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

ST MARK'S HOSPITAL

Salt Lake City, UT · CCN 460047 · Rates published

29,348 distinct procedures filed
36 distinct payers
685,496 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

273,683 of 685,496 rate rows are consumer-grade (39.9%)

411,813 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 409,740
per-diem day rate — not a per-procedure price 1,701
template filing: same amount across many unrelated codes — excluded 256
placeholder amount (≤ $0.02) — excluded from medians 93
exceeds 10× this hospital's gross charge — excluded from medians 23

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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/2ddf8eab94114b028790e2ef86501adc?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 e2057692eef65451… · 437,700,612 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 9 $3,202,768.80 $3,709,629.00 $3,672,900.00 nat. median
$3,746,358
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
773
OTHER 		Inj, Beqvez, Per Tx Dose 9 $3,143,560.00 $3,641,050.00 $3,605,000.00 nat. median
$3,605,000
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 10 $5,323.97 $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 10 $8,781.88 $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 10 $7,800.05 $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
9141
OTHER 		Inj Onase Abepar-xioi Tre 9 $2,082,871.41 $2,412,500.14 $2,388,614.00 nat. median
$2,588,981
0.9× 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
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 33 $235,461.70 $1,026,253.41 $529,503.28 nat. median
$370,174
1.4× 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 9 $461,456.21 $534,484.83 $529,192.90 nat. median
$566,531
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 9 $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
9422
OTHER 		Idecabtagene Vicleucel Ca 9 $459,184.39 $531,853.48 $526,587.60 nat. median
$558,082
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 1 $526,587.60 $526,587.60 $526,587.60 nat. median
$530,178
1.0× 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
09413
OTHER 		Lisocabtagene Car Pos T 1 $516,726.10 $516,726.10 $516,726.10 nat. median
$534,091
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 9 $450,585.16 $521,893.36 $516,726.10 nat. median
$562,201
0.9× 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 9 $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
9391
OTHER 		Brexucabtagene Car Pos T 9 $401,582.51 $465,135.70 $460,530.40 nat. median
$489,450
0.9× median
09391
OTHER 		Brexucabtagene Car Pos T 1 $460,530.40 $460,530.40 $460,530.40 nat. median
$464,978
1.0× 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
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 32 $173,187.15 $584,740.56 $378,963.85 nat. median
$265,286
1.4× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 33 $136,258.04 $593,876.96 $306,774.20 nat. median
$202,976
1.5× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 24 $146,105.99 $734,221.59 $250,750.00 nat. median
$206,474
1.2× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 32 $77,162.65 $302,755.30 $189,958.98 nat. median
$108,660
1.7× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 26 $93,947.70 $409,468.50 $181,662.60 nat. median
$133,161
1.4× median
001
OTHER 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $180,460.61 $180,460.61 $180,460.61 nat. median
$263,894
0.7× median
215
MS_DRG 		Other Heart Assist System Implant 33 $65,282.79 $284,533.25 $170,148.62 nat. median
$99,019
1.7× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 32 $73,246.61 $260,108.64 $166,677.62 nat. median
$117,357
1.4× median
7
MS_DRG 		Lung Transplant 32 $78,394.56 $247,490.80 $162,942.68 nat. median
$122,708
1.3× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 32 $68,835.54 $300,017.85 $159,874.42 nat. median
$102,358
1.6× median
A9543
HCPCS 		Y90 Ibritum Tiu Tx 40mci 1 $115,238.78 $186,608.25 $151,905.67 nat. median
$62,507
outlier · 2.4×
018
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $148,906.56 $148,906.56 $148,906.56 nat. median
$424,868
outlier · 0.4×
