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

LEWISGALE MEDICAL CENTER

Salem, VA · CCN 490048 · Rates published

37,076 distinct procedures filed
50 distinct payers
738,894 rate rows
2024-10-01 last MRF observed · ⚠ 21 mo old
Data quality

231,272 of 738,894 rate rows are consumer-grade (31.3%)

507,622 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 504,958
per-diem day rate — not a per-procedure price 2,344
template filing: same amount across many unrelated codes — excluded 243
placeholder amount (≤ $0.02) — excluded from medians 62
exceeds 10× this hospital's gross charge — excluded from medians 15

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 21 months old.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://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1760148_LEWISGALE-MEDICAL-CENTER_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 Latest re-check couldn't be parsed — showing last good data · 2026-06-08

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
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 14 $3,672,900.00 $4,223,835.00 $3,764,722.50 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 14 $3,605,000.00 $4,145,750.00 $3,695,125.00 nat. median
$3,605,000
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 16 $5,150.11 $3,824,273.25 $3,363,365.19 nat. median
$13,041
outlier · 257.9×
748
OTHER 		Inj, Lovotibeglogene Auto 16 $8,495.09 $3,778,900.00 $3,323,460.40 nat. median
$17,963
outlier · 185.0×
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,121,965.00 $3,562,713.00 $3,305,610.00 nat. median
$3,574,709
0.9× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $3,064,250.00 $3,496,850.00 $3,244,500.00 nat. median
$3,496,850
0.9× median
746
OTHER 		Inj, Betibeglogene Autote 16 $7,545.33 $3,413,200.00 $3,001,835.20 nat. median
$21,896
outlier · 137.1×
00714
OTHER 		Inj Delandistrogene Mox R 2 $2,826,636.75 $3,225,691.35 $2,992,909.50 nat. median
$3,228,024
0.9× median
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $2,793,100.00 $3,187,420.00 $2,957,400.00 nat. median
$3,187,420
0.9× median
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,522,800.00 $2,878,960.00 $2,671,200.00 nat. median
$2,878,960
0.9× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 14 $2,388,614.00 $2,746,906.10 $2,448,329.35 nat. median
$2,588,981
0.9× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,030,321.90 $2,316,955.58 $2,149,752.60 nat. median
$2,457,321
0.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 14 $529,192.90 $608,571.83 $542,422.72 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 14 $527,123.40 $606,191.91 $540,301.48 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 14 $526,587.60 $605,575.74 $539,752.29 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 14 $516,726.10 $594,235.01 $529,644.25 nat. median
$562,201
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 14 $489,456.00 $562,874.40 $501,692.40 nat. median
$532,192
0.9× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 $440,504.85 $1,570,357.68 $484,555.34 nat. median
$753,246
0.6× median
5834
APR_DRG 		Neonate With Ecmo 7 $481,555.00 $520,079.40 $481,555.00 nat. median
$309,665
1.6× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $449,813.97 $513,317.11 $476,273.61 nat. median
$538,205
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $431,371.60 $1,523,061.00 $474,508.76 nat. median
$674,867
0.7× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $448,054.89 $511,309.70 $474,411.06 nat. median
$554,552
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $447,599.46 $510,789.97 $473,928.84 nat. median
$530,178
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 14 $460,530.40 $529,609.96 $472,043.66 nat. median
$489,450
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $439,217.18 $501,224.32 $465,053.49 nat. median
$534,091
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $411,986.50 $1,510,363.59 $453,185.15 nat. median
$625,184
0.7× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $402,951.85 $1,489,170.63 $443,247.04 nat. median
$673,137
0.7× median
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 $441,020.00 $476,301.60 $441,020.00 nat. median
$93,370
outlier · 4.7×
09035
OTHER 		Axicabtagene Ciloleucel C 2 $416,037.60 $474,772.32 $440,510.40 nat. median
$505,583
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 3 $390,473.85 $1,467,410.73 $429,521.23 nat. median
$634,303
0.7× median
5892
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 $425,416.00 $459,449.28 $425,416.00 nat. median
$89,796
outlier · 4.7×
5833
