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

HOLY CROSS HOSPITAL-DAVIS

Layton, UT · CCN 460041 · Rates published

14,310 distinct procedures filed
22 distinct payers
490,178 rate rows
2024-12-02 last MRF observed · ⚠ 18 mo old
Data quality

485,872 of 490,178 rate rows are consumer-grade (99.1%)

4,306 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 3,889
per-diem day rate — not a per-procedure price 300
exceeds 10× this hospital's gross charge — excluded from medians 95
placeholder amount (≤ $0.02) — excluded from medians 22

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 18 months old.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://sthpiprd.blob.core.windows.net/machine-readable-files/11395/680562507_holy-cross-hospital-davis_standardcharges.csv
Found on page https://www.mountain.commonspirit.org/price-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint e4ee2fc430988793… · 468,018,208 bytes · first seen 2026-05-08

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 1 $631,174.54 $1,288,924.85 $773,252.69 nat. median
$753,246
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 1 $598,592.52 $1,222,388.94 $733,336.42 nat. median
$625,184
1.2× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $555,058.40 $1,133,487.68 $680,002.72 nat. median
$634,303
1.1× median
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 1 $310,098.74 $310,098.74 $310,098.74 nat. median
$111,989
outlier · 2.8×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 18 $253,742.36 $806,279.65 $253,742.36 nat. median
$370,174
0.7× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 19 $187,189.22 $593,036.06 $187,189.22 nat. median
$265,286
0.7× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 19 $182,135.63 $576,843.81 $182,135.63 nat. median
$206,474
0.9× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 19 $147,722.88 $466,581.55 $147,722.88 nat. median
$202,976
0.7× median
L7181
HCPCS 		Electronic Elbo Simultaneous 1 $137,681.92 $137,681.92 $137,681.92 nat. median
$50,598
outlier · 2.7×
L7180
HCPCS 		Electronic Elbow Sequential 1 $120,655.92 $120,655.92 $120,655.92 nat. median
$49,027
outlier · 2.5×
222
MS_DRG 		Carve Out DRG 5 $68,273.90 $124,975.37 $112,279.76 nat. median
$63,570
1.8× median
224
MS_DRG 		Carve Out DRG 5 $63,214.40 $118,186.69 $105,236.24 nat. median
$54,196
1.9× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And… 19 $102,505.59 $321,700.39 $102,505.59 nat. median
$133,161
0.8× median
226
MS_DRG 		Carve Out DRG 5 $57,076.83 $106,414.56 $94,138.30 nat. median
$49,935
1.9× median
7
MS_DRG 		Lung Transplant 19 $85,883.86 $268,442.56 $85,883.86 nat. median
$122,708
0.7× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 19 $85,731.56 $267,954.54 $85,731.56 nat. median
$108,660
0.8× median
L5856
HCPCS 		Elec Knee-shin Swing/stance 1 $82,430.80 $82,430.80 $82,430.80 nat. median
$30,273
outlier · 2.7×
L6880
HCPCS 		Elec Hand Ind Art Digits 1 $82,263.57 $82,263.57 $82,263.57 nat. median
$30,168
outlier · 2.7×
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 2 $65,981.93 $134,742.04 $80,834.54 nat. median
$66,682
1.2× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 19 $80,382.22 $250,814.69 $80,382.22 nat. median
$117,357
0.7× median
225
MS_DRG 		Carve Out DRG 5 $45,099.51 $101,866.18 $79,793.28 nat. median
$48,704
1.6× median
B0407
LOCAL 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 $76,419.51 $76,419.51 $76,419.51 nat. median
$79,920
1.0× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 16 $75,668.08 $235,710.09 $75,668.08 nat. median
$102,358
0.7× median
223
MS_DRG 		Carve Out DRG 5 $46,535.15 $91,143.53 $74,636.58 nat. median
$44,728
1.7× median
227
MS_DRG 		Carve Out DRG 5 $44,769.58 $83,207.52 $74,457.62 nat. median
$39,020
1.9× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 19 $72,794.66 $226,503.33 $72,794.66 nat. median
$100,136
0.7× median
33276
CPT 		Insj Phrnc Nrv Stim Sys 1 $58,941.65 $91,913.52 $72,203.30 nat. median
$43,787
1.6× median
215
MS_DRG 		Other Heart Assist System Implant 19 $71,871.24 $223,544.56 $71,871.24 nat. median
$99,019
0.7× median
J9269
HCPCS 		Tagraxofusp-erzs 1,000 Mcg/ml Intravenous Solution 22 $37,868.03 $99,538.83 $70,375.04 nat. median
$509
outlier · 138.2×
33249
CPT 		Hc Insert/replace (icd) Single/dual Lead/s System 22 $891.38 $112,559.16 $68,519.81 nat. median
$31,833
outlier · 2.2×
33264
CPT 		Hc Replace Generator Only (icd) Multiple 22 $395.53 $113,125.86 $68,519.81 nat. median
$31,873
outlier · 2.1×
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 19 $68,391.30 $212,394.47 $68,391.30 nat. median
$93,672
0.7× median
J9226
HCPCS 		Supprelin La Implant 2 $55,051.29 $112,420.52 $67,443.40 nat. median
$60,368
1.1× median
L8614
HCPCS 		Cochlear Device 1 $65,608.09 $65,608.09 $65,608.09 nat. median
$23,403
outlier · 2.8×
Q0483
