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

OGDEN REGIONAL MEDICAL CENTER

Ogden, UT · CCN 460005 · Rates published

Your selected procedure

You selected G0121 (HCPCS)

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

This hospital’s price: $2,327 across 5 payers · range $1,184-$3,746

Source: https://www.hcadam.com/api/public/content/60297fd2cdf147a6bd8450b739878a54?download=true · observed 2024-10-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

25,825 distinct procedures filed
40 distinct payers
778,056 rate rows
2024-10-01 last MRF observed · ⚠ 24 mo old
Data quality

739,282 of 778,056 rate rows are consumer-grade (95.0%)

38,774 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 28,101
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 8,404
per-diem day rate — not a per-procedure price 1,790
template filing: same amount across many unrelated codes — excluded 256
placeholder amount (≤ $0.02) — excluded from medians 93
percent-of-charges filed in the dollar field — excluded from medians 60
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 38
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 17
exceeds 10× this hospital's gross charge — excluded from medians 15

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 24 months old.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://www.hcadam.com/api/public/content/60297fd2cdf147a6bd8450b739878a54?download=true
Found on page https://www.mountainstar.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-09-21
Content fingerprint fd6b7812ba273c54… · 409,278,793 bytes · first seen 2026-05-06

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
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 9 $3,202,768.80 $4,040,190.00 $3,672,900.00 nat. median
$3,765,001
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,672,900.00 $3,672,900.00 $3,672,900.00 nat. median
$3,562,713
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 9 $3,143,560.00 $3,965,500.00 $3,605,000.00 nat. median
$3,677,100
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 1 $3,605,000.00 $3,605,000.00 $3,605,000.00 nat. median
$3,496,850
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 10 $5,274.03 $3,658,000.50 $3,325,455.00 nat. median
$3,391,964
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,325,455.00 $3,325,455.00 $3,325,455.00 nat. median
$3,225,691
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 1 $3,286,000.00 $3,286,000.00 $3,286,000.00 nat. median
$3,187,420
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 10 $8,699.50 $3,614,600.00 $3,286,000.00 nat. median
$3,351,720
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 1 $2,968,000.00 $2,968,000.00 $2,968,000.00 nat. median
$2,878,960
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 10 $7,726.88 $3,264,800.00 $2,968,000.00 nat. median
$3,001,835
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 9 $2,082,871.41 $2,627,475.40 $2,388,614.00 nat. median
$2,508,045
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,388,614.00 $2,388,614.00 $2,388,614.00 nat. median
$2,316,956
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 9 $461,456.21 $582,112.19 $529,192.90 nat. median
$555,653
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $529,192.90 $529,192.90 $529,192.90 nat. median
$513,317
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 9 $459,651.60 $579,835.74 $527,123.40 nat. median
$553,480
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $527,123.40 $527,123.40 $527,123.40 nat. median
$511,310
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 9 $459,184.39 $579,246.36 $526,587.60 nat. median
$552,917
