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 HOSPITAL PULASKI

Pulaski, VA · CCN 490116 · Rates published

23,381 distinct procedures filed
47 distinct payers
738,033 rate rows
2024-10-01 last MRF observed · ⚠ 24 mo old
Data quality

680,064 of 738,033 rate rows are consumer-grade (92.1%)

57,969 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 36,087
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 17,562
per-diem day rate — not a per-procedure price 3,866
percent-of-charges filed in the dollar field — excluded from medians 220
placeholder amount (≤ $0.02) — excluded from medians 153
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 65
exceeds 10× this hospital's gross charge — excluded from medians 16

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 24 months old.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://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/54-0941129_LEWISGALE-HOSPITAL-PULASKI_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.hcavirginia.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaCMS hospital list
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-10-01
Content fingerprint 6e538acc08fbd920… · 272,233,350 bytes · first seen 2026-06-08

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 14 $3,672,900.00 $4,223,835.00 $3,764,722.50 nat. median
$3,765,001
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 $4,389.80 $3,824,273.25 $3,363,365.19 nat. median
$3,391,964
1.0× median
748
OTHER 		Inj, Lovotibeglogene Auto 16 $7,240.96 $3,778,900.00 $3,323,460.40 nat. median
$3,351,720
1.0× median
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $2,754,675.00 $3,305,610.00 $3,121,965.00 nat. median
$3,562,713
0.9× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $2,703,750.00 $3,244,500.00 $3,064,250.00 nat. median
$3,496,850
0.9× median
746
OTHER 		Inj, Betibeglogene Autote 16 $6,431.41 $3,413,200.00 $3,001,835.20 nat. median
$3,001,835
1.0× median
00714
OTHER 		Inj Delandistrogene Mox R 2 $2,494,091.25 $2,992,909.50 $2,826,636.75 nat. median
$3,225,691
0.9× median
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $2,464,500.00 $2,957,400.00 $2,793,100.00 nat. median
$3,187,420
0.9× median
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,226,000.00 $2,671,200.00 $2,522,800.00 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 $1,791,460.50 $2,149,752.60 $2,030,321.90 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
5834
APR_DRG 		Neonate With Ecmo 8 $481,555.00 $520,079.40 $481,555.00 nat. median
$390,362
1.2× median
9391
OTHER 		Brexucabtagene Car Pos T 14 $460,530.40 $529,609.96 $472,043.66 nat. median
$483,557
1.0× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 $388,680.75 $1,387,149.28 $453,460.88 nat. median
$621,313
0.7× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $396,894.68 $476,273.61 $449,813.97 nat. median
$513,317
0.9× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $395,342.55 $474,411.06 $448,054.89 nat. median
$511,310
0.9× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $394,940.70 $473,928.84 $447,599.46 nat. median
$510,790
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $380,622.00 $1,345,370.55 $444,059.00 nat. median
$599,737
0.7× median
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 $441,020.00 $476,301.60 $441,020.00 nat. median
$99,483
outlier · 4.4×
09413
OTHER 		Lisocabtagene Car Pos T 2 $387,544.57 $465,053.49 $439,217.18 nat. median
$501,224
0.9× median
5892
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 $425,416.00 $459,449.28 $425,416.00 nat. median
$96,548
outlier · 4.4×
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 3 $363,517.50 $1,334,154.50 $424,103.75 nat. median
$574,037
0.7× median
5833
APR_DRG 		Neonate With Ecmo 8 $422,976.00 $456,814.08 $422,976.00 nat. median
$268,208
1.6× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $367,092.00 $440,510.40 $416,037.60 nat. median
$474,772
0.9× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $355,545.75 $1,315,434.06 $414,803.38 nat. median
$579,571
0.7× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 3 $344,535.75 $1,296,212.81 $401,958.38 nat. median
$562,501
0.7× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $337,080.00 $1,191,016.00 $393,260.00 nat. median
$513,770
