
58
|
30
|
—
|
—
|
$2,253.12
|
$559,326.00
|
$75,927.38
|
2024-10-01
|
|
6303
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
1
|
1
|
—
|
—
|
$75,595.42
|
$75,595.42
|
$75,595.42
|
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
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
51
|
27
|
—
|
—
|
$21,031.00
|
$347,391.67
|
$74,767.16
|
2024-10-01
|
|
13
|
APR_DRG
|
Liver Transplant And/or Intestinal Transplant
|
1
|
1
|
—
|
—
|
$74,555.68
|
$74,555.68
|
$74,555.68
|
2024-10-01
|
|
12
|
APR_DRG
|
Liver Transplant And/or Intestinal Transplant
|
1
|
1
|
—
|
—
|
$74,555.68
|
$74,555.68
|
$74,555.68
|
2024-10-01
|
|
14
|
APR_DRG
|
Liver Transplant And/or Intestinal Transplant
|
1
|
1
|
—
|
—
|
$74,555.68
|
$74,555.68
|
$74,555.68
|
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
|
|
5933
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
1
|
1
|
—
|
—
|
$73,515.93
|
$73,515.93
|
$73,515.93
|
2024-10-01
|
|
014
|
OTHER
|
Allogeneic Bone Marrow Transplant
|
2
|
2
|
—
|
—
|
$66,170.66
|
$79,861.14
|
$73,015.90
|
2024-10-01
|
|
651
|
OTHER
|
Kidney Transplant With Hemodialysis Without Mcc
|
2
|
2
|
—
|
—
|
$64,440.54
|
$77,773.07
|
$71,106.81
|
2024-10-01
|
|
23
|
APR_DRG
|
Heart And/or Lung Transplant
|
1
|
1
|
—
|
—
|
$70,580.19
|
$70,580.19
|
$70,580.19
|
2024-10-01
|
|
1624
|
APR_DRG
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
1
|
1
|
—
|
—
|
$70,335.54
|
$70,335.54
|
$70,335.54
|
2024-10-01
|
|
1583
|
OTHER
|
New Technology - Level 46
|
31
|
22
|
—
|
—
|
$60,187.12
|
$100,539.84
|
$69,762.34
|
2024-10-01
|
|
1597
|
OTHER
|
New Technology - Level 46
|
31
|
22
|
—
|
—
|
$60,187.12
|
$100,539.84
|
$69,762.34
|
2024-10-01
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
59
|
30
|
—
|
—
|
$2,253.12
|
$319,843.21
|
$68,936.67
|
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
|
|
1634
|
APR_DRG
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
1
|
1
|
—
|
—
|
$68,194.90
|
$68,194.90
|
$68,194.90
|
2024-10-01
|
|
1604
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
1
|
1
|
—
|
—
|
$67,705.61
|
$67,705.61
|
$67,705.61
|
2024-10-01
|
|
L8702
|
HCPCS
|
Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge…
|
31
|
22
|
—
|
—
|
$57,967.10
|
$96,831.40
|
$67,189.13
|
2024-10-01
|
|
1643
|
OTHER
|
Y90 Ibritumomab, Rx
|
31
|
22
|
—
|
—
|
$57,619.39
|
$96,250.57
|
$66,786.11
|
2024-10-01
|
|
850
|
MS_DRG
|
Acute Leukemia With Other Procedures
|
51
|
27
|
—
|
—
|
$11,050.00
|
$305,290.12
|
$65,856.58
|
2024-10-01
|
|
5881
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
1
|
1
|
—
|
—
|
$64,647.54
|
$64,647.54
|
$64,647.54
|
2024-10-01
|
|
6314
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
1
|
1
|
—
|
—
|
$64,280.57
|
$64,280.57
|
$64,280.57
|
2024-10-01
|
|
717
|
OTHER
|
Instill Adstiladrin, Tx D
|
33
|
23
|
—
|
—
|
$10,690.96
|
$93,131.51
|
$63,988.32
|
2024-10-01
|
|
6334
