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 Ashland City Medical Center

Ashland City, TN · CCN 441311 · Rates published

24,045 distinct procedures filed
34 distinct payers
407,431 rate rows
2026-07-30 last MRF observed
Data quality

370,820 of 407,431 rate rows are consumer-grade (91.0%)

36,611 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
per-diem day rate — not a per-procedure price 20,621
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 10,058
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 2,566
exceeds 10× this hospital's gross charge — excluded from medians 2,491
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 436
placeholder amount (≤ $0.02) — excluded from medians 215
template filing: same amount across many unrelated codes — excluded 119
percent-of-charges filed in the dollar field — excluded from medians 71
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 34
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.hcadam.com/api/public/content/90c028b4b2ff4b1abf268237de5f50dd?download=true
Found on page https://www.tristarhealth.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-09-21
Content fingerprint daf9263664873e2f… · 247,637,474 bytes · first seen 2026-05-09

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
$3,685,267
1.1× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 13 $3,489,255.00 $4,435,026.75 $3,856,545.00 nat. median
$3,765,001
1.0× 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
773
OTHER 		Inj, Beqvez, Per Tx Dose 13 $3,424,750.00 $4,353,037.50 $3,785,250.00 nat. median
$3,677,100
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 16 $5,291.16 $4,888,418.85 $3,491,727.75 nat. median
$3,391,964
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 16 $8,727.76 $4,830,420.00 $3,450,300.00 nat. median
$3,351,720
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 16 $7,751.98 $4,362,960.00 $3,116,400.00 nat. median
$3,001,835
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 16 $2,269,183.30 $3,511,262.58 $2,520,584.92 nat. median
$2,508,045
1.0× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 1 $1,387,149.28 $1,387,149.28 $1,387,149.28 nat. median
$621,313
outlier · 2.2×
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
$599,737
outlier · 2.2×
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
$574,037
outlier · 2.3×
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
$579,571
outlier · 2.3×
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
$562,501
outlier · 2.3×
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
$513,770
outlier · 2.3×
9194
OTHER 		Tisagenlecleucel Car-pos 16 $502,733.26 $777,913.56 $558,430.81 nat. median
$555,653
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 16 $500,767.23 $774,871.40 $556,246.97 nat. median
$553,480
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 16 $500,258.22 $774,083.77 $555,681.56 nat. median
$552,917
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 16 $490,889.79 $759,587.37 $545,275.22 nat. median
$542,562
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 16 $464,983.20 $719,500.32 $516,498.45 nat. median
$513,929
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 16 $437,503.88 $676,979.69 $485,974.70 nat. median
$483,557
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 11 $1,854.72 $910,889.88 $330,755.33 nat. median
$168,055
2.0× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 12 $2,253.12 $680,359.39 $288,748.01 nat. median
$186,516
1.5× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 2 $87,248.40 $192,914.70 $192,914.70 nat. median
$92,809
outlier · 2.1×
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $179,348.40 $179,348.40 $179,348.40 nat. median
$177,883
1.0× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 12 $2,253.12 $517,646.48 $179,175.80 nat. median
$145,435
1.2× 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
$65,477
outlier · 2.7×
J9029
HCPCS 		Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 3 $72,000.00 $168,273.22 $168,273.22 nat. median
$66,211
outlier · 2.5×
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $147,988.90 $147,988.90 $147,988.90 nat. median
$149,977
1.0× 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
$63,499
outlier · 2.3×
1908
OTHER 		New Technology - Level 52 16 $130,550.14 $202,009.16 $145,013.72 nat. median
$149,948
1.0× median
1907
OTHER 		New Technology - Level 52 16 $130,550.14 $202,009.16 $145,013.72 nat. median
$149,948
