Price Transparency Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

MT SAN RAFAEL HOSPITAL

Trinidad, CO · CCN 061321 · Rates published

33,188 distinct procedures filed
102 distinct payers
1,554,942 rate rows
2026-05-09 last MRF observed
Data quality

1,508,893 of 1,554,942 rate rows are consumer-grade (97.0%)

46,049 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
template filing: same amount across many unrelated codes — excluded 38,093
per-diem day rate — not a per-procedure price 4,678
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 2,207
placeholder amount (≤ $0.02) — excluded from medians 870
exceeds 10× this hospital's gross charge — excluded from medians 201
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/health-plan-documents/coverage-information/machine-readable/941105628-san-rafael-medical-center-standard-charges-ncal-en.csv
Found on page https://healthy.kaiserpermanente.org/northern-california/doctors-locations/price-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-17
Content fingerprint ee14db8ad0bfe326… · 215,532,055 bytes · first seen 2026-05-09

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
OTHER 		"Inj, Atidarsagene Autotemcel" 1 $4,632,500.00 $4,632,500.00 $4,632,500.00 nat. median
$4,505,000
1.0× median
J1414
OTHER 		Beqvez (fidanacogene Elaparvovec-dz 1 $3,815,000.00 $3,815,000.00 $3,815,000.00 nat. median
$3,710,000
1.0× median
J1411
OTHER 		"Inj, Hemgenix, Per Tx Dose" 1 $3,815,000.00 $3,815,000.00 $3,815,000.00 nat. median
$3,685,267
1.0× median
53010010
OTHER 		Etranacogene Dezaparvovec-drlb 1x10exp13 gc/mL Susp 1 Each Kit 1 $3,815,000.00 $3,815,000.00 $3,815,000.00 nat. median
$3,815,000
1.0× median
J1413
OTHER 		Inj Delandistrogene Mox Rokl 1 $3,383,360.00 $3,383,360.00 $3,383,360.00 nat. median
$3,327,860
1.0× median
J3394
OTHER 		"Inj, Lovotibeglogene Autotem" 1 $3,379,000.00 $3,379,000.00 $3,379,000.00 nat. median
$3,286,000
1.0× median
J3393
OTHER 		"Inj, Betibeglogene Autotemce" 1 $3,052,000.00 $3,052,000.00 $3,052,000.00 nat. median
$2,968,000
1.0× median
J3399
OTHER 		Inj Onase Abepar-xioi Treat 1 $2,737,307.00 $2,737,307.00 $2,737,307.00 nat. median
$2,472,216
1.1× median
J3392
OTHER 		Casgevy (exagamglogene Autotemcel) 1 $2,398,000.00 $2,398,000.00 $2,398,000.00 nat. median
$2,332,000
1.0× median
Q2057
OTHER 		Tecelra (afamitresgene Autoleucel) 1 $792,430.00 $792,430.00 $792,430.00 nat. median
$770,620
1.0× median
Q2056
OTHER 		Ciltacabtagene Car-pos T 1 $605,288.00 $605,288.00 $605,288.00 nat. median
$583,076
1.0× median
Q2055
OTHER 		Idecabtagene Vicleucel Auto Bcma Dir Car-pos Tc 1 $575,861.00 $575,861.00 $575,861.00 nat. median
$558,082
1.0× median
73153090001
OTHER 		Lisocabtagene maraleuceL 1.5 X To 70 X 10exp6 cell/mL Susp 1 Each Vial 1 $567,588.00 $567,588.00 $567,588.00 nat. median
$567,588
1.0× median
Q2054
OTHER 		Lisocabtagene Mara Car Pos T 1 $567,588.00 $567,588.00 $567,588.00 nat. median
$562,538
1.0× median
Q2042
OTHER 		Tisagenlecleucel Car-pos T 1 $557,936.00 $557,936.00 $557,936.00 nat. median
$591,726
0.9× median
Q2041
OTHER 		"axicabtagene Ciloleucel Car+, Per Infusion" 1 $548,902.00 $548,902.00 $548,902.00 nat. median
$533,230
1.0× median
Q2053
