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

37,063 distinct procedures filed
54 distinct payers
1,616,649 rate rows
2024-10-01 last MRF observed · ⚠ 24 mo old
Data quality

1,549,617 of 1,616,649 rate rows are consumer-grade (95.9%)

67,032 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 40,687
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 20,947
per-diem day rate — not a per-procedure price 4,581
percent-of-charges filed in the dollar field — excluded from medians 349
template filing: same amount across many unrelated codes — excluded 243
placeholder amount (≤ $0.02) — excluded from medians 135
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 60
exceeds 10× this hospital's gross charge — excluded from medians 30

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 24 months old.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/ba27c3b6b7d64073bf70d290161047f0?download=true
Found on page https://www.hcavirginia.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-09-21
Content fingerprint cfab7e8e67dee981… · 490,929,056 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
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 14 $3,672,900.00 $4,223,835.00 $3,764,722.50 nat. median
$3,765,001
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
$3,677,100
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 16 $5,150.11 $3,824,273.25 $3,363,365.19 nat. median
$3,391,964
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 16 $8,495.09 $3,778,900.00 $3,323,460.40 nat. median
$3,351,720
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,121,965.00 $3,562,713.00 $3,305,610.00 nat. median
$3,562,713
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
$3,001,835
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 2 $2,826,636.75 $3,225,691.35 $2,992,909.50 nat. median
$3,225,691
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
$2,508,045
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,030,321.90 $2,316,955.58 $2,149,752.60 nat. median
$2,316,956
0.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 14 $529,192.90 $608,571.83 $542,422.72 nat. median
$555,653
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 14 $527,123.40 $606,191.91 $540,301.48 nat. median
$553,480
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 14 $526,587.60 $605,575.74 $539,752.29 nat. median
$552,917
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 14 $516,726.10 $594,235.01 $529,644.25 nat. median
$542,562
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 14 $489,456.00 $562,874.40 $501,692.40 nat. median
$513,929
1.0× 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
$621,313
0.8× median
5834
APR_DRG 		Neonate With Ecmo 7 $481,555.00 $520,079.40 $481,555.00 nat. median
$390,362
1.2× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $449,813.97 $513,317.11 $476,273.61 nat. median
$513,317
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
$599,737
0.8× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $448,054.89 $511,309.70 $474,411.06 nat. median
$511,310
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $447,599.46 $510,789.97 $473,928.84 nat. median
$510,790
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 14 $460,530.40 $529,609.96 $472,043.66 nat. median
$483,557
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $439,217.18 $501,224.32 $465,053.49 nat. median
$501,224
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
$574,037
0.8× 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
$579,571
0.8× 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
$99,483
outlier · 4.4×
09035
OTHER 		Axicabtagene Ciloleucel C 2 $416,037.60 $474,772.32 $440,510.40 nat. median
$474,772
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
$562,501
0.8× 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
$96,548
outlier · 4.4×
5833
APR_DRG 		Neonate With Ecmo 7 $422,976.00 $456,814.08 $422,976.00 nat. median
$268,208
1.6× 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
$513,770
0.8× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $391,450.84 $446,714.49 $414,477.36 nat. median
$446,714
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
$286,698
1.2× median
1614
APR_DRG 		Implantable Heart Assist Systems 7 $329,494.00 $355,853.52 $329,494.00 nat. median
$202,242
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
$168,055
1.9× 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
$187,567
1.6× median
5832
APR_DRG 		Neonate With Ecmo 7 $291,035.00 $314,317.80 $291,035.00 nat. median
$201,678
1.4× 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
$198,578
1.4× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 7 $279,223.00 $301,560.84 $279,223.00 nat. median
$173,018
1.6× 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
