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

24,049 distinct procedures filed
34 distinct payers
407,431 rate rows
2026-07-30 last MRF observed
Data quality

370,825 of 407,431 rate rows are consumer-grade (91.0%)

36,606 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 437
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 28
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 not_modified · 2026-08-05
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
$3,710,000
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
$3,758,972
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
$3,324,572
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
$3,646,097
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 16 $5,291.16 $4,888,418.85 $3,491,727.75 nat. median
$3,325,455
1.1× median
748
OTHER 		Inj, Lovotibeglogene Auto 16 $8,727.76 $4,830,420.00 $3,450,300.00 nat. median
$3,252,508
1.1× median
746
OTHER 		Inj, Betibeglogene Autote 16 $7,751.98 $4,362,960.00 $3,116,400.00 nat. median
$2,939,969
1.1× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 16 $2,269,183.30 $3,511,262.58 $2,520,584.92 nat. median
$2,588,981
1.0× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 1 $1,387,149.28 $1,387,149.28 $1,387,149.28 nat. median
$691,418
outlier · 2.0×
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 2 $620,118.79 $1,345,370.55 $1,345,370.55 nat. median
$631,793
outlier · 2.1×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 2 $591,090.52 $1,334,154.50 $1,334,154.50 nat. median
$610,161
outlier · 2.2×
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 2 $579,352.98 $1,315,434.06 $1,315,434.06 nat. median
$624,417
outlier · 2.1×
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 2 $549,504.00 $1,296,212.81 $1,296,212.81 nat. median
$588,565
outlier · 2.2×
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 2 $549,504.00 $1,191,016.00 $1,191,016.00 nat. median
$577,541
outlier · 2.1×
9194
OTHER 		Tisagenlecleucel Car-pos 16 $502,733.26 $777,913.56 $558,430.81 nat. median
$576,820
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 16 $500,767.23 $774,871.40 $556,246.97 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 16 $500,258.22 $774,083.77 $555,681.56 nat. median
$560,872
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 16 $490,889.79 $759,587.37 $545,275.22 nat. median
$562,201
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 16 $464,983.20 $719,500.32 $516,498.45 nat. median
$533,230
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 16 $437,503.88 $676,979.69 $485,974.70 nat. median
$492,768
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
$370,165
0.9× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 12 $2,253.12 $680,359.39 $324,575.52 nat. median
$261,939
1.2× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 2 $87,248.40 $192,914.70 $192,914.70 nat. median
$75,807
outlier · 2.5×
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $179,348.40 $179,348.40 $179,348.40 nat. median
$214,447
0.8× 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
$199,832
0.9× 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
$63,643
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
$69,291
outlier · 2.4×
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $147,988.90 $147,988.90 $147,988.90 nat. median
$292,434
0.5× median
Q2043
HCPCS 		Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 3 $65,321.65 $147,108.87 $147,108.87 nat. median
$65,655
outlier · 2.2×
1908
OTHER 		New Technology - Level 52 16 $130,550.14 $202,009.16 $145,013.72 nat. median
$155,877
0.9× median
1907
OTHER 		New Technology - Level 52 16 $130,550.14 $202,009.16 $145,013.72 nat. median
$155,877
0.9× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 12 $2,253.12 $544,086.00 $133,033.43 nat. median
$108,240
1.2× 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
$96,835
1.4× median
1906
OTHER 		New Technology - Level 51 16 $117,709.27 $182,139.61 $130,750.23 nat. median
$140,545
0.9× median
1905
OTHER 		New Technology - Level 51 16 $117,709.27 $182,139.61 $130,750.23 nat. median
$140,545
0.9× median
A9699
HCPCS 		Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 $123,321.96 $123,321.96 $123,321.96 nat. median
$4,125
outlier · 29.9×
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
$163,765
0.7× 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
$132,706
0.9× median
J9226
HCPCS 		Histrelin Implant (supprelin La), 50 Mg 3 $54,500.39 $117,019.36 $117,019.36 nat. median
$55,200
outlier · 2.1×
1904
OTHER 		New Technology - Level 50 16 $104,868.22 $162,269.77 $116,486.51 nat. median
$122,500
1.0× median
1903
OTHER 		New Technology - Level 50 16 $104,868.22 $162,269.77 $116,486.51 nat. median
$122,500
1.0× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 12 $1,854.72 $316,452.24 $115,676.50 nat. median
$114,305
1.0× median
7
MS_DRG 		Lung Transplant 11 $2,253.12 $315,655.12 $115,095.63 nat. median
$122,690
0.9× median
215
MS_DRG 		Other Heart Assist System Implant 12 $2,253.12 $459,401.00 $108,722.31 nat. median
$98,002
1.1× 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
$111,503
0.9× 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
$81,124
1.3× median
1901
OTHER 		New Technology - Level 49 16 $92,027.31 $142,400.15 $102,222.96 nat. median
$107,500
1.0× median
1902
OTHER 		New Technology - Level 49 16 $92,027.31 $142,400.15 $102,222.96 nat. median
$107,500