OTHER 		Brexucabtagene Car Pos T 1 $503,580.00 $503,580.00 $503,580.00 nat. median
$489,720
1.0× median
Q2058
OTHER 		Obecbtge Autol Up To 400 Mil 1 $294,709.00 $294,709.00 $294,709.00 nat. median
$281,111
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other I 1 $264,576.17 $264,576.17 $264,576.17 nat. median
$370,174
0.7× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System 1 $171,699.28 $171,699.28 $171,699.28 nat. median
$265,286
0.6× median
0100T
OTHER 		Plmt Scjncl Rta Prosth&pls&impltj Intra-oc Rta 1 $137,655.43 $412,142.00 $145,073.98 nat. median
$10,612
outlier · 13.7×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >9 1 $130,812.11 $130,812.11 $130,812.11 nat. median
$206,368
0.6× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principa 1 $130,044.41 $130,044.41 $130,044.41 nat. median
$202,986
0.6× median
72893000704
OTHER 		Yttrium-90-ibritumomab 3.2 Mg/2 Ml Kit 1 Each Vial 1 $93,567.00 $157,192.00 $93,567.00 nat. median
$93,567
1.0× median
A9543
OTHER 		Yttrium Y-90 Ibritumomab Tiuxetan Tx To 40 Mci 1 $93,567.00 $157,192.00 $93,567.00 nat. median
$66,156
1.4× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagno 1 $84,865.96 $84,865.96 $84,865.96 nat. median
$133,176
0.6× median
7
MS_DRG 		Lung Transplant 1 $79,344.42 $79,344.42 $79,344.42 nat. median
$122,708
0.6× median
38240
OTHER 		Trnsplj Allogeneic Hematopoietic Cells Per Donor 1 $71,467.00 $223,801.00 $75,088.00 nat. median
$18,374
outlier · 4.1×
14
MS_DRG 		Allogeneic Bone Marrow Transplant 1 $73,632.31 $73,632.31 $73,632.31 nat. median
$117,303
0.6× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System 1 $69,428.66 $69,428.66 $69,428.66 nat. median
$108,660
0.6× median
209
MS_DRG 		Complex Aortic Arch Procedures 1 $69,349.01 $69,349.01 $69,349.01 nat. median
$98,017
0.7× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spi 1 $67,525.64 $67,525.64 $67,525.64 nat. median
$98,905
0.7× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 1 $66,624.38 $66,624.38 $66,624.38 nat. median
$102,358
0.7× median
55566105000
OTHER 		Nadofaragene Firadenovec-vncg 3x10exp11 vp/mL Susp 1 Each Vial 1 $63,431.00 $106,564.00 $63,431.00 nat. median
$63,431
1.0× median
J9029
OTHER 		"Instill Adstiladrin, Tx Dose" 1 $63,431.00 $106,564.00 $63,431.00 nat. median
$66,509
1.0× median
J2350
CPT 		Ocrelizumab 30mg/ml 93 $4,000.00 $65,834.00 $63,200.64 nat. median
$712
outlier · 88.8×
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 1 $63,171.26 $63,171.26 $63,171.26 nat. median
$100,136
0.6× median
215
MS_DRG 		Other Heart Assist System Implant 1 $61,005.41 $61,005.41 $61,005.41 nat. median
$99,019
0.6× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Proce 1 $59,938.11 $59,938.11 $59,938.11 nat. median
$93,672
0.6× median
A9699
OTHER 		Radiopharmaceutical Therapeutic Noc 1 $59,004.00 $99,127.00 $59,004.00 nat. median
$258
outlier · 229.0×
33276
OTHER 		Insertion Phrenic Nerve Stimulator System 1 $54,378.00 $170,287.00 $57,134.00 nat. median
$43,556
1.3× median
30237890006
OTHER 		Sipuleucel-t In Lr 50 Million Cell/250 Ml Susp 250 Ml Bag 1 $55,946.00 $93,989.00 $55,946.00 nat. median
$62,565
0.9× median
Q2043
OTHER 		Sipuleucel-t Auto Cd54+ 1 $55,946.00 $93,989.00 $55,946.00 nat. median
$55,946
1.0× median
