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

RESTON HOSPITAL CENTER

Reston, VA · CCN 490107 · Rates published

33,114 distinct procedures filed
32 distinct payers
512,744 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

255,271 of 512,744 rate rows are consumer-grade (49.8%)

257,473 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 253,907
per-diem day rate — not a per-procedure price 3,118
template filing: same amount across many unrelated codes — excluded 324
placeholder amount (≤ $0.02) — excluded from medians 114
exceeds 10× this hospital's gross charge — excluded from medians 10

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://core.secure.ehc.com/src/util/detail-price-list/62-1777534_reston-hospital-center_standardcharges.csv
Found on page https://hcavirginia.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-06-18

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
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,897,200.00 $4,897,200.00 $4,897,200.00 nat. median
$3,004,655
1.6× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 $3,884,946.48 $3,884,946.48 $3,884,946.48 nat. median
$2,468,984
1.6× median
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 12 $3,672,900.00 $4,223,835.00 $3,819,816.00 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 12 $3,605,000.00 $4,145,750.00 $3,749,200.00 nat. median
$3,605,000
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $3,562,713.00 $3,672,900.00 $3,617,806.50 nat. median
$3,574,709
1.0× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $3,496,850.00 $3,605,000.00 $3,550,925.00 nat. median
$3,496,850
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 14 $6,036.37 $3,824,273.25 $3,441,845.92 nat. median
$13,041
outlier · 263.9×
748
OTHER 		Inj, Lovotibeglogene Auto 14 $9,956.97 $3,778,900.00 $3,401,010.00 nat. median
$17,963
outlier · 189.3×
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,225,691.35 $3,325,455.00 $3,275,573.17 nat. median
$3,228,024
1.0× median
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $3,187,420.00 $3,286,000.00 $3,236,710.00 nat. median
$3,187,420
1.0× median
746
OTHER 		Inj, Betibeglogene Autote 14 $8,843.77 $3,413,200.00 $3,071,880.00 nat. median
$21,896
outlier · 140.3×
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,878,960.00 $2,968,000.00 $2,923,480.00 nat. median
$2,878,960
1.0× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 12 $2,388,614.00 $2,746,906.10 $2,484,158.56 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $2,316,955.58 $2,388,614.00 $2,352,784.79 nat. median
$2,457,321
1.0× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $492,271.12 $1,345,370.55 $767,250.00 nat. median
$674,867
1.1× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 $459,839.17 $1,315,434.06 $707,459.77 nat. median
$673,137
1.1× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 $445,599.57 $1,296,212.81 $699,600.00 nat. median
$634,303
1.1× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 $435,956.80 $1,191,016.00 $699,600.00 nat. median
$619,808
1.1× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 $502,693.77 $1,387,149.28 $690,968.86 nat. median
$753,246
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $470,149.30 $1,334,154.50 $657,694.98 nat. median
$625,184
1.1× median
5834
APR_DRG 		Neonate With Ecmo 8 $573,902.00 $619,814.16 $573,902.00 nat. median
$309,665
1.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 12 $529,192.90 $608,571.83 $550,360.62 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 12 $527,123.40 $606,191.91 $548,208.34 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 12 $526,587.60 $605,575.74 $547,651.10 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 12 $516,726.10 $594,235.01 $537,395.14 nat. median
$562,201
1.0× median
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 $525,593.00 $567,640.44 $525,593.00 nat. median
$93,370
outlier · 5.6×
09194
OTHER 		Tisagenlecleucel Car-pos 2 $513,317.11 $529,192.90 $521,255.01 nat. median
$538,205
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $511,309.70 $527,123.40 $519,216.55 nat. median
$554,552
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $510,789.97 $526,587.60 $518,688.78 nat. median
$530,178
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 12 $489,456.00 $562,874.40 $509,034.24 nat. median
$532,192
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $501,224.32 $516,726.10 $508,975.21 nat. median
$534,091
1.0× median
5892
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 $506,998.00 $547,557.84 $506,998.00 nat. median