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Anomaly
|
1
|
1
|
—
|
—
|
$63,913.60
|
$63,913.60
|
$63,913.60
|
2024-10-01
|
|
007
|
OTHER
|
Lung Transplant
|
2
|
2
|
—
|
—
|
$57,093.24
|
$68,905.63
|
$62,999.43
|
2024-10-01
|
|
002
|
OTHER
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
2
|
2
|
—
|
—
|
$56,989.66
|
$68,780.63
|
$62,885.15
|
2024-10-01
|
|
9504
|
APR_DRG
|
Extensive O.r. Procedure Unrelated To Principal Diagnosis
|
1
|
1
|
—
|
—
|
$62,873.86
|
$62,873.86
|
$62,873.86
|
2024-10-01
|
|
6344
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…
|
1
|
1
|
—
|
—
|
$62,384.57
|
$62,384.57
|
$62,384.57
|
2024-10-01
|
|
J9600
|
HCPCS
|
Injection, Porfimer Sodium, 75 Mg
|
6
|
3
|
—
|
—
|
$26,766.00
|
$62,320.47
|
$62,320.47
|
2024-10-01
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
59
|
30
|
—
|
—
|
$2,253.12
|
$190,941.52
|
$61,241.43
|
2024-10-01
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
59
|
30
|
—
|
—
|
$2,253.12
|
$280,833.90
|
$60,680.52
|
2024-10-01
|
|
1596
|
OTHER
|
New Technology - Level 45
|
31
|
22
|
—
|
—
|
$52,162.23
|
$87,134.63
|
$60,460.77
|
2024-10-01
|
|
1582
|
OTHER
|
New Technology - Level 45
|
31
|
22
|
—
|
—
|
$52,162.23
|
$87,134.63
|
$60,460.77
|
2024-10-01
|
|
6024
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
1
|
1
|
—
|
—
|
$60,243.92
|
$60,243.92
|
$60,243.92
|
2024-10-01
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
51
|
27
|
—
|
—
|
$21,031.00
|
$276,412.62
|
$59,744.79
|
2024-10-01
|
|
43
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
1
|
1
|
—
|
—
|
$58,531.40
|
$58,531.40
|
$58,531.40
|
2024-10-01
|
|
955
|
OTHER
|
Craniotomy For Multiple Significant Trauma
|
2
|
2
|
—
|
—
|
$52,743.22
|
$63,655.61
|
$58,199.42
|
2024-10-01
|
|
9104
|
APR_DRG
|
Craniotomy For Multiple Significant Trauma
|
1
|
1
|
—
|
—
|
$57,980.95
|
$57,980.95
|
$57,980.95
|
2024-10-01
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$267,149.15
|
$57,784.21
|
2024-10-01
|
|
5913
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
1
|
1
|
—
|
—
|
$57,430.50
|
$57,430.50
|
$57,430.50
|
2024-10-01
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
48
|
29
|
—
|
—
|
$2,253.12
|
$264,235.88
|
$57,167.63
|
2024-10-01
|
|
19
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
49
|
29
|
—
|
—
|
$2,253.12
|
$262,714.62
|
$56,845.67
|
2024-10-01
|
|
9273
|
OTHER
|
Sipuleucel-t Auto Cd54+
|
31
|
22
|
—
|
—
|
$48,413.40
|
$80,872.39
|
$56,115.53
|
2024-10-01
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
59
|
30
|
—
|
—
|
$2,253.12
|
$259,039.06
|
$56,067.76
|
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
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
59
|
30
|
—
|
—
|
$2,253.12
|
$256,427.39
|
$55,515.01
|
2024-10-01
|
|
J9266
|
HCPCS
|
Injection, Pegaspargase, Per Single Dose Vial
|
8
|
5
|
—
|
—
|
$30,286.51
|
$71,589.38
|
$54,840.17
|
2024-10-01