APR_DRG 		Neonate With Ecmo 7 $422,976.00 $456,814.08 $422,976.00 nat. median
$244,017
1.7× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $382,024.00 $1,348,320.00 $420,226.40 nat. median
$619,808
0.7× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $391,450.84 $446,714.49 $414,477.36 nat. median
$464,978
0.9× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 7 $340,206.00 $367,422.48 $340,206.00 nat. median
$246,434
1.4× median
1614
APR_DRG 		Implantable Heart Assist Systems 7 $329,494.00 $355,853.52 $329,494.00 nat. median
$207,730
1.6× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 18 $12,503.00 $665,660.45 $314,536.58 nat. median
$370,174
0.8× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 $298,207.00 $322,063.56 $298,207.00 nat. median
$150,721
2.0× median
5832
APR_DRG 		Neonate With Ecmo 7 $291,035.00 $314,317.80 $291,035.00 nat. median
$156,126
1.9× median
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 $284,670.00 $307,443.60 $284,670.00 nat. median
$162,982
1.7× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 7 $279,223.00 $301,560.84 $279,223.00 nat. median
$160,267
1.7× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 $265,262.00 $286,482.96 $265,262.00 nat. median
$117,173
outlier · 2.3×
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 7 $264,654.00 $285,826.32 $264,654.00 nat. median
$97,957
outlier · 2.7×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 39 $23,576.00 $497,193.29 $261,790.64 nat. median
$265,286
1.0× median
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 7 $251,563.00 $271,688.04 $251,563.00 nat. median
$164,289
1.5× median
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 $237,859.00 $256,887.72 $237,859.00 nat. median
$122,924
1.9× median
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 7 $219,604.00 $237,172.32 $219,604.00 nat. median
$151,838
1.4× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 1 $218,394.00 $218,394.00 $218,394.00 nat. median
$76,329
outlier · 2.9×
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 7 $199,298.00 $215,241.84 $199,298.00 nat. median
$164,834
1.2× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 18 $16,458.00 $418,754.87 $197,971.19 nat. median
$206,474
1.0× median

Other procedures at this hospital

Browse this hospital's 37,076 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 3 2 — — $174,567.39 $199,212.20 $184,836.06 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 3 2 — — $65,791.10 $75,079.25 $69,661.16 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 3 2 — — $116,925.24 $133,432.33 $123,803.19 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 3 2 — — $82,212.97 $93,819.51 $87,049.03 2024-10-01
007 OTHER Lung Transplant 3 2 — — $65,910.66 $75,215.69 $69,787.76 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 3 2 — — $2,826,636.75 $3,225,691.35 $2,992,909.50 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 3 2 — — $2,522,800.00 $2,878,960.00 $2,671,200.00 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 3 2 — — $2,793,100.00 $3,187,420.00 $2,957,400.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 3 2 — — $3,064,250.00 $3,496,850.00 $3,244,500.00 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 3 2 — — $76,389.99 $87,174.46 $80,883.52 2024-10-01
01583 OTHER New Technology - Level 46 3 2 — — $58,536.92 $66,800.95 $61,980.26 2024-10-01
01584 OTHER New Technology - Level 47 3 2 — — $66,341.79 $75,707.69 $70,244.24 2024-10-01
01585 OTHER New Technology - Level 48 3 2 — — $74,146.66 $84,614.42 $78,508.22 2024-10-01
01597 OTHER New Technology - Level 46 3 2 — — $58,536.92 $66,800.95 $61,980.26 2024-10-01
01598 OTHER New Technology - Level 47 3 2 — — $66,341.79 $75,707.69 $70,244.24 2024-10-01
01599 OTHER New Technology - Level 48 3 2 — — $74,146.66 $84,614.42 $78,508.22 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 2 — — $144,043.80 $164,379.40 $152,516.97 2024-10-01
01901 OTHER New Technology - Level 49 3 2 — — $83,902.74 $95,747.84 $88,838.20 2024-10-01
01902 OTHER New Technology - Level 49 3 2 — — $83,902.74 $95,747.84 $88,838.20 2024-10-01
01903 OTHER New Technology - Level 50 3 2 — — $95,610.04 $109,107.93 $101,234.16 2024-10-01
01904 OTHER New Technology - Level 50 3 2 — — $95,610.04 $109,107.93 $101,234.16 2024-10-01
01905 OTHER New Technology - Level 51 3 2 — — $107,317.35 $122,468.03 $113,630.13 2024-10-01
01906 OTHER New Technology - Level 51 3 2 — — $107,317.35 $122,468.03 $113,630.13 2024-10-01
01907 OTHER New Technology - Level 52 3 2 — — $119,024.65 $135,828.13 $126,026.10 2024-10-01