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 32 $66,146.85 $231,265.52 $148,706.18 nat. median
$100,136
1.5× median
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 15 $56,633.21 $246,834.30 $147,214.18 nat. median
$87,428
1.7× median
01908
OTHER 		New Technology - Level 52 1 $145,711.20 $145,711.20 $145,711.20 nat. median
$82,736
1.8× median
1908
OTHER 		New Technology - Level 52 9 $127,060.17 $147,168.31 $145,711.20 nat. median
$152,962
1.0× median
01907
OTHER 		New Technology - Level 52 1 $145,711.20 $145,711.20 $145,711.20 nat. median
$84,819
1.7× median
1907
OTHER 		New Technology - Level 52 9 $127,060.17 $147,168.31 $145,711.20 nat. median
$153,199
1.0× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 33 $62,026.57 $270,341.13 $139,932.65 nat. median
$93,672
1.5× median

Other procedures at this hospital

Browse this hospital's 29,348 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
             
9138 OTHER Inj, Hemgenix, Per Tx Dos 12 9 — — $3,202,768.80 $3,709,629.00 $3,672,900.00 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
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 $3,641,050.00 $3,605,000.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 13 10 — — $5,323.97 $3,358,709.55 $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 — — $8,781.88 $3,318,860.00 $3,286,000.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 13 10 — — $7,800.05 $2,997,680.00 $2,968,000.00 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
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 $2,412,500.14 $2,388,614.00 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 53 33 — — $235,461.70 $1,026,253.41 $529,503.28 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 1 1 — — $529,192.90 $529,192.90 $529,192.90 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 12 9 — — $461,456.21 $534,484.83 $529,192.90 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 1 1 — — $527,123.40 $527,123.40 $527,123.40 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 12 9 — — $459,651.60 $532,394.63 $527,123.40 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 12 9 — — $459,184.39 $531,853.48 $526,587.60 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 1 1 — — $526,587.60 $526,587.60 $526,587.60 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
09413 OTHER Lisocabtagene Car Pos T 1 1 — — $516,726.10 $516,726.10 $516,726.10 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 12 9 — — $450,585.16 $521,893.36 $516,726.10 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
09035 OTHER Axicabtagene Ciloleucel C 1 1 — — $489,456.00 $489,456.00 $489,456.00 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 12 9 — — $426,805.63 $494,350.56 $489,456.00 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
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
9391 OTHER Brexucabtagene Car Pos T 12 9 — — $401,582.51 $465,135.70 $460,530.40 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 1 1 — — $460,530.40 $460,530.40 $460,530.40 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
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
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 50 32 — — $173,187.15 $584,740.56 $378,963.85 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 53 33 — — $136,258.04 $593,876.96 $306,774.20 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 37 24 — — $146,105.99 $734,221.59 $250,750.00 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 50 32 — — $77,162.65 $302,755.30 $189,958.98 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 45 26 — — $93,947.70 $409,468.50 $181,662.60 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 1 1 — — $180,460.61 $180,460.61 $180,460.61 2024-10-01
215 MS_DRG Other Heart Assist System Implant 53 33 — — $65,282.79 $284,533.25 $170,148.62 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 49 32 — — $73,246.61 $260,108.64 $166,677.62 2024-10-01
7 MS_DRG Lung Transplant 49 32 — — $78,394.56 $247,490.80 $162,942.68 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 49 32 — — $68,835.54 $300,017.85 $159,874.42 2024-10-01