|
|
1654
|
APR_DRG
|
Coronary Bypass With Ami Or Complex Principal Diagnosis
|
1
|
1
|
—
|
—
|
$54,494.76
|
$54,494.76
|
$54,494.76
|
2024-10-01
|
|
6023
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
1
|
1
|
—
|
—
|
$54,250.11
|
$54,250.11
|
$54,250.11
|
2024-10-01
|
|
22
|
APR_DRG
|
Heart And/or Lung Transplant
|
1
|
1
|
—
|
—
|
$53,944.30
|
$53,944.30
|
$53,944.30
|
2024-10-01
|
|
21
|
APR_DRG
|
Heart And/or Lung Transplant
|
1
|
1
|
—
|
—
|
$53,944.30
|
$53,944.30
|
$53,944.30
|
2024-10-01
|
|
020
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
2
|
2
|
—
|
—
|
$48,609.99
|
$58,667.23
|
$53,638.61
|
2024-10-01
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$247,369.41
|
$53,597.93
|
2024-10-01
|
|
5932
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
1
|
1
|
—
|
—
|
$53,393.85
|
$53,393.85
|
$53,393.85
|
2024-10-01
|
|
3034
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
1
|
1
|
—
|
—
|
$52,659.92
|
$52,659.92
|
$52,659.92
|
2024-10-01
|
|
8424
|
APR_DRG
|
Burns With Skin Graft Except Extensive Third Degree Burns
|
1
|
1
|
—
|
—
|
$52,537.59
|
$52,537.59
|
$52,537.59
|
2024-10-01
|
|
B0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
3
|
1
|
—
|
—
|
$52,409.09
|
$52,409.09
|
$52,409.09
|
2024-10-01
|
|
B0505
|
OTHER
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
3
|
1
|
—
|
—
|
$51,870.83
|
$51,870.83
|
$51,870.83
|
2024-10-01
|
|
005
|
OTHER
|
Liver Transplant With Mcc Or Intestinal Transplant
|
2
|
2
|
—
|
—
|
$46,845.50
|
$56,537.67
|
$51,691.58
|
2024-10-01
|
|
453
|
OTHER
|
Combined Anterior And Posterior Spinal Fusion With Mcc
|
2
|
2
|
—
|
—
|
$46,738.57
|
$56,408.63
|
$51,573.60
|
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
|
|
7114
|
APR_DRG
|
Post-operative, Post-trauma, Other Device Infections With O.r. Procedure
|
1
|
1
|
—
|
—
|
$51,375.53
|
$51,375.53
|
$51,375.53
|
2024-10-01
|
|
214
|
APR_DRG
|
Open Craniotomy Except Trauma
|
1
|
1
|
—
|
—
|
$51,192.04
|
$51,192.04
|
$51,192.04
|
2024-10-01
|
|
1581
|
OTHER
|
New Technology - Level 44
|
31
|
22
|
—
|
—
|
$44,137.32
|
$73,729.39
|
$51,159.17
|
2024-10-01
|
|
1595
|
OTHER
|
New Technology - Level 44
|
31
|
22
|
—
|
—
|
$44,137.32
|
$73,729.39
|
$51,159.17
|
2024-10-01
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$320,043.00
|
$51,060.82
|
2024-10-01
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
51
|
27
|
—
|
—
|
$21,031.00
|
$235,272.21
|
$51,037.62
|
2024-10-01
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
58
|
30
|
—
|
—
|
$1,854.72
|
$230,559.28
|
$50,040.14
|
2024-10-01
|
|
B0106
|
OTHER
|
Stroke; M > 30.05 & M < 34.25
|
3
|
1
|
—
|
—
|
$49,980.90
|
$49,980.90
|
$49,980.90
|
2024-10-01
|
|
6022
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
1
|
1
|
—
|
—
|
$49,907.66
|
$49,907.66
|
$49,907.66
|
2024-10-01
|
|
73
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
1
|