1.0× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 11 $2,253.12 $257,216.93 $97,114.05 nat. median
$99,646
1.0× median
K1007
HCPCS 		Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 16 $86,480.30 $133,816.89 $96,061.41 nat. median
$97,404
1.0× median

Other procedures at this hospital

Browse this hospital's 24,049 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
             
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
850 MS_DRG Acute Leukemia With Other Procedures 19 8 — — $8,476.00 $222,498.95 $72,810.86 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
245 MS_DRG Aicd Generator Procedures 26 12 — — $2,253.12 $118,033.41 $49,209.15 2024-10-01
265 MS_DRG Aicd Lead Procedures 26 12 — — $2,253.12 $86,158.47 $37,099.67 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 26 12 — — $1,854.72 $316,452.24 $115,676.50 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $78,482.16 $78,482.16 $78,482.16 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
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
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
616 OTHER Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 1 1 — — $26,196.20 $26,196.20 $26,196.20 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 26 12 — — $2,253.12 $161,046.22 $58,600.83 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 26 12 — — $2,253.12 $100,494.46 $43,462.64 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
016 OTHER Autologous Bone Marrow Transplant With Cc/mcc 1 1 — — $26,753.71 $26,753.71 $26,753.71 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
017 OTHER Autologous Bone Marrow Transplant Without Cc/mcc 1 1 — — $34,099.87 $34,099.87 $34,099.87 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 5 2 — — $87,248.40 $192,914.70 $192,914.70 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 20 16 — — $464,983.20 $719,500.32 $516,498.45 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
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 26 12 — — $2,253.12 $86,566.69 $29,508.83 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
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
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
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
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
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
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
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
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 1 1 — — $68,674.05 $68,674.05 $68,674.05 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
9391 OTHER Brexucabtagene Car Pos T 20 16 — — $437,503.88 $676,979.69 $485,974.70 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 26 12 — — $2,253.12 $262,864.00 $73,677.93 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 26 12 — — $2,253.12 $170,944.00 $64,805.50 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 26 12 — — $2,253.12 $170,944.00 $49,289.12 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
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
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 26 12 — — $2,253.12 $233,105.41 $89,301.50 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 26 12 — — $2,253.12 $155,978.50 $66,993.57 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 26 12 — — $2,253.12 $143,700.51 $60,847.27 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
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
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 26 12 — — $2,253.12 $186,887.24 $80,566.49 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 26 12 — — $2,253.12 $127,932.13 $55,071.71 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 26 12 — — $2,253.12 $118,019.00 $48,278.24 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
220 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $26,343.41 $26,343.41 $26,343.41 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
472 MS_DRG Cervical Spinal Fusion With Cc 26 12 — — $2,253.12 $73,002.00 $31,015.15 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 26 12 — — $2,253.12 $99,762.78 $46,154.98 2024-10-01
473 MS_DRG Cervical Spinal Fusion Without Cc/mcc 26 12 — — $2,253.12 $73,002.00 $27,693.98 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
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
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
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 26 12 — — $2,253.12 $84,629.46 $28,659.91 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
9498 OTHER Ciltacabtagene Car-pos T 20 16 — — $500,767.23 $774,871.40 $556,246.97 2024-10-01
5166 OTHER Cochlear Implant Procedur 20 16 — — $27,352.44 $42,324.30 $30,382.80 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
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
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 — — $30,345.47 $30,345.47 $30,345.47 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 — — $55,434.60 $55,434.60 $55,434.60 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
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 26 12 — — $2,253.12 $263,122.83 $88,311.18 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
317 OTHER Concomitant Left Atrial Appendage Closure And Cardiac Ablation 1 1 — — $27,820.00 $27,820.00 $27,820.00 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 26 12 — — $2,253.12 $188,790.65 $63,664.33 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
