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 STONECREST MEDICAL CENTER

Smyrna, TN · CCN 440227 · Rates published

27,914 distinct procedures filed
34 distinct payers
604,313 rate rows
2024-10-01 last MRF observed · ⚠ 21 mo old
Data quality

545,162 of 604,313 rate rows are consumer-grade (90.2%)

59,151 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 31,021
per-diem day rate — not a per-procedure price 23,213
exceeds 10× this hospital's gross charge — excluded from medians 3,697
template filing: same amount across many unrelated codes — excluded 974
placeholder amount (≤ $0.02) — excluded from medians 246

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 21 months old.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/62-1113737_TRISTAR-STONECREST-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 17 $3,232,152.00 $4,223,835.00 $3,709,629.00 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 17 $3,172,400.00 $4,145,750.00 $3,641,050.00 nat. median
$3,605,000
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 20 $4,511.13 $4,888,418.85 $3,358,709.55 nat. median
$13,041
outlier · 257.5×
748
OTHER 		Inj, Lovotibeglogene Auto 20 $7,441.09 $4,830,420.00 $3,318,860.00 nat. median
$17,963
outlier · 184.8×
746
OTHER 		Inj, Betibeglogene Autote 20 $6,609.17 $4,362,960.00 $2,997,680.00 nat. median
$21,896
outlier · 136.9×
9141
OTHER 		Inj Onase Abepar-xioi Tre 20 $2,101,980.32 $3,511,262.58 $2,436,386.28 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 20 $465,689.75 $777,913.56 $539,776.76 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 20 $463,868.59 $774,871.40 $537,665.86 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 20 $463,397.09 $774,083.77 $537,119.35 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 20 $454,718.97 $759,587.37 $527,060.62 nat. median
$562,201
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 20 $430,721.28 $719,500.32 $499,245.12 nat. median
$532,192
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 20 $405,266.75 $676,979.69 $469,741.01 nat. median
$489,450
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 25 $1,854.72 $910,889.88 $276,131.44 nat. median
$370,174
0.7× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 26 $2,253.12 $680,359.39 $208,672.95 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×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 26 $2,253.12 $573,024.23 $174,294.95 nat. median
$206,474
0.8× median
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×
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 27 $2,253.12 $517,646.48 $159,148.60 nat. median
$202,976
0.8× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $152,908.50 $152,908.50 $152,908.50 nat. median
$263,894
0.6× 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×
1907
OTHER 		New Technology - Level 52 20 $123,322.14 $206,004.04 $142,941.58 nat. median
$153,199
0.9× median
1908
OTHER 		New Technology - Level 52 20 $123,322.14 $206,004.04 $142,941.58 nat. median
$152,962
0.9× median
1906
OTHER 		New Technology - Level 51 20 $111,192.14 $185,741.41 $128,881.79 nat. median
$138,020
0.9× median
1905
OTHER 		New Technology - Level 51 20 $111,192.14 $185,741.41 $128,881.79 nat. median
$137,903
0.9× median
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $126,172.10 $126,172.10 $126,172.10 nat. median
$424,868
outlier · 0.3×
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
1903
OTHER 		New Technology - Level 50 20 $99,062.13 $165,478.78 $114,822.01 nat. median
$119,935
1.0× median
1904
OTHER 		New Technology - Level 50 20 $99,062.13 $165,478.78 $114,822.01 nat. median
$120,174
1.0× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 27 $2,253.12 $341,288.41 $104,447.29 nat. median
$133,161
0.8× median
003
OTHER 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 $102,418.14 $102,418.14 $102,418.14 nat. median
$218,232
outlier · 0.5×
Q0480
HCPCS 		Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 20 $87,999.91 $146,999.85 $101,999.90 nat. median
$111,989
0.9× median
1901
OTHER 		New Technology - Level 49 20 $86,932.13 $145,216.17 $100,762.24 nat. median
$105,693
1.0× median
1902
OTHER 		New Technology - Level 49 20 $86,932.13 $145,216.17 $100,762.24 nat. median
$105,172
1.0× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 26 $1,854.72 $316,452.24 $96,961.34 nat. median
$117,357
0.8× median
7
MS_DRG 		Lung Transplant 26 $2,253.12 $315,655.12 $96,721.08 nat. median