0.8× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $345,397.80 $414,477.36 $391,450.84 nat. median
$446,714
0.9× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 8 $340,206.00 $367,422.48 $340,206.00 nat. median
$286,698
1.2× median
1614
APR_DRG 		Implantable Heart Assist Systems 8 $329,494.00 $355,853.52 $329,494.00 nat. median
$202,242
1.6× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 $298,207.00 $322,063.56 $298,207.00 nat. median
$187,567
1.6× median
5832
APR_DRG 		Neonate With Ecmo 8 $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 8 $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 8 $279,223.00 $301,560.84 $279,223.00 nat. median
$173,018
1.6× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 17 $19,893.00 $650,915.76 $265,642.66 nat. median
$168,055
1.6× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 $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 8 $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 8 $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 8 $237,859.00 $256,887.72 $237,859.00 nat. median
$181,762
1.3× median
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 8 $219,604.00 $237,172.32 $219,604.00 nat. median
$168,439
1.3× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 17 $26,741.00 $486,180.23 $199,419.64 nat. median
$186,516
1.1× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 8 $199,298.00 $215,241.84 $199,298.00 nat. median
$152,792
1.3× median
5893
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 $197,713.00 $213,530.04 $197,713.00 nat. median
$77,096
outlier · 2.6×
6034
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 $196,456.00 $212,172.48 $196,456.00 nat. median
$115,963
1.7× median

Other procedures at this hospital

Browse this hospital's 23,381 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 — — $4,389.80 $3,824,273.25 $3,363,365.19 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 17 16 — — $7,240.96 $3,778,900.00 $3,323,460.40 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 3 2 — — $2,754,675.00 $3,305,610.00 $3,121,965.00 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 3 2 — — $2,703,750.00 $3,244,500.00 $3,064,250.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 17 16 — — $6,431.41 $3,413,200.00 $3,001,835.20 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 3 2 — — $2,494,091.25 $2,992,909.50 $2,826,636.75 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 3 2 — — $2,464,500.00 $2,957,400.00 $2,793,100.00 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 3 2 — — $2,226,000.00 $2,671,200.00 $2,522,800.00 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 — — $1,791,460.50 $2,149,752.60 $2,030,321.90 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
5834 APR_DRG Neonate With Ecmo 8 8 — — $481,555.00 $520,079.40 $481,555.00 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 14 14 — — $460,530.40 $529,609.96 $472,043.66 2024-10-01
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 4 3 — — $388,680.75 $1,387,149.28 $453,460.88 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 3 2 — — $396,894.68 $476,273.61 $449,813.97 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 3 2 — — $395,342.55 $474,411.06 $448,054.89 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 3 2 — — $394,940.70 $473,928.84 $447,599.46 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 3 — — $380,622.00 $1,345,370.55 $444,059.00 2024-10-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 8 — — $441,020.00 $476,301.60 $441,020.00 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 3 2 — — $387,544.57 $465,053.49 $439,217.18 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 8 — — $425,416.00 $459,449.28 $425,416.00 2024-10-01
Q2055 HCPCS Idecabtagene Vicleucel, Up To 510 Million Autologous B-cell Maturation Antigen (… 4 3 — — $363,517.50 $1,334,154.50 $424,103.75 2024-10-01
5833 APR_DRG Neonate With Ecmo 8 8 — — $422,976.00 $456,814.08 $422,976.00 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 3 2 — — $367,092.00 $440,510.40 $416,037.60 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 4 3 — — $355,545.75 $1,315,434.06 $414,803.38 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 4 3 — — $344,535.75 $1,296,212.81 $401,958.38 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 4 3 — — $337,080.00 $1,191,016.00 $393,260.00 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 3 2 — — $345,397.80 $414,477.36 $391,450.84 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $340,206.00 $367,422.48 $340,206.00 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 8 8 — — $329,494.00 $355,853.52 $329,494.00 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 8 — — $298,207.00 $322,063.56 $298,207.00 2024-10-01