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $526,587.60 $526,587.60 $526,587.60 nat. median
$510,790
1.0× median
Q2042
HCPCS 		$1,809,462.45 1 $518,241.00 $518,241.00 $518,241.00 nat. median
$621,313
0.8× median
9413
OTHER 		Lisocabtagene Car Pos T 9 $450,585.16 $568,398.71 $516,726.10 nat. median
$542,562
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $516,726.10 $516,726.10 $516,726.10 nat. median
$501,224
1.0× median
Q2056
HCPCS 		$1,873,020.00 1 $507,496.00 $507,496.00 $507,496.00 nat. median
$599,737
0.8× median
9035
OTHER 		Axicabtagene Ciloleucel C 9 $426,805.63 $538,401.60 $489,456.00 nat. median
$513,929
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $489,456.00 $489,456.00 $489,456.00 nat. median
$474,772
1.0× median
Q2055
HCPCS 		$1,689,746.00 1 $484,690.00 $484,690.00 $484,690.00 nat. median
$574,037
0.8× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 24 $235,461.70 $1,026,253.41 $478,013.08 nat. median
$168,055
outlier · 2.8×
Q2054
HCPCS 		$1,652,688.40 1 $474,061.00 $474,061.00 $474,061.00 nat. median
$579,571
0.8× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $460,530.40 $460,530.40 $460,530.40 nat. median
$446,714
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 9 $401,582.51 $506,583.44 $460,530.40 nat. median
$483,557
1.0× median
Q2041
HCPCS 		$1,652,840.51 1 $459,381.00 $459,381.00 $459,381.00 nat. median
$562,501
0.8× median
Q2053
HCPCS 		$1,656,861.71 1 $449,440.00 $449,440.00 $449,440.00 nat. median
$513,770
0.9× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 22 $173,187.15 $626,166.29 $301,413.78 nat. median
$186,516
1.6× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 24 $136,258.04 $593,876.96 $280,992.13 nat. median
$145,435
1.9× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 22 $146,105.99 $734,221.59 $263,567.85 nat. median
$131,925
2.0× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 24 $93,947.70 $409,468.50 $181,126.62 nat. median
$97,418
1.9× median
001
OTHER 		$3,392.00 1 $178,767.78 $178,767.78 $178,767.78 nat. median
$177,883
1.0× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 22 $74,645.36 $299,736.06 $158,764.92 nat. median
$65,418
outlier · 2.4×
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 23 $66,146.85 $253,771.53 $152,120.16 nat. median
$69,922
outlier · 2.2×
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 $113,274.48 $183,334.42 $149,286.60 nat. median
$65,477
outlier · 2.3×
018
OTHER 		$3,392.00 1 $147,509.80 $147,509.80 $147,509.80 nat. median
$149,977
1.0× median
7
MS_DRG 		Lung Transplant 23 $78,394.56 $271,575.80 $146,007.29 nat. median
$70,649
outlier · 2.1×
01907
OTHER 		New Technology - Level 52 1 $145,711.20 $145,711.20 $145,711.20 nat. median
$145,788
1.0× median
01908
OTHER 		New Technology - Level 52 1 $145,711.20 $145,711.20 $145,711.20 nat. median
$145,788
1.0× median
1907
OTHER 		New Technology - Level 52 9 $127,060.17 $160,282.32 $145,711.20 nat. median
$149,948
1.0× median
1908
OTHER 		New Technology - Level 52 9 $127,060.17 $160,282.32 $145,711.20 nat. median
$149,948
1.0× median
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 15 $56,633.21 $246,834.30 $139,584.10 nat. median
$2,106
outlier · 66.3×
14
MS_DRG 		Allogeneic Bone Marrow Transplant 23 $73,246.61 $268,857.54 $136,281.23 nat. median
$72,715
1.9× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 25 $62,026.57 $270,341.13 $131,703.96 nat. median
$69,822
1.9× median
01905
OTHER 		New Technology - Level 51 1 $131,379.00 $131,379.00 $131,379.00 nat. median
$131,449
1.0× median
1906
OTHER 		New Technology - Level 51 9 $114,562.49 $144,516.90 $131,379.00 nat. median
$135,199
1.0× median