01908 OTHER New Technology - Level 52 3 2 — — $119,024.65 $135,828.13 $126,026.10 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 3 2 — — $56,117.27 $64,039.71 $59,418.29 2024-10-01
0208 RC — 5 4 — — $94,175.50 $94,175.50 $94,175.50 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 3 2 — — $416,037.60 $474,772.32 $440,510.40 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 3 2 — — $3,121,965.00 $3,562,713.00 $3,305,610.00 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 3 2 — — $2,030,321.90 $2,316,955.58 $2,149,752.60 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 3 2 — — $449,813.97 $513,317.11 $476,273.61 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 3 2 — — $391,450.84 $446,714.49 $414,477.36 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 3 2 — — $439,217.18 $501,224.32 $465,053.49 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 3 2 — — $447,599.46 $510,789.97 $473,928.84 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 3 2 — — $448,054.89 $511,309.70 $474,411.06 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 54 39 — — $23,576.00 $497,193.29 $261,790.64 2024-10-01
10 MS_DRG Pancreas Transplant 51 39 — — $23,576.00 $140,732.34 $83,560.17 2024-10-01
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $59,571.00 $64,336.68 $59,571.00 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $104,752.00 $113,132.16 $104,752.00 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $150,735.00 $162,793.80 $150,735.00 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $265,262.00 $286,482.96 $265,262.00 2024-10-01
1204 APR_DRG Major Respiratory And Chest Procedures 7 7 — — $71,079.00 $76,765.32 $71,079.00 2024-10-01
1214 APR_DRG Other Respiratory And Chest Procedures 7 7 — — $64,129.00 $69,259.32 $64,129.00 2024-10-01
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 7 7 — — $72,234.00 $78,012.72 $72,234.00 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 52 40 — — $12,503.00 $231,257.09 $121,880.04 2024-10-01
1582 OTHER New Technology - Level 45 14 14 — — $59,684.76 $68,637.47 $61,176.88 2024-10-01
1583 OTHER New Technology - Level 46 14 14 — — $68,866.96 $79,197.00 $70,588.64 2024-10-01
1584 OTHER New Technology - Level 47 14 14 — — $78,049.16 $89,756.53 $80,000.39 2024-10-01
1585 OTHER New Technology - Level 48 14 14 — — $87,231.36 $100,316.06 $89,412.15 2024-10-01
1596 OTHER New Technology - Level 45 14 14 — — $59,684.76 $68,637.47 $61,176.88 2024-10-01
1597 OTHER New Technology - Level 46 14 14 — — $68,866.96 $79,197.00 $70,588.64 2024-10-01
1598 OTHER New Technology - Level 47 14 14 — — $78,049.16 $89,756.53 $80,000.39 2024-10-01
1599 OTHER New Technology - Level 48 14 14 — — $87,231.36 $100,316.06 $89,412.15 2024-10-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 52 40 — — $12,503.00 $106,538.65 $59,520.82 2024-10-01
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 7 7 — — $65,864.00 $71,133.12 $65,864.00 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 7 7 — — $264,654.00 $285,826.32 $264,654.00 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 7 7 — — $148,161.00 $160,013.88 $148,161.00 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 7 7 — — $155,996.00 $168,475.68 $155,996.00 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 7 7 — — $159,784.00 $172,566.72 $159,784.00 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 7 7 — — $329,494.00 $355,853.52 $329,494.00 2024-10-01
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 7 7 — — $75,541.00 $81,584.28 $75,541.00 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 7 7 — — $95,233.00 $102,851.64 $95,233.00 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 7 7 — — $83,819.00 $90,524.52 $83,819.00 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 14 14 — — $65,476.58 $75,298.07 $67,113.49 2024-10-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 7 7 — — $65,431.00 $70,665.48 $65,431.00 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 7 7 — — $73,219.00 $79,076.52 $73,219.00 2024-10-01
1694 APR_DRG Major Abdominal Vascular Procedures 7 7 — — $74,572.00 $80,537.76 $74,572.00 2024-10-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 52 40 — — $12,503.00 $106,538.65 $59,520.82 2024-10-01
1774 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 7 7 — — $78,763.00 $85,064.04 $78,763.00 2024-10-01
1782 APR_DRG External Heart Assist Devices 7 7 — — $65,351.00 $70,579.08 $65,351.00 2024-10-01
1783 APR_DRG External Heart Assist Devices 7 7 — — $67,192.00 $72,567.36 $67,192.00 2024-10-01
1784 APR_DRG External Heart Assist Devices 7 7 — — $70,835.00 $76,501.80 $70,835.00 2024-10-01