A9543 HCPCS Y90 Ibritum Tiu Tx 40mci 7 1 $189,598.72 $189,598.72 $115,238.78 $186,608.25 $151,905.67 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 1 — — $148,906.56 $148,906.56 $148,906.56 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 49 32 — — $66,146.85 $231,265.52 $148,706.18 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 32 15 — — $56,633.21 $246,834.30 $147,214.18 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
1907 OTHER New Technology - Level 52 12 9 — — $127,060.17 $147,168.31 $145,711.20 2024-10-01
1908 OTHER New Technology - Level 52 12 9 — — $127,060.17 $147,168.31 $145,711.20 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 53 33 — — $62,026.57 $270,341.13 $139,932.65 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 53 33 — — $54,019.29 $235,441.60 $139,608.29 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 20 9 — — $58,932.85 $170,171.43 $131,979.22 2024-10-01
01906 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 $132,692.79 $131,379.00 2024-10-01
1905 OTHER New Technology - Level 51 12 9 — — $114,562.49 $132,692.79 $131,379.00 2024-10-01
01905 OTHER New Technology - Level 51 1 1 — — $131,379.00 $131,379.00 $131,379.00 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 53 33 — — $46,222.91 $201,461.29 $123,842.10 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 20 9 — — $54,565.57 $152,066.28 $123,466.36 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 1 1 — — $120,872.54 $120,872.54 $120,872.54 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 53 33 — — $51,864.24 $226,048.90 $120,559.92 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 49 32 — — $44,965.80 $195,982.21 $120,474.01 2024-10-01
1903 OTHER New Technology - Level 50 12 9 — — $102,064.81 $118,217.27 $117,046.80 2024-10-01
1904 OTHER New Technology - Level 50 12 9 — — $102,064.81 $118,217.27 $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
01903 OTHER New Technology - Level 50 1 1 — — $117,046.80 $117,046.80 $117,046.80 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 53 33 — — $49,282.28 $214,795.48 $116,754.90 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 53 33 — — $49,847.24 $217,257.86 $112,095.85 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 20 9 — — $49,267.73 $136,382.27 $109,673.48 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 32 15 — — $42,387.03 $184,742.72 $108,510.35 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 53 33 — — $51,086.46 $222,658.94 $107,643.37 2024-10-01
0424T CPT Insertion Or Replacement Of Neurostimulator System For Treatment Of Central Slee… 11 2 — — $5,642.00 $156,751.43 $107,250.97 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 49 32 — — $39,689.39 $172,985.12 $106,337.26 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 52 32 — — $47,090.88 $192,748.24 $106,239.62 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 53 33 — — $38,922.47 $169,642.52 $104,282.49 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 11 3 — — $55,453.60 $151,227.95 $103,471.76 2024-10-01
1902 OTHER New Technology - Level 49 12 9 — — $89,567.13 $103,741.75 $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
1901 OTHER New Technology - Level 49 12 9 — — $89,567.13 $103,741.75 $102,714.60 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 53 33 — — $39,116.45 $171,068.70 $101,437.50 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 53 33 — — $44,512.68 $194,007.29 $100,099.54 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 20 11 — — $87,199.91 $100,999.90 $99,999.90 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 53 33 — — $53,872.30 $185,192.91 $99,812.58 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 53 33 — — $43,808.39 $190,937.67 $99,410.37 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 32 15 — — $33,877.00 $170,369.54 $98,190.31 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 53 33 — — $43,337.80 $189,929.32 $97,995.48 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 53 33 — — $39,918.83 $173,985.12 $95,428.57 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 53 33 — — $43,922.79 $191,436.27 $94,303.37 2024-10-01
