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

33,105 distinct procedures filed
34 distinct payers
1,084,978 rate rows
2024-10-01 last MRF observed · ⚠ 24 mo old
Data quality

1,056,811 of 1,084,978 rate rows are consumer-grade (97.4%)

28,167 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 13,849
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 6,912
per-diem day rate — not a per-procedure price 6,653
template filing: same amount across many unrelated codes — excluded 324
placeholder amount (≤ $0.02) — excluded from medians 220
percent-of-charges filed in the dollar field — excluded from medians 92
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 81
exceeds 10× this hospital's gross charge — excluded from medians 24
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 12

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 24 months old.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/977c855a86684e33923858d0335f1e99?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 a7ebd399a95aca22… · 358,302,873 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
J3393
HCPCS 		Injection, Betibeglogene Autotemcel, Per Treatment 1 $4,897,200.00 $4,897,200.00 $4,897,200.00 nat. median
$2,968,000
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
$2,455,111
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
$3,765,001
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
$3,677,100
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
$3,562,713
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
$3,391,964
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 14 $9,956.97 $3,778,900.00 $3,401,010.00 nat. median
$3,351,720
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 2 $3,225,691.35 $3,325,455.00 $3,275,573.17 nat. median
$3,225,691
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
$3,001,835
1.0× median
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
$2,508,045
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
$2,316,956
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
$599,737
1.3× 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
$579,571
1.2× 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
$513,770
1.4× 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
$562,501
1.2× 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
$621,313
1.1× 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
$574,037
1.1× median
5834
APR_DRG 		Neonate With Ecmo 8 $573,902.00 $619,814.16 $573,902.00 nat. median
$390,362
1.5× median
9194
OTHER 		Tisagenlecleucel Car-pos 12 $529,192.90 $608,571.83 $550,360.62 nat. median
$555,653
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 12 $527,123.40 $606,191.91 $548,208.34 nat. median
$553,480
1.0× median
9422
OTHER 		Idecabtagene Vicleucel Ca 12 $526,587.60 $605,575.74 $547,651.10 nat. median
$552,917
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 12 $516,726.10 $594,235.01 $537,395.14 nat. median
$542,562
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
$99,483
outlier · 5.3×
09194
OTHER 		Tisagenlecleucel Car-pos 2 $513,317.11 $529,192.90 $521,255.01 nat. median
$513,317
1.0× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $511,309.70 $527,123.40 $519,216.55 nat. median
$511,310
1.0× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $510,789.97 $526,587.60 $518,688.78 nat. median
$510,790
1.0× median
9035
OTHER 		Axicabtagene Ciloleucel C 12 $489,456.00 $562,874.40 $509,034.24 nat. median
$513,929
1.0× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $501,224.32 $516,726.10 $508,975.21 nat. median
$501,224
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
$96,548
outlier · 5.3×
5833
APR_DRG 		Neonate With Ecmo 8 $504,089.00 $544,416.12 $504,089.00 nat. median
$268,208
1.9× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $474,772.32 $489,456.00 $482,114.16 nat. median
$474,772
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 12 $460,530.40 $529,609.96 $478,951.62 nat. median
$483,557
1.0× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $446,714.49 $460,530.40 $453,622.45 nat. median
$446,714
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
$286,698
1.4× median
1614
APR_DRG 		Implantable Heart Assist Systems 8 $392,681.00 $424,095.48 $392,681.00 nat. median
$202,242
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
$187,567
1.9× median
5832
APR_DRG 		Neonate With Ecmo 8 $346,846.00 $374,593.68 $346,846.00 nat. median
$201,678
1.7× median
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 $339,261.00 $366,401.88 $339,261.00 nat. median
$198,578
1.7× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 8 $332,769.00 $359,390.52 $332,769.00 nat. median
$173,018
1.9× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 $316,132.00 $341,422.56 $316,132.00 nat. median
$135,803
outlier · 2.3×
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 8 $315,407.00 $340,639.56 $315,407.00 nat. median
$106,926
outlier · 2.9×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 18 $19,893.00 $602,267.62 $300,415.08 nat. median
$168,055
1.8× 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
$171,497
1.7× 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
$181,762
1.6× median
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 8 $261,717.00 $282,654.36 $261,717.00 nat. median
