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

JOHN RANDOLPH MEDICAL CENTER

Hopewell, VA · CCN 490020 · Rates published

Your selected procedure

You selected 27447 (CPT)

Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)

This hospital’s price: $26,325 across 9 payers · range $1,995-$34,078

Source: https://www.hcadam.com/api/public/content/6ec4d6074f5941b7ac009a0dd41b5dd8?download=true · observed 2024-10-01

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

39,897 distinct procedures filed
36 distinct payers
611,527 rate rows
2026-07-31 last MRF observed
Data quality

595,552 of 611,527 rate rows are consumer-grade (97.4%)

15,975 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 8,041
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 4,655
per-diem day rate — not a per-procedure price 2,474
template filing: same amount across many unrelated codes — excluded 324
percent-of-charges filed in the dollar field — excluded from medians 316
placeholder amount (≤ $0.02) — excluded from medians 117
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 40
exceeds 10× this hospital's gross charge — excluded from medians 6
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/61-1272888_TRICITIES-HOSPITAL_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.hcavirginia.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaCMS hospital list
Last fetch not_modified · 2026-08-11

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 15 $3,672,900.00 $4,958,415.00 $3,819,816.00 nat. median
$3,758,972
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 15 $3,605,000.00 $4,866,750.00 $3,749,200.00 nat. median
$3,646,097
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 3 $3,121,965.00 $3,672,900.00 $3,525,984.00 nat. median
$3,574,709
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 3 $3,064,250.00 $3,605,000.00 $3,460,800.00 nat. median
$3,496,850
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 18 $4,438.55 $4,489,364.25 $3,425,218.65 nat. median
$3,325,455
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 18 $7,321.38 $4,436,100.00 $3,384,580.00 nat. median
$3,252,508
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 3 $2,826,636.75 $3,325,455.00 $3,192,436.80 nat. median
$3,228,024
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 3 $2,793,100.00 $3,286,000.00 $3,154,560.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 18 $6,502.84 $4,006,800.00 $3,057,040.00 nat. median
$2,939,969
1.0× median
00746
OTHER 		Inj, Betibeglogene Autote 3 $2,522,800.00 $2,968,000.00 $2,849,280.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 15 $2,388,614.00 $3,224,628.90 $2,484,158.56 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 3 $2,030,321.90 $2,388,614.00 $2,293,069.44 nat. median
$2,511,312
0.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 15 $529,192.90 $714,410.42 $550,360.62 nat. median
$576,820
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 15 $527,123.40 $711,616.59 $548,208.34 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 15 $526,587.60 $710,893.26 $547,651.10 nat. median
$560,872
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 15 $516,726.10 $697,580.23 $537,395.14 nat. median
$562,201
1.0× median
5834
APR_DRG 		Neonate With Ecmo 7 $510,011.00 $550,811.88 $510,011.00 nat. median
$311,018
1.6× median
9035
OTHER 		Axicabtagene Ciloleucel C 15 $489,456.00 $660,765.60 $509,034.24 nat. median
$533,230
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 3 $449,813.97 $529,192.90 $508,025.18 nat. median
$549,535
0.9× median
09498
OTHER 		Ciltacabtagene Car-pos T 3 $448,054.89 $527,123.40 $506,038.46 nat. median
$570,020
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 3 $447,599.46 $526,587.60 $505,524.09 nat. median
$541,339
0.9× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 $440,504.85 $518,241.00 $497,511.36 nat. median
$691,418
0.7× median
09413
OTHER 		Lisocabtagene Car Pos T 3 $439,217.18 $516,726.10 $496,057.05 nat. median
$545,335
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $431,371.60 $507,496.00 $487,196.16 nat. median
$631,793
0.8× median
9391
OTHER 		Brexucabtagene Car Pos T 15 $460,530.40 $621,716.04 $478,951.62 nat. median
$492,768
1.0× median
09035
OTHER 		Axicabtagene Ciloleucel C 3 $416,037.60 $489,456.00 $469,877.76 nat. median
$516,226
0.9× median
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 $467,080.00 $504,446.40 $467,080.00 nat. median
$96,420
outlier · 4.8×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $411,986.50 $484,690.00 $465,302.40 nat. median
$610,161