$135,803
2.0× median
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 7 $264,654.00 $285,826.32 $264,654.00 nat. median
$106,926
outlier · 2.5×
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 7 $251,563.00 $271,688.04 $251,563.00 nat. median
$171,497
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
$181,762
1.3× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 18 $23,576.00 $497,193.29 $235,002.39 nat. median
$186,516
1.3× median
77145
CDM 		Tavr 27 $45,399.60 $302,664.00 $226,998.00 nat. median
$226,998
1.0× 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
$168,439
1.3× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 1 $218,394.00 $218,394.00 $218,394.00 nat. median
$92,809
outlier · 2.4×
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 7 $199,298.00 $215,241.84 $199,298.00 nat. median
$152,792
1.3× median

Other procedures at this hospital

Browse this hospital's 37,063 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 14 14 — — $3,672,900.00 $4,223,835.00 $3,764,722.50 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
714 OTHER Inj Delandistrogene Mox R 17 16 — — $5,150.11 $3,824,273.25 $3,363,365.19 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 17 16 — — $8,495.09 $3,778,900.00 $3,323,460.40 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
00773 OTHER Inj, Beqvez, Per Tx Dose 3 2 — — $3,064,250.00 $3,496,850.00 $3,244,500.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 17 16 — — $7,545.33 $3,413,200.00 $3,001,835.20 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
00748 OTHER Inj, Lovotibeglogene Auto 3 2 — — $2,793,100.00 $3,187,420.00 $2,957,400.00 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
9141 OTHER Inj Onase Abepar-xioi Tre 14 14 — — $2,388,614.00 $2,746,906.10 $2,448,329.35 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
9194 OTHER Tisagenlecleucel Car-pos 14 14 — — $529,192.90 $608,571.83 $542,422.72 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 14 14 — — $527,123.40 $606,191.91 $540,301.48 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 14 14 — — $526,587.60 $605,575.74 $539,752.29 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 14 14 — — $516,726.10 $594,235.01 $529,644.25 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 14 14 — — $489,456.00 $562,874.40 $501,692.40 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
5834 APR_DRG Neonate With Ecmo 7 7 — — $481,555.00 $520,079.40 $481,555.00 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 3 2 — — $449,813.97 $513,317.11 $476,273.61 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
09498 OTHER Ciltacabtagene Car-pos T 3 2 — — $448,054.89 $511,309.70 $474,411.06 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 3 2 — — $447,599.46 $510,789.97 $473,928.84 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 14 14 — — $460,530.40 $529,609.96 $472,043.66 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 3 2 — — $439,217.18 $501,224.32 $465,053.49 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
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
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
09035 OTHER Axicabtagene Ciloleucel C 3 2 — — $416,037.60 $474,772.32 $440,510.40 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
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
5833 APR_DRG Neonate With Ecmo 7 7 — — $422,976.00 $456,814.08 $422,976.00 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
09391 OTHER Brexucabtagene Car Pos T 3 2 — — $391,450.84 $446,714.49 $414,477.36 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
1614 APR_DRG Implantable Heart Assist Systems 7 7 — — $329,494.00 $355,853.52 $329,494.00 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
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
5832 APR_DRG Neonate With Ecmo 7 7 — — $291,035.00 $314,317.80 $291,035.00 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
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $279,223.00 $301,560.84 $279,223.00 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
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 7 7 — — $264,654.00 $285,826.32 $264,654.00 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
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
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 27 18 — — $23,576.00 $497,193.29 $235,002.39 2024-10-01
77145 CDM Tavr 31 27 $302,664.00 $302,664.00 $45,399.60 $302,664.00 $226,998.00 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
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 1 1 — — $218,394.00 $218,394.00 $218,394.00 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $199,298.00 $215,241.84 $199,298.00 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