HCPCS 		Monitor Elec Vad, Rep 1 $64,555.85 $64,555.85 $64,555.85 nat. median
$23,616
outlier · 2.7×
L5858
HCPCS 		Stance Phase Only 1 $63,862.38 $63,862.38 $63,862.38 nat. median
$23,442
outlier · 2.7×
L6975
HCPCS 		Interscap-thor Myoelectronic 1 $63,781.38 $63,781.38 $63,781.38 nat. median
$23,177
outlier · 2.8×
C0407
LOCAL 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 $63,524.11 $63,524.11 $63,524.11 nat. median
$70,083
0.9× median
J3357
HCPCS 		Ustekinumab 90 Mg/ml Subcutaneous Syringe 22 $190.14 $89,653.98 $63,386.34 nat. median
$14,292
outlier · 4.4×
453
MS_DRG 		DRG 19 $62,627.38 $193,926.24 $62,627.38 nat. median
$87,428
0.7× median
B1806
LOCAL 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 16 $62,027.72 $62,027.72 $62,027.72 nat. median
$64,290
1.0× median
33263
CPT 		Hc Replace Generator Only (icd) Dual 22 $379.26 $102,031.40 $61,218.84 nat. median
$23,504
outlier · 2.6×
B0406
LOCAL 		Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 16 $60,722.63 $60,722.63 $60,722.63 nat. median
$59,111
1.0× median
D0407
LOCAL 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 $60,288.19 $60,288.19 $60,288.19 nat. median
$67,662
0.9× median
L5973
HCPCS 		Ank-foot Sys Dors-plant Flex 1 $59,930.72 $59,930.72 $59,930.72 nat. median
$21,820
outlier · 2.7×
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 19 $59,833.87 $184,975.53 $59,833.87 nat. median
$77,570
0.8× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 19 $59,676.79 $184,472.19 $59,676.79 nat. median
$81,118
0.7× median
L6970
HCPCS 		Interscapular-thor Switch CT 1 $59,530.84 $59,530.84 $59,530.84 nat. median
$22,513
outlier · 2.6×
L6965
HCPCS 		Shldr Disartic Myoelectronic 1 $58,804.85 $58,804.85 $58,804.85 nat. median
$22,149
outlier · 2.7×
230
MS_DRG 		DRG 1 $58,705.71 $58,705.71 $58,705.71 nat. median
$29,847
2.0× median

Other procedures at this hospital

Browse this hospital's 14,310 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
             
0266T CPT Hc Insert/repl Carotid Sinus Baroflex Activation System 51 22 $86,813.85 $34,725.54 60% off $5,724.00 $79,868.74 $42,796.37 2024-12-02
0268T CPT Implt/rpl Crtd Sns Dev Gen 4 1 — — $39,377.15 $61,404.66 $48,236.85 2024-12-02
0308T CPT Insj Ocular Telescope Prosth 4 1 — — $31,653.01 $49,359.65 $38,774.82 2024-12-02
0312T CPT Fee Schedule 4 1 — — $39,377.15 $61,404.66 $48,236.85 2024-12-02
0316T CPT Fee Schedule 4 1 — — $39,377.15 $61,404.66 $48,236.85 2024-12-02
0408T CPT Insj/rplc Cardiac Modulj Sys 4 1 — — $30,846.90 $48,102.61 $37,787.33 2024-12-02
0424T CPT Fee Schedule 4 1 — — $39,377.15 $61,404.66 $48,236.85 2024-12-02
0515T CPT Insj Wcs Lv Compl Sys 4 1 — — $30,846.90 $48,102.61 $37,787.33 2024-12-02
0520T CPT Rmv&rplcmt Pg Wcs Lv Battery 4 1 — — $30,846.90 $48,102.61 $37,787.33 2024-12-02
0571T CPT Insj/rplcmt Icds Ss Eltrd 4 1 — — $43,939.90 $68,519.81 $53,826.21 2024-12-02
0775T CPT Fee Schedule 4 1 — — $28,681.52 $44,725.91 $35,134.75 2024-12-02
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 29 19 — — $187,189.22 $593,036.06 $187,189.22 2024-12-02
10 MS_DRG Pancreas Transplant 29 19 — — $34,980.52 $105,342.65 $34,980.52 2024-12-02
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 30 19 — — $37,321.19 $112,842.43 $37,321.19 2024-12-02
129 MS_DRG DRG 1 1 — — $30,333.54 $30,333.54 $30,333.54 2024-12-02
131 MS_DRG DRG 1 1 — — $32,790.36 $32,790.36 $32,790.36 2024-12-02
14 MS_DRG Allogeneic Bone Marrow Transplant 29 19 — — $80,382.22 $250,814.69 $80,382.22 2024-12-02
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 29 19 — — $44,292.68 $135,179.82 $44,292.68 2024-12-02
163 MS_DRG Major Chest Procedures With Mcc 30 19 — — $34,297.51 $103,154.21 $34,297.51 2024-12-02
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 29 19 — — $38,968.18 $135,179.82 $44,292.68 2024-12-02
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 28 18 — — $253,742.36 $806,279.65 $253,742.36 2024-12-02
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 28 18 — — $56,699.55 $174,932.79 $56,699.55 2024-12-02
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 29 19 — — $85,731.56 $267,954.54 $85,731.56 2024-12-02
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 30 19 — — $59,833.87 $184,975.53 $59,833.87 2024-12-02
207 MS_DRG Respiratory System Diagnosis With Ventilator Support &gt;96 Hours 30 19 — — $49,285.47 $151,177.30 $49,285.47 2024-12-02
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 30 19 — — $44,049.52 $134,400.73 $44,049.52 2024-12-02
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 20 16 — — $75,668.08 $235,710.09 $75,668.08 2024-12-02
215 MS_DRG Other Heart Assist System Implant 30 19 — — $71,871.24 $223,544.56 $71,871.24 2024-12-02
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 30 19 — — $68,391.30 $212,394.47 $68,391.30 2024-12-02