0.8× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $402,951.85 $474,061.00 $455,098.56 nat. median
$624,417
0.7× median
5892
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 $450,554.00 $486,598.32 $450,554.00 nat. median
$89,188
outlier · 5.1×
5833
APR_DRG 		Neonate With Ecmo 7 $447,970.00 $483,807.60 $447,970.00 nat. median
$250,089
1.8× median
09391
OTHER 		Brexucabtagene Car Pos T 3 $391,450.84 $460,530.40 $442,109.18 nat. median
$474,767
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 3 $390,473.85 $459,381.00 $441,005.76 nat. median
$588,565
0.7× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $382,024.00 $449,440.00 $431,462.40 nat. median
$577,541
0.7× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 7 $360,309.00 $389,133.72 $360,309.00 nat. median
$254,667
1.4× median
1614
APR_DRG 		Implantable Heart Assist Systems 7 $348,964.00 $376,881.12 $348,964.00 nat. median
$209,486
1.7× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 $315,828.00 $341,094.24 $315,828.00 nat. median
$160,171
2.0× median
5832
APR_DRG 		Neonate With Ecmo 7 $308,232.00 $332,890.56 $308,232.00 nat. median
$169,230
1.8× median
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 $301,492.00 $325,611.36 $301,492.00 nat. median
$168,174
1.8× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 7 $295,723.00 $319,380.84 $295,723.00 nat. median
$165,646
1.8× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 $280,937.00 $303,411.96 $280,937.00 nat. median
$119,243
outlier · 2.4×
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 7 $280,293.00 $302,716.44 $280,293.00 nat. median
$101,315
outlier · 2.8×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 20 $19,893.00 $829,850.66 $275,528.60 nat. median
$370,165
0.7× median
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 7 $266,428.00 $287,742.24 $266,428.00 nat. median
$168,361
1.6× median
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 $251,914.00 $272,067.12 $251,914.00 nat. median
$147,677
1.7× median
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 7 $232,580.00 $251,186.40 $232,580.00 nat. median
$156,285
1.5× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 7 $211,075.00 $227,961.00 $211,075.00 nat. median
$165,599
1.3× median
5893
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 $209,396.00 $226,147.68 $209,396.00 nat. median
$71,350
outlier · 2.9×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 20 $27,899.00 $619,829.80 $208,970.74 nat. median
$261,939
0.8× median
6034
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 $208,065.00 $224,710.20 $208,065.00 nat. median
$109,499
1.9× median

Other procedures at this hospital

Browse this hospital's 39,897 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 15 15 — — $3,672,900.00 $4,958,415.00 $3,819,816.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 15 15 — — $3,605,000.00 $4,866,750.00 $3,749,200.00 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 4 3 — — $3,121,965.00 $3,672,900.00 $3,525,984.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 4 3 — — $3,064,250.00 $3,605,000.00 $3,460,800.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 19 18 — — $4,438.55 $4,489,364.25 $3,425,218.65 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 19 18 — — $7,321.38 $4,436,100.00 $3,384,580.00 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 4 3 — — $2,826,636.75 $3,325,455.00 $3,192,436.80 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 4 3 — — $2,793,100.00 $3,286,000.00 $3,154,560.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 19 18 — — $6,502.84 $4,006,800.00 $3,057,040.00 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 4 3 — — $2,522,800.00 $2,968,000.00 $2,849,280.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 15 15 — — $2,388,614.00 $3,224,628.90 $2,484,158.56 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 4 3 — — $2,030,321.90 $2,388,614.00 $2,293,069.44 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 15 15 — — $529,192.90 $714,410.42 $550,360.62 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 15 15 — — $527,123.40 $711,616.59 $548,208.34 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 15 15 — — $526,587.60 $710,893.26 $547,651.10 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 15 15 — — $516,726.10 $697,580.23 $537,395.14 2024-10-01