$89,796
outlier · 5.6×
5833
APR_DRG 		Neonate With Ecmo 8 $504,089.00 $544,416.12 $504,089.00 nat. median
$244,017
outlier · 2.1×
09035
OTHER 		Axicabtagene Ciloleucel C 2 $474,772.32 $489,456.00 $482,114.16 nat. median
$505,583
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 12 $460,530.40 $529,609.96 $478,951.62 nat. median
$489,450
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $446,714.49 $460,530.40 $453,622.45 nat. median
$464,978
1.0× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 8 $405,447.00 $437,882.76 $405,447.00 nat. median
$246,434
1.6× median
1614
APR_DRG 		Implantable Heart Assist Systems 8 $392,681.00 $424,095.48 $392,681.00 nat. median
$207,730
1.9× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 $355,394.00 $383,825.52 $355,394.00 nat. median
$150,721
outlier · 2.4×
5832
APR_DRG 		Neonate With Ecmo 8 $346,846.00 $374,593.68 $346,846.00 nat. median
$156,126
outlier · 2.2×
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 $339,261.00 $366,401.88 $339,261.00 nat. median
$162,982
outlier · 2.1×
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 8 $332,769.00 $359,390.52 $332,769.00 nat. median
$160,267
outlier · 2.1×
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 $316,132.00 $341,422.56 $316,132.00 nat. median
$117,173
outlier · 2.7×
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 8 $315,407.00 $340,639.56 $315,407.00 nat. median
$97,957
outlier · 3.2×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 18 $19,893.00 $602,267.62 $300,415.08 nat. median
$370,174
0.8× median
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 8 $299,805.00 $323,789.40 $299,805.00 nat. median
$164,289
1.8× median
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 8 $283,473.00 $306,150.84 $283,473.00 nat. median
$122,924
outlier · 2.3×
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 8 $261,717.00 $282,654.36 $261,717.00 nat. median
$151,838
1.7× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 8 $237,518.00 $256,519.44 $237,518.00 nat. median
$164,834
1.4× median
5893
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 $235,628.00 $254,478.24 $235,628.00 nat. median
$69,788
outlier · 3.4×

Other procedures at this hospital

Browse this hospital's 33,114 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 2 2 — — $204,607.92 $210,936.00 $207,771.96 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 2 — — $77,112.80 $79,497.73 $78,305.26 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 2 — — $137,046.45 $141,285.00 $139,165.73 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 2 — — $96,360.63 $99,340.86 $97,850.74 2024-10-01
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 2 2 — — $63,386.71 $65,347.12 $64,366.92 2024-10-01
007 OTHER Lung Transplant 2 2 — — $77,252.93 $79,642.20 $78,447.57 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $3,225,691.35 $3,325,455.00 $3,275,573.17 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 2 2 — — $61,454.13 $63,354.77 $62,404.45 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 2 2 — — $2,878,960.00 $2,968,000.00 $2,923,480.00 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 2 2 — — $3,187,420.00 $3,286,000.00 $3,236,710.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 2 2 — — $3,496,850.00 $3,605,000.00 $3,550,925.00 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 2 2 — — $89,535.61 $92,304.75 $90,920.18 2024-10-01
01582 OTHER New Technology - Level 45 2 2 — — $63,708.73 $65,679.10 $64,693.92 2024-10-01
01583 OTHER New Technology - Level 46 2 2 — — $73,510.00 $75,783.51 $74,646.76 2024-10-01
01584 OTHER New Technology - Level 47 2 2 — — $83,311.27 $85,887.91 $84,599.59 2024-10-01
01585 OTHER New Technology - Level 48 2 2 — — $93,112.53 $95,992.30 $94,552.42 2024-10-01
01596 OTHER New Technology - Level 45 2 2 — — $63,708.73 $65,679.10 $64,693.92 2024-10-01
01597 OTHER New Technology - Level 46 2 2 — — $73,510.00 $75,783.51 $74,646.76 2024-10-01
01598 OTHER New Technology - Level 47 2 2 — — $83,311.27 $85,887.91 $84,599.59 2024-10-01
01599 OTHER New Technology - Level 48 2 2 — — $93,112.53 $95,992.30 $94,552.42 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 2 2 — — $63,512.28 $65,476.58 $64,494.43 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $168,831.70 $174,053.30 $171,442.50 2024-10-01
01901 OTHER New Technology - Level 49 2 2 — — $105,364.12 $108,622.80 $106,993.46 2024-10-01
01902 OTHER New Technology - Level 49 2 2 — — $105,364.12 $108,622.80 $106,993.46 2024-10-01
01903 OTHER New Technology - Level 50 2 2 — — $120,066.02 $123,779.40 $121,922.71 2024-10-01