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fu 1 $55,200.80 $55,200.80 $55,200.80 nat. median
$82,712
0.7× median
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With 1 $54,292.79 $54,292.79 $54,292.79 nat. median
$87,411
0.6× median
850
MS_DRG 		Acute Leukemia With Other Procedures 1 $53,055.77 $53,055.77 $53,055.77 nat. median
$83,442
0.6× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 1 $51,649.04 $51,649.04 $51,649.04 nat. median
$79,312
0.7× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvatur 1 $51,486.68 $51,486.68 $51,486.68 nat. median
$81,118
0.6× median
71258001522
OTHER 		Iobenguane I-131 337.5 mCi/22.5 Ml Soln 1 Each Vial 1 $47,673.91 $142,736.25 $50,243.16 nat. median
$50,243
1.0× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Di 1 $48,211.25 $48,211.25 $48,211.25 nat. median
$77,576
0.6× median

Other procedures at this hospital

Browse this hospital's 33,188 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J3391 OTHER "Inj, Atidarsagene Autotemcel" 3 1 — — $4,632,500.00 $4,632,500.00 $4,632,500.00 2026-05-09
J1414 OTHER Beqvez (fidanacogene Elaparvovec-dz 3 1 — — $3,815,000.00 $3,815,000.00 $3,815,000.00 2026-05-09
J1411 OTHER "Inj, Hemgenix, Per Tx Dose" 3 1 — — $3,815,000.00 $3,815,000.00 $3,815,000.00 2026-05-09
53010010 OTHER Etranacogene Dezaparvovec-drlb 1x10exp13 gc/mL Susp 1 Each Kit 3 1 — $4,704,002.80 $3,815,000.00 $3,815,000.00 $3,815,000.00 2026-05-09
J1413 OTHER Inj Delandistrogene Mox Rokl 3 1 — — $3,383,360.00 $3,383,360.00 $3,383,360.00 2026-05-09
J3394 OTHER "Inj, Lovotibeglogene Autotem" 3 1 — — $3,379,000.00 $3,379,000.00 $3,379,000.00 2026-05-09
J3393 OTHER "Inj, Betibeglogene Autotemce" 3 1 — — $3,052,000.00 $3,052,000.00 $3,052,000.00 2026-05-09
J3399 OTHER Inj Onase Abepar-xioi Treat 3 1 — — $2,737,307.00 $2,737,307.00 $2,737,307.00 2026-05-09
J3392 OTHER Casgevy (exagamglogene Autotemcel) 3 1 — — $2,398,000.00 $2,398,000.00 $2,398,000.00 2026-05-09
Q2057 OTHER Tecelra (afamitresgene Autoleucel) 3 1 — — $792,430.00 $792,430.00 $792,430.00 2026-05-09
Q2056 OTHER Ciltacabtagene Car-pos T 3 1 — — $605,288.00 $605,288.00 $605,288.00 2026-05-09
Q2055 OTHER Idecabtagene Vicleucel Auto Bcma Dir Car-pos Tc 3 1 $1,296,255.00 $725,902.80 44% off $575,861.00 $575,861.00 $575,861.00 2026-05-09
Q2054 OTHER Lisocabtagene Mara Car Pos T 3 1 — — $567,588.00 $567,588.00 $567,588.00 2026-05-09
73153090001 OTHER Lisocabtagene maraleuceL 1.5 X To 70 X 10exp6 cell/mL Susp 1 Each Vial 3 1 $1,472,908.31 $824,828.65 44% off $567,588.00 $567,588.00 $567,588.00 2026-05-09
Q2042 OTHER Tisagenlecleucel Car-pos T 3 1 — — $557,936.00 $557,936.00 $557,936.00 2026-05-09
Q2041 OTHER "axicabtagene Ciloleucel Car+, Per Infusion" 3 1 $658,682.00 $368,861.92 44% off $548,902.00 $548,902.00 $548,902.00 2026-05-09
Q2053 OTHER Brexucabtagene Car Pos T 3 1 — — $503,580.00 $503,580.00 $503,580.00 2026-05-09
Q2058 OTHER Obecbtge Autol Up To 400 Mil 3 1 — — $294,709.00 $294,709.00 $294,709.00 2026-05-09
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other I 1 1 — — $264,576.17 $264,576.17 $264,576.17 2026-03-31
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System 1 1 — — $171,699.28 $171,699.28 $171,699.28 2026-03-31