5834 APR_DRG Neonate With Ecmo 7 7 — — $510,011.00 $550,811.88 $510,011.00 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 15 15 — — $489,456.00 $660,765.60 $509,034.24 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 4 3 — — $449,813.97 $529,192.90 $508,025.18 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 4 3 — — $448,054.89 $527,123.40 $506,038.46 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 4 3 — — $447,599.46 $526,587.60 $505,524.09 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 3 — — $440,504.85 $518,241.00 $497,511.36 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 4 3 — — $439,217.18 $516,726.10 $496,057.05 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 3 — — $431,371.60 $507,496.00 $487,196.16 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 15 15 — — $460,530.40 $621,716.04 $478,951.62 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 4 3 — — $416,037.60 $489,456.00 $469,877.76 2024-10-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 7 — — $467,080.00 $504,446.40 $467,080.00 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 3 — — $411,986.50 $484,690.00 $465,302.40 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 3 — — $402,951.85 $474,061.00 $455,098.56 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 7 — — $450,554.00 $486,598.32 $450,554.00 2024-10-01
5833 APR_DRG Neonate With Ecmo 7 7 — — $447,970.00 $483,807.60 $447,970.00 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 4 3 — — $391,450.84 $460,530.40 $442,109.18 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 3 — — $390,473.85 $459,381.00 $441,005.76 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 3 — — $382,024.00 $449,440.00 $431,462.40 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $360,309.00 $389,133.72 $360,309.00 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 7 7 — — $348,964.00 $376,881.12 $348,964.00 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 7 — — $315,828.00 $341,094.24 $315,828.00 2024-10-01
5832 APR_DRG Neonate With Ecmo 7 7 — — $308,232.00 $332,890.56 $308,232.00 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 7 — — $301,492.00 $325,611.36 $301,492.00 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $295,723.00 $319,380.84 $295,723.00 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $280,937.00 $303,411.96 $280,937.00 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 7 7 — — $280,293.00 $302,716.44 $280,293.00 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 30 20 — — $19,893.00 $829,850.66 $275,528.60 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $266,428.00 $287,742.24 $266,428.00 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 7 — — $251,914.00 $272,067.12 $251,914.00 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 7 — — $232,580.00 $251,186.40 $232,580.00 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $211,075.00 $227,961.00 $211,075.00 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 7 — — $209,396.00 $226,147.68 $209,396.00 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 30 20 — — $27,899.00 $619,829.80 $208,970.74 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 7 — — $208,065.00 $224,710.20 $208,065.00 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $202,565.00 $218,770.20 $202,565.00 2024-10-01
5831 APR_DRG Neonate With Ecmo 7 7 — — $192,932.00 $208,366.56 $192,932.00 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 25 18 — — $26,741.00 $522,043.94 $173,585.18 2024-10-01
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 7 7 — — $173,451.00 $187,327.08 $173,451.00 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 4 3 — — $150,448.55 $176,998.30 $170,803.36 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 7 7 — — $169,225.00 $182,763.00 $169,225.00 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 7 7 — — $165,214.00 $178,431.12 $165,214.00 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 7 — — $160,362.00 $173,190.96 $160,362.00 2024-10-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 7 7 — — $159,670.00 $172,443.60 $159,670.00 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $159,642.00 $172,413.36 $159,642.00 2024-10-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 7 7 — — $157,615.00 $170,224.20 $157,615.00 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 7 7 — — $156,916.00 $169,469.28 $156,916.00 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $156,912.00 $169,464.96 $156,912.00 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 29 19 — — $28,280.00 $471,592.98 $156,876.21 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $156,444.00 $168,959.52 $156,444.00 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 7 — — $147,646.00 $159,457.68 $147,646.00 2024-10-01
1907 OTHER New Technology - Level 52 15 15 — — $141,529.60 $191,064.96 $147,190.78 2024-10-01