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 20 9 — — $40,168.33 $122,417.14 $93,444.44 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 53 33 — — $44,149.03 $192,422.34 $92,437.25 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 53 33 — — $40,680.63 $177,305.43 $91,482.09 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 13 10 — — $79,379.82 $91,942.22 $91,031.90 2024-10-01
01585 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 $91,678.79 $90,771.08 2024-10-01
01599 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 $91,678.79 $90,771.08 2024-10-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 20 9 — — $38,929.12 $115,195.98 $90,530.85 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 49 32 — — $39,477.21 $140,409.88 $89,943.54 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 53 33 — — $39,739.88 $173,205.18 $89,262.60 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 53 33 — — $38,512.81 $167,857.02 $86,607.11 2024-10-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 20 9 — — $38,644.33 $106,639.08 $86,530.11 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 53 33 — — $37,582.91 $163,804.11 $86,040.36 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 53 33 — — $38,827.24 $132,825.73 $85,500.00 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 53 33 — — $38,017.50 $165,698.25 $85,493.28 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 53 33 — — $36,407.61 $158,681.58 $85,303.49 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 1 1 — — $84,988.40 $84,988.40 $84,988.40 2024-10-01
834 MS_DRG Acute Leukemia With Mcc 53 33 — — $16,243.00 $155,960.15 $84,950.07 2024-10-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 53 33 — — $36,229.30 $157,904.42 $82,325.83 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 53 33 — — $38,644.46 $168,430.83 $82,263.27 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 49 32 — — $30,564.32 $133,213.75 $81,889.04 2024-10-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 53 33 — — $36,320.69 $158,302.75 $81,601.53 2024-10-01
1584 OTHER New Technology - Level 47 12 9 — — $70,820.60 $82,028.44 $81,216.28 2024-10-01
1598 OTHER New Technology - Level 47 12 9 — — $70,820.60 $82,028.44 $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
01598 OTHER New Technology - Level 47 1 1 — — $81,216.28 $81,216.28 $81,216.28 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 53 33 — — $36,196.71 $157,762.36 $81,087.55 2024-10-01
653 MS_DRG Major Bladder Procedures With Mcc 53 33 — — $34,598.32 $150,795.83 $79,816.44 2024-10-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 53 33 — — $35,183.73 $153,347.35 $79,603.85 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 1 1 — — $78,968.84 $78,968.84 $78,968.84 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 53 33 — — $33,518.24 $146,088.33 $78,069.78 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $76,904.11 $76,904.11 $76,904.11 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 32 15 — — $28,534.00 $128,288.99 $76,560.67 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 18 14 — — $1,751.00 $113,368.99 $76,494.99 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 53 33 — — $31,189.36 $135,937.97 $75,796.92 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 53 33 — — $33,147.56 $144,472.74 $75,340.62 2024-10-01
799 MS_DRG Splenic Procedures With Mcc 53 33 — — $31,664.85 $138,010.38 $74,803.40 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 53 33 — — $33,219.78 $144,787.50 $74,704.22 2024-10-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 53 33 — — $30,958.00 $134,929.62 $74,434.81 2024-10-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 53 33 — — $32,953.91 $143,628.74 $74,192.93 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 49 32 — — $33,627.52 $114,529.13 $74,078.32 2024-10-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. 53 33 — — $29,575.63 $128,904.58 $73,858.25 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 53 33 — — $32,318.65 $140,859.95 $73,437.39 2024-10-01
245 MS_DRG Aicd Generator Procedures 53 33 — — $28,960.18 $126,222.15 $73,357.01 2024-10-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 53 33 — — $25,850.32 $112,667.90 $72,939.16 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 53 33 — — $32,202.33 $140,352.99 $72,416.20 2024-10-01