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
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
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
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
5831 APR_DRG Neonate With Ecmo 7 7 — — $182,168.00 $196,741.44 $182,168.00 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 27 18 — — $23,576.00 $299,852.00 $178,865.57 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
1613 APR_DRG Implantable Heart Assist Systems 7 7 — — $159,784.00 $172,566.72 $159,784.00 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 7 7 — — $155,996.00 $168,475.68 $155,996.00 2024-10-01
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
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
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
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
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
84398 CDM Ins/repl Subq Icd W/eval 31 27 $198,014.00 $198,014.00 $29,702.10 $198,014.00 $148,510.50 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 7 7 — — $148,161.00 $160,013.88 $148,161.00 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
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
A9543 HCPCS Y90 Ibritum Tiu Tx 40mci 35 27 $199,929.00 $199,929.00 $36,786.94 $196,429.74 $143,948.88 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
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 1 — — $139,609.77 $139,609.77 $139,609.77 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
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
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
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
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
33271 CPT Insertion Of Subcutaneous Implantable Defibrillator Electrode 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
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
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
33272 CPT Removal Of Subcutaneous Implantable Defibrillator Electrode 6 4 — — $1,995.00 $141,902.00 $133,428.50 2024-10-01
1906 OTHER New Technology - Level 51 14 14 — — $126,255.70 $145,194.05 $129,412.09 2024-10-01
1905 OTHER New Technology - Level 51 14 14 — — $126,255.70 $145,194.05 $129,412.09 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
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
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
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
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
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
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
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
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
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
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
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 30 18 — — $16,458.00 $249,406.87 $115,707.00 2024-10-01
1904 OTHER New Technology - Level 50 14 14 — — $112,482.40 $129,354.76 $115,294.46 2024-10-01
1903 OTHER New Technology - Level 50 14 14 — — $112,482.40 $129,354.76 $115,294.46 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
76842 CDM Rmv Icd W Rplc Sgl Ld 31 27 $147,395.00 $147,395.00 $22,109.25 $147,395.00 $110,546.25 2024-10-01
76843 CDM Rmv Icd W Rplc Dual Ld 31 27 $147,395.00 $147,395.00 $22,109.25 $147,395.00 $110,546.25 2024-10-01
76844 CDM Rmv Icd W Rplc Mult Ld 31 27 $147,395.00 $147,395.00 $22,109.25 $147,395.00 $110,546.25 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
14 MS_DRG Allogeneic Bone Marrow Transplant 27 19 — — $12,503.00 $231,257.09 $109,452.53 2024-10-01
7 MS_DRG Lung Transplant 26 18 — — $23,576.00 $230,674.57 $109,177.54 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
4404 APR_DRG Kidney Transplant 7 7 — — $105,412.00 $113,844.96 $105,412.00 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
4403 APR_DRG Kidney Transplant 7 7 — — $102,978.00 $111,216.24 $102,978.00 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
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
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
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
01904 OTHER New Technology - Level 50 3 2 — — $95,610.04 $109,107.93 $101,234.16 2024-10-01
01903 OTHER New Technology - Level 50 3 2 — — $95,610.04 $109,107.93 $101,234.16 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
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
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
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
66661 CDM Icd Ins/repl Ld/gen 31 27 $131,475.00 $131,475.00 $19,721.25 $131,475.00 $98,606.25 2024-10-01
93654 CPT Ep Repos Ele Vt 3d Map 40 28 $151,528.00 $151,528.00 $7,650.00 $136,375.20 $98,493.20 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
