Hospital

GRAND RIVER HOSPITAL DISTRICT

Rifle, CO · CCN 061317 · Rates published

Your selected procedure

You selected 93306 (CPT)

ULTRASOUND OF HEART WITH COLOR-DEPICTED BLOOD FLOW; RATE; DIRECTION AND VALVE FUNCTION

This hospital’s price: $2,181 across 6 payers · range $776-$2,431

Source: https://apim.services.craneware.com/api-pricing-transparency/api/public/f73a5211c3c0ff9dedca389bbfa031d7/charges/mrf · observed 2026-07-15

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

4,945 distinct procedures filed

9 distinct payers

78,896 rate rows

2026-07-15 last MRF observed

Data quality

49,743 of 78,896 rate rows are consumer-grade (63.0%)

29,153 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 — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	15,721
per-diem day rate — not a per-procedure price	5,692
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	3,934
exceeds 10× this hospital's gross charge — excluded from medians	3,781
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	25

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://apim.services.craneware.com/api-pricing-transparency/api/public/f73a5211c3c0ff9dedca389bbfa031d7/charges/mrf
Found on page	https://www.cdmpricing.com/f73a5211c3c0ff9dedca389bbfa031d7/shoppable-services
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-21
Content fingerprint	c95e7d8c91e47f9e… · 15,828,523 bytes · first seen 2026-05-18

