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

LAKEVIEW HOSPITAL

Bountiful, UT · CCN 460042 · Rates published

22,784 distinct procedures filed
53 distinct payers
530,772 rate rows
2026-03-31 last MRF observed
Data quality

290,476 of 530,772 rate rows are consumer-grade (54.7%)

240,296 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 234,475
per-diem day rate — not a per-procedure price 4,768
template filing: same amount across many unrelated codes — excluded 772
placeholder amount (≤ $0.02) — excluded from medians 146
exceeds 10× this hospital's gross charge — excluded from medians 89
percent-of-charges filed in the dollar field — excluded from medians 27
exceeds 3× this hospital's gross charge for a DRG stay — excluded 19
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.hcadam.com/api/public/content/ff147b50990440edae816f9adf8525e8?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 · 2026-05-15
Content fingerprint da0a759d449ab12b… · 310,135,379 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
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 1 $3,672,900.00 $3,672,900.00 $3,672,900.00 nat. median
$3,574,709
1.0× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 8 $3,202,768.80 $3,709,629.00 $3,672,900.00 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 8 $3,143,560.00 $3,641,050.00 $3,605,000.00 nat. median
$3,605,000
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 9 $5,166.40 $3,358,709.55 $3,325,455.00 nat. median
$13,041
outlier · 255.0×
00714
OTHER 		Inj Delandistrogene Mox R 1 $3,325,455.00 $3,325,455.00 $3,325,455.00 nat. median
$3,228,024
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 9 $8,521.96 $3,318,860.00 $3,286,000.00 nat. median
$17,963
outlier · 182.9×
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
746
OTHER 		Inj, Betibeglogene Autote 9 $7,569.19 $2,997,680.00 $2,968,000.00 nat. median
$21,896
outlier · 135.6×
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
09141
OTHER 		Inj Onase Abepar-xioi Tre 1 $2,388,614.00 $2,388,614.00 $2,388,614.00 nat. median
$2,457,321
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 8 $2,082,871.41 $2,412,500.14 $2,388,614.00 nat. median
$2,588,981
0.9× median
09194
OTHER 		Tisagenlecleucel Car-pos 1 $529,192.90 $529,192.90 $529,192.90 nat. median
$538,205
1.0× median
9194
OTHER 		Tisagenlecleucel Car-pos 8 $461,456.21 $534,484.83 $529,192.90 nat. median
$566,531
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 8 $459,651.60 $532,394.63 $527,123.40 nat. median
$587,650
0.9× median
09498
OTHER 		Ciltacabtagene Car-pos T 1 $527,123.40 $527,123.40 $527,123.40 nat. median
$554,552
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $526,587.60 $526,587.60 $526,587.60 nat. median
$530,178
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 8 $459,184.39 $531,853.48 $526,587.60 nat. median
$558,082
0.9× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 1 $518,241.00 $518,241.00 $518,241.00 nat. median
$753,246
0.7× median
9413
OTHER 		Lisocabtagene Car Pos T 8 $450,585.16 $521,893.36 $516,726.10 nat. median
$562,201
0.9× median
09413
OTHER 		Lisocabtagene Car Pos T 1 $516,726.10 $516,726.10 $516,726.10 nat. median
$534,091
1.0× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 1 $507,496.00 $507,496.00 $507,496.00 nat. median
$674,867
0.8× median
9035
OTHER 		Axicabtagene Ciloleucel C 8 $426,805.63 $494,350.56 $489,456.00 nat. median
$532,192
0.9× median
09035
OTHER 		Axicabtagene Ciloleucel C 1 $489,456.00 $489,456.00 $489,456.00 nat. median
$505,583
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 1 $484,690.00 $484,690.00 $484,690.00 nat. median
$625,184
0.8× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 1 $474,061.00 $474,061.00 $474,061.00 nat. median
$673,137
0.7× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $460,530.40 $460,530.40 $460,530.40 nat. median
$464,978
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 8 $401,582.51 $465,135.70 $460,530.40 nat. median
$489,450
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 1 $459,381.00 $459,381.00 $459,381.00 nat. median
$634,303
0.7× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 1 $449,440.00 $449,440.00 $449,440.00 nat. median
$619,808
0.7× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 24 $235,461.70 $1,026,253.41 $446,742.24 nat. median
$370,174
1.2× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 23 $173,187.15 $572,423.53 $268,846.92 nat. median
$265,286
1.0× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 24 $136,258.04 $593,876.96 $254,180.62 nat. median
$202,976