$168,439
1.6× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 8 $237,518.00 $256,519.44 $237,518.00 nat. median
$152,792
1.6× 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
$77,096
outlier · 3.1×

Other procedures at this hospital

Browse this hospital's 33,105 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
             
B0404 HCPCS Traumatic Spinal Cord Injury; M < 16.05 & A > 63.5 1 1 — — $61,498.45 $61,498.45 $61,498.45 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 2 2 — — $61,454.13 $63,354.77 $62,404.45 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
005 OTHER Liver Transplant With Mcc Or Intestinal Transplant 2 2 — — $63,386.71 $65,347.12 $64,366.92 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 2 2 — — $63,512.28 $65,476.58 $64,494.43 2024-10-01
01582 OTHER New Technology - Level 45 2 2 — — $63,708.73 $65,679.10 $64,693.92 2024-10-01
01596 OTHER New Technology - Level 45 2 2 — — $63,708.73 $65,679.10 $64,693.92 2024-10-01
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 8 8 — — $60,933.00 $65,807.64 $60,933.00 2024-10-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 8 8 — — $60,945.00 $65,820.60 $60,945.00 2024-10-01
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 8 8 — — $61,101.00 $65,989.08 $61,101.00 2024-10-01
1804 APR_DRG Other Circulatory System Procedures 8 8 — — $61,172.00 $66,065.76 $61,172.00 2024-10-01
3032 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 8 — — $61,500.00 $66,420.00 $61,500.00 2024-10-01
1704 APR_DRG Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock 8 8 — — $61,948.00 $66,903.84 $61,948.00 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
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
1781 APR_DRG External Heart Assist Devices 8 8 — — $62,507.00 $67,507.56 $62,507.00 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
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
2244 APR_DRG Peritoneal Adhesiolysis 8 8 — — $63,059.00 $68,103.72 $63,059.00 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
494 APR_DRG Bacterial And Tuberculous Infections Of Nervous System 8 8 — — $63,430.00 $68,504.40 $63,430.00 2024-10-01
2314 APR_DRG Major Large Bowel Procedures 8 8 — — $64,139.00 $69,270.12 $64,139.00 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
4424 APR_DRG Kidney And Urinary Tract Procedures For Malignancy 8 8 — — $65,088.00 $70,295.04 $65,088.00 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
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
294 APR_DRG Other Percutaneous Intracranial Procedures 8 8 — — $66,372.00 $71,681.76 $66,372.00 2024-10-01
8633 APR_DRG Neonatal Aftercare 8 8 — — $66,379.00 $71,689.32 $66,379.00 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
1673 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 8 8 — — $67,128.00 $72,498.24 $67,128.00 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
717 OTHER Instill Adstiladrin, Tx D 14 14 — — $14,465.95 $72,857.99 $65,572.18 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
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 8 8 — — $67,640.00 $73,051.20 $67,640.00 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
955 OTHER Craniotomy For Multiple Significant Trauma 2 2 — — $71,366.93 $73,574.15 $72,470.54 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
2634 APR_DRG Cholecystectomy 8 8 — — $68,520.00 $74,001.60 $68,520.00 2024-10-01
6954 APR_DRG Chemotherapy For Acute Leukemia 8 8 — — $68,576.00 $74,062.08 $68,576.00 2024-10-01
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
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
1643 OTHER Y90 Ibritumomab, Rx 12 12 — — $65,476.58 $75,298.07 $68,095.64 2024-10-01
1596 OTHER New Technology - Level 45 12 12 — — $65,679.10 $75,530.96 $68,306.26 2024-10-01
1582 OTHER New Technology - Level 45 12 12 — — $65,679.10 $75,530.96 $68,306.26 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
01583 OTHER New Technology - Level 46 2 2 — — $73,510.00 $75,783.51 $74,646.76 2024-10-01
01597 OTHER New Technology - Level 46 2 2 — — $73,510.00 $75,783.51 $74,646.76 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
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
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
1814 APR_DRG Lower Extremity Vascular Procedures 8 8 — — $71,114.00 $76,803.12 $71,114.00 2024-10-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $71,270.00 $76,971.60 $71,270.00 2024-10-01
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $71,270.00 $76,971.60 $71,270.00 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
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
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $72,256.00 $78,036.48 $72,256.00 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
2294 APR_DRG Other Digestive System And Abdominal Procedures 8 8 — — $72,741.00 $78,560.28 $72,741.00 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
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
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
007 OTHER Lung Transplant 2 2 — — $77,252.93 $79,642.20 $78,447.57 2024-10-01
2324 APR_DRG Gastric Fundoplication 8 8 — — $73,767.00 $79,668.36 $73,767.00 2024-10-01