0100T OTHER Plmt Scjncl Rta Prosth&pls&impltj Intra-oc Rta 3 1 $873,740.00 $489,294.40 44% off $137,655.43 $412,142.00 $145,073.98 2026-05-09
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >9 1 1 — — $130,812.11 $130,812.11 $130,812.11 2026-03-31
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principa 1 1 — — $130,044.41 $130,044.41 $130,044.41 2026-03-31
A9543 OTHER Yttrium Y-90 Ibritumomab Tiuxetan Tx To 40 Mci 3 1 $169,668.00 $95,014.08 44% off $93,567.00 $157,192.00 $93,567.00 2026-05-09
72893000704 OTHER Yttrium-90-ibritumomab 3.2 Mg/2 Ml Kit 1 Each Vial 3 1 $195,328.32 $109,383.86 44% off $93,567.00 $157,192.00 $93,567.00 2026-05-09
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagno 1 1 — — $84,865.96 $84,865.96 $84,865.96 2026-03-31
7 MS_DRG Lung Transplant 1 1 — — $79,344.42 $79,344.42 $79,344.42 2026-03-31
38240 OTHER Trnsplj Allogeneic Hematopoietic Cells Per Donor 3 1 $106,060.00 $59,393.60 44% off $71,467.00 $223,801.00 $75,088.00 2026-05-09
14 MS_DRG Allogeneic Bone Marrow Transplant 1 1 — — $73,632.31 $73,632.31 $73,632.31 2026-03-31
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System 1 1 — — $69,428.66 $69,428.66 $69,428.66 2026-03-31
209 MS_DRG Complex Aortic Arch Procedures 1 1 — — $69,349.01 $69,349.01 $69,349.01 2026-03-31
426 MS_DRG Multiple Level Combined Anterior And Posterior Spi 1 1 — — $67,525.64 $67,525.64 $67,525.64 2026-03-31
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 1 1 — — $66,624.38 $66,624.38 $66,624.38 2026-03-31
J9029 OTHER "Instill Adstiladrin, Tx Dose" 3 1 — — $63,431.00 $106,564.00 $63,431.00 2026-05-09
55566105000 OTHER Nadofaragene Firadenovec-vncg 3x10exp11 vp/mL Susp 1 Each Vial 3 1 $43,853.00 $24,557.68 44% off $63,431.00 $106,564.00 $63,431.00 2026-05-09
J2350 CPT Ocrelizumab 30mg/ml 168 93 $65,834.00 — $4,000.00 $65,834.00 $63,200.64 2026-03-31
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 1 1 — — $63,171.26 $63,171.26 $63,171.26 2026-03-31
215 MS_DRG Other Heart Assist System Implant 1 1 — — $61,005.41 $61,005.41 $61,005.41 2026-03-31
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Proce 1 1 — — $59,938.11 $59,938.11 $59,938.11 2026-03-31
A9699 OTHER Radiopharmaceutical Therapeutic Noc 3 1 $154,842.00 $86,711.52 44% off $59,004.00 $99,127.00 $59,004.00 2026-05-09
33276 OTHER Insertion Phrenic Nerve Stimulator System 3 1 $222,540.00 $124,622.40 44% off $54,378.00 $170,287.00 $57,134.00 2026-05-09
Q2043 OTHER Sipuleucel-t Auto Cd54+ 3 1 — — $55,946.00 $93,989.00 $55,946.00 2026-05-09
30237890006 OTHER Sipuleucel-t In Lr 50 Million Cell/250 Ml Susp 250 Ml Bag 3 1 $180,340.20 $100,990.51 44% off $55,946.00 $93,989.00 $55,946.00 2026-05-09
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fu 1 1 — — $55,200.80 $55,200.80 $55,200.80 2026-03-31
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With 1 1 — — $54,292.79 $54,292.79 $54,292.79 2026-03-31
850 MS_DRG Acute Leukemia With Other Procedures 1 1 — — $53,055.77 $53,055.77 $53,055.77 2026-03-31
231 MS_DRG Coronary Bypass With Ptca With Mcc 1 1 — — $51,649.04 $51,649.04 $51,649.04 2026-03-31
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvatur 1 1 — — $51,486.68 $51,486.68 $51,486.68 2026-03-31
