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

STONESPRINGS HOSPITAL CENTER

Dulles, VA · CCN 490145 · Rates published

29,054 distinct procedures filed
24 distinct payers
401,714 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

226,114 of 401,714 rate rows are consumer-grade (56.3%)

175,600 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 171,992
per-diem day rate — not a per-procedure price 3,157
template filing: same amount across many unrelated codes — excluded 324
placeholder amount (≤ $0.02) — excluded from medians 112
exceeds 10× this hospital's gross charge — excluded from medians 15

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/04-3665595_STONESPRINGS-HOSPITAL-CENTER_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://www.hcavirginia.com/patient-resources/patient-financial-resources/pricing-transparency-cms-required-file-of-standard-charges
Discovered viaCMS hospital list
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-06-08

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
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 10 $3,672,900.00 $4,223,835.00 $3,801,451.50 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 10 $3,605,000.00 $4,145,750.00 $3,731,175.00 nat. median
$3,605,000
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 12 $5,352.21 $3,824,273.25 $3,408,591.38 nat. median
$13,041
outlier · 261.4×
748
OTHER 		Inj, Lovotibeglogene Auto 12 $8,828.45 $3,778,900.00 $3,368,150.00 nat. median
$17,963
outlier · 187.5×
09138
OTHER 		Inj, Hemgenix, Per Tx Dos 2 $2,754,675.00 $3,672,900.00 $3,213,787.50 nat. median
$3,574,709
0.9× median
00773
OTHER 		Inj, Beqvez, Per Tx Dose 2 $2,703,750.00 $3,605,000.00 $3,154,375.00 nat. median
$3,496,850
0.9× median
746
OTHER 		Inj, Betibeglogene Autote 12 $7,841.42 $3,413,200.00 $3,042,200.00 nat. median
$21,896
outlier · 138.9×
00714
OTHER 		Inj Delandistrogene Mox R 2 $2,494,091.25 $3,325,455.00 $2,909,773.12 nat. median
$3,228,024
0.9× median
00748
OTHER 		Inj, Lovotibeglogene Auto 2 $2,464,500.00 $3,286,000.00 $2,875,250.00 nat. median
$3,187,420
0.9× median
00746
OTHER 		Inj, Betibeglogene Autote 2 $2,226,000.00 $2,968,000.00 $2,597,000.00 nat. median
$2,878,960
0.9× median
9141
OTHER 		Inj Onase Abepar-xioi Tre 10 $2,388,614.00 $2,746,906.10 $2,472,215.49 nat. median
$2,588,981
1.0× median
09141
OTHER 		Inj Onase Abepar-xioi Tre 2 $1,791,460.50 $2,388,614.00 $2,090,037.25 nat. median
$2,457,321
0.9× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 4 $380,622.00 $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 $355,545.75 $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 $344,535.75 $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 $337,080.00 $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 $388,680.75 $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 $363,517.50 $1,334,154.50 $657,694.98 nat. median
$625,184
1.1× median
5834
APR_DRG 		Neonate With Ecmo 7 $604,107.00 $652,435.56 $604,107.00 nat. median
$309,665
2.0× median
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 $553,256.00 $597,516.48 $553,256.00 nat. median
$93,370
outlier · 5.9×
9194
OTHER 		Tisagenlecleucel Car-pos 10 $529,192.90 $608,571.83 $547,714.66 nat. median
$566,531
1.0× median
9498
OTHER 		Ciltacabtagene Car-pos T 10 $527,123.40 $606,191.91 $545,572.72 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 10 $526,587.60 $605,575.74 $545,018.17 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 10 $516,726.10 $594,235.01 $534,811.51 nat. median
$562,201
1.0× median
5892
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 $533,682.00 $576,376.56 $533,682.00 nat. median
$89,796
outlier · 5.9×
5833
APR_DRG 		Neonate With Ecmo 7 $530,620.00 $573,069.60 $530,620.00 nat. median
$244,017
outlier · 2.2×
9035
OTHER 		Axicabtagene Ciloleucel C 10 $489,456.00 $562,874.40 $506,586.96 nat. median
$532,192
1.0× median
9391
OTHER 		Brexucabtagene Car Pos T 10 $460,530.40 $529,609.96 $476,648.96 nat. median
$489,450
1.0× median
09194
OTHER 		Tisagenlecleucel Car-pos 2 $396,894.68 $529,192.90 $463,043.79 nat. median
$538,205
0.9× median
09498
OTHER 		Ciltacabtagene Car-pos T 2 $395,342.55 $527,123.40 $461,232.97 nat. median
$554,552
0.8× median
09422
OTHER 		Idecabtagene Vicleucel Ca 2 $394,940.70 $526,587.60 $460,764.15 nat. median
$530,178
0.9× median
09413
OTHER 		Lisocabtagene Car Pos T 2 $387,544.57 $516,726.10 $452,135.33 nat. median
$534,091
0.8× median
09035
OTHER 		Axicabtagene Ciloleucel C 2 $367,092.00 $489,456.00 $428,274.00 nat. median
$505,583