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 30 19 — — $45,578.78 $139,300.64 $45,578.78 2024-12-02
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 30 19 — — $41,012.18 $124,668.75 $41,012.18 2024-12-02
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 30 19 — — $54,771.41 $168,754.83 $54,771.41 2024-12-02
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 30 19 — — $37,924.29 $114,774.82 $37,924.29 2024-12-02
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 30 19 — — $33,853.55 $101,731.73 $33,853.55 2024-12-02
222 MS_DRG Carve Out DRG 10 5 — — $68,273.90 $124,975.37 $112,279.76 2024-12-02
223 MS_DRG Carve Out DRG 10 5 — — $46,535.15 $91,143.53 $74,636.58 2024-12-02
224 MS_DRG Carve Out DRG 10 5 — — $63,214.40 $118,186.69 $105,236.24 2024-12-02
225 MS_DRG Carve Out DRG 10 5 — — $45,099.51 $101,866.18 $79,793.28 2024-12-02
226 MS_DRG Carve Out DRG 10 5 — — $57,076.83 $106,414.56 $94,138.30 2024-12-02
227 MS_DRG Carve Out DRG 10 5 — — $44,769.58 $83,207.52 $74,457.62 2024-12-02
228 MS_DRG Other Cardiothoracic Procedures With Mcc 30 19 — — $36,517.98 $110,268.83 $36,517.98 2024-12-02
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 30 19 — — $40,821.62 $124,058.17 $40,821.62 2024-12-02
230 MS_DRG DRG 1 1 — — $58,705.71 $58,705.71 $58,705.71 2024-12-02
231 MS_DRG Coronary Bypass With Ptca With Mcc 30 19 — — $57,530.76 $177,596.12 $57,530.76 2024-12-02
232 MS_DRG Coronary Bypass With Ptca Without Mcc 30 19 — — $42,732.68 $130,181.42 $42,732.68 2024-12-02
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 30 19 — — $55,375.18 $170,689.41 $55,375.18 2024-12-02
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 30 19 — — $37,605.32 $113,752.82 $37,605.32 2024-12-02
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 30 19 — — $42,268.23 $128,693.29 $42,268.23 2024-12-02
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 30 19 — — $34,934.08 $105,193.84 $34,934.08 2024-12-02
245 MS_DRG Aicd Generator Procedures 30 19 — — $33,053.07 $99,166.88 $33,053.07 2024-12-02
246 MS_DRG Carve Out DRG 10 5 — — $26,709.98 $49,108.35 $43,617.40 2024-12-02
248 MS_DRG Carve Out DRG 10 5 — — $26,838.39 $49,704.08 $40,408.60 2024-12-02
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 30 19 — — $32,264.87 $96,641.42 $32,264.87 2024-12-02
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 30 19 — — $44,764.64 $136,692.03 $44,764.64 2024-12-02
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 30 19 — — $35,435.41 $106,800.15 $35,435.41 2024-12-02
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 30 19 — — $48,921.43 $150,010.86 $48,921.43 2024-12-02
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 30 19 — — $30,506.81 $91,008.38 $30,506.81 2024-12-02
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 30 19 — — $36,642.28 $110,667.12 $36,642.28 2024-12-02
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 20 16 — — $50,158.36 $153,974.12 $50,158.36 2024-12-02
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 20 16 — — $44,519.43 $135,906.38 $44,519.43 2024-12-02
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 20 16 — — $34,767.42 $104,659.86 $34,767.42 2024-12-02
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 20 16 — — $32,568.13 $97,613.09 $32,568.13 2024-12-02
28 MS_DRG Spinal Procedures With Mcc 30 19 — — $43,262.01 $131,877.46 $43,262.01 2024-12-02
3 MS_DRG Ecmo Or Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mo… 30 19 — — $147,722.88 $466,581.55 $147,722.88 2024-12-02
31 MS_DRG Ventricular Shunt Procedures With Mcc 30 19 — — $30,219.95 $90,089.24 $30,219.95 2024-12-02
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 29 18 — — $31,895.36 $95,457.48 $31,895.36 2024-12-02
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 20 16 — — $30,379.76 $90,601.33 $30,379.76 2024-12-02
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 30 19 — — $36,793.23 $111,150.77 $36,793.23 2024-12-02
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 30 19 — — $32,953.35 $98,847.37 $32,953.35 2024-12-02
33221 CPT Hc Insert Generator Only (pacemaker) To Existing Multiple Leads 67 22 $64,716.12 $25,886.45 60% off $352.56 $59,538.83 $36,758.76 2024-12-02
33229 CPT Hc Replace Generator Only (pacemaker) Multiple 67 22 $64,716.16 $25,886.46 60% off $366.95 $59,538.87 $36,758.78 2024-12-02
33230 CPT Hc Insert Generator Only (icd) To Existing Dual Leads 67 22 $80,519.02 $32,207.61 60% off $375.26 $74,077.50 $45,734.80 2024-12-02
33231 CPT Hc Insert Generator Only (icd) To Existing Multiple Leads 67 22 $46,308.65 $18,523.46 60% off $391.18 $68,519.81 $30,121.46 2024-12-02
33240 CPT Hc Insert Generator Only (icd) To Existing Single Lead 67 22 $80,519.02 $32,207.61 60% off $358.05 $74,077.50 $45,734.80 2024-12-02
33249 CPT Hc Insert/replace (icd) Single/dual Lead/s System 67 22 $122,346.91 $48,938.76 60% off $891.38 $112,559.16 $68,519.81 2024-12-02