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
19357 CPT	Tiss Xpndr Plmt Brst Rcnstj	2	$832.04	$16,683.77	$16,683.77	nat. median $13,795 1.2× median
C1776 HCPCS	Joint Device (implantable)	1	$13,770.66	$13,770.66	$13,770.66	nat. median $3,390 outlier · 4.1×
27447 CPT	Replacement Of Knee Joint; Both Sides Of Knee	8	$1,497.13	$21,376.00	$13,048.08	nat. median $12,739 1.0× median
23485 CPT	Revision Of Collar Bone	2	$561.41	$13,048.08	$13,048.08	nat. median $11,715 1.1× median
27130 CPT	Replacement Of Thigh Bone And Hip Joint With Prosthesis	8	$1,122.85	$24,215.00	$13,048.08	nat. median $13,091 1.0× median
28730 CPT	Fusion Of Foot Bones	2	$411.71	$13,048.08	$13,048.08	nat. median $10,638 1.2× median
27827 CPT	Treat Lower Leg Fracture	2	$562.17	$13,048.08	$13,048.08	nat. median $11,028 1.2× median
28735 CPT	Fusion Of Foot Bones	2	$523.99	$13,048.08	$13,048.08	nat. median $11,242 1.2× median
23615 CPT	Optx Prox Humrl Fx W/int Fix	2	$449.14	$13,048.08	$13,048.08	nat. median $11,353 1.1× median
24365 CPT	Reconstruct Head Of Radius	2	$374.29	$13,048.08	$13,048.08	nat. median $10,628 1.2× median
25810 CPT	Arthrd Wrst Iliac/oth Agrft	2	$598.84	$13,048.08	$13,048.08	nat. median $11,309 1.2× median
29889 CPT	Knee Arthroscopy/surgery	2	$636.27	$13,048.08	$13,048.08	nat. median $11,552 1.1× median
24515 CPT	Treat Humerus Fracture	2	$449.14	$13,048.08	$13,048.08	nat. median $11,494 1.1× median
24666 CPT	Treat Radius Fracture	2	$299.42	$13,048.08	$13,048.08	nat. median $10,791 1.2× median
27758 CPT	Treatment Of Tibia Fracture	2	$523.99	$13,048.08	$13,048.08	nat. median $10,538 1.2× median
28420 CPT	Treat/graft Heel Fracture	2	$542.71	$13,048.08	$13,048.08	nat. median $11,215 1.2× median
24575 CPT	Treat Humerus Fracture	2	$374.29	$13,048.08	$13,048.08	nat. median $10,594 1.2× median
24586 CPT	Treat Elbow Fracture	2	$561.41	$13,048.08	$13,048.08	nat. median $11,251 1.2× median
24579 CPT	Treat Humerus Fracture	2	$374.29	$13,048.08	$13,048.08	nat. median $11,086 1.2× median
24545 CPT	Treat Humerus Fracture	2	$374.29	$13,048.08	$13,048.08	nat. median $11,397 1.1× median
22551 CPT	Arthrd Ant Ntrbdy Cervical	7	$1,434.61	$13,048.08	$7,241.35	nat. median $12,537 0.6× median
23473 CPT	Revis Reconst Shoulder Joint	7	$1,402.80	$13,048.08	$7,225.44	nat. median $12,689 0.6× median
23472 CPT	Reconstruct Shoulder Joint	8	$1,309.98	$29,559.00	$7,179.03	nat. median $16,677 outlier · 0.4×
27429 CPT	Reconstruction Knee	7	$1,085.41	$13,048.08	$7,066.74	nat. median $11,277 0.6× median
22554 CPT	Arthrd Ant Ntrbd Min Dsc Crv	7	$1,047.98	$13,048.08	$7,048.03	nat. median $12,300 0.6× median
27415 CPT	Osteochondral Knee Allograft	7	$1,040.87	$13,048.08	$7,044.48	nat. median $11,847 0.6× median
29856 CPT	Tibial Arthroscopy/surgery	7	$900.52	$13,048.08	$6,974.30	nat. median $10,970 0.6× median
27759 CPT	Treatment Of Tibia Fracture	8	$881.44	$13,048.08	$6,964.76	nat. median $10,667 0.7× median
27442 CPT	Revision Of Knee Joint	7	$785.99	$13,048.08	$6,917.03	nat. median $11,338 0.6× median
23470 CPT	Reconstruct Shoulder Joint	7	$748.56	$13,048.08	$6,898.32	nat. median $12,420 0.6× median
27438 CPT	Revise Kneecap With Implant	7	$748.56	$13,048.08	$6,898.32	nat. median $11,472 0.6× median
24435 CPT	Repair Humerus With Graft	7	$748.56	$13,048.08	$6,898.32	nat. median $11,617 0.6× median
20900 CPT	Removal Of Bone For Graft	2	$89.84	$6,614.63	$6,614.63	nat. median $6,211 1.1× median
28297 CPT	Correction Of Bunion With Midfoot And Hindfoot Bone Fusion	8	$449.14	$6,614.63	$6,614.63	nat. median $7,584 0.9× median
24538 CPT	Treat Humerus Fracture	2	$299.42	$6,614.63	$6,614.63	nat. median $6,672 1.0× median
26372 CPT	Repair/graft Hand Tendon	2	$318.15	$6,614.63	$6,614.63	nat. median $6,954 1.0× median
20690 CPT	Appl Unipln Uni Ext Fixj Sys	2	$206.61	$6,614.63	$6,614.63	nat. median $6,407 1.0× median
25515 CPT	Treatment Of Broken Midpart Of Forearm Bone On Thumb Side	8	$299.42	$6,614.63	$6,614.63	nat. median $6,925 1.0× median
27784 CPT	Treatment Of Fibula Fracture	2	$318.15	$6,614.63	$6,614.63	nat. median $6,849 1.0× median
28306 CPT	Incision Of Metatarsal	2	$261.99	$6,614.63	$6,614.63	nat. median $6,344 1.0× median
26530 CPT	Revise Knuckle Joint	2	$261.99	$6,614.63	$6,614.63	nat. median $6,733 1.0× median
26850 CPT	Fusion Of Knuckle	2	$280.72	$6,614.63	$6,614.63	nat. median $6,816 1.0× median
25545 CPT	Optx Ulnar Shft Fx Int Fixj	2	$299.42	$6,614.63	$6,614.63	nat. median $6,962 1.0× median
22100 CPT	Remove Part Of Neck Vertebra	2	$299.42	$6,614.63	$6,614.63	nat. median $7,460 0.9× median
22102 CPT	Remove Part Lumbar Vertebra	2	$254.51	$6,614.63	$6,614.63	nat. median $7,199 0.9× median
28202 CPT	Repair/graft Of Foot Tendon	3	$299.42	$22,052.00	$6,614.63	nat. median $6,466 1.0× median
28298 CPT	Cor Hlx Vlgs Prx Phlx Osteot	2	$127.26	$6,614.63	$6,614.63	nat. median $6,631 1.0× median
24665 CPT	Treat Radius Fracture	2	$299.42	$6,614.63	$6,614.63	nat. median $7,071 0.9× median
27792 CPT	Treatment Of Broken Outer Lower Leg Bone At Ankle	8	$336.85	$6,614.63	$6,614.63	nat. median $6,924 1.0× median
20924 CPT	Removal Of Tendon For Graft	2	$74.87	$6,614.63	$6,614.63	nat. median $6,841 1.0× median

Other procedures at this hospital

Browse this hospital's 4,945 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