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 26 12 — — $2,253.12 $128,502.18 $44,436.85 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
231 MS_DRG Coronary Bypass With Ptca With Mcc 26 12 — — $2,253.12 $223,811.00 $86,672.51 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
232 MS_DRG Coronary Bypass With Ptca Without Mcc 26 12 — — $2,253.12 $223,811.00 $62,993.67 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
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 26 12 — — $2,253.12 $142,123.19 $47,964.64 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
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 26 12 — — $2,253.12 $99,320.53 $34,607.60 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
323 OTHER Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 1 1 — — $31,912.09 $31,912.09 $31,912.09 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
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 26 12 — — $2,253.12 $108,021.16 $46,436.19 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $62,556.46 $62,556.46 $62,556.46 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
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
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
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
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
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
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
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
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
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
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 26 12 — — $2,253.12 $178,671.00 $63,994.42 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 26 12 — — $2,253.12 $134,159.00 $50,072.11 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
37 MS_DRG Extracranial Procedures With Mcc 26 12 — — $2,253.12 $80,211.51 $27,308.47 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
793 MS_DRG Full Term Neonate With Major Problems 14 7 — — $1,854.72 $85,664.12 $40,226.18 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 28 12 — — $2,253.12 $680,359.39 $324,575.52 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
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 28 12 — — $2,253.12 $544,086.00 $133,033.43 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
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 26 12 — — $2,253.12 $85,247.83 $27,862.46 2024-10-01
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 26 12 — — $2,253.12 $70,402.16 $26,772.78 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
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
969 OTHER HIV With Extensive O.r. Procedures With Mcc 1 1 — — $37,939.80 $37,939.80 $37,939.80 2024-10-01
64565 CPT HPercutaneous Implantation Of Neurostimulator Electrode Array; Neuromuscular 5 2 — — $9,885.00 $34,755.00 $26,066.00 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 20 16 — — $500,258.22 $774,083.77 $555,681.56 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
5200 OTHER Implantation Wireless Pa 20 16 — — $23,706.53 $36,682.73 $26,332.96 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
714 OTHER Inj Delandistrogene Mox R 21 16 — — $5,291.16 $4,888,418.85 $3,491,727.75 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
773 OTHER Inj, Beqvez, Per Tx Dose 17 13 — — $3,424,750.00 $4,353,037.50 $3,785,250.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 21 16 — — $7,751.98 $4,362,960.00 $3,116,400.00 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 17 13 — — $3,489,255.00 $4,435,026.75 $3,856,545.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 21 16 — — $8,727.76 $4,830,420.00 $3,450,300.00 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
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
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
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
717 OTHER Instill Adstiladrin, Tx D 21 16 — — $12,680.09 $93,131.51 $66,522.51 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
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
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
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
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
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 6 3 — — $72,000.00 $168,273.22 $168,273.22 2024-10-01
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 26 12 — — $2,253.12 $83,028.00 $26,406.70 2024-10-01
652 MS_DRG Kidney Transplant 23 12 — — $2,253.12 $74,184.84 $30,260.32 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
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $76,430.16 $76,430.16 $76,430.16 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
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
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 26 12 — — $2,253.12 $77,866.06 $26,564.06 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
5244 OTHER Level 4 Blood Product Exc 20 16 — — $44,571.98 $68,969.27 $49,510.08 2024-10-01
5465 OTHER Level 5 Neurostimulator A 20 16 — — $25,327.76 $39,191.38 $28,133.81 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
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
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
9413 OTHER Lisocabtagene Car Pos T 20 16 — — $490,889.79 $759,587.37 $545,275.22 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