$122,708
0.8× median
K1007
HCPCS 		Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 20 $80,108.07 $133,816.89 $92,852.54 nat. median
$96,983
1.0× median
1585
OTHER 		New Technology - Level 48 20 $76,823.79 $128,330.65 $89,045.76 nat. median
$95,360
0.9× median
1599
OTHER 		New Technology - Level 48 20 $76,823.79 $128,330.65 $89,045.76 nat. median
$95,288
0.9× median
30230G2
OTHER 		Transfusion Of Allogeneic Related Bone Marrow Into Peripheral Vein, Open Approac… 1 $83,298.00 $83,298.00 $83,298.00 nat. median
$212,688
outlier · 0.4×
30230U2
OTHER 		Transfusion Of Allogeneic Related T-cell Depleted Hematopoietic Stem Cells Into… 1 $83,298.00 $83,298.00 $83,298.00 nat. median
$203,400
outlier · 0.4×

Other procedures at this hospital

Browse this hospital's 27,914 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
             
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $152,908.50 $152,908.50 $152,908.50 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $57,628.29 $57,628.29 $57,628.29 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $102,418.14 $102,418.14 $102,418.14 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $72,012.68 $72,012.68 $72,012.68 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $47,370.45 $47,370.45 $47,370.45 2024-10-01
006 OTHER Liver Transplant Without Mcc 1 1 — — $30,907.52 $30,907.52 $30,907.52 2024-10-01
007 OTHER Lung Transplant 1 1 — — $57,733.02 $57,733.02 $57,733.02 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $66,912.16 $66,912.16 $66,912.16 2024-10-01
017 OTHER Autologous Bone Marrow Transplant Without Cc/mcc 1 1 — — $29,072.79 $29,072.79 $29,072.79 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $126,172.10 $126,172.10 $126,172.10 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $37,622.27 $37,622.27 $37,622.27 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $49,154.71 $49,154.71 $49,154.71 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $38,569.94 $38,569.94 $38,569.94 2024-10-01
023 OTHER Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 1 1 — — $26,350.18 $26,350.18 $26,350.18 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 53 26 — — $2,253.12 $680,359.39 $208,672.95 2024-10-01
10 MS_DRG Pancreas Transplant 47 26 — — $2,253.12 $192,578.15 $59,624.33 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 57 27 — — $2,253.12 $130,330.72 $40,862.27 2024-10-01
1142 OTHER Supprelin La Implant 30 20 — — $39,908.18 $66,664.81 $46,257.21 2024-10-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 57 27 — — $2,253.12 $99,117.63 $31,454.30 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 47 26 — — $1,854.72 $316,452.24 $96,961.34 2024-10-01
140 MS_DRG Major Head And Neck Procedures With Mcc 57 27 — — $2,253.12 $102,151.49 $32,368.74 2024-10-01
1579 OTHER New Technology - Level 42 30 20 — — $28,303.76 $47,280.14 $32,806.62 2024-10-01
1580 OTHER New Technology - Level 43 30 20 — — $36,390.43 $60,788.56 $42,179.82 2024-10-01
1581 OTHER New Technology - Level 44 30 20 — — $44,477.10 $74,296.98 $51,553.00 2024-10-01
1582 OTHER New Technology - Level 45 30 20 — — $52,563.77 $87,805.39 $60,926.19 2024-10-01
1583 OTHER New Technology - Level 46 30 20 — — $60,650.44 $101,313.81 $70,299.38 2024-10-01
1584 OTHER New Technology - Level 47 30 20 — — $68,737.12 $114,822.23 $79,672.57 2024-10-01
1585 OTHER New Technology - Level 48 30 20 — — $76,823.79 $128,330.65 $89,045.76 2024-10-01
1593 OTHER New Technology - Level 42 30 20 — — $28,303.76 $47,280.14 $32,806.62 2024-10-01
1594 OTHER New Technology - Level 43 30 20 — — $36,390.43 $60,788.56 $42,179.82 2024-10-01
1595 OTHER New Technology - Level 44 30 20 — — $44,477.10 $74,296.98 $51,553.00 2024-10-01
1596 OTHER New Technology - Level 45 30 20 — — $52,563.77 $87,805.39 $60,926.19 2024-10-01
1597 OTHER New Technology - Level 46 30 20 — — $60,650.44 $101,313.81 $70,299.38 2024-10-01
1598 OTHER New Technology - Level 47 30 20 — — $68,737.12 $114,822.23 $79,672.57 2024-10-01
1599 OTHER New Technology - Level 48 30 20 — — $76,823.79 $128,330.65 $89,045.76 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 47 26 — — $1,854.72 $145,787.50 $45,521.11 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 57 27 — — $2,253.12 $111,327.98 $35,134.63 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 30 20 — — $57,619.39 $96,250.57 $66,786.12 2024-10-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 57 27 — — $2,253.12 $93,020.90 $29,616.68 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 47 26 — — $1,854.72 $145,787.50 $45,521.11 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 46 25 — — $1,854.72 $910,889.88 $276,131.44 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 48 26 — — $2,253.12 $191,469.44 $59,290.15 2024-10-01