471 MS_DRG Cervical Spinal Fusion With Mcc 53 33 — — $31,437.33 $137,018.74 $72,351.47 2024-10-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 53 33 — — $31,950.53 $139,255.50 $71,849.94 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 $72,378.09 $71,661.48 2024-10-01
1597 OTHER New Technology - Level 46 12 9 — — $62,488.81 $72,378.09 $71,661.48 2024-10-01
01583 OTHER New Technology - Level 46 1 1 — — $71,661.48 $71,661.48 $71,661.48 2024-10-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 49 32 — — $28,506.42 $124,244.44 $69,883.72 2024-10-01
163 MS_DRG Major Chest Procedures With Mcc 53 33 — — $30,124.62 $131,297.33 $69,574.91 2024-10-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 53 33 — — $30,720.26 $133,893.41 $69,083.33 2024-10-01
007 OTHER Lung Transplant 1 1 — — $68,135.74 $68,135.74 $68,135.74 2024-10-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 53 33 — — $30,295.90 $132,043.84 $68,129.03 2024-10-01
0268T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Pulse… 7 1 — — $51,670.92 $83,671.67 $68,111.67 2024-10-01
0266T CPT Implantation Or Replacement Of Carotid Sinus Baroreflex Activation Device; Total… 7 1 — — $51,670.92 $83,671.67 $68,111.67 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 1 — — $68,012.14 $68,012.14 $68,012.14 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 53 33 — — $29,709.20 $129,486.75 $67,964.70 2024-10-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 49 32 — — $26,458.74 $115,319.70 $67,525.35 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 18 14 — — $1,751.00 $99,629.42 $67,328.90 2024-10-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 53 33 — — $28,743.52 $125,277.86 $66,704.98 2024-10-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 53 33 — — $28,866.87 $125,815.46 $66,409.08 2024-10-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 53 33 — — $24,785.58 $108,027.26 $66,406.42 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 49 32 — — $33,636.66 $98,201.68 $65,919.17 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 13 10 — — $57,440.12 $66,530.42 $65,871.70 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 53 33 — — $28,957.62 $101,273.70 $65,494.81 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 12 9 — — $57,095.58 $66,131.35 $65,476.58 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 1 1 — — $65,476.58 $65,476.58 $65,476.58 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 53 33 — — $28,222.66 $123,007.68 $65,219.74 2024-10-01
6 MS_DRG Liver Transplant Without Mcc 49 32 — — $30,912.63 $99,352.66 $65,132.64 2024-10-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 53 33 — — $25,069.98 $109,266.81 $64,791.24 2024-10-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 53 33 — — $28,771.64 $125,400.42 $64,701.31 2024-10-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 46 27 — — $6,248.00 $141,475.54 $63,775.35 2024-10-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 53 33 — — $28,301.90 $123,353.08 $63,644.96 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
00717 OTHER Instill Adstiladrin, Tx D 1 1 — — $63,354.77 $63,354.77 $63,354.77 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 13 10 — — $12,758.72 $63,988.32 $63,354.77 2024-10-01
901 MS_DRG Wound Debridements For Injuries With Mcc 53 33 — — $27,658.97 $120,550.87 $63,181.49 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 1 1 — — $62,944.38 $62,944.38 $62,944.38 2024-10-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 53 33 — — $27,876.90 $121,500.72 $62,689.23 2024-10-01
0408T CPT Insertion Or Replacement Of Permanent Cardiac Contractility Modulation System, I… 11 2 — — $9,243.00 $91,417.54 $62,548.84 2024-10-01
0571T CPT Insertion Or Replacement Of Implantable Cardioverter-defibrillator System With S… 11 2 — — $6,778.00 $91,417.54 $62,548.84 2024-10-01
1582 OTHER New Technology - Level 45 12 9 — — $54,157.02 $62,727.75 $62,106.68 2024-10-01
1596 OTHER New Technology - Level 45 12 9 — — $54,157.02 $62,727.75 $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