5832 APR_DRG Neonate With Ecmo 8 8 — — $291,035.00 $314,317.80 $291,035.00 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 8 — — $284,670.00 $307,443.60 $284,670.00 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $279,223.00 $301,560.84 $279,223.00 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 22 17 — — $19,893.00 $650,915.76 $265,642.66 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $265,262.00 $286,482.96 $265,262.00 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 8 8 — — $264,654.00 $285,826.32 $264,654.00 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $251,563.00 $271,688.04 $251,563.00 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 8 8 — — $237,859.00 $256,887.72 $237,859.00 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 8 — — $219,604.00 $237,172.32 $219,604.00 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 23 17 — — $26,741.00 $486,180.23 $199,419.64 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $199,298.00 $215,241.84 $199,298.00 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 8 — — $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 8 8 — — $196,456.00 $212,172.48 $196,456.00 2024-10-01
J7330 HCPCS Algrf Maci Fnl 1 Membran 1 1 — — $192,914.70 $192,914.70 $192,914.70 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $191,263.00 $206,564.04 $191,263.00 2024-10-01
5831 APR_DRG Neonate With Ecmo 8 8 — — $182,168.00 $196,741.44 $182,168.00 2024-10-01
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 1 1 — — $173,512.94 $173,512.94 $173,512.94 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 23 17 — — $11,750.00 $409,479.25 $166,664.29 2024-10-01
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 8 8 — — $163,774.00 $176,875.92 $163,774.00 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 8 8 — — $159,784.00 $172,566.72 $159,784.00 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 8 8 — — $155,996.00 $168,475.68 $155,996.00 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 3 2 — — $148,795.90 $157,548.60 $152,296.98 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 8 — — $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 8 8 — — $150,761.00 $162,821.88 $150,761.00 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $150,735.00 $162,793.80 $150,735.00 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 23 17 — — $11,750.00 $369,906.68 $150,623.82 2024-10-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 8 8 — — $148,821.00 $160,726.68 $148,821.00 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 8 8 — — $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… 8 8 — — $148,157.00 $160,009.56 $148,157.00 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $147,715.00 $159,532.20 $147,715.00 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
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 8 — — $139,408.00 $150,560.64 $139,408.00 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 8 8 — — $137,614.00 $148,623.12 $137,614.00 2024-10-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 8 — — $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… 8 8 — — $134,015.00 $144,736.20 $134,015.00 2024-10-01
1905 OTHER New Technology - Level 51 14 14 — — $126,255.70 $145,194.05 $129,412.09 2024-10-01
1906 OTHER New Technology - Level 51 14 14 — — $126,255.70 $145,194.05 $129,412.09 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 2 — — $122,778.59 $130,000.86 $125,667.50 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $125,440.00 $135,475.20 $125,440.00 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 1 1 — — $123,321.96 $123,321.96 $123,321.96 2024-10-01
33272 CPT Removal Of Subcutaneous Implantable Defibrillator Electrode 6 4 — — $1,995.00 $162,553.00 $123,021.00 2024-10-01
33240 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Singl… 6 4 — — $4,250.00 $162,553.00 $123,021.00 2024-10-01
