|
Q2055
|
HCPCS
|
Idecabtagene Vicleucel 460000000 Cells IV Susp
|
18
|
11
|
$1,624,811.86
|
$812,405.93
50% off
|
$503,455.00
|
$1,376,216.00
|
$541,213.50
|
2024-12-15
|
|
Q2054
|
HCPCS
|
Lisocabtagene Maraleucel 70000000 Cells/ml IV Susp
|
18
|
11
|
$1,589,189.84
|
$794,594.92
50% off
|
$496,390.00
|
$1,346,044.00
|
$533,619.50
|
2024-12-15
|
|
Q2042
|
HCPCS
|
Tisagenlecleucel IV Infusion (wrapped)
|
18
|
11
|
$1,392,190.32
|
$696,095.16
50% off
|
$421,729.00
|
$1,179,185.00
|
$549,625.00
|
2024-12-15
|
|
5834
|
APR_DRG
|
Neonate With Ecmo
|
4
|
3
|
$0.01
|
—
|
$267,255.00
|
$293,981.00
|
$277,945.50
|
2024-12-15
|
|
74
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
4
|
3
|
$0.01
|
—
|
$259,986.00
|
$285,985.00
|
$270,385.50
|
2024-12-15
|
|
18
|
MS_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
15
|
9
|
$0.01
|
—
|
$248,134.00
|
$1,979,545.00
|
$664,801.00
|
2024-12-15
|
|
5833
|
APR_DRG
|
Neonate With Ecmo
|
4
|
3
|
$0.01
|
—
|
$226,302.00
|
$248,932.00
|
$235,354.00
|
2024-12-15
|
|
24
|
APR_DRG
|
Heart And/or Lung Transplant
|
4
|
3
|
$0.01
|
—
|
$217,696.00
|
$239,466.00
|
$226,404.00
|
2024-12-15
|
|
1
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System With Mcc
|
15
|
9
|
$0.01
|
—
|
$185,705.00
|
$1,478,554.00
|
$496,551.00
|
2024-12-15
|
|
5884
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
4
|
3
|
$0.01
|
—
|
$169,168.00
|
$186,085.00
|
$175,935.00
|
2024-12-15
|
|
1614
|
APR_DRG
|
Implantable Heart Assist Systems
|
4
|
3
|
$0.01
|
—
|
$164,274.00
|
$180,701.00
|
$170,845.00
|
2024-12-15
|
|
927
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft
|
15
|
9
|
$0.01
|
—
|
$156,628.00
|
$1,245,210.00
|
$418,186.00
|
2024-12-15
|
|
94
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
4
|
3
|
$0.01
|
—
|
$153,899.00
|
$169,289.00
|
$160,055.00
|
2024-12-15
|
|
3
|
MS_DRG
|
Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…
|
15
|
9
|
$0.01
|
—
|
$141,642.00
|
$1,124,945.00
|
$377,796.00
|
2024-12-15
|
|
6304
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
4
|
3
|
$0.01
|
—
|
$125,872.00
|
$138,460.00
|
$130,907.00
|
2024-12-15
|
|
6094
|
APR_DRG
|
Neonate Birth Weight 1500-2499 Grams With Major Procedure
|
4
|
3
|
$0.01
|
—
|
$124,757.00
|
$137,233.00
|
$129,747.00
|
2024-12-15
|
|
5832
|
APR_DRG
|
Neonate With Ecmo
|
4
|
3
|
$0.01
|
—
|
$112,761.00
|
$124,037.00
|
$117,271.50
|
2024-12-15
|
|
114
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
4
|
3
|
$0.01
|
—
|
$107,074.00
|
$117,781.00
|
$111,357.00
|
2024-12-15
|
|
2004
|
APR_DRG
|
Cardiac Structural And Valvular Disorders
|
4
|
3
|
$0.01
|
—
|
$99,501.00
|
$109,451.00
|
$103,481.00
|
2024-12-15
|
|
5831
|
APR_DRG
|
Neonate With Ecmo
|
4
|
3
|
$0.01
|
—
|
$99,288.00
|
$109,217.00
|
$103,259.50
|
2024-12-15
|
|
4
|
MS_DRG
|
Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…
|
15
|
9
|
$0.01
|
—
|
$93,884.00
|
$741,684.00
|
$249,084.00
|
2024-12-15
|
|
73
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
4
|
3
|
$0.01
|
—
|
$91,739.00
|
$100,913.00
|
$95,408.50
|
2024-12-15
|
|
5883
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
4
|
3
|
$0.01
|
—
|
$90,770.00
|
$99,847.00
|
$94,401.00
|
2024-12-15
|
|
5882
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
4
|
3
|
$0.01
|
—
|
$90,355.00
|
$99,391.00
|
$93,969.50
|
2024-12-15
|
|
44
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
4
|
3
|
$0.01
|
—
|
$90,122.00
|
$99,134.00
|
$93,726.50
|
2024-12-15
|
|
8414
|
APR_DRG
|
Extensive Third Degree Burns With Skin Graft
|
4
|
3
|
$0.01
|
—
|
$89,734.00
|
$98,708.00
|
$93,323.50
|
2024-12-15
|
|
6314
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Other Major Procedure
|
4
|
3
|
$0.01
|
—
|
$88,838.00
|
$97,722.00
|
$92,391.50
|
2024-12-15
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
15
|
9
|
$0.01
|
—
|
$87,159.00
|
$687,713.00
|
$230,959.00
|
2024-12-15
|
|
7
|
MS_DRG
|
Lung Transplant
|
15
|
9
|
$0.01
|
—
|
$86,943.00
|
$685,981.00
|
$230,377.00
|
2024-12-15
|
|
8504
|
APR_DRG
|
Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…
|
4
|
3
|
$0.01
|
—
|
$86,498.00
|
$95,147.00
|
$89,957.50
|
2024-12-15
|
|
5914
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
4
|
3
|
$0.01
|
—
|
$85,723.00
|
$94,295.00
|
$89,152.00
|
2024-12-15
|
|
1613
|
APR_DRG
|
Implantable Heart Assist Systems
|
4
|
3
|
$0.01
|
—
|
$85,622.00
|
$94,184.00
|
$89,047.00
|
2024-12-15
|
|
5881
|
APR_DRG
|
Neonate Birth Weight < 1500 Grams With Major Procedure
|
4
|
3
|
$0.01
|
—
|
$85,169.00
|
$93,686.00
|
$88,576.00
|
2024-12-15
|
|
14
|
APR_DRG
|
Liver Transplant And/or Intestinal Transplant
|
4
|
3
|
$0.01
|
—
|
$77,982.00
|
$85,781.00
|
$81,101.50
|
2024-12-15
|
|
84
|
APR_DRG
|
Autologous Bone Marrow Transplant Or T-cell Immunotherapy
|
4
|
3
|
$0.01
|
—
|
$77,670.00
|
$85,437.00
|
$80,777.00
|
2024-12-15
|
|
6814
|
APR_DRG
|
Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
4
|
3
|
$0.01
|
—
|
$76,290.00
|
$83,919.00
|
$79,341.50
|
2024-12-15
|
|
1604
|
APR_DRG
|
Major Cardiothoracic Repair Of Heart Anomaly
|
4
|
3
|
$0.01
|
—
|
$76,247.00
|
$83,872.00
|
$79,297.00
|
2024-12-15
|
|
93
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
4
|
3
|
$0.01
|
—
|
$75,610.00
|
$83,171.00
|
$78,634.50
|
2024-12-15
|
|
2464
|
APR_DRG
|
Gastrointestinal Vascular Insufficiency