1794 APR_DRG Defibrillator Implants 7 7 — — $63,430.00 $68,504.40 $63,430.00 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 26 18 — — $12,503.00 $665,660.45 $314,536.58 2024-10-01
1814 APR_DRG Lower Extremity Vascular Procedures 7 7 — — $59,671.00 $64,444.68 $59,671.00 2024-10-01
1834 APR_DRG Percutaneous Structural Cardiac Procedures 7 7 — — $75,828.00 $81,894.24 $75,828.00 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 51 39 — — $23,576.00 $139,922.11 $83,155.05 2024-10-01
1901 OTHER New Technology - Level 49 14 14 — — $98,709.11 $113,515.48 $101,176.83 2024-10-01
1902 OTHER New Technology - Level 49 14 14 — — $98,709.11 $113,515.48 $101,176.83 2024-10-01
1903 OTHER New Technology - Level 50 14 14 — — $112,482.40 $129,354.76 $115,294.46 2024-10-01
1904 OTHER New Technology - Level 50 14 14 — — $112,482.40 $129,354.76 $115,294.46 2024-10-01
1905 OTHER New Technology - Level 51 14 14 — — $126,255.70 $145,194.05 $129,412.09 2024-10-01
1906 OTHER New Technology - Level 51 14 14 — — $126,255.70 $145,194.05 $129,412.09 2024-10-01
1907 OTHER New Technology - Level 52 14 14 — — $140,029.00 $161,033.35 $143,529.72 2024-10-01
1908 OTHER New Technology - Level 52 14 14 — — $140,029.00 $161,033.35 $143,529.72 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 54 39 — — $23,576.00 $313,196.00 $110,453.87 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 58 40 — — $26,388.00 $142,283.95 $84,335.98 2024-10-01
204 APR_DRG Open Craniotomy For Trauma 7 7 — — $87,789.00 $94,812.12 $87,789.00 2024-10-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 55 40 — — $12,212.00 $114,167.84 $63,189.92 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 58 40 — — $26,388.00 $97,567.90 $61,977.95 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 55 40 — — $16,458.00 $192,285.00 $104,371.50 2024-10-01
214 APR_DRG Open Craniotomy Except Trauma 7 7 — — $69,148.00 $74,679.84 $69,148.00 2024-10-01
215 MS_DRG Other Heart Assist System Implant 55 40 — — $26,388.00 $187,008.82 $106,698.41 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 55 40 — — $26,388.00 $170,348.86 $98,368.43 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 55 40 — — $26,388.00 $113,986.02 $70,187.01 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 55 40 — — $26,388.00 $105,013.51 $65,700.76 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 55 40 — — $63,482.25 $136,573.52 $100,027.88 2024-10-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 58 40 — — $26,388.00 $97,091.00 $61,739.50 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 55 40 — — $43,541.25 $129,371.00 $86,456.12 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 55 40 — — $37,789.43 $129,371.00 $83,580.21 2024-10-01
224 APR_DRG Ventricular Shunt Procedures 7 7 — — $64,895.00 $70,086.60 $64,895.00 2024-10-01
22633 CPT Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Inter… 7 5 — — $4,250.00 $80,000.00 $63,761.00 2024-10-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 55 40 — — $26,388.00 $132,015.00 $79,201.50 2024-10-01
22800 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; Up To 6 Vert… 7 5 — — $4,250.00 $111,327.00 $80,000.00 2024-10-01
22802 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 7 To 12 Vert… 7 5 — — $4,250.00 $111,327.00 $80,000.00 2024-10-01
22804 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 13 Or More V… 7 5 — — $4,250.00 $111,327.00 $80,000.00 2024-10-01
22808 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 2 To 3 Verteb… 7 5 — — $4,250.00 $111,327.00 $80,000.00 2024-10-01
22810 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 Verteb… 7 5 — — $4,250.00 $111,327.00 $80,000.00 2024-10-01
22812 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 8 Or More Ver… 7 5 — — $4,250.00 $111,327.00 $80,000.00 2024-10-01
2294 APR_DRG Other Digestive System And Abdominal Procedures 7 7 — — $61,036.00 $65,918.88 $61,036.00 2024-10-01
230 MS_DRG Other Cardiothoracic Procedures Without Cc/mcc 3 1 — — $76,801.00 $76,801.00 $76,801.00 2024-10-01
2304 APR_DRG Major Small Bowel Procedures 7 7 — — $70,652.00 $76,304.16 $70,652.00 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 55 40 — — $26,388.00 $149,572.46 $87,980.23 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 55 40 — — $26,388.00 $130,658.00 $78,523.00 2024-10-01
2324 APR_DRG Gastric Fundoplication 7 7 — — $61,897.00 $66,848.76 $61,897.00 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 58 40 — — $64,126.07 $137,964.50 $101,045.29 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 58 40 — — $43,734.07 $134,933.00 $89,333.54 2024-10-01