71258001522 OTHER Iobenguane I-131 337.5 mCi/22.5 Ml Soln 1 Each Vial 3 1 $285,472.50 $159,864.60 44% off $47,673.91 $142,736.25 $50,243.16 2026-05-09
20 MS_DRG Intracranial Vascular Procedures With Principal Di 1 1 — — $48,211.25 $48,211.25 $48,211.25 2026-03-31
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Proce 1 1 — — $47,044.07 $47,044.07 $47,044.07 2026-03-31
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Cathete 1 1 — — $46,911.12 $46,911.12 $46,911.12 2026-03-31
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Op 1 1 — — $46,841.27 $46,841.27 $46,841.27 2026-03-31
957 MS_DRG Other O.r. Procedures For Multiple Significant Tra 1 1 — — $46,686.27 $46,686.27 $46,686.27 2026-03-31
67979000201 OTHER Histrelin 50 Mg (65 Mcg/day) Kit 1 Each Kit 3 1 $144,528.07 $80,935.72 44% off $45,560.00 $76,541.00 $45,560.00 2026-05-09
0620T OTHER Endovascular Venous Arterialization Tibl/prnl Vn 3 1 $101,610.00 $56,901.60 44% off $42,294.00 $132,446.00 $44,437.00 2026-05-09
427 MS_DRG Multiple Level Combined Anterior And Posterior Spi 1 1 — — $44,227.55 $44,227.55 $44,227.55 2026-03-31
10 MS_DRG Pancreas Transplant 1 1 — — $43,964.69 $43,964.69 $43,964.69 2026-03-31
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation 1 1 — — $43,946.32 $43,946.32 $43,946.32 2026-03-31
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With H 1 1 — — $43,712.88 $43,712.88 $43,712.88 2026-03-31
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Cathete 1 1 — — $43,687.15 $43,687.15 $43,687.15 2026-03-31
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Cathete 1 1 — — $43,434.72 $43,434.72 $43,434.72 2026-03-31
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 1 1 — — $42,347.81 $42,347.81 $42,347.81 2026-03-31
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsatio 1 1 — — $42,140.11 $42,140.11 $42,140.11 2026-03-31
955 MS_DRG Craniotomy For Multiple Significant Trauma 1 1 — — $41,240.68 $41,240.68 $41,240.68 2026-03-31
317 MS_DRG Concomitant Left Atrial Appendage Closure And Card 1 1 — — $40,967.43 $40,967.43 $40,967.43 2026-03-31
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With 1 1 — — $40,937.40 $40,937.40 $40,937.40 2026-03-31
0408T OTHER Insj/rplc Cardiac Modulj Sys 3 1 — — $38,743.00 $121,324.00 $40,706.00 2026-05-09
33264 OTHER Rmvl Impltbl Dfb Pls Gen W/rplcmt Pls Gen Mlt Ld 3 1 $100,870.00 $56,487.20 44% off $38,743.00 $121,324.00 $40,706.00 2026-05-09
33231 OTHER Insj Implntbl Defib Pulse Gen W/exist Multileads 3 1 $108,350.00 $60,676.00 44% off $38,743.00 $121,324.00 $40,706.00 2026-05-09
0571T OTHER Insj/rplcmt Icds W/substernal Electrode 3 1 $47,040.00 $26,342.40 44% off $38,743.00 $121,324.00 $40,706.00 2026-05-09
33249 OTHER Insj/rplcmt Perm Dfb W/trnsvns Lds 1/dual Chmbr 3 1 $62,180.00 $34,820.80 44% off $38,743.00 $121,324.00 $40,706.00 2026-05-09
33270 OTHER Ins/rplcmnt Perm Subq Impltbl Dfb W/subq Eltrd 3 1 $143,270.00 $80,231.20 44% off $38,743.00 $121,324.00 $40,706.00 2026-05-09
459 MS_DRG Spinal Fusion Except Cervical With Mcc 1 1 — — $40,635.35 $40,635.35 $40,635.35 2026-03-31
J1932 CPT Laneotide 120mg .5ml 161 93 $42,695.00 — $4,000.00 $42,695.00 $40,560.25 2026-03-31
69930 OTHER Cochlear Device Implantation W/wo Mastoidectomy 3 1 $70,640.00 $39,558.40 44% off $38,436.00 $120,364.00 $40,384.00 2026-05-09