|
4
|
3
|
$0.01
|
—
|
$73,939.00
|
$81,333.00
|
$76,896.50
|
2024-12-15
|
|
6034
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition
|
4
|
3
|
$0.01
|
—
|
$73,557.00
|
$80,913.00
|
$76,499.50
|
2024-12-15
|
|
2
|
MS_DRG
|
Heart Transplant Or Implant Of Heart Assist System Without Mcc
|
15
|
9
|
$0.01
|
—
|
$73,540.00
|
$578,424.00
|
$194,255.00
|
2024-12-15
|
|
212
|
MS_DRG
|
Concomitant Aortic And Mitral Valve Procedures
|
15
|
9
|
$0.01
|
—
|
$72,718.00
|
$571,821.00
|
$192,038.00
|
2024-12-15
|
|
64
|
APR_DRG
|
Pancreas Transplant
|
4
|
3
|
$0.01
|
—
|
$71,385.00
|
$78,524.00
|
$74,240.50
|
2024-12-15
|
|
5891
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
4
|
3
|
$0.01
|
—
|
$71,380.00
|
$78,517.00
|
$74,235.00
|
2024-12-15
|
|
5934
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
4
|
3
|
$0.01
|
—
|
$71,166.00
|
$78,283.00
|
$74,012.50
|
2024-12-15
|
|
5
|
MS_DRG
|
Liver Transplant With Mcc Or Intestinal Transplant
|
15
|
9
|
$0.01
|
—
|
$71,118.00
|
$558,987.00
|
$187,728.00
|
2024-12-15
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
15
|
9
|
$0.01
|
—
|
$70,761.00
|
$434,133.00
|
$231,179.00
|
2024-12-15
|
|
426
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
15
|
9
|
$0.01
|
—
|
$69,980.00
|
$549,854.00
|
$184,660.00
|
2024-12-15
|
|
5892
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
4
|
3
|
$0.01
|
—
|
$69,181.00
|
$76,099.00
|
$71,948.50
|
2024-12-15
|
|
1624
|
APR_DRG
|
Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis
|
4
|
3
|
$0.01
|
—
|
$66,513.00
|
$73,164.00
|
$69,173.50
|
2024-12-15
|
|
6024
|
APR_DRG
|
Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…
|
4
|
3
|
$0.01
|
—
|
$65,422.00
|
$71,964.00
|
$68,038.50
|
2024-12-15
|
|
5893
|
APR_DRG
|
Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …
|
4
|
3
|
$0.01
|
—
|
$64,891.00
|
$71,380.00
|
$67,486.50
|
2024-12-15
|
|
216
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
15
|
9
|
$0.01
|
—
|
$64,589.00
|
$395,463.00
|
$210,587.00
|
2024-12-15
|
|
6214
|
APR_DRG
|
Neonate Birth Weight 2000-2499 Grams With Major Anomaly
|
4
|
3
|
$0.01
|
—
|
$62,125.00
|
$68,338.00
|
$64,610.00
|
2024-12-15
|
|
850
|
MS_DRG
|
Acute Leukemia With Other Procedures
|
15
|
9
|
$0.01
|
—
|
$61,716.00
|
$483,533.00
|
$162,387.00
|
2024-12-15
|
|
72
|
APR_DRG
|
Allogeneic Bone Marrow Transplant
|
4
|
3
|
$0.01
|
—
|
$61,638.00
|
$67,802.00
|
$64,104.00
|
2024-12-15
|
|
1612
|
APR_DRG
|
Implantable Heart Assist Systems
|
4
|
3
|
$0.01
|
—
|
$61,549.00
|
$67,704.00
|
$64,011.00
|
2024-12-15
|
|
113
|
APR_DRG
|
Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies
|
4
|
3
|
$0.01
|
—
|
$60,845.00
|
$66,929.00
|
$63,279.00
|
2024-12-15
|
|
8634
|
APR_DRG
|
Neonatal Aftercare
|
4
|
3
|
$0.01
|
—
|
$59,901.00
|
$65,891.00
|
$62,297.00
|
2024-12-15
|
|
6303
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure
|
4
|
3
|
$0.01
|
—
|
$59,326.00
|
$65,259.00
|
$61,699.00
|
2024-12-15
|
|
1611
|
APR_DRG
|
Implantable Heart Assist Systems
|
4
|
3
|
$0.01
|
—
|
$58,373.00
|
$64,211.00
|
$60,708.00
|
2024-12-15
|
|
4404
|
APR_DRG
|
Kidney Transplant
|
4
|
3
|
$0.01
|
—
|
$58,229.00
|
$64,052.00
|
$60,558.00
|
2024-12-15
|
|
54
|
APR_DRG
|
Tracheostomy With Mv >96 Hours Without Extensive Procedure
|
4
|
3
|
$0.01
|
—
|
$57,963.00
|
$63,759.00
|
$60,281.50
|
2024-12-15
|
|
43
|
APR_DRG
|
Tracheostomy With Mv >96 Hours With Extensive Procedure
|
4
|
3
|
$0.01
|
—
|
$57,943.00
|
$63,738.00
|
$60,261.00
|
2024-12-15
|
|
231
|
MS_DRG
|
Coronary Bypass With Ptca With Mcc
|
15
|
9
|
$0.01
|
—
|
$56,889.00
|
$347,227.00
|
$184,900.00
|
2024-12-15
|
|
456
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
15
|
9
|
$0.01
|
—
|
$56,858.00
|
$337,955.00
|
$184,798.00
|
2024-12-15
|
|
6804
|
APR_DRG
|
Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms
|
4
|
3
|
$0.01
|
—
|
$56,448.00
|
$62,093.00
|
$58,706.00
|
2024-12-15
|
|
5913
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
4
|
3
|
$0.01
|
—
|
$56,448.00
|
$62,093.00
|
$58,706.00
|
2024-12-15
|
|
6084
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition
|
4
|
3
|
$0.01
|
—
|
$56,288.00
|
$61,917.00
|
$58,539.50
|
2024-12-15
|
|
429
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion With Mcc
|
15
|
9
|
$0.01
|
—
|
$56,017.00
|
$437,798.00
|
$147,028.00
|
2024-12-15
|
|
4414
|
APR_DRG
|
Major Bladder Procedures
|
4
|
3
|
$0.01
|
—
|
$55,106.00
|
$60,616.00
|
$57,310.00
|
2024-12-15
|
|
20
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc
|
15
|
9
|
$0.01
|
—
|
$54,189.00
|
$275,029.00
|
$151,307.00
|
2024-12-15
|
|
23
|
APR_DRG
|
Heart And/or Lung Transplant
|
4
|
3
|
$0.01
|
—
|
$53,618.00
|
$58,980.00
|
$55,763.00
|
2024-12-15
|
|
10
|
MS_DRG
|
Pancreas Transplant
|
15
|
9
|
$0.01
|
—
|
$53,613.00
|
$418,503.00
|
$140,548.00
|
2024-12-15
|
|
19
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant With Hemodialysis
|
15
|
9
|
$0.01
|
—
|
$53,314.00
|
$416,104.00
|
$139,742.00
|
2024-12-15
|
|
233
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc
|
15
|
9
|
$0.01
|
—
|
$52,588.00
|
$320,285.00
|
$170,554.00
|
2024-12-15
|
|
83
|
APR_DRG
|
Autologous Bone Marrow Transplant Or T-cell Immunotherapy
|
4
|
3
|
$0.01
|
—
|
$52,499.00
|
$57,749.00
|
$54,599.00
|
2024-12-15
|
|
219