1.0× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 8 $21,031.00 $253,183.05 $131,732.75 nat. median
$2,736
outlier · 48.1×
1905
OTHER 		New Technology - Level 51 16 $117,709.27 $182,139.61 $130,750.23 nat. median
$135,199
1.0× median
1906
OTHER 		New Technology - Level 51 16 $117,709.27 $182,139.61 $130,750.23 nat. median
$135,199
1.0× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 12 $2,253.12 $544,086.00 $125,446.93 nat. median
$65,418
1.9× median
A9699
HCPCS 		Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 $123,321.96 $123,321.96 $123,321.96 nat. median
$7,098
outlier · 17.4×
003
OTHER 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 $120,127.60 $120,127.60 $120,127.60 nat. median
$119,739
1.0× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 12 $2,253.12 $341,288.41 $117,611.16 nat. median
$97,418
1.2× median
J9226
HCPCS 		Histrelin Implant (supprelin La), 50 Mg 3 $54,500.39 $117,019.36 $117,019.36 nat. median
$57,036
outlier · 2.1×
1903
OTHER 		New Technology - Level 50 16 $104,868.22 $162,269.77 $116,486.51 nat. median
$3,015
outlier · 38.6×
1904
OTHER 		New Technology - Level 50 16 $104,868.22 $162,269.77 $116,486.51 nat. median
$3,015
outlier · 38.6×
14
MS_DRG 		Allogeneic Bone Marrow Transplant 12 $1,854.72 $316,452.24 $115,676.50 nat. median
$72,715
1.6× median
7
MS_DRG 		Lung Transplant 11 $2,253.12 $315,655.12 $115,095.63 nat. median
$70,649
1.6× median
215
MS_DRG 		Other Heart Assist System Implant 12 $2,253.12 $459,401.00 $108,722.31 nat. median
$73,023
1.5× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 9 $21,031.00 $223,811.00 $106,493.69 nat. median
$60,505
1.8× median
Q0480
HCPCS 		Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 16 $94,999.90 $146,999.85 $105,524.89 nat. median
$108,243
1.0× median
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 8 $21,031.00 $201,452.70 $104,817.12 nat. median
$2,596
outlier · 40.4×
1901
OTHER 		New Technology - Level 49 16 $92,027.31 $142,400.15 $102,222.96 nat. median
$3,015
outlier · 33.9×
1902
OTHER 		New Technology - Level 49 16 $92,027.31 $142,400.15 $102,222.96 nat. median
$3,015
outlier · 33.9×
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 9 $21,031.00 $233,105.41 $97,751.78 nat. median
$69,822
1.4× median

Other procedures at this hospital

Browse this hospital's 24,045 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J1411 HCPCS Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 1 1 — — $4,200,000.00 $4,200,000.00 $4,200,000.00 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 17 13 — — $3,489,255.00 $4,435,026.75 $3,856,545.00 2024-10-01
J1413 HCPCS Injection, Delandistrogene Moxeparvovec-rokl, Per Therapeutic Dose 1 1 — — $3,840,000.00 $3,840,000.00 $3,840,000.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 17 13 — — $3,424,750.00 $4,353,037.50 $3,785,250.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 21 16 — — $5,291.16 $4,888,418.85 $3,491,727.75 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 21 16 — — $8,727.76 $4,830,420.00 $3,450,300.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 21 16 — — $7,751.98 $4,362,960.00 $3,116,400.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 20 16 — — $2,269,183.30 $3,511,262.58 $2,520,584.92 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 1 — — $1,387,149.28 $1,387,149.28 $1,387,149.28 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 5 2 — — $620,118.79 $1,345,370.55 $1,345,370.55 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 5 2 — — $591,090.52 $1,334,154.50 $1,334,154.50 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 5 2 — — $579,352.98 $1,315,434.06 $1,315,434.06 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 5 2 — — $549,504.00 $1,296,212.81 $1,296,212.81 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 5 2 — — $549,504.00 $1,191,016.00 $1,191,016.00 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 20 16 — — $502,733.26 $777,913.56 $558,430.81 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 20 16 — — $500,767.23 $774,871.40 $556,246.97 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 20 16 — — $500,258.22 $774,083.77 $555,681.56 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 20 16 — — $490,889.79 $759,587.37 $545,275.22 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 20 16 — — $464,983.20 $719,500.32 $516,498.45 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 20 16 — — $437,503.88 $676,979.69 $485,974.70 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 22 11 — — $1,854.72 $910,889.88 $330,755.33 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 26 12 — — $2,253.12 $680,359.39 $288,748.01 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 5 2 — — $87,248.40 $192,914.70 $192,914.70 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $179,348.40 $179,348.40 $179,348.40 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 25 12 — — $2,253.12 $517,646.48 $179,175.80 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