1
|
—
|
—
|
$49,663.01
|
$49,663.01
|
$49,663.01
|
2024-10-01
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
58
|
30
|
—
|
—
|
$2,253.12
|
$226,297.09
|
$49,138.07
|
2024-10-01
|
|
L7181
|
HCPCS
|
Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi…
|
31
|
22
|
—
|
—
|
$41,793.84
|
$69,814.71
|
$48,442.86
|
2024-10-01
|
|
5244
|
OTHER
|
Level 4 Blood Product Exc
|
31
|
22
|
—
|
—
|
$41,782.56
|
$69,795.86
|
$48,429.78
|
2024-10-01
|
|
84
|
APR_DRG
|
Autologous Bone Marrow Transplant
|
1
|
1
|
—
|
—
|
$48,378.62
|
$48,378.62
|
$48,378.62
|
2024-10-01
|
|
83
|
APR_DRG
|
Autologous Bone Marrow Transplant
|
1
|
1
|
—
|
—
|
$48,378.62
|
$48,378.62
|
$48,378.62
|
2024-10-01
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
51
|
27
|
—
|
—
|
$21,031.00
|
$222,197.30
|
$48,270.37
|
2024-10-01
|
|
113
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
1
|
1
|
—
|
—
|
$48,195.14
|
$48,195.14
|
$48,195.14
|
2024-10-01
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
50
|
30
|
—
|
—
|
$2,253.12
|
$221,345.53
|
$48,090.09
|
2024-10-01
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
59
|
30
|
—
|
—
|
$2,253.12
|
$220,971.01
|
$48,010.83
|
2024-10-01
|
|
215
|
OTHER
|
Other Heart Assist System Implant
|
2
|
2
|
—
|
—
|
$43,468.72
|
$52,462.25
|
$47,965.49
|
2024-10-01
|
|
1304
|
APR_DRG
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
1
|
1
|
—
|
—
|
$47,216.56
|
$47,216.56
|
$47,216.56
|
2024-10-01
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
58
|
30
|
—
|
—
|
$1,854.72
|
$214,358.98
|
$46,611.43
|
2024-10-01
|
|
C0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
3
|
1
|
—
|
—
|
$46,606.88
|
$46,606.88
|
$46,606.88
|
2024-10-01
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
59
|
30
|
—
|
—
|
$2,253.12
|
$214,017.61
|
$46,539.17
|
2024-10-01
|
|
216
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
2
|
2
|
—
|
—
|
$42,077.42
|
$50,783.09
|
$46,430.25
|
2024-10-01
|
|
9124
|
APR_DRG
|
Musculoskeletal And Other Procedures For Multiple Significant Trauma
|
1
|
1
|
—
|
—
|
$46,299.14
|
$46,299.14
|
$46,299.14
|
2024-10-01
|
|
1142
|
OTHER
|
Supprelin La Implant
|
31
|
22
|
—
|
—
|
$39,908.18
|
$66,664.81
|
$46,257.21
|
2024-10-01
|
|
217
|
OTHER
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
2
|
2
|
—
|
—
|
$41,843.44
|
$50,500.71
|
$46,172.07
|
2024-10-01
|
|
1784
|
APR_DRG
|
External Heart Assist Devices
|
1
|
1
|
—
|
—
|
$46,115.65
|
$46,115.65
|
$46,115.65
|
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
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$209,593.02
|
$45,602.73
|
2024-10-01
|
|
B0205
|
OTHER
|
Traumatic Brain Injury; M > 28.75 & M < 40.65
|
3
|
1
|
—
|
—
|
$45,373.86
|
$45,373.86
|
$45,373.86
|
2024-10-01
|
|
D0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
3
|
1
|
—
|
—
|
$45,243.17
|
$45,243.17
|
$45,243.17
|
2024-10-01