33264 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 6 4 — — $1,995.00 $162,553.00 $123,021.00 2024-10-01
33270 CPT Insertion Or Replacement Of Permanent Subcutaneous Implantable Defibrillator Sys… 6 4 — — $1,995.00 $162,553.00 $123,021.00 2024-10-01
33271 CPT Insertion Of Subcutaneous Implantable Defibrillator Electrode 6 4 — — $1,995.00 $162,553.00 $123,021.00 2024-10-01
33262 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 6 4 — — $1,995.00 $162,553.00 $123,021.00 2024-10-01
33231 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multi… 6 4 — — $1,995.00 $162,553.00 $123,021.00 2024-10-01
33249 CPT Insertion Or Replacement Of Permanent Implantable Defibrillator System, With Tra… 6 4 — — $4,250.00 $162,553.00 $123,021.00 2024-10-01
33230 CPT Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Dual … 6 4 — — $1,995.00 $162,553.00 $123,021.00 2024-10-01
33263 CPT Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implant… 6 4 — — $1,995.00 $162,553.00 $123,021.00 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 8 — — $123,007.00 $132,847.56 $123,007.00 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $121,973.00 $131,730.84 $121,973.00 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $120,200.00 $129,816.00 $120,200.00 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 8 8 — — $120,200.00 $129,816.00 $120,200.00 2024-10-01
01908 OTHER New Technology - Level 52 3 2 — — $105,021.75 $126,026.10 $119,024.65 2024-10-01
01907 OTHER New Technology - Level 52 3 2 — — $105,021.75 $126,026.10 $119,024.65 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $116,206.00 $125,502.48 $116,206.00 2024-10-01
1903 OTHER New Technology - Level 50 14 14 — — $112,482.40 $129,354.76 $115,294.46 2024-10-01
1904 OTHER New Technology - Level 50 14 14 — — $112,482.40 $129,354.76 $115,294.46 2024-10-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 8 8 — — $110,101.00 $118,909.08 $110,101.00 2024-10-01
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $108,690.00 $117,385.20 $108,690.00 2024-10-01
01906 OTHER New Technology - Level 51 3 2 — — $94,691.77 $113,630.13 $107,317.35 2024-10-01
01905 OTHER New Technology - Level 51 3 2 — — $94,691.77 $113,630.13 $107,317.35 2024-10-01
4404 APR_DRG Kidney Transplant 8 8 — — $105,412.00 $113,844.96 $105,412.00 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $104,752.00 $113,132.16 $104,752.00 2024-10-01
4403 APR_DRG Kidney Transplant 8 8 — — $102,978.00 $111,216.24 $102,978.00 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 8 8 — — $102,611.00 $110,819.88 $102,611.00 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $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… 8 8 — — $102,132.00 $110,302.56 $102,132.00 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 3 2 — — $99,663.52 $105,526.08 $102,008.54 2024-10-01
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 8 8 — — $101,921.00 $110,074.68 $101,921.00 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… 8 8 — — $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 — — $74,999.92 $114,999.88 $101,139.90 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 8 — — $100,696.00 $108,751.68 $100,696.00 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 23 17 — — $11,750.00 $243,882.40 $99,540.72 2024-10-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 8 — — $98,118.00 $105,967.44 $98,118.00 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $96,513.00 $104,234.04 $96,513.00 2024-10-01
01903 OTHER New Technology - Level 50 3 2 — — $84,361.80 $101,234.16 $95,610.04 2024-10-01
01904 OTHER New Technology - Level 50 3 2 — — $84,361.80 $101,234.16 $95,610.04 2024-10-01
6904 APR_DRG Acute Leukemia 8 8 — — $95,352.00 $102,980.16 $95,352.00 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 8 8 — — $95,233.00 $102,851.64 $95,233.00 2024-10-01
8634 APR_DRG Neonatal Aftercare 8 8 — — $94,228.00 $101,766.24 $94,228.00 2024-10-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $93,300.00 $100,764.00 $93,300.00 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 8 8 — — $93,278.00 $100,740.24 $93,278.00 2024-10-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 8 8 — — $92,972.00 $100,409.76 $92,972.00 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 22 17 — — $19,893.00 $226,134.63 $92,735.56 2024-10-01