01904 OTHER New Technology - Level 50 2 2 — — $120,066.02 $123,779.40 $121,922.71 2024-10-01
01905 OTHER New Technology - Level 51 2 2 — — $134,767.92 $138,936.00 $136,851.96 2024-10-01
01906 OTHER New Technology - Level 51 2 2 — — $134,767.92 $138,936.00 $136,851.96 2024-10-01
01907 OTHER New Technology - Level 52 2 2 — — $149,469.82 $154,092.60 $151,781.21 2024-10-01
01908 OTHER New Technology - Level 52 2 2 — — $149,469.82 $154,092.60 $151,781.21 2024-10-01
020 OTHER Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 2 2 — — $65,774.24 $67,808.50 $66,791.37 2024-10-01
0208 RC — 3 3 — — $92,869.50 $92,869.50 $92,869.50 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $474,772.32 $489,456.00 $482,114.16 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $3,562,713.00 $3,672,900.00 $3,617,806.50 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $2,316,955.58 $2,388,614.00 $2,352,784.79 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $513,317.11 $529,192.90 $521,255.01 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $446,714.49 $460,530.40 $453,622.45 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 2 2 — — $501,224.32 $516,726.10 $508,975.21 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 2 2 — — $510,789.97 $526,587.60 $518,688.78 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 2 2 — — $511,309.70 $527,123.40 $519,216.55 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 27 17 — — $20,990.00 $410,835.11 $224,535.57 2024-10-01
10 MS_DRG Pancreas Transplant 31 22 — — $20,990.00 $116,288.34 $62,238.64 2024-10-01
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $70,995.00 $76,674.60 $70,995.00 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $124,840.00 $134,827.20 $124,840.00 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $179,641.00 $194,012.28 $179,641.00 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $316,132.00 $341,422.56 $316,132.00 2024-10-01
1204 APR_DRG Major Respiratory And Chest Procedures 8 8 — — $84,710.00 $91,486.80 $84,710.00 2024-10-01
1214 APR_DRG Other Respiratory And Chest Procedures 8 8 — — $76,427.00 $82,541.16 $76,427.00 2024-10-01
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 8 8 — — $86,087.00 $92,973.96 $86,087.00 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 33 23 — — $19,893.00 $191,089.73 $105,491.37 2024-10-01
1582 OTHER New Technology - Level 45 12 12 — — $65,679.10 $75,530.96 $68,306.26 2024-10-01
1583 OTHER New Technology - Level 46 12 12 — — $75,783.51 $87,151.04 $78,814.85 2024-10-01
1584 OTHER New Technology - Level 47 12 12 — — $85,887.91 $98,771.10 $89,323.43 2024-10-01
1585 OTHER New Technology - Level 48 12 12 — — $95,992.30 $110,391.14 $99,831.99 2024-10-01
1596 OTHER New Technology - Level 45 12 12 — — $65,679.10 $75,530.96 $68,306.26 2024-10-01
1597 OTHER New Technology - Level 46 12 12 — — $75,783.51 $87,151.04 $78,814.85 2024-10-01
1598 OTHER New Technology - Level 47 12 12 — — $85,887.91 $98,771.10 $89,323.43 2024-10-01
1599 OTHER New Technology - Level 48 12 12 — — $95,992.30 $110,391.14 $99,831.99 2024-10-01
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 8 8 — — $78,494.00 $84,773.52 $78,494.00 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 8 8 — — $315,407.00 $340,639.56 $315,407.00 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 8 8 — — $176,574.00 $190,699.92 $176,574.00 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 8 8 — — $185,911.00 $200,783.88 $185,911.00 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 8 8 — — $190,425.00 $205,659.00 $190,425.00 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 8 8 — — $392,681.00 $424,095.48 $392,681.00 2024-10-01
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 8 8 — — $90,028.00 $97,230.24 $90,028.00 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 8 8 — — $113,496.00 $122,575.68 $113,496.00 2024-10-01
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 8 8 — — $67,542.00 $72,945.36 $67,542.00 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 8 8 — — $99,893.00 $107,884.44 $99,893.00 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 12 12 — — $65,476.58 $75,298.07 $68,095.64 2024-10-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 8 8 — — $77,978.00 $84,216.24 $77,978.00 2024-10-01
1673 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 8 8 — — $67,128.00 $72,498.24 $67,128.00 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 8 8 — — $87,260.00 $94,240.80 $87,260.00 2024-10-01
1694 APR_DRG Major Abdominal Vascular Procedures 8 8 — — $88,873.00 $95,982.84 $88,873.00 2024-10-01