19357	CPT	Tiss Xpndr Plmt Brst Rcnstj	3	2	$6,321.00	$3,160.50 50% off	$832.04	$16,683.77	$16,683.77	2026-07-15
C1776	HCPCS	Joint Device (implantable)	1	1	$17,516.50	$8,758.25 50% off	$13,770.66	$13,770.66	$13,770.66	2026-07-15
27130	CPT	Replacement Of Thigh Bone And Hip Joint With Prosthesis	41	8	$24,048.00	$12,024.00 50% off	$1,122.85	$24,215.00	$13,048.08	2026-07-15
27758	CPT	Treatment Of Tibia Fracture	3	2	$3,579.00	$1,789.50 50% off	$523.99	$13,048.08	$13,048.08	2026-07-15
24515	CPT	Treat Humerus Fracture	3	2	$3,680.00	$1,840.00 50% off	$449.14	$13,048.08	$13,048.08	2026-07-15
24545	CPT	Treat Humerus Fracture	3	2	$4,080.00	$2,040.00 50% off	$374.29	$13,048.08	$13,048.08	2026-07-15
23615	CPT	Optx Prox Humrl Fx W/int Fix	3	2	$3,715.00	$1,857.50 50% off	$449.14	$13,048.08	$13,048.08	2026-07-15
28420	CPT	Treat/graft Heel Fracture	3	2	$5,351.00	$2,675.50 50% off	$542.71	$13,048.08	$13,048.08	2026-07-15
27447	CPT	Replacement Of Knee Joint; Both Sides Of Knee	41	8	$26,052.00	$13,026.00 50% off	$1,497.13	$21,376.00	$13,048.08	2026-07-15
29889	CPT	Knee Arthroscopy/surgery	3	2	$5,668.00	$2,834.00 50% off	$636.27	$13,048.08	$13,048.08	2026-07-15
24666	CPT	Treat Radius Fracture	3	2	$3,082.00	$1,541.00 50% off	$299.42	$13,048.08	$13,048.08	2026-07-15
24575	CPT	Treat Humerus Fracture	3	2	$3,079.00	$1,539.50 50% off	$374.29	$13,048.08	$13,048.08	2026-07-15
24586	CPT	Treat Elbow Fracture	3	2	$4,197.00	$2,098.50 50% off	$561.41	$13,048.08	$13,048.08	2026-07-15
28730	CPT	Fusion Of Foot Bones	3	2	$3,393.00	$1,696.50 50% off	$411.71	$13,048.08	$13,048.08	2026-07-15
27827	CPT	Treat Lower Leg Fracture	3	2	$4,509.00	$2,254.50 50% off	$562.17	$13,048.08	$13,048.08	2026-07-15
25810	CPT	Arthrd Wrst Iliac/oth Agrft	3	2	$3,641.00	$1,820.50 50% off	$598.84	$13,048.08	$13,048.08	2026-07-15
28735	CPT	Fusion Of Foot Bones	3	2	$2,543.00	$1,271.50 50% off	$523.99	$13,048.08	$13,048.08	2026-07-15
24579	CPT	Treat Humerus Fracture	3	2	$3,523.00	$1,761.50 50% off	$374.29	$13,048.08	$13,048.08	2026-07-15
23485	CPT	Revision Of Collar Bone	3	2	$4,004.00	$2,002.00 50% off	$561.41	$13,048.08	$13,048.08	2026-07-15
24365	CPT	Reconstruct Head Of Radius	3	2	$2,954.00	$1,477.00 50% off	$374.29	$13,048.08	$13,048.08	2026-07-15
22551	CPT	Arthrd Ant Ntrbdy Cervical	13	7	$7,116.00	$3,558.00 50% off	$1,434.61	$13,048.08	$7,241.35	2026-07-15
23473	CPT	Revis Reconst Shoulder Joint	13	7	$6,155.00	$3,077.50 50% off	$1,402.80	$13,048.08	$7,225.44	2026-07-15
23472	CPT	Reconstruct Shoulder Joint	15	8	$5,985.00	$2,992.50 50% off	$1,309.98	$29,559.00	$7,179.03	2026-07-15
27429	CPT	Reconstruction Knee	13	7	$5,408.00	$2,704.00 50% off	$1,085.41	$13,048.08	$7,066.74	2026-07-15
22554	CPT	Arthrd Ant Ntrbd Min Dsc Crv	13	7	$5,345.00	$2,672.50 50% off	$1,047.98	$13,048.08	$7,048.03	2026-07-15
27415	CPT	Osteochondral Knee Allograft	13	7	$5,238.00	$2,619.00 50% off	$1,040.87	$13,048.08	$7,044.48	2026-07-15
29856	CPT	Tibial Arthroscopy/surgery	13	7	$3,519.00	$1,759.50 50% off	$900.52	$13,048.08	$6,974.30	2026-07-15
27759	CPT	Treatment Of Tibia Fracture	14	8	$4,201.00	$2,100.50 50% off	$881.44	$13,048.08	$6,964.76	2026-07-15
27442	CPT	Revision Of Knee Joint	13	7	$3,654.00	$1,827.00 50% off	$785.99	$13,048.08	$6,917.03	2026-07-15
27438	CPT	Revise Kneecap With Implant	13	7	$3,526.00	$1,763.00 50% off	$748.56	$13,048.08	$6,898.32	2026-07-15
24435	CPT	Repair Humerus With Graft	13	7	$4,663.00	$2,331.50 50% off	$748.56	$13,048.08	$6,898.32	2026-07-15
23470	CPT	Reconstruct Shoulder Joint	13	7	$4,893.00	$2,446.50 50% off	$748.56	$13,048.08	$6,898.32	2026-07-15
28202	CPT	Repair/graft Of Foot Tendon	4	3	$1,802.00	$901.00 50% off	$299.42	$22,052.00	$6,614.63	2026-07-15
26530	CPT	Revise Knuckle Joint	3	2	$2,250.00	$1,125.00 50% off	$261.99	$6,614.63	$6,614.63	2026-07-15
28531	CPT	Treat Sesamoid Bone Fracture	3	2	$1,447.00	$723.50 50% off	$265.35	$6,614.63	$6,614.63	2026-07-15
29836	CPT	Elbow Arthroscopy/surgery	3	2	$2,640.00	$1,320.00 50% off	$134.74	$6,614.63	$6,614.63	2026-07-15
28465	CPT	Treat Midfoot Fracture Each	3	2	$2,915.00	$1,457.50 50% off	$224.58	$6,614.63	$6,614.63	2026-07-15
28615	CPT	Repair Foot Dislocation	3	2	$3,572.00	$1,786.00 50% off	$224.58	$6,614.63	$6,614.63	2026-07-15
28485	CPT	Treat Metatarsal Fracture	3	2	$2,269.00	$1,134.50 50% off	$224.58	$6,614.63	$6,614.63	2026-07-15
28456	CPT	Treat Midfoot Fracture	3	2	$1,651.00	$825.50 50% off	$168.43	$6,614.63	$6,614.63	2026-07-15
28298	CPT	Cor Hlx Vlgs Prx Phlx Osteot	3	2	$1,980.00	$990.00 50% off	$127.26	$6,614.63	$6,614.63	2026-07-15
20900	CPT	Removal Of Bone For Graft	3	2	$1,735.00	$867.50 50% off	$89.84	$6,614.63	$6,614.63	2026-07-15
29827	CPT	Repair Of Shoulder Rotator Cuff Using An Endoscope	27	8	$20,562.00	$10,281.00 50% off	$817.82	$6,614.63	$6,614.63	2026-07-15