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
15
|
9
|
$0.01
|
—
|
$52,072.00
|
$317,052.00
|
$168,832.00
|
2024-12-15
|
|
1784
|
APR_DRG
|
External Heart Assist Systems
|
4
|
3
|
$0.01
|
—
|
$51,613.00
|
$56,774.00
|
$53,677.50
|
2024-12-15
|
|
5933
|
APR_DRG
|
Neonate Birth Weight 750-999 Grams Without Major Procedure
|
4
|
3
|
$0.01
|
—
|
$50,828.00
|
$55,911.00
|
$52,861.00
|
2024-12-15
|
|
6114
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Major Anomaly
|
4
|
3
|
$0.01
|
—
|
$50,770.00
|
$55,847.00
|
$52,800.50
|
2024-12-15
|
|
1674
|
APR_DRG
|
Other Cardiothoracic And Thoracic Vascular Procedures
|
4
|
3
|
$0.01
|
—
|
$50,545.00
|
$55,600.00
|
$52,567.00
|
2024-12-15
|
|
957
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Mcc
|
15
|
9
|
$0.01
|
—
|
$50,285.00
|
$391,796.00
|
$131,579.00
|
2024-12-15
|
|
6904
|
APR_DRG
|
Acute Leukemia
|
4
|
3
|
$0.01
|
—
|
$50,091.00
|
$55,100.00
|
$52,095.00
|
2024-12-15
|
|
434
|
APR_DRG
|
Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies
|
4
|
3
|
$0.01
|
—
|
$49,784.00
|
$54,763.00
|
$51,775.50
|
2024-12-15
|
|
92
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
4
|
3
|
$0.01
|
—
|
$49,728.00
|
$54,701.00
|
$51,717.50
|
2024-12-15
|
|
91
|
APR_DRG
|
Extracorporeal Membrane Oxygenation (ecmo)
|
4
|
3
|
$0.01
|
—
|
$48,227.00
|
$53,049.00
|
$50,156.00
|
2024-12-15
|
|
427
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
15
|
9
|
$0.01
|
—
|
$47,920.00
|
$372,821.00
|
$125,206.00
|
2024-12-15
|
|
275
|
MS_DRG
|
Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc
|
15
|
9
|
$0.01
|
—
|
$47,687.00
|
$370,947.00
|
$124,577.00
|
2024-12-15
|
|
6334
|
APR_DRG
|
Neonate Birth Weight > 2499 Grams With Major Anomaly
|
4
|
3
|
$0.01
|
—
|
$47,213.00
|
$51,934.00
|
$49,101.50
|
2024-12-15
|
|
870
|
MS_DRG
|
Septicemia Or Severe Sepsis With Mv >96 Hours
|
15
|
9
|
$0.01
|
—
|
$46,964.00
|
$365,147.00
|
$122,629.00
|
2024-12-15
|
|
3034
|
APR_DRG
|
Dorsal And Lumbar Fusion Procedure For Curvature Of Back
|
4
|
3
|
$0.01
|
—
|
$46,925.00
|
$51,618.00
|
$48,802.00
|
2024-12-15
|
|
5912
|
APR_DRG
|
Neonate Birth Weight 500-749 Grams Without Major Procedure
|
4
|
3
|
$0.01
|
—
|
$46,607.00
|
$51,268.00
|
$48,471.50
|
2024-12-15
|
|
6074
|
APR_DRG
|
Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…
|
4
|
3
|
$0.01
|
—
|
$46,151.00
|
$50,766.00
|
$47,997.00
|
2024-12-15
|
|
63
|
APR_DRG
|
Pancreas Transplant
|
4
|
3
|
$0.01
|
—
|
$46,132.00
|
$50,745.00
|
$47,977.00
|
2024-12-15
|
|
955
|
MS_DRG
|
Craniotomy For Multiple Significant Trauma
|
15
|
9
|
$0.01
|
—
|
$46,126.00
|
$358,417.00
|
$120,369.00
|
2024-12-15
|
|
447
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…
|
15
|
9
|
$0.01
|
—
|
$45,317.00
|
$351,930.00
|
$118,190.00
|
2024-12-15
|
|
928
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$45,148.00
|
$350,575.00
|
$117,736.00
|
2024-12-15
|
|
268
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc
|
15
|
9
|
$0.01
|
—
|
$45,074.00
|
$273,212.00
|
$145,487.00
|
2024-12-15
|
|
2204
|
APR_DRG
|
Major Stomach, Esophageal And Duodenal Procedures
|
4
|
3
|
$0.01
|
—
|
$43,978.00
|
$48,375.00
|
$45,737.00
|
2024-12-15
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
15
|
9
|
$0.01
|
—
|
$43,764.00
|
$339,463.00
|
$114,004.00
|
2024-12-15
|
|
6134
|
APR_DRG
|
Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection
|
4
|
3
|
$0.01
|
—
|
$43,738.00
|
$48,112.00
|
$45,487.50
|
2024-12-15
|
|
217
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
15
|
9
|
$0.01
|
—
|
$43,703.00
|
$264,619.00
|
$140,911.00
|
2024-12-15
|
|
4474
|
APR_DRG
|
Other Kidney, Urinary Tract And Related Procedures
|
4
|
3
|
$0.01
|
—
|
$43,636.00
|
$47,999.00
|
$45,381.50
|
2024-12-15
|
|
22
|
APR_DRG
|
Heart And/or Lung Transplant
|
4
|
3
|
$0.01
|
—
|
$43,073.00
|
$47,381.00
|
$44,796.00
|
2024-12-15
|
|
234
|
APR_DRG
|
Spinal Procedures
|
4
|
3
|
$0.01
|
—
|
$42,989.00
|
$47,288.00
|
$44,708.50
|
2024-12-15
|
|
969
|
MS_DRG
|
HIV With Extensive O.r. Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$42,829.00
|
$331,963.00
|
$111,485.00
|
2024-12-15
|
|
276
|
MS_DRG
|
Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator
|
15
|
9
|
$0.01
|
—
|
$41,979.00
|
$325,144.00
|
$109,195.00
|
2024-12-15
|
|
317
|
MS_DRG
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
15
|
9
|
$0.01
|
—
|
$41,927.00
|
$324,724.00
|
$109,054.00
|
2024-12-15
|
|
573
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Mcc
|
15
|
9
|
$0.01
|
—
|
$41,743.00
|
$323,244.00
|
$108,557.00
|
2024-12-15
|
|
461
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc
|
15
|
9
|
$0.01
|
—
|
$41,602.00
|
$369,393.00
|
$133,897.00
|
2024-12-15
|
|
232
|
MS_DRG
|
Coronary Bypass With Ptca Without Mcc
|
15
|
9
|
$0.01
|
—
|
$41,419.00
|
$250,310.00
|
$133,292.00
|
2024-12-15
|
|
28
|
MS_DRG
|
Spinal Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$41,228.00
|
$319,113.00
|
$107,169.00
|
2024-12-15
|
|
17
|
MS_DRG
|
Autologous Bone Marrow Transplant Without Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$40,943.00
|
$316,824.00
|
$106,401.00
|
2024-12-15
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$40,943.00
|
$316,824.00
|
$106,401.00
|
2024-12-15
|
|
266
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$40,648.00
|
$245,479.00