1764 APR_DRG Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 8 8 — — $69,169.00 $74,702.52 $69,169.00 2024-10-01
1773 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 8 8 — — $67,128.00 $72,498.24 $67,128.00 2024-10-01
1774 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 8 8 — — $93,868.00 $101,377.44 $93,868.00 2024-10-01
1781 APR_DRG External Heart Assist Devices 8 8 — — $62,507.00 $67,507.56 $62,507.00 2024-10-01
1782 APR_DRG External Heart Assist Devices 8 8 — — $77,884.00 $84,114.72 $77,884.00 2024-10-01
1783 APR_DRG External Heart Assist Devices 8 8 — — $80,077.00 $86,483.16 $80,077.00 2024-10-01
1784 APR_DRG External Heart Assist Devices 8 8 — — $84,419.00 $91,172.52 $84,419.00 2024-10-01
1794 APR_DRG Defibrillator Implants 8 8 — — $75,594.00 $81,641.52 $75,594.00 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 28 18 — — $19,893.00 $602,267.62 $300,415.08 2024-10-01
1814 APR_DRG Lower Extremity Vascular Procedures 8 8 — — $71,114.00 $76,803.12 $71,114.00 2024-10-01
1834 APR_DRG Percutaneous Structural Cardiac Procedures 8 8 — — $90,369.00 $97,598.52 $90,369.00 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 33 23 — — $20,990.00 $130,669.74 $66,645.79 2024-10-01
1901 OTHER New Technology - Level 49 12 12 — — $108,622.80 $124,916.22 $112,967.71 2024-10-01
1902 OTHER New Technology - Level 49 12 12 — — $108,622.80 $124,916.22 $112,967.71 2024-10-01
1903 OTHER New Technology - Level 50 12 12 — — $123,779.40 $142,346.31 $128,730.58 2024-10-01
1904 OTHER New Technology - Level 50 12 12 — — $123,779.40 $142,346.31 $128,730.58 2024-10-01
1905 OTHER New Technology - Level 51 12 12 — — $138,936.00 $159,776.40 $144,493.44 2024-10-01
1906 OTHER New Technology - Level 51 12 12 — — $138,936.00 $159,776.40 $144,493.44 2024-10-01
1907 OTHER New Technology - Level 52 12 12 — — $154,092.60 $177,206.49 $160,256.30 2024-10-01
1908 OTHER New Technology - Level 52 12 12 — — $154,092.60 $177,206.49 $160,256.30 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 27 17 — — $20,990.00 $350,637.00 $88,207.84 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 41 23 — — $26,741.00 $138,171.38 $82,456.19 2024-10-01
204 APR_DRG Open Craniotomy For Trauma 8 8 — — $104,624.00 $112,993.92 $104,624.00 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 41 23 — — $26,741.00 $100,393.47 $63,514.20 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 28 17 — — $8,596.00 $176,068.63 $88,031.77 2024-10-01
214 APR_DRG Open Craniotomy Except Trauma 8 8 — — $82,409.00 $89,001.72 $82,409.00 2024-10-01
215 MS_DRG Other Heart Assist System Implant 37 23 — — $43,687.00 $166,981.34 $105,334.17 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 37 23 — — $56,680.00 $158,652.54 $85,517.00 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 37 23 — — $49,461.45 $104,053.56 $76,028.00 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 37 23 — — $45,612.57 $103,745.00 $74,678.79 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 37 23 — — $59,150.66 $126,054.99 $92,602.82 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 37 23 — — $40,669.53 $103,794.00 $71,304.09 2024-10-01
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 8 8 — — $67,640.00 $73,051.20 $67,640.00 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 37 23 — — $35,338.79 $103,794.00 $62,459.87 2024-10-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 2 1 — — $85,554.85 $92,690.80 $89,122.83 2024-10-01
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 2 1 — — $79,214.72 $85,821.86 $82,518.29 2024-10-01
224 APR_DRG Ventricular Shunt Procedures 8 8 — — $77,340.00 $83,527.20 $77,340.00 2024-10-01
2244 APR_DRG Peritoneal Adhesiolysis 8 8 — — $63,059.00 $68,103.72 $63,059.00 2024-10-01
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 2 1 — — $71,523.66 $77,489.30 $74,506.48 2024-10-01
22800 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; Up To 6 Vert… 13 6 — — $4,250.00 $111,639.00 $62,835.00 2024-10-01
22802 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 7 To 12 Vert… 13 6 — — $4,250.00 $111,639.00 $62,835.00 2024-10-01
22804 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 13 Or More V… 13 6 — — $4,250.00 $111,639.00 $62,835.00 2024-10-01
22808 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 2 To 3 Verteb… 13 6 — — $4,250.00 $111,639.00 $62,835.00 2024-10-01
22810 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 Verteb… 13 6 — — $4,250.00 $111,639.00 $62,835.00 2024-10-01
22812 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 8 Or More Ver… 13 6 — — $4,250.00 $111,639.00 $62,835.00 2024-10-01
