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Hospital

IVINSON MEMORIAL HOSPITAL

Laramie, WY · CCN 530025 · Rates published

12,075 distinct procedures filed
16 distinct payers
141,734 rate rows
2025-11-01 last MRF observed
Data quality

141,694 of 141,734 rate rows are consumer-grade (100.0%)

40 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-charges filed in the dollar field — excluded from medians 30
placeholder amount (≤ $0.02) — excluded from medians 8
exceeds 10× this hospital's gross charge — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/8078/300975387_ivinson-memorial-hospital_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/IvinsonMemorialHospital/8078or
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-16
Content fingerprint 3904568dc6e53f7d… · 39,127,346 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
J3391
HCPCS 		Inj, Atidarsagene Autotemcel 1 $4,505,000.00 $4,505,000.00 $4,505,000.00 nat. median
$4,505,000
1.0× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 1 $3,685,266.67 $3,685,266.67 $3,685,266.67 nat. median
$3,710,000
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 1 $3,316,462.59 $3,316,462.59 $3,316,462.59 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 1 $3,248,445.72 $3,248,445.72 $3,248,445.72 nat. median
$3,286,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 1 $2,945,740.00 $2,945,740.00 $2,945,740.00 nat. median
$3,004,655
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 1 $2,455,110.61 $2,455,110.61 $2,455,110.61 nat. median
$2,468,984
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 1 $2,332,000.00 $2,332,000.00 $2,332,000.00 nat. median
$2,448,600
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 1 $770,620.00 $770,620.00 $770,620.00 nat. median
$824,563
0.9× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 1 $591,726.20 $591,726.20 $591,726.20 nat. median
$753,246
0.8× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 1 $565,868.95 $565,868.95 $565,868.95 nat. median
$674,867
0.8× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 1 $562,538.19 $562,538.19 $562,538.19 nat. median
$673,137
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 1 $557,317.93 $557,317.93 $557,317.93 nat. median
$625,184
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $533,230.17 $533,230.17 $533,230.17 nat. median
$634,303
0.8× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 1 $489,304.61 $489,304.61 $489,304.61 nat. median
$619,808
0.8× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 1 $429,676.38 $429,676.38 $429,676.38 nat. median
$370,174
1.2× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 1 $278,842.70 $278,842.70 $278,842.70 nat. median
$265,286
1.1× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 1 $278,250.00 $278,250.00 $278,250.00 nat. median
$324,450
0.9× median
J3403
HCPCS 		Revakinagene, Per Implant 1 $257,500.00 $257,500.00 $257,500.00 nat. median
$265,000
1.0× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 1 $212,441.20 $212,441.20 $212,441.20 nat. median
$206,474
1.0× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 1 $211,194.45 $211,194.45 $211,194.45 nat. median
$202,976
1.0× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 1 $205,640.00 $205,640.00 $205,640.00 nat. median
$209,753
1.0× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And… 1 $137,823.84 $137,823.84 $137,823.84 nat. median
$133,161
1.0× median
Q2043
HCPCS 		Sipuleucel-t In Lactated Ringers 50 Million Cell/250 Ml IV Suspension 16 $55,272.32 $134,716.57 $133,313.27 nat. median
$66,682
2.0× median
7
MS_DRG 		Lung Transplant 1 $128,856.75 $128,856.75 $128,856.75 nat. median
$122,708
1.1× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 1 $119,580.20 $119,580.20 $119,580.20 nat. median
$117,357
1.0× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 1 $112,753.39 $112,753.39 $112,753.39 nat. median
$108,660
1.0× median
209
MS_DRG 		Complex Aortic Arch Procedures 1 $112,624.03 $112,624.03 $112,624.03 nat. median
$98,047
1.1× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 1 $109,662.86 $109,662.86 $109,662.86 nat. median
$98,894
1.1× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 1 $108,199.19 $108,199.19 $108,199.19 nat. median
$102,358
1.1× median
J9043
HCPCS 		Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution 16 $227.28 $107,817.67 $106,694.57 nat. median
$735
outlier · 145.1×
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 1 $102,591.28 $102,591.28 $102,591.28 nat. median
$100,136
1.0× median
215
MS_DRG 		Other Heart Assist System Implant 1 $99,073.88 $99,073.88 $99,073.88 nat. median
$99,019
1.0× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 $97,340.56 $97,340.56 $97,340.56 nat. median