1.3× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 22 $146,105.99 $734,221.59 $224,240.62 nat. median
$206,474
1.1× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 24 $93,947.70 $409,468.50 $175,253.40 nat. median
$133,161
1.3× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $175,119.46 $175,119.46 $175,119.46 nat. median
$263,894
0.7× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 23 $74,673.79 $296,378.04 $158,764.92 nat. median
$108,660
1.5× median
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 $113,274.48 $184,643.96 $149,941.37 nat. median
$62,507
outlier · 2.4×
1908
OTHER 		New Technology - Level 52 8 $127,060.17 $147,168.31 $145,711.20 nat. median
$152,962
1.0× median
1907
OTHER 		New Technology - Level 52 8 $127,060.17 $147,168.31 $145,711.20 nat. median
$153,199
1.0× median
01908
OTHER 		New Technology - Level 52 1 $145,711.20 $145,711.20 $145,711.20 nat. median
$82,736
1.8× median
01907
OTHER 		New Technology - Level 52 1 $145,711.20 $145,711.20 $145,711.20 nat. median
$84,819
1.7× median
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $144,499.39 $144,499.39 $144,499.39 nat. median
$424,868
outlier · 0.3×
7
MS_DRG 		Lung Transplant 24 $78,394.56 $234,367.95 $144,207.45 nat. median
$122,708
1.2× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 24 $66,146.85 $225,151.15 $141,805.35 nat. median
$100,136
1.4× median
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 14 $56,633.21 $246,834.30 $139,106.26 nat. median
$87,428
1.6× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 23 $73,246.61 $252,136.89 $131,567.00 nat. median
$117,357
1.1× median
01905
OTHER 		New Technology - Level 51 1 $131,379.00 $131,379.00 $131,379.00 nat. median
$82,736
1.6× median
01906
OTHER 		New Technology - Level 51 1 $131,379.00 $131,379.00 $131,379.00 nat. median
$82,736
1.6× median
1906
OTHER 		New Technology - Level 51 8 $114,562.49 $132,692.79 $131,379.00 nat. median
$138,020
1.0× median

Other procedures at this hospital

Browse this hospital's 22,784 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $175,119.46 $175,119.46 $175,119.46 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $65,999.16 $65,999.16 $65,999.16 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $117,295.01 $117,295.01 $117,295.01 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $82,472.97 $82,472.97 $82,472.97 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $54,251.30 $54,251.30 $54,251.30 2024-10-01
007 OTHER Lung Transplant 1 1 — — $66,119.11 $66,119.11 $66,119.11 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
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $63,354.77 $63,354.77 $63,354.77 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
00748 OTHER Inj, Lovotibeglogene Auto 1 1 — — $3,286,000.00 $3,286,000.00 $3,286,000.00 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
01142 OTHER Supprelin La Implant 1 1 — — $45,350.21 $45,350.21 $45,350.21 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $76,631.57 $76,631.57 $76,631.57 2024-10-01
01580 OTHER New Technology - Level 43 1 1 — — $42,997.08 $42,997.08 $42,997.08 2024-10-01
01581 OTHER New Technology - Level 44 1 1 — — $52,551.88 $52,551.88 $52,551.88 2024-10-01
01582 OTHER New Technology - Level 45 1 1 — — $62,106.68 $62,106.68 $62,106.68 2024-10-01
01583 OTHER New Technology - Level 46 1 1 — — $71,661.48 $71,661.48 $71,661.48 2024-10-01
01584 OTHER New Technology - Level 47 1 1 — — $81,216.28 $81,216.28 $81,216.28 2024-10-01
01585 OTHER New Technology - Level 48 1 1 — — $90,771.08 $90,771.08 $90,771.08 2024-10-01
01594 OTHER New Technology - Level 43 1 1 — — $42,997.08 $42,997.08 $42,997.08 2024-10-01
01595 OTHER New Technology - Level 44 1 1 — — $52,551.88 $52,551.88 $52,551.88 2024-10-01
01596 OTHER New Technology - Level 45 1 1 — — $62,106.68 $62,106.68 $62,106.68 2024-10-01
01597 OTHER New Technology - Level 46 1 1 — — $71,661.48 $71,661.48 $71,661.48 2024-10-01
01598 OTHER New Technology - Level 47 1 1 — — $81,216.28 $81,216.28 $81,216.28 2024-10-01
01599 OTHER New Technology - Level 48 1 1 — — $90,771.08 $90,771.08 $90,771.08 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $65,476.58 $65,476.58 $65,476.58 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $144,499.39 $144,499.39 $144,499.39 2024-10-01
019 OTHER Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 1 — — $43,087.14 $43,087.14 $43,087.14 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
01903 OTHER New Technology - Level 50 1 1 — — $117,046.80 $117,046.80 $117,046.80 2024-10-01
01904 OTHER New Technology - Level 50 1 1 — — $117,046.80 $117,046.80 $117,046.80 2024-10-01