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 22 11 — — $2,253.12 $257,216.93 $97,114.05 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
6 MS_DRG Liver Transplant Without Mcc 22 11 — — $2,253.12 $117,125.18 $45,384.64 2024-10-01
006 OTHER Liver Transplant Without Mcc 1 1 — — $36,251.84 $36,251.84 $36,251.84 2024-10-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 26 12 — — $2,253.12 $85,032.85 $28,961.61 2024-10-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 26 12 — — $2,253.12 $85,774.40 $28,582.08 2024-10-01
7 MS_DRG Lung Transplant 22 11 — — $2,253.12 $315,655.12 $115,095.63 2024-10-01
007 OTHER Lung Transplant 1 1 — — $67,715.83 $67,715.83 $67,715.83 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
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
653 MS_DRG Major Bladder Procedures With Mcc 26 12 — — $2,253.12 $134,644.80 $44,778.76 2024-10-01
653 OTHER Major Bladder Procedures With Mcc 1 1 — — $29,885.44 $29,885.44 $29,885.44 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
140 MS_DRG Major Head And Neck Procedures With Mcc 26 12 — — $2,253.12 $102,151.49 $33,137.20 2024-10-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 26 12 — — $2,253.12 $78,950.62 $28,466.46 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 26 12 — — $2,253.12 $110,912.51 $37,126.79 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
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
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
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
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
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
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
1578 OTHER New Technology - Level 41 20 16 — — $23,542.19 $36,428.44 $26,150.42 2024-10-01
1592 OTHER New Technology - Level 41 20 16 — — $23,542.19 $36,428.44 $26,150.42 2024-10-01
1593 OTHER New Technology - Level 42 20 16 — — $29,962.67 $46,363.29 $33,282.21 2024-10-01
1579 OTHER New Technology - Level 42 20 16 — — $29,962.67 $46,363.29 $33,282.21 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
1581 OTHER New Technology - Level 44 20 16 — — $47,083.95 $72,856.21 $52,300.35 2024-10-01
1595 OTHER New Technology - Level 44 20 16 — — $47,083.95 $72,856.21 $52,300.35 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
1597 OTHER New Technology - Level 46 20 16 — — $64,205.23 $99,349.14 $71,318.49 2024-10-01
1583 OTHER New Technology - Level 46 20 16 — — $64,205.23 $99,349.14 $71,318.49 2024-10-01
1598 OTHER New Technology - Level 47 20 16 — — $72,765.87 $112,595.61 $80,827.56 2024-10-01
1584 OTHER New Technology - Level 47 20 16 — — $72,765.87 $112,595.61 $80,827.56 2024-10-01
1585 OTHER New Technology - Level 48 20 16 — — $81,326.51 $125,842.07 $90,336.62 2024-10-01
1599 OTHER New Technology - Level 48 20 16 — — $81,326.51 $125,842.07 $90,336.62 2024-10-01
1902 OTHER New Technology - Level 49 20 16 — — $92,027.31 $142,400.15 $102,222.96 2024-10-01
1901 OTHER New Technology - Level 49 20 16 — — $92,027.31 $142,400.15 $102,222.96 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
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
1907 OTHER New Technology - Level 52 20 16 — — $130,550.14 $202,009.16 $145,013.72 2024-10-01
1908 OTHER New Technology - Level 52 20 16 — — $130,550.14 $202,009.16 $145,013.72 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
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
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
228 MS_DRG Other Cardiothoracic Procedures With Mcc 26 12 — — $2,253.12 $120,361.95 $52,357.01 2024-10-01
228 OTHER Other Cardiothoracic Procedures With Mcc 1 1 — — $31,936.46 $31,936.46 $31,936.46 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
264 MS_DRG Other Circulatory System O.r. Procedures 26 12 — — $2,253.12 $84,419.31 $29,765.50 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
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 26 12 — — $2,253.12 $79,752.56 $27,023.28 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
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 26 12 — — $2,253.12 $106,100.84 $45,737.82 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
215 OTHER Other Heart Assist System Implant 1 1 — — $51,556.38 $51,556.38 $51,556.38 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
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 26 12 — — $2,253.12 $98,240.80 $32,507.96 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
271 MS_DRG Other Major Cardiovascular Procedures With Cc 28 12 — — $2,253.12 $83,199.48 $39,691.54 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 26 12 — — $2,253.12 $123,982.78 $49,656.55 2024-10-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 26 12 — — $2,253.12 $74,692.09 $32,671.42 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
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
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
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
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
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 26 12 — — $2,253.12 $93,020.90 $32,267.26 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
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 26 12 — — $2,253.12 $78,723.56 $26,925.07 2024-10-01
253 MS_DRG Other Vascular Procedures With Cc 26 12 — — $2,253.12 $108,078.00 $26,665.88 2024-10-01