33262 CPT Hc Replace Generator Only (icd) Single 67 22 $67,156.50 $26,862.60 60% off $365.44 $61,783.98 $41,301.25 2024-12-02
33263 CPT Hc Replace Generator Only (icd) Dual 67 22 $110,903.70 $44,361.48 60% off $379.26 $102,031.40 $61,218.84 2024-12-02
33264 CPT Hc Replace Generator Only (icd) Multiple 67 22 $122,962.89 $49,185.16 60% off $395.53 $113,125.86 $68,519.81 2024-12-02
33270 CPT Hc Insert/replace (sicd) Subcutaneous Icd System 67 22 $49,691.36 $19,876.54 60% off $549.05 $68,519.81 $32,321.74 2024-12-02
33274 CPT Hc Insert/replace (pacemaker) Leadless Rt Ventricular System 67 22 $56,542.51 $22,617.00 60% off $468.26 $52,019.11 $32,116.15 2024-12-02
33276 CPT Insj Phrnc Nrv Stim Sys 4 1 — — $58,941.65 $91,913.52 $72,203.30 2024-12-02
33287 CPT Rmv&rplcmt Phrnc Nrv Stim Pg 4 1 — — $38,752.12 $60,430.00 $47,471.20 2024-12-02
33340 CPT Hc Closure Left Atrial Appendage With Implant Including Imaging 67 22 $59,686.98 $23,874.79 60% off $753.56 $54,912.02 $33,902.20 2024-12-02
338 MS_DRG Carve Out DRG 10 5 — — $20,054.02 $43,968.51 $36,903.22 2024-12-02
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 30 19 — — $31,327.10 $93,636.70 $31,327.10 2024-12-02
37227 CPT Hc Revasc Arterial Fem/pop W Atherect & Stent W/wo Angioplas 67 22 $77,750.67 $31,100.27 60% off $680.37 $71,530.62 $42,918.37 2024-12-02
37231 CPT Hc Revasc Arterial Tib/per W Atherect & Stent W/wo Angioplas Initial Ves 67 22 $77,750.67 $31,100.27 60% off $699.90 $71,530.62 $42,918.37 2024-12-02
37236 CPT Hc Plc Stent Art W/wo Anpl Ini 86 22 $70,790.60 $28,316.24 60% off $419.56 $65,127.35 $34,069.15 2024-12-02
4 MS_DRG Tracheostomy With Mv &gt;96 Hours Or Principal Diagnosis Except Face, Mouth And … 30 19 — — $102,505.59 $321,700.39 $102,505.59 2024-12-02
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 30 19 — — $39,704.22 $120,477.89 $39,704.22 2024-12-02
453 MS_DRG DRG 30 19 — — $62,627.38 $193,926.24 $62,627.38 2024-12-02
454 MS_DRG DRG 30 19 — — $43,878.09 $133,851.43 $43,878.09 2024-12-02
455 MS_DRG DRG 30 19 — — $33,559.86 $100,790.70 $33,559.86 2024-12-02
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 30 19 — — $59,676.79 $184,472.19 $59,676.79 2024-12-02
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 30 19 — — $43,598.05 $132,954.17 $43,598.05 2024-12-02
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 30 19 — — $33,050.33 $99,158.13 $33,050.33 2024-12-02
459 MS_DRG DRG 30 19 — — $47,402.41 $145,143.77 $47,402.41 2024-12-02
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 30 19 — — $48,674.18 $149,218.65 $48,674.18 2024-12-02
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 30 19 — — $40,786.79 $123,946.56 $40,786.79 2024-12-02
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 30 19 — — $37,528.15 $113,505.53 $37,528.15 2024-12-02
471 MS_DRG Cervical Spinal Fusion With Mcc 30 19 — — $34,657.56 $107,649.27 $35,700.41 2024-12-02
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 30 19 — — $31,491.71 $94,164.11 $31,491.71 2024-12-02
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 29 19 — — $72,794.66 $226,503.33 $72,794.66 2024-12-02
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 30 19 — — $44,573.39 $136,079.26 $44,573.39 2024-12-02
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 30 19 — — $40,919.29 $124,371.12 $40,919.29 2024-12-02
6 MS_DRG Liver Transplant Without Mcc 29 19 — — $35,139.66 $105,852.56 $35,139.66 2024-12-02
61645 CPT Hc Mthromb &or Lysis Intracran 67 22 $62,216.17 $24,886.47 60% off $816.08 $57,238.88 $35,338.78 2024-12-02
61891 CPT Rev/rplcmt Sk-mnt Crnl Nstm 4 1 — — $27,299.95 $42,571.50 $33,442.33 2024-12-02
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 28 18 — — $32,821.52 $98,425.00 $32,821.52 2024-12-02
653 MS_DRG Major Bladder Procedures With Mcc 30 19 — — $39,078.58 $118,473.28 $39,078.58 2024-12-02
7 MS_DRG Lung Transplant 29 19 — — $85,883.86 $268,442.56 $85,883.86 2024-12-02
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 28 17 — — $43,084.43 $131,308.47 $43,084.43 2024-12-02
791 MS_DRG Prematurity With Major Problems 28 17 — — $20,795.76 $89,675.62 $30,090.85 2024-12-02
793 MS_DRG Full Term Neonate With Major Problems 28 17 — — $4,815.22 $92,117.92 $30,853.10 2024-12-02
799 MS_DRG Splenic Procedures With Mcc 30 19 — — $35,943.57 $108,428.35 $35,943.57 2024-12-02
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 29 19 — — $38,041.09 $115,149.04 $38,041.09 2024-12-02
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 30 19 — — $43,402.71 $132,328.28 $43,402.71 2024-12-02
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 30 19 — — $32,851.58 $98,521.29 $32,851.58 2024-12-02
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 30 19 — — $32,079.09 $101,274.35 $32,079.09 2024-12-02
834 MS_DRG Acute Leukemia With Mcc 30 19 — — $40,344.88 $122,530.64 $40,344.88 2024-12-02