Other procedures at this hospital

Browse this hospital's 25,825 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
             
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,672,900.00 $3,672,900.00 $3,672,900.00 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 12 9 — — $3,202,768.80 $4,040,190.00 $3,672,900.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 1 1 — — $3,605,000.00 $3,605,000.00 $3,605,000.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 12 9 — — $3,143,560.00 $3,965,500.00 $3,605,000.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 13 10 — — $5,274.03 $3,658,000.50 $3,325,455.00 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 1 1 — — $3,325,455.00 $3,325,455.00 $3,325,455.00 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,286,000.00 $3,286,000.00 $3,286,000.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 13 10 — — $8,699.50 $3,614,600.00 $3,286,000.00 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 1 1 — — $2,968,000.00 $2,968,000.00 $2,968,000.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 13 10 — — $7,726.88 $3,264,800.00 $2,968,000.00 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 1 1 — — $2,388,614.00 $2,388,614.00 $2,388,614.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 12 9 — — $2,082,871.41 $2,627,475.40 $2,388,614.00 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 12 9 — — $461,456.21 $582,112.19 $529,192.90 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $529,192.90 $529,192.90 $529,192.90 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 12 9 — — $459,651.60 $579,835.74 $527,123.40 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $527,123.40 $527,123.40 $527,123.40 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $526,587.60 $526,587.60 $526,587.60 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 12 9 — — $459,184.39 $579,246.36 $526,587.60 2024-10-01
Q2042 HCPCS $1,809,462.45 1 1 — — $518,241.00 $518,241.00 $518,241.00 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 12 9 — — $450,585.16 $568,398.71 $516,726.10 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $516,726.10 $516,726.10 $516,726.10 2024-10-01
Q2056 HCPCS $1,873,020.00 1 1 — — $507,496.00 $507,496.00 $507,496.00 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 12 9 — — $426,805.63 $538,401.60 $489,456.00 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $489,456.00 $489,456.00 $489,456.00 2024-10-01
Q2055 HCPCS $1,689,746.00 1 1 — — $484,690.00 $484,690.00 $484,690.00 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 43 24 — — $235,461.70 $1,026,253.41 $478,013.08 2024-10-01
Q2054 HCPCS $1,652,688.40 1 1 — — $474,061.00 $474,061.00 $474,061.00 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $460,530.40 $460,530.40 $460,530.40 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 12 9 — — $401,582.51 $506,583.44 $460,530.40 2024-10-01
Q2041 HCPCS $1,652,840.51 1 1 — — $459,381.00 $459,381.00 $459,381.00 2024-10-01
Q2053 HCPCS $1,656,861.71 1 1 — — $449,440.00 $449,440.00 $449,440.00 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 36 22 — — $173,187.15 $626,166.29 $301,413.78 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 43 24 — — $136,258.04 $593,876.96 $280,992.13 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 35 22 — — $146,105.99 $734,221.59 $263,567.85 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 43 24 — — $93,947.70 $409,468.50 $181,126.62 2024-10-01
001 OTHER $3,392.00 1 1 — — $178,767.78 $178,767.78 $178,767.78 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 36 22 — — $74,645.36 $299,736.06 $158,764.92 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 40 23 — — $66,146.85 $253,771.53 $152,120.16 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 7 1 — — $113,274.48 $183,334.42 $149,286.60 2024-10-01
018 OTHER $3,392.00 1 1 — — $147,509.80 $147,509.80 $147,509.80 2024-10-01
7 MS_DRG Lung Transplant 40 23 — — $78,394.56 $271,575.80 $146,007.29 2024-10-01
1908 OTHER New Technology - Level 52 12 9 — — $127,060.17 $160,282.32 $145,711.20 2024-10-01
1907 OTHER New Technology - Level 52 12 9 — — $127,060.17 $160,282.32 $145,711.20 2024-10-01
01908 OTHER New Technology - Level 52 1 1 — — $145,711.20 $145,711.20 $145,711.20 2024-10-01
01907 OTHER New Technology - Level 52 1 1 — — $145,711.20 $145,711.20 $145,711.20 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 32 15 — — $56,633.21 $246,834.30 $139,584.10 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 37 23 — — $73,246.61 $268,857.54 $136,281.23 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 44 25 — — $62,026.57 $270,341.13 $131,703.96 2024-10-01
01905 OTHER New Technology - Level 51 1 1 — — $131,379.00 $131,379.00 $131,379.00 2024-10-01
1906 OTHER New Technology - Level 51 12 9 — — $114,562.49 $144,516.90 $131,379.00 2024-10-01