01905 OTHER New Technology - Level 51 1 1 — — $131,379.00 $131,379.00 $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
01907 OTHER New Technology - Level 52 1 1 — — $145,711.20 $145,711.20 $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
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $56,294.75 $56,294.75 $56,294.75 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $44,172.48 $44,172.48 $44,172.48 2024-10-01
0238T CPT Transluminal Peripheral Atherectomy, Open Or Percutaneous, Including Radiologica… 7 1 — — $29,717.25 $48,440.83 $39,336.70 2024-10-01
0266T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Total… 7 1 — — $50,790.17 $82,790.91 $67,230.92 2024-10-01
0268T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Pulse… 7 1 — — $50,790.17 $82,790.91 $67,230.92 2024-10-01
0408T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 11 2 — — $9,242.00 $90,455.25 $61,586.55 2024-10-01
0409T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 11 2 — — $6,465.00 $64,347.66 $43,811.17 2024-10-01
0414T CPT Removal And Replacement Of Permanent Cardiac Contractility Modulation System Pul… 11 2 — — $6,465.00 $64,347.66 $43,811.17 2024-10-01
0424T CPT Insertion Or Replacement Of Neurostimulator System For Treatment Of Central Slee… 11 2 — — $5,254.00 $155,101.41 $105,600.96 2024-10-01
0427T CPT Insertion Or Replacement Of Neurostimulator System For Treatment Of Central Slee… 11 2 — — $3,501.00 $82,790.91 $56,368.28 2024-10-01
0431T CPT Removal And Replacement Of Neurostimulator System For Treatment Of Central Sleep… 11 2 — — $5,254.00 $82,790.91 $56,368.28 2024-10-01
0515T CPT Insertion Of Wireless Cardiac Stimulator For Left Ventricular Pacing, Including … 11 2 — — $5,645.00 $64,347.66 $43,811.17 2024-10-01
0520T CPT Removal And Replacement Of Pulse Generator For Wireless Cardiac Stimulator For L… 11 2 — — $5,645.00 $64,347.66 $43,811.17 2024-10-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $49,748.18 $49,748.18 $49,748.18 2024-10-01
0571T CPT Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S… 11 2 — — $6,465.00 $90,455.25 $61,586.55 2024-10-01
0614T CPT Removal And Replacement Of Substernal Implantable Defibrillator Pulse Generator 11 2 — — $6,608.00 $64,347.66 $43,811.17 2024-10-01
0645T CPT Transcatheter Implantation Of Coronary Sinus Reduction Device Including Vascular… 7 1 — — $29,717.25 $48,440.83 $39,336.70 2024-10-01
0775T CPT Arthrodesis, Sacroiliac Joint, Percutaneous, With Image Guidance, Includes Place… 11 2 — — $5,821.00 $61,751.32 $42,043.45 2024-10-01
0809T CPT Arthrodesis, Sacroiliac Joint, Percutaneous Or Minimally Invasive, With Image Gu… 11 2 — — $6,608.00 $61,751.32 $42,043.45 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $489,456.00 $489,456.00 $489,456.00 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 1 1 — — $3,672,900.00 $3,672,900.00 $3,672,900.00 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
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $529,192.90 $529,192.90 $529,192.90 2024-10-01
09273 OTHER Sipuleucel-t Auto Cd54+ 1 1 — — $55,015.23 $55,015.23 $55,015.23 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $460,530.40 $460,530.40 $460,530.40 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $516,726.10 $516,726.10 $516,726.10 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $526,587.60 $526,587.60 $526,587.60 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $527,123.40 $527,123.40 $527,123.40 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 38 23 — — $173,187.15 $572,423.53 $268,846.92 2024-10-01
10 MS_DRG Pancreas Transplant 41 24 — — $30,763.72 $86,231.64 $57,105.50 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 $64,013.53 2024-10-01
1142 OTHER Supprelin La Implant 11 8 — — $39,545.38 $45,803.71 $45,350.21 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 $49,243.91 2024-10-01
129 MS_DRG Major Head & Neck Procedures W Cc/mcc Or Major Device 1 1 — — $45,254.88 $45,254.88 $45,254.88 2024-10-01
131 MS_DRG Cranial/facial Procedures W Cc/mcc 1 1 — — $53,162.08 $53,162.08 $53,162.08 2024-10-01
133 MS_DRG Other Ear, Nose, Mouth & Throat O.r. Procedures W Cc/mcc 1 1 — — $42,439.92 $42,439.92 $42,439.92 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 37 23 — — $73,246.61 $252,136.89 $131,567.00 2024-10-01
140 MS_DRG Major Head And Neck Procedures With Mcc 43 24 — — $24,145.84 $105,238.98 $49,099.27 2024-10-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 43 24 — — $21,253.91 $92,634.59 $39,494.27 2024-10-01