0.8× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 7 $426,787.00 $460,929.96 $426,787.00 nat. median
$246,434
1.7× median
1614
APR_DRG 		Implantable Heart Assist Systems 7 $413,348.00 $446,415.84 $413,348.00 nat. median
$207,730
2.0× median
09391
OTHER 		Brexucabtagene Car Pos T 2 $345,397.80 $460,530.40 $402,964.10 nat. median
$464,978
0.9× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 $374,099.00 $404,026.92 $374,099.00 nat. median
$150,721
outlier · 2.5×
5832
APR_DRG 		Neonate With Ecmo 7 $365,101.00 $394,309.08 $365,101.00 nat. median
$156,126
outlier · 2.3×
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 $357,117.00 $385,686.36 $357,117.00 nat. median
$162,982
outlier · 2.2×
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 7 $350,283.00 $378,305.64 $350,283.00 nat. median
$160,267
outlier · 2.2×
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 $332,770.00 $359,391.60 $332,770.00 nat. median
$117,173
outlier · 2.8×
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 7 $332,007.00 $358,567.56 $332,007.00 nat. median
$97,957
outlier · 3.4×
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 7 $315,584.00 $340,830.72 $315,584.00 nat. median
$164,289
1.9× median
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 $298,393.00 $322,264.44 $298,393.00 nat. median
$122,924
outlier · 2.4×
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 15 $19,893.00 $602,267.62 $288,980.68 nat. median
$370,174
0.8× median
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 7 $275,492.00 $297,531.36 $275,492.00 nat. median
$151,838
1.8× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 7 $250,019.00 $270,020.52 $250,019.00 nat. median
$164,834
1.5× median
5893
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 $248,029.00 $267,871.32 $248,029.00 nat. median
$69,788
outlier · 3.6×

Other procedures at this hospital

Browse this hospital's 29,054 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
             
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
9138 OTHER Inj, Hemgenix, Per Tx Dos 10 10 — — $3,672,900.00 $4,223,835.00 $3,801,451.50 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 10 10 — — $3,605,000.00 $4,145,750.00 $3,731,175.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 12 12 — — $5,352.21 $3,824,273.25 $3,408,591.38 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 12 12 — — $8,828.45 $3,778,900.00 $3,368,150.00 2024-10-01
09138 OTHER Inj, Hemgenix, Per Tx Dos 2 2 — — $2,754,675.00 $3,672,900.00 $3,213,787.50 2024-10-01
00773 OTHER Inj, Beqvez, Per Tx Dose 2 2 — — $2,703,750.00 $3,605,000.00 $3,154,375.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 12 12 — — $7,841.42 $3,413,200.00 $3,042,200.00 2024-10-01
00714 OTHER Inj Delandistrogene Mox R 2 2 — — $2,494,091.25 $3,325,455.00 $2,909,773.12 2024-10-01
00748 OTHER Inj, Lovotibeglogene Auto 2 2 — — $2,464,500.00 $3,286,000.00 $2,875,250.00 2024-10-01
00746 OTHER Inj, Betibeglogene Autote 2 2 — — $2,226,000.00 $2,968,000.00 $2,597,000.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 10 10 — — $2,388,614.00 $2,746,906.10 $2,472,215.49 2024-10-01
09141 OTHER Inj Onase Abepar-xioi Tre 2 2 — — $1,791,460.50 $2,388,614.00 $2,090,037.25 2024-10-01
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 6 4 — — $380,622.00 $1,345,370.55 $767,250.00 2024-10-01
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 6 4 — — $355,545.75 $1,315,434.06 $707,459.77 2024-10-01
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 6 4 — — $344,535.75 $1,296,212.81 $699,600.00 2024-10-01
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 6 4 — — $337,080.00 $1,191,016.00 $699,600.00 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 $690,968.86 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 $657,694.98 2024-10-01
5834 APR_DRG Neonate With Ecmo 7 7 — — $604,107.00 $652,435.56 $604,107.00 2024-10-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 7 — — $553,256.00 $597,516.48 $553,256.00 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 10 10 — — $529,192.90 $608,571.83 $547,714.66 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 10 10 — — $527,123.40 $606,191.91 $545,572.72 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 10 10 — — $526,587.60 $605,575.74 $545,018.17 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 10 10 — — $516,726.10 $594,235.01 $534,811.51 2024-10-01
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 7 — — $533,682.00 $576,376.56 $533,682.00 2024-10-01
5833 APR_DRG Neonate With Ecmo 7 7 — — $530,620.00 $573,069.60 $530,620.00 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 10 10 — — $489,456.00 $562,874.40 $506,586.96 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 10 10 — — $460,530.40 $529,609.96 $476,648.96 2024-10-01