1905 OTHER New Technology - Level 51 12 9 — — $114,562.49 $144,516.90 $131,379.00 2024-10-01
01906 OTHER New Technology - Level 51 1 1 — — $131,379.00 $131,379.00 $131,379.00 2024-10-01
215 MS_DRG Other Heart Assist System Implant 40 24 — — $65,282.79 $284,533.25 $128,240.48 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 20 9 — — $58,932.85 $200,214.13 $126,043.49 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 44 25 — — $54,019.29 $260,296.00 $121,477.89 2024-10-01
003 OTHER $3,392.00 1 1 — — $119,738.65 $119,738.65 $119,738.65 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 20 9 — — $54,565.57 $189,338.46 $117,897.89 2024-10-01
01904 OTHER New Technology - Level 50 1 1 — — $117,046.80 $117,046.80 $117,046.80 2024-10-01
1903 OTHER New Technology - Level 50 12 9 — — $102,064.81 $128,751.48 $117,046.80 2024-10-01
1904 OTHER New Technology - Level 50 12 9 — — $102,064.81 $128,751.48 $117,046.80 2024-10-01
01903 OTHER New Technology - Level 50 1 1 — — $117,046.80 $117,046.80 $117,046.80 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 44 25 — — $51,864.24 $226,048.90 $113,894.67 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 44 25 — — $49,282.28 $214,795.48 $106,836.29 2024-10-01
0424T CPT Insertion Or Replacement Of Neurostimulator System For Treatment Of Central Slee… 11 2 — — $5,524.00 $154,001.40 $105,600.96 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 20 9 — — $49,267.73 $165,313.27 $104,749.05 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 44 25 — — $49,847.24 $217,257.86 $104,329.09 2024-10-01
1901 OTHER New Technology - Level 49 12 9 — — $89,567.13 $112,986.06 $102,714.60 2024-10-01
1902 OTHER New Technology - Level 49 12 9 — — $89,567.13 $112,986.06 $102,714.60 2024-10-01
01901 OTHER New Technology - Level 49 1 1 — — $102,714.60 $102,714.60 $102,714.60 2024-10-01
01902 OTHER New Technology - Level 49 1 1 — — $102,714.60 $102,714.60 $102,714.60 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 32 15 — — $42,387.03 $184,742.72 $102,295.33 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 11 3 — — $55,453.60 $148,574.83 $101,879.88 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 20 11 — — $87,199.91 $109,999.89 $99,999.90 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 33 23 — — $46,222.91 $201,461.29 $99,520.00 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 44 25 — — $53,872.30 $216,556.60 $99,056.40 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 43 24 — — $51,086.46 $222,658.94 $98,783.67 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 24 16 — — $68,835.54 $300,017.85 $98,459.00 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 32 15 — — $33,877.00 $170,369.54 $92,566.38 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 44 25 — — $43,808.39 $190,937.67 $92,487.43 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 13 10 — — $79,379.82 $100,135.09 $91,031.90 2024-10-01
01599 OTHER New Technology - Level 48 1 1 — — $90,771.08 $90,771.08 $90,771.08 2024-10-01
1599 OTHER New Technology - Level 48 12 9 — — $79,152.38 $99,848.19 $90,771.08 2024-10-01
01585 OTHER New Technology - Level 48 1 1 — — $90,771.08 $90,771.08 $90,771.08 2024-10-01
1585 OTHER New Technology - Level 48 12 9 — — $79,152.38 $99,848.19 $90,771.08 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 44 25 — — $44,512.68 $194,007.29 $90,181.94 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 44 25 — — $39,918.83 $177,473.17 $89,768.95 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 20 9 — — $40,168.33 $146,014.55 $88,791.30 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 44 25 — — $37,793.59 $189,952.87 $88,264.20 2024-10-01
431255 CDM Ins/repl Sq Icd With Elec 25 18 $198,440.51 $198,440.51 $42,029.70 $178,596.46 $87,313.82 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 44 25 — — $43,138.44 $191,436.27 $87,259.51 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 44 25 — — $41,882.41 $189,929.32 $86,669.04 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 44 25 — — $44,103.28 $192,422.34 $86,255.95 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 20 9 — — $38,929.12 $141,461.82 $86,037.53 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 35 22 — — $45,517.66 $192,748.24 $85,513.65 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 44 25 — — $40,680.63 $177,305.43 $85,454.24 2024-10-01
004 OTHER $3,392.00 1 1 — — $84,191.15 $84,191.15 $84,191.15 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 44 25 — — $16,243.00 $155,960.15 $83,008.96 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 20 9 — — $38,644.33 $131,245.89 $82,638.59 2024-10-01
01598 OTHER New Technology - Level 47 1 1 — — $81,216.28 $81,216.28 $81,216.28 2024-10-01
01584 OTHER New Technology - Level 47 1 1 — — $81,216.28 $81,216.28 $81,216.28 2024-10-01