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 6 3 — — $72,000.00 $168,273.22 $168,273.22 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $147,988.90 $147,988.90 $147,988.90 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
1908 OTHER New Technology - Level 52 20 16 — — $130,550.14 $202,009.16 $145,013.72 2024-10-01
1907 OTHER New Technology - Level 52 20 16 — — $130,550.14 $202,009.16 $145,013.72 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 19 8 — — $21,031.00 $253,183.05 $131,732.75 2024-10-01
1905 OTHER New Technology - Level 51 20 16 — — $117,709.27 $182,139.61 $130,750.23 2024-10-01
1906 OTHER New Technology - Level 51 20 16 — — $117,709.27 $182,139.61 $130,750.23 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 26 12 — — $2,253.12 $544,086.00 $125,446.93 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 4 1 — — $123,321.96 $123,321.96 $123,321.96 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $120,127.60 $120,127.60 $120,127.60 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 26 12 — — $2,253.12 $341,288.41 $117,611.16 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
1904 OTHER New Technology - Level 50 20 16 — — $104,868.22 $162,269.77 $116,486.51 2024-10-01
1903 OTHER New Technology - Level 50 20 16 — — $104,868.22 $162,269.77 $116,486.51 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 26 12 — — $1,854.72 $316,452.24 $115,676.50 2024-10-01
7 MS_DRG Lung Transplant 22 11 — — $2,253.12 $315,655.12 $115,095.63 2024-10-01
215 MS_DRG Other Heart Assist System Implant 26 12 — — $2,253.12 $459,401.00 $108,722.31 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 23 9 — — $21,031.00 $223,811.00 $106,493.69 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 20 16 — — $94,999.90 $146,999.85 $105,524.89 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 19 8 — — $21,031.00 $201,452.70 $104,817.12 2024-10-01
1901 OTHER New Technology - Level 49 20 16 — — $92,027.31 $142,400.15 $102,222.96 2024-10-01
1902 OTHER New Technology - Level 49 20 16 — — $92,027.31 $142,400.15 $102,222.96 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 23 9 — — $21,031.00 $233,105.41 $97,751.78 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 22 11 — — $2,253.12 $257,216.93 $97,114.05 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 20 16 — — $86,480.30 $133,816.89 $96,061.41 2024-10-01
1599 OTHER New Technology - Level 48 20 16 — — $81,326.51 $125,842.07 $90,336.62 2024-10-01
1585 OTHER New Technology - Level 48 20 16 — — $81,326.51 $125,842.07 $90,336.62 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 19 8 — — $20,413.02 $171,469.10 $89,216.46 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 23 9 — — $20,320.43 $262,864.00 $88,811.77 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 26 12 — — $2,253.12 $263,122.83 $88,311.18 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 23 9 — — $24,352.31 $173,945.04 $85,280.00 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $84,464.62 $84,464.62 $84,464.62 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 19 8 — — $19,278.60 $161,939.95 $84,258.39 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 23 9 — — $21,031.00 $186,887.24 $81,076.02 2024-10-01
1584 OTHER New Technology - Level 47 20 16 — — $72,765.87 $112,595.61 $80,827.56 2024-10-01
1598 OTHER New Technology - Level 47 20 16 — — $72,765.87 $112,595.61 $80,827.56 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 23 9 — — $18,568.90 $155,978.50 $78,879.00 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $78,482.16 $78,482.16 $78,482.16 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 23 9 — — $17,811.47 $170,944.00 $77,846.19 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 23 9 — — $17,565.03 $223,811.00 $76,769.11 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $76,430.16 $76,430.16 $76,430.16 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 23 9 — — $17,225.99 $178,671.00 $75,287.35 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 22 11 — — $2,253.12 $191,469.44 $75,003.01 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