$93,672
1.0× median
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 1 $89,647.08 $89,647.08 $89,647.08 nat. median
$82,711
1.1× median
850
MS_DRG 		Acute Leukemia With Other Procedures 1 $86,163.54 $86,163.54 $86,163.54 nat. median
$83,470
1.0× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 1 $83,878.98 $83,878.98 $83,878.98 nat. median
$79,312
1.1× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 1 $83,615.29 $83,615.29 $83,615.29 nat. median
$81,118
1.0× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 1 $78,295.93 $78,295.93 $78,295.93 nat. median
$77,570
1.0× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 $76,400.42 $76,400.42 $76,400.42 nat. median
$74,915
1.0× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 $76,071.08 $76,071.08 $76,071.08 nat. median
$73,807
1.0× median
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 1 $75,819.33 $75,819.33 $75,819.33 nat. median
$72,135
1.1× median
427
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 1 $71,826.33 $71,826.33 $71,826.33 nat. median
$68,090
1.1× median
10
MS_DRG 		Pancreas Transplant 1 $71,399.46 $71,399.46 $71,399.46 nat. median
$68,884
1.0× median
928
MS_DRG 		Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 1 $71,369.61 $71,369.61 $71,369.61 nat. median
$64,023
1.1× median
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 1 $70,990.51 $70,990.51 $70,990.51 nat. median
$71,271
1.0× median
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 1 $70,948.73 $70,948.73 $70,948.73 nat. median
$68,886
1.0× median
870
MS_DRG 		Septicemia Or Severe Sepsis With Mv >96 Hours 1 $68,773.62 $68,773.62 $68,773.62 nat. median
$66,526
1.0× median
268
MS_DRG 		Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 1 $68,436.31 $68,436.31 $68,436.31 nat. median
$65,950
1.0× median
955
MS_DRG 		Craniotomy For Multiple Significant Trauma 1 $66,975.62 $66,975.62 $66,975.62 nat. median
$64,732
1.0× median
317
MS_DRG 		Concomitant Left Atrial Appendage Closure And Cardiac Ablation 1 $66,531.84 $66,531.84 $66,531.84 nat. median
$60,691
1.1× median

Other procedures at this hospital

Browse this hospital's 12,075 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
J3391 HCPCS Inj, Atidarsagene Autotemcel 2 1 — — $4,505,000.00 $4,505,000.00 $4,505,000.00 2025-11-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 2 1 — — $3,685,266.67 $3,685,266.67 $3,685,266.67 2025-11-01
J1413 HCPCS Inj Delandistrogene Mox Rokl 2 1 — — $3,316,462.59 $3,316,462.59 $3,316,462.59 2025-11-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 2 1 — — $3,248,445.72 $3,248,445.72 $3,248,445.72 2025-11-01
J3393 HCPCS Inj, Betibeglogene Autotemce 2 1 — — $2,945,740.00 $2,945,740.00 $2,945,740.00 2025-11-01
J3399 HCPCS Inj Onase Abepar-xioi Treat 2 1 — — $2,455,110.61 $2,455,110.61 $2,455,110.61 2025-11-01
J3392 HCPCS Inj, Exagamglogene Autotem 2 1 — — $2,332,000.00 $2,332,000.00 $2,332,000.00 2025-11-01
Q2057 HCPCS Afamitresgene Autoleucel 2 1 — — $770,620.00 $770,620.00 $770,620.00 2025-11-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 2 1 — — $591,726.20 $591,726.20 $591,726.20 2025-11-01
Q2056 HCPCS Ciltacabtagene Car-pos T 2 1 — — $565,868.95 $565,868.95 $565,868.95 2025-11-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 2 1 — — $562,538.19 $562,538.19 $562,538.19 2025-11-01
Q2055 HCPCS Idecabtagene Vicleucel Car 2 1 — — $557,317.93 $557,317.93 $557,317.93 2025-11-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 2 1 — — $533,230.17 $533,230.17 $533,230.17 2025-11-01
Q2053 HCPCS Brexucabtagene Car Pos T 2 1 — — $489,304.61 $489,304.61 $489,304.61 2025-11-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 1 — — $429,676.38 $429,676.38 $429,676.38 2025-11-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 2 1 — — $278,842.70 $278,842.70 $278,842.70 2025-11-01
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 2 1 — — $278,250.00 $278,250.00 $278,250.00 2025-11-01
J3403 HCPCS Revakinagene, Per Implant 2 1 — — $257,500.00 $257,500.00 $257,500.00 2025-11-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 2 1 — — $212,441.20 $212,441.20 $212,441.20 2025-11-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 2 1 — — $211,194.45 $211,194.45 $211,194.45 2025-11-01
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 2 1 — — $205,640.00 $205,640.00 $205,640.00 2025-11-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And … 2 1 — — $137,823.84 $137,823.84 $137,823.84 2025-11-01
7 MS_DRG Lung Transplant 2 1 — — $128,856.75 $128,856.75 $128,856.75 2025-11-01
14 MS_DRG Allogeneic Bone Marrow Transplant 2 1 — — $119,580.20 $119,580.20 $119,580.20 2025-11-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 2 1 — — $112,753.39 $112,753.39 $112,753.39 2025-11-01