1598 OTHER New Technology - Level 47 12 9 — — $70,820.60 $89,337.91 $81,216.28 2024-10-01
1584 OTHER New Technology - Level 47 12 9 — — $70,820.60 $89,337.91 $81,216.28 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 44 25 — — $37,582.91 $163,804.11 $80,541.94 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 44 25 — — $36,407.61 $158,681.58 $79,926.04 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 33 23 — — $38,922.47 $169,642.52 $79,178.00 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 44 25 — — $39,739.88 $173,205.18 $79,177.58 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 44 25 — — $38,017.50 $165,698.25 $78,664.93 2024-10-01
014 OTHER $3,392.00 1 1 — — $78,228.06 $78,228.06 $78,228.06 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 44 25 — — $38,512.81 $167,857.02 $78,039.82 2024-10-01
651 OTHER $3,392.00 1 1 — — $76,182.70 $76,182.70 $76,182.70 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 44 25 — — $36,229.30 $157,904.42 $75,988.31 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 24 16 — — $44,965.80 $195,982.21 $75,519.68 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 44 25 — — $35,183.73 $153,347.35 $75,092.01 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 44 25 — — $38,827.24 $163,573.26 $74,851.73 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 44 25 — — $38,644.46 $168,430.83 $74,280.00 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 16 12 — — $1,751.00 $113,368.99 $73,994.71 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 44 25 — — $36,320.69 $158,302.75 $73,579.74 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 44 25 — — $34,598.32 $150,795.83 $73,418.01 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 32 15 — — $28,534.00 $128,288.99 $72,637.51 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 44 25 — — $33,518.24 $146,088.33 $72,184.32 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 36 22 — — $39,477.21 $140,409.88 $71,696.79 2024-10-01
01583 OTHER New Technology - Level 46 1 1 — — $71,661.48 $71,661.48 $71,661.48 2024-10-01
1597 OTHER New Technology - Level 46 12 9 — — $62,488.81 $78,827.63 $71,661.48 2024-10-01
01597 OTHER New Technology - Level 46 1 1 — — $71,661.48 $71,661.48 $71,661.48 2024-10-01
1583 OTHER New Technology - Level 46 12 9 — — $62,488.81 $78,827.63 $71,661.48 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 44 25 — — $36,196.71 $157,762.36 $71,385.81 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 44 25 — — $33,147.56 $144,472.74 $70,530.36 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 44 25 — — $31,189.36 $140,963.24 $70,138.23 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 44 25 — — $33,219.78 $144,787.50 $70,060.24 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 44 25 — — $30,958.00 $143,514.07 $69,617.97 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 44 25 — — $32,318.65 $140,859.95 $68,597.66 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 44 25 — — $31,664.85 $138,010.38 $68,454.46 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 44 25 — — $32,202.33 $140,352.99 $68,232.70 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 44 25 — — $32,953.91 $143,628.74 $67,905.98 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 43 24 — — $32,459.89 $141,475.54 $67,857.25 2024-10-01
007 OTHER $3,392.00 1 1 — — $67,496.59 $67,496.59 $67,496.59 2024-10-01
002 OTHER $3,392.00 1 1 — — $67,374.14 $67,374.14 $67,374.14 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 44 25 — — $31,437.33 $137,018.74 $67,005.10 2024-10-01
0266T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Total… 7 1 — — $50,790.17 $82,203.74 $66,937.33 2024-10-01
0268T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Pulse… 7 1 — — $50,790.17 $82,203.74 $66,937.33 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 24 16 — — $39,689.39 $172,985.12 $66,195.27 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 41 24 — — $33,627.52 $136,815.93 $66,048.60 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 13 10 — — $57,440.12 $72,458.87 $65,871.70 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 44 25 — — $31,950.53 $139,255.50 $65,729.69 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 44 25 — — $30,124.62 $131,297.33 $65,580.79 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $65,476.58 $65,476.58 $65,476.58 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 12 9 — — $57,095.58 $72,024.24 $65,476.58 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 44 25 — — $29,575.63 $128,904.58 $65,448.65 2024-10-01