26850	CPT	Fusion Of Knuckle	3	2	$2,851.00	$1,425.50 50% off	$280.72	$6,614.63	$6,614.63	2026-07-15
24665	CPT	Treat Radius Fracture	3	2	$2,736.00	$1,368.00 50% off	$299.42	$6,614.63	$6,614.63	2026-07-15
25545	CPT	Optx Ulnar Shft Fx Int Fixj	3	2	$2,619.00	$1,309.50 50% off	$299.42	$6,614.63	$6,614.63	2026-07-15
27792	CPT	Treatment Of Broken Outer Lower Leg Bone At Ankle	40	8	$12,367.00	$6,183.50 50% off	$336.85	$6,614.63	$6,614.63	2026-07-15
27784	CPT	Treatment Of Fibula Fracture	3	2	$3,001.00	$1,500.50 50% off	$318.15	$6,614.63	$6,614.63	2026-07-15
28750	CPT	Fusion Of Big Toe Joint	3	2	$3,254.00	$1,627.00 50% off	$261.99	$6,614.63	$6,614.63	2026-07-15
28310	CPT	Revision Of Big Toe	3	2	$1,553.00	$776.50 50% off	$119.77	$6,614.63	$6,614.63	2026-07-15
28238	CPT	Revision Of Foot Tendon	3	2	$2,823.00	$1,411.50 50% off	$243.29	$6,614.63	$6,614.63	2026-07-15
26500	CPT	Hand Tendon Reconstruction	3	2	$2,678.00	$1,339.00 50% off	$224.58	$6,614.63	$6,614.63	2026-07-15
25515	CPT	Treatment Of Broken Midpart Of Forearm Bone On Thumb Side	16	8	$16,390.00	$8,195.00 50% off	$299.42	$6,614.63	$6,614.63	2026-07-15
28306	CPT	Incision Of Metatarsal	3	2	$2,594.00	$1,297.00 50% off	$261.99	$6,614.63	$6,614.63	2026-07-15
29914	CPT	Hip Arthro W/femoroplasty	26	8	$15,968.50	$7,984.25 50% off	$861.98	$6,614.63	$6,614.63	2026-07-15
20690	CPT	Appl Unipln Uni Ext Fixj Sys	3	2	$2,501.00	$1,250.50 50% off	$206.61	$6,614.63	$6,614.63	2026-07-15
20924	CPT	Removal Of Tendon For Graft	3	2	$1,935.00	$967.50 50% off	$74.87	$6,614.63	$6,614.63	2026-07-15
22102	CPT	Remove Part Lumbar Vertebra	3	2	$3,360.00	$1,680.00 50% off	$254.51	$6,614.63	$6,614.63	2026-07-15
28297	CPT	Correction Of Bunion With Midfoot And Hindfoot Bone Fusion	27	8	$15,794.00	$7,897.00 50% off	$449.14	$6,614.63	$6,614.63	2026-07-15
28322	CPT	Repair Of Metatarsals	3	2	$3,316.00	$1,658.00 50% off	$179.64	$6,614.63	$6,614.63	2026-07-15
29820	CPT	Sho Arthrs Srg Prtl Synvct	3	2	$2,460.00	$1,230.00 50% off	$134.74	$6,614.63	$6,614.63	2026-07-15
29868	CPT	Meniscal Trnspl Knee W/scpe	26	8	$21,111.00	$10,555.50 50% off	$1,322.71	$6,614.63	$6,614.63	2026-07-15
24685	CPT	Treat Ulnar Fracture	3	2	$2,739.00	$1,369.50 50% off	$299.42	$6,614.63	$6,614.63	2026-07-15
24538	CPT	Treat Humerus Fracture	3	2	$3,128.00	$1,564.00 50% off	$299.42	$6,614.63	$6,614.63	2026-07-15
26372	CPT	Repair/graft Hand Tendon	3	2	$3,554.00	$1,777.00 50% off	$318.15	$6,614.63	$6,614.63	2026-07-15
25695	CPT	Optx Lunate Dislocation	3	2	$2,653.00	$1,326.50 50% off	$299.42	$6,614.63	$6,614.63	2026-07-15
22100	CPT	Remove Part Of Neck Vertebra	3	2	$3,908.00	$1,954.00 50% off	$299.42	$6,614.63	$6,614.63	2026-07-15
64555	CPT	Implant Neuroelectrodes	3	2	$7,942.00	$3,971.00 50% off	$75.23	$6,603.85	$6,603.85	2026-07-15
31287	CPT	Nasal/sinus Endoscopy Surg	3	2	$969.00	$484.50 50% off	$225.70	$6,187.08	$6,187.08	2026-07-15
31267	CPT	Removal Of Nasal Sinus Tissue Using An Endoscope	27	8	$9,675.00	$4,837.50 50% off	$324.12	$6,187.08	$6,187.08	2026-07-15
31288	CPT	Nasal/sinus Endoscopy Surg	3	2	$1,124.00	$562.00 50% off	$261.63	$6,187.08	$6,187.08	2026-07-15
31254	CPT	Nsl/sins Ndsc W/prtl Ethmdct	3	2	$1,113.00	$556.50 50% off	$265.35	$6,187.08	$6,187.08	2026-07-15
62365	CPT	Remove Spine Infusion Device	3	2	$1,274.00	$637.00 50% off	$293.81	$6,178.65	$6,178.65	2026-07-15
64834	CPT	Repair Of Hand Or Foot Nerve	3	2	$3,133.00	$1,566.50 50% off	$299.42	$6,178.65	$6,178.65	2026-07-15
250	MS_DRG	Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
245	MS_DRG	Aicd Generator Procedures	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
258	MS_DRG	Cardiac Pacemaker Device Replacement With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
201	MS_DRG	Pneumothorax Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
300	MS_DRG	Peripheral Vascular Disorders With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
313	MS_DRG	Chest Pain	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
306	MS_DRG	Cardiac Congenital And Valvular Disorders With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
268	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
311	MS_DRG	Angina Pectoris	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
297	MS_DRG	Cardiac Arrest, Unexplained With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
289	MS_DRG	Acute And Subacute Endocarditis With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
30	MS_DRG	Spinal Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
312	MS_DRG	Syncope & Collapse	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
314	MS_DRG	Other Circulatory System Diagnoses With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
262	MS_DRG	Cardiac Pacemaker Revision Except Device Replacement Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