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Proce 1 1 — — $40,286.11 $40,286.11 $40,286.11 2026-03-31
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Proce 1 1 — — $40,286.11 $40,286.11 $40,286.11 2026-03-31
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 1 1 — — $40,139.68 $40,139.68 $40,139.68 2026-03-31
207 MS_DRG Respiratory System Diagnosis With Ventilator Suppo 1 1 — — $39,424.67 $39,424.67 $39,424.67 2026-03-31
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Cath 1 1 — — $39,217.58 $39,217.58 $39,217.58 2026-03-31
17156006730 OTHER flutemetamoL F-18 5 mCi (185 MBq) Soln 1 Each Vial 2 1 $10,029.00 $5,616.24 44% off $38,099.55 $40,152.82 $39,126.18 2026-05-09
64582 OTHER Open Impltj Hpglsl Nrv Nstim Ra Pg&respir Sensor 3 1 $118,490.00 $66,354.40 44% off $36,824.00 $115,316.00 $38,690.00 2026-05-09
64568 OTHER Open Implantation Cranial Nerve Nea & Pulse Gen 3 1 $63,390.00 $35,498.40 44% off $36,824.00 $115,316.00 $38,690.00 2026-05-09
33287 OTHER Rmvl&rplcmt Phrenic Nrv Stimulator Pls Generator 3 1 $97,990.00 $54,874.40 44% off $36,824.00 $115,316.00 $38,690.00 2026-05-09
61886 OTHER Insj/rplcmt Cranial Neurostim Gener 2/> Eltrds 3 1 $41,540.00 $23,262.40 44% off $36,824.00 $115,316.00 $38,690.00 2026-05-09
63685 OTHER Insj/rplcmt Spinal Npg/rcvr Pocket Crtj&connj 3 1 $41,540.00 $23,262.40 44% off $36,824.00 $115,316.00 $38,690.00 2026-05-09
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplem 1 1 — — $37,548.01 $37,548.01 $37,548.01 2026-03-31
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 1 1 — — $37,504.51 $37,504.51 $37,504.51 2026-03-31
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With 1 1 — — $37,473.87 $37,473.87 $37,473.87 2026-03-31
232 MS_DRG Coronary Bypass With Ptca Without Mcc 1 1 — — $37,144.86 $37,144.86 $37,144.86 2026-03-31
28 MS_DRG Spinal Procedures With Mcc 1 1 — — $36,812.17 $36,812.17 $36,812.17 2026-03-31
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid 1 1 — — $36,801.75 $36,801.75 $36,801.75 2026-03-31
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvatur 1 1 — — $36,535.24 $36,535.24 $36,535.24 2026-03-31
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrom 1 1 — — $36,415.15 $36,415.15 $36,415.15 2026-03-31
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 1 1 — — $36,330.60 $36,330.60 $36,330.60 2026-03-31
33289 OTHER Tcat Impl Wrls P-art Prs Snr L-t Hemodyn Mntr 3 1 $84,190.00 $47,146.40 44% off $34,352.00 $107,576.00 $36,093.00 2026-05-09
235 MS_DRG Coronary Bypass Without Cardiac Catheterization Wi 1 1 — — $35,956.24 $35,956.24 $35,956.24 2026-03-31
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures W 1 1 — — $35,932.97 $35,932.97 $35,932.97 2026-03-31
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fu 1 1 — — $35,334.36 $35,334.36 $35,334.36 2026-03-31
23 MS_DRG Craniotomy With Major Device Implant Or Acute Comp 1 1 — — $35,108.89 $35,108.89 $35,108.89 2026-03-31
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Pro 1 1 — — $34,965.53 $34,965.53 $34,965.53 2026-03-31
463 MS_DRG Wound Debridement And Skin Graft Except Hand For M 1 1 — — $34,920.19 $34,920.19 $34,920.19 2026-03-31