252 MS_DRG Other Vascular Procedures With Mcc 26 12 — — $2,253.12 $108,078.00 $35,444.15 2024-10-01
10 MS_DRG Pancreas Transplant 22 11 — — $2,253.12 $192,578.15 $56,585.74 2024-10-01
010 OTHER Pancreas Transplant 1 1 — — $26,573.18 $26,573.18 $26,573.18 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 26 12 — — $2,253.12 $131,123.00 $44,587.07 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
843 OTHER Pegaspargase Injection 21 16 — — $10,350.56 $39,793.68 $28,424.06 2024-10-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 26 12 — — $2,253.12 $94,446.05 $33,674.26 2024-10-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 26 12 — — $2,253.12 $75,382.92 $27,705.60 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
335 MS_DRG Peritoneal Adhesiolysis With Mcc 26 12 — — $2,253.12 $87,535.30 $29,341.82 2024-10-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 26 12 — — $2,253.12 $81,933.76 $35,771.73 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
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
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
791 MS_DRG Prematurity With Major Problems 14 7 — — $1,854.72 $83,394.45 $39,159.67 2024-10-01
665 MS_DRG Prostatectomy With Mcc 26 12 — — $2,253.12 $82,933.78 $26,997.90 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 4 1 — — $123,321.96 $123,321.96 $123,321.96 2024-10-01
332 MS_DRG Rectal Resection With Mcc 26 12 — — $2,253.12 $83,781.62 $29,063.67 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
207 OTHER Respiratory System Diagnosis With Ventilator Support >96 Hours 1 1 — — $32,871.45 $32,871.45 $32,871.45 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
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
466 OTHER Revision Of Hip Or Knee Replacement With Mcc 1 1 — — $37,878.13 $37,878.13 $37,878.13 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
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
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
870 OTHER Septicemia Or Severe Sepsis With Mv >96 Hours 1 1 — — $37,322.61 $37,322.61 $37,322.61 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
008 OTHER Simultaneous Pancreas And Kidney Transplant 1 1 — — $29,046.93 $29,046.93 $29,046.93 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
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $44,127.66 $44,127.66 $44,127.66 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
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
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
9273 OTHER Sipuleucel-t Auto Cd54+ 20 16 — — $52,264.47 $80,872.39 $58,054.82 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
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
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
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 26 12 — — $2,253.12 $83,689.83 $28,004.46 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 26 12 — — $2,253.12 $148,741.66 $50,465.66 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
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
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 26 12 — — $2,253.12 $93,260.04 $29,413.76 2024-10-01
500 MS_DRG Soft Tissue Procedures With Mcc 26 12 — — $2,253.12 $76,535.12 $26,148.94 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
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 26 12 — — $2,253.12 $173,945.04 $84,912.46 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 26 12 — — $2,253.12 $117,879.06 $67,349.27 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 26 12 — — $2,253.12 $111,362.00 $50,736.67 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
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
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 7 4 — — $2,253.12 $38,111.66 $30,740.99 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
28 MS_DRG Spinal Procedures With Mcc 26 12 — — $2,253.12 $146,840.66 $49,347.85 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 26 12 — — $2,253.12 $114,844.95 $39,610.20 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 26 12 — — $2,253.12 $122,676.00 $41,414.17 2024-10-01
1142 OTHER Supprelin La Implant 20 16 — — $43,082.70 $66,664.81 $47,855.81 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 20 16 — — $502,733.26 $777,913.56 $558,430.81 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
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
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
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
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
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
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
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
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
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
31 MS_DRG Ventricular Shunt Procedures With Mcc 26 12 — — $2,253.12 $101,216.70 $42,176.63 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
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
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
901 MS_DRG Wound Debridements For Injuries With Mcc 26 12 — — $2,253.12 $107,011.48 $35,694.75 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
1643 OTHER Y90 Ibritumomab, Rx 20 16 — — $62,202.75 $96,250.57 $69,094.16 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
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