251	MS_DRG	Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
278	MS_DRG	Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
284	MS_DRG	Acute Myocardial Infarction, Expired With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
232	MS_DRG	Coronary Bypass With Ptca Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
287	MS_DRG	Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
296	MS_DRG	Cardiac Arrest, Unexplained With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
209	MS_DRG	Complex Aortic Arch Procedures	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
272	MS_DRG	Other Major Cardiovascular Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
117	MS_DRG	Intraocular Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
24	MS_DRG	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
253	MS_DRG	Other Vascular Procedures With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
27	MS_DRG	Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
291	MS_DRG	Heart Failure And Shock With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
194	MS_DRG	Simple Pneumonia & Pleurisy With Complication	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
263	MS_DRG	Vein Ligation And Stripping	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
233	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
205	MS_DRG	Other Respiratory System Diagnoses With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
189	MS_DRG	Pulmonary Edema & Respiratory Failure	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
252	MS_DRG	Other Vascular Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
219	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
136	MS_DRG	Sinus And Mastoid Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
218	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
288	MS_DRG	Acute And Subacute Endocarditis With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
275	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
182	MS_DRG	Respiratory Neoplasms Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
235	MS_DRG	Coronary Bypass Without Cardiac Catheterization With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
200	MS_DRG	Pneumothorax With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
239	MS_DRG	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
185	MS_DRG	Major Chest Trauma Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
292	MS_DRG	Heart Failure & Shock With Complication	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
173	MS_DRG	Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
157	MS_DRG	Dental And Oral Diseases With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
150	MS_DRG	Epistaxis With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
135	MS_DRG	Sinus And Mastoid Procedures With Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
202	MS_DRG	Bronchitis & Asthma With Complication/comorbity	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
217	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
259	MS_DRG	Cardiac Pacemaker Device Replacement Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
J7613	HCPCS	Albuterol Sulfate	8	7	$14.00	$7.00 50% off	$5.46	$5,791.08	$5,791.08	2026-07-15
148	MS_DRG	Ear, Nose, Mouth And Throat Malignancy Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
28	MS_DRG	Spinal Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
293	MS_DRG	Heart Failure And Shock Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
302	MS_DRG	Atherosclerosis With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
307	MS_DRG	Cardiac Congenital And Valvular Disorders Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
315	MS_DRG	Other Circulatory System Diagnoses With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
229	MS_DRG	Other Cardiothoracic Procedures Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
241	MS_DRG	Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
25	MS_DRG	Craniotomy And Endovascular Intracranial Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
199	MS_DRG	Pneumothorax With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
256	MS_DRG	Upper Limb And Toe Amputation For Circulatory System Disorders With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
277	MS_DRG	Cardiac Defibrillator Implant Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
298	MS_DRG	Cardiac Arrest, Unexplained Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
242	MS_DRG	Permanent Cardiac Pacemaker Implant With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
240	MS_DRG	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
267	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