09194 OTHER Tisagenlecleucel Car-pos 2 2 — — $396,894.68 $529,192.90 $463,043.79 2024-10-01
09498 OTHER Ciltacabtagene Car-pos T 2 2 — — $395,342.55 $527,123.40 $461,232.97 2024-10-01
09422 OTHER Idecabtagene Vicleucel Ca 2 2 — — $394,940.70 $526,587.60 $460,764.15 2024-10-01
09413 OTHER Lisocabtagene Car Pos T 2 2 — — $387,544.57 $516,726.10 $452,135.33 2024-10-01
09035 OTHER Axicabtagene Ciloleucel C 2 2 — — $367,092.00 $489,456.00 $428,274.00 2024-10-01
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $426,787.00 $460,929.96 $426,787.00 2024-10-01
1614 APR_DRG Implantable Heart Assist Systems 7 7 — — $413,348.00 $446,415.84 $413,348.00 2024-10-01
09391 OTHER Brexucabtagene Car Pos T 2 2 — — $345,397.80 $460,530.40 $402,964.10 2024-10-01
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 7 — — $374,099.00 $404,026.92 $374,099.00 2024-10-01
5832 APR_DRG Neonate With Ecmo 7 7 — — $365,101.00 $394,309.08 $365,101.00 2024-10-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 7 — — $357,117.00 $385,686.36 $357,117.00 2024-10-01
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $350,283.00 $378,305.64 $350,283.00 2024-10-01
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $332,770.00 $359,391.60 $332,770.00 2024-10-01
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 7 7 — — $332,007.00 $358,567.56 $332,007.00 2024-10-01
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $315,584.00 $340,830.72 $315,584.00 2024-10-01
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 7 — — $298,393.00 $322,264.44 $298,393.00 2024-10-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 25 15 — — $19,893.00 $602,267.62 $288,980.68 2024-10-01
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 7 — — $275,492.00 $297,531.36 $275,492.00 2024-10-01
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $250,019.00 $270,020.52 $250,019.00 2024-10-01
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 7 — — $248,029.00 $267,871.32 $248,029.00 2024-10-01
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 7 — — $246,453.00 $266,169.24 $246,453.00 2024-10-01
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $239,938.00 $259,133.04 $239,938.00 2024-10-01
5831 APR_DRG Neonate With Ecmo 7 7 — — $228,528.00 $246,810.24 $228,528.00 2024-10-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 24 14 — — $20,990.00 $417,088.05 $214,025.55 2024-10-01
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 7 7 — — $205,453.00 $221,889.24 $205,453.00 2024-10-01
1613 APR_DRG Implantable Heart Assist Systems 7 7 — — $200,448.00 $216,483.84 $200,448.00 2024-10-01
1612 APR_DRG Implantable Heart Assist Systems 7 7 — — $195,696.00 $211,351.68 $195,696.00 2024-10-01
001 OTHER Heart Transplant Or Implant Of Heart Assist System With Mcc 2 2 — — $181,417.62 $208,526.00 $194,971.81 2024-10-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 7 — — $189,949.00 $205,144.92 $189,949.00 2024-10-01
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 7 7 — — $189,129.00 $204,259.32 $189,129.00 2024-10-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $189,096.00 $204,223.68 $189,096.00 2024-10-01
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 7 7 — — $186,695.00 $201,630.60 $186,695.00 2024-10-01
1611 APR_DRG Implantable Heart Assist Systems 7 7 — — $185,867.00 $200,736.36 $185,867.00 2024-10-01
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $185,862.00 $200,730.96 $185,862.00 2024-10-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $185,308.00 $200,132.64 $185,308.00 2024-10-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 23 13 — — $8,596.00 $351,287.22 $178,673.17 2024-10-01
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 7 — — $174,887.00 $188,877.96 $174,887.00 2024-10-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 7 7 — — $172,635.00 $186,445.80 $172,635.00 2024-10-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 7 — — $172,526.00 $186,328.08 $172,526.00 2024-10-01
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $168,121.00 $181,570.68 $168,121.00 2024-10-01
018 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $149,696.29 $172,064.70 $160,880.49 2024-10-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 25 14 — — $8,596.00 $307,529.00 $160,147.04 2024-10-01
1908 OTHER New Technology - Level 52 10 10 — — $152,528.00 $175,407.20 $157,866.48 2024-10-01
1907 OTHER New Technology - Level 52 10 10 — — $152,528.00 $175,407.20 $157,866.48 2024-10-01