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
58
|
30
|
—
|
—
|
$2,253.12
|
$208,125.00
|
$44,910.62
|
2024-10-01
|
|
1303
|
APR_DRG
|
Respiratory System Diagnosis With Ventilator Support > 96 Hours
|
1
|
1
|
—
|
—
|
$44,708.94
|
$44,708.94
|
$44,708.94
|
2024-10-01
|
|
317
|
MS_DRG
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
51
|
27
|
—
|
—
|
$21,031.00
|
$205,022.60
|
$44,635.42
|
2024-10-01
|
|
573
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$204,087.97
|
$44,437.62
|
2024-10-01
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$203,388.65
|
$44,289.60
|
2024-10-01
|
|
42
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
1
|
1
|
—
|
—
|
$44,280.81
|
$44,280.81
|
$44,280.81
|
2024-10-01
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
59
|
30
|
—
|
—
|
$2,253.12
|
$272,490.00
|
$44,090.40
|
2024-10-01
|
|
1664
|
APR_DRG
|
Coronary Bypass Without Ami Or Complex Principal Diagnosis
|
1
|
1
|
—
|
—
|
$44,036.17
|
$44,036.17
|
$44,036.17
|
2024-10-01
|
|
B0105
|
OTHER
|
Stroke; M > 34.25 & M < 38.85
|
3
|
1
|
—
|
—
|
$43,943.09
|
$43,943.09
|
$43,943.09
|
2024-10-01
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$201,479.61
|
$43,885.57
|
2024-10-01
|
|
2204
|
APR_DRG
|
Major Stomach, Esophageal And Duodenal Procedures
|
1
|
1
|
—
|
—
|
$43,669.20
|
$43,669.20
|
$43,669.20
|
2024-10-01
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/mcc
|
48
|
29
|
—
|
—
|
$1,854.72
|
$200,034.58
|
$43,579.73
|
2024-10-01
|
|
17
|
MS_DRG
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
48
|
29
|
—
|
—
|
$1,854.72
|
$200,034.58
|
$43,579.73
|
2024-10-01
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$208,820.00
|
$43,475.44
|
2024-10-01
|
|
C0106
|
OTHER
|
Stroke; M > 30.05 & M < 34.25
|
3
|
1
|
—
|
—
|
$43,346.36
|
$43,346.36
|
$43,346.36
|
2024-10-01
|
|
B1903
|
OTHER
|
Guillian Barre; M < 18.05
|
3
|
1
|
—
|
—
|
$43,188.15
|
$43,188.15
|
$43,188.15
|
2024-10-01
|
|
4404
|
APR_DRG
|
Kidney Transplant
|
1
|
1
|
—
|
—
|
$43,179.91
|
$43,179.91
|
$43,179.91
|
2024-10-01
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
59
|
30
|
—
|
—
|
$2,253.12
|
$197,171.02
|
$42,973.67
|
2024-10-01
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
45
|
26
|
—
|
—
|
$1,854.72
|
$134,041.92
|
$42,944.92
|
2024-10-01
|
|
B0604
|
OTHER
|
Neurological; M < 25.85
|
3
|
1
|
—
|
—
|
$42,827.01
|
$42,827.01
|
$42,827.01
|
2024-10-01
|
|
6074
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
1
|
1
|
—
|
—
|
$42,629.46
|
$42,629.46
|
$42,629.46
|
2024-10-01
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
59
|
30
|
—
|
—
|
$2,253.12
|
$195,006.78
|
$42,515.62
|
2024-10-01
|
|
6114
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
1
|
1
|
—
|
—
|
$42,507.13
|
$42,507.13
|
$42,507.13
|
2024-10-01
|
|
1674
|
APR_DRG
|
Other Cardiothoracic And Thoracic Circulatory Procedures
|
1
|
1
|
—
|
—
|
$42,507.13
|
$42,507.13