1901 OTHER New Technology - Level 49 30 20 — — $86,932.13 $145,216.17 $100,762.24 2024-10-01
1902 OTHER New Technology - Level 49 30 20 — — $86,932.13 $145,216.17 $100,762.24 2024-10-01
1903 OTHER New Technology - Level 50 30 20 — — $99,062.13 $165,478.78 $114,822.01 2024-10-01
1904 OTHER New Technology - Level 50 30 20 — — $99,062.13 $165,478.78 $114,822.01 2024-10-01
1905 OTHER New Technology - Level 51 30 20 — — $111,192.14 $185,741.41 $128,881.79 2024-10-01
1906 OTHER New Technology - Level 51 30 20 — — $111,192.14 $185,741.41 $128,881.79 2024-10-01
1907 OTHER New Technology - Level 52 30 20 — — $123,322.14 $206,004.04 $142,941.58 2024-10-01
1908 OTHER New Technology - Level 52 30 20 — — $123,322.14 $206,004.04 $142,941.58 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 53 26 — — $2,253.12 $524,238.00 $82,611.05 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 57 27 — — $2,253.12 $194,701.38 $60,264.29 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 57 27 — — $1,854.72 $156,227.29 $48,667.78 2024-10-01
207 OTHER Respiratory System Diagnosis With Ventilator Support >96 Hours 1 1 — — $28,025.47 $28,025.47 $28,025.47 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 57 27 — — $2,253.12 $133,511.93 $42,231.13 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 57 27 — — $2,253.12 $263,122.83 $80,887.27 2024-10-01
215 MS_DRG Other Heart Assist System Implant 57 27 — — $2,253.12 $391,771.00 $79,482.78 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $43,955.83 $43,955.83 $43,955.83 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 57 27 — — $2,253.12 $233,105.41 $72,544.00 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $42,548.93 $42,548.93 $42,548.93 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 57 27 — — $2,253.12 $155,978.50 $49,069.19 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $42,312.33 $42,312.33 $42,312.33 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 57 27 — — $2,253.12 $143,700.51 $45,332.18 2024-10-01
218 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $26,811.93 $26,811.93 $26,811.93 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 57 27 — — $2,253.12 $186,887.24 $58,476.76 2024-10-01
219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $32,419.57 $32,419.57 $32,419.57 2024-10-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 57 27 — — $2,253.12 $85,276.81 $27,550.00 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 57 27 — — $2,253.12 $127,932.13 $40,532.83 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 57 27 — — $2,253.12 $110,927.01 $35,357.05 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 57 27 — — $2,253.12 $120,361.95 $38,228.73 2024-10-01
228 OTHER Other Cardiothoracic Procedures With Mcc 1 1 — — $27,228.31 $27,228.31 $27,228.31 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 57 27 — — $2,253.12 $137,797.03 $43,535.37 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 57 27 — — $2,253.12 $204,674.98 $63,890.75 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $38,195.11 $38,195.11 $38,195.11 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 57 27 — — $2,253.12 $190,927.00 $46,502.63 2024-10-01
232 OTHER Coronary Bypass With Ptca Without Mcc 1 1 — — $32,422.53 $32,422.53 $32,422.53 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 57 27 — — $2,253.12 $188,790.65 $58,482.74 2024-10-01
233 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 1 — — $31,932.38 $31,932.38 $31,932.38 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 57 27 — — $2,253.12 $128,502.18 $40,311.12 2024-10-01
234 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 1 1 — — $25,866.80 $25,866.80 $25,866.80 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 57 27 — — $2,253.12 $142,123.19 $44,416.64 2024-10-01
235 OTHER Coronary Bypass Without Cardiac Catheterization With Mcc 1 1 — — $26,206.01 $26,206.01 $26,206.01 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 57 27 — — $2,253.12 $99,320.53 $31,824.44 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 57 27 — — $2,253.12 $121,656.66 $38,247.81 2024-10-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 57 27 — — $2,253.12 $91,822.82 $29,542.38 2024-10-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 57 27 — — $2,253.12 $81,933.76 $26,532.49 2024-10-01