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 30 19 — — $34,591.21 $106,007.94 $34,591.21 2024-12-02
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 30 19 — — $36,248.87 $109,406.58 $36,248.87 2024-12-02
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 30 19 — — $32,349.56 $96,912.79 $32,349.56 2024-12-02
870 MS_DRG Septicemia Or Severe Sepsis With Mv &gt;96 Hours 30 19 — — $49,674.10 $152,422.52 $49,674.10 2024-12-02
901 MS_DRG Wound Debridements For Injuries With Mcc 30 19 — — $31,662.46 $94,711.22 $31,662.46 2024-12-02
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv &gt;96 Hours With Skin Graft 24 19 — — $182,135.63 $576,843.81 $182,135.63 2024-12-02
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 24 19 — — $49,365.38 $151,433.34 $49,365.38 2024-12-02
92933 CPT Hc Cor Atherectomy & Bare Metal Stent Initial Vessel 67 22 $57,021.60 $22,808.64 60% off $629.25 $52,459.87 $32,388.27 2024-12-02
92941 CPT Hc Cor Revasc Acute Mi Bare Metal Stent/pta/atherect Initial Ves 67 22 $57,021.60 $22,808.64 60% off $630.08 $52,459.87 $32,388.27 2024-12-02
92943 CPT Hc Cor Revasc Chronic Occ Bare Metal Stent/pta/atherect Initial Ves 67 22 $57,021.60 $22,808.64 60% off $630.52 $52,459.87 $31,475.92 2024-12-02
92944 CPT Hc Cor Revasc Chronic Occ Bare Metal Stent/pta/atherect Addl Ves 51 22 $56,478.54 $22,591.42 60% off $13,120.61 $51,960.26 $36,736.47 2024-12-02
93656 CPT Hc Comp Ep Eval W Pv Iso Abl 67 22 $58,000.22 $23,200.09 60% off $919.54 $53,360.20 $35,670.14 2024-12-02
955 MS_DRG Craniotomy For Multiple Significant Trauma 25 19 — — $43,699.82 $133,280.25 $43,699.82 2024-12-02
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 25 19 — — $51,501.84 $158,278.78 $51,501.84 2024-12-02
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 30 19 — — $49,043.69 $150,402.59 $49,043.69 2024-12-02
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 30 19 — — $34,480.56 $103,740.71 $34,480.56 2024-12-02
984 MS_DRG DRG 1 1 — — $46,029.89 $46,029.89 $46,029.89 2024-12-02
A0105 LOCAL Stroke M <41.50 And A >=84.50 16 16 — — $33,732.21 $33,732.21 $33,732.21 2024-12-02
A0106 LOCAL Stroke M <41.50 And A <84.50 16 16 — — $38,528.88 $38,528.88 $38,528.88 2024-12-02
A0205 LOCAL Traumatic Brain Injury M <35.50 16 16 — — $33,108.27 $33,108.27 $33,108.27 2024-12-02
A0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50 16 16 — — $40,878.05 $40,878.05 $40,878.05 2024-12-02
A0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50 16 16 — — $33,751.88 $33,751.88 $33,751.88 2024-12-02
A0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 16 16 — — $44,058.54 $44,058.54 $44,058.54 2024-12-02
A0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 16 — — $55,448.62 $55,448.62 $55,448.62 2024-12-02
A0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50 16 16 — — $36,653.48 $36,653.48 $36,653.48 2024-12-02
A1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 16 16 — — $30,832.40 $30,832.40 $30,832.40 2024-12-02
A1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 16 16 — — $42,260.02 $42,260.02 $42,260.02 2024-12-02
A1903 LOCAL Guillain-barré M >=38.50 And M <51.50 16 16 — — $30,893.18 $30,893.18 $30,893.18 2024-12-02
A1904 LOCAL Guillain-barré M <38.50 16 16 — — $47,669.90 $47,669.90 $47,669.90 2024-12-02
A5102 LOCAL Expired, Orthopedic, Length Of Stay Is 14 Days Or More 16 16 — — $33,846.63 $33,846.63 $33,846.63 2024-12-02
A5104 LOCAL Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More 16 16 — — $40,504.40 $40,504.40 $40,504.40 2024-12-02
A9543 HCPCS Y-90 Zevalin 50 22 $70,810.44 $28,324.18 60% off $26,971.70 $122,128.94 $50,516.17 2024-12-02
B0104 LOCAL Stroke M >=41.50 And M <50.50 16 16 — — $37,314.96 $37,314.96 $37,314.96 2024-12-02
B0105 LOCAL Stroke M <41.50 And A >=84.50 16 16 — — $44,948.87 $44,948.87 $44,948.87 2024-12-02
B0106 LOCAL Stroke M <41.50 And A <84.50 16 16 — — $51,342.04 $51,342.04 $51,342.04 2024-12-02
B0203 LOCAL Traumatic Brain Injury M >=49.50 And M <61.50 16 16 — — $30,844.91 $30,844.91 $30,844.91 2024-12-02
B0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50 16 16 — — $38,069.41 $38,069.41 $38,069.41 2024-12-02
B0205 LOCAL Traumatic Brain Injury M <35.50 16 16 — — $48,317.08 $48,317.08 $48,317.08 2024-12-02
B0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50 16 16 — — $33,108.27 $33,108.27 $33,108.27 2024-12-02
B0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50 16 16 — — $38,532.45 $38,532.45 $38,532.45 2024-12-02
B0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50 16 16 — — $42,029.39 $42,029.39 $42,029.39 2024-12-02
B0402 LOCAL Traumatic Spinal Cord Injury M >=47.50 And M <56.50 16 16 — — $30,330.03 $30,330.03 $30,330.03 2024-12-02
B0403 LOCAL Traumatic Spinal Cord Injury M >=41.50 And M <47.50 16 16 — — $37,427.59 $37,427.59 $37,427.59 2024-12-02