1580 OTHER New Technology - Level 43 11 8 — — $37,493.45 $43,427.05 $42,997.08 2024-10-01
1581 OTHER New Technology - Level 44 11 8 — — $45,825.24 $53,077.40 $52,551.88 2024-10-01
1582 OTHER New Technology - Level 45 11 8 — — $54,157.02 $62,727.75 $62,106.68 2024-10-01
1583 OTHER New Technology - Level 46 11 8 — — $62,488.81 $72,378.09 $71,661.48 2024-10-01
1584 OTHER New Technology - Level 47 11 8 — — $70,820.60 $82,028.44 $81,216.28 2024-10-01
1585 OTHER New Technology - Level 48 11 8 — — $79,152.38 $91,678.79 $90,771.08 2024-10-01
1594 OTHER New Technology - Level 43 11 8 — — $37,493.45 $43,427.05 $42,997.08 2024-10-01
1595 OTHER New Technology - Level 44 11 8 — — $45,825.24 $53,077.40 $52,551.88 2024-10-01
1596 OTHER New Technology - Level 45 11 8 — — $54,157.02 $62,727.75 $62,106.68 2024-10-01
1597 OTHER New Technology - Level 46 11 8 — — $62,488.81 $72,378.09 $71,661.48 2024-10-01
1598 OTHER New Technology - Level 47 11 8 — — $70,820.60 $82,028.44 $81,216.28 2024-10-01
1599 OTHER New Technology - Level 48 11 8 — — $79,152.38 $91,678.79 $90,771.08 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 37 23 — — $39,477.21 $136,106.63 $71,518.00 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 44 25 — — $30,124.62 $131,297.33 $61,296.25 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 11 8 — — $57,095.58 $66,131.35 $65,476.58 2024-10-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 44 25 — — $25,933.40 $113,030.02 $47,977.75 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 37 23 — — $33,636.66 $96,133.15 $52,237.25 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 43 24 — — $235,461.70 $1,026,253.41 $446,742.24 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 43 24 — — $51,086.46 $222,658.94 $88,532.74 2024-10-01
1901 OTHER New Technology - Level 49 11 8 — — $89,567.13 $103,741.75 $102,714.60 2024-10-01
1902 OTHER New Technology - Level 49 11 8 — — $89,567.13 $103,741.75 $102,714.60 2024-10-01
1903 OTHER New Technology - Level 50 11 8 — — $102,064.81 $118,217.27 $117,046.80 2024-10-01
1904 OTHER New Technology - Level 50 11 8 — — $102,064.81 $118,217.27 $117,046.80 2024-10-01
1905 OTHER New Technology - Level 51 11 8 — — $114,562.49 $132,692.79 $131,379.00 2024-10-01
1906 OTHER New Technology - Level 51 11 8 — — $114,562.49 $132,692.79 $131,379.00 2024-10-01
1907 OTHER New Technology - Level 52 11 8 — — $127,060.17 $147,168.31 $145,711.20 2024-10-01
1908 OTHER New Technology - Level 52 11 8 — — $127,060.17 $147,168.31 $145,711.20 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 38 23 — — $74,673.79 $296,378.04 $158,764.92 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 44 25 — — $54,019.29 $235,441.60 $115,806.33 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 53 34 $160,198.55 $60,875.45 62% off $25,854.62 $192,422.34 $77,941.00 2026-03-31
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 44 25 — — $37,851.00 $171,068.70 $84,143.32 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 25 17 — — $68,835.54 $300,017.85 $94,279.78 2024-10-01
215 MS_DRG Other Heart Assist System Implant 40 24 — — $65,282.79 $284,533.25 $123,832.35 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $50,340.69 $50,340.69 $50,340.69 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 44 25 — — $62,026.57 $270,341.13 $123,099.46 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $48,729.44 $48,729.44 $48,729.44 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 44 25 — — $40,680.63 $177,305.43 $79,871.38 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $48,458.47 $48,458.47 $48,458.47 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 44 25 — — $36,407.61 $158,681.58 $74,978.11 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 44 25 — — $49,282.28 $214,795.48 $101,756.43 2024-10-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 44 25 — — $24,463.15 $109,266.81 $53,744.91 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 44 25 — — $33,518.24 $146,088.33 $67,510.99 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 44 25 — — $29,709.20 $129,486.75 $58,298.54 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 19 8 — — $58,932.85 $164,956.05 $125,427.02 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 19 8 — — $40,168.33 $118,665.33 $91,472.92 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 19 8 — — $54,565.57 $148,863.14 $118,613.80 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 19 8 — — $38,929.12 $111,665.48 $88,620.79 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 19 8 — — $49,267.73 $132,202.45 $103,562.88 2024-10-01