234 APR_DRG Spinal Procedures 7 7 — — $71,446.00 $77,161.68 $71,446.00 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 58 40 — — $26,388.00 $128,132.00 $77,260.00 2024-10-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 58 40 — — $33,863.65 $128,132.00 $76,801.00 2024-10-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 55 40 — — $26,388.00 $97,277.00 $61,832.50 2024-10-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 55 40 — — $25,257.16 $97,277.00 $61,267.08 2024-10-01
2614 APR_DRG Major Biliary Tract Procedures 7 7 — — $62,381.00 $67,371.48 $62,381.00 2024-10-01
264 APR_DRG Other Nervous System And Related Procedures 7 7 — — $62,746.00 $67,765.68 $62,746.00 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 55 40 — — $26,388.00 $143,889.00 $85,138.50 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 55 40 — — $26,388.00 $108,040.00 $67,214.00 2024-10-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 55 40 — — $25,032.00 $211,094.00 $118,063.00 2024-10-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 55 40 — — $19,270.00 $131,215.00 $75,242.50 2024-10-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 55 40 — — $25,032.00 $159,140.00 $92,086.00 2024-10-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 55 40 — — $19,270.00 $105,623.00 $62,446.50 2024-10-01
274 APR_DRG Other Open Craniotomy 7 7 — — $69,916.00 $75,509.28 $69,916.00 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 55 40 — — $26,388.00 $179,233.00 $102,810.50 2024-10-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 55 40 — — $26,388.00 $156,309.00 $91,348.50 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 55 40 — — $26,388.00 $156,309.00 $91,348.50 2024-10-01
28 MS_DRG Spinal Procedures With Mcc 55 40 — — $21,744.00 $107,308.27 $64,526.14 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 55 40 — — $23,576.00 $299,852.00 $160,022.50 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 7 7 — — $100,696.00 $108,751.68 $100,696.00 2024-10-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 7 7 — — $88,469.00 $95,546.52 $88,469.00 2024-10-01
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 7 7 — — $90,411.00 $97,643.88 $90,411.00 2024-10-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 55 40 — — $23,576.00 $116,826.00 $71,607.00 2024-10-01
33230 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Dual … 9 6 — — $1,995.00 $141,902.00 $126,406.00 2024-10-01
33231 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multi… 9 6 — — $1,995.00 $141,902.00 $126,406.00 2024-10-01
33240 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Singl… 9 6 — — $4,250.00 $141,902.00 $126,406.00 2024-10-01
33249 CPT Insertion Or Replacement Of Permanent Implantable Defibrillator System, With Tra… 9 6 — — $4,250.00 $141,902.00 $126,406.00 2024-10-01
33262 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 6 4 — — $1,995.00 $141,902.00 $133,428.50 2024-10-01
33263 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 6 4 — — $1,995.00 $141,902.00 $133,428.50 2024-10-01
33264 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 6 4 — — $1,995.00 $141,902.00 $133,428.50 2024-10-01
33270 CPT Insertion Or Replacement Of Permanent Subcutaneous Implantable Defibrillator Sys… 6 4 — — $1,995.00 $141,902.00 $133,428.50 2024-10-01
33271 CPT Insertion Of Subcutaneous Implantable Defibrillator Electrode 6 4 — — $1,995.00 $141,902.00 $133,428.50 2024-10-01
33272 CPT Removal Of Subcutaneous Implantable Defibrillator Electrode 6 4 — — $1,995.00 $141,902.00 $133,428.50 2024-10-01
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 7 7 — — $81,138.00 $87,629.04 $81,138.00 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 58 40 — — $16,458.00 $249,406.87 $132,932.43 2024-10-01
4014 APR_DRG Adrenal Procedures 7 7 — — $70,789.00 $76,452.12 $70,789.00 2024-10-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 55 40 — — $23,576.00 $146,475.00 $89,423.38 2024-10-01
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 7 7 — — $64,831.00 $70,017.48 $64,831.00 2024-10-01
4054 APR_DRG Other Procedures For Endocrine, Nutritional And Metabolic Disorders 7 7 — — $64,665.00 $69,838.20 $64,665.00 2024-10-01
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $68,134.00 $73,584.72 $68,134.00 2024-10-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $88,057.00 $95,101.56 $88,057.00 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 55 40 — — $23,576.00 $199,044.00 $142,475.09 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 55 40 — — $23,576.00 $146,475.00 $102,371.11 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 55 40 — — $23,576.00 $146,475.00 $95,861.51 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 55 40 — — $23,576.00 $158,481.00 $113,444.94 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $102,160.00 $110,332.80 $102,160.00 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 55 40 — — $23,576.00 $146,475.00 $95,718.12 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $191,263.00 $206,564.04 $191,263.00 2024-10-01