2614 APR_DRG Major Biliary Tract Procedures 8 8 — — $74,343.00 $80,290.44 $74,343.00 2024-10-01
264 APR_DRG Other Nervous System And Related Procedures 8 8 — — $74,779.00 $80,761.32 $74,779.00 2024-10-01
1794 APR_DRG Defibrillator Implants 8 8 — — $75,594.00 $81,641.52 $75,594.00 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
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
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
1214 APR_DRG Other Respiratory And Chest Procedures 8 8 — — $76,427.00 $82,541.16 $76,427.00 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
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 8 8 — — $77,264.00 $83,445.12 $77,264.00 2024-10-01
224 APR_DRG Ventricular Shunt Procedures 8 8 — — $77,340.00 $83,527.20 $77,340.00 2024-10-01
1782 APR_DRG External Heart Assist Devices 8 8 — — $77,884.00 $84,114.72 $77,884.00 2024-10-01
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
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 8 8 — — $78,494.00 $84,773.52 $78,494.00 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
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
01584 OTHER New Technology - Level 47 2 2 — — $83,311.27 $85,887.91 $84,599.59 2024-10-01
01598 OTHER New Technology - Level 47 2 2 — — $83,311.27 $85,887.91 $84,599.59 2024-10-01
1783 APR_DRG External Heart Assist Devices 8 8 — — $80,077.00 $86,483.16 $80,077.00 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
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
1597 OTHER New Technology - Level 46 12 12 — — $75,783.51 $87,151.04 $78,814.85 2024-10-01
1583 OTHER New Technology - Level 46 12 12 — — $75,783.51 $87,151.04 $78,814.85 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
214 APR_DRG Open Craniotomy Except Trauma 8 8 — — $82,409.00 $89,001.72 $82,409.00 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
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 2 2 — — $87,194.60 $89,891.34 $88,542.97 2024-10-01
274 APR_DRG Other Open Craniotomy 8 8 — — $83,324.00 $89,989.92 $83,324.00 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
2304 APR_DRG Major Small Bowel Procedures 8 8 — — $84,201.00 $90,937.08 $84,201.00 2024-10-01
4014 APR_DRG Adrenal Procedures 8 8 — — $84,364.00 $91,113.12 $84,364.00 2024-10-01
1784 APR_DRG External Heart Assist Devices 8 8 — — $84,419.00 $91,172.52 $84,419.00 2024-10-01
1204 APR_DRG Major Respiratory And Chest Procedures 8 8 — — $84,710.00 $91,486.80 $84,710.00 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
234 APR_DRG Spinal Procedures 8 8 — — $85,147.00 $91,958.76 $85,147.00 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 2 2 — — $89,535.61 $92,304.75 $90,920.18 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
0208 RC — 3 3 — — $92,869.50 $92,869.50 $92,869.50 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
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
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 8 8 — — $87,260.00 $94,240.80 $87,260.00 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
1694 APR_DRG Major Abdominal Vascular Procedures 8 8 — — $88,873.00 $95,982.84 $88,873.00 2024-10-01
01599 OTHER New Technology - Level 48 2 2 — — $93,112.53 $95,992.30 $94,552.42 2024-10-01
01585 OTHER New Technology - Level 48 2 2 — — $93,112.53 $95,992.30 $94,552.42 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
1834 APR_DRG Percutaneous Structural Cardiac Procedures 8 8 — — $90,369.00 $97,598.52 $90,369.00 2024-10-01
1598 OTHER New Technology - Level 47 12 12 — — $85,887.91 $98,771.10 $89,323.43 2024-10-01
1584 OTHER New Technology - Level 47 12 12 — — $85,887.91 $98,771.10 $89,323.43 2024-10-01
4414 APR_DRG Major Bladder Procedures 8 8 — — $91,537.00 $98,859.96 $91,537.00 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
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
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
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
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
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
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 30 18 — — $45,612.57 $103,745.00 $61,717.50 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 30 18 — — $40,669.53 $103,794.00 $61,589.40 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 30 18 — — $49,461.45 $104,053.56 $61,415.50 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
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
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
4402 APR_DRG Kidney Transplant 8 8 — — $99,348.00 $107,295.84 $99,348.00 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
459 MS_DRG Spinal Fusion Except Cervical With Mcc 8 4 — — $55,398.00 $108,418.21 $77,208.12 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
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
1585 OTHER New Technology - Level 48 12 12 — — $95,992.30 $110,391.14 $99,831.99 2024-10-01
1599 OTHER New Technology - Level 48 12 12 — — $95,992.30 $110,391.14 $99,831.99 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
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
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
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
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