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 23 9 — — $17,107.23 $143,700.51 $74,768.29 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
850 MS_DRG Acute Leukemia With Other Procedures 19 8 — — $8,476.00 $222,498.95 $72,810.86 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 23 9 — — $16,503.07 $117,879.06 $72,127.75 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
1583 OTHER New Technology - Level 46 20 16 — — $64,205.23 $99,349.14 $71,318.49 2024-10-01
1597 OTHER New Technology - Level 46 20 16 — — $64,205.23 $99,349.14 $71,318.49 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 20 16 — — $62,578.11 $96,831.40 $69,511.11 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 19 8 — — $15,830.75 $132,978.11 $69,189.35 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 20 16 — — $62,202.75 $96,250.57 $69,094.16 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 26 12 — — $2,253.12 $194,701.38 $68,910.99 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 19 8 — — $15,729.82 $132,130.27 $68,748.22 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
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 23 9 — — $21,031.00 $188,790.65 $67,809.72 2024-10-01
007 OTHER Lung Transplant 1 1 — — $67,715.83 $67,715.83 $67,715.83 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $67,592.98 $67,592.98 $67,592.98 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 23 9 — — $15,230.04 $127,932.13 $66,563.90 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 21 16 — — $12,680.09 $93,131.51 $66,522.51 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 19 8 — — $14,808.48 $124,391.00 $64,721.43 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 23 9 — — $19,172.20 $161,046.22 $64,506.00 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 25 12 — — $1,854.72 $145,787.50 $63,246.00 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 25 12 — — $1,854.72 $145,787.50 $63,246.00 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $62,556.46 $62,556.46 $62,556.46 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 6 3 — — $26,766.00 $62,320.47 $62,320.47 2024-10-01
1596 OTHER New Technology - Level 45 20 16 — — $55,644.59 $86,102.68 $61,809.42 2024-10-01
1582 OTHER New Technology - Level 45 20 16 — — $55,644.59 $86,102.68 $61,809.42 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 19 8 — — $17,788.46 $149,422.83 $60,424.00 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 26 12 — — $2,253.12 $180,285.67 $59,889.49 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 26 12 — — $2,253.12 $137,797.03 $59,421.39 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 23 9 — — $13,527.97 $134,159.00 $59,124.90 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 23 9 — — $13,377.87 $170,944.00 $58,468.85 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 22 9 — — $12,000.00 $148,741.66 $58,344.43 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 20 16 — — $52,264.47 $80,872.39 $58,054.82 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 23 9 — — $13,205.62 $118,019.00 $57,716.03 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $57,654.21 $57,654.21 $57,654.21 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 14 7 — — $1,854.72 $122,110.30 $57,339.96 2024-10-01
10 MS_DRG Pancreas Transplant 22 11 — — $2,253.12 $192,578.15 $56,585.74 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
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $55,561.42 $55,561.42 $55,561.42 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $55,434.60 $55,434.60 $55,434.60 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 23 9 — — $12,415.98 $111,362.00 $54,264.85 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 26 12 — — $2,253.12 $152,753.80 $53,872.30 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 26 12 — — $2,253.12 $164,927.92 $53,459.54 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 26 12 — — $2,253.12 $133,511.93 $53,411.67 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 26 12 — — $2,253.12 $148,231.99 $52,908.83 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 26 12 — — $2,253.12 $120,361.95 $52,357.01 2024-10-01
1595 OTHER New Technology - Level 44 20 16 — — $47,083.95 $72,856.21 $52,300.35 2024-10-01