22633 CPT Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Inter… 17 6 — — $4,000.00 $61,751.32 $42,043.45 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 19 8 — — $38,644.33 $103,370.83 $82,220.88 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 44 25 — — $32,202.33 $140,352.99 $63,774.78 2024-10-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 44 25 — — $20,320.82 $88,567.76 $41,946.22 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 $71,023.97 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 44 25 — — $51,864.24 $226,048.90 $106,453.65 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $43,743.20 $43,743.20 $43,743.20 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 44 25 — — $38,017.50 $165,698.25 $73,525.64 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 44 25 — — $49,847.24 $217,257.86 $97,513.09 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 44 25 — — $33,219.78 $144,787.50 $67,508.35 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 44 25 — — $37,582.91 $163,804.11 $75,280.01 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 44 25 — — $25,827.31 $112,567.63 $51,556.10 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 $58,901.85 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 $49,119.90 2024-10-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 44 25 — — $22,081.54 $96,241.81 $44,774.55 2024-10-01
245 MS_DRG Aicd Generator Procedures 44 25 — — $28,960.18 $126,222.15 $62,084.71 2024-10-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 19 8 — — $23,055.59 $62,719.91 $49,285.83 2024-10-01
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 19 8 — — $23,166.43 $62,605.24 $49,883.71 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 44 25 — — $28,222.66 $123,007.68 $57,872.90 2024-10-01
252 MS_DRG Other Vascular Procedures With Mcc 53 34 $73,876.95 $28,073.24 62% off $14,786.90 $93,420.10 $39,495.49 2026-03-31
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 44 25 — — $21,187.44 $92,344.90 $43,981.32 2024-10-01
264 MS_DRG Other Circulatory System O.r. Procedures 53 34 $106,561.00 $40,493.18 62% off $14,160.80 $90,974.43 $38,903.00 2026-03-31
265 MS_DRG Aicd Lead Procedures 44 25 — — $22,586.43 $98,442.36 $43,014.91 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 44 25 — — $39,918.83 $173,985.12 $84,826.11 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 44 25 — — $31,189.36 $135,937.97 $66,821.08 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 44 25 — — $43,808.39 $190,937.67 $86,445.14 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 44 25 — — $26,577.61 $115,837.80 $53,488.46 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 44 25 — — $32,318.65 $140,859.95 $64,116.08 2024-10-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 44 25 — — $22,088.57 $96,272.45 $43,873.95 2024-10-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 44 25 — — $24,905.73 $108,550.93 $49,403.66 2024-10-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 44 25 — — $20,711.95 $90,272.48 $41,623.52 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 25 17 — — $44,965.80 $195,982.21 $61,160.56 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 25 17 — — $39,689.39 $172,985.12 $53,609.07 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 25 17 — — $30,564.32 $133,213.75 $40,264.79 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 25 17 — — $28,506.42 $124,244.44 $43,300.10 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 44 25 — — $38,512.81 $167,857.02 $74,063.62 2024-10-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 44 25 — — $21,909.63 $95,492.51 $42,283.40 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 $254,180.62 2024-10-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 44 25 — — $26,309.19 $114,667.89 $52,818.24 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 17 13 — — $1,663.00 $66,907.78 $44,028.26 2024-10-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 44 25 — — $27,876.90 $121,500.72 $53,948.96 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 53 34 $271,566.79 $103,195.38 62% off $6,248.00 $141,475.54 $60,168.00 2026-03-31
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 53 34 $120,096.55 $45,636.69 62% off $19,484.56 $155,106.24 $49,663.83 2026-03-31
332 MS_DRG Rectal Resection With Mcc 44 25 — — $23,354.63 $101,790.53 $49,855.04 2024-10-01
33230 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Dual … 23 10 — — $1,568.00 $64,906.00 $39,475.69 2024-10-01
33231 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multi… 23 10 — — $1,568.00 $90,455.25 $54,492.00 2024-10-01