167	MS_DRG	Other Respiratory System O.r. Procedures With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
280	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
281	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
303	MS_DRG	Atherosclerosis Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
236	MS_DRG	Coronary Bypass Without Cardiac Catheterization Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
215	MS_DRG	Other Heart Assist System Implant	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
243	MS_DRG	Permanent Cardiac Pacemaker Implant With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
2	MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
164	MS_DRG	Major Chest Procedures With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
276	MS_DRG	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
283	MS_DRG	Acute Myocardial Infarction, Expired With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
180	MS_DRG	Respiratory Neoplasms With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
168	MS_DRG	Other Respiratory System O.r. Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
23	MS_DRG	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
190	MS_DRG	Chronic Obstructive Pulmonary Disease With Comorbity	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
192	MS_DRG	Chronic Obstructive Pulmonary Disease Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
31720	CPT	Insertion Of Tube Into Airway For Aspiration Of Secretions	14	7	$212.00	$106.00 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
114	MS_DRG	Orbital Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
147	MS_DRG	Ear, Nose, Mouth And Throat Malignancy With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
140	MS_DRG	Major Head And Neck Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
158	MS_DRG	Dental And Oral Diseases With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
G0237	HCPCS	Therapeutic Procd Strg Endur	7	7	$76.00	$38.00 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
266	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
282	MS_DRG	Acute Myocardial Infarction, Discharged Alive Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
14	MS_DRG	Allogeneic Bone Marrow Transplant	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
163	MS_DRG	Major Chest Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
286	MS_DRG	Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
290	MS_DRG	Acute And Subacute Endocarditis Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
304	MS_DRG	Hypertension With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
100	MS_DRG	Seizures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
149	MS_DRG	Dysequilibrium	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
101	MS_DRG	Seizures Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
94781	CPT	Cars/bd Tst Inft-12mo +30min	7	7	$39.00	$19.50 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
213	MS_DRG	Endovascular Abdominal Aorta With Iliac Branch Procedures	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
145	MS_DRG	Other Ear, Nose, Mouth And Throat O.r. Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
103	MS_DRG	Headaches Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
102	MS_DRG	Headaches With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
191	MS_DRG	Chronic Obstructive Pulmonary Disease With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
166	MS_DRG	Other Respiratory System O.r. Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
151	MS_DRG	Epistaxis Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
179	MS_DRG	Respiratory Infections And Inflammations Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
228	MS_DRG	Other Cardiothoracic Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
94002	CPT	Initial Hospital Inpatient Or Observation Ventilation Assistance And Management	21	7	$1,891.00	$945.50 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
221	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
22	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
10	MS_DRG	Pancreas Transplant	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
94667	CPT	Initial Therapy Service To Facilitate Lung Function	21	7	$163.00	$81.50 50% off	$65.20	$5,791.08	$5,791.08	2026-07-15
J7500	HCPCS	azaTHIOprine	7	7	$42.00	$21.00 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
142	MS_DRG	Major Head And Neck Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
A9579	HCPCS	Prohance	9	7	$191.05	$95.53 50% off	$26.99	$5,791.08	$5,791.08	2026-07-15
21	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
231	MS_DRG	Coronary Bypass With Ptca With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
26	MS_DRG	Craniotomy And Endovascular Intracranial Procedures With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