4402 APR_DRG Kidney Transplant 7 7 — — $83,362.00 $90,030.96 $83,362.00 2024-10-01
4403 APR_DRG Kidney Transplant 7 7 — — $102,978.00 $111,216.24 $102,978.00 2024-10-01
4404 APR_DRG Kidney Transplant 7 7 — — $105,412.00 $113,844.96 $105,412.00 2024-10-01
4414 APR_DRG Major Bladder Procedures 7 7 — — $76,808.00 $82,952.64 $76,808.00 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 55 40 — — $23,576.00 $146,475.00 $100,759.54 2024-10-01
4474 APR_DRG Other Kidney, Urinary Tract And Related Non-percutaneous Procedures 7 7 — — $61,718.00 $66,655.44 $61,718.00 2024-10-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 55 40 — — $23,576.00 $146,475.00 $90,052.49 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 55 40 — — $23,576.00 $146,475.00 $94,409.25 2024-10-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 55 40 — — $23,576.00 $146,475.00 $85,978.01 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 4 2 — — $33,311.00 $146,475.00 $73,413.50 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 4 2 — — $33,311.00 $146,475.00 $73,413.50 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 4 2 — — $33,311.00 $146,475.00 $73,413.50 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 58 40 — — $65,226.00 $149,487.73 $107,356.87 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 58 40 — — $33,311.00 $126,000.00 $79,655.50 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 58 40 — — $33,311.00 $126,000.00 $79,655.50 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 4 2 — — $76,640.00 $146,475.00 $96,731.50 2024-10-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 7 3 — — $61,439.00 $146,475.00 $68,266.00 2024-10-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 58 40 — — $26,388.00 $108,325.03 $67,356.51 2024-10-01
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 58 40 — — $23,665.61 $95,375.00 $59,520.31 2024-10-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective 55 40 — — $23,576.00 $95,333.16 $60,860.58 2024-10-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 58 40 — — $31,406.00 $89,924.58 $60,665.29 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 51 39 — — $23,576.00 $187,969.09 $107,178.54 2024-10-01
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 7 — — $67,376.00 $72,766.08 $67,376.00 2024-10-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 7 — — $79,946.00 $86,341.68 $79,946.00 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 7 — — $139,408.00 $150,560.64 $139,408.00 2024-10-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 55 40 — — $16,458.00 $108,697.49 $62,577.75 2024-10-01
5831 APR_DRG Neonate With Ecmo 7 7 — — $182,168.00 $196,741.44 $182,168.00 2024-10-01
5832 APR_DRG Neonate With Ecmo 7 7 — — $291,035.00 $314,317.80 $291,035.00 2024-10-01
5833 APR_DRG Neonate With Ecmo 7 7 — — $422,976.00 $456,814.08 $422,976.00 2024-10-01
5834 APR_DRG Neonate With Ecmo 7 7 — — $481,555.00 $520,079.40 $481,555.00 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $120,200.00 $129,816.00 $120,200.00 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $120,200.00 $129,816.00 $120,200.00 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $125,440.00 $135,475.20 $125,440.00 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $340,206.00 $367,422.48 $340,206.00 2024-10-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 7 — — $441,020.00 $476,301.60 $441,020.00 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 7 — — $425,416.00 $459,449.28 $425,416.00 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 7 — — $197,713.00 $213,530.04 $197,713.00 2024-10-01
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $87,942.00 $94,977.36 $87,942.00 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $121,973.00 $131,730.84 $121,973.00 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $147,715.00 $159,532.20 $147,715.00 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $251,563.00 $271,688.04 $251,563.00 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 7 — — $102,611.00 $110,819.88 $102,611.00 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 7 — — $151,415.00 $163,528.20 $151,415.00 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 7 — — $219,604.00 $237,172.32 $219,604.00 2024-10-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $101,143.00 $109,234.44 $101,143.00 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $134,015.00 $144,736.20 $134,015.00 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $148,157.00 $160,009.56 $148,157.00 2024-10-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 7 — — $98,118.00 $105,967.44 $98,118.00 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 7 — — $196,456.00 $212,172.48 $196,456.00 2024-10-01