33240 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Singl… 23 10 — — $1,568.00 $64,906.00 $39,475.69 2024-10-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 44 25 — — $22,847.83 $99,581.63 $47,248.09 2024-10-01
338 MS_DRG Appendectomy With Complicated Principal Diagnosis With Mcc 19 8 — — $20,447.08 $57,526.86 $44,127.41 2024-10-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 44 25 — — $24,933.85 $108,673.50 $49,681.48 2024-10-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 53 34 $68,291.05 $25,950.60 62% off $18,621.08 $119,183.19 $50,474.02 2026-03-31
37 MS_DRG Extracranial Procedures With Mcc 44 25 — — $21,573.46 $94,027.34 $41,842.60 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 $175,253.40 2024-10-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 44 25 — — $24,608.55 $107,255.68 $47,636.42 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 44 25 — — $35,183.73 $153,347.35 $70,186.08 2024-10-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 44 25 — — $23,788.58 $103,681.88 $46,197.39 2024-10-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 44 25 — — $19,139.92 $84,690.34 $41,656.52 2024-10-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 44 25 — — $22,529.55 $98,194.45 $44,579.43 2024-10-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 44 25 — — $20,456.31 $89,158.28 $42,137.72 2024-10-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 44 25 — — $24,994.56 $108,938.12 $50,482.86 2024-10-01
423 OTHER Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 1 1 — — $40,203.11 $40,203.11 $40,203.11 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 26 22 $256,414.55 $97,437.53 62% off $1,663.00 $133,797.37 $75,507.83 2026-03-31
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 26 22 $113,434.30 $43,105.03 62% off $1,663.00 $87,633.80 $51,410.29 2026-03-31
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 17 13 — — $1,663.00 $59,544.24 $39,273.78 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 17 13 — — $1,663.00 $90,205.44 $59,071.07 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 26 22 $134,001.00 $50,920.38 62% off $1,663.00 $88,524.47 $39,809.24 2026-03-31
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 17 13 — — $1,663.00 $72,512.63 $47,647.20 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 31 14 — — $56,633.21 $246,834.30 $139,106.26 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $54,127.47 $54,127.47 $54,127.47 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 31 14 — — $33,877.00 $170,369.54 $96,013.68 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 31 14 — — $28,534.00 $128,288.99 $72,581.29 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 44 25 — — $53,872.30 $179,517.16 $98,610.50 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 44 25 — — $38,827.24 $128,754.91 $73,407.36 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 44 25 — — $28,957.62 $99,140.46 $60,907.45 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 31 14 — — $42,387.03 $184,742.72 $104,113.85 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 31 14 — — $23,377.64 $101,890.80 $57,421.71 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 44 25 — — $41,936.60 $189,929.32 $80,948.51 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 53 34 $166,491.45 $63,266.75 62% off $24,160.18 $157,762.36 $61,612.00 2026-03-31
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 53 34 $101,454.25 $38,552.61 62% off $22,065.69 $144,472.74 $61,653.00 2026-03-31
471 MS_DRG Cervical Spinal Fusion With Mcc 44 25 — — $31,437.33 $137,018.74 $62,627.61 2024-10-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 44 25 — — $27,499.19 $119,854.49 $52,235.82 2024-10-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 44 25 — — $21,531.28 $93,843.50 $42,180.96 2024-10-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 53 34 $61,748.50 $23,464.43 62% off $15,563.91 $96,436.80 $41,275.16 2026-03-31
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 44 25 — — $22,887.45 $99,754.33 $46,043.75 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 41 24 — — $66,146.85 $225,151.15 $141,805.35 2024-10-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 44 25 — — $20,205.15 $88,063.58 $39,078.67 2024-10-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 53 34 $123,611.20 $46,972.26 62% off $15,842.41 $101,720.89 $43,536.76 2026-03-31
5244 OTHER Level 4 Blood Product Exc 11 8 — — $43,380.41 $50,245.66 $49,748.18 2024-10-01