C9760 OTHER Nrnd Nbld Pd Nyha Cls Ii Iii IV Hf; 3 1 — — $33,231.00 $104,065.00 $34,915.00 2026-05-09
428 MS_DRG Multiple Level Combined Anterior And Posterior Spi 1 1 — — $34,445.35 $34,445.35 $34,445.35 2026-03-31
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 1 1 — — $34,338.75 $34,338.75 $34,338.75 2026-03-31
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of P 1 1 — — $34,103.47 $34,103.47 $34,103.47 2026-03-31
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lo 1 1 — — $33,838.79 $33,838.79 $33,838.79 2026-03-31
Q0480 OTHER Driver For Use With Pneumatic Vad Repl Only 3 1 $191,402.00 $107,185.12 44% off $31,964.13 $95,701.00 $33,686.75 2026-05-09
834 MS_DRG Acute Leukemia With Mcc 1 1 — — $33,635.99 $33,635.99 $33,635.99 2026-03-31
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 1 1 — — $33,517.12 $33,517.12 $33,517.12 2026-03-31
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Op 1 1 — — $33,469.34 $33,469.34 $33,469.34 2026-03-31
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or 1 1 — — $33,416.65 $33,416.65 $33,416.65 2026-03-31
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 1 1 — — $33,283.08 $33,283.08 $33,283.08 2026-03-31
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Proce 1 1 — — $32,673.45 $32,673.45 $32,673.45 2026-03-31
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mc 1 1 — — $32,653.85 $32,653.85 $32,653.85 2026-03-31
21 MS_DRG Intracranial Vascular Procedures With Principal Di 1 1 — — $32,434.51 $32,434.51 $32,434.51 2026-03-31
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 1 1 — — $32,327.28 $32,327.28 $32,327.28 2026-03-31
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Cathete 1 1 — — $31,974.38 $31,974.38 $31,974.38 2026-03-31
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 1 1 — — $31,892.89 $31,892.89 $31,892.89 2026-03-31
653 MS_DRG Major Bladder Procedures With Mcc 1 1 — — $31,837.75 $31,837.75 $31,837.75 2026-03-31
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Cathete 1 1 — — $30,987.95 $30,987.95 $30,987.95 2026-03-31
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Proce 1 1 — — $30,880.73 $30,880.73 $30,880.73 2026-03-31
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Cath 1 1 — — $30,761.25 $30,761.25 $30,761.25 2026-03-31
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With M 1 1 — — $30,557.22 $30,557.22 $30,557.22 2026-03-31
228 MS_DRG Other Cardiothoracic Procedures With Mcc 1 1 — — $30,312.16 $30,312.16 $30,312.16 2026-03-31
853 MS_DRG Infectious And Parasitic Diseases With O.r. Proced 1 1 — — $30,258.23 $30,258.23 $30,258.23 2026-03-31
239 MS_DRG Amputation For Circulatory System Disorders Except 1 1 — — $30,154.69 $30,154.69 $30,154.69 2026-03-31
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis Wit 1 1 — — $30,029.09 $30,029.09 $30,029.09 2026-03-31
471 MS_DRG Cervical Spinal Fusion With Mcc 1 1 — — $29,584.90 $29,584.90 $29,584.90 2026-03-31
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diag 1 1 — — $29,435.40 $29,435.40 $29,435.40 2026-03-31
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplem 1 1 — — $29,168.88 $29,168.88 $29,168.88 2026-03-31
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 1 1 — — $28,804.94 $28,804.94 $28,804.94 2026-03-31