209 MS_DRG Complex Aortic Arch Procedures 2 1 — — $112,624.03 $112,624.03 $112,624.03 2025-11-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 2 1 — — $109,662.86 $109,662.86 $109,662.86 2025-11-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 2 1 — — $108,199.19 $108,199.19 $108,199.19 2025-11-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 2 1 — — $102,591.28 $102,591.28 $102,591.28 2025-11-01
215 MS_DRG Other Heart Assist System Implant 2 1 — — $99,073.88 $99,073.88 $99,073.88 2025-11-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 1 — — $97,340.56 $97,340.56 $97,340.56 2025-11-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 2 1 — — $89,647.08 $89,647.08 $89,647.08 2025-11-01
850 MS_DRG Acute Leukemia With Other Procedures 2 1 — — $86,163.54 $86,163.54 $86,163.54 2025-11-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 2 1 — — $83,878.98 $83,878.98 $83,878.98 2025-11-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 2 1 — — $83,615.29 $83,615.29 $83,615.29 2025-11-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 2 1 — — $78,295.93 $78,295.93 $78,295.93 2025-11-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 2 1 — — $76,400.42 $76,400.42 $76,400.42 2025-11-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 2 1 — — $76,071.08 $76,071.08 $76,071.08 2025-11-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 2 1 — — $75,819.33 $75,819.33 $75,819.33 2025-11-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 2 1 — — $71,826.33 $71,826.33 $71,826.33 2025-11-01
10 MS_DRG Pancreas Transplant 2 1 — — $71,399.46 $71,399.46 $71,399.46 2025-11-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 2 1 — — $71,369.61 $71,369.61 $71,369.61 2025-11-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 2 1 — — $70,990.51 $70,990.51 $70,990.51 2025-11-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 2 1 — — $70,948.73 $70,948.73 $70,948.73 2025-11-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 2 1 — — $68,773.62 $68,773.62 $68,773.62 2025-11-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 2 1 — — $68,436.31 $68,436.31 $68,436.31 2025-11-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 2 1 — — $66,975.62 $66,975.62 $66,975.62 2025-11-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 2 1 — — $66,531.84 $66,531.84 $66,531.84 2025-11-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 2 1 — — $66,483.08 $66,483.08 $66,483.08 2025-11-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 1 — — $65,425.38 $65,425.38 $65,425.38 2025-11-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 1 — — $65,425.38 $65,425.38 $65,425.38 2025-11-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 2 1 — — $65,187.58 $65,187.58 $65,187.58 2025-11-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 2 1 — — $64,026.40 $64,026.40 $64,026.40 2025-11-01
J9029 HCPCS Instill Adstiladrin, Tx Dose 2 1 — — $63,342.28 $63,342.28 $63,342.28 2025-11-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 2 1 — — $60,978.64 $60,978.64 $60,978.64 2025-11-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 2 1 — — $60,908.01 $60,908.01 $60,908.01 2025-11-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 2 1 — — $60,323.93 $60,323.93 $60,323.93 2025-11-01
28 MS_DRG Spinal Procedures With Mcc 2 1 — — $59,783.63 $59,783.63 $59,783.63 2025-11-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 2 1 — — $59,766.72 $59,766.72 $59,766.72 2025-11-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 2 1 — — $59,333.88 $59,333.88 $59,333.88 2025-11-01
38240 CPT Transplt Allo Hct/donor 2 1 — — $59,142.33 $59,142.33 $59,142.33 2025-11-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 2 1 — — $59,138.88 $59,138.88 $59,138.88 2025-11-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 2 1 — — $59,001.55 $59,001.55 $59,001.55 2025-11-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 2 1 — — $58,393.60 $58,393.60 $58,393.60 2025-11-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 2 1 — — $58,355.78 $58,355.78 $58,355.78 2025-11-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 2 1 — — $57,383.65 $57,383.65 $57,383.65 2025-11-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 2 1 — — $57,017.49 $57,017.49 $57,017.49 2025-11-01
A9543 HCPCS Y90 Ibritumomab, Rx 2 1 — — $56,824.55 $56,824.55 $56,824.55 2025-11-01