7 MS_DRG Lung Transplant 22 17 — — $26,741.00 $225,565.02 $92,503.69 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 17 16 — — $68,273.92 $104,686.68 $92,069.66 2024-10-01
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 8 — — $91,749.00 $99,088.92 $91,749.00 2024-10-01
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 8 8 — — $90,411.00 $97,643.88 $90,411.00 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
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 8 8 — — $88,469.00 $95,546.52 $88,469.00 2024-10-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $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 8 8 — — $88,034.00 $95,076.72 $88,034.00 2024-10-01
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 8 8 — — $87,942.00 $94,977.36 $87,942.00 2024-10-01
204 APR_DRG Open Craniotomy For Trauma 8 8 — — $87,789.00 $94,812.12 $87,789.00 2024-10-01
8904 APR_DRG HIV With Multiple Major HIV Related Conditions 8 8 — — $87,704.00 $94,720.32 $87,704.00 2024-10-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $86,541.00 $93,464.28 $86,541.00 2024-10-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 8 8 — — $84,578.00 $91,344.24 $84,578.00 2024-10-01
01902 OTHER New Technology - Level 49 3 2 — — $74,031.83 $88,838.20 $83,902.74 2024-10-01
01901 OTHER New Technology - Level 49 3 2 — — $74,031.83 $88,838.20 $83,902.74 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 8 8 — — $83,819.00 $90,524.52 $83,819.00 2024-10-01
4402 APR_DRG Kidney Transplant 8 8 — — $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 8 8 — — $83,297.00 $89,960.76 $83,297.00 2024-10-01
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 8 8 — — $81,138.00 $87,629.04 $81,138.00 2024-10-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 8 8 — — $80,204.00 $86,620.32 $80,204.00 2024-10-01
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 8 8 — — $80,021.00 $86,422.68 $80,021.00 2024-10-01
1584 OTHER New Technology - Level 47 14 14 — — $78,049.16 $89,756.53 $80,000.39 2024-10-01
1598 OTHER New Technology - Level 47 14 14 — — $78,049.16 $89,756.53 $80,000.39 2024-10-01
C1882 HCPCS Crt-d Unfy.5ch Cd335740c 21 18 $99,999.00 $99,999.00 $36,799.63 $89,999.10 $79,999.20 2024-10-01
C1778 HCPCS Lead Nrstm 3mm Perenniaf 21 18 $99,999.00 $99,999.00 $36,799.63 $89,999.10 $79,999.20 2024-10-01
C1767 HCPCS Neurostm Vns Demipul 106 21 18 $99,999.00 $99,999.00 $36,799.63 $89,999.10 $79,999.20 2024-10-01
C1721 HCPCS Icd 2ch Frtfy Cd2357-40q 21 18 $99,999.00 $99,999.00 $36,799.63 $89,999.10 $79,999.20 2024-10-01
C1722 HCPCS Icd Frtfy Asr Cd1357-40q 21 18 $99,999.00 $99,999.00 $36,799.63 $89,999.10 $79,999.20 2024-10-01
C1820 HCPCS Kit Generator Nrstm Ipg 21 18 $99,999.00 $99,999.00 $36,799.63 $89,999.10 $79,999.20 2024-10-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 8 — — $79,946.00 $86,341.68 $79,946.00 2024-10-01
1774 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 8 8 — — $78,763.00 $85,064.04 $78,763.00 2024-10-01
376998 CDM Hip Hybrid Stryker Cap 22 18 $99,999.00 $99,999.00 $14,999.85 $89,999.10 $78,499.21 2024-10-01
468603 CDM Allograft Chndrfx Ost9mm 22 18 $99,999.00 $99,999.00 $14,999.85 $89,999.10 $78,499.21 2024-10-01
439337 CDM Graft Bn Ostchnd Algrf 22 18 $99,999.00 $99,999.00 $14,999.85 $89,999.10 $78,499.21 2024-10-01
447314 CDM Allograft Chondrofix 11m 22 18 $99,999.00 $99,999.00 $14,999.85 $89,999.10 $78,499.21 2024-10-01
477247 CDM Mesh Viaable Crtlg 20mm 22 18 $99,999.00 $99,999.00 $14,999.85 $89,999.10 $78,499.21 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 23 17 — — $26,741.00 $247,502.00 $78,440.33 2024-10-01
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 8 8 — — $78,240.00 $84,499.20 $78,240.00 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 23 17 — — $11,750.00 $188,025.80 $77,547.09 2024-10-01
4414 APR_DRG Major Bladder Procedures 8 8 — — $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
476007 CDM Sys Reflux Mgmt Bead 14 22 18 $96,701.00 $96,701.00 $14,505.15 $87,030.90 $75,910.29 2024-10-01
476009 CDM Sys Reflux Mgmt Bead 16 22 18 $96,701.00 $96,701.00 $14,505.15 $87,030.90 $75,910.29 2024-10-01
476008 CDM Sys Reflux Mgmt Bead 15 22 18 $96,701.00 $96,701.00 $14,505.15 $87,030.90 $75,910.29 2024-10-01
476010 CDM Sys Reflux Mgmt Bead 17 22 18 $96,701.00 $96,701.00 $14,505.15 $87,030.90 $75,910.29 2024-10-01