01596 OTHER New Technology - Level 45 1 1 — — $62,106.68 $62,106.68 $62,106.68 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 32 15 — — $23,377.64 $101,890.80 $61,880.38 2024-10-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 53 33 — — $27,499.19 $119,854.49 $61,839.84 2024-10-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 53 33 — — $27,345.17 $119,183.19 $61,493.48 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 53 33 — — $26,577.61 $115,837.80 $61,424.77 2024-10-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 53 33 — — $24,843.10 $108,277.96 $61,265.33 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 18 14 — — $1,751.00 $90,205.44 $61,041.87 2024-10-01
140 MS_DRG Major Head And Neck Procedures With Mcc 53 33 — — $24,145.84 $105,238.98 $59,701.09 2024-10-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 53 33 — — $26,309.19 $114,667.89 $59,194.04 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 53 33 — — $25,827.31 $112,567.63 $58,582.14 2024-10-01
10 MS_DRG Pancreas Transplant 49 32 — — $30,763.72 $86,231.64 $58,497.68 2024-10-01
332 MS_DRG Rectal Resection With Mcc 53 33 — — $23,354.63 $101,790.53 $58,322.15 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 1 — — $58,011.73 $58,011.73 $58,011.73 2024-10-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 53 33 — — $24,905.73 $108,550.93 $57,642.73 2024-10-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 53 33 — — $25,595.32 $111,556.49 $57,558.42 2024-10-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 53 33 — — $24,933.85 $108,673.50 $57,447.38 2024-10-01
0431T CPT Removal And Replacement Of Neurostimulator System For Treatment Of Central Sleep… 11 2 — — $5,642.00 $83,671.67 $57,249.04 2024-10-01
0427T CPT Insertion Or Replacement Of Neurostimulator System For Treatment Of Central Slee… 11 2 — — $3,188.00 $83,671.67 $57,249.04 2024-10-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 53 33 — — $25,293.66 $110,241.73 $56,880.06 2024-10-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 53 33 — — $24,214.22 $105,537.02 $56,720.56 2024-10-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 53 33 — — $25,933.40 $113,030.02 $56,709.93 2024-10-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 53 33 — — $24,994.56 $108,938.12 $56,677.09 2024-10-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 53 33 — — $25,656.67 $111,823.90 $56,385.06 2024-10-01
B0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 1 1 — — $56,384.01 $56,384.01 $56,384.01 2024-10-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 53 33 — — $23,111.77 $100,732.04 $56,052.64 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $55,905.96 $55,905.96 $55,905.96 2024-10-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 53 33 — — $23,243.43 $101,305.85 $55,850.10 2024-10-01
B0505 OTHER Nontraumatic Spinal Cord Injury; M > 23.75 & M < 2 1 1 — — $55,804.93 $55,804.93 $55,804.93 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 1 1 — — $55,778.36 $55,778.36 $55,778.36 2024-10-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 53 33 — — $23,771.32 $103,606.67 $55,526.91 2024-10-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 53 33 — — $24,608.55 $107,255.68 $55,339.39 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 $55,565.38 $55,015.23 2024-10-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 53 33 — — $24,449.41 $106,562.09 $54,981.52 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
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures 49 32 — — $20,455.03 $89,152.71 $54,803.87 2024-10-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 53 33 — — $21,926.24 $95,564.93 $54,755.57 2024-10-01
33270 CPT Insertion Or Replacement Of Permanent Subcutaneous Implantable Defibrillator Sys… 23 10 — — $1,348.00 $91,417.54 $54,492.00 2024-10-01
33264 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 23 10 — — $1,348.00 $91,417.54 $54,492.00 2024-10-01
33231 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multi… 23 10 — — $1,568.00 $91,417.54 $54,492.00 2024-10-01
33249 CPT Insertion Or Replacement Of Permanent Implantable Defibrillator System, With Tra… 23 10 — — $1,568.00 $91,417.54 $54,492.00 2024-10-01