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $157,364.00 $169,953.12 $157,364.00 2024-10-01
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 7 — — $154,312.00 $166,656.96 $154,312.00 2024-10-01
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $153,014.00 $165,255.12 $153,014.00 2024-10-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $150,790.00 $162,853.20 $150,790.00 2024-10-01
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 7 7 — — $150,790.00 $162,853.20 $150,790.00 2024-10-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $145,780.00 $157,442.40 $145,780.00 2024-10-01
1905 OTHER New Technology - Level 51 10 10 — — $137,525.20 $158,153.98 $142,338.58 2024-10-01
1906 OTHER New Technology - Level 51 10 10 — — $137,525.20 $158,153.98 $142,338.58 2024-10-01
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 7 7 — — $138,121.00 $149,170.68 $138,121.00 2024-10-01
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $136,351.00 $147,259.08 $136,351.00 2024-10-01
01907 OTHER New Technology - Level 52 2 2 — — $114,396.00 $152,528.00 $133,462.00 2024-10-01
01908 OTHER New Technology - Level 52 2 2 — — $114,396.00 $152,528.00 $133,462.00 2024-10-01
4404 APR_DRG Kidney Transplant 7 7 — — $132,239.00 $142,818.12 $132,239.00 2024-10-01
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $131,411.00 $141,923.88 $131,411.00 2024-10-01
003 OTHER Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 2 — — $121,513.60 $139,670.80 $130,592.20 2024-10-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 31 17 — — $20,990.00 $198,798.00 $130,559.00 2024-10-01
4403 APR_DRG Kidney Transplant 7 7 — — $129,186.00 $139,520.88 $129,186.00 2024-10-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 7 7 — — $128,725.00 $139,023.00 $128,725.00 2024-10-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $128,159.00 $138,411.72 $128,159.00 2024-10-01
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 7 7 — — $128,123.00 $138,372.84 $128,123.00 2024-10-01
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 7 — — $127,860.00 $138,088.80 $127,860.00 2024-10-01
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $126,884.00 $137,034.72 $126,884.00 2024-10-01
1904 OTHER New Technology - Level 50 10 10 — — $122,522.50 $140,900.88 $126,810.79 2024-10-01
1903 OTHER New Technology - Level 50 10 10 — — $122,522.50 $140,900.88 $126,810.79 2024-10-01
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 7 7 — — $126,323.00 $136,428.84 $126,323.00 2024-10-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 7 — — $123,089.00 $132,936.12 $123,089.00 2024-10-01
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $121,075.00 $130,761.00 $121,075.00 2024-10-01
01906 OTHER New Technology - Level 51 2 2 — — $103,143.90 $137,525.20 $120,334.55 2024-10-01
01905 OTHER New Technology - Level 51 2 2 — — $103,143.90 $137,525.20 $120,334.55 2024-10-01
6904 APR_DRG Acute Leukemia 7 7 — — $119,619.00 $129,188.52 $119,619.00 2024-10-01
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 7 7 — — $119,469.00 $129,026.52 $119,469.00 2024-10-01
8634 APR_DRG Neonatal Aftercare 7 7 — — $118,209.00 $127,665.72 $118,209.00 2024-10-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $117,044.00 $126,407.52 $117,044.00 2024-10-01
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 7 7 — — $117,016.00 $126,377.28 $117,016.00 2024-10-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 7 7 — — $116,632.00 $125,962.56 $116,632.00 2024-10-01
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 7 7 — — $115,098.00 $124,305.84 $115,098.00 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
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 7 7 — — $113,420.00 $122,493.60 $113,420.00 2024-10-01
1902 OTHER New Technology - Level 49 10 10 — — $107,519.90 $123,647.88 $111,283.10 2024-10-01
1901 OTHER New Technology - Level 49 10 10 — — $107,519.90 $123,647.88 $111,283.10 2024-10-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 7 7 — — $110,984.00 $119,862.72 $110,984.00 2024-10-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $110,467.00 $119,304.36 $110,467.00 2024-10-01
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 7 7 — — $110,438.00 $119,273.04 $110,438.00 2024-10-01
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 7 7 — — $110,322.00 $119,147.76 $110,322.00 2024-10-01
204 APR_DRG Open Craniotomy For Trauma 7 7 — — $110,130.00 $118,940.40 $110,130.00 2024-10-01