476006 CDM System Gs Impl Anrflx 22 18 $96,701.00 $96,701.00 $14,505.15 $87,030.90 $75,910.29 2024-10-01
1834 APR_DRG Percutaneous Structural Cardiac Procedures 8 8 — — $75,828.00 $81,894.24 $75,828.00 2024-10-01
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 8 8 — — $75,541.00 $81,584.28 $75,541.00 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 22 17 — — $26,741.00 $183,805.48 $75,505.47 2024-10-01
215 MS_DRG Other Heart Assist System Implant 23 17 — — $51,975.00 $182,866.49 $75,438.19 2024-10-01
489014 CDM Awl Surg 15mm Wgnr Sl Rv 28 22 $99,999.00 $99,999.00 $14,999.85 $89,999.10 $74,999.25 2024-10-01
C2624 HCPCS Sensor Artery Impl Systm 27 22 $99,999.00 $99,999.00 $18,999.81 $89,999.10 $74,999.25 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 23 17 — — $72,469.65 $180,922.90 $74,643.74 2024-10-01
1694 APR_DRG Major Abdominal Vascular Procedures 8 8 — — $74,572.00 $80,537.76 $74,572.00 2024-10-01
01585 OTHER New Technology - Level 48 3 2 — — $65,423.52 $78,508.22 $74,146.66 2024-10-01
01599 OTHER New Technology - Level 48 3 2 — — $65,423.52 $78,508.22 $74,146.66 2024-10-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 8 8 — — $73,811.00 $79,715.88 $73,811.00 2024-10-01
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 8 8 — — $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… 8 8 — — $72,915.00 $78,748.20 $72,915.00 2024-10-01
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 8 8 — — $72,234.00 $78,012.72 $72,234.00 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 3 2 — — $70,075.84 $74,197.94 $71,724.68 2024-10-01
234 APR_DRG Spinal Procedures 8 8 — — $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… 8 8 — — $71,140.00 $76,831.20 $71,140.00 2024-10-01
1204 APR_DRG Major Respiratory And Chest Procedures 8 8 — — $71,079.00 $76,765.32 $71,079.00 2024-10-01
1784 APR_DRG External Heart Assist Devices 8 8 — — $70,835.00 $76,501.80 $70,835.00 2024-10-01
4014 APR_DRG Adrenal Procedures 8 8 — — $70,789.00 $76,452.12 $70,789.00 2024-10-01
2304 APR_DRG Major Small Bowel Procedures 8 8 — — $70,652.00 $76,304.16 $70,652.00 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
914 APR_DRG Other Major Head And Neck Procedures 8 8 — — $70,544.00 $76,187.52 $70,544.00 2024-10-01
274 APR_DRG Other Open Craniotomy 8 8 — — $69,916.00 $75,509.28 $69,916.00 2024-10-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 8 8 — — $69,515.00 $75,076.20 $69,515.00 2024-10-01
214 APR_DRG Open Craniotomy Except Trauma 8 8 — — $69,148.00 $74,679.84 $69,148.00 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 23 17 — — $61,909.00 $166,575.55 $68,779.17 2024-10-01
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 8 8 — — $68,134.00 $73,584.72 $68,134.00 2024-10-01
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 8 8 — — $67,546.00 $72,949.68 $67,546.00 2024-10-01
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 8 8 — — $67,376.00 $72,766.08 $67,376.00 2024-10-01
1783 APR_DRG External Heart Assist Devices 8 8 — — $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
014 OTHER Allogeneic Bone Marrow Transplant 3 2 — — $65,112.51 $68,942.65 $66,644.57 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 17 16 — — $49,403.77 $75,752.45 $66,622.64 2024-10-01
01598 OTHER New Technology - Level 47 3 2 — — $58,536.87 $70,244.24 $66,341.79 2024-10-01
01584 OTHER New Technology - Level 47 3 2 — — $58,536.87 $70,244.24 $66,341.79 2024-10-01
894 APR_DRG Major Cranial Or Facial Bone Procedures 8 8 — — $66,008.00 $71,288.64 $66,008.00 2024-10-01
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 8 8 — — $65,864.00 $71,133.12 $65,864.00 2024-10-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 8 8 — — $65,431.00 $70,665.48 $65,431.00 2024-10-01
1782 APR_DRG External Heart Assist Devices 8 8 — — $65,351.00 $70,579.08 $65,351.00 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 23 17 — — $11,750.00 $158,996.25 $65,132.68 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 3 2 — — $63,410.06 $67,140.06 $64,902.06 2024-10-01
224 APR_DRG Ventricular Shunt Procedures 8 8 — — $64,895.00 $70,086.60 $64,895.00 2024-10-01
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 8 8 — — $64,831.00 $70,017.48 $64,831.00 2024-10-01