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 2 1 — — $56,784.65 $56,784.65 $56,784.65 2025-11-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 2 1 — — $56,711.01 $56,711.01 $56,711.01 2025-11-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 2 1 — — $55,939.88 $55,939.88 $55,939.88 2025-11-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 2 1 — — $55,766.75 $55,766.75 $55,766.75 2025-11-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 2 1 — — $55,384.65 $55,384.65 $55,384.65 2025-11-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 2 1 — — $54,954.81 $54,954.81 $54,954.81 2025-11-01
834 MS_DRG Acute Leukemia With Mcc 2 1 — — $54,625.47 $54,625.47 $54,625.47 2025-11-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 2 1 — — $54,432.42 $54,432.42 $54,432.42 2025-11-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 2 1 — — $54,354.81 $54,354.81 $54,354.81 2025-11-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 2 1 — — $54,269.25 $54,269.25 $54,269.25 2025-11-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 2 1 — — $54,052.33 $54,052.33 $54,052.33 2025-11-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 2 1 — — $53,062.30 $53,062.30 $53,062.30 2025-11-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 2 1 — — $53,030.45 $53,030.45 $53,030.45 2025-11-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 2 1 — — $52,674.24 $52,674.24 $52,674.24 2025-11-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 2 1 — — $52,500.10 $52,500.10 $52,500.10 2025-11-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 2 1 — — $51,794.64 $51,794.64 $51,794.64 2025-11-01
653 MS_DRG Major Bladder Procedures With Mcc 2 1 — — $51,705.09 $51,705.09 $51,705.09 2025-11-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 2 1 — — $50,150.87 $50,150.87 $50,150.87 2025-11-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 2 1 — — $49,625.50 $49,625.50 $49,625.50 2025-11-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 2 1 — — $49,227.49 $49,227.49 $49,227.49 2025-11-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 2 1 — — $49,139.93 $49,139.93 $49,139.93 2025-11-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 2 1 — — $48,971.78 $48,971.78 $48,971.78 2025-11-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 2 1 — — $48,767.79 $48,767.79 $48,767.79 2025-11-01
471 MS_DRG Cervical Spinal Fusion With Mcc 2 1 — — $48,046.40 $48,046.40 $48,046.40 2025-11-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 2 1 — — $47,803.62 $47,803.62 $47,803.62 2025-11-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 2 1 — — $47,370.78 $47,370.78 $47,370.78 2025-11-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 2 1 — — $46,779.75 $46,779.75 $46,779.75 2025-11-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 2 1 — — $46,684.22 $46,684.22 $46,684.22 2025-11-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 2 1 — — $46,544.92 $46,544.92 $46,544.92 2025-11-01
6 MS_DRG Liver Transplant Without Mcc 2 1 — — $46,138.95 $46,138.95 $46,138.95 2025-11-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 2 1 — — $45,954.88 $45,954.88 $45,954.88 2025-11-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 2 1 — — $45,735.98 $45,735.98 $45,735.98 2025-11-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 2 1 — — $45,619.56 $45,619.56 $45,619.56 2025-11-01
245 MS_DRG Aicd Generator Procedures 2 1 — — $45,396.68 $45,396.68 $45,396.68 2025-11-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 2 1 — — $45,260.35 $45,260.35 $45,260.35 2025-11-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 2 1 — — $45,240.46 $45,240.46 $45,240.46 2025-11-01
799 MS_DRG Splenic Procedures With Mcc 2 1 — — $45,063.34 $45,063.34 $45,063.34 2025-11-01
J9226 HCPCS Supprelin La Implant 2 1 — — $45,020.65 $45,020.65 $45,020.65 2025-11-01
33276 CPT Insj Phrnc Nrv Stim Sys 2 1 — — $45,000.50 $45,000.50 $45,000.50 2025-11-01
0266T CPT Apc 2 1 — — $45,000.50 $45,000.50 $45,000.50 2025-11-01
163 MS_DRG Major Chest Procedures With Mcc 2 1 — — $44,594.71 $44,594.71 $44,594.71 2025-11-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 2 1 — — $44,581.76 $44,581.76 $44,581.76 2025-11-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 2 1 — — $44,406.64 $44,406.64 $44,406.64 2025-11-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 2 1 — — $43,709.14 $43,709.14 $43,709.14 2025-11-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 2 1 — — $43,058.39 $43,058.39 $43,058.39 2025-11-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 2 1 — — $42,715.09 $42,715.09 $42,715.09 2025-11-01
140 MS_DRG Major Head And Neck Procedures With Mcc 2 1 — — $42,440.49 $42,440.49 $42,440.49 2025-11-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 2 1 — — $42,196.70 $42,196.70 $42,196.70 2025-11-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 2 1 — — $42,021.57 $42,021.57 $42,021.57 2025-11-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 2 1 — — $41,949.93 $41,949.93 $41,949.93 2025-11-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 2 1 — — $41,929.04 $41,929.04 $41,929.04 2025-11-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 2 1 — — $41,806.65 $41,806.65 $41,806.65 2025-11-01