8904 APR_DRG HIV With Multiple Major HIV Related Conditions 7 7 — — $110,025.00 $118,827.00 $110,025.00 2024-10-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 31 17 — — $20,990.00 $158,285.00 $109,926.37 2024-10-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $108,565.00 $117,250.20 $108,565.00 2024-10-01
01903 OTHER New Technology - Level 50 2 2 — — $91,891.88 $122,522.50 $107,207.19 2024-10-01
01904 OTHER New Technology - Level 50 2 2 — — $91,891.88 $122,522.50 $107,207.19 2024-10-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 29 14 — — $8,596.00 $209,223.71 $106,790.61 2024-10-01
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 7 7 — — $106,103.00 $114,591.24 $106,103.00 2024-10-01
215 MS_DRG Other Heart Assist System Implant 33 18 — — $43,687.00 $166,981.34 $105,334.17 2024-10-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 7 7 — — $105,151.00 $113,563.08 $105,151.00 2024-10-01
4402 APR_DRG Kidney Transplant 7 7 — — $104,577.00 $112,943.16 $104,577.00 2024-10-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 7 7 — — $104,495.00 $112,854.60 $104,495.00 2024-10-01
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 12 12 — — $74,999.92 $114,999.88 $102,499.90 2024-10-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 33 18 — — $56,680.00 $158,652.54 $102,444.00 2024-10-01
14 MS_DRG Allogeneic Bone Marrow Transplant 29 18 — — $19,893.00 $193,998.13 $101,972.69 2024-10-01
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 7 7 — — $101,787.00 $109,929.96 $101,787.00 2024-10-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 7 7 — — $100,616.00 $108,665.28 $100,616.00 2024-10-01
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 7 7 — — $100,386.00 $108,416.88 $100,386.00 2024-10-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 7 — — $100,292.00 $108,315.36 $100,292.00 2024-10-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 37 18 — — $62,503.23 $137,795.40 $100,149.32 2024-10-01
A9699 HCPCS Radiopharmaceutical, Therapeutic, Not Otherwise Classified 2 1 — — $76,785.37 $123,321.96 $100,053.67 2024-10-01
7 MS_DRG Lung Transplant 23 14 — — $20,990.00 $193,509.46 $98,839.41 2024-10-01
1774 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 7 7 — — $98,808.00 $106,712.64 $98,808.00 2024-10-01
1599 OTHER New Technology - Level 48 10 10 — — $95,017.60 $109,270.24 $98,343.21 2024-10-01
1585 OTHER New Technology - Level 48 10 10 — — $95,017.60 $109,270.24 $98,343.21 2024-10-01
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 7 7 — — $98,151.00 $106,003.08 $98,151.00 2024-10-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 31 17 — — $52,303.73 $179,233.00 $96,584.92 2024-10-01
4414 APR_DRG Major Bladder Procedures 7 7 — — $96,355.00 $104,063.40 $96,355.00 2024-10-01
1834 APR_DRG Percutaneous Structural Cardiac Procedures 7 7 — — $95,125.00 $102,735.00 $95,125.00 2024-10-01
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 7 7 — — $94,766.00 $102,347.28 $94,766.00 2024-10-01
0208 RC — 3 3 — — $94,283.00 $94,283.00 $94,283.00 2024-10-01
01902 OTHER New Technology - Level 49 2 2 — — $80,639.92 $107,519.90 $94,079.91 2024-10-01
01901 OTHER New Technology - Level 49 2 2 — — $80,639.92 $107,519.90 $94,079.91 2024-10-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 31 17 — — $20,990.00 $134,793.00 $93,665.48 2024-10-01
1694 APR_DRG Major Abdominal Vascular Procedures 7 7 — — $93,551.00 $101,035.08 $93,551.00 2024-10-01
K1007 HCPCS Bilateral Hip, Knee, Ankle, Foot Device, Powered, Includes Pelvic Component, Sin… 12 12 — — $68,273.92 $104,686.68 $93,307.70 2024-10-01
J9029 HCPCS Intravesical Instillation, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 7 4 — — $47,629.05 $168,273.22 $92,717.88 2024-10-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 33 18 — — $57,754.47 $127,500.06 $92,627.26 2024-10-01
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 7 7 — — $92,596.00 $100,003.68 $92,596.00 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
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 7 7 — — $91,852.00 $99,200.16 $91,852.00 2024-10-01
004 OTHER Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 2 2 — — $85,439.12 $98,205.88 $91,822.50 2024-10-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 33 18 — — $57,181.24 $126,054.99 $91,618.12 2024-10-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 33 18 — — $50,439.00 $132,659.17 $91,549.09 2024-10-01
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition… 7 7 — — $91,472.00 $98,789.76 $91,472.00 2024-10-01
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 7 7 — — $90,618.00 $97,867.44 $90,618.00 2024-10-01
234 APR_DRG Spinal Procedures 7 7 — — $89,629.00 $96,799.32 $89,629.00 2024-10-01