1908 OTHER New Technology - Level 52 15 15 — — $141,529.60 $191,064.96 $147,190.78 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 7 7 — — $145,745.00 $157,404.60 $145,745.00 2024-10-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 7 — — $145,653.00 $157,305.24 $145,653.00 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $141,934.00 $153,288.72 $141,934.00 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 3 — — $124,142.25 $146,049.70 $140,937.96 2024-10-01
01907 OTHER New Technology - Level 52 4 3 — — $120,300.16 $141,529.60 $135,868.41 2024-10-01
01908 OTHER New Technology - Level 52 4 3 — — $120,300.16 $141,529.60 $135,868.41 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $132,852.00 $143,480.16 $132,852.00 2024-10-01
1906 OTHER New Technology - Level 51 15 15 — — $127,608.70 $172,271.74 $132,713.05 2024-10-01
1905 OTHER New Technology - Level 51 15 15 — — $127,608.70 $172,271.74 $132,713.05 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 7 — — $130,276.00 $140,698.08 $130,276.00 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $129,180.00 $139,514.40 $129,180.00 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $127,303.00 $137,487.24 $127,303.00 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $127,303.00 $137,487.24 $127,303.00 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $123,073.00 $132,918.84 $123,073.00 2024-10-01
01906 OTHER New Technology - Level 51 4 3 — — $108,467.39 $127,608.70 $122,504.35 2024-10-01
01905 OTHER New Technology - Level 51 4 3 — — $108,467.39 $127,608.70 $122,504.35 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 5 2 — — $96,600.00 $154,973.00 $120,261.00 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 5 2 — — $96,600.00 $122,424.00 $120,261.00 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 5 2 — — $96,600.00 $122,424.00 $120,261.00 2024-10-01
1903 OTHER New Technology - Level 50 15 15 — — $113,687.80 $153,478.53 $118,235.31 2024-10-01
1904 OTHER New Technology - Level 50 15 15 — — $113,687.80 $153,478.53 $118,235.31 2024-10-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 7 7 — — $116,607.00 $125,935.56 $116,607.00 2024-10-01
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $115,113.00 $124,322.04 $115,113.00 2024-10-01
286476 CDM Hearmate Implant Kit 18 12 $332,875.00 $332,875.00 $49,931.25 $332,875.00 $114,841.88 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 4 3 — — $100,770.47 $118,553.50 $114,404.13 2024-10-01
89242 CDM Angio Av Shnt Evl W Stnt 15 11 $187,997.00 $187,997.00 $28,199.55 $187,997.00 $112,798.20 2024-10-01
4404 APR_DRG Kidney Transplant 7 7 — — $111,641.00 $120,572.28 $111,641.00 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $110,942.00 $119,817.36 $110,942.00 2024-10-01
01904 OTHER New Technology - Level 50 4 3 — — $96,634.63 $113,687.80 $109,140.29 2024-10-01
01903 OTHER New Technology - Level 50 4 3 — — $96,634.63 $113,687.80 $109,140.29 2024-10-01
4403 APR_DRG Kidney Transplant 7 7 — — $109,063.00 $117,788.04 $109,063.00 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 7 — — $108,675.00 $117,369.00 $108,675.00 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $108,197.00 $116,852.76 $108,197.00 2024-10-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 7 7 — — $108,167.00 $116,820.36 $108,167.00 2024-10-01
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 7 — — $107,944.00 $116,579.52 $107,944.00 2024-10-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $107,120.00 $115,689.60 $107,120.00 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 7 7 — — $106,646.00 $115,177.68 $106,646.00 2024-10-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 7 — — $103,916.00 $112,229.28 $103,916.00 2024-10-01
1901 OTHER New Technology - Level 49 15 15 — — $99,766.91 $134,685.33 $103,757.59 2024-10-01
1902 OTHER New Technology - Level 49 15 15 — — $99,766.91 $134,685.33 $103,757.59 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 29 19 — — $28,280.00 $310,924.97 $103,664.04 2024-10-01
22800 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; Up To 6 Vert… 9 4 — — $4,250.00 $113,044.00 $103,231.00 2024-10-01
22802 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 7 To 12 Vert… 9 4 — — $4,250.00 $113,044.00 $103,231.00 2024-10-01
22808 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 2 To 3 Verteb… 9 4 — — $4,250.00 $113,044.00 $103,231.00 2024-10-01
22810 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 Verteb… 9 4 — — $4,250.00 $113,044.00 $103,231.00 2024-10-01
22804 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 13 Or More V… 9 4 — — $4,250.00 $113,044.00 $103,231.00 2024-10-01