1581 OTHER New Technology - Level 44 20 16 — — $47,083.95 $72,856.21 $52,300.35 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 22 9 — — $12,000.00 $131,123.00 $51,655.29 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 23 9 — — $14,759.88 $123,982.78 $51,605.00 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $51,556.38 $51,556.38 $51,556.38 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 26 12 — — $1,854.72 $168,034.26 $51,510.56 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
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 19 8 — — $11,741.65 $98,629.70 $51,317.66 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 23 9 — — $16,919.46 $142,123.19 $51,125.94 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 22 9 — — $12,000.00 $134,644.80 $50,795.81 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 20 16 — — $45,118.35 $69,814.71 $50,116.99 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 23 9 — — $13,966.79 $99,762.78 $49,974.00 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $49,906.21 $49,906.21 $49,906.21 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $49,628.70 $49,628.70 $49,628.70 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 26 12 — — $1,854.72 $156,227.29 $49,560.53 2024-10-01
5244 OTHER Level 4 Blood Product Exc 20 16 — — $44,571.98 $68,969.27 $49,510.08 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 26 12 — — $2,253.12 $120,845.05 $49,449.15 2024-10-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 19 8 — — $11,298.81 $94,909.83 $49,382.19 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 22 11 — — $2,253.12 $131,422.52 $49,370.53 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 26 12 — — $2,253.12 $146,840.66 $49,347.85 2024-10-01
245 MS_DRG Aicd Generator Procedures 26 12 — — $2,253.12 $118,033.41 $49,209.15 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 26 12 — — $2,253.12 $130,453.91 $48,418.97 2024-10-01
1142 OTHER Supprelin La Implant 20 16 — — $43,082.70 $66,664.81 $47,855.81 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 22 9 — — $12,000.00 $122,676.00 $47,656.26 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 26 12 — — $2,253.12 $108,021.16 $46,436.19 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 24 12 — — $2,253.12 $314,996.79 $46,019.46 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
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 26 12 — — $2,253.12 $106,100.84 $45,737.82 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 22 11 — — $2,253.12 $117,125.18 $45,384.64 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 23 9 — — $15,297.90 $128,502.18 $45,384.00 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $45,239.21 $45,239.21 $45,239.21 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 26 12 — — $2,253.12 $130,313.81 $45,202.61 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $44,799.56 $44,799.56 $44,799.56 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 16 9 — — $2,253.12 $573,024.23 $44,624.14 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 23 9 — — $11,963.65 $100,494.46 $44,157.00 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $44,127.66 $44,127.66 $44,127.66 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $43,426.42 $43,426.42 $43,426.42 2024-10-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 25 9 — — $9,904.72 $83,199.48 $43,289.22 2024-10-01
252 MS_DRG Other Vascular Procedures With Mcc 23 9 — — $9,863.88 $108,078.00 $43,110.75 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 23 9 — — $8,476.00 $114,844.95 $43,075.29 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 26 12 — — $2,253.12 $130,330.72 $42,991.37 2024-10-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $42,913.16 $42,913.16 $42,913.16 2024-10-01
1594 OTHER New Technology - Level 43 20 16 — — $38,523.31 $59,609.75 $42,791.29 2024-10-01
1580 OTHER New Technology - Level 43 20 16 — — $38,523.31 $59,609.75 $42,791.29 2024-10-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 23 9 — — $9,754.04 $81,933.76 $42,630.66 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 26 12 — — $2,253.12 $123,052.82 $42,220.60 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 22 11 — — $2,253.12 $111,282.09 $42,200.04 2024-10-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 26 12 — — $2,253.12 $101,216.70 $42,176.63 2024-10-01