459 MS_DRG Spinal Fusion Except Cervical With Mcc 4 2 — — $76,640.00 $146,475.00 $96,731.50 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $96,513.00 $104,234.04 $96,513.00 2024-10-01
6904 APR_DRG Acute Leukemia 7 7 — — $95,352.00 $102,980.16 $95,352.00 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
8634 APR_DRG Neonatal Aftercare 7 7 — — $94,228.00 $101,766.24 $94,228.00 2024-10-01
0208 RC — 5 4 — — $94,175.50 $94,175.50 $94,175.50 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
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
9104 APR_DRG Craniotomy For Multiple Significant Trauma 7 7 — — $92,972.00 $100,409.76 $92,972.00 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 28 19 — — $16,458.00 $192,285.00 $92,838.95 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 27 18 — — $23,576.00 $313,196.00 $92,108.61 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
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
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
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 28 19 — — $23,576.00 $199,044.00 $90,201.49 2024-10-01
215 MS_DRG Other Heart Assist System Implant 28 19 — — $26,388.00 $187,008.82 $89,430.93 2024-10-01
1599 OTHER New Technology - Level 48 14 14 — — $87,231.36 $100,316.06 $89,412.15 2024-10-01
1585 OTHER New Technology - Level 48 14 14 — — $87,231.36 $100,316.06 $89,412.15 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 26 18 — — $23,576.00 $187,969.09 $89,016.01 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
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
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
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
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
204 APR_DRG Open Craniotomy For Trauma 7 7 — — $87,789.00 $94,812.12 $87,789.00 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
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
44081 CDM Ppi Ins Ven To Exist Pcr 31 27 $115,443.00 $115,443.00 $17,316.45 $115,443.00 $86,582.25 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
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
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
4402 APR_DRG Kidney Transplant 7 7 — — $83,362.00 $90,030.96 $83,362.00 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
76838 CDM Rmv Ppm W Rplc Mult Ld 31 27 $110,193.00 $110,193.00 $16,528.95 $110,193.00 $82,644.75 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 28 19 — — $26,388.00 $170,348.86 $82,279.71 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
014 OTHER Allogeneic Bone Marrow Transplant 3 2 — — $76,389.99 $87,174.46 $80,883.52 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
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
1598 OTHER New Technology - Level 47 14 14 — — $78,049.16 $89,756.53 $80,000.39 2024-10-01
1584 OTHER New Technology - Level 47 14 14 — — $78,049.16 $89,756.53 $80,000.39 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
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
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
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
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
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
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 3 2 — — $74,392.68 $84,895.18 $78,768.72 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
01599 OTHER New Technology - Level 48 3 2 — — $74,146.66 $84,614.42 $78,508.22 2024-10-01
01585 OTHER New Technology - Level 48 3 2 — — $74,146.66 $84,614.42 $78,508.22 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
850 MS_DRG Acute Leukemia With Other Procedures 28 19 — — $16,458.00 $162,597.87 $77,038.13 2024-10-01
4414 APR_DRG Major Bladder Procedures 7 7 — — $76,808.00 $82,952.64 $76,808.00 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
1834 APR_DRG Percutaneous Structural Cardiac Procedures 7 7 — — $75,828.00 $81,894.24 $75,828.00 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
93656 CPT Com Ep Repo Cth Tx Afib 40 28 $115,888.00 $115,888.00 $7,650.00 $104,299.20 $75,327.20 2024-10-01
578977 CDM Valve Aor 26mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
416062 CDM Valve Mtrl 31mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
574830 CDM Valve Tavr 23mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
575013 CDM Valve Tavr Sz 23mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
459377 CDM Graft Evas 31x14.5m 15cm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
482282 CDM Graft Evas 23x14.5m 12cm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
482331 CDM Graft Evas 10cm 10mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