B0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50 16 16 — — $56,338.94 $56,338.94 $56,338.94 2024-12-02
B0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50 16 16 — — $46,518.56 $46,518.56 $46,518.56 2024-12-02
B0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 16 16 — — $60,722.63 $60,722.63 $60,722.63 2024-12-02
B0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 16 — — $76,419.51 $76,419.51 $76,419.51 2024-12-02
B0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50 16 16 — — $31,817.48 $31,817.48 $31,817.48 2024-12-02
B0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 16 16 — — $38,623.63 $38,623.63 $38,623.63 2024-12-02
B0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50 16 16 — — $53,065.48 $53,065.48 $53,065.48 2024-12-02
B0603 LOCAL Neurological M >=43.50 And M <52.50 16 16 — — $35,800.70 $35,800.70 $35,800.70 2024-12-02
B0604 LOCAL Neurological M <43.50 16 16 — — $44,408.95 $44,408.95 $44,408.95 2024-12-02
B0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50 16 16 — — $33,998.59 $33,998.59 $33,998.59 2024-12-02
B0704 LOCAL Fracture Of Lower Extremity M <41.50 16 16 — — $40,931.68 $40,931.68 $40,931.68 2024-12-02
B0805 LOCAL Replacement Of Lower-extremity Joint M <42.50 16 16 — — $35,092.73 $35,092.73 $35,092.73 2024-12-02
B0903 LOCAL Other Orthopedic M >=44.50 And M <51.50 16 16 — — $32,257.28 $32,257.28 $32,257.28 2024-12-02
B0904 LOCAL Other Orthopedic M <44.5 16 16 — — $37,706.49 $37,706.49 $37,706.49 2024-12-02
B1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50 16 16 — — $32,114.25 $32,114.25 $32,114.25 2024-12-02
B1004 LOCAL Amputation Lower Extremity M <47.50 16 16 — — $40,289.86 $40,289.86 $40,289.86 2024-12-02
B1103 LOCAL Amputation Non-lower Extremity M <52.50 16 16 — — $38,900.74 $38,900.74 $38,900.74 2024-12-02
B1202 LOCAL Osteoarthritis M >=49.50 And M <61.50 16 16 — — $30,530.26 $30,530.26 $30,530.26 2024-12-02
B1203 LOCAL Osteoarthritis M <49.50 And A >=74.50 16 16 — — $37,556.31 $37,556.31 $37,556.31 2024-12-02
B1204 LOCAL Osteoarthritis M <49.50 And A <74.50 16 16 — — $38,696.93 $38,696.93 $38,696.93 2024-12-02
B1303 LOCAL Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50 16 16 — — $33,476.56 $33,476.56 $33,476.56 2024-12-02
B1304 LOCAL Rheumatoid Other Arthritis M <44.50 And A >=64.50 16 16 — — $41,058.61 $41,058.61 $41,058.61 2024-12-02
B1305 LOCAL Rheumatoid Other Arthritis M <51.50 And A <64.50 16 16 — — $37,896.00 $37,896.00 $37,896.00 2024-12-02
B1403 LOCAL Cardiac M >=45.50 And M <55.50 16 16 — — $31,474.22 $31,474.22 $31,474.22 2024-12-02
B1404 LOCAL Cardiac M <45.50 16 16 — — $38,555.69 $38,555.69 $38,555.69 2024-12-02
B1503 LOCAL Pulmonary M >=45.50 And M <56.50 16 16 — — $33,512.31 $33,512.31 $33,512.31 2024-12-02
B1504 LOCAL Pulmonary M <45.50 16 16 — — $39,966.27 $39,966.27 $39,966.27 2024-12-02
B1604 LOCAL Pain Syndrome M <43.50 16 16 — — $35,789.97 $35,789.97 $35,789.97 2024-12-02
B1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50 16 16 — — $34,236.37 $34,236.37 $34,236.37 2024-12-02
B1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50 16 16 — — $38,798.84 $38,798.84 $38,798.84 2024-12-02
B1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 16 16 — — $44,380.35 $44,380.35 $44,380.35 2024-12-02
B1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 16 16 — — $32,827.58 $32,827.58 $32,827.58 2024-12-02
B1804 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 16 16 — — $38,046.17 $38,046.17 $38,046.17 2024-12-02
B1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 16 16 — — $45,252.79 $45,252.79 $45,252.79 2024-12-02
B1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 16 16 — — $62,027.72 $62,027.72 $62,027.72 2024-12-02
B1903 LOCAL Guillain-barré M >=38.50 And M <51.50 16 16 — — $37,280.99 $37,280.99 $37,280.99 2024-12-02
B1904 LOCAL Guillain-barré M <38.50 16 16 — — $57,526.04 $57,526.04 $57,526.04 2024-12-02
B2003 LOCAL Miscellaneous M >=46.50 And M <55.50 16 16 — — $31,597.58 $31,597.58 $31,597.58 2024-12-02
B2004 LOCAL Miscellaneous M <46.50 And A >=77.50 16 16 — — $37,171.94 $37,171.94 $37,171.94 2024-12-02
B2005 LOCAL Miscellaneous M <46.50 And A <77.50 16 16 — — $39,826.82 $39,826.82 $39,826.82 2024-12-02
B2102 LOCAL Burns M <52.50 16 16 — — $42,903.62 $42,903.62 $42,903.62 2024-12-02
C0104 LOCAL Stroke M >=41.50 And M <50.50 16 16 — — $32,516.51 $32,516.51 $32,516.51 2024-12-02
C0105 LOCAL Stroke M <41.50 And A >=84.50 16 16 — — $39,168.91 $39,168.91 $39,168.91 2024-12-02
C0106 LOCAL Stroke M <41.50 And A <84.50 16 16 — — $44,739.70 $44,739.70 $44,739.70 2024-12-02
C0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50 16 16 — — $30,664.35 $30,664.35 $30,664.35 2024-12-02
C0205 LOCAL Traumatic Brain Injury M <35.50 16 16 — — $38,918.62 $38,918.62 $38,918.62 2024-12-02