570 MS_DRG Skin Debridement With Mcc 44 25 — — $18,675.78 $81,397.88 $41,721.75 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 44 25 — — $39,739.88 $173,205.18 $73,773.71 2024-10-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 44 25 — — $21,766.47 $94,868.56 $41,816.53 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 44 25 — — $36,320.69 $158,302.75 $67,434.10 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 41 24 — — $30,912.63 $96,307.72 $56,812.65 2024-10-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 53 34 $75,312.39 $28,618.71 62% off $14,783.09 $110,241.73 $44,250.00 2026-03-31
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 44 25 — — $24,449.41 $106,562.09 $46,303.53 2024-10-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 44 25 — — $25,656.67 $111,823.90 $47,583.37 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 43 24 — — $28,743.52 $125,277.86 $54,858.93 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $74,627.95 $74,627.95 $74,627.95 2024-10-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 43 24 — — $22,102.63 $96,333.73 $44,118.21 2024-10-01
652 MS_DRG Kidney Transplant 41 24 — — $19,201.12 $66,912.70 $41,163.28 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 44 25 — — $34,598.32 $150,795.83 $68,881.49 2024-10-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 44 25 — — $20,052.40 $87,397.85 $41,043.12 2024-10-01
665 MS_DRG Prostatectomy With Mcc 44 25 — — $19,742.44 $86,046.88 $38,427.64 2024-10-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 44 25 — — $23,633.92 $103,007.79 $45,333.83 2024-10-01
7 MS_DRG Lung Transplant 41 24 — — $78,394.56 $234,367.95 $144,207.45 2024-10-01
714 OTHER Inj Delandistrogene Mox R 12 9 — — $5,166.40 $3,358,709.55 $3,325,455.00 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 12 9 — — $12,381.09 $63,988.32 $63,354.77 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 $52,042.21 2024-10-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 44 25 — — $23,111.77 $100,732.04 $47,822.63 2024-10-01
746 OTHER Inj, Betibeglogene Autote 12 9 — — $7,569.19 $2,997,680.00 $2,968,000.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 12 9 — — $8,521.96 $3,318,860.00 $3,286,000.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 11 8 — — $3,143,560.00 $3,641,050.00 $3,605,000.00 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 40 21 $19,872.00 $7,551.36 62% off $608.00 $112,296.24 $44,462.46 2026-03-31
799 MS_DRG Splenic Procedures With Mcc 44 25 — — $31,664.85 $138,010.38 $64,554.90 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 41 24 — — $33,627.52 $111,019.06 $65,720.00 2024-10-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 44 25 — — $21,926.24 $95,564.93 $46,018.71 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 44 25 — — $38,644.46 $168,430.83 $70,552.95 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 53 34 $34,501.65 $13,110.63 62% off $19,434.97 $125,400.42 $52,680.13 2026-03-31
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 53 34 $55,038.80 $20,914.74 62% off $19,829.19 $128,904.58 $60,175.84 2026-03-31
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 44 25 — — $20,155.94 $87,849.10 $43,355.10 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 44 25 — — $16,243.00 $155,960.15 $78,463.88 2024-10-01
834 OTHER Acute Leukemia With Mcc 1 1 — — $41,142.76 $41,142.76 $41,142.76 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 44 25 — — $30,958.00 $134,929.62 $66,367.64 2024-10-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 44 25 — — $19,973.15 $87,052.45 $39,371.54 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 17 13 — — $1,663.00 $99,629.42 $65,155.94 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 53 34 $76,377.50 $29,023.45 62% off $20,934.73 $139,255.50 $54,747.37 2026-03-31
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 53 34 $24,343.65 $9,250.59 62% off $19,281.94 $123,353.08 $52,265.34 2026-03-31
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 53 34 $151,322.50 $57,502.55 62% off $27,771.61 $194,007.29 $83,080.00 2026-03-31
901 MS_DRG Wound Debridements For Injuries With Mcc 44 25 — — $27,658.97 $120,550.87 $54,269.43 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 11 8 — — $426,805.63 $494,350.56 $489,456.00 2024-10-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 44 25 — — $20,810.37 $90,701.45 $44,536.29 2024-10-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 44 25 — — $23,771.32 $103,606.67 $48,635.50 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 11 8 — — $3,202,768.80 $3,709,629.00 $3,672,900.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 11 8 — — $2,082,871.41 $2,412,500.14 $2,388,614.00 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 11 8 — — $461,456.21 $534,484.83 $529,192.90 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 $224,240.62 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 11 8 — — $47,973.28 $55,565.38 $55,015.23 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 35 22 — — $45,569.00 $192,748.24 $73,138.87 2024-10-01