551581 CDM Valve Heart Trnscth 23mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
480996 CDM Graft Evas 14.5mm 12cm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
575011 CDM Valve Tavr Sz 29mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
551580 CDM Valve Heart Trnscth 26mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
418576 CDM Graft Bn Fem Hemi Cndyl 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
431762 CDM Valve Trfcta 18x25x31mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
469508 CDM Kit Aor Vlv 14fr 20mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
478737 CDM Graft Evas 10cm 14.5mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
468315 CDM Graft Evas 31x14.5m 13cm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
473744 CDM Graft Evas 14.5mm 16cm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
545488 CDM Valve Aor Tavr 26mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
476745 CDM Graft Evas 23x12mm 12cm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
469507 CDM Kit Aor Vlv 14fr 29mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
575010 CDM Valve Tavr Size 34mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
575012 CDM Valve Tavr Sz 26mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
484071 CDM Allograft Vein 70-79cm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
777080 CDM Valve Aor Tavr 29mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
777081 CDM Valve Aor Tavr 34mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
777083 CDM Valve Aor Tavr 23mm 27 23 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $75,000.00 2024-10-01
562279 CDM Graft Evasc 20x12mmx12cm 27 23 $99,999.00 $99,999.00 $14,999.85 $99,999.00 $74,999.25 2024-10-01
519398 CDM Stent Graft 46mm 100mm 27 23 $99,999.00 $99,999.00 $14,999.85 $99,999.00 $74,999.25 2024-10-01
592902 CDM Pump Pain Infn 20ml 27 23 $99,999.00 $99,999.00 $14,999.85 $99,999.00 $74,999.25 2024-10-01
C1822 HCPCS Implant Pulse 8.5x15.5in 50 21 $97,784.50 $97,784.50 $17,584.88 $89,999.10 $74,999.25 2024-10-01
551632 CDM Graft Bn Ost Talus Rt 27 23 $99,999.00 $99,999.00 $14,999.85 $99,999.00 $74,999.25 2024-10-01
594774 CDM Pump Pain Infn 148gm 27 23 $99,999.00 $99,999.00 $14,999.85 $99,999.00 $74,999.25 2024-10-01
568157 CDM Mesh Surg 19.5x19.5in 27 23 $99,999.00 $99,999.00 $14,999.85 $99,999.00 $74,999.25 2024-10-01
1694 APR_DRG Major Abdominal Vascular Procedures 7 7 — — $74,572.00 $80,537.76 $74,572.00 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
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
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
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
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 7 7 — — $73,219.00 $79,076.52 $73,219.00 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
482289 CDM Graft Evas 26x14.5m 18cm 27 23 $96,979.00 $96,979.00 $14,546.85 $96,979.00 $72,734.25 2024-10-01
474489 CDM Graft Evas 14.5mm 18cm 27 23 $96,979.00 $96,979.00 $14,546.85 $96,979.00 $72,734.25 2024-10-01
467555 CDM Graft Evas 26x14.5m 12cm 27 23 $96,979.00 $96,979.00 $14,546.85 $96,979.00 $72,734.25 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 31 19 — — $65,226.00 $149,487.73 $72,695.00 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
478864 CDM Graft Nrv 4-5mm 70mm 27 23 $96,151.00 $96,151.00 $14,422.65 $96,151.00 $72,113.25 2024-10-01
371977 CDM Set Vntrc 17.4x13.8in 36 28 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $72,000.00 2024-10-01
551981 CDM Pump Heart 21fr 85mm 36 28 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $72,000.00 2024-10-01
399586 CDM Kit Device Guided 3cm 36 28 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $72,000.00 2024-10-01
443520 CDM Pump Cath Lv Impella 9fr 36 28 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $72,000.00 2024-10-01
589193 CDM Kit Lo Prfl Comp Shth 7f 36 28 $100,000.00 $100,000.00 $15,000.00 $100,000.00 $72,000.00 2024-10-01
C2624 HCPCS System Mntr 2x15mm 4.5cm 34 27 $100,000.00 $100,000.00 $18,400.00 $90,000.00 $72,000.00 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 28 19 — — $23,576.00 $158,481.00 $71,829.32 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 28 19 — — $26,388.00 $149,572.46 $71,583.75 2024-10-01
234 APR_DRG Spinal Procedures 7 7 — — $71,446.00 $77,161.68 $71,446.00 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
1204 APR_DRG Major Respiratory And Chest Procedures 7 7 — — $71,079.00 $76,765.32 $71,079.00 2024-10-01
1784 APR_DRG External Heart Assist Devices 7 7 — — $70,835.00 $76,501.80 $70,835.00 2024-10-01
4014 APR_DRG Adrenal Procedures 7 7 — — $70,789.00 $76,452.12 $70,789.00 2024-10-01
2304 APR_DRG Major Small Bowel Procedures 7 7 — — $70,652.00 $76,304.16 $70,652.00 2024-10-01