245 MS_DRG Aicd Generator Procedures 44 25 — — $28,960.18 $136,425.62 $65,125.28 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 16 12 — — $1,751.00 $99,629.42 $65,116.38 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 44 25 — — $28,957.62 $126,096.38 $64,518.27 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 1 1 — — $63,505.40 $63,505.40 $63,505.40 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 13 10 — — $12,639.03 $69,690.25 $63,354.77 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $63,354.77 $63,354.77 $63,354.77 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 44 25 — — $28,866.87 $125,815.46 $63,280.99 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 44 25 — — $30,720.26 $133,893.41 $63,019.03 2024-10-01
955 OTHER $3,392.00 1 1 — — $62,353.92 $62,353.92 $62,353.92 2024-10-01
01596 OTHER New Technology - Level 45 1 1 — — $62,106.68 $62,106.68 $62,106.68 2024-10-01
1582 OTHER New Technology - Level 45 12 9 — — $54,157.02 $68,317.35 $62,106.68 2024-10-01
1596 OTHER New Technology - Level 45 12 9 — — $54,157.02 $68,317.35 $62,106.68 2024-10-01
01582 OTHER New Technology - Level 45 1 1 — — $62,106.68 $62,106.68 $62,106.68 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 44 25 — — $29,709.20 $129,486.75 $62,078.06 2024-10-01
0408T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 11 2 — — $9,243.00 $89,813.72 $61,586.55 2024-10-01
0571T CPT Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S… 11 2 — — $6,445.00 $89,813.72 $61,586.55 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 44 25 — — $30,295.90 $132,043.84 $61,249.17 2024-10-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 44 25 — — $28,301.90 $123,353.08 $60,400.18 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 44 25 — — $28,222.66 $123,007.68 $60,224.82 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 32 15 — — $23,377.64 $101,890.80 $59,715.19 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 16 12 — — $1,751.00 $90,205.44 $59,026.73 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 44 25 — — $28,771.64 $125,400.42 $58,766.52 2024-10-01
J9999 HCPCS Carmustine Wafers 8/box 28 20 $121,912.27 $121,912.27 $25,821.02 $109,721.04 $58,517.89 2024-10-01
41214 CDM Graft Evas 34mm 115mm 23 18 $116,640.00 $116,640.00 $37,091.52 $104,976.00 $58,320.00 2024-10-01
41213 CDM Gft Evas 32x36x112mm 23 18 $116,640.00 $116,640.00 $37,091.52 $104,976.00 $58,320.00 2024-10-01
429639 CDM Implant Cranial Peek 23 18 $116,640.00 $116,640.00 $37,091.52 $104,976.00 $58,320.00 2024-10-01
573228 CDM Graft Evas 23x14.5m 16cm 23 18 $116,640.00 $116,640.00 $37,091.52 $104,976.00 $58,320.00 2024-10-01
565334 CDM Pump Pain Infn 148gm 23 18 $116,640.00 $116,640.00 $37,091.52 $104,976.00 $58,320.00 2024-10-01
495856 CDM Impl Unilat Tmj Mndble 23 18 $116,640.00 $116,640.00 $37,091.52 $104,976.00 $58,320.00 2024-10-01
495839 CDM Implant Crnl Cstm 3d 23 18 $116,640.00 $116,640.00 $37,091.52 $104,976.00 $58,320.00 2024-10-01
494428 CDM Graft Evas 26x14.5m 12cm 23 18 $116,640.00 $116,640.00 $37,091.52 $104,976.00 $58,320.00 2024-10-01
C1822 HCPCS Pulse Gen Imp 23 18 $116,640.00 $116,640.00 $37,091.52 $104,976.00 $58,320.00 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 40 23 — — $30,912.63 $106,992.50 $58,293.53 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 36 22 — — $33,636.66 $97,221.61 $58,230.56 2024-10-01
10 MS_DRG Pancreas Transplant 41 24 — — $30,763.72 $92,253.86 $58,152.68 2024-10-01
901 MS_DRG Wound Debridements For Injuries With Mcc 44 25 — — $27,658.97 $120,550.87 $57,780.12 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 43 24 — — $28,743.52 $125,277.86 $57,702.21 2024-10-01
41480 CDM Revsc Fem/pop W Stnt/ath 25 18 $130,709.82 $130,709.82 $27,684.34 $117,638.84 $57,512.32 2024-10-01
020 OTHER $3,392.00 1 1 — — $57,467.55 $57,467.55 $57,467.55 2024-10-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 44 25 — — $27,876.90 $121,500.72 $57,455.41 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 44 25 — — $26,577.61 $115,837.80 $57,227.18 2024-10-01
342739 CDM Dvc Revasc 6x40mm 200cm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
490380 CDM Frame Ex Fix Foot 180mm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
342737 CDM Dvc Revasc 3x20mm 200c 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
440090 CDM Dvc Revasc 4mm 31mm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
487040 CDM Frame Ex Fix Foot 160mm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
565125 CDM Template Mndbl Cust 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
440091 CDM Dvc Revasc 6mm 31mm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
337566 CDM Frame Exfx 180mm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
493791 CDM Frame Exfx 200mm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
497773 CDM System Mech Thrmb 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
487831 CDM Kit Device Guided 3cm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