2294 APR_DRG Other Digestive System And Abdominal Procedures 8 8 — — $72,741.00 $78,560.28 $72,741.00 2024-10-01
2304 APR_DRG Major Small Bowel Procedures 8 8 — — $84,201.00 $90,937.08 $84,201.00 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 37 23 — — $50,439.00 $132,659.17 $91,549.09 2024-10-01
2314 APR_DRG Major Large Bowel Procedures 8 8 — — $64,139.00 $69,270.12 $64,139.00 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 37 23 — — $46,818.04 $130,658.00 $76,643.00 2024-10-01
2324 APR_DRG Gastric Fundoplication 8 8 — — $73,767.00 $79,668.36 $73,767.00 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 37 23 — — $59,747.34 $127,500.06 $93,171.00 2024-10-01
234 APR_DRG Spinal Procedures 8 8 — — $85,147.00 $91,958.76 $85,147.00 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 37 23 — — $40,848.23 $107,566.00 $69,090.00 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 37 23 — — $45,118.11 $96,130.17 $68,116.00 2024-10-01
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 8 8 — — $68,346.00 $73,813.68 $68,346.00 2024-10-01
2614 APR_DRG Major Biliary Tract Procedures 8 8 — — $74,343.00 $80,290.44 $74,343.00 2024-10-01
2634 APR_DRG Cholecystectomy 8 8 — — $68,520.00 $74,001.60 $68,520.00 2024-10-01
264 APR_DRG Other Nervous System And Related Procedures 8 8 — — $74,779.00 $80,761.32 $74,779.00 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 37 23 — — $26,741.00 $139,640.00 $80,648.76 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 37 23 — — $26,741.00 $106,494.00 $63,335.34 2024-10-01
274 APR_DRG Other Open Craniotomy 8 8 — — $83,324.00 $89,989.92 $83,324.00 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 35 22 — — $54,073.59 $179,233.00 $93,135.00 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 35 22 — — $35,792.36 $148,749.00 $63,274.57 2024-10-01
294 APR_DRG Other Percutaneous Intracranial Procedures 8 8 — — $66,372.00 $71,681.76 $66,372.00 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 28 17 — — $20,990.00 $302,916.00 $170,164.04 2024-10-01
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 8 — — $64,142.00 $69,273.36 $64,142.00 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 8 — — $120,007.00 $129,607.56 $120,007.00 2024-10-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 8 8 — — $105,435.00 $113,869.80 $105,435.00 2024-10-01
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 8 8 — — $107,749.00 $116,368.92 $107,749.00 2024-10-01
3254 APR_DRG Non-elective Or Complex Knee Joint Replacement 8 8 — — $63,209.00 $68,265.72 $63,209.00 2024-10-01
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 8 8 — — $96,697.00 $104,432.76 $96,697.00 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 32 17 — — $8,596.00 $206,087.05 $110,778.56 2024-10-01
4014 APR_DRG Adrenal Procedures 8 8 — — $84,364.00 $91,113.12 $84,364.00 2024-10-01
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 8 8 — — $77,264.00 $83,445.12 $77,264.00 2024-10-01
4054 APR_DRG Other Procedures For Endocrine, Nutritional And Metabolic Disorders 8 8 — — $77,066.00 $83,231.28 $77,066.00 2024-10-01
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $81,200.00 $87,696.00 $81,200.00 2024-10-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $104,944.00 $113,339.52 $104,944.00 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 35 22 — — $20,990.00 $198,798.00 $114,911.00 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 35 22 — — $20,990.00 $134,793.00 $84,321.00 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 35 22 — — $20,990.00 $130,559.00 $68,636.00 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 35 22 — — $20,990.00 $158,285.00 $111,000.80 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $121,751.00 $131,491.08 $121,751.00 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 35 22 — — $20,990.00 $130,559.00 $68,636.00 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $227,941.00 $246,176.28 $227,941.00 2024-10-01
4402 APR_DRG Kidney Transplant 8 8 — — $99,348.00 $107,295.84 $99,348.00 2024-10-01
4403 APR_DRG Kidney Transplant 8 8 — — $122,726.00 $132,544.08 $122,726.00 2024-10-01
4404 APR_DRG Kidney Transplant 8 8 — — $125,627.00 $135,677.16 $125,627.00 2024-10-01
4414 APR_DRG Major Bladder Procedures 8 8 — — $91,537.00 $98,859.96 $91,537.00 2024-10-01
4424 APR_DRG Kidney And Urinary Tract Procedures For Malignancy 8 8 — — $65,088.00 $70,295.04 $65,088.00 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 35 22 — — $20,990.00 $127,239.00 $65,950.00 2024-10-01