4054 APR_DRG Other Procedures For Endocrine, Nutritional And Metabolic Disorders 8 8 — — $64,665.00 $69,838.20 $64,665.00 2024-10-01
1214 APR_DRG Other Respiratory And Chest Procedures 8 8 — — $64,129.00 $69,259.32 $64,129.00 2024-10-01
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 8 8 — — $64,109.00 $69,237.72 $64,109.00 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 17 16 — — $10,520.00 $72,857.99 $64,077.01 2024-10-01
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 8 — — $63,642.00 $68,733.36 $63,642.00 2024-10-01
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 8 8 — — $63,620.00 $68,709.60 $63,620.00 2024-10-01
1794 APR_DRG Defibrillator Implants 8 8 — — $63,430.00 $68,504.40 $63,430.00 2024-10-01
C1895 HCPCS Lead Dc Spnt 6947m62 21 18 $78,573.00 $78,573.00 $28,914.86 $70,715.70 $62,858.40 2024-10-01
C1777 HCPCS Lead Icd Df4 8.6fr 55cm 21 18 $78,573.00 $78,573.00 $28,914.86 $70,715.70 $62,858.40 2024-10-01
562943 CDM Filler Bn 5cc 22 18 $79,973.00 $79,973.00 $11,995.95 $71,975.70 $62,778.81 2024-10-01
264 APR_DRG Other Nervous System And Related Procedures 8 8 — — $62,746.00 $67,765.68 $62,746.00 2024-10-01
2614 APR_DRG Major Biliary Tract Procedures 8 8 — — $62,381.00 $67,371.48 $62,381.00 2024-10-01
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 1 1 — — $62,320.47 $62,320.47 $62,320.47 2024-10-01
2324 APR_DRG Gastric Fundoplication 8 8 — — $61,897.00 $66,848.76 $61,897.00 2024-10-01
4474 APR_DRG Other Kidney, Urinary Tract And Related Non-percutaneous Procedures 8 8 — — $61,718.00 $66,655.44 $61,718.00 2024-10-01
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 8 8 — — $61,393.00 $66,304.44 $61,393.00 2024-10-01
1596 OTHER New Technology - Level 45 14 14 — — $59,684.76 $68,637.47 $61,176.88 2024-10-01
1582 OTHER New Technology - Level 45 14 14 — — $59,684.76 $68,637.47 $61,176.88 2024-10-01
2294 APR_DRG Other Digestive System And Abdominal Procedures 8 8 — — $61,036.00 $65,918.88 $61,036.00 2024-10-01
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $60,629.00 $65,479.32 $60,629.00 2024-10-01
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 8 8 — — $60,629.00 $65,479.32 $60,629.00 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 23 17 — — $58,713.39 $146,259.36 $60,474.79 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 23 17 — — $58,680.51 $146,176.50 $60,440.93 2024-10-01
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $59,802.00 $64,586.16 $59,802.00 2024-10-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 8 8 — — $59,802.00 $64,586.16 $59,802.00 2024-10-01
1814 APR_DRG Lower Extremity Vascular Procedures 8 8 — — $59,671.00 $64,444.68 $59,671.00 2024-10-01
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 8 — — $59,571.00 $64,336.68 $59,571.00 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 23 17 — — $57,799.60 $143,956.74 $59,533.59 2024-10-01
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 8 8 — — $59,174.00 $63,907.92 $59,174.00 2024-10-01
9514 APR_DRG Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 8 8 — — $58,922.00 $63,635.76 $58,922.00 2024-10-01
01583 OTHER New Technology - Level 46 3 2 — — $51,650.22 $61,980.26 $58,536.92 2024-10-01
01597 OTHER New Technology - Level 46 3 2 — — $51,650.22 $61,980.26 $58,536.92 2024-10-01
1764 APR_DRG Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 8 8 — — $58,039.00 $62,682.12 $58,039.00 2024-10-01
64565 CPT HPercutaneous Implantation Of Neurostimulator Electrode Array; Neuromuscular 4 2 — — $36,611.00 $61,080.00 $58,026.00 2024-10-01
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 8 8 — — $57,977.00 $62,615.16 $57,977.00 2024-10-01
22808 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 2 To 3 Verteb… 6 4 — — $4,250.00 $112,365.00 $57,974.50 2024-10-01
22802 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 7 To 12 Vert… 6 4 — — $4,250.00 $112,365.00 $57,974.50 2024-10-01
22810 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 Verteb… 6 4 — — $4,250.00 $112,365.00 $57,974.50 2024-10-01
22804 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 13 Or More V… 6 4 — — $4,250.00 $112,365.00 $57,974.50 2024-10-01
22812 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 8 Or More Ver… 6 4 — — $4,250.00 $112,365.00 $57,974.50 2024-10-01