22812 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 8 Or More Ver… 9 4 — — $4,250.00 $113,044.00 $103,231.00 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 19 18 — — $84,999.91 $134,999.86 $102,999.90 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $102,216.00 $110,393.28 $102,216.00 2024-10-01
6904 APR_DRG Acute Leukemia 7 7 — — $100,987.00 $109,065.96 $100,987.00 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 7 7 — — $100,860.00 $108,928.80 $100,860.00 2024-10-01
8634 APR_DRG Neonatal Aftercare 7 7 — — $99,796.00 $107,779.68 $99,796.00 2024-10-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $98,813.00 $106,718.04 $98,813.00 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 7 7 — — $98,789.00 $106,692.12 $98,789.00 2024-10-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 7 7 — — $98,465.00 $106,342.20 $98,465.00 2024-10-01
74678 CDM Revasc Fem/pop Stnt/ath 15 11 $163,384.00 $163,384.00 $24,507.60 $163,384.00 $98,030.40 2024-10-01
74682 CDM Revasc Tib Stnt/ath Init 15 11 $162,832.00 $162,832.00 $24,424.80 $162,832.00 $97,699.20 2024-10-01
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 7 — — $97,170.00 $104,943.60 $97,170.00 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 3 1 — — $63,005.77 $97,028.89 $97,028.89 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 30 20 — — $19,893.00 $288,298.41 $96,170.31 2024-10-01
7 MS_DRG Lung Transplant 30 20 — — $26,741.00 $287,572.21 $95,929.79 2024-10-01
01902 OTHER New Technology - Level 49 4 3 — — $84,801.87 $99,766.91 $95,776.23 2024-10-01
01901 OTHER New Technology - Level 49 4 3 — — $84,801.87 $99,766.91 $95,776.23 2024-10-01
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 7 7 — — $95,753.00 $103,413.24 $95,753.00 2024-10-01
382251 CDM Ventak Gentrator & Lead 10 7 $204,718.00 $204,718.00 $30,707.70 $204,718.00 $95,193.87 2024-10-01
360200 CDM Lead & Generator 10 7 $201,773.00 $201,773.00 $30,265.95 $201,773.00 $93,824.45 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 19 18 — — $77,377.11 $122,893.07 $93,762.86 2024-10-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 7 7 — — $93,697.00 $101,192.76 $93,697.00 2024-10-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $93,260.00 $100,720.80 $93,260.00 2024-10-01
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 7 7 — — $93,236.00 $100,694.88 $93,236.00 2024-10-01
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $93,138.00 $100,589.04 $93,138.00 2024-10-01
204 APR_DRG Open Craniotomy For Trauma 7 7 — — $92,976.00 $100,414.08 $92,976.00 2024-10-01
8904 APR_DRG HIV With Multiple Major HIV Related Conditions 7 7 — — $92,887.00 $100,317.96 $92,887.00 2024-10-01
1585 OTHER New Technology - Level 48 15 15 — — $88,166.16 $119,024.32 $91,692.81 2024-10-01
1599 OTHER New Technology - Level 48 15 15 — — $88,166.16 $119,024.32 $91,692.81 2024-10-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $91,655.00 $98,987.40 $91,655.00 2024-10-01
0208 RC — 5 4 — — $91,149.50 $91,149.50 $91,149.50 2024-10-01
74672 CDM Revasc Iliac W Stnt Init 15 11 $149,891.00 $149,891.00 $22,483.65 $149,891.00 $89,934.60 2024-10-01
74677 CDM Revasc Fem/pop W Stntplc 15 11 $149,717.00 $149,717.00 $22,457.55 $149,717.00 $89,830.20 2024-10-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 7 7 — — $89,576.00 $96,742.08 $89,576.00 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 7 7 — — $88,772.00 $95,873.76 $88,772.00 2024-10-01
4402 APR_DRG Kidney Transplant 7 7 — — $88,288.00 $95,351.04 $88,288.00 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 3 1 — — $57,294.42 $88,233.41 $88,233.41 2024-10-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 7 7 — — $88,219.00 $95,276.52 $88,219.00 2024-10-01
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 7 7 — — $85,932.00 $92,806.56 $85,932.00 2024-10-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 7 7 — — $84,943.00 $91,738.44 $84,943.00 2024-10-01
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 7 7 — — $84,750.00 $91,530.00 $84,750.00 2024-10-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 7 — — $84,670.00 $91,443.60 $84,670.00 2024-10-01
01585 OTHER New Technology - Level 48 4 3 — — $74,941.24 $88,166.16 $84,639.51 2024-10-01
01599 OTHER New Technology - Level 48 4 3 — — $74,941.24 $88,166.16 $84,639.51 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 30 20 — — $77,746.93 $239,713.56 $83,577.95 2024-10-01
1774 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 7 7 — — $83,418.00 $90,091.44 $83,418.00 2024-10-01