245 MS_DRG Aicd Generator Procedures 57 27 — — $2,253.12 $118,033.41 $37,520.00 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 57 27 — — $2,253.12 $108,021.16 $34,472.61 2024-10-01
252 MS_DRG Other Vascular Procedures With Mcc 57 27 — — $2,253.12 $92,272.00 $26,813.33 2024-10-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 57 27 — — $2,253.12 $82,291.25 $26,641.30 2024-10-01
264 MS_DRG Other Circulatory System O.r. Procedures 57 27 — — $2,253.12 $84,419.31 $27,289.01 2024-10-01
265 MS_DRG Aicd Lead Procedures 57 27 — — $2,253.12 $86,158.47 $27,818.34 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 57 27 — — $2,253.12 $146,346.00 $45,635.82 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 57 27 — — $2,253.12 $113,634.78 $36,181.20 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 57 27 — — $2,253.12 $161,046.22 $50,611.64 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 57 27 — — $2,253.12 $100,494.46 $32,181.73 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 57 27 — — $2,253.12 $123,982.78 $39,330.79 2024-10-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 59 27 — — $2,253.12 $83,199.48 $26,917.73 2024-10-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 57 27 — — $2,253.12 $94,446.05 $30,340.80 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 57 27 — — $2,253.12 $224,238.00 $53,547.27 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 57 27 — — $2,253.12 $149,616.07 $47,132.69 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 57 27 — — $2,253.12 $145,856.00 $35,797.43 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 57 27 — — $2,253.12 $120,845.05 $38,375.76 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 57 27 — — $2,253.12 $146,840.66 $45,838.54 2024-10-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 57 27 — — $2,253.12 $81,076.26 $26,016.43 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 57 27 — — $2,253.12 $517,646.48 $159,148.60 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
31 MS_DRG Ventricular Shunt Procedures With Mcc 57 27 — — $2,253.12 $101,216.70 $32,401.55 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 63 32 — — $19,567.31 $149,422.83 $47,530.90 2024-10-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 57 27 — — $2,253.12 $106,100.84 $33,888.12 2024-10-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 57 27 — — $2,253.12 $102,880.98 $32,588.61 2024-10-01
323 OTHER Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 1 1 — — $27,207.54 $27,207.54 $27,207.54 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 57 27 — — $2,253.12 $122,676.00 $38,555.05 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 57 27 — — $2,253.12 $110,912.51 $35,009.41 2024-10-01
332 MS_DRG Rectal Resection With Mcc 57 27 — — $2,253.12 $83,781.62 $26,831.85 2024-10-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 57 27 — — $2,253.12 $87,535.30 $27,963.26 2024-10-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 57 27 — — $2,253.12 $93,926.72 $30,182.74 2024-10-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 57 27 — — $2,253.12 $103,030.74 $32,633.76 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 57 27 — — $2,253.12 $341,288.41 $104,447.29 2024-10-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 57 27 — — $2,253.12 $91,107.83 $29,040.05 2024-10-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 63 32 — — $12,428.69 $94,909.83 $30,922.03 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 57 27 — — $2,253.12 $131,123.00 $41,101.07 2024-10-01