94644	CPT	Cbt 1st Hour	7	7	$331.00	$165.50 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
257	MS_DRG	Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
197	MS_DRG	Interstitial Lung Disease With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
204	MS_DRG	Respiratory Signs And Symptoms	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
165	MS_DRG	Major Chest Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
206	MS_DRG	Other Respiratory System Diagnoses Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
116	MS_DRG	Intraocular Procedures With Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
264	MS_DRG	Other Circulatory System O.r. Procedures	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
187	MS_DRG	Pleural Effusion With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
17	MS_DRG	Autologous Bone Marrow Transplant Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
121	MS_DRG	Acute Major Eye Infections With Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
208	MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
154	MS_DRG	Other Ear, Nose, Mouth And Throat Diagnoses With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
254	MS_DRG	Other Vascular Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
159	MS_DRG	Dental And Oral Diseases Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
144	MS_DRG	Other Ear, Nose, Mouth And Throat O.r. Procedures With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
12	MS_DRG	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
177	MS_DRG	Respiratory Infections & Inflammations With Comorbity	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
146	MS_DRG	Ear, Nose, Mouth And Throat Malignancy With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
193	MS_DRG	Simple Pneumonia And Pleurisy With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
255	MS_DRG	Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
308	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
203	MS_DRG	Bronchitis And Asthma Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
J7608	HCPCS	Acetylcysteine	7	7	$84.00	$42.00 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
309	MS_DRG	Cardiac Arrhythmia & Conduction Disorders With Complication	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
155	MS_DRG	Other Ear, Nose, Mouth And Throat Diagnoses With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
183	MS_DRG	Major Chest Trauma With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
141	MS_DRG	Major Head And Neck Procedures With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
188	MS_DRG	Pleural Effusion Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
186	MS_DRG	Pleural Effusion With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
115	MS_DRG	Extraocular Procedures Except Orbit	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
178	MS_DRG	Respiratory Infections & Inflammations With Complication	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
153	MS_DRG	Otitis Media And Uri Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
220	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
122	MS_DRG	Acute Major Eye Infections Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
176	MS_DRG	Pulmonary Embolism Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
143	MS_DRG	Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
234	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
20	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
124	MS_DRG	Other Disorders Of The Eye With Mcc Or Thrombolytic Agent	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
184	MS_DRG	Major Chest Trauma With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
195	MS_DRG	Simple Pneumonia And Pleurisy Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
269	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
270	MS_DRG	Other Major Cardiovascular Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
123	MS_DRG	Neurological Eye Disorders	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
301	MS_DRG	Peripheral Vascular Disorders Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
212	MS_DRG	Concomitant Aortic And Mitral Valve Procedures	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
274	MS_DRG	Percutaneous And Other Intracardiac Procedures Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
279	MS_DRG	Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
A9575	HCPCS	Dotarem	7	7	$221.85	$110.93 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
244	MS_DRG	Permanent Cardiac Pacemaker Implant Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
13	MS_DRG	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