834 OTHER Acute Leukemia With Mcc 1 1 — — $42,136.32 $42,136.32 $42,136.32 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 26 12 — — $1,854.72 $133,502.27 $41,179.07 2024-10-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $41,173.98 $41,173.98 $41,173.98 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 26 12 — — $2,253.12 $120,811.23 $40,772.20 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 23 9 — — $11,823.89 $99,320.53 $40,702.97 2024-10-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 20 16 — — $36,375.03 $56,285.57 $40,404.99 2024-10-01
793 MS_DRG Full Term Neonate With Major Problems 14 7 — — $1,854.72 $85,664.12 $40,226.18 2024-10-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 26 12 — — $2,253.12 $85,276.81 $40,190.02 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 26 12 — — $2,253.12 $121,656.66 $40,104.01 2024-10-01
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 20 16 — — $35,816.42 $55,421.21 $39,784.51 2024-10-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 26 12 — — $2,253.12 $99,920.00 $39,655.19 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 23 9 — — $8,476.00 $110,912.51 $39,269.06 2024-10-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 23 9 — — $11,243.60 $94,446.05 $39,250.58 2024-10-01
791 MS_DRG Prematurity With Major Problems 14 7 — — $1,854.72 $83,394.45 $39,159.67 2024-10-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 26 12 — — $2,253.12 $93,926.72 $38,852.45 2024-10-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 19 8 — — $8,873.53 $74,537.50 $38,782.33 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 26 12 — — $2,253.12 $114,840.12 $38,706.57 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
232 OTHER Coronary Bypass With Ptca Without Mcc 1 1 — — $38,028.82 $38,028.82 $38,028.82 2024-10-01
219 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $38,025.34 $38,025.34 $38,025.34 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 26 12 — — $2,253.12 $111,327.98 $38,022.10 2024-10-01
969 OTHER HIV With Extensive O.r. Procedures With Mcc 1 1 — — $37,939.80 $37,939.80 $37,939.80 2024-10-01
466 OTHER Revision Of Hip Or Knee Replacement With Mcc 1 1 — — $37,878.13 $37,878.13 $37,878.13 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 24 12 — — $2,253.12 $241,075.40 $37,745.55 2024-10-01
461 OTHER Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 1 1 — — $37,640.90 $37,640.90 $37,640.90 2024-10-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 19 8 — — $10,305.58 $86,566.69 $37,554.64 2024-10-01
233 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 1 — — $37,453.90 $37,453.90 $37,453.90 2024-10-01
870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 1 1 — — $37,322.61 $37,322.61 $37,322.61 2024-10-01
265 MS_DRG Aicd Lead Procedures 26 12 — — $2,253.12 $86,158.47 $37,099.67 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 24 12 — — $2,253.12 $234,521.98 $36,986.77 2024-10-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 26 12 — — $2,253.12 $108,970.45 $36,437.98 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 26 12 — — $1,854.72 $120,939.25 $36,422.68 2024-10-01
472 MS_DRG Cervical Spinal Fusion With Cc 23 9 — — $8,330.61 $73,002.00 $36,409.50 2024-10-01
006 OTHER Liver Transplant Without Mcc 1 1 — — $36,251.84 $36,251.84 $36,251.84 2024-10-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 26 12 — — $2,253.12 $108,320.68 $35,803.90 2024-10-01
901 MS_DRG Wound Debridements For Injuries With Mcc 26 12 — — $2,253.12 $107,011.48 $35,694.75 2024-10-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 23 9 — — $8,891.93 $74,692.09 $35,480.00 2024-10-01
L8701 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand With S… 20 16 — — $31,806.85 $49,216.92 $35,330.71 2024-10-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 23 9 — — $8,476.00 $93,020.90 $35,278.51 2024-10-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 26 12 — — $2,253.12 $103,030.74 $34,837.14 2024-10-01
573 OTHER Skin Graft For Skin Ulcer Or Cellulitis With Mcc 1 1 — — $34,326.65 $34,326.65 $34,326.65 2024-10-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 26 12 — — $2,253.12 $102,880.98 $34,229.43 2024-10-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 21 9 — — $8,476.00 $163,450.13 $34,137.44 2024-10-01
017 OTHER Autologous Bone Marrow Transplant Without Cc/mcc 1 1 — — $34,099.87 $34,099.87 $34,099.87 2024-10-01
405 OTHER Pancreas, Liver And Shunt Procedures With Mcc 1 1 — — $34,046.16 $34,046.16 $34,046.16 2024-10-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 23 9 — — $8,476.00 $98,240.80 $34,001.36 2024-10-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 23 9 — — $9,398.90 $78,950.62 $33,537.75 2024-10-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 26 12 — — $2,253.12 $109,029.00 $33,461.93 2024-10-01