342738 CDM Dvc Revasc 4x40mm 200cm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
494684 CDM Model Lf Vsp Bndl Recon 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
495553 CDM Frame Ex Fx 160mm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
440092 CDM Dvc Revasc 6mm 42cm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
441396 CDM Set Vntrc 17.4x13.8in 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
487484 CDM Frame Ex Fix 200mm 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
338040 CDM Kit Cath Rt Heart 37 24 $127,189.00 $127,189.00 $26,938.63 $114,470.10 $56,891.64 2024-10-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 44 25 — — $27,345.17 $119,183.19 $56,807.09 2024-10-01
426120 CDM Graft Evas 16cm 25.5mm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
406655 CDM Graft Evas 16cm 26mm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
489547 CDM Graft Evas 26x14.5m 18cm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
492247 CDM Graft Evas 31x14.5m 17cm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
495803 CDM Graft Evas 26x12mm 18cm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
491342 CDM Graft Evas 26x14.5m 14cm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
490047 CDM Graft Evas 23x14.5m 12cm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
495619 CDM Graft Evas 23x14.5m 18cm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
490286 CDM Graft Evas 35x14.5m 14cm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
426855 CDM Graft Evas 15cm 31mm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
489970 CDM Graft Evas 14.5mm 12cm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
494429 CDM Graft Evas 31x14.5m 13cm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
491339 CDM Graft Evas 23x12mm 12cm 23 18 $113,074.00 $113,074.00 $35,957.53 $101,766.60 $56,537.00 2024-10-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 44 25 — — $26,309.19 $114,667.89 $56,510.24 2024-10-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 44 25 — — $24,395.19 $121,946.55 $56,377.04 2024-10-01
B0404 HCPCS $50,364.00 1 1 — — $56,374.98 $56,374.98 $56,374.98 2024-10-01
0431T CPT Removal And Replacement Of Neurostimulator System For Treatment Of Central Sleep… 11 2 — — $5,524.00 $82,203.74 $56,368.28 2024-10-01
0427T CPT Insertion Or Replacement Of Neurostimulator System For Treatment Of Central Slee… 11 2 — — $2,254.00 $82,203.74 $56,368.28 2024-10-01
C1772 HCPCS Pump Infs Pain 20ml 23 18 $111,999.00 $111,999.00 $35,615.68 $100,799.10 $55,999.50 2024-10-01
C1820 HCPCS Ipg Nrstm 57.1mm 47.2mm 46 18 $112,320.00 $112,320.00 $34,344.00 $104,976.00 $55,987.20 2024-10-01
C1767 HCPCS Gen Nrstm 45x32x6.9mm 46 18 $112,320.00 $112,320.00 $34,344.00 $104,976.00 $55,987.20 2024-10-01
B0505 HCPCS $47,437.70 1 1 — — $55,795.99 $55,795.99 $55,795.99 2024-10-01
341963 CDM Impl Cust Cranial Prosth 23 18 $111,286.00 $111,286.00 $35,388.95 $100,157.40 $55,643.00 2024-10-01
005 OTHER $3,392.00 1 1 — — $55,381.53 $55,381.53 $55,381.53 2024-10-01
453 OTHER $3,392.00 1 1 — — $55,255.12 $55,255.12 $55,255.12 2024-10-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 44 25 — — $24,843.10 $108,277.96 $55,125.21 2024-10-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 44 25 — — $27,499.19 $119,854.49 $55,029.73 2024-10-01
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $55,015.23 $55,015.23 $55,015.23 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 12 9 — — $47,973.28 $60,516.75 $55,015.23 2024-10-01
33264 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 22 9 — — $1,348.00 $89,813.72 $54,992.03 2024-10-01
33249 CPT Insertion Or Replacement Of Permanent Implantable Defibrillator System, With Tra… 22 9 — — $1,568.00 $89,813.72 $54,992.03 2024-10-01
33270 CPT Insertion Or Replacement Of Permanent Subcutaneous Implantable Defibrillator Sys… 22 9 — — $1,348.00 $89,813.72 $54,992.03 2024-10-01
33231 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multi… 22 9 — — $1,568.00 $89,813.72 $54,992.03 2024-10-01
131 MS_DRG Cranial/facial Procedures W Cc/mcc 1 1 — — $54,842.89 $54,842.89 $54,842.89 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 44 25 — — $25,827.31 $112,567.63 $54,461.35 2024-10-01
429536 CDM Pack Surg Crnl Tumor 37 24 $120,948.00 $120,948.00 $25,616.79 $108,853.20 $54,100.04 2024-10-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 44 25 — — $24,994.56 $108,938.12 $54,011.63 2024-10-01
407309 CDM Gft Bif 28-13x145mm 20fr 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
493652 CDM Occluder Cv 35x18mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
485839 CDM Graft Bn Ptla Fsh Rt 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
338481 CDM Graft Endo Aaa 28.5x12mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