901 MS_DRG Wound Debridements For Injuries With Mcc 2 1 — — $41,756.91 $41,756.91 $41,756.91 2025-11-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 2 1 — — $41,679.29 $41,679.29 $41,679.29 2025-11-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 2 1 — — $41,518.11 $41,518.11 $41,518.11 2025-11-01
793 MS_DRG Full Term Neonate With Major Problems 2 1 — — $41,488.25 $41,488.25 $41,488.25 2025-11-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 2 1 — — $41,323.08 $41,323.08 $41,323.08 2025-11-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 2 1 — — $41,049.44 $41,049.44 $41,049.44 2025-11-01
791 MS_DRG Prematurity With Major Problems 2 1 — — $40,387.75 $40,387.75 $40,387.75 2025-11-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 2 1 — — $40,004.68 $40,004.68 $40,004.68 2025-11-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 2 1 — — $39,642.49 $39,642.49 $39,642.49 2025-11-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 2 1 — — $38,924.09 $38,924.09 $38,924.09 2025-11-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 2 1 — — $38,747.97 $38,747.97 $38,747.97 2025-11-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 2 1 — — $38,514.14 $38,514.14 $38,514.14 2025-11-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 2 1 — — $38,456.43 $38,456.43 $38,456.43 2025-11-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 2 1 — — $38,419.61 $38,419.61 $38,419.61 2025-11-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 2 1 — — $38,201.70 $38,201.70 $38,201.70 2025-11-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 2 1 — — $37,442.51 $37,442.51 $37,442.51 2025-11-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 2 1 — — $37,279.32 $37,279.32 $37,279.32 2025-11-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 2 1 — — $37,190.77 $37,190.77 $37,190.77 2025-11-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 2 1 — — $37,186.79 $37,186.79 $37,186.79 2025-11-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 2 1 — — $37,082.31 $37,082.31 $37,082.31 2025-11-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 2 1 — — $36,873.37 $36,873.37 $36,873.37 2025-11-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 2 1 — — $36,547.99 $36,547.99 $36,547.99 2025-11-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 2 1 — — $36,533.06 $36,533.06 $36,533.06 2025-11-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 2 1 — — $36,104.21 $36,104.21 $36,104.21 2025-11-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 2 1 — — $36,076.34 $36,076.34 $36,076.34 2025-11-01
332 MS_DRG Rectal Resection With Mcc 2 1 — — $36,026.59 $36,026.59 $36,026.59 2025-11-01
265 MS_DRG Aicd Lead Procedures 2 1 — — $36,001.73 $36,001.73 $36,001.73 2025-11-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 2 1 — — $35,938.04 $35,938.04 $35,938.04 2025-11-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 2 1 — — $35,884.31 $35,884.31 $35,884.31 2025-11-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 2 1 — — $35,649.48 $35,649.48 $35,649.48 2025-11-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 2 1 — — $35,566.90 $35,566.90 $35,566.90 2025-11-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 2 1 — — $35,531.09 $35,531.09 $35,531.09 2025-11-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 2 1 — — $35,478.33 $35,478.33 $35,478.33 2025-11-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 2 1 — — $35,448.49 $35,448.49 $35,448.49 2025-11-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 2 1 — — $35,414.65 $35,414.65 $35,414.65 2025-11-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 2 1 — — $35,385.81 $35,385.81 $35,385.81 2025-11-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 2 1 — — $35,090.29 $35,090.29 $35,090.29 2025-11-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 2 1 — — $35,018.65 $35,018.65 $35,018.65 2025-11-01
0620T CPT Evasc Ven Artlz Tibl/prnl Vn 2 1 — — $35,000.50 $35,000.50 $35,000.50 2025-11-01
252 MS_DRG Other Vascular Procedures With Mcc 2 1 — — $34,709.19 $34,709.19 $34,709.19 2025-11-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 2 1 — — $34,700.24 $34,700.24 $34,700.24 2025-11-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 2 1 — — $34,541.03 $34,541.03 $34,541.03 2025-11-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 2 1 — — $34,373.87 $34,373.87 $34,373.87 2025-11-01