C0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50 16 16 — — $31,061.24 $31,061.24 $31,061.24 2024-12-02
C0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50 16 16 — — $33,880.60 $33,880.60 $33,880.60 2024-12-02
C0403 LOCAL Traumatic Spinal Cord Injury M >=41.50 And M <47.50 16 16 — — $31,111.30 $31,111.30 $31,111.30 2024-12-02
C0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50 16 16 — — $46,831.42 $46,831.42 $46,831.42 2024-12-02
C0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50 16 16 — — $38,668.33 $38,668.33 $38,668.33 2024-12-02
C0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 16 16 — — $50,474.96 $50,474.96 $50,474.96 2024-12-02
C0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 16 — — $63,524.11 $63,524.11 $63,524.11 2024-12-02
C0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 16 16 — — $30,417.63 $30,417.63 $30,417.63 2024-12-02
C0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50 16 16 — — $41,791.61 $41,791.61 $41,791.61 2024-12-02
C0604 LOCAL Neurological M <43.50 16 16 — — $33,217.32 $33,217.32 $33,217.32 2024-12-02
C0704 LOCAL Fracture Of Lower Extremity M <41.50 16 16 — — $31,737.03 $31,737.03 $31,737.03 2024-12-02
C0904 LOCAL Other Orthopedic M <44.5 16 16 — — $30,199.52 $30,199.52 $30,199.52 2024-12-02
C1004 LOCAL Amputation Lower Extremity M <47.50 16 16 — — $35,015.85 $35,015.85 $35,015.85 2024-12-02
C1103 LOCAL Amputation Non-lower Extremity M <52.50 16 16 — — $38,900.74 $38,900.74 $38,900.74 2024-12-02
C1204 LOCAL Osteoarthritis M <49.50 And A <74.50 16 16 — — $30,762.67 $30,762.67 $30,762.67 2024-12-02
C1304 LOCAL Rheumatoid Other Arthritis M <44.50 And A >=64.50 16 16 — — $32,024.86 $32,024.86 $32,024.86 2024-12-02
C1404 LOCAL Cardiac M <45.50 16 16 — — $30,451.60 $30,451.60 $30,451.60 2024-12-02
C1504 LOCAL Pulmonary M <45.50 16 16 — — $31,118.45 $31,118.45 $31,118.45 2024-12-02
C1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50 16 16 — — $30,567.80 $30,567.80 $30,567.80 2024-12-02
C1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 16 16 — — $34,965.79 $34,965.79 $34,965.79 2024-12-02
C1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 16 16 — — $35,643.37 $35,643.37 $35,643.37 2024-12-02
C1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 16 16 — — $48,855.21 $48,855.21 $48,855.21 2024-12-02
C1903 LOCAL Guillain-barré M >=38.50 And M <51.50 16 16 — — $34,005.74 $34,005.74 $34,005.74 2024-12-02
C1904 LOCAL Guillain-barré M <38.50 16 16 — — $52,471.93 $52,471.93 $52,471.93 2024-12-02
C2004 LOCAL Miscellaneous M <46.50 And A >=77.50 16 16 — — $30,029.68 $30,029.68 $30,029.68 2024-12-02
C2005 LOCAL Miscellaneous M <46.50 And A <77.50 16 16 — — $32,173.25 $32,173.25 $32,173.25 2024-12-02
C2102 LOCAL Burns M <52.50 16 16 — — $32,219.73 $32,219.73 $32,219.73 2024-12-02
C2616 HCPCS Yttrium-90 Brachytx Src Non-stranded 51 22 $79,875.00 $31,950.00 60% off $23,266.25 $73,485.00 $48,375.62 2024-12-02
C9602 HCPCS Hc Cor Atherectomy & Drug-eluting Stent Inital Ves 51 22 $57,687.05 $23,074.82 60% off $13,120.61 $53,072.09 $37,522.54 2024-12-02
C9606 HCPCS Hc Cor Revasc Acute Mi Drug-eluting Stent/pta/atherect Initial Ves 51 22 $57,155.30 $22,862.12 60% off $13,120.61 $52,582.88 $32,851.75 2024-12-02
C9607 HCPCS Hc Cor Revasc Chronic Occ Drug-eluting Stent/pta/atherect Initial Ves 51 22 $59,298.39 $23,719.36 60% off $13,120.61 $54,554.52 $38,570.64 2024-12-02
C9608 HCPCS Hc Cor Revasc Chronic Occ Drug-eluting Stent/pta/atherect Addl Ves 51 22 $51,566.06 $20,626.42 60% off $13,120.61 $47,440.78 $33,541.14 2024-12-02
D0105 LOCAL Stroke M <41.50 And A >=84.50 16 16 — — $35,562.92 $35,562.92 $35,562.92 2024-12-02
D0106 LOCAL Stroke M <41.50 And A <84.50 16 16 — — $40,620.60 $40,620.60 $40,620.60 2024-12-02
D0205 LOCAL Traumatic Brain Injury M <35.50 16 16 — — $35,219.66 $35,219.66 $35,219.66 2024-12-02
D0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50 16 16 — — $31,404.49 $31,404.49 $31,404.49 2024-12-02
D0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50 16 16 — — $44,446.50 $44,446.50 $44,446.50 2024-12-02
D0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50 16 16 — — $36,698.17 $36,698.17 $36,698.17 2024-12-02
D0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 16 16 — — $47,905.89 $47,905.89 $47,905.89 2024-12-02
D0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50 16 16 — — $60,288.19 $60,288.19 $60,288.19 2024-12-02
D0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50 16 16 — — $39,497.87 $39,497.87 $39,497.87 2024-12-02
D0604 LOCAL Neurological M <43.50 16 16 — — $31,467.07 $31,467.07 $31,467.07 2024-12-02
D0704 LOCAL Fracture Of Lower Extremity M <41.50 16 16 — — $30,310.36 $30,310.36 $30,310.36 2024-12-02
D1004 LOCAL Amputation Lower Extremity M <47.50 16 16 — — $30,399.75 $30,399.75 $30,399.75 2024-12-02
D1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 16 16 — — $32,788.25 $32,788.25 $32,788.25 2024-12-02