|
$42,507.13
|
2024-10-01
|
|
1633
|
APR_DRG
|
Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis
|
1
|
1
|
—
|
—
|
$42,507.13
|
$42,507.13
|
$42,507.13
|
2024-10-01
|
|
3033
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
1
|
1
|
—
|
—
|
$42,384.81
|
$42,384.81
|
$42,384.81
|
2024-10-01
|
|
3032
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
1
|
1
|
—
|
—
|
$42,384.81
|
$42,384.81
|
$42,384.81
|
2024-10-01
|
|
3031
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
1
|
1
|
—
|
—
|
$42,384.81
|
$42,384.81
|
$42,384.81
|
2024-10-01
|
|
63
|
APR_DRG
|
Pancreas Transplant
|
1
|
1
|
—
|
—
|
$42,201.33
|
$42,201.33
|
$42,201.33
|
2024-10-01
|
|
021
|
OTHER
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
2
|
2
|
—
|
—
|
$38,142.53
|
$46,034.09
|
$42,088.31
|
2024-10-01
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
56
|
30
|
—
|
—
|
$2,253.12
|
$314,996.79
|
$42,081.43
|
2024-10-01
|
|
93
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
1
|
1
|
—
|
—
|
$42,079.00
|
$42,079.00
|
$42,079.00
|
2024-10-01
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
59
|
30
|
—
|
—
|
$2,253.12
|
$135,581.00
|
$41,906.78
|
2024-10-01
|
|
6093
|
APR_DRG
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
1
|
1
|
—
|
—
|
$41,895.52
|
$41,895.52
|
$41,895.52
|
2024-10-01
|
|
1580
|
OTHER
|
New Technology - Level 43
|
31
|
22
|
—
|
—
|
$36,112.44
|
$60,324.18
|
$41,857.60
|
2024-10-01
|
|
1594
|
OTHER
|
New Technology - Level 43
|
31
|
22
|
—
|
—
|
$36,112.44
|
$60,324.18
|
$41,857.60
|
2024-10-01
|
|
231
|
OTHER
|
Coronary Bypass With Ptca With Mcc
|
2
|
2
|
—
|
—
|
$37,771.85
|
$45,586.72
|
$41,679.29
|
2024-10-01
|
|
B0405
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5
|
3
|
1
|
—
|
—
|
$41,678.26
|
$41,678.26
|
$41,678.26
|
2024-10-01
|
|
8634
|
APR_DRG
|
Neonatal Aftercare
|
1
|
1
|
—
|
—
|
$41,650.87
|
$41,650.87
|
$41,650.87
|
2024-10-01
|
|
23
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
58
|
30
|
—
|
—
|
$2,253.12
|
$189,070.87
|
$41,461.57
|
2024-10-01
|
|
1603
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
1
|
1
|
—
|
—
|
$41,406.23
|
$41,406.23
|
$41,406.23
|
2024-10-01
|
|
1794
|
APR_DRG
|
Defibrillator Implants
|
1
|
1
|
—
|
—
|
$41,345.07
|
$41,345.07
|
$41,345.07
|
2024-10-01
|
|
4403
|
APR_DRG
|
Kidney Transplant
|
1
|
1
|
—
|
—
|
$41,283.91
|
$41,283.91
|
$41,283.91
|
2024-10-01
|
|
1824
|
APR_DRG
|
Other Peripheral Vascular And Related Procedures
|
1
|
1
|
—
|
—
|
$41,161.58
|
$41,161.58
|
$41,161.58
|
2024-10-01
|
|
A0404
|
OTHER
|
Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5
|
3
|
1
|
—
|
—
|
$41,110.77
|
$41,110.77
|
$41,110.77
|
2024-10-01
|
|
019
|
OTHER
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
2
|
2
|
—
|
—
|
$37,205.35
|
$44,903.01
|
$41,054.18
|
2024-10-01
|
|
304
|
APR_DRG
|
Percutaneous Intracranial And Extracranial Vascular Procedures