1579 OTHER New Technology - Level 42 20 16 — — $29,962.67 $46,363.29 $33,282.21 2024-10-01
1593 OTHER New Technology - Level 42 20 16 — — $29,962.67 $46,363.29 $33,282.21 2024-10-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 26 12 — — $2,253.12 $99,264.97 $33,238.18 2024-10-01
140 MS_DRG Major Head And Neck Procedures With Mcc 26 12 — — $2,253.12 $102,151.49 $33,137.20 2024-10-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 26 12 — — $2,253.12 $99,117.63 $33,046.41 2024-10-01
207 OTHER Respiratory System Diagnosis With Ventilator Support >96 Hours 1 1 — — $32,871.45 $32,871.45 $32,871.45 2024-10-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 26 12 — — $2,253.12 $94,470.00 $32,838.54 2024-10-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 26 12 — — $2,253.12 $101,209.45 $32,632.50 2024-10-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 26 12 — — $2,253.12 $95,322.88 $32,462.33 2024-10-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 22 11 — — $2,253.12 $83,870.99 $32,450.17 2024-10-01
457 OTHER Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 1 — — $32,171.70 $32,171.70 $32,171.70 2024-10-01
253 MS_DRG Other Vascular Procedures With Cc 23 9 — — $7,341.12 $108,078.00 $32,084.85 2024-10-01
228 OTHER Other Cardiothoracic Procedures With Mcc 1 1 — — $31,936.46 $31,936.46 $31,936.46 2024-10-01
323 OTHER Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 1 1 — — $31,912.09 $31,912.09 $31,912.09 2024-10-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 26 12 — — $2,253.12 $93,356.66 $31,904.74 2024-10-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 18 6 — — $8,476.00 $80,709.88 $31,900.60 2024-10-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 26 12 — — $2,253.12 $95,105.48 $31,895.41 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
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 26 12 — — $2,253.12 $82,728.46 $31,661.00 2024-10-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 26 12 — — $2,253.12 $96,221.44 $31,487.16 2024-10-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 26 12 — — $2,253.12 $81,763.58 $31,465.03 2024-10-01
218 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $31,448.07 $31,448.07 $31,448.07 2024-10-01
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/mcc 23 9 — — $7,194.75 $64,506.00 $31,445.14 2024-10-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 26 12 — — $2,253.12 $83,336.00 $31,408.66 2024-10-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 26 12 — — $2,253.12 $92,325.24 $31,402.32 2024-10-01
576 OTHER Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc* 1 1 — — $31,372.97 $31,372.97 $31,372.97 2024-10-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 23 9 — — $9,354.00 $85,032.85 $31,134.95 2024-10-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 26 12 — — $2,253.12 $91,107.83 $31,087.14 2024-10-01
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 26 12 — — $2,253.12 $71,223.43 $31,084.99 2024-10-01
023 OTHER Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 1 1 — — $30,906.47 $30,906.47 $30,906.47 2024-10-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 26 12 — — $2,253.12 $90,436.32 $30,863.56 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
235 OTHER Coronary Bypass Without Cardiac Catheterization With Mcc 1 1 — — $30,737.38 $30,737.38 $30,737.38 2024-10-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 23 9 — — $8,476.00 $84,629.46 $30,648.09 2024-10-01
456 OTHER Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 1 — — $30,439.47 $30,439.47 $30,439.47 2024-10-01
5166 OTHER Cochlear Implant Procedur 20 16 — — $27,352.44 $42,324.30 $30,382.80 2024-10-01
454 OTHER Combined Anterior And Posterior Spinal Fusion With Cc 1 1 — — $30,345.47 $30,345.47 $30,345.47 2024-10-01
234 OTHER Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 1 1 — — $30,339.51 $30,339.51 $30,339.51 2024-10-01
652 MS_DRG Kidney Transplant 23 12 — — $2,253.12 $74,184.84 $30,260.32 2024-10-01
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 23 9 — — $8,381.22 $70,402.16 $30,157.58 2024-10-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 23 9 — — $10,211.26 $85,774.40 $30,099.50 2024-10-01
L5856 HCPCS Addition To Lower Extremity Prosthesis, Endoskeletal Knee-shin System, Microproc… 20 16 — — $27,031.58 $41,827.82 $30,026.40 2024-10-01
653 OTHER Major Bladder Procedures With Mcc 1 1 — — $29,885.44 $29,885.44 $29,885.44 2024-10-01