93621 CPT Ep W/la Rec W/arrhythmia 7 4 $10,369.17 $10,369.17 $8,300.00 $90,062.00 $54,194.00 2024-10-01
93622 CPT Ep W/lvrec W/arrhythmia 7 4 $10,369.17 $10,369.17 $8,300.00 $90,062.00 $54,194.00 2024-10-01
93623 CPT Stim & Pace After IV Inf 7 4 $10,369.17 $10,369.17 $8,300.00 $90,062.00 $54,194.00 2024-10-01
B0106 OTHER Stroke; M > 30.05 & M < 34.25 1 1 — — $53,771.66 $53,771.66 $53,771.66 2024-10-01
C9760 HCPCS Non-randomized, Non-blinded Procedure For Nyha Class Ii, Iii, IV Heart Failure; … 11 2 — — $9,243.00 $78,376.43 $53,625.97 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
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 53 33 — — $23,788.58 $103,681.88 $53,495.46 2024-10-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 53 33 — — $22,887.45 $99,754.33 $53,353.64 2024-10-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 53 33 — — $23,633.92 $103,007.79 $53,147.66 2024-10-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 53 33 — — $22,847.83 $99,581.63 $52,988.79 2024-10-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 49 32 — — $19,652.33 $85,654.13 $52,653.23 2024-10-01
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc 52 32 — — $22,619.94 $89,567.75 $52,622.36 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 $53,077.40 $52,551.88 2024-10-01
1595 OTHER New Technology - Level 44 12 9 — — $45,825.24 $53,077.40 $52,551.88 2024-10-01
01595 OTHER New Technology - Level 44 1 1 — — $52,551.88 $52,551.88 $52,551.88 2024-10-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 53 33 — — $18,351.00 $101,720.89 $52,483.67 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 7 1 — — $39,582.44 $64,096.56 $52,176.85 2024-10-01
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 20 9 — — $23,166.43 $63,952.33 $52,176.35 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 18 14 — — $1,751.00 $76,779.54 $52,085.04 2024-10-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 53 33 — — $22,280.94 $97,110.89 $52,082.43 2024-10-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 53 33 — — $23,152.68 $100,910.31 $52,065.44 2024-10-01
215 OTHER Other Heart Assist System Implant 1 1 — — $51,876.08 $51,876.08 $51,876.08 2024-10-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 53 33 — — $21,766.47 $94,868.56 $51,776.47 2024-10-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 20 9 — — $23,055.59 $64,702.91 $51,743.24 2024-10-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 53 33 — — $20,810.37 $90,701.45 $51,019.49 2024-10-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 53 33 — — $22,102.63 $96,333.73 $50,937.62 2024-10-01
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 49 32 — — $18,972.32 $82,690.35 $50,831.33 2024-10-01
265 MS_DRG Aicd Lead Procedures 53 33 — — $22,586.43 $98,442.36 $50,792.09 2024-10-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 53 33 — — $22,529.55 $98,194.45 $50,772.43 2024-10-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 53 33 — — $22,081.54 $96,241.81 $50,471.70 2024-10-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 53 33 — — $21,187.44 $92,344.90 $50,253.89 2024-10-01
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 11 3 — — $25,781.50 $73,423.01 $50,236.80 2024-10-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 53 33 — — $19,431.20 $84,690.34 $50,218.29 2024-10-01
216 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $50,215.68 $50,215.68 $50,215.68 2024-10-01
C0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 1 1 — — $50,141.74 $50,141.74 $50,141.74 2024-10-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 53 33 — — $22,126.28 $96,436.80 $50,071.47 2024-10-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 53 33 — — $22,088.57 $96,272.45 $50,041.30 2024-10-01
217 OTHER Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $49,936.45 $49,936.45 $49,936.45 2024-10-01
5244 OTHER Level 4 Blood Product Exc 12 9 — — $43,380.41 $50,245.66 $49,748.18 2024-10-01