22800 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; Up To 6 Vert… 6 4 — — $4,250.00 $112,365.00 $57,974.50 2024-10-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 23 17 — — $26,741.00 $139,132.29 $57,561.56 2024-10-01
6954 APR_DRG Chemotherapy For Acute Leukemia 8 8 — — $57,541.00 $62,144.28 $57,541.00 2024-10-01
007 OTHER Lung Transplant 3 2 — — $56,180.25 $59,484.97 $57,502.14 2024-10-01
2634 APR_DRG Cholecystectomy 8 8 — — $57,495.00 $62,094.60 $57,495.00 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 3 2 — — $56,078.32 $59,377.05 $57,397.82 2024-10-01
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 8 8 — — $57,348.00 $61,935.84 $57,348.00 2024-10-01
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 8 8 — — $57,072.00 $61,637.76 $57,072.00 2024-10-01
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 8 8 — — $56,756.00 $61,296.48 $56,756.00 2024-10-01
10 MS_DRG Pancreas Transplant 22 17 — — $26,741.00 $137,615.05 $56,703.66 2024-10-01
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 8 8 — — $56,674.00 $61,207.92 $56,674.00 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 14 14 — — $55,015.23 $63,267.51 $56,390.61 2024-10-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 22 17 — — $26,741.00 $136,822.77 $56,381.16 2024-10-01
1673 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 8 8 — — $56,326.00 $60,832.08 $56,326.00 2024-10-01
1773 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 8 8 — — $56,326.00 $60,832.08 $56,326.00 2024-10-01
5114 APR_DRG Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 8 8 — — $56,317.00 $60,822.36 $56,317.00 2024-10-01
5104 APR_DRG Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced… 8 8 — — $56,304.00 $60,808.32 $56,304.00 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 23 17 — — $54,208.80 $134,908.52 $55,835.06 2024-10-01
8633 APR_DRG Neonatal Aftercare 8 8 — — $55,697.00 $60,152.76 $55,697.00 2024-10-01
294 APR_DRG Other Percutaneous Intracranial Procedures 8 8 — — $55,692.00 $60,147.36 $55,692.00 2024-10-01
01643 OTHER Y90 Ibritumomab, Rx 3 2 — — $49,107.43 $58,928.92 $55,655.09 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 4 3 — — $47,629.05 $168,273.22 $55,567.22 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 23 17 — — $53,669.02 $133,548.36 $55,279.09 2024-10-01
6091 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 8 — — $55,196.00 $59,611.68 $55,196.00 2024-10-01
6092 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 8 8 — — $55,196.00 $59,611.68 $55,196.00 2024-10-01
5894 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 8 8 — — $55,085.00 $59,491.80 $55,085.00 2024-10-01
4424 APR_DRG Kidney And Urinary Tract Procedures For Malignancy 8 8 — — $54,615.00 $58,984.20 $54,615.00 2024-10-01
00717 OTHER Instill Adstiladrin, Tx D 3 2 — — $47,516.08 $57,019.29 $53,851.55 2024-10-01
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 8 8 — — $53,821.00 $58,126.68 $53,821.00 2024-10-01
2314 APR_DRG Major Large Bowel Procedures 8 8 — — $53,818.00 $58,123.44 $53,818.00 2024-10-01
494 APR_DRG Bacterial And Tuberculous Infections Of Nervous System 8 8 — — $53,223.00 $57,480.84 $53,223.00 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 3 2 — — $51,899.78 $54,952.71 $53,120.96 2024-10-01
3254 APR_DRG Non-elective Or Complex Knee Joint Replacement 8 8 — — $53,038.00 $57,281.04 $53,038.00 2024-10-01
2244 APR_DRG Peritoneal Adhesiolysis 8 8 — — $52,912.00 $57,144.96 $52,912.00 2024-10-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 23 17 — — $11,750.00 $128,830.93 $52,905.35 2024-10-01
9524 APR_DRG Non-extensive O.r. Procedure Unrelated To Principal Diagnosis 8 8 — — $52,552.00 $56,756.16 $52,552.00 2024-10-01
1781 APR_DRG External Heart Assist Devices 8 8 — — $52,449.00 $56,644.92 $52,449.00 2024-10-01
6604 APR_DRG Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula… 8 8 — — $52,304.00 $56,488.32 $52,304.00 2024-10-01
5184 APR_DRG Other Female Reproductive System And Related Procedures 8 8 — — $52,211.00 $56,387.88 $52,211.00 2024-10-01
1704 APR_DRG Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock 8 8 — — $51,980.00 $56,138.40 $51,980.00 2024-10-01
1581 OTHER New Technology - Level 44 14 14 — — $50,502.56 $58,077.94 $51,765.12 2024-10-01
1595 OTHER New Technology - Level 44 14 14 — — $50,502.56 $58,077.94 $51,765.12 2024-10-01
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