|
1
|
1
|
—
|
—
|
$41,039.26
|
$41,039.26
|
$41,039.26
|
2024-10-01
|
|
A5104
|
OTHER
|
Expired, Not Orthopedic, Length Of Stay Is 16 Days
|
3
|
1
|
—
|
—
|
$40,986.95
|
$40,986.95
|
$40,986.95
|
2024-10-01
|
|
72
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
1
|
1
|
—
|
—
|
$40,672.29
|
$40,672.29
|
$40,672.29
|
2024-10-01
|
|
914
|
APR_DRG
|
Other Major Head And Neck Procedures
|
1
|
1
|
—
|
—
|
$40,488.81
|
$40,488.81
|
$40,488.81
|
2024-10-01
|
|
956
|
OTHER
|
Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma
|
2
|
2
|
—
|
—
|
$36,614.11
|
$44,189.44
|
$40,401.78
|
2024-10-01
|
|
C0505
|
OTHER
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
3
|
1
|
—
|
—
|
$40,354.11
|
$40,354.11
|
$40,354.11
|
2024-10-01
|
|
653
|
MS_DRG
|
Major Bladder Procedures With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$184,745.71
|
$40,343.92
|
2024-10-01
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$183,191.30
|
$40,211.09
|
2024-10-01
|
|
B0704
|
OTHER
|
Fracture Of Lower Extremity; M < 28.15
|
3
|
1
|
—
|
—
|
$40,022.21
|
$40,022.21
|
$40,022.21
|
2024-10-01
|
|
834
|
MS_DRG
|
Acute Leukemia With Mcc
|
58
|
30
|
—
|
—
|
$1,854.72
|
$183,178.05
|
$40,012.13
|
2024-10-01
|
|
913
|
APR_DRG
|
Other Major Head And Neck Procedures
|
1
|
1
|
—
|
—
|
$39,999.52
|
$39,999.52
|
$39,999.52
|
2024-10-01
|
|
957
|
OTHER
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
2
|
2
|
—
|
—
|
$36,181.38
|
$43,667.18
|
$39,924.28
|
2024-10-01
|
|
6134
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
1
|
1
|
—
|
—
|
$39,877.19
|
$39,877.19
|
$39,877.19
|
2024-10-01
|
|
428
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
51
|
27
|
—
|
—
|
$19,389.48
|
$182,458.84
|
$39,859.92
|
2024-10-01
|
|
B2102
|
OTHER
|
Burns; M=12-45
|
3
|
1
|
—
|
—
|
$39,855.40
|
$39,855.40
|
$39,855.40
|
2024-10-01
|
|
6033
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
1
|
1
|
—
|
—
|
$39,754.87
|
$39,754.87
|
$39,754.87
|
2024-10-01
|
|
430
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
51
|
27
|
—
|
—
|
$19,265.86
|
$181,295.52
|
$39,613.70
|
2024-10-01
|
|
D0106
|
OTHER
|
Stroke; M > 30.05 & M < 34.25
|
3
|
1
|
—
|
—
|
$39,611.20
|
$39,611.20
|
$39,611.20
|
2024-10-01
|
|
B1004
|
OTHER
|
Amputation, Lower Extremity; M=39-45
|
3
|
1
|
—
|
—
|
$39,571.65
|
$39,571.65
|
$39,571.65
|
2024-10-01
|
|
11
|
APR_DRG
|
Liver Transplant And/or Intestinal Transplant
|
1
|
1
|
—
|
—
|
$39,510.23
|
$39,510.23
|
$39,510.23
|
2024-10-01
|
|
1834
|
APR_DRG
|
Percutaneous Structural Cardiac Procedures
|
1
|
1
|
—
|
—
|
$39,449.07
|
$39,449.07
|
$39,449.07
|
2024-10-01
|
|
8
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant
|
48
|
29
|
—
|
—
|
$2,253.12
|
$180,324.43
|
$39,408.17
|
2024-10-01
|
|
7104
|
APR_DRG
|
Infectious And Parasitic Diseases Including HIV With O.r. Procedure
|
1
|
1
|
—
|
—
|
$39,326.74
|
$39,326.74
|