|
$130,719.00
|
2024-12-15
|
|
218
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…
|
15
|
9
|
$0.01
|
—
|
$40,376.00
|
$243,779.00
|
$129,814.00
|
2024-12-15
|
|
790
|
MS_DRG
|
Extreme Immaturity Or Respiratory Distress Syndrome, Neonate
|
12
|
7
|
$0.01
|
—
|
$40,347.00
|
$312,043.00
|
$51,609.50
|
2024-12-15
|
|
235
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization With Mcc
|
15
|
9
|
$0.01
|
—
|
$39,950.00
|
$241,111.00
|
$128,393.00
|
2024-12-15
|
|
820
|
MS_DRG
|
Lymphoma And Leukemia With Major O.r. Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$39,546.00
|
$305,613.00
|
$102,636.00
|
2024-12-15
|
|
457
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
15
|
9
|
$0.01
|
—
|
$39,003.00
|
$229,025.00
|
$125,234.00
|
2024-12-15
|
|
23
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
15
|
9
|
$0.01
|
—
|
$38,779.00
|
$299,461.00
|
$100,570.00
|
2024-12-15
|
|
653
|
MS_DRG
|
Major Bladder Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$37,925.00
|
$292,611.00
|
$98,269.00
|
2024-12-15
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
15
|
9
|
$0.01
|
—
|
$37,616.00
|
$188,580.00
|
$103,747.00
|
2024-12-15
|
|
834
|
MS_DRG
|
Acute Leukemia With Mcc
|
15
|
9
|
$0.01
|
—
|
$37,616.00
|
$290,128.00
|
$97,435.00
|
2024-12-15
|
|
428
|
MS_DRG
|
Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…
|
15
|
9
|
$0.01
|
—
|
$37,464.00
|
$288,910.00
|
$97,026.00
|
2024-12-15
|
|
430
|
MS_DRG
|
Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc
|
15
|
9
|
$0.01
|
—
|
$37,244.00
|
$287,147.00
|
$96,434.00
|
2024-12-15
|
|
8
|
MS_DRG
|
Simultaneous Pancreas And Kidney Transplant
|
15
|
9
|
$0.01
|
—
|
$37,052.00
|
$285,603.00
|
$95,916.00
|
2024-12-15
|
|
405
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$36,971.00
|
$284,952.00
|
$95,697.00
|
2024-12-15
|
|
463
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
15
|
9
|
$0.01
|
—
|
$36,790.00
|
$325,108.00
|
$117,844.00
|
2024-12-15
|
|
11
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc
|
15
|
9
|
$0.01
|
—
|
$36,757.00
|
$283,231.00
|
$95,119.00
|
2024-12-15
|
|
576
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc
|
15
|
9
|
$0.01
|
—
|
$36,753.00
|
$283,199.00
|
$95,108.00
|
2024-12-15
|
|
234
|
MS_DRG
|
Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc
|
15
|
9
|
$0.01
|
—
|
$36,261.00
|
$218,001.00
|
$116,087.00
|
2024-12-15
|
|
220
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
15
|
9
|
$0.01
|
—
|
$36,108.00
|
$217,038.00
|
$115,574.00
|
2024-12-15
|
|
450
|
MS_DRG
|
Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically …
|
15
|
9
|
$0.01
|
—
|
$35,149.00
|
$270,329.00
|
$90,786.00
|
2024-12-15
|
|
270
|
MS_DRG
|
Other Major Cardiovascular Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$35,037.00
|
$210,330.00
|
$112,002.00
|
2024-12-15
|
|
466
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Mcc
|
15
|
9
|
$0.01
|
—
|
$34,786.00
|
$306,664.00
|
$111,159.00
|
2024-12-15
|
|
326
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$34,684.00
|
$266,597.00
|
$89,533.00
|
2024-12-15
|
|
239
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc
|
15
|
9
|
$0.01
|
—
|
$34,408.00
|
$206,392.00
|
$109,905.00
|
2024-12-15
|
|
837
|
MS_DRG
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
15
|
9
|
$0.01
|
—
|
$34,214.00
|
$262,828.00
|
$88,267.00
|
2024-12-15
|
|
278
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …
|
15
|
9
|
$0.01
|
—
|
$34,189.00
|
$262,623.00
|
$88,198.00
|
2024-12-15
|
|
853
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$34,176.00
|
$262,518.00
|
$88,163.00
|
2024-12-15
|
|
228
|
MS_DRG
|
Other Cardiothoracic Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$34,058.00
|
$204,196.00
|
$108,736.00
|
2024-12-15
|
|
245
|
MS_DRG
|
Aicd Generator Procedures
|
15
|
9
|
$0.01
|
—
|
$33,427.00
|
$200,242.00
|
$106,630.00
|
2024-12-15
|
|
471
|
MS_DRG
|
Cervical Spinal Fusion With Mcc
|
15
|
9
|
$0.01
|
—
|
$33,234.00
|
$193,826.00
|
$105,986.00
|
2024-12-15
|
|
6
|
MS_DRG
|
Liver Transplant Without Mcc
|
15
|
9
|
$0.01
|
—
|
$33,181.00
|
$254,535.00
|
$85,482.00
|
2024-12-15
|
|
826
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …
|
15
|
9
|
$0.01
|
—
|
$32,699.00
|
$250,666.00
|
$84,183.00
|
2024-12-15
|
|
799
|
MS_DRG
|
Splenic Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$32,563.00
|
$249,579.00
|
$83,818.00
|
2024-12-15
|
|
981
|
MS_DRG
|
Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
15
|
9
|
$0.01
|
—
|
$32,557.00
|
$249,532.00
|
$83,802.00
|
2024-12-15
|
|
267
|
MS_DRG
|
Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc
|
15
|
9
|
$0.01
|
—
|
$32,236.00
|
$192,780.00
|
$102,657.00
|
2024-12-15
|
|
823
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Other Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$32,071.00
|
$245,627.00
|
$82,490.00
|
2024-12-15
|
|
C1831
|
HCPCS
|
Kit Imp Aprevo Spine Lvl 1
|
54
|
11
|
$302,750.00
|
$151,375.00
50% off
|
$32,048.51
|
$305,129.00
|
$166,329.50
|
2024-12-15
|
|
C1824
|
HCPCS
|
Generator Pul Implantable Optimizer Smt F/hrt Fail
|
27
|
11
|
$224,900.00
|
$112,450.00
50% off
|
$32,048.51
|
$158,667.00
|
$102,120.00
|
2024-12-15
|
|
277
|
MS_DRG
|
Cardiac Defibrillator Implant Without Mcc
|
15
|
9
|
$0.01
|
—
|
$31,890.00
|
$244,178.00