4474 APR_DRG Other Kidney, Urinary Tract And Related Non-percutaneous Procedures 8 8 — — $73,554.00 $79,438.32 $73,554.00 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 35 22 — — $20,990.00 $99,750.00 $65,950.00 2024-10-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 8 4 — — $96,500.00 $144,857.31 $114,911.00 2024-10-01
453 OTHER Combined Anterior And Posterior Spinal Fusion With Mcc 2 2 — — $63,242.02 $65,197.96 $64,219.99 2024-10-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 8 4 — — $60,830.00 $118,330.00 $84,321.00 2024-10-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/mcc 8 4 — — $53,501.11 $118,330.00 $67,851.38 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 41 23 — — $64,690.38 $137,795.40 $100,722.00 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 41 23 — — $44,021.68 $116,416.00 $80,218.84 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 41 23 — — $33,259.50 $119,907.00 $65,980.42 2024-10-01
459 MS_DRG Spinal Fusion Except Cervical With Mcc 8 4 — — $55,398.00 $108,418.21 $77,208.12 2024-10-01
494 APR_DRG Bacterial And Tuberculous Infections Of Nervous System 8 8 — — $63,430.00 $68,504.40 $63,430.00 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 26 17 — — $20,990.00 $155,320.48 $85,257.35 2024-10-01
5104 APR_DRG Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced… 8 8 — — $67,102.00 $72,470.16 $67,102.00 2024-10-01
5114 APR_DRG Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 8 8 — — $67,117.00 $72,486.36 $67,117.00 2024-10-01
5184 APR_DRG Other Female Reproductive System And Related Procedures 8 8 — — $62,223.00 $67,200.84 $62,223.00 2024-10-01
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 8 — — $80,296.00 $86,719.68 $80,296.00 2024-10-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 8 — — $95,277.00 $102,899.16 $95,277.00 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 8 — — $166,143.00 $179,434.44 $166,143.00 2024-10-01
5831 APR_DRG Neonate With Ecmo 8 8 — — $217,102.00 $234,470.16 $217,102.00 2024-10-01
5832 APR_DRG Neonate With Ecmo 8 8 — — $346,846.00 $374,593.68 $346,846.00 2024-10-01
5833 APR_DRG Neonate With Ecmo 8 8 — — $504,089.00 $544,416.12 $504,089.00 2024-10-01
5834 APR_DRG Neonate With Ecmo 8 8 — — $573,902.00 $619,814.16 $573,902.00 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $143,251.00 $154,711.08 $143,251.00 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $143,251.00 $154,711.08 $143,251.00 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $149,496.00 $161,455.68 $149,496.00 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $405,447.00 $437,882.76 $405,447.00 2024-10-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 8 — — $525,593.00 $567,640.44 $525,593.00 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 8 — — $506,998.00 $547,557.84 $506,998.00 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 8 — — $235,628.00 $254,478.24 $235,628.00 2024-10-01
5894 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 8 — — $65,649.00 $70,900.92 $65,649.00 2024-10-01
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $104,806.00 $113,190.48 $104,806.00 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $145,363.00 $156,992.04 $145,363.00 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $176,042.00 $190,125.36 $176,042.00 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $299,805.00 $323,789.40 $299,805.00 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 8 — — $122,289.00 $132,072.12 $122,289.00 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 8 — — $180,451.00 $194,887.08 $180,451.00 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 8 — — $261,717.00 $282,654.36 $261,717.00 2024-10-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $120,540.00 $130,183.20 $120,540.00 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $159,715.00 $172,492.20 $159,715.00 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $176,569.00 $190,694.52 $176,569.00 2024-10-01
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 8 — — $68,017.00 $73,458.36 $68,017.00 2024-10-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 8 — — $116,934.00 $126,288.72 $116,934.00 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 8 — — $234,130.00 $252,860.40 $234,130.00 2024-10-01
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $75,847.00 $81,914.76 $75,847.00 2024-10-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $103,137.00 $111,387.96 $103,137.00 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $138,491.00 $149,570.28 $138,491.00 2024-10-01