405 OTHER Pancreas, Liver And Shunt Procedures With Mcc 1 1 — — $29,027.00 $29,027.00 $29,027.00 2024-10-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 57 27 — — $2,253.12 $84,569.07 $27,069.20 2024-10-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 57 27 — — $2,253.12 $84,629.46 $27,087.41 2024-10-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 57 27 — — $2,253.12 $85,247.83 $27,273.79 2024-10-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $35,104.02 $35,104.02 $35,104.02 2024-10-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 57 27 — — $2,253.12 $98,240.80 $31,190.02 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 $80,182.23 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 $54,828.35 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 $42,885.52 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 63 32 — — $21,031.00 $201,452.70 $64,131.54 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 63 32 — — $17,302.80 $132,130.27 $42,622.46 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 $51,871.69 2024-10-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 63 32 — — $12,915.81 $98,629.70 $32,228.03 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 $40,221.15 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
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $47,262.32 $47,262.32 $47,262.32 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
454 OTHER Combined Anterior And Posterior Spinal Fusion With Cc 1 1 — — $25,871.88 $25,871.88 $25,871.88 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
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 57 27 — — $2,253.12 $173,945.04 $63,855.46 2024-10-01
456 OTHER Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 1 — — $25,952.02 $25,952.02 $25,952.02 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 57 27 — — $2,253.12 $117,879.06 $43,787.55 2024-10-01
457 OTHER Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 1 — — $27,428.87 $27,428.87 $27,428.87 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 57 27 — — $2,253.12 $95,072.00 $33,338.20 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
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 7 4 — — $2,253.12 $38,111.66 $30,740.99 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 57 27 — — $2,253.12 $148,231.99 $46,257.91 2024-10-01
461 OTHER Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 1 1 — — $32,091.80 $32,091.80 $32,091.80 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 57 27 — — $2,253.12 $130,453.91 $41,300.37 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 57 27 — — $2,253.12 $123,052.82 $38,668.63 2024-10-01
466 OTHER Revision Of Hip Or Knee Replacement With Mcc 1 1 — — $32,294.06 $32,294.06 $32,294.06 2024-10-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 57 27 — — $2,253.12 $82,728.46 $26,774.37 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 57 27 — — $2,253.12 $99,762.78 $37,303.11 2024-10-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 57 27 — — $2,253.12 $108,320.68 $34,228.20 2024-10-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 57 27 — — $2,253.12 $83,064.21 $26,615.63 2024-10-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 57 27 — — $2,253.12 $85,774.40 $27,432.50 2024-10-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 57 27 — — $2,253.12 $85,032.85 $27,208.99 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 47 26 — — $2,253.12 $257,216.93 $79,107.17 2024-10-01
5166 OTHER Cochlear Implant Procedur 30 20 — — $25,838.05 $43,161.29 $29,948.64 2024-10-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 57 27 — — $2,253.12 $86,566.69 $27,671.30 2024-10-01
5200 OTHER Implantation Wireless Pa 30 20 — — $22,393.99 $37,408.15 $25,956.68 2024-10-01
5232 OTHER Level 2 Icd And Similar P 30 20 — — $25,348.46 $42,343.45 $29,381.17 2024-10-01
5244 OTHER Level 4 Blood Product Exc 30 20 — — $42,104.21 $70,333.16 $48,802.60 2024-10-01
5465 OTHER Level 5 Neurostimulator A 30 20 — — $23,925.47 $39,966.40 $27,731.79 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 57 27 — — $2,253.12 $148,741.66 $46,411.53 2024-10-01
573 OTHER Skin Graft For Skin Ulcer Or Cellulitis With Mcc 1 1 — — $29,266.15 $29,266.15 $29,266.15 2024-10-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 57 27 — — $2,253.12 $83,689.83 $26,804.19 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 57 27 — — $2,253.12 $130,313.81 $40,857.17 2024-10-01
576 OTHER Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc* 1 1 — — $26,747.91 $26,747.91 $26,747.91 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 47 26 — — $2,253.12 $117,125.18 $36,881.98 2024-10-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 57 27 — — $2,253.12 $93,356.66 $29,717.88 2024-10-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 57 27 — — $2,253.12 $90,436.32 $28,837.65 2024-10-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 57 27 — — $2,253.12 $95,322.88 $30,310.52 2024-10-01