|
$82,004.00
|
2024-12-15
|
|
163
|
MS_DRG
|
Major Chest Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$31,611.00
|
$241,937.00
|
$81,251.00
|
2024-12-15
|
|
650
|
MS_DRG
|
Kidney Transplant With Hemodialysis With Mcc
|
15
|
9
|
$0.01
|
—
|
$31,599.00
|
$241,837.00
|
$81,217.00
|
2024-12-15
|
|
221
|
MS_DRG
|
Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…
|
15
|
9
|
$0.01
|
—
|
$31,502.00
|
$188,186.00
|
$100,211.00
|
2024-12-15
|
|
329
|
MS_DRG
|
Major Small And Large Bowel Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$31,498.00
|
$241,029.00
|
$80,946.00
|
2024-12-15
|
|
856
|
MS_DRG
|
Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$30,973.00
|
$236,814.00
|
$79,530.00
|
2024-12-15
|
|
474
|
MS_DRG
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc
|
15
|
9
|
$0.01
|
—
|
$30,797.00
|
$269,952.00
|
$97,852.00
|
2024-12-15
|
|
25
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$30,716.00
|
$234,751.00
|
$78,838.00
|
2024-12-15
|
|
901
|
MS_DRG
|
Wound Debridements For Injuries With Mcc
|
15
|
9
|
$0.01
|
—
|
$30,442.00
|
$232,557.00
|
$78,101.00
|
2024-12-15
|
|
319
|
MS_DRG
|
Other Endovascular Cardiac Valve Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$30,196.00
|
$230,578.00
|
$77,436.00
|
2024-12-15
|
|
933
|
MS_DRG
|
Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft
|
15
|
9
|
$0.01
|
—
|
$29,764.00
|
$227,119.00
|
$76,275.00
|
2024-12-15
|
|
458
|
MS_DRG
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…
|
15
|
9
|
$0.01
|
—
|
$29,706.00
|
$172,305.00
|
$94,219.00
|
2024-12-15
|
|
356
|
MS_DRG
|
Other Digestive System O.r. Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$29,364.00
|
$223,907.00
|
$75,196.00
|
2024-12-15
|
|
323
|
MS_DRG
|
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc
|
15
|
9
|
$0.01
|
—
|
$29,323.00
|
$223,576.00
|
$75,085.00
|
2024-12-15
|
|
140
|
MS_DRG
|
Major Head And Neck Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$29,125.00
|
$221,991.00
|
$74,552.00
|
2024-12-15
|
|
31
|
MS_DRG
|
Ventricular Shunt Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$28,873.00
|
$219,965.00
|
$73,872.00
|
2024-12-15
|
|
673
|
MS_DRG
|
Other Kidney And Urinary Tract Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$28,866.00
|
$219,912.00
|
$73,854.00
|
2024-12-15
|
|
269
|
MS_DRG
|
Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc
|
15
|
9
|
$0.01
|
—
|
$28,677.00
|
$170,489.00
|
$90,786.00
|
2024-12-15
|
|
236
|
MS_DRG
|
Coronary Bypass Without Cardiac Catheterization Without Mcc
|
15
|
9
|
$0.01
|
—
|
$28,360.00
|
$168,497.00
|
$89,726.00
|
2024-12-15
|
|
958
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma With Cc
|
15
|
9
|
$0.01
|
—
|
$28,344.00
|
$215,723.00
|
$72,448.00
|
2024-12-15
|
|
12
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc
|
15
|
9
|
$0.01
|
—
|
$28,305.00
|
$215,403.00
|
$72,340.00
|
2024-12-15
|
|
448
|
MS_DRG
|
Multiple Level Spinal Fusion Except Cervical Without Mcc
|
15
|
9
|
$0.01
|
—
|
$28,172.00
|
$214,343.00
|
$71,984.00
|
2024-12-15
|
|
423
|
MS_DRG
|
Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$28,067.00
|
$213,498.00
|
$71,700.00
|
2024-12-15
|
|
C1825
|
HCPCS
|
System Neo Barostim Includes 2102 Ipg 1036 Csl Kit
|
27
|
11
|
$196,560.00
|
$98,280.00
50% off
|
$28,010.01
|
$170,872.00
|
$109,975.00
|
2024-12-15
|
|
907
|
MS_DRG
|
Other O.r. Procedures For Injuries With Mcc
|
15
|
9
|
$0.01
|
—
|
$27,520.00
|
$209,104.00
|
$70,225.00
|
2024-12-15
|
|
739
|
MS_DRG
|
Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc…
|
15
|
9
|
$0.01
|
—
|
$27,501.00
|
$208,957.00
|
$70,175.00
|
2024-12-15
|
|
628
|
MS_DRG
|
Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$27,271.00
|
$207,110.00
|
$69,555.00
|
2024-12-15
|
|
736
|
MS_DRG
|
Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc
|
15
|
9
|
$0.01
|
—
|
$27,218.00
|
$206,685.00
|
$69,412.00
|
2024-12-15
|
|
876
|
MS_DRG
|
O.r. Procedures With Principal Diagnosis Of Mental Illness
|
15
|
9
|
$0.01
|
—
|
$27,166.00
|
$206,265.00
|
$69,271.00
|
2024-12-15
|
|
402
|
MS_DRG
|
Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical
|
15
|
9
|
$0.01
|
—
|
$27,052.00
|
$205,351.00
|
$68,964.00
|
2024-12-15
|
|
273
|
MS_DRG
|
Percutaneous And Other Intracardiac Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$27,040.00
|
$160,228.00
|
$85,323.00
|
2024-12-15
|
|
34
|
MS_DRG
|
Carotid Artery Stent Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$26,898.00
|
$132,675.00
|
$72,991.00
|
2024-12-15
|
|
616
|
MS_DRG
|
Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…
|
15
|
9
|
$0.01
|
—
|
$26,743.00
|
$202,874.00
|
$68,132.00
|
2024-12-15
|
|
904
|
MS_DRG
|
Skin Grafts For Injuries With Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$26,718.00
|
$202,669.00
|
$68,063.00
|
2024-12-15
|
|
166
|
MS_DRG
|
Other Respiratory System O.r. Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$26,647.00
|
$202,102.00
|
$67,873.00
|
2024-12-15
|
|
956
|
MS_DRG
|
Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma
|
15
|
9
|
$0.01
|
—
|
$26,465.00
|
$200,638.00
|
$67,381.00
|
2024-12-15
|
|
24
|
MS_DRG
|
Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…
|
15
|
9
|
$0.01
|
—
|
$26,329.00
|
$199,551.00
|
$67,016.00
|
2024-12-15
|
|
40
|
MS_DRG
|
Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$26,136.00
|
$128,697.00
|
$70,802.00
|
2024-12-15
|
|
622
|
MS_DRG
|
Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…
|
15
|
9
|
$0.01
|
—
|
$25,939.00
|
$196,418.00
|
$65,964.00
|
2024-12-15
|
|
94
|
MS_DRG
|
Bacterial And Tuberculous Infections Of Nervous System With Mcc
|
15
|
9
|
$0.01
|
—
|
$25,329.00
|
$191,520.00
|
$64,319.00
|
2024-12-15
|
|
C1822
|
HCPCS
|
Construct Neuromod Nevro Pain Mgmt Omnia With Ipg Rm
|
36
|
11
|
$184,785.62
|
$92,392.81
50% off
|
$25,269.01
|
$158,667.00
|
$104,617.00
|
2024-12-15
|
|
335
|
MS_DRG
|
Peritoneal Adhesiolysis With Mcc
|
15
|
9
|
$0.01
|
—
|
$25,163.00
|
$190,192.00
|
$63,873.00
|
2024-12-15
|
|
802
|
MS_DRG
|
Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc
|
15
|
9
|
$0.01
|
—
|
$24,911.00
|
$188,166.00
|
$63,193.00
|
2024-12-15
|
|
97
|
MS_DRG
|
Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc
|
15
|
9
|
$0.01
|
—
|
$24,909.00
|
$188,156.00
|
$63,189.00
|
2024-12-15
|
|
518
|
MS_DRG
|
Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…
|
15
|
9
|
$0.01
|
—
|
$24,905.00
|
$143,016.00
|
$78,203.00
|
2024-12-15
|
|
265
|
MS_DRG
|
Aicd Lead Procedures
|
15
|
9
|
$0.01
|
—
|
$24,795.00
|
$146,170.00
|
$77,836.00
|
2024-12-15
|
|
492
|
MS_DRG
|
Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc
|
15
|
9
|
$0.01
|
—
|
$24,691.00
|
$213,761.00
|
$77,484.00
|
2024-12-15
|
|
22
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…
|
15
|
9
|
$0.01
|
—
|
$24,555.00
|
$120,450.00
|
$66,266.00
|
2024-12-15
|
|
420
|
MS_DRG
|
Hepatobiliary Diagnostic Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$24,549.00
|
$185,263.00
|
$62,218.00
|
2024-12-15
|
|
495
|
MS_DRG
|
Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit…
|
15
|
9
|
$0.01
|
—
|
$24,491.00
|
$211,919.00
|
$76,816.00
|
2024-12-15
|
|
414
|
MS_DRG
|
Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc
|
15
|
9
|
$0.01
|
—
|
$24,381.00
|
$183,914.00
|
$61,765.00
|
2024-12-15
|
|
987
|
MS_DRG
|
Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc
|
15
|
9
|
$0.01
|
—
|
$24,374.00
|
$183,857.00
|
$61,746.00
|
2024-12-15
|
|
408
|
MS_DRG
|
Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With…
|
15
|
9
|
$0.01
|
—
|
$24,364.00
|
$183,783.00
|
$61,721.00
|
2024-12-15
|
|
264
|
MS_DRG
|
Other Circulatory System O.r. Procedures
|
15
|
9
|
$0.01
|
—
|
$24,324.00
|
$143,215.00
|
$76,263.00
|
2024-12-15
|
|
651
|
MS_DRG
|
Kidney Transplant With Hemodialysis Without Mcc
|
15
|
9
|
$0.01
|
—
|
$24,176.00
|
$182,272.00
|
$61,213.00
|
2024-12-15
|
|
332
|
MS_DRG
|
Rectal Resection With Mcc
|
15
|
9
|
$0.01
|
—
|
$24,151.00
|
$182,072.00
|
$61,146.00
|
2024-12-15
|
|
574
|
MS_DRG
|
Skin Graft For Skin Ulcer Or Cellulitis With Cc
|
15
|
9
|
$0.01
|
—
|
$24,126.00
|
$181,873.00
|
$61,079.00
|
2024-12-15
|
|
271
|
MS_DRG
|
Other Major Cardiovascular Procedures With Cc
|
15
|
9
|
$0.01
|
—
|
$23,992.00
|
$141,138.00
|
$75,157.00
|
2024-12-15
|
|
477
|
MS_DRG
|
Biopsies Of Musculoskeletal System And Connective Tissue With Mcc
|
15
|
9
|
$0.01
|
—
|
$23,957.00
|
$207,007.00
|
$75,036.00
|
2024-12-15
|
|
665
|
MS_DRG
|
Prostatectomy With Mcc
|
15
|
9
|
$0.01
|
—
|
$23,922.00
|
$180,230.00
|
$60,528.00
|
2024-12-15
|
|
252
|
MS_DRG
|
Other Vascular Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$23,901.00
|
$140,564.00
|
$74,851.00
|
2024-12-15
|
|
467
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Cc
|
15
|
9
|
$0.01
|
—
|
$23,867.00
|
$206,176.00
|
$74,734.00
|
2024-12-15
|
|
260
|
MS_DRG
|
Cardiac Pacemaker Revision Except Device Replacement With Mcc
|
15
|
9
|
$0.01
|
—
|
$23,742.00
|
$139,572.00
|
$74,323.00
|
2024-12-15
|
|
242
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant With Mcc
|
15
|
9
|
$0.01
|
—
|
$23,650.00
|
$138,991.00
|
$74,013.00
|
2024-12-15
|
|
29
|
MS_DRG
|
Spinal Procedures With Cc Or Spinal Neurostimulators
|
15
|
9
|
$0.01
|
—
|
$23,419.00
|
$176,193.00
|
$59,172.00
|
2024-12-15
|
|
37
|
MS_DRG
|
Extracranial Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$23,184.00
|
$113,302.00
|
$62,333.00
|
2024-12-15
|
|
143
|
MS_DRG
|
Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$23,060.00
|
$173,317.00
|
$58,206.00
|
2024-12-15
|
|
469
|
MS_DRG
|
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc…
|
15
|
9
|
$0.01
|
—
|
$22,843.00
|
$196,756.00
|
$71,320.00
|
2024-12-15
|
|
579
|
MS_DRG
|
Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$22,782.00
|
$171,086.00
|
$57,457.00
|
2024-12-15
|
|
656
|
MS_DRG
|
Kidney And Ureter Procedures For Neoplasm With Mcc
|
15
|
9
|
$0.01
|
—
|
$22,773.00
|
$171,012.00
|
$57,432.00
|
2024-12-15
|
|
485
|
MS_DRG
|
Knee Procedures With Principal Diagnosis Of Infection With Mcc
|
15
|
9
|
$0.01
|
—
|
$22,520.00
|
$193,783.00
|
$70,242.00
|
2024-12-15
|
|
279
|
MS_DRG
|
Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …
|
15
|
9
|
$0.01
|
—
|
$22,422.00
|
$168,199.00
|
$56,487.00
|
2024-12-15
|
|
324
|
MS_DRG
|
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc
|
15
|
9
|
$0.01
|
—
|
$22,362.00
|
$167,711.00
|
$56,323.00
|
2024-12-15
|
|
840
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Mcc
|
15
|
9
|
$0.01
|
—
|
$22,322.00
|
$167,391.00
|
$56,216.00
|
2024-12-15
|
|
929
|
MS_DRG
|
Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$22,265.00