93609 CPT Intraventricular And/or Intra-atrial Mapping Of Tachycardia Site(s) With Cathete… 7 4 — — $8,300.00 $71,218.00 $42,855.00 2024-10-01
93653 CPT Comprehensive Electrophysiologic Evaluation With Insertion And Repositioning Of … 20 9 — — $3,280.00 $66,217.24 $43,550.00 2024-10-01
93656 CPT Comprehensive Electrophysiologic Evaluation With Transseptal Catheterizations, I… 20 9 — — $3,280.00 $66,217.24 $43,550.00 2024-10-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 44 25 — — $20,548.98 $89,562.18 $40,226.43 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 11 8 — — $401,582.51 $465,135.70 $460,530.40 2024-10-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 44 25 — — $23,152.68 $100,910.31 $44,888.49 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 11 8 — — $450,585.16 $521,893.36 $516,726.10 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 11 8 — — $459,184.39 $531,853.48 $526,587.60 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 11 8 — — $459,651.60 $532,394.63 $527,123.40 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
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $61,081.39 $61,081.39 $61,081.39 2024-10-01
956 OTHER Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $42,402.43 $42,402.43 $42,402.43 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 33 23 — — $46,222.91 $201,461.29 $96,180.88 2024-10-01
957 OTHER Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 1 — — $41,901.28 $41,901.28 $41,901.28 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 44 25 — — $43,191.66 $191,436.27 $85,403.98 2024-10-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 44 25 — — $23,243.43 $101,305.85 $47,880.34 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 53 34 $103,718.00 $39,412.84 62% off $19,888.54 $132,043.84 $45,359.70 2026-03-31
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 44 25 — — $21,580.49 $94,057.98 $41,663.26 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 7 1 — — $113,274.48 $184,643.96 $149,941.37 2024-10-01
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 7 1 — — $29,859.54 $48,672.78 $39,525.06 2024-10-01
C2616 HCPCS Brachytherapy Source, Non-stranded, Yttrium-90, Per Source 7 1 — — $30,464.88 $49,659.52 $40,326.35 2024-10-01
C9760 HCPCS Non-randomized, Non-blinded Procedure For Nyha Class Ii, Iii, IV Heart Failure; … 11 2 — — $9,242.00 $77,551.41 $52,800.96 2024-10-01
C9782 HCPCS Blinded Procedure For New York Heart Association (nyha) Class Ii Or Iii Heart Fa… 7 1 — — $30,275.86 $49,351.41 $40,076.15 2024-10-01
J2351 HCPCS Ocrelizumab-hyaluronidase-ocsq 920-23000 Mg-ut/23ml Sc Soln 11 11 $109,517.05 $40,521.31 63% off $48.41 $98,565.35 $42,366.00 2026-03-31
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 1 1 — — $63,505.40 $63,505.40 $63,505.40 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
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 7 1 — — $38,907.73 $63,421.86 $51,502.15 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 12 9 — — $79,379.82 $91,942.22 $91,031.90 2024-10-01
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device… 19 10 — — $36,492.76 $42,268.00 $41,012.51 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 19 10 — — $41,642.36 $48,232.55 $46,799.90 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 12 9 — — $57,440.12 $66,530.42 $65,871.70 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 19 10 — — $87,199.91 $100,999.90 $99,999.90 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 1 1 — — $459,381.00 $459,381.00 $459,381.00 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 1 1 — — $518,241.00 $518,241.00 $518,241.00 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 11 3 — — $55,453.60 $149,636.08 $101,879.88 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 1 1 — — $449,440.00 $449,440.00 $449,440.00 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 1 1 — — $474,061.00 $474,061.00 $474,061.00 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 1 1 — — $484,690.00 $484,690.00 $484,690.00 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 1 1 — — $507,496.00 $507,496.00 $507,496.00 2024-10-01
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