64565 CPT HPercutaneous Implantation Of Neurostimulator Electrode Array; Neuromuscular 5 2 — — $9,885.00 $41,714.00 $31,286.00 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 48 26 — — $2,253.12 $111,282.09 $35,120.80 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $65,162.66 $65,162.66 $65,162.66 2024-10-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 48 26 — — $2,253.12 $83,870.99 $26,858.79 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 57 27 — — $2,253.12 $134,644.80 $42,162.58 2024-10-01
665 MS_DRG Prostatectomy With Mcc 57 27 — — $2,253.12 $82,933.78 $26,576.30 2024-10-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 57 27 — — $2,253.12 $101,209.45 $32,084.79 2024-10-01
7 MS_DRG Lung Transplant 47 26 — — $2,253.12 $315,655.12 $96,721.08 2024-10-01
714 OTHER Inj Delandistrogene Mox R 31 20 — — $4,511.13 $4,888,418.85 $3,358,709.55 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 31 20 — — $10,810.76 $93,131.51 $63,988.32 2024-10-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 57 27 — — $2,253.12 $95,105.48 $30,245.00 2024-10-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 57 27 — — $2,253.12 $81,763.58 $30,560.97 2024-10-01
746 OTHER Inj, Betibeglogene Autote 31 20 — — $6,609.17 $4,362,960.00 $2,997,680.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 31 20 — — $7,441.09 $4,830,420.00 $3,318,860.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 27 17 — — $3,172,400.00 $4,145,750.00 $3,641,050.00 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 44 24 — — $1,854.72 $122,110.30 $44,862.22 2024-10-01
791 MS_DRG Prematurity With Major Problems 44 24 — — $1,854.72 $83,394.45 $31,139.05 2024-10-01
793 MS_DRG Full Term Neonate With Major Problems 44 24 — — $1,854.72 $85,664.12 $31,943.55 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 57 27 — — $2,253.12 $114,844.95 $36,194.69 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 47 26 — — $2,253.12 $131,422.52 $41,191.35 2024-10-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 57 27 — — $2,253.12 $86,586.01 $27,677.13 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 55 27 — — $2,253.12 $314,996.79 $43,965.98 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 55 27 — — $2,253.12 $234,521.98 $35,646.46 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 55 27 — — $2,253.12 $241,075.40 $36,345.39 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 57 27 — — $1,854.72 $133,502.27 $41,818.20 2024-10-01
834 OTHER Acute Leukemia With Mcc 1 1 — — $35,924.50 $35,924.50 $35,924.50 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 57 27 — — $1,854.72 $120,939.25 $38,031.58 2024-10-01
843 OTHER Pegaspargase Injection 31 20 — — $8,824.66 $39,793.68 $27,341.24 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 50 24 — — $10,109.00 $222,498.95 $68,642.79 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 57 27 — — $2,253.12 $120,811.23 $37,992.99 2024-10-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 57 27 — — $2,253.12 $108,970.45 $34,424.05 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 57 27 — — $1,854.72 $168,034.26 $52,226.53 2024-10-01
870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 1 1 — — $31,820.43 $31,820.43 $31,820.43 2024-10-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 63 31 — — $10,109.00 $80,709.88 $30,779.39 2024-10-01
901 MS_DRG Wound Debridements For Injuries With Mcc 57 27 — — $2,253.12 $107,011.48 $33,833.59 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
9035 OTHER Axicabtagene Ciloleucel C 30 20 — — $430,721.28 $719,500.32 $499,245.12 2024-10-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 57 27 — — $2,253.12 $93,260.04 $29,688.75 2024-10-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 57 27 — — $2,253.12 $96,221.44 $30,581.35 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 27 17 — — $3,232,152.00 $4,223,835.00 $3,709,629.