198	MS_DRG	Interstitial Lung Disease Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
175	MS_DRG	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
125	MS_DRG	Other Disorders Of The Eye Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
265	MS_DRG	Aicd Lead Procedures	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
29	MS_DRG	Spinal Procedures With Cc Or Spinal Neurostimulators	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
305	MS_DRG	Hypertension Without Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
J7644	HCPCS	Ipratropium Bromide	8	7	$20.00	$10.00 50% off	$8.00	$5,791.08	$5,791.08	2026-07-15
94003	CPT	Vent Mgmt Inpat Subq Day	7	7	$1,513.00	$756.50 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
271	MS_DRG	Other Major Cardiovascular Procedures With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
J8540	HCPCS	dexAMETHasone	9	7	$16.00	$8.00 50% off	$20.58	$5,791.08	$5,791.08	2026-07-15
Q4154	HCPCS	Biovance 1 Square Cm	7	7	$265.00	$132.50 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
152	MS_DRG	Otitis Media And Uri With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
181	MS_DRG	Respiratory Neoplasms With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
260	MS_DRG	Cardiac Pacemaker Revision Except Device Replacement With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
261	MS_DRG	Cardiac Pacemaker Revision Except Device Replacement With Cc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
285	MS_DRG	Acute Myocardial Infarction, Expired Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
S4990	HCPCS	Sunmark Nicotine Transdermal System	7	7	$17.00	$8.50 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
139	MS_DRG	Salivary Gland Procedures	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
94664	CPT	Evaluate Pt Use Of Inhaler	7	7	$166.00	$83.00 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
A9581	HCPCS	Eovist	7	7	$693.17	$346.59 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
J7633	HCPCS	Budesonide	8	7	$54.00	$27.00 50% off	$21.60	$5,791.08	$5,791.08	2026-07-15
J7614	HCPCS	Levalbuterol	7	7	$41.00	$20.50 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
137	MS_DRG	Mouth Procedures With Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
Q9958	HCPCS	Cystografin	7	7	$239.00	$119.50 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
G0238	HCPCS	Oth Resp Proc, Indiv	7	7	$76.00	$38.00 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
16	MS_DRG	Autologous Bone Marrow Transplant With Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
Q9967	HCPCS	Isovue-m 300	7	7	$437.96	$218.98 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
Q9963	HCPCS	Gastrografin	7	7	$249.00	$124.50 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
216	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
94668	CPT	Follow-up Therapy Service To Facilitate Lung Function	7	7	$136.00	$68.00 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
Q9966	HCPCS	Omnipaque 240	9	7	$70.00	$35.00 50% off	$27.30	$5,791.08	$5,791.08	2026-07-15
94780	CPT	Cars/bd Tst Inft-12mo 60 Min	7	7	$96.00	$48.00 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
94640	CPT	Inhalation Treatment For Airway Obstruction Or Sputum Production	28	7	$217.00	$108.50 50% off	$83.46	$5,791.08	$5,791.08	2026-07-15
113	MS_DRG	Orbital Procedures With Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
J7620	HCPCS	Ipratropium Bromide-albuterol Sulfate	9	7	$21.00	$10.50 50% off	$8.40	$5,791.08	$5,791.08	2026-07-15
138	MS_DRG	Mouth Procedures Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
94645	CPT	Cbt Each Addl Hour	7	7	$213.00	$106.50 50% off	$5,791.08	$5,791.08	$5,791.08	2026-07-15
156	MS_DRG	Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
94660	CPT	Therapy Procedure Using A Positive Pressure Ventilator	14	7	$886.00	$443.00 50% off	$354.40	$5,791.08	$5,791.08	2026-07-15
196	MS_DRG	Interstitial Lung Disease With Comorbity	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
273	MS_DRG	Percutaneous And Other Intracardiac Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
299	MS_DRG	Peripheral Vascular Disorders With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
31	MS_DRG	Ventricular Shunt Procedures With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
310	MS_DRG	Cardiac Arrhythmia & Conduction Disorders Without Complication/comorbity	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
11	MS_DRG	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
316	MS_DRG	Other Circulatory System Diagnoses Without Cc/mcc	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15
317	MS_DRG	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	1	1	—	—	$5,791.08	$5,791.08	$5,791.08	2026-07-15

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