|
$166,939.00
|
$56,064.00
|
2024-12-15
|
|
939
|
MS_DRG
|
O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc
|
15
|
9
|
$0.01
|
—
|
$22,224.00
|
$166,603.00
|
$55,951.00
|
2024-12-15
|
|
500
|
MS_DRG
|
Soft Tissue Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$22,189.00
|
$190,737.00
|
$69,138.00
|
2024-12-15
|
|
274
|
MS_DRG
|
Percutaneous And Other Intracardiac Procedures Without Mcc
|
15
|
9
|
$0.01
|
—
|
$21,877.00
|
$127,886.00
|
$68,100.00
|
2024-12-15
|
|
662
|
MS_DRG
|
Minor Bladder Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$21,868.00
|
$163,748.00
|
$54,992.00
|
2024-12-15
|
|
229
|
MS_DRG
|
Other Cardiothoracic Procedures Without Mcc
|
15
|
9
|
$0.01
|
—
|
$21,781.00
|
$127,284.00
|
$67,779.00
|
2024-12-15
|
|
515
|
MS_DRG
|
Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$21,690.00
|
$186,144.00
|
$67,473.00
|
2024-12-15
|
|
451
|
MS_DRG
|
Single Level Spinal Fusion Except Cervical Without Mcc
|
15
|
9
|
$0.01
|
—
|
$21,648.00
|
$161,984.00
|
$54,400.00
|
2024-12-15
|
|
829
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce…
|
15
|
9
|
$0.01
|
—
|
$21,634.00
|
$161,869.00
|
$54,361.00
|
2024-12-15
|
|
652
|
MS_DRG
|
Kidney Transplant
|
15
|
9
|
$0.01
|
—
|
$21,553.00
|
$161,218.00
|
$54,143.00
|
2024-12-15
|
|
26
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Cc
|
15
|
9
|
$0.01
|
—
|
$21,469.00
|
$160,546.00
|
$53,917.00
|
2024-12-15
|
|
570
|
MS_DRG
|
Skin Debridement With Mcc
|
15
|
9
|
$0.01
|
—
|
$21,152.00
|
$158,005.00
|
$53,064.00
|
2024-12-15
|
|
974
|
MS_DRG
|
HIV With Major Related Condition With Mcc
|
15
|
9
|
$0.01
|
—
|
$20,995.00
|
$156,746.00
|
$52,641.00
|
2024-12-15
|
|
464
|
MS_DRG
|
Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …
|
15
|
9
|
$0.01
|
—
|
$20,749.00
|
$154,772.00
|
$51,978.00
|
2024-12-15
|
|
480
|
MS_DRG
|
Hip And Femur Procedures Except Major Joint With Mcc
|
15
|
9
|
$0.01
|
—
|
$20,700.00
|
$177,031.00
|
$64,170.00
|
2024-12-15
|
|
353
|
MS_DRG
|
Hernia Procedures Except Inguinal And Femoral With Mcc
|
15
|
9
|
$0.01
|
—
|
$20,647.00
|
$153,953.00
|
$51,703.00
|
2024-12-15
|
|
668
|
MS_DRG
|
Transurethral Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$20,538.00
|
$153,077.00
|
$51,409.00
|
2024-12-15
|
|
521
|
MS_DRG
|
Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc
|
15
|
9
|
$0.01
|
—
|
$20,528.00
|
$152,993.00
|
$51,380.00
|
2024-12-15
|
|
800
|
MS_DRG
|
Splenic Procedures With Cc
|
15
|
9
|
$0.01
|
—
|
$20,522.00
|
$152,945.00
|
$51,364.00
|
2024-12-15
|
|
240
|
MS_DRG
|
Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc
|
15
|
9
|
$0.01
|
—
|
$20,511.00
|
$119,330.00
|
$63,544.00
|
2024-12-15
|
|
472
|
MS_DRG
|
Cervical Spinal Fusion With Cc
|
15
|
9
|
$0.01
|
—
|
$20,413.00
|
$115,610.00
|
$63,217.00
|
2024-12-15
|
|
C1767
|
HCPCS
|
Stimulator Proclaim Elite 7 Rechrg-free Scs
|
243
|
11
|
$142,725.00
|
$71,362.50
50% off
|
$20,338.51
|
$238,885.00
|
$81,334.00
|
2024-12-15
|
|
625
|
MS_DRG
|
Thyroid, Parathyroid And Thyroglossal Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$20,216.00
|
$150,494.00
|
$50,541.00
|
2024-12-15
|
|
462
|
MS_DRG
|
Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc
|
15
|
9
|
$0.01
|
—
|
$20,195.00
|
$172,384.00
|
$62,485.00
|
2024-12-15
|
|
325
|
MS_DRG
|
Coronary Intravascular Lithotripsy Without Intraluminal Device
|
15
|
9
|
$0.01
|
—
|
$20,184.00
|
$150,232.00
|
$50,453.00
|
2024-12-15
|
|
510
|
MS_DRG
|
Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$20,157.00
|
$172,040.00
|
$62,361.00
|
2024-12-15
|
|
321
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A…
|
15
|
9
|
$0.01
|
—
|
$20,083.00
|
$149,429.00
|
$50,183.00
|
2024-12-15
|
|
654
|
MS_DRG
|
Major Bladder Procedures With Cc
|
15
|
9
|
$0.01
|
—
|
$19,922.00
|
$148,132.00
|
$49,748.00
|
2024-12-15
|
|
406
|
MS_DRG
|
Pancreas, Liver And Shunt Procedures With Cc
|
15
|
9
|
$0.01
|
—
|
$19,832.00
|
$147,413.00
|
$49,506.00
|
2024-12-15
|
|
258
|
MS_DRG
|
Cardiac Pacemaker Device Replacement With Mcc
|
15
|
9
|
$0.01
|
—
|
$19,813.00
|
$114,958.00
|
$62,675.00
|
2024-12-15
|
|
411
|
MS_DRG
|
Cholecystectomy With C.d.e. With Mcc
|
15
|
9
|
$0.01
|
—
|
$19,361.00
|
$143,634.00
|
$48,237.00
|
2024-12-15
|
|
288
|
MS_DRG
|
Acute And Subacute Endocarditis With Mcc
|
15
|
9
|
$0.01
|
—
|
$19,329.00
|
$143,376.00
|
$48,151.00
|
2024-12-15
|
|
963
|
MS_DRG
|
Other Multiple Significant Trauma With Mcc
|
15
|
9
|
$0.01
|
—
|
$19,233.00
|
$142,600.00
|
$47,890.00
|
2024-12-15
|
|
61
|
MS_DRG
|
Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A…
|
15
|
9
|
$0.01
|
—
|
$19,146.00
|
$141,901.00
|
$47,656.00
|
2024-12-15
|
|
344
|
MS_DRG
|
Minor Small And Large Bowel Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$19,087.00
|
$141,434.00
|
$47,499.00
|
2024-12-15
|
|
208
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support <=96 Hours
|
15
|
9
|
$0.01
|
—
|
$19,017.00
|
$140,873.00
|
$47,310.00
|
2024-12-15
|
|
263
|
MS_DRG
|
Vein Ligation And Stripping
|
15
|
9
|
$0.01
|
—
|
$19,006.00
|
$109,902.00
|
$58,523.00
|
2024-12-15
|
|
849
|
MS_DRG
|
Radiotherapy
|
15
|
9
|
$0.01
|
—
|
$18,934.00
|
$140,206.00
|
$47,086.00
|
2024-12-15
|
|
577
|
MS_DRG
|
Skin Graft Except For Skin Ulcer Or Cellulitis With Cc
|
15
|
9
|
$0.01
|
—
|
$18,880.00
|