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $63,642.00 $68,733.36 $63,642.00 2024-10-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $86,541.00 $93,464.28 $86,541.00 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $116,206.00 $125,502.48 $116,206.00 2024-10-01
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 7 7 — — $63,620.00 $68,709.60 $63,620.00 2024-10-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 7 7 — — $83,297.00 $89,960.76 $83,297.00 2024-10-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 7 — — $137,527.00 $148,529.16 $137,527.00 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 7 — — $284,670.00 $307,443.60 $284,670.00 2024-10-01
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 7 7 — — $64,109.00 $69,237.72 $64,109.00 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 7 7 — — $93,278.00 $100,740.24 $93,278.00 2024-10-01
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $71,140.00 $76,831.20 $71,140.00 2024-10-01
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $108,690.00 $117,385.20 $108,690.00 2024-10-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 7 7 — — $110,101.00 $118,909.08 $110,101.00 2024-10-01
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition… 7 7 — — $72,915.00 $78,748.20 $72,915.00 2024-10-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 7 7 — — $80,204.00 $86,620.32 $80,204.00 2024-10-01
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 7 7 — — $61,393.00 $66,304.44 $61,393.00 2024-10-01
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 7 7 — — $88,034.00 $95,076.72 $88,034.00 2024-10-01
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 7 — — $91,749.00 $99,088.92 $91,749.00 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 7 — — $123,007.00 $132,847.56 $123,007.00 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 7 — — $298,207.00 $322,063.56 $298,207.00 2024-10-01
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 7 — — $101,921.00 $110,074.68 $101,921.00 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 7 — — $237,859.00 $256,887.72 $237,859.00 2024-10-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 7 7 — — $84,578.00 $91,344.24 $84,578.00 2024-10-01
64565 CPT HPercutaneous Implantation Of Neurostimulator Electrode Array; Neuromuscular 4 2 — — $52,082.00 $67,587.00 $64,207.50 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 3 2 — — $74,392.68 $84,895.18 $78,768.72 2024-10-01
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 7 7 — — $78,240.00 $84,499.20 $78,240.00 2024-10-01
652 MS_DRG Kidney Transplant 51 39 — — $23,576.00 $166,555.00 $95,958.37 2024-10-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 7 7 — — $150,761.00 $162,821.88 $150,761.00 2024-10-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 7 7 — — $148,821.00 $160,726.68 $148,821.00 2024-10-01
6904 APR_DRG Acute Leukemia 7 7 — — $95,352.00 $102,980.16 $95,352.00 2024-10-01
7 MS_DRG Lung Transplant 51 39 — — $23,576.00 $230,674.57 $128,531.29 2024-10-01
714 OTHER Inj Delandistrogene Mox R 17 16 — — $5,150.11 $3,824,273.25 $3,363,365.19 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 17 16 — — $12,342.06 $72,857.99 $64,077.01 2024-10-01
746 OTHER Inj, Betibeglogene Autote 17 16 — — $7,545.33 $3,413,200.00 $3,001,835.20 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 17 16 — — $8,495.09 $3,778,900.00 $3,323,460.40 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 14 14 — — $3,605,000.00 $4,145,750.00 $3,695,125.00 2024-10-01
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 7 7 — — $163,774.00 $176,875.92 $163,774.00 2024-10-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 51 39 — — $23,576.00 $96,041.00 $61,214.50 2024-10-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 55 40 — — $16,458.00 $102,768.18 $59,613.09 2024-10-01
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $60,629.00 $65,479.32 $60,629.00 2024-10-01