L6880 HCPCS Electric Hand, Switch Or Myoelectric Controlled, Independently Articulating Digi… 20 16 — — $26,904.00 $41,630.40 $29,884.68 2024-10-01
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 26 12 — — $2,253.12 $69,170.26 $29,831.63 2024-10-01
5232 OTHER Level 2 Icd And Similar P 20 16 — — $26,834.17 $41,522.34 $29,807.11 2024-10-01
264 MS_DRG Other Circulatory System O.r. Procedures 26 12 — — $2,253.12 $84,419.31 $29,765.50 2024-10-01
473 MS_DRG Cervical Spinal Fusion Without Cc/mcc 23 9 — — $6,807.12 $73,002.00 $29,750.97 2024-10-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 23 9 — — $8,457.14 $71,039.85 $29,701.32 2024-10-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 23 9 — — $8,476.00 $83,689.83 $29,610.03 2024-10-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 26 12 — — $2,253.12 $84,569.07 $29,477.82 2024-10-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 26 12 — — $2,253.12 $93,260.04 $29,413.76 2024-10-01
408 OTHER Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 1 1 — — $29,343.34 $29,343.34 $29,343.34 2024-10-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 26 12 — — $2,253.12 $87,535.30 $29,341.82 2024-10-01
332 MS_DRG Rectal Resection With Mcc 26 12 — — $2,253.12 $83,781.62 $29,063.67 2024-10-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 23 9 — — $8,476.00 $78,723.56 $29,057.09 2024-10-01
008 OTHER Simultaneous Pancreas And Kidney Transplant 1 1 — — $29,046.93 $29,046.93 $29,046.93 2024-10-01
011 OTHER Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 1 1 — — $29,036.49 $29,036.49 $29,036.49 2024-10-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 23 9 — — $8,185.97 $68,762.04 $28,953.98 2024-10-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 23 9 — — $8,476.00 $79,752.56 $28,912.77 2024-10-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 26 12 — — $2,253.12 $82,291.25 $28,750.17 2024-10-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 26 12 — — $2,253.12 $86,586.01 $28,583.35 2024-10-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 23 9 — — $8,974.17 $75,382.92 $28,517.00 2024-10-01
843 OTHER Pegaspargase Injection 21 16 — — $10,350.56 $39,793.68 $28,424.06 2024-10-01
243 MS_DRG Permanent Cardiac Pacemaker Implant With Cc 23 9 — — $6,477.86 $76,820.00 $28,311.93 2024-10-01
500 MS_DRG Soft Tissue Procedures With Mcc 23 9 — — $8,476.00 $76,535.12 $28,192.90 2024-10-01
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 26 12 — — $2,253.12 $67,764.44 $28,133.95 2024-10-01
5465 OTHER Level 5 Neurostimulator A 20 16 — — $25,327.76 $39,191.38 $28,133.81 2024-10-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 26 12 — — $2,253.12 $84,614.96 $28,031.57 2024-10-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 26 12 — — $2,253.12 $85,247.83 $27,862.46 2024-10-01
317 OTHER Concomitant Left Atrial Appendage Closure And Cardiac Ablation 1 1 — — $27,820.00 $27,820.00 $27,820.00 2024-10-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 26 12 — — $2,253.12 $83,064.21 $27,747.47 2024-10-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 26 12 — — $2,253.12 $81,076.26 $27,670.97 2024-10-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 26 12 — — $2,253.12 $63,363.40 $27,651.53 2024-10-01
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 23 9 — — $8,218.46 $69,034.99 $27,401.88 2024-10-01
463 OTHER Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 1 1 — — $27,324.65 $27,324.65 $27,324.65 2024-10-01
37 MS_DRG Extracranial Procedures With Mcc 26 12 — — $2,253.12 $80,211.51 $27,308.47 2024-10-01
503 MS_DRG Foot Procedures With Mcc 23 9 — — $7,610.28 $63,926.21 $27,012.10 2024-10-01
665 MS_DRG Prostatectomy With Mcc 26 12 — — $2,253.12 $82,933.78 $26,997.90 2024-10-01
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 23 9 — — $7,431.13 $83,028.00 $26,973.75 2024-10-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 26 12 — — $1,854.72 $88,127.10 $26,899.92 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
166 OTHER Other Respiratory System O.r. Procedures With Mcc 1 1 — — $26,864.12 $26,864.12 $26,864.12 2024-10-01
826 OTHER Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 1 1 — — $26,830.30 $26,830.30 $26,830.30 2024-10-01
016 OTHER Autologous Bone Marrow Transplant With Cc/mcc 1 1 — — $26,753.71 $26,753.71 $26,753.71 2024-10-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 26 12 — — $1,854.72 $86,590.84 $26,728.12 2024-10-01
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