482283 CDM Graft Evas 23x14.5m14cm 27 23 $94,153.00 $94,153.00 $14,122.95 $94,153.00 $70,614.75 2024-10-01
476831 CDM Graft Evas 10cm 12mm 27 23 $94,153.00 $94,153.00 $14,122.95 $94,153.00 $70,614.75 2024-10-01
474099 CDM Graft Evas 14.5mm 14cm 27 23 $94,153.00 $94,153.00 $14,122.95 $94,153.00 $70,614.75 2024-10-01
482286 CDM Graft Evas 26x12mm 16cm 27 23 $94,153.00 $94,153.00 $14,122.95 $94,153.00 $70,614.75 2024-10-01
1597 OTHER New Technology - Level 46 14 14 — — $68,866.96 $79,197.00 $70,588.64 2024-10-01
1583 OTHER New Technology - Level 46 14 14 — — $68,866.96 $79,197.00 $70,588.64 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 1 1 — — $70,551.48 $70,551.48 $70,551.48 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
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 31 19 — — $64,126.07 $137,964.50 $70,538.68 2024-10-01
01598 OTHER New Technology - Level 47 3 2 — — $66,341.79 $75,707.69 $70,244.24 2024-10-01
01584 OTHER New Technology - Level 47 3 2 — — $66,341.79 $75,707.69 $70,244.24 2024-10-01
274 APR_DRG Other Open Craniotomy 7 7 — — $69,916.00 $75,509.28 $69,916.00 2024-10-01
007 OTHER Lung Transplant 3 2 — — $65,910.66 $75,215.69 $69,787.76 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
C1820 HCPCS Kit Generator Ipg 50 21 $93,509.00 $93,509.00 $16,011.50 $89,999.10 $69,615.20 2024-10-01
402572 CDM Valve Aortic 29mm 27 23 $92,743.00 $92,743.00 $13,911.45 $92,743.00 $69,557.25 2024-10-01
402566 CDM Valve Aortic 19mm 27 23 $92,743.00 $92,743.00 $13,911.45 $92,743.00 $69,557.25 2024-10-01
416052 CDM Valve Mtrl 25mm 27 23 $92,743.00 $92,743.00 $13,911.45 $92,743.00 $69,557.25 2024-10-01
402569 CDM Valve Aortic 25mm 27 23 $92,743.00 $92,743.00 $13,911.45 $92,743.00 $69,557.25 2024-10-01
402571 CDM Valve Aortic 27mm 27 23 $92,743.00 $92,743.00 $13,911.45 $92,743.00 $69,557.25 2024-10-01
416061 CDM Valve Mtrl 29mm 27 23 $92,743.00 $92,743.00 $13,911.45 $92,743.00 $69,557.25 2024-10-01
402900 CDM Valve Aortic 23mm 27 23 $92,743.00 $92,743.00 $13,911.45 $92,743.00 $69,557.25 2024-10-01
416060 CDM Vlv Mtrl 27mm 27 23 $92,743.00 $92,743.00 $13,911.45 $92,743.00 $69,557.25 2024-10-01
416063 CDM Valve Mtrl 31x33.5mm 27 23 $92,743.00 $92,743.00 $13,911.45 $92,743.00 $69,557.25 2024-10-01
402568 CDM Valve Aortic 21mm 27 23 $92,743.00 $92,743.00 $13,911.45 $92,743.00 $69,557.25 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
434367 CDM Valve Aortic 23mm 27 23 $92,511.00 $92,511.00 $13,876.65 $92,511.00 $69,383.25 2024-10-01
214 APR_DRG Open Craniotomy Except Trauma 7 7 — — $69,148.00 $74,679.84 $69,148.00 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 28 19 — — $63,482.25 $136,573.52 $68,878.24 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
469290 CDM Implant Cranial Peek 27 23 $90,979.00 $90,979.00 $13,646.85 $90,979.00 $68,234.25 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
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 31 19 — — $26,388.00 $142,283.95 $68,109.07 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
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
1783 APR_DRG External Heart Assist Devices 7 7 — — $67,192.00 $72,567.36 $67,192.00 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 14 14 — — $65,476.58 $75,298.07 $67,113.49 2024-10-01
10 MS_DRG Pancreas Transplant 26 18 — — $23,576.00 $140,732.34 $66,715.29 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
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 26 18 — — $23,576.00 $139,922.11 $66,332.78 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
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 7 7 — — $65,864.00 $71,133.12 $65,864.00 2024-10-01
493317 CDM Valve Aortic 27mm 27 23 $87,570.00 $87,570.00 $13,135.50 $87,570.00 $65,677.50 2024-10-01
370752 CDM Valve Aor 19mm Mstr Hmdn 27 23 $87,570.00 $87,570.00 $13,135.50 $87,570.00 $65,677.50 2024-10-01
428449 CDM Valve Aor 29mm Mstr Hmdn 27 23 $87,513.00 $87,513.00 $13,126.95 $87,513.00 $65,634.75 2024-10-01
428448 CDM Valve Aor 25mm Mstr Hmdn 27 23 $87,513.00 $87,513.00 $13,126.95 $87,513.00 $65,634.75 2024-10-01
412827 CDM Valve Aor 27mm Mstr Hmdn 27 23 $87,513.00 $87,513.00 $13,126.95 $87,513.00 $65,634.75 2024-10-01
428463 CDM Valve Aor 23mm Mstr Hmdn 27 23 $87,513.00 $87,513.00 $13,126.95 $87,513.00 $65,634.75 2024-10-01
428459 CDM Valve Aor 21mm Mstr Hmdn 27 23 $87,513.00 $87,513.00 $13,126.95 $87,513.00 $65,634.75 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
419277 CDM Gft Stnt 82x28mm 18fr 27 23 $87,162.00 $87,162.00 $13,074.30 $87,162.00 $65,371.50 2024-10-01
1782 APR_DRG External Heart Assist Devices 7 7 — — $65,351.00 $70,579.08 $65,351.00 2024-10-01
493314 CDM Valve Aortic 21mm 27 23 $86,672.00 $86,672.00 $13,000.80 $86,672.00 $65,004.00 2024-10-01
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