8904 APR_DRG HIV With Multiple Major HIV Related Conditions 8 8 — — $104,523.00 $112,884.84 $104,523.00 2024-10-01
204 APR_DRG Open Craniotomy For Trauma 8 8 — — $104,624.00 $112,993.92 $104,624.00 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
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
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
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
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
10 MS_DRG Pancreas Transplant 26 17 — — $20,990.00 $116,288.34 $63,067.35 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
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 34 18 — — $44,021.68 $116,416.00 $75,172.83 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
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
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
9104 APR_DRG Craniotomy For Multiple Significant Trauma 8 8 — — $110,801.00 $119,665.08 $110,801.00 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
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $111,192.00 $120,087.36 $111,192.00 2024-10-01
8634 APR_DRG Neonatal Aftercare 8 8 — — $112,298.00 $121,281.84 $112,298.00 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
6904 APR_DRG Acute Leukemia 8 8 — — $113,638.00 $122,729.04 $113,638.00 2024-10-01
533182 CDM System Mech Thrmb 20 13 $136,440.00 $136,440.00 $20,466.00 $122,796.00 $62,080.20 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $76,785.37 $123,321.96 $100,053.67 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
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $115,021.00 $124,222.68 $115,021.00 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
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 30 18 — — $59,150.66 $126,054.99 $66,929.87 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
585009 CDM Cage Spn Custm L4/l5 13 8 $140,800.00 $140,800.00 $21,120.00 $126,720.00 $78,848.00 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 30 18 — — $59,747.34 $127,500.06 $67,557.04 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
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
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 28 18 — — $20,990.00 $130,669.74 $63,616.43 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
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
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
J9999 HCPCS Carmustine Wafers 8/box 12 8 $146,579.31 $146,579.31 $45,146.43 $131,921.38 $96,742.35 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
4403 APR_DRG Kidney Transplant 8 8 — — $122,726.00 $132,544.08 $122,726.00 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 30 18 — — $50,439.00 $132,659.17 $71,199.40 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 26 16 — — $8,596.00 $134,356.02 $72,775.15 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
4404 APR_DRG Kidney Transplant 8 8 — — $125,627.00 $135,677.16 $125,627.00 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 34 18 — — $64,690.38 $137,795.40 $95,015.18 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 34 18 — — $26,741.00 $138,171.38 $66,836.24 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
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
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
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
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
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
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
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
C1820 HCPCS Device Neurostimulator 108 7 $139,920.00 $139,920.00 $17,390.67 $149,688.00 $75,323.25 2024-10-01
84398 CDM Ins/repl Sq Icd With Elec 16 11 $166,771.48 $166,771.48 $25,015.72 $150,094.33 $84,219.60 2024-10-01
593732 CDM Graft Condyl Whole Rt 13 8 $167,176.00 $167,176.00 $25,076.40 $150,458.40 $93,618.56 2024-10-01
01908 OTHER New Technology - Level 52 2 2 — — $149,469.82 $154,092.60 $151,781.21 2024-10-01
01907 OTHER New Technology - Level 52 2 2 — — $149,469.82 $154,092.60 $151,781.21 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
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 26 17 — — $20,990.00 $155,320.48 $85,257.35 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
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 26 16 — — $20,990.00 $158,285.00 $69,132.52 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
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 30 18 — — $56,680.00 $158,652.54 $79,898.37 2024-10-01
1906 OTHER New Technology - Level 51 12 12 — — $138,936.00 $159,776.40 $144,493.44 2024-10-01
1905 OTHER New Technology - Level 51 12 12 — — $138,936.00 $159,776.40 $144,493.44 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
215 MS_DRG Other Heart Assist System Implant 30 18 — — $43,687.00 $166,981.34 $85,632.68 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
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
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
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
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 28 17 — — $8,596.00 $176,068.63 $88,031.77 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
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