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $89,245.00 $96,384.60 $89,245.00 2024-10-01
1204 APR_DRG Major Respiratory And Chest Procedures 7 7 — — $89,168.00 $96,301.44 $89,168.00 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
1784 APR_DRG External Heart Assist Devices 7 7 — — $88,863.00 $95,972.04 $88,863.00 2024-10-01
4014 APR_DRG Adrenal Procedures 7 7 — — $88,804.00 $95,908.32 $88,804.00 2024-10-01
2304 APR_DRG Major Small Bowel Procedures 7 7 — — $88,633.00 $95,723.64 $88,633.00 2024-10-01
914 APR_DRG Other Major Head And Neck Procedures 7 7 — — $88,496.00 $95,575.68 $88,496.00 2024-10-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 31 17 — — $20,990.00 $127,239.00 $88,453.60 2024-10-01
1598 OTHER New Technology - Level 47 10 10 — — $85,015.80 $97,768.17 $87,991.35 2024-10-01
1584 OTHER New Technology - Level 47 10 10 — — $85,015.80 $97,768.17 $87,991.35 2024-10-01
274 APR_DRG Other Open Craniotomy 7 7 — — $87,709.00 $94,725.72 $87,709.00 2024-10-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 7 7 — — $87,206.00 $94,182.48 $87,206.00 2024-10-01
214 APR_DRG Open Craniotomy Except Trauma 7 7 — — $86,746.00 $93,685.68 $86,746.00 2024-10-01
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 7 7 — — $85,474.00 $92,311.92 $85,474.00 2024-10-01
014 OTHER Allogeneic Bone Marrow Transplant 2 2 — — $79,387.63 $91,250.15 $85,318.89 2024-10-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 24 14 — — $20,990.00 $350,637.00 $85,114.12 2024-10-01
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 7 7 — — $84,736.00 $91,514.88 $84,736.00 2024-10-01
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 7 — — $84,522.00 $91,283.76 $84,522.00 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
1783 APR_DRG External Heart Assist Devices 7 7 — — $84,291.00 $91,034.28 $84,291.00 2024-10-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 25 14 — — $8,596.00 $176,068.63 $84,147.13 2024-10-01
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 5 2 — — $49,273.20 $192,914.70 $83,649.85 2024-10-01
22810 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 Verteb… 12 5 — — $4,950.00 $112,090.00 $83,147.00 2024-10-01
22812 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 8 Or More Ver… 12 5 — — $4,950.00 $112,090.00 $83,147.00 2024-10-01
22808 CPT Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 2 To 3 Verteb… 12 5 — — $4,950.00 $112,090.00 $83,147.00 2024-10-01
22802 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 7 To 12 Vert… 12 5 — — $4,950.00 $112,090.00 $83,147.00 2024-10-01
22804 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 13 Or More V… 12 5 — — $4,950.00 $112,090.00 $83,147.00 2024-10-01
22800 CPT Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; Up To 6 Vert… 12 5 — — $4,950.00 $112,090.00 $83,147.00 2024-10-01
01585 OTHER New Technology - Level 48 2 2 — — $71,263.20 $95,017.60 $83,140.40 2024-10-01
01599 OTHER New Technology - Level 48 2 2 — — $71,263.20 $95,017.60 $83,140.40 2024-10-01
651 OTHER Kidney Transplant With Hemodialysis Without Mcc 2 2 — — $77,311.94 $88,864.30 $83,088.12 2024-10-01
894 APR_DRG Major Cranial Or Facial Bone Procedures 7 7 — — $82,806.00 $89,430.48 $82,806.00 2024-10-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 33 18 — — $26,741.00 $139,640.00 $82,715.44 2024-10-01
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 7 7 — — $82,626.00 $89,236.08 $82,626.00 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
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 37 18 — — $26,741.00 $138,171.38 $82,456.19 2024-10-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 7 7 — — $82,082.00 $88,648.56 $82,082.00 2024-10-01
1782 APR_DRG External Heart Assist Devices 7 7 — — $81,983.00 $88,541.64 $81,983.00 2024-10-01
224 APR_DRG Ventricular Shunt Procedures 7 7 — — $81,410.00 $87,922.80 $81,410.00 2024-10-01
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 7 7 — — $81,331.00 $87,837.48 $81,331.00 2024-10-01
4054 APR_DRG Other Procedures For Endocrine, Nutritional And Metabolic Disorders 7 7 — — $81,123.00 $87,612.84 $81,123.00 2024-10-01
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 9 5 — — $41,590.20 $147,108.87 $80,962.21 2024-10-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 23 14 — — $20,990.00 $157,684.47 $80,712.37 2024-10-01
1214 APR_DRG Other Respiratory And Chest Procedures 7 7 — — $80,449.00 $86,884.92 $80,449.00 2024-10-01
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 7 7 — — $80,425.00 $86,859.00 $80,425.00 2024-10-01
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 7 7 — — $79,839.00 $86,226.12 $79,839.00 2024-10-01