D1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 16 16 — — $33,347.83 $33,347.83 $33,347.83 2024-12-02
D1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 16 16 — — $45,708.68 $45,708.68 $45,708.68 2024-12-02
D1903 LOCAL Guillain-barré M >=38.50 And M <51.50 16 16 — — $32,632.71 $32,632.71 $32,632.71 2024-12-02
D1904 LOCAL Guillain-barré M <38.50 16 16 — — $50,353.39 $50,353.39 $50,353.39 2024-12-02
D2102 LOCAL Burns M <52.50 16 16 — — $30,557.08 $30,557.08 $30,557.08 2024-12-02
E0766 HCPCS Elec Stim Cancer Treatment 1 1 — — $45,226.91 $45,226.91 $45,226.91 2024-12-02
J2350 HCPCS Ocrelizumab 30 Mg/ml Intravenous Solution 51 22 $69,000.33 $27,600.13 60% off $24,150.12 $63,480.30 $44,881.26 2024-12-02
J2507 HCPCS Pegloticase 8 Mg/ml Intravenous Solution 73 22 $65,041.27 $26,016.51 60% off $4,074.21 $92,193.75 $42,306.10 2024-12-02
J3241 HCPCS Teprotumumab-trbw 500 Mg Intravenous Solution 51 22 $55,721.05 $22,288.42 60% off $19,502.37 $51,263.37 $36,243.76 2024-12-02
J3245 HCPCS Tildrakizumab-asmn 100 Mg/ml Subcutaneous Syringe 35 11 $60,331.15 $24,132.46 60% off $173.72 $55,504.66 $34,268.09 2024-12-02
J3357 HCPCS Ustekinumab 90 Mg/ml Subcutaneous Syringe 51 22 $97,449.98 $38,979.99 60% off $190.14 $89,653.98 $63,386.34 2024-12-02
J7311 HCPCS Fluocinolone 0.59 Mg Intravitreal Implant 35 11 $66,587.50 $26,635.00 60% off $369.33 $61,260.50 $37,821.70 2024-12-02
J9226 HCPCS Supprelin La Implant 7 2 — — $55,051.29 $112,420.52 $67,443.40 2024-12-02
J9266 HCPCS Pegaspargase 750 Unit/ml Injection Solution 51 22 $65,104.83 $26,041.93 60% off $22,786.69 $65,020.84 $43,903.76 2024-12-02
J9269 HCPCS Tagraxofusp-erzs 1,000 Mcg/ml Intravenous Solution 51 22 $108,194.38 $43,277.75 60% off $37,868.03 $99,538.83 $70,375.04 2024-12-02
J9281 HCPCS Mitomycin 40 Mg X 2 Intra-pyelocalyceal Kit 51 22 $82,845.00 $33,138.00 60% off $371.43 $76,217.40 $53,886.53 2024-12-02
J9298 HCPCS Nivolumab 240 Mg-relatlimab-rmbw 80 Mg/20 Ml Intravenous Solution 51 22 $50,863.68 $20,345.47 60% off $17,802.29 $46,794.59 $32,298.44 2024-12-02
J9600 HCPCS Porfimer Sodium Injection 4 1 — — $28,627.45 $44,641.59 $35,068.51 2024-12-02
L5856 HCPCS Elec Knee-shin Swing/stance 1 1 — — $82,430.80 $82,430.80 $82,430.80 2024-12-02
L5858 HCPCS Stance Phase Only 1 1 — — $63,862.38 $63,862.38 $63,862.38 2024-12-02
L5859 HCPCS Knee-shin Pro Flex/ext Cont 1 1 — — $49,856.77 $49,856.77 $49,856.77 2024-12-02
L5973 HCPCS Ank-foot Sys Dors-plant Flex 1 1 — — $59,930.72 $59,930.72 $59,930.72 2024-12-02
L6880 HCPCS Elec Hand Ind Art Digits 1 1 — — $82,263.57 $82,263.57 $82,263.57 2024-12-02
L6935 HCPCS Below Elbow Myoelectronic CT 1 1 — — $30,924.79 $30,924.79 $30,924.79 2024-12-02
L6940 HCPCS Elbow Disarticulation Switch 1 1 — — $39,532.09 $39,532.09 $39,532.09 2024-12-02
L6945 HCPCS Elbow Disart Myoelectronic C 1 1 — — $45,991.00 $45,991.00 $45,991.00 2024-12-02
L6950 HCPCS Above Elbow Switch Control 1 1 — — $44,933.80 $44,933.80 $44,933.80 2024-12-02
L6955 HCPCS Above Elbow Myoelectronic CT 1 1 — — $53,814.35 $53,814.35 $53,814.35 2024-12-02
L6960 HCPCS Shldr Disartic Switch Contro 1 1 — — $54,275.83 $54,275.83 $54,275.83 2024-12-02
L6965 HCPCS Shldr Disartic Myoelectronic 1 1 — — $58,804.85 $58,804.85 $58,804.85 2024-12-02
L6970 HCPCS Interscapular-thor Switch CT 1 1 — — $59,530.84 $59,530.84 $59,530.84 2024-12-02
L6975 HCPCS Interscap-thor Myoelectronic 1 1 — — $63,781.38 $63,781.38 $63,781.38 2024-12-02
L7180 HCPCS Electronic Elbow Sequential 1 1 — — $120,655.92 $120,655.92 $120,655.92 2024-12-02
L7181 HCPCS Electronic Elbo Simultaneous 1 1 — — $137,681.92 $137,681.92 $137,681.92 2024-12-02
L7186 HCPCS Electron Elbow Child Switch 1 1 — — $39,092.64 $39,092.64 $39,092.64 2024-12-02
L7191 HCPCS Elbow Child Myoelectronic CT 1 1 — — $40,053.27 $40,053.27 $40,053.27 2024-12-02
L8614 HCPCS Cochlear Device 1 1 — — $65,608.09 $65,608.09 $65,608.09 2024-12-02
Q0479 HCPCS Power Module Combo Vad, Rep 1 1 — — $41,248.02 $41,248.02 $41,248.02 2024-12-02
Q0480 HCPCS Driver Pneumatic Vad, Rep 1 1 — — $310,098.74 $310,098.74 $310,098.74 2024-12-02
Q0481 HCPCS Microprcsr Cu Elec Vad, Rep 1 1 — — $50,030.89 $50,030.89 $50,030.89 2024-12-02
Q0483 HCPCS Monitor Elec Vad, Rep 1 1 — — $64,555.85 $64,555.85 $64,555.85 2024-12-02
Q0489 HCPCS Pwr Pck Base Combo Vad, Rep 1 1 — — $55,966.45 $55,966.45 $55,966.45 2024-12-02
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 3 1 — — $555,058.40 $1,133,487.68 $680,002.72 2024-12-02
Q2042 HCPCS Tisagenlecleucel Car-pos T 3 1 — — $631,174.54 $1,288,924.85 $773,252.69 2024-12-02
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 7 2 — — $65,981.93 $134,742.04 $80,834.54 2024-12-02
Q2055 HCPCS Idecabtagene Vicleucel Car 3 1 — — $598,592.52 $1,222,388.94 $733,336.42 2024-12-02
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