1908 OTHER New Technology - Level 52 12 12 — — $154,092.60 $177,206.49 $160,256.30 2024-10-01
1907 OTHER New Technology - Level 52 12 12 — — $154,092.60 $177,206.49 $160,256.30 2024-10-01
C1822 HCPCS Pulse Gen Imp 36 7 $180,400.00 $180,400.00 $32,947.20 $178,200.00 $104,632.00 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 28 17 — — $54,073.59 $179,233.00 $64,828.47 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
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
7 MS_DRG Lung Transplant 26 17 — — $20,990.00 $190,608.39 $104,492.40 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
1611 APR_DRG Implantable Heart Assist Systems 8 8 — — $176,574.00 $190,699.92 $176,574.00 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 28 18 — — $19,893.00 $191,089.73 $104,754.77 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
J7330 HCPCS Algrf Maci Fnl 1 Membran 5 2 — — $49,273.20 $192,914.70 $83,649.85 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
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
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
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 26 16 — — $20,990.00 $198,798.00 $86,727.26 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
585010 CDM Cage Spn Custm L5/s1 13 8 $228,800.00 $228,800.00 $34,320.00 $205,920.00 $128,128.00 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
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
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
5831 APR_DRG Neonate With Ecmo 8 8 — — $217,102.00 $234,470.16 $217,102.00 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
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
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
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $237,518.00 $256,519.44 $237,518.00 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
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
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
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
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 8 8 — — $315,407.00 $340,639.56 $315,407.00 2024-10-01
371977 CDM Set Vntrc 17.4x13.8in 20 13 $379,000.00 $379,000.00 $56,850.00 $341,100.00 $172,445.00 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
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
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 26 16 — — $20,990.00 $350,637.00 $88,207.84 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
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
5832 APR_DRG Neonate With Ecmo 8 8 — — $346,846.00 $374,593.68 $346,846.00 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
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 26 16 — — $20,990.00 $410,835.11 $224,535.57 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 8 8 — — $392,681.00 $424,095.48 $392,681.00 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
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $446,714.49 $460,530.40 $453,622.45 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $474,772.32 $489,456.00 $482,114.16 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
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $513,317.11 $529,192.90 $521,255.01 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 12 12 — — $460,530.40 $529,609.96 $478,951.62 2024-10-01
5833 APR_DRG Neonate With Ecmo 8 8 — — $504,089.00 $544,416.12 $504,089.00 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
9035 OTHER Axicabtagene Ciloleucel C 12 12 — — $489,456.00 $562,874.40 $509,034.24 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
9413 OTHER Lisocabtagene Car Pos T 12 12 — — $516,726.10 $594,235.01 $537,395.14 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
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
9194 OTHER Tisagenlecleucel Car-pos 12 12 — — $529,192.90 $608,571.83 $550,360.62 2024-10-01
5834 APR_DRG Neonate With Ecmo 8 8 — — $573,902.00 $619,814.16 $573,902.00 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
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
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
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
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $2,316,955.58 $2,388,614.00 $2,352,784.79 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
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
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $3,225,691.35 $3,325,455.00 $3,275,573.17 2024-10-01
746 OTHER Inj, Betibeglogene Autote 14 14 — — $8,843.77 $3,413,200.00 $3,071,880.00 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
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $3,562,713.00 $3,672,900.00 $3,617,806.50 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 14 14 — — $9,956.97 $3,778,900.00 $3,401,010.00 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
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
773 OTHER Inj, Beqvez, Per Tx Dose 12 12 — — $3,605,000.00 $4,145,750.00 $3,749,200.00 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
J3393 HCPCS Injection, Betibeglogene Autotemcel, Per Treatment 1 1 — — $4,897,200.00 $4,897,200.00 $4,897,200.00 2024-10-01
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