487916 CDM Valve Aortic 27mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
427291 CDM Valve Aortic 25mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
485884 CDM Graft Bn Fem Condrl Lt 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
561628 CDM Graft Evas 10cm 14.5mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
C1882 HCPCS Crt Defib Card 74x51x13 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
498038 CDM Cage Spn Szc 25mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
489971 CDM Graft Evas 10cm 12mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
428886 CDM Implant Cranial Plate 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
487914 CDM Valve Aortic 23mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
439375 CDM Prosthesis Tmj Pt Cstm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
426752 CDM Graft Evas 14cm 26mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
493650 CDM Occluder Cv 18x18mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
428899 CDM Gft Bif 28-13x124mm 20fr 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
39567 CDM Spacer Spn 8d 37x27x12 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
487913 CDM Valve Aortic 19mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
488551 CDM Valve Aortic 21mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
39828 CDM Spacer Spn 12d10x27x37mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
493651 CDM Occluder Cv 25x18mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
427380 CDM Nrstm Impl 60mm Fsn Spn 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
494121 CDM Valve Aor Cndt 24mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
561707 CDM Valve Aortic 21mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
407373 CDM Gft Bif 25-16x145mm 18fr 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
487915 CDM Valve Aortic 25mm 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
441354 CDM Graft Bn Fem Whole Left 23 18 $108,000.00 $108,000.00 $34,344.00 $97,200.00 $54,000.00 2024-10-01
B0106 HCPCS $45,897.04 1 1 — — $53,763.04 $53,763.04 $53,763.04 2024-10-01
492709 CDM Kit Impl Uni Tmj Cstm 23 18 $107,474.00 $107,474.00 $34,176.73 $96,726.60 $53,737.00 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 4 2 — — $44,578.80 $65,181.79 $53,617.28 2024-10-01
338165 CDM Valve Aortic 29mm 23 18 $107,030.00 $107,030.00 $34,035.54 $96,327.00 $53,515.00 2024-10-01
336873 CDM Valve Mitral 27mm 23 18 $107,030.00 $107,030.00 $34,035.54 $96,327.00 $53,515.00 2024-10-01
336875 CDM Valve Aortic 19mm 23 18 $107,030.00 $107,030.00 $34,035.54 $96,327.00 $53,515.00 2024-10-01
335967 CDM Valve Mitral 31mm 23 18 $107,030.00 $107,030.00 $34,035.54 $96,327.00 $53,515.00 2024-10-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 44 25 — — $24,933.85 $108,673.50 $53,154.07 2024-10-01
C9760 HCPCS Non-randomized, Non-blinded Procedure For Nyha Class Ii, Iii, IV Heart Failure; … 11 2 — — $9,243.00 $77,001.40 $52,800.96 2024-10-01
491211 CDM Template Vrtual Sur Plan 37 24 $118,027.00 $118,027.00 $24,998.12 $106,224.30 $52,793.48 2024-10-01
22721 CDM System Del Handpiece 37 24 $117,966.00 $117,966.00 $24,985.20 $106,169.40 $52,766.19 2024-10-01
01595 OTHER New Technology - Level 44 1 1 — — $52,551.88 $52,551.88 $52,551.88 2024-10-01
01581 OTHER New Technology - Level 44 1 1 — — $52,551.88 $52,551.88 $52,551.88 2024-10-01
1581 OTHER New Technology - Level 44 12 9 — — $45,825.24 $57,807.07 $52,551.88 2024-10-01
1595 OTHER New Technology - Level 44 12 9 — — $45,825.24 $57,807.07 $52,551.88 2024-10-01
332 MS_DRG Rectal Resection With Mcc 44 25 — — $23,354.63 $104,790.73 $52,519.60 2024-10-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 44 25 — — $24,214.22 $105,537.02 $52,365.01 2024-10-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 44 25 — — $24,905.73 $108,550.93 $52,282.25 2024-10-01
429792 CDM Spacer Spn Med 12d 12mm 23 18 $104,454.00 $104,454.00 $33,216.37 $94,008.60 $52,227.00 2024-10-01
337397 CDM Impl Sphenoid Lft Cstm 23 18 $104,001.00 $104,001.00 $33,072.32 $93,600.90 $52,000.50 2024-10-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 44 25 — — $23,771.32 $103,606.67 $51,925.74 2024-10-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 44 25 — — $25,595.32 $111,556.49 $51,887.98 2024-10-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 44 25 — — $25,293.66 $110,241.73 $51,447.33 2024-10-01
215 OTHER $3,392.00 1 1 — — $51,389.46 $51,389.46 $51,389.46 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 7 1 — — $38,907.73 $62,972.06 $51,277.25 2024-10-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 44 25 — — $24,608.55 $107,255.68 $50,966.12 2024-10-01
140 MS_DRG Major Head And Neck Procedures With Mcc 43 24 — — $24,145.84 $105,238.98 $50,773.92 2024-10-01
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