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 7 7 — — $82,863.00 $89,492.04 $82,863.00 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 30 20 — — $27,899.00 $355,969.00 $82,181.68 2024-10-01
1584 OTHER New Technology - Level 47 15 15 — — $78,885.56 $106,495.51 $82,040.98 2024-10-01
1598 OTHER New Technology - Level 47 15 15 — — $78,885.56 $106,495.51 $82,040.98 2024-10-01
C9150 HCPCS Xenon Xe-129 Hyperpolarized Gas, Diagnostic, Per Study Dose 3 1 — — $53,040.00 $81,681.60 $81,681.60 2024-10-01
4414 APR_DRG Major Bladder Procedures 7 7 — — $81,347.00 $87,854.76 $81,347.00 2024-10-01
215 MS_DRG Other Heart Assist System Implant 30 20 — — $75,631.93 $233,135.97 $80,499.76 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 4 3 — — $70,854.13 $83,357.80 $80,440.28 2024-10-01
1834 APR_DRG Percutaneous Structural Cardiac Procedures 7 7 — — $80,308.00 $86,732.64 $80,308.00 2024-10-01
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 7 7 — — $80,005.00 $86,405.40 $80,005.00 2024-10-01
1694 APR_DRG Major Abdominal Vascular Procedures 7 7 — — $78,979.00 $85,297.32 $78,979.00 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 30 20 — — $26,741.00 $234,333.09 $78,297.37 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 30 20 — — $27,899.00 $230,658.09 $78,202.76 2024-10-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 7 7 — — $78,173.00 $84,426.84 $78,173.00 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 7 7 — — $77,545.00 $83,748.60 $77,545.00 2024-10-01
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition… 7 7 — — $77,224.00 $83,401.92 $77,224.00 2024-10-01
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 7 7 — — $76,503.00 $82,623.24 $76,503.00 2024-10-01
01598 OTHER New Technology - Level 47 4 3 — — $67,052.73 $78,885.56 $75,730.14 2024-10-01
01584 OTHER New Technology - Level 47 4 3 — — $67,052.73 $78,885.56 $75,730.14 2024-10-01
234 APR_DRG Spinal Procedures 7 7 — — $75,668.00 $81,721.44 $75,668.00 2024-10-01
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $75,344.00 $81,371.52 $75,344.00 2024-10-01
1204 APR_DRG Major Respiratory And Chest Procedures 7 7 — — $75,279.00 $81,301.32 $75,279.00 2024-10-01
1784 APR_DRG External Heart Assist Devices 7 7 — — $75,021.00 $81,022.68 $75,021.00 2024-10-01
4014 APR_DRG Adrenal Procedures 7 7 — — $74,972.00 $80,969.76 $74,972.00 2024-10-01
2304 APR_DRG Major Small Bowel Procedures 7 7 — — $74,827.00 $80,813.16 $74,827.00 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 4 3 — — $65,835.68 $77,453.74 $74,742.86 2024-10-01
914 APR_DRG Other Major Head And Neck Procedures 7 7 — — $74,712.00 $80,688.96 $74,712.00 2024-10-01
274 APR_DRG Other Open Craniotomy 7 7 — — $74,047.00 $79,970.76 $74,047.00 2024-10-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 7 7 — — $73,623.00 $79,512.84 $73,623.00 2024-10-01
351176 CDM Lead & Gen (1746-0074) 10 7 $158,184.00 $158,184.00 $23,727.60 $158,184.00 $73,555.56 2024-10-01
214 APR_DRG Open Craniotomy Except Trauma 7 7 — — $73,234.00 $79,092.72 $73,234.00 2024-10-01
230 MS_DRG Other Cardiothoracic Procedures Without Cc/mcc 6 2 — — $45,228.00 $76,801.00 $72,977.50 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 4 3 — — $64,114.33 $75,428.62 $72,788.62 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 30 20 — — $60,400.00 $212,366.70 $72,401.33 2024-10-01
1597 OTHER New Technology - Level 46 15 15 — — $69,604.96 $93,966.70 $72,389.16 2024-10-01
1583 OTHER New Technology - Level 46 15 15 — — $69,604.96 $93,966.70 $72,389.16 2024-10-01
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $72,160.00 $77,932.80 $72,160.00 2024-10-01
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 7 7 — — $71,537.00 $77,259.96 $71,537.00 2024-10-01
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 7 — — $71,357.00 $77,065.56 $71,357.00 2024-10-01
1783 APR_DRG External Heart Assist Devices 7 7 — — $71,162.00 $76,854.96 $71,162.00 2024-10-01
894 APR_DRG Major Cranial Or Facial Bone Procedures 7 7 — — $69,908.00 $75,500.64 $69,908.00 2024-10-01
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 7 7 — — $69,756.00 $75,336.48 $69,756.00 2024-10-01
22633 CPT Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Inter… 9 4 — — $4,250.00 $106,619.00 $69,303.00 2024-10-01
22634 CPT Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Inter… 5 3 — — $4,250.00 $106,619.00 $69,303.00 2024-10-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 7 7 — — $69,297.00 $74,840.76 $69,297.00 2024-10-01
1782 APR_DRG External Heart Assist Devices 7 7 — — $69,213.00 $74,750.04 $69,213.00 2024-10-01
224 APR_DRG Ventricular Shunt Procedures 7 7 — — $68,730.00 $74,228.40 $68,730.00 2024-10-01