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 7 7 — — $79,811.00 $86,195.88 $79,811.00 2024-10-01
1794 APR_DRG Defibrillator Implants 7 7 — — $79,572.00 $85,937.76 $79,572.00 2024-10-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 37 18 — — $42,646.90 $116,416.00 $79,531.45 2024-10-01
264 APR_DRG Other Nervous System And Related Procedures 7 7 — — $78,715.00 $85,012.20 $78,715.00 2024-10-01
2614 APR_DRG Major Biliary Tract Procedures 7 7 — — $78,256.00 $84,516.48 $78,256.00 2024-10-01
2324 APR_DRG Gastric Fundoplication 7 7 — — $77,650.00 $83,862.00 $77,650.00 2024-10-01
1597 OTHER New Technology - Level 46 10 10 — — $75,014.00 $86,266.10 $77,639.49 2024-10-01
1583 OTHER New Technology - Level 46 10 10 — — $75,014.00 $86,266.10 $77,639.49 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
4474 APR_DRG Other Kidney, Urinary Tract And Related Non-percutaneous Procedures 7 7 — — $77,425.00 $83,619.00 $77,425.00 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
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 7 7 — — $77,017.00 $83,178.36 $77,017.00 2024-10-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 33 18 — — $45,333.35 $130,658.00 $76,808.00 2024-10-01
2294 APR_DRG Other Digestive System And Abdominal Procedures 7 7 — — $76,569.00 $82,694.52 $76,569.00 2024-10-01
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $76,059.00 $82,143.72 $76,059.00 2024-10-01
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 7 7 — — $76,059.00 $82,143.72 $76,059.00 2024-10-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 33 18 — — $47,872.86 $104,053.56 $75,963.21 2024-10-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 31 17 — — $20,990.00 $130,559.00 $75,245.07 2024-10-01
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $75,021.00 $81,022.68 $75,021.00 2024-10-01
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 7 7 — — $75,021.00 $81,022.68 $75,021.00 2024-10-01
1814 APR_DRG Lower Extremity Vascular Procedures 7 7 — — $74,856.00 $80,844.48 $74,856.00 2024-10-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 31 17 — — $20,990.00 $130,559.00 $74,765.33 2024-10-01
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 7 7 — — $74,731.00 $80,709.48 $74,731.00 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
01598 OTHER New Technology - Level 47 2 2 — — $63,761.85 $85,015.80 $74,388.82 2024-10-01
01584 OTHER New Technology - Level 47 2 2 — — $63,761.85 $85,015.80 $74,388.82 2024-10-01
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 7 7 — — $74,233.00 $80,171.64 $74,233.00 2024-10-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 37 18 — — $32,307.73 $119,907.00 $74,068.26 2024-10-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 33 18 — — $44,175.26 $103,745.00 $73,960.13 2024-10-01
9514 APR_DRG Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 7 7 — — $73,918.00 $79,831.44 $73,918.00 2024-10-01
007 OTHER Lung Transplant 2 2 — — $68,497.07 $78,732.27 $73,614.67 2024-10-01
002 OTHER Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 2 — — $68,372.82 $78,589.45 $73,481.14 2024-10-01
1764 APR_DRG Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 7 7 — — $72,810.00 $78,634.80 $72,810.00 2024-10-01
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 7 7 — — $72,732.00 $78,550.56 $72,732.00 2024-10-01
6954 APR_DRG Chemotherapy For Acute Leukemia 7 7 — — $72,185.00 $77,959.80 $72,185.00 2024-10-01
2634 APR_DRG Cholecystectomy 7 7 — — $72,127.00 $77,897.16 $72,127.00 2024-10-01
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 7 7 — — $71,943.00 $77,698.44 $71,943.00 2024-10-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 33 18 — — $39,426.50 $103,794.00 $71,610.25 2024-10-01
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 7 7 — — $71,596.00 $77,323.68 $71,596.00 2024-10-01
850 MS_DRG Acute Leukemia With Other Procedures 31 17 — — $8,596.00 $136,400.93 $71,301.26 2024-10-01
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 7 7 — — $71,200.00 $76,896.00 $71,200.00 2024-10-01
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 7 7 — — $71,097.00 $76,784.76 $71,097.00 2024-10-01
1773 APR_DRG Cardiac Pacemaker And Defibrillator Revision Except Device Replacement 7 7 — — $70,661.00 $76,313.88 $70,661.00 2024-10-01
1673 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 7 7 — — $70,661.00 $76,313.88 $70,661.00 2024-10-01
5114 APR_DRG Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 7 7 — — $70,650.00 $76,302.00 $70,650.00 2024-10-01