$39,326.74
|
2024-10-01
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$179,913.46
|
$39,321.19
|
2024-10-01
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective
|
58
|
30
|
—
|
—
|
$2,253.12
|
$178,995.40
|
$39,318.69
|
2024-10-01
|
|
834
|
OTHER
|
Acute Leukemia With Mcc
|
2
|
2
|
—
|
—
|
$35,526.40
|
$42,876.69
|
$39,201.54
|
2024-10-01
|
|
B1504
|
OTHER
|
Pulmonary; M < 29.15
|
3
|
1
|
—
|
—
|
$39,112.49
|
$39,112.49
|
$39,112.49
|
2024-10-01
|
|
11
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$178,826.37
|
$39,091.11
|
2024-10-01
|
|
576
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
58
|
30
|
—
|
—
|
$2,253.12
|
$178,803.17
|
$39,086.21
|
2024-10-01
|
|
L7180
|
HCPCS
|
Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device…
|
31
|
22
|
—
|
—
|
$33,694.76
|
$56,285.57
|
$39,055.29
|
2024-10-01
|
|
6073
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
1
|
1
|
—
|
—
|
$38,959.77
|
$38,959.77
|
$38,959.77
|
2024-10-01
|
|
3124
|
APR_DRG
|
Skin Graft For Musculoskeletal And Connective Tissue Diagnoses
|
1
|
1
|
—
|
—
|
$38,715.13
|
$38,715.13
|
$38,715.13
|
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
|
|
71
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
1
|
1
|
—
|
—
|
$38,653.97
|
$38,653.97
|
$38,653.97
|
2024-10-01
|
|
1833
|
APR_DRG
|
Percutaneous Structural Cardiac Procedures
|
1
|
1
|
—
|
—
|
$38,653.97
|
$38,653.97
|
$38,653.97
|
2024-10-01
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
59
|
30
|
—
|
—
|
$2,253.12
|
$176,317.45
|
$38,560.12
|
2024-10-01
|
|
8413
|
APR_DRG
|
Extensive Third Degree Burns With Skin Graft
|
1
|
1
|
—
|
—
|
$38,531.65
|
$38,531.65
|
$38,531.65
|
2024-10-01
|
|
894
|
APR_DRG
|
Major Cranial Or Facial Bone Procedures
|
1
|
1
|
—
|
—
|
$38,470.48
|
$38,470.48
|
$38,470.48
|
2024-10-01
|
|
893
|
APR_DRG
|
Major Cranial Or Facial Bone Procedures
|
1
|
1
|
—
|
—
|
$38,470.48
|
$38,470.48
|
$38,470.48
|
2024-10-01
|
|
L2006
|
HCPCS
|
Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance…
|
31
|
22
|
—
|
—
|
$33,177.32
|
$55,421.21
|
$38,455.53
|
2024-10-01
|
|
B1704
|
OTHER
|
Major Multiple Trauma,no Brain Or Spinal Cord Inju
|
3
|
1
|
—
|
—
|
$38,422.90
|
$38,422.90
|
$38,422.90
|
2024-10-01
|
|
220
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
59
|
30
|
—
|
—
|
$2,253.12
|
$175,535.27
|
$38,394.57
|
2024-10-01
|
|
423
|
OTHER
|
Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc
|
2
|
2
|
—
|
—
|
$34,715.01
|
$41,897.43
|
$38,306.22
|
2024-10-01
|
|
B2005
|
OTHER
|
Miscellaneous; M=12-32 And A Tm81
|
3
|
1
|
—
|
—
|
$38,197.62
|
$38,197.62
|
$38,197.62
|
2024-10-01
|
|
D0505
|
OTHER
|
Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2
|
3
|
1
|
—
|
—
|
$38,123.68
|
$38,123.68
|
$38,123.68
|
2024-10-01
|
|
C0105
|
OTHER
|
Stroke; M > 34.25 & M < 38.85
|
3
|
1
|
—
|
—
|
$38,109.92
|
$38,109.92
|
$38,109.92
|
2024-10-01
|