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 7 7 — — $68,662.00 $74,154.96 $68,662.00 2024-10-01
4054 APR_DRG Other Procedures For Endocrine, Nutritional And Metabolic Disorders 7 7 — — $68,487.00 $73,965.96 $68,487.00 2024-10-01
82165 CDM Transcth Stnt Plc In Vn 15 11 $113,745.00 $113,745.00 $17,061.75 $113,745.00 $68,247.00 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 15 15 — — $65,476.58 $88,393.38 $68,095.64 2024-10-01
1214 APR_DRG Other Respiratory And Chest Procedures 7 7 — — $67,918.00 $73,351.44 $67,918.00 2024-10-01
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 7 7 — — $67,898.00 $73,329.84 $67,898.00 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 19 18 — — $55,990.94 $88,926.79 $67,847.85 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 5 2 — — $51,564.00 $72,185.00 $67,827.00 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 30 20 — — $26,741.00 $202,703.87 $67,821.99 2024-10-01
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $67,403.00 $72,795.24 $67,403.00 2024-10-01
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 7 7 — — $67,380.00 $72,770.40 $67,380.00 2024-10-01
1794 APR_DRG Defibrillator Implants 7 7 — — $67,178.00 $72,552.24 $67,178.00 2024-10-01
01597 OTHER New Technology - Level 46 4 3 — — $59,164.22 $69,604.96 $66,820.76 2024-10-01
01583 OTHER New Technology - Level 46 4 3 — — $59,164.22 $69,604.96 $66,820.76 2024-10-01
264 APR_DRG Other Nervous System And Related Procedures 7 7 — — $66,454.00 $71,770.32 $66,454.00 2024-10-01
2614 APR_DRG Major Biliary Tract Procedures 7 7 — — $66,067.00 $71,352.36 $66,067.00 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 34 20 — — $51,161.00 $186,360.01 $65,784.71 2024-10-01
2324 APR_DRG Gastric Fundoplication 7 7 — — $65,555.00 $70,799.40 $65,555.00 2024-10-01
4474 APR_DRG Other Kidney, Urinary Tract And Related Non-percutaneous Procedures 7 7 — — $65,365.00 $70,594.20 $65,365.00 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 19 18 — — $10,636.84 $85,528.94 $65,255.41 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 30 20 — — $60,625.25 $186,465.64 $65,172.15 2024-10-01
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 7 7 — — $65,020.00 $70,221.60 $65,020.00 2024-10-01
2294 APR_DRG Other Digestive System And Abdominal Procedures 7 7 — — $64,643.00 $69,814.44 $64,643.00 2024-10-01
007 OTHER Lung Transplant 4 3 — — $56,804.21 $66,828.48 $64,489.49 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 4 3 — — $56,701.16 $66,707.25 $64,372.49 2024-10-01
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $64,211.00 $69,347.88 $64,211.00 2024-10-01
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $64,211.00 $69,347.88 $64,211.00 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 7 4 — — $53,979.59 $97,798.32 $63,505.40 2024-10-01
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $63,335.00 $68,401.80 $63,335.00 2024-10-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $63,335.00 $68,401.80 $63,335.00 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 9 3 — — $3,159.00 $96,936.00 $63,335.00 2024-10-01
1814 APR_DRG Lower Extremity Vascular Procedures 7 7 — — $63,197.00 $68,252.76 $63,197.00 2024-10-01
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $63,091.00 $68,138.28 $63,091.00 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 4 3 — — $55,655.09 $65,476.58 $62,857.51 2024-10-01
1596 OTHER New Technology - Level 45 15 15 — — $60,324.36 $81,437.89 $62,737.33 2024-10-01
1582 OTHER New Technology - Level 45 15 15 — — $60,324.36 $81,437.89 $62,737.33 2024-10-01
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 7 7 — — $62,671.00 $67,684.68 $62,671.00 2024-10-01
9514 APR_DRG Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 7 7 — — $62,404.00 $67,396.32 $62,404.00 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 30 20 — — $27,899.00 $183,530.04 $62,366.98 2024-10-01
90288 CPT Botulism Immune Globulin, Human, For Intravenous Use 6 2 — — $48,705.00 $75,005.70 $61,855.35 2024-10-01
1764 APR_DRG Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 7 7 — — $61,469.00 $66,386.52 $61,469.00 2024-10-01
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 7 7 — — $61,403.00 $66,315.24 $61,403.00 2024-10-01
367402 CDM Graft Bone Infuse Bmp Me 10 7 $131,890.00 $131,890.00 $19,783.50 $131,890.00 $61,328.85 2024-10-01
389364 CDM Graft Bn 26mm 18mm Infs 10 7 $131,890.00 $131,890.00 $19,783.50 $131,890.00 $61,328.85 2024-10-01
409977 CDM Valve Aortic 29mm 10 7 $131,890.00 $131,890.00 $19,783.50 $131,890.00 $61,328.85 2024-10-01