05244 OTHER Level 4 Blood Product Exc 1 1 — — $49,748.18 $49,748.18 $49,748.18 2024-10-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 53 33 — — $21,909.63 $95,492.51 $49,270.09 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 18 14 — — $1,751.00 $72,512.63 $49,238.45 2024-10-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 49 32 — — $18,372.21 $80,074.77 $49,223.49 2024-10-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 53 33 — — $21,531.28 $93,843.50 $48,877.82 2024-10-01
B0205 OTHER Traumatic Brain Injury; M > 28.75 & M < 40.65 1 1 — — $48,815.21 $48,815.21 $48,815.21 2024-10-01
D0404 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 1 1 — — $48,674.60 $48,674.60 $48,674.60 2024-10-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 53 33 — — $21,580.49 $94,057.98 $48,529.93 2024-10-01
37 MS_DRG Extracranial Procedures With Mcc 53 33 — — $21,573.46 $94,027.34 $48,514.12 2024-10-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 53 33 — — $20,711.95 $90,272.48 $48,255.86 2024-10-01
252 MS_DRG Other Vascular Procedures With Mcc 53 33 — — $21,434.14 $93,420.10 $48,200.81 2024-10-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 53 33 — — $21,360.00 $93,096.98 $48,034.10 2024-10-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 53 33 — — $21,280.75 $92,751.58 $47,855.89 2024-10-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 53 33 — — $21,253.91 $92,634.59 $47,795.52 2024-10-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 53 33 — — $20,456.31 $89,158.28 $47,613.41 2024-10-01
264 MS_DRG Other Circulatory System O.r. Procedures 53 33 — — $20,873.01 $90,974.43 $47,540.53 2024-10-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 53 33 — — $20,052.40 $87,397.85 $47,477.33 2024-10-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 53 33 — — $20,320.82 $88,567.76 $47,414.13 2024-10-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 53 33 — — $21,051.95 $91,754.37 $47,341.37 2024-10-01
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 20 11 — — $41,642.36 $48,232.55 $47,277.45 2024-10-01
B0105 OTHER Stroke; M > 34.25 & M < 38.85 1 1 — — $47,275.91 $47,275.91 $47,275.91 2024-10-01
963 MS_DRG Other Multiple Significant Trauma With Mcc 53 33 — — $17,474.91 $76,163.93 $46,819.42 2024-10-01
129 MS_DRG Major Head & Neck Procedures W Cc/mcc Or Major Device 1 1 — — $46,685.69 $46,685.69 $46,685.69 2024-10-01
C0106 OTHER Stroke; M > 30.05 & M < 34.25 1 1 — — $46,633.92 $46,633.92 $46,633.92 2024-10-01
500 MS_DRG Soft Tissue Procedures With Mcc 53 33 — — $20,724.73 $90,328.19 $46,605.52 2024-10-01
B1903 OTHER Guillian Barre; M < 18.05 1 1 — — $46,463.71 $46,463.71 $46,463.71 2024-10-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 53 33 — — $20,548.98 $89,562.18 $46,210.29 2024-10-01
338 MS_DRG Appendectomy With Complicated Principal Diagnosis With Mcc 20 9 — — $20,447.08 $59,345.67 $46,102.40 2024-10-01
B0604 OTHER Neurological; M < 25.85 1 1 — — $46,075.19 $46,075.19 $46,075.19 2024-10-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 52 32 — — $23,345.00 $84,456.36 $45,855.24 2024-10-01
570 MS_DRG Skin Debridement With Mcc 53 33 — — $18,675.78 $81,397.88 $45,794.00 2024-10-01
021 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 1 1 — — $45,519.73 $45,519.73 $45,519.73 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 18 14 — — $1,751.00 $66,907.78 $45,499.27 2024-10-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 53 33 — — $20,155.94 $87,849.10 $45,457.75 2024-10-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 53 33 — — $20,205.15 $88,063.58 $45,437.08 2024-10-01
01142 OTHER Supprelin La Implant 1 1 — — $45,350.21 $45,350.21 $45,350.21 2024-10-01
1142 OTHER Supprelin La Implant 12 9 — — $39,545.38 $45,803.71 $45,350.21 2024-10-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 49 32 — — $16,899.72 $73,656.98 $45,278.35 2024-10-01
231 OTHER Coronary Bypass With Ptca With Mcc 1 1 — — $45,077.37 $45,077.37 $45,077.37 2024-10-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 35 16 — — $2,975.00 $114,712.55 $45,073.10 2024-10-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 53 33 — — $19,973.15 $87,052.45 $44,915.37 2024-10-01
B0405 OTHER Traumatic Spinal Cord Injury; M < 16.05 & A < 63.5 1 1 — — $44,839.31 $44,839.31 $44,839.31 2024-10-01
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