359 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc 2 1 — — $34,214.67 $34,214.67 $34,214.67 2025-11-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 2 1 — — $34,113.19 $34,113.19 $34,113.19 2025-11-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 2 1 — — $33,946.01 $33,946.01 $33,946.01 2025-11-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 2 1 — — $33,901.24 $33,901.24 $33,901.24 2025-11-01
264 MS_DRG Other Circulatory System O.r. Procedures 2 1 — — $33,239.55 $33,239.55 $33,239.55 2025-11-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 2 1 — — $32,868.41 $32,868.41 $32,868.41 2025-11-01
37 MS_DRG Extracranial Procedures With Mcc 2 1 — — $32,756.97 $32,756.97 $32,756.97 2025-11-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 2 1 — — $32,752.99 $32,752.99 $32,752.99 2025-11-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 2 1 — — $32,365.93 $32,365.93 $32,365.93 2025-11-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 2 1 — — $32,223.64 $32,223.64 $32,223.64 2025-11-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 2 1 — — $32,187.82 $32,187.82 $32,187.82 2025-11-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 2 1 — — $32,143.03 $32,143.03 $32,143.03 2025-11-01
652 MS_DRG Kidney Transplant 2 1 — — $32,134.08 $32,134.08 $32,134.08 2025-11-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 2 1 — — $32,110.21 $32,110.21 $32,110.21 2025-11-01
0915T CPT Insj Perm Ccm-d Sys Pg&eltrd 2 1 — — $32,061.58 $32,061.58 $32,061.58 2025-11-01
33270 CPT Ins/rep Subq Defibrillator 2 1 — — $32,061.58 $32,061.58 $32,061.58 2025-11-01
33249 CPT Insj/rplcmt Defib W/lead(s) 2 1 — — $32,061.58 $32,061.58 $32,061.58 2025-11-01
33231 CPT Insrt Pulse Gen W/mult Leads 2 1 — — $32,061.58 $32,061.58 $32,061.58 2025-11-01
0408T CPT Insj/rplc Cardiac Modulj Sys 2 1 — — $32,061.58 $32,061.58 $32,061.58 2025-11-01
0571T CPT Insj/rplcmt Icds Ss Eltrd 2 1 — — $32,061.58 $32,061.58 $32,061.58 2025-11-01
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 2 1 — — $32,061.58 $32,061.58 $32,061.58 2025-11-01
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc 2 1 — — $32,047.53 $32,047.53 $32,047.53 2025-11-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 2 1 — — $31,944.03 $31,944.03 $31,944.03 2025-11-01
69930 CPT Implant Cochlear Device 2 1 — — $31,807.82 $31,807.82 $31,807.82 2025-11-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 2 1 — — $31,768.91 $31,768.91 $31,768.91 2025-11-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 2 1 — — $31,710.20 $31,710.20 $31,710.20 2025-11-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 2 1 — — $31,679.37 $31,679.37 $31,679.37 2025-11-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 2 1 — — $31,615.68 $31,615.68 $31,615.68 2025-11-01
500 MS_DRG Soft Tissue Procedures With Mcc 2 1 — — $31,490.31 $31,490.31 $31,490.31 2025-11-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 2 1 — — $31,442.55 $31,442.55 $31,442.55 2025-11-01
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 2 1 — — $31,353.00 $31,353.00 $31,353.00 2025-11-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 2 1 — — $31,338.07 $31,338.07 $31,338.07 2025-11-01
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 2 1 — — $31,264.44 $31,264.44 $31,264.44 2025-11-01
665 MS_DRG Prostatectomy With Mcc 2 1 — — $31,056.50 $31,056.50 $31,056.50 2025-11-01
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 2 1 — — $30,991.81 $30,991.81 $30,991.81 2025-11-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 2 1 — — $30,937.08 $30,937.08 $30,937.08 2025-11-01
61886 CPT Implant Neurostim Arrays 2 1 — — $30,473.59 $30,473.59 $30,473.59 2025-11-01
33287 CPT Rmv&rplcmt Phrnc Nrv Stim Pg 2 1 — — $30,473.59 $30,473.59 $30,473.59 2025-11-01
64568 CPT Opn Impltj Crnl Nrv Nea&pg 2 1 — — $30,473.59 $30,473.59 $30,473.59 2025-11-01
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 2 1 — — $30,473.59 $30,473.59 $30,473.59 2025-11-01
0268T CPT Apc 2 1 — — $30,473.59 $30,473.59 $30,473.59 2025-11-01
0674T CPT Laps Insj Nw/rpcmt Prm Isdss 2 1 — — $30,473.59 $30,473.59 $30,473.59 2025-11-01
662 MS_DRG Minor Bladder Procedures With Mcc 2 1 — — $30,462.47 $30,462.47 $30,462.47 2025-11-01
263 MS_DRG Vein Ligation And Stripping 2 1 — — $30,421.66 $30,421.66 $30,421.66 2025-11-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 2 1 — — $30,180.86 $30,180.86 $30,180.86 2025-11-01
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 2 1 — — $30,054.51 $30,054.51 $30,054.51 2025-11-01
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 2 1 — — $30,050.53 $30,050.53 $30,050.53 2025-11-01
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 2 1 — — $30,017.69 $30,017.69 $30,017.69 2025-11-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 2 1 — — $29,615.69 $29,615.69 $29,615.69 2025-11-01