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 30 20 — — $2,101,980.32 $3,511,262.58 $2,436,386.28 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 30 20 — — $465,689.75 $777,913.56 $539,776.76 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 47 26 — — $2,253.12 $573,024.23 $174,294.95 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 30 20 — — $48,413.40 $80,872.39 $56,115.54 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 47 26 — — $2,253.12 $161,319.17 $50,202.52 2024-10-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 47 26 — — $1,854.72 $104,511.44 $33,080.05 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 30 20 — — $405,266.75 $676,979.69 $469,741.01 2024-10-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 57 27 — — $1,854.72 $88,127.10 $28,141.64 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 30 20 — — $454,718.97 $759,587.37 $527,060.62 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 30 20 — — $463,397.09 $774,083.77 $537,119.35 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 30 20 — — $463,868.59 $774,871.40 $537,665.86 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $53,334.25 $53,334.25 $53,334.25 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 57 27 — — $2,253.12 $164,927.92 $51,793.09 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $37,024.41 $37,024.41 $37,024.41 2024-10-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 57 27 — — $2,253.12 $92,325.24 $29,695.30 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 57 27 — — $2,253.12 $180,285.67 $56,467.47 2024-10-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $36,586.81 $36,586.81 $36,586.81 2024-10-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 57 27 — — $2,253.12 $99,264.97 $31,807.52 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 57 27 — — $2,253.12 $152,753.80 $47,620.83 2024-10-01
969 OTHER HIV With Extensive O.r. Procedures With Mcc 1 1 — — $32,346.63 $32,346.63 $32,346.63 2024-10-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 57 27 — — $1,854.72 $86,590.84 $27,678.59 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 57 27 — — $2,253.12 $114,840.12 $36,193.23 2024-10-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 57 27 — — $2,253.12 $84,614.96 $27,083.04 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
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
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 4 1 — — $123,321.96 $123,321.96 $123,321.96 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
G0173 HCPCS Linear Accelerator Based Stereotactic Radiosurgery, Complete Course Of Therapy I… 1 1 — — $26,882.00 $26,882.00 $26,882.00 2024-10-01
G0251 HCPCS Linear Accelerator Based Stereotactic Radiosurgery, Delivery Including Collimato… 1 1 — — $26,882.00 $26,882.00 $26,882.00 2024-10-01
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
J1412 HCPCS Injection, Valoctocogene Roxaparvovec-rvox, Per Ml, Containing Nominal 2 X 10°13… 5 2 — — $13,593.76 $31,820.70 $31,820.70 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
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 5 2 — — $87,248.40 $192,914.70 $192,914.70 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
J9216 HCPCS Injection, Interferon, Gamma 1-b, 3 Million Units 5 2 — — $11,709.97 $25,891.88 $25,891.88 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
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 6 3 — — $31,521.48 $71,589.38 $71,589.38 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 6 3 — — $26,766.00 $62,320.47 $62,320.47 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 30 20 — — $80,108.07 $133,816.89 $92,852.54 2024-10-01
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 30 20 — — $33,177.32 $55,421.21 $38,455.53 2024-10-01
L5856 HCPCS Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc… 30 20 — — $25,039.78 $41,827.82 $29,023.39 2024-10-01
L6880 HCPCS Electric Hand, Switch Or Myoelectric Controlled, Independently Articulating Digi… 30 20 — — $24,921.60 $41,630.40 $28,886.40 2024-10-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 30 20 — — $33,694.76 $56,285.57 $39,055.29 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 30 20 — — $41,793.84 $69,814.71 $48,442.86 2024-10-01
L8701 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand With S… 30 20 — — $29,463.19 $49,216.92 $34,150.52 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 30 20 — — $57,967.10 $96,831.40 $67,189.14 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 30 20 — — $87,999.91 $146,999.85 $101,999.90 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
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
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
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
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
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
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
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