367401 CDM Graft Bn Lg Sp 26x18mm 10 7 $131,890.00 $131,890.00 $19,783.50 $131,890.00 $61,328.85 2024-10-01
6954 APR_DRG Chemotherapy For Acute Leukemia 7 7 — — $60,942.00 $65,817.36 $60,942.00 2024-10-01
2634 APR_DRG Cholecystectomy 7 7 — — $60,892.00 $65,763.36 $60,892.00 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 4 3 — — $53,851.55 $63,354.77 $60,820.58 2024-10-01
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 7 7 — — $60,737.00 $65,595.96 $60,737.00 2024-10-01
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 7 — — $60,444.00 $65,279.52 $60,444.00 2024-10-01
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 7 7 — — $60,109.00 $64,917.72 $60,109.00 2024-10-01
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 7 7 — — $60,023.00 $64,824.84 $60,023.00 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 30 20 — — $26,741.00 $229,226.00 $60,011.73 2024-10-01
464273 CDM Grft Bn Implnt 10cc 10 7 $128,547.00 $128,547.00 $19,282.05 $128,547.00 $59,774.35 2024-10-01
367403 CDM Graft Bn Sm 2.8cc 1x2in 10 7 $128,513.00 $128,513.00 $19,276.95 $128,513.00 $59,758.54 2024-10-01
1773 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 7 7 — — $59,655.00 $64,427.40 $59,655.00 2024-10-01
1673 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 7 7 — — $59,655.00 $64,427.40 $59,655.00 2024-10-01
5114 APR_DRG Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 7 7 — — $59,645.00 $64,416.60 $59,645.00 2024-10-01
5104 APR_DRG Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced… 7 7 — — $59,631.00 $64,401.48 $59,631.00 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 4 3 — — $52,476.22 $61,736.73 $59,575.94 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 30 20 — — $55,972.10 $171,994.49 $59,565.85 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 30 20 — — $55,414.52 $170,260.42 $59,366.12 2024-10-01
64565 CPT HPercutaneous Implantation Of Neurostimulator Electrode Array; Neuromuscular 5 2 — — $5,658.00 $64,301.00 $59,318.00 2024-10-01
8633 APR_DRG Neonatal Aftercare 7 7 — — $58,989.00 $63,708.12 $58,989.00 2024-10-01
294 APR_DRG Other Percutaneous Intracranial Procedures 7 7 — — $58,983.00 $63,701.64 $58,983.00 2024-10-01
10 MS_DRG Pancreas Transplant 30 20 — — $26,741.00 $175,445.04 $58,794.06 2024-10-01
443074 CDM Spacer Spn 20mm 41mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
448341 CDM Spacer Spn 20mm 26-34mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
567634 CDM Spacer Tissue Shldr Med 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
557760 CDM Cage Spnl 21/24x10x10mm6 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
463583 CDM Disc Spn Mobi-c 15x15x5 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
472784 CDM Disc Intvrt 6x16x17.8mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
461846 CDM Cage Spnl 50x21x12mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
488496 CDM Disc Intvrt 5x16x15mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
469319 CDM Disc Intvrtb 19x5x15mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
489616 CDM Cage Spnl 25x10x8mm 8d 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
492478 CDM Cage Lordotic 9x27mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
493828 CDM Disc Intvrt 5x14x15mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
568877 CDM Cage Spn Lordotc 10x28mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
494333 CDM Cage Spn 23x9x10-15mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
464325 CDM Disc Intvrtb Spn Xl 6mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
796494 CDM Disc Spnl Std 5x17x17mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
492477 CDM Concorde Lift Expandable 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
557758 CDM Cage Spn 10x21/24 12d 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
469318 CDM Disc Spn Cerv19x6x15mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
514575 CDM Cage Spn Xl 15d 55x22x10 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
463555 CDM Disc Intvrtb 17mm 5mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
463043 CDM Disc Intvrtb 15x5x13mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
468590 CDM Spacer Rise 26x10mm 8-15 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
565350 CDM Cage Spn 12x28mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
472677 CDM Disc Spnl 13x17x5mm 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
968767 CDM Graft Bn Algrf Whl 10 7 $125,928.00 $125,928.00 $18,889.20 $125,928.00 $58,556.52 2024-10-01
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