472 MS_DRG Cervical Spinal Fusion With Cc 2 1 — — $29,314.21 $29,314.21 $29,314.21 2025-11-01
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/mcc 2 1 — — $29,294.31 $29,294.31 $29,294.31 2025-11-01
570 MS_DRG Skin Debridement With Mcc 2 1 — — $29,264.46 $29,264.46 $29,264.46 2025-11-01
668 MS_DRG Transurethral Procedures With Mcc 2 1 — — $29,054.52 $29,054.52 $29,054.52 2025-11-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 2 1 — — $28,977.89 $28,977.89 $28,977.89 2025-11-01
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 2 1 — — $28,875.41 $28,875.41 $28,875.41 2025-11-01
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 2 1 — — $28,857.49 $28,857.49 $28,857.49 2025-11-01
619 MS_DRG O.r. Procedures For Obesity With Mcc 2 1 — — $28,730.13 $28,730.13 $28,730.13 2025-11-01
974 MS_DRG HIV With Major Related Condition With Mcc 2 1 — — $28,716.20 $28,716.20 $28,716.20 2025-11-01
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc 2 1 — — $28,674.42 $28,674.42 $28,674.42 2025-11-01
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 2 1 — — $28,559.00 $28,559.00 $28,559.00 2025-11-01
33289 CPT Tcat Impl Wrls P-art Prs Snr 2 1 — — $28,428.33 $28,428.33 $28,428.33 2025-11-01
J9266 HCPCS Pegaspargase Injection 2 1 — — $28,424.06 $28,424.06 $28,424.06 2025-11-01
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 2 1 — — $28,362.97 $28,362.97 $28,362.97 2025-11-01
800 MS_DRG Splenic Procedures With Cc 2 1 — — $27,954.03 $27,954.03 $27,954.03 2025-11-01
654 MS_DRG Major Bladder Procedures With Cc 2 1 — — $27,853.52 $27,853.52 $27,853.52 2025-11-01
503 MS_DRG Foot Procedures With Mcc 2 1 — — $27,771.94 $27,771.94 $27,771.94 2025-11-01
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 2 1 — — $27,580.90 $27,580.90 $27,580.90 2025-11-01
C9760 HCPCS Non-blind Interatrial Shunt 2 1 — — $27,500.50 $27,500.50 $27,500.50 2025-11-01
61 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 2 1 — — $27,433.62 $27,433.62 $27,433.62 2025-11-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 2 1 — — $27,350.04 $27,350.04 $27,350.04 2025-11-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 2 1 — — $27,343.08 $27,343.08 $27,343.08 2025-11-01
963 MS_DRG Other Multiple Significant Trauma With Mcc 2 1 — — $27,201.78 $27,201.78 $27,201.78 2025-11-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 2 1 — — $27,072.44 $27,072.44 $27,072.44 2025-11-01
849 MS_DRG Radiotherapy 2 1 — — $26,960.00 $26,960.00 $26,960.00 2025-11-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 2 1 — — $26,927.16 $26,927.16 $26,927.16 2025-11-01
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 2 1 — — $26,839.60 $26,839.60 $26,839.60 2025-11-01
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 2 1 — — $26,467.46 $26,467.46 $26,467.46 2025-11-01
577 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 2 1 — — $26,374.93 $26,374.93 $26,374.93 2025-11-01
970 MS_DRG HIV With Extensive O.r. Procedures Without Mcc 2 1 — — $26,242.58 $26,242.58 $26,242.58 2025-11-01
253 MS_DRG Other Vascular Procedures With Cc 2 1 — — $25,826.66 $25,826.66 $25,826.66 2025-11-01
846 MS_DRG Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc 2 1 — — $25,795.84 $25,795.84 $25,795.84 2025-11-01
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 2 1 — — $25,699.31 $25,699.31 $25,699.31 2025-11-01
96 MS_DRG Bacterial And Tuberculous Infections Of Nervous System Without Cc/mcc 2 1 — — $25,663.48 $25,663.48 $25,663.48 2025-11-01
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 2 1 — — $25,663.48 $25,663.48 $25,663.48 2025-11-01
749 MS_DRG Other Female Reproductive System O.r. Procedures With Cc/mcc 2 1 — — $25,548.07 $25,548.07 $25,548.07 2025-11-01
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/mcc 2 1 — — $25,402.80 $25,402.80 $25,402.80 2025-11-01
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 2 1 — — $25,282.40 $25,282.40 $25,282.40 2025-11-01
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 2 1 — — $25,234.63 $25,234.63 $25,234.63 2025-11-01
164 MS_DRG Major Chest Procedures With Cc 2 1 — — $25,114.23 $25,114.23 $25,114.23 2025-11-01
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc 2 1 — — $25,103.30 $25,103.30 $25,103.30 2025-11-01
350 MS_DRG Inguinal And Femoral Hernia Procedures With Mcc 2 1 — — $24,794.84 $24,794.84 $24,794.84 2025-11-01
545 MS_DRG Connective Tissue Disorders With Mcc 2 1 — — $24,693.35 $24,693.35 $24,693.35 2025-11-01
93653 CPT Compre Ep Eval Tx Svt 2 1 — — $24,532.30 $24,532.30 $24,532.30 2025-11-01
93654 CPT Compre Ep Eval Tx Vt 2 1 — — $24,532.30 $24,532.30 $24,532.30 2025-11-01
93656 CPT Compre Ep Eval Abltj Atr Fib 2 1 — — $24,532.30 $24,532.30 $24,532.30 2025-11-01