5104 APR_DRG Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced… 7 7 — — $70,633.00 $76,283.64 $70,633.00 2024-10-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 33 18 — — $43,700.24 $96,130.17 $69,915.21 2024-10-01
8633 APR_DRG Neonatal Aftercare 7 7 — — $69,872.00 $75,461.76 $69,872.00 2024-10-01
294 APR_DRG Other Percutaneous Intracranial Procedures 7 7 — — $69,866.00 $75,455.28 $69,866.00 2024-10-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 33 18 — — $39,598.18 $107,566.00 $69,392.00 2024-10-01
6091 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 7 — — $69,243.00 $74,782.44 $69,243.00 2024-10-01
6092 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 7 7 — — $69,243.00 $74,782.44 $69,243.00 2024-10-01
5894 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational 7 7 — — $69,104.00 $74,632.32 $69,104.00 2024-10-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically 31 17 — — $20,990.00 $99,750.00 $69,055.04 2024-10-01
4424 APR_DRG Kidney And Urinary Tract Procedures For Malignancy 7 7 — — $68,514.00 $73,995.12 $68,514.00 2024-10-01
955 OTHER Craniotomy For Multiple Significant Trauma 2 2 — — $63,278.19 $72,733.55 $68,005.87 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
1643 OTHER Y90 Ibritumomab, Rx 10 10 — — $65,476.58 $75,298.07 $67,768.26 2024-10-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 33 18 — — $34,305.29 $103,794.00 $67,692.91 2024-10-01
L8702 HCPCS Powered Upper Extremity Range Of Motion Assist Device, Elbow, Wrist, Hand, Finge… 12 12 — — $49,403.77 $75,752.45 $67,518.49 2024-10-01
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 7 7 — — $67,518.00 $72,919.44 $67,518.00 2024-10-01
2314 APR_DRG Major Large Bowel Procedures 7 7 — — $67,515.00 $72,916.20 $67,515.00 2024-10-01
1596 OTHER New Technology - Level 45 10 10 — — $65,012.20 $74,764.03 $67,287.63 2024-10-01
1582 OTHER New Technology - Level 45 10 10 — — $65,012.20 $74,764.03 $67,287.63 2024-10-01
494 APR_DRG Bacterial And Tuberculous Infections Of Nervous System 7 7 — — $66,768.00 $72,109.44 $66,768.00 2024-10-01
3254 APR_DRG Non-elective Or Complex Knee Joint Replacement 7 7 — — $66,536.00 $71,858.88 $66,536.00 2024-10-01
2244 APR_DRG Peritoneal Adhesiolysis 7 7 — — $66,378.00 $71,688.24 $66,378.00 2024-10-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 31 17 — — $34,741.03 $148,749.00 $66,169.00 2024-10-01
9524 APR_DRG Non-extensive O.r. Procedure Unrelated To Principal Diagnosis 7 7 — — $65,926.00 $71,200.08 $65,926.00 2024-10-01
1781 APR_DRG External Heart Assist Devices 7 7 — — $65,797.00 $71,060.76 $65,797.00 2024-10-01
01597 OTHER New Technology - Level 46 2 2 — — $56,260.50 $75,014.00 $65,637.25 2024-10-01
01583 OTHER New Technology - Level 46 2 2 — — $56,260.50 $75,014.00 $65,637.25 2024-10-01
6604 APR_DRG Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula… 7 7 — — $65,615.00 $70,864.20 $65,615.00 2024-10-01
5184 APR_DRG Other Female Reproductive System And Related Procedures 7 7 — — $65,498.00 $70,737.84 $65,498.00 2024-10-01
1704 APR_DRG Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock 7 7 — — $65,208.00 $70,424.64 $65,208.00 2024-10-01
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 9 5 — — $33,434.10 $117,019.36 $65,084.97 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 12 12 — — $12,826.38 $72,857.99 $64,938.64 2024-10-01
3032 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 7 7 — — $64,737.00 $69,915.96 $64,737.00 2024-10-01
1804 APR_DRG Other Circulatory System Procedures 7 7 — — $64,392.00 $69,543.36 $64,392.00 2024-10-01
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 7 7 — — $64,317.00 $69,462.36 $64,317.00 2024-10-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 33 18 — — $26,741.00 $106,494.00 $64,299.74 2024-10-01
2004 APR_DRG Cardiac Structural And Valvular Disorders 7 7 — — $64,153.00 $69,285.24 $64,153.00 2024-10-01
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 7 7 — — $64,140.00 $69,271.20 $64,140.00 2024-10-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 37 18 — — $26,741.00 $100,393.47 $63,567.24 2024-10-01
4401 APR_DRG Kidney Transplant 7 7 — — $63,351.00 $68,419.08 $63,351.00 2024-10-01
1303 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 7 7 — — $63,261.00 $68,321.88 $63,261.00 2024-10-01
6233 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 7 7 — — $63,159.00 $68,211.72 $63,159.00 2024-10-01
734 APR_DRG Orbit And Eye Procedures 7 7 — — $62,986.00 $68,024.88 $62,986.00 2024-10-01
6312 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 7 7 — — $62,942.00 $67,977.36 $62,942.00 2024-10-01
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