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 8 8 — — $75,821.00 $81,886.68 $75,821.00 2024-10-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 8 8 — — $99,271.00 $107,212.68 $99,271.00 2024-10-01
6091 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 8 — — $65,780.00 $71,042.40 $65,780.00 2024-10-01
6092 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 8 — — $65,780.00 $71,042.40 $65,780.00 2024-10-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 8 — — $163,900.00 $177,012.00 $163,900.00 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 8 — — $339,261.00 $366,401.88 $339,261.00 2024-10-01
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 8 8 — — $76,403.00 $82,515.24 $76,403.00 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 8 8 — — $111,165.00 $120,058.20 $111,165.00 2024-10-01
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $84,783.00 $91,565.64 $84,783.00 2024-10-01
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $129,534.00 $139,896.72 $129,534.00 2024-10-01
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 8 8 — — $70,522.00 $76,163.76 $70,522.00 2024-10-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 8 8 — — $131,215.00 $141,712.20 $131,215.00 2024-10-01
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition… 8 8 — — $86,898.00 $93,849.84 $86,898.00 2024-10-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 8 8 — — $95,585.00 $103,231.80 $95,585.00 2024-10-01
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 8 8 — — $73,166.00 $79,019.28 $73,166.00 2024-10-01
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 8 8 — — $104,916.00 $113,309.28 $104,916.00 2024-10-01
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 8 — — $109,343.00 $118,090.44 $109,343.00 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 8 — — $146,596.00 $158,323.68 $146,596.00 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 8 — — $355,394.00 $383,825.52 $355,394.00 2024-10-01
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 8 8 — — $121,467.00 $131,184.36 $121,467.00 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 8 8 — — $283,473.00 $306,150.84 $283,473.00 2024-10-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 8 8 — — $100,797.00 $108,860.76 $100,797.00 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 2 2 — — $87,194.60 $89,891.34 $88,542.97 2024-10-01
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 8 8 — — $93,244.00 $100,703.52 $93,244.00 2024-10-01
6604 APR_DRG Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula… 8 8 — — $62,334.00 $67,320.72 $62,334.00 2024-10-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 8 8 — — $179,672.00 $194,045.76 $179,672.00 2024-10-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 8 8 — — $177,360.00 $191,548.80 $177,360.00 2024-10-01
6904 APR_DRG Acute Leukemia 8 8 — — $113,638.00 $122,729.04 $113,638.00 2024-10-01
6954 APR_DRG Chemotherapy For Acute Leukemia 8 8 — — $68,576.00 $74,062.08 $68,576.00 2024-10-01
7 MS_DRG Lung Transplant 26 17 — — $20,990.00 $190,608.39 $104,492.40 2024-10-01
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 8 8 — — $69,095.00 $74,622.60 $69,095.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 14 14 — — $6,036.37 $3,824,273.25 $3,441,845.92 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 14 14 — — $14,465.95 $72,857.99 $65,572.18 2024-10-01
746 OTHER Inj, Betibeglogene Autote 14 14 — — $8,843.77 $3,413,200.00 $3,071,880.00 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 14 14 — — $9,956.97 $3,778,900.00 $3,401,010.00 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 12 12 — — $3,605,000.00 $4,145,750.00 $3,749,200.00 2024-10-01
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 8 8 — — $195,180.00 $210,794.40 $195,180.00 2024-10-01
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $72,256.00 $78,036.48 $72,256.00 2024-10-01
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $72,256.00 $78,036.48 $72,256.00 2024-10-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $111,192.00 $120,087.36 $111,192.00 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $332,769.00 $359,390.52 $332,769.00 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 8 8 — — $164,004.00 $177,124.32 $164,004.00 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 35 22 — — $8,596.00 $134,356.02 $71,720.43 2024-10-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 8 8 — — $121,717.00 $131,454.36 $121,717.00 2024-10-01
8633 APR_DRG Neonatal Aftercare 8 8 — — $66,379.00 $71,689.32 $66,379.00 2024-10-01
8634 APR_DRG Neonatal Aftercare 8 8 — — $112,298.00 $121,281.84 $112,298.00 2024-10-01