478 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Cc 2 1 — — $24,469.47 $24,469.47 $24,469.47 2025-11-01
982 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 2 1 — — $24,462.51 $24,462.51 $24,462.51 2025-11-01
783 MS_DRG Cesarean Section With Sterilization With Mcc 2 1 — — $24,428.67 $24,428.67 $24,428.67 2025-11-01
792 MS_DRG Prematurity Without Major Problems 2 1 — — $24,369.97 $24,369.97 $24,369.97 2025-11-01
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 2 1 — — $24,320.22 $24,320.22 $24,320.22 2025-11-01
473 MS_DRG Cervical Spinal Fusion Without Cc/mcc 2 1 — — $24,291.36 $24,291.36 $24,291.36 2025-11-01
J9600 HCPCS Porfimer Sodium Injection 2 1 — — $24,228.42 $24,228.42 $24,228.42 2025-11-01
318 MS_DRG Percutaneous Coronary Atherectomy Without Intraluminal Device 2 1 — — $24,101.32 $24,101.32 $24,101.32 2025-11-01
360 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc 2 1 — — $24,022.72 $24,022.72 $24,022.72 2025-11-01
320 MS_DRG Other Endovascular Cardiac Valve Procedures Without Mcc 2 1 — — $23,933.16 $23,933.16 $23,933.16 2025-11-01
330 MS_DRG Major Small And Large Bowel Procedures With Cc 2 1 — — $23,852.56 $23,852.56 $23,852.56 2025-11-01
397 MS_DRG Appendix Procedures With Mcc 2 1 — — $23,829.68 $23,829.68 $23,829.68 2025-11-01
35 MS_DRG Carotid Artery Stent Procedures With Cc 2 1 — — $23,785.90 $23,785.90 $23,785.90 2025-11-01
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 2 1 — — $23,745.09 $23,745.09 $23,745.09 2025-11-01
113 MS_DRG Orbital Procedures With Cc/mcc 2 1 — — $23,393.86 $23,393.86 $23,393.86 2025-11-01
333 MS_DRG Rectal Resection With Cc 2 1 — — $23,305.29 $23,305.29 $23,305.29 2025-11-01
674 MS_DRG Other Kidney And Urinary Tract Procedures With Cc 2 1 — — $23,269.48 $23,269.48 $23,269.48 2025-11-01
940 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Cc 2 1 — — $23,252.57 $23,252.57 $23,252.57 2025-11-01
709 MS_DRG Penis Procedures With Cc/mcc 2 1 — — $23,155.05 $23,155.05 $23,155.05 2025-11-01
357 MS_DRG Other Digestive System O.r. Procedures With Cc 2 1 — — $23,139.12 $23,139.12 $23,139.12 2025-11-01
56 MS_DRG Degenerative Nervous System Disorders With Mcc 2 1 — — $23,115.24 $23,115.24 $23,115.24 2025-11-01
827 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 2 1 — — $22,996.84 $22,996.84 $22,996.84 2025-11-01
347 MS_DRG Anal And Stomal Procedures With Mcc 2 1 — — $22,841.62 $22,841.62 $22,841.62 2025-11-01
98 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Cc 2 1 — — $22,834.66 $22,834.66 $22,834.66 2025-11-01
82 MS_DRG Traumatic Stupor And Coma >1 Hour With Mcc 2 1 — — $22,742.12 $22,742.12 $22,742.12 2025-11-01
817 MS_DRG Other Antepartum Diagnoses With O.r. Procedures With Mcc 2 1 — — $22,702.31 $22,702.31 $22,702.31 2025-11-01
475 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc 2 1 — — $22,643.61 $22,643.61 $22,643.61 2025-11-01
85 MS_DRG Traumatic Stupor And Coma <1 Hour With Mcc 2 1 — — $22,605.81 $22,605.81 $22,605.81 2025-11-01
824 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Cc 2 1 — — $22,543.10 $22,543.10 $22,543.10 2025-11-01
0956T CPT Prt Crn Ch Cr&tun Elt S-sclp 2 1 — — $22,500.50 $22,500.50 $22,500.50 2025-11-01
0960T CPT Rpl S-sclp Eltr Ra Rcvr&tlmt 2 1 — — $22,500.50 $22,500.50 $22,500.50 2025-11-01
0414T CPT Rmvl & Rpl Car Modulj Pls Gn 2 1 — — $22,446.19 $22,446.19 $22,446.19 2025-11-01
0916T CPT Insj Perm Ccm-d Sys Pg Only 2 1 — — $22,446.19 $22,446.19 $22,446.19 2025-11-01
0614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 2 1 — — $22,446.19 $22,446.19 $22,446.19 2025-11-01
Q2043 HCPCS Sipuleucel-t In Lactated Ringers 50 Million Cell/250 Ml IV Suspension 34 16 $140,329.76 $140,329.76 $55,272.32 $134,716.57 $133,313.27 2025-11-01
J9043 HCPCS Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution 34 16 $112,310.07 $112,310.07 $227.28 $107,817.67 $106,694.57 2025-11-01
J2507 HCPCS Pegloticase 8 Mg/ml Intravenous Solution 34 16 $58,371.83 $58,371.83 $3,660.83 $56,036.96 $55,453.24 2025-11-01
J3357 HCPCS Ustekinumab 90 Mg/ml Subcutaneous Syringe 34 16 $57,154.34 $57,154.34 $149.40 $54,868.17 $54,296.62 2025-11-01
J2350 HCPCS Ocrelizumab 30 Mg/ml Intravenous Solution 34 16 $39,893.27 $39,893.27 $59.41 $38,297.54 $37,898.61 2025-11-01
J9298 HCPCS Nivolumab 240 Mg-relatlimab-rmbw 80 Mg/20 Ml Intravenous Solution 34 16 $31,715.92 $31,715.92 $197.83 $30,447.28 $30,130.12 2025-11-01
J9307 HCPCS Pralatrexate 40 Mg/2 Ml (20 Mg/ml) Intravenous Solution 34 16 $29,343.64 $29,343.64 $392.63 $28,169.89 $27,876.46 2025-11-01
J9228 HCPCS Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Intravenous Solution 64 16 $45,054.28 $45,054.28 $183.48 $67,852.12 $42,191.93 2025-11-01
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