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $60,629.00 $65,479.32 $60,629.00 2024-10-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $93,300.00 $100,764.00 $93,300.00 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $279,223.00 $301,560.84 $279,223.00 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 7 7 — — $137,614.00 $148,623.12 $137,614.00 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 55 40 — — $16,458.00 $162,597.87 $89,527.93 2024-10-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 7 7 — — $102,132.00 $110,302.56 $102,132.00 2024-10-01
8634 APR_DRG Neonatal Aftercare 7 7 — — $94,228.00 $101,766.24 $94,228.00 2024-10-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 55 40 — — $12,212.00 $122,796.14 $67,504.07 2024-10-01
8904 APR_DRG HIV With Multiple Major HIV Related Conditions 7 7 — — $87,704.00 $94,720.32 $87,704.00 2024-10-01
894 APR_DRG Major Cranial Or Facial Bone Procedures 7 7 — — $66,008.00 $71,288.64 $66,008.00 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 14 14 — — $489,456.00 $562,874.40 $501,692.40 2024-10-01
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $59,802.00 $64,586.16 $59,802.00 2024-10-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 7 7 — — $92,972.00 $100,409.76 $92,972.00 2024-10-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 7 7 — — $73,811.00 $79,715.88 $73,811.00 2024-10-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 7 7 — — $69,515.00 $75,076.20 $69,515.00 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 14 14 — — $3,672,900.00 $4,223,835.00 $3,764,722.50 2024-10-01
914 APR_DRG Other Major Head And Neck Procedures 7 7 — — $70,544.00 $76,187.52 $70,544.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 14 14 — — $2,388,614.00 $2,746,906.10 $2,448,329.35 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 14 14 — — $529,192.90 $608,571.83 $542,422.72 2024-10-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $59,802.00 $64,586.16 $59,802.00 2024-10-01
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 7 7 — — $67,546.00 $72,949.68 $67,546.00 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 27 18 — — $16,458.00 $418,754.87 $197,971.19 2024-10-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 55 40 — — $16,458.00 $117,888.88 $67,173.44 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $96,513.00 $104,234.04 $96,513.00 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 14 14 — — $460,530.40 $529,609.96 $472,043.66 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $199,298.00 $215,241.84 $199,298.00 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 14 14 — — $516,726.10 $594,235.01 $529,644.25 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 14 14 — — $526,587.60 $605,575.74 $539,752.29 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 14 14 — — $527,123.40 $606,191.91 $540,301.48 2024-10-01
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 7 7 — — $80,021.00 $86,422.68 $80,021.00 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 55 40 — — $23,576.00 $120,526.09 $73,457.04 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 3 2 — — $60,888.83 $69,484.90 $64,470.53 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 55 40 — — $23,576.00 $131,749.23 $79,068.62 2024-10-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 55 40 — — $16,458.00 $111,629.48 $64,043.74 2024-10-01
A9543 HCPCS Y90 Ibritum Tiu Tx 40mci 1 1 $199,929.00 $199,929.00 $196,429.74 $196,429.74 $196,429.74 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 1 — — $139,609.77 $139,609.77 $139,609.77 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 1 1 — — $218,394.00 $218,394.00 $218,394.00 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 1 1 — — $70,551.48 $70,551.48 $70,551.48 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 17 16 — — $77,377.11 $104,686.68 $92,069.66 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 17 16 — — $55,990.94 $75,752.45 $66,622.64 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 17 16 — — $84,999.91 $114,999.88 $101,139.90 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 3 — — $390,473.85 $1,467,410.73 $429,521.23 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 3 — — $440,504.85 $1,570,357.68 $484,555.34 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 3 — — $382,024.00 $1,348,320.00 $420,226.40 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 3 — — $402,951.85 $1,489,170.63 $443,247.04 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 3 — — $411,986.50 $1,510,363.59 $453,185.15 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 3 — — $431,371.60 $1,523,061.00 $474,508.76 2024-10-01
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