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal D 1 1 — — $28,746.11 $28,746.11 $28,746.11 2026-03-31
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentia 1 1 — — $28,660.35 $28,660.35 $28,660.35 2026-03-31
0614T OTHER Rmvl&rplcmt Substernal Impltbl Defibrillator Pg 3 1 $28,600.00 $16,016.00 44% off $27,124.00 $84,939.00 $28,498.00 2026-05-09
33263 OTHER Rmvl Impltbl Dfb Plse Gen W/rplcmt Plse Gen 2 Ld 3 1 $133,910.00 $74,989.60 44% off $27,124.00 $84,939.00 $28,498.00 2026-05-09
33262 OTHER Rmvl Impltbl Dfb Plse Gen W/repl Plse Gen 1 Lead 3 1 $86,560.00 $48,473.60 44% off $27,124.00 $84,939.00 $28,498.00 2026-05-09
0414T OTHER Rmvl & Rpl Car Modulj Pls Gn 3 1 — — $27,124.00 $84,939.00 $28,498.00 2026-05-09
0515T OTHER Insertion Wrls Car Stimulator Lv Pacg Compl Sys 3 1 $91,970.00 $51,503.20 44% off $27,124.00 $84,939.00 $28,498.00 2026-05-09
33240 OTHER Insj Implntbl Defib Pulse Gen W/1 Existing Ld 3 1 $131,590.00 $73,690.40 44% off $27,124.00 $84,939.00 $28,498.00 2026-05-09
33230 OTHER Insj Implntbl Defib Pulse Gen W/exist Dual Leads 3 1 $48,580.00 $27,204.80 44% off $27,124.00 $84,939.00 $28,498.00 2026-05-09
0409T OTHER Insj/rplc Car Modulj Pls Gn 3 1 — — $27,124.00 $84,939.00 $28,498.00 2026-05-09
J9266 OTHER Pegaspargase Injection 3 1 — — $28,424.00 $47,752.00 $28,424.00 2026-05-09
72694095401 OTHER Pegaspargase In Sterile Diluent 750 Unit/ml Inj 5 Ml Vial 3 1 $79,203.32 $44,353.86 44% off $28,424.00 $47,752.00 $28,424.00 2026-05-09
6 MS_DRG Liver Transplant Without Mcc 1 1 — — $28,410.37 $28,410.37 $28,410.37 2026-03-31
69488000301 OTHER Lutetium Lu 177 Dotatate 10 mCi/mL (370 MBq/mL) Soln 1 Each Vial 3 1 $193,132.79 $108,154.36 44% off $26,891.26 $80,512.74 $28,340.48 2026-05-09
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 1 1 — — $28,297.02 $28,297.02 $28,297.02 2026-03-31
455 MS_DRG Combined Anterior And Posterior Spinal Fusion With 1 1 — — $28,217.98 $28,217.98 $28,217.98 2026-03-31
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 1 1 — — $28,162.23 $28,162.23 $28,162.23 2026-03-31
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedu 1 1 — — $28,090.54 $28,090.54 $28,090.54 2026-03-31
245 MS_DRG Aicd Generator Procedures 1 1 — — $27,953.30 $27,953.30 $27,953.30 2026-03-31
856 MS_DRG Postoperative Or Post-traumatic Infections With O. 1 1 — — $27,869.36 $27,869.36 $27,869.36 2026-03-31
25 MS_DRG Craniotomy And Endovascular Intracranial Procedure 1 1 — — $27,857.11 $27,857.11 $27,857.11 2026-03-31
799 MS_DRG Splenic Procedures With Mcc 1 1 — — $27,748.05 $27,748.05 $27,748.05 2026-03-31
163 MS_DRG Major Chest Procedures With Mcc 1 1 — — $27,459.47 $27,459.47 $27,459.47 2026-03-31
31 MS_DRG Ventricular Shunt Procedures With Mcc 1 1 — — $27,451.51 $27,451.51 $27,451.51 2026-03-31
319 MS_DRG Other Endovascular Cardiac Valve Procedures With M 1 1 — — $27,343.67 $27,343.67 $27,343.67 2026-03-31
63655 OTHER Lam Impltj Nstim Eltrds Plate/paddle Edrl 3 1 $32,740.00 $18,334.40 44% off $25,913.00 $81,149.00 $27,226.00 2026-05-09
64580 OTHER Open Implantation Nea Neuromuscular 3 1 $41,160.00 $23,049.60 44% off $25,913.00 $81,149.00 $27,226.00 2026-05-09
0817T OTHER Open Insj/rplcmt Integrated Nstimj Sys Ptn Subf 3 1 $69,030.00 $38