8904 APR_DRG HIV With Multiple Major HIV Related Conditions 8 8 — — $104,523.00 $112,884.84 $104,523.00 2024-10-01
894 APR_DRG Major Cranial Or Facial Bone Procedures 8 8 — — $78,666.00 $84,959.28 $78,666.00 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 12 12 — — $489,456.00 $562,874.40 $509,034.24 2024-10-01
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $71,270.00 $76,971.60 $71,270.00 2024-10-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 8 8 — — $110,801.00 $119,665.08 $110,801.00 2024-10-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 8 8 — — $87,966.00 $95,003.28 $87,966.00 2024-10-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 8 8 — — $82,846.00 $89,473.68 $82,846.00 2024-10-01
9138 OTHER Inj, Hemgenix, Per Tx Dos 12 12 — — $3,672,900.00 $4,223,835.00 $3,819,816.00 2024-10-01
914 APR_DRG Other Major Head And Neck Procedures 8 8 — — $84,072.00 $90,797.76 $84,072.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 12 12 — — $2,388,614.00 $2,746,906.10 $2,484,158.56 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 12 12 — — $529,192.90 $608,571.83 $550,360.62 2024-10-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $71,270.00 $76,971.60 $71,270.00 2024-10-01
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 8 8 — — $80,499.00 $86,938.92 $80,499.00 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 26 16 — — $8,596.00 $346,020.76 $186,502.96 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $115,021.00 $124,222.68 $115,021.00 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 12 12 — — $460,530.40 $529,609.96 $478,951.62 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $237,518.00 $256,519.44 $237,518.00 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 12 12 — — $516,726.10 $594,235.01 $537,395.14 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 12 12 — — $526,587.60 $605,575.74 $547,651.10 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 12 12 — — $527,123.40 $606,191.91 $548,208.34 2024-10-01
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 8 8 — — $95,367.00 $102,996.36 $95,367.00 2024-10-01
9514 APR_DRG Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 8 8 — — $70,222.00 $75,839.76 $70,222.00 2024-10-01
9524 APR_DRG Non-extensive O.r. Procedure Unrelated To Principal Diagnosis 8 8 — — $62,629.00 $67,639.32 $62,629.00 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 2 2 — — $71,366.93 $73,574.15 $72,470.54 2024-10-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 37 23 — — $20,990.00 $99,591.75 $63,166.38 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 37 23 — — $20,990.00 $118,229.68 $72,485.34 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 5 2 — — $54,184.96 $173,512.94 $91,988.42 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $76,785.37 $123,321.96 $100,053.67 2024-10-01
C9150 HCPCS Xenon Xe-129 Hyperpolarized Gas, Diagnostic, Per Study Dose 3 1 — — $45,614.40 $77,438.40 $77,438.40 2024-10-01
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 1 1 — — $4,897,200.00 $4,897,200.00 $4,897,200.00 2024-10-01
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10°15 Vector Ge… 1 1 — — $3,884,946.48 $3,884,946.48 $3,884,946.48 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 5 2 — — $49,273.20 $192,914.70 $83,649.85 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 7 4 — — $54,614.64 $168,273.22 $92,717.88 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 9 5 — — $38,337.72 $117,019.36 $65,084.97 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 14 14 — — $88,300.94 $104,686.68 $94,218.02 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 14 14 — — $63,895.55 $75,752.45 $68,177.21 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 14 14 — — $96,999.90 $114,999.88 $103,499.90 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 6 4 — — $445,599.57 $1,296,212.81 $699,600.00 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 3 — — $502,693.77 $1,387,149.28 $690,968.86 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 9 5 — — $47,690.07 $147,108.87 $80,962.21 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 6 4 — — $435,956.80 $1,191,016.00 $699,600.00 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 6 4 — — $459,839.17 $1,315,434.06 $707,459.77 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 3 — — $470,149.30 $1,334,154.50 $657,694.98 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 6 4 — — $492,271.12 $1,345,370.55 $767,250.00 2024-10-01
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