$139,770.00
|
$46,940.00
|
2024-12-15
|
|
970
|
MS_DRG
|
HIV With Extensive O.r. Procedures Without Mcc
|
15
|
9
|
$0.01
|
—
|
$18,818.00
|
$139,272.00
|
$46,772.00
|
2024-12-15
|
|
13
|
MS_DRG
|
Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$18,796.00
|
$139,099.00
|
$46,714.00
|
2024-12-15
|
|
503
|
MS_DRG
|
Foot Procedures With Mcc
|
15
|
9
|
$0.01
|
—
|
$18,774.00
|
$159,309.00
|
$57,746.00
|
2024-12-15
|
|
959
|
MS_DRG
|
Other O.r. Procedures For Multiple Significant Trauma Without Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$18,756.00
|
$138,778.00
|
$46,607.00
|
2024-12-15
|
|
468
|
MS_DRG
|
Revision Of Hip Or Knee Replacement Without Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$18,622.00
|
$157,907.00
|
$57,238.00
|
2024-12-15
|
|
255
|
MS_DRG
|
Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc
|
15
|
9
|
$0.01
|
—
|
$18,577.00
|
$107,214.00
|
$58,453.00
|
2024-12-15
|
|
749
|
MS_DRG
|
Other Female Reproductive System O.r. Procedures With Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$18,395.00
|
$135,876.00
|
$45,632.00
|
2024-12-15
|
|
659
|
MS_DRG
|
Kidney And Ureter Procedures For Non-neoplasm With Mcc
|
15
|
9
|
$0.01
|
—
|
$18,367.00
|
$135,650.00
|
$45,556.00
|
2024-12-15
|
|
846
|
MS_DRG
|
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc
|
15
|
9
|
$0.01
|
—
|
$18,167.00
|
$134,049.00
|
$45,018.00
|
2024-12-15
|
|
253
|
MS_DRG
|
Other Vascular Procedures With Cc
|
15
|
9
|
$0.01
|
—
|
$18,162.00
|
$104,612.00
|
$55,706.00
|
2024-12-15
|
|
483
|
MS_DRG
|
Major Joint Or Limb Reattachment Procedures Of Upper Extremities
|
15
|
9
|
$0.01
|
—
|
$18,130.00
|
$153,386.00
|
$55,599.00
|
2024-12-15
|
|
498
|
MS_DRG
|
Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc…
|
15
|
9
|
$0.01
|
—
|
$17,978.00
|
$151,984.00
|
$55,091.00
|
2024-12-15
|
|
272
|
MS_DRG
|
Other Major Cardiovascular Procedures Without Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$17,830.00
|
$102,530.00
|
$54,598.00
|
2024-12-15
|
|
C2616
|
HCPCS
|
Microsphere Gl Therasphere Y-90 3 Gbq
|
27
|
11
|
$128,781.90
|
$64,390.95
50% off
|
$17,177.00
|
$90,856.00
|
$67,925.00
|
2024-12-15
|
|
473
|
MS_DRG
|
Cervical Spinal Fusion Without Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$16,948.00
|
$94,469.00
|
$51,657.00
|
2024-12-15
|
|
478
|
MS_DRG
|
Biopsies Of Musculoskeletal System And Connective Tissue With Cc
|
15
|
9
|
$0.01
|
—
|
$16,759.00
|
$140,770.00
|
$51,026.00
|
2024-12-15
|
|
250
|
MS_DRG
|
Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc
|
15
|
9
|
$0.01
|
—
|
$16,589.00
|
$94,761.00
|
$50,461.00
|
2024-12-15
|
|
243
|
MS_DRG
|
Permanent Cardiac Pacemaker Implant With Cc
|
15
|
9
|
$0.01
|
—
|
$16,198.00
|
$92,311.00
|
$49,156.00
|
2024-12-15
|
|
30
|
MS_DRG
|
Spinal Procedures Without Cc/mcc
|
15
|
9
|
$0.01
|
—
|
$16,019.00
|
$88,802.00
|
$48,558.00
|
2024-12-15
|
|
475
|
MS_DRG
|
Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc
|
15
|
9
|
$0.01
|
—
|
$15,574.00
|
$129,857.00
|
$47,070.00
|
2024-12-15
|
|
486
|
MS_DRG
|
Knee Procedures With Principal Diagnosis Of Infection With Cc
|
15
|
9
|
$0.01
|
—
|
$15,336.00
|
$127,665.00
|
$46,276.00
|
2024-12-15
|
|
C1772
|
HCPCS
|
Pump Inf Synchromed Ii Ti 3.4x0.78x0.78in 20ml
|
27
|
11
|
$99,475.00
|
$49,737.50
50% off
|
$14,175.00
|
$70,180.00
|
$47,913.00
|
2024-12-15
|
|
38240
|
CPT
|
Hc Trnsplj Allogeneic Hematopoietic Cells Per Donor
|
18
|
11
|
$177,055.20
|
$88,527.60
50% off
|
$13,172.00
|
$149,966.00
|
$54,669.00
|
2024-12-15
|
|
C1722
|
HCPCS
|
System Defib Cell Fortify Assura 40 1chmbr
|
441
|
11
|
$89,154.00
|
$44,577.00
50% off
|
$9,784.00
|
$110,443.00
|
$49,202.00
|
2024-12-15
|
|
C1820
|
HCPCS
|
Stimulator Neurostim Gastric Enterra Ii
|
171
|
11
|
$107,581.50
|
$53,790.75
50% off
|
$2,330.00
|
$155,951.00
|
$62,030.00
|
2024-12-15
|
|
L8619
|
HCPCS
|
Abutment Cochlear Imp Baha Dermalock Ba400 2s Surg
|
135
|
11
|
$80,730.00
|
$40,365.00
50% off
|
$750.00
|
$104,005.00
|
$45,168.00
|
2024-12-15
|
|
A9595
|
HCPCS
|
Piflufolastat F 18 9 Mci IV Sosy
|
18
|
11
|
$470,574.06
|
$235,287.03
50% off
|
$615.00
|
$398,576.00
|
$74,218.50
|
2024-12-15
|
|
L8614
|
HCPCS
|
Processor Sound Nuc 7 Cp100 Wht
|
119
|
11
|
$94,111.88
|
$47,055.94
50% off
|
$485.00
|
$104,005.00
|
$50,014.00
|
2024-12-15
|
|
A9588
|
HCPCS
|
Fluciclovine F 18 9-221 Mci/ml IV Soln
|
18
|
11
|
$455,729.00
|
$227,864.50
50% off
|
$82.00
|
$386,002.00
|
$71,595.00
|
2024-12-15
|
|
A9572
|
HCPCS
|
Indium In-111 Pentetreotide IV Kit
|
18
|
11
|
$382,998.47
|
$191,499.24
50% off
|
$59.00
|
$324,400.00
|
$60,163.00
|
2024-12-15
|
|
A9569
|
HCPCS
|
Technetium-99 (tc-99) Exametazime White Blood Cells Radio-isotope Injection
|
18
|
11
|
$314,347.24
|
$157,173.62
50% off
|
$56.00
|
$266,252.00
|
$49,383.50
|
2024-12-15
|
|
C1721
|
HCPCS
|
Defibrillator Crdc Evera MRI Xt Dr 2chb Is4 Df1
|
457
|
11
|
$92,186.64
|
$46,093.32
50% off
|
$16.00
|
$102,108.00
|
$52,592.00
|
2024-12-15
|
|
A9520
|
HCPCS
|
Technetium-99 (tc-99) Tilmanocept (lymphoseek) Radio-isotope Injection
|
18
|
11
|
$763,049.00
|
$381,524.50
50% off
|
$10.00
|
$646,303.00
|
$119,804.00
|
2024-12-15
|
|
C1882
|
HCPCS
|
System Defib Crdc Viva Quad Xt Crt-d
|
549
|
11
|
$112,811.40
|
$56,405.70
50% off
|
$4.50
|
$161,411.00
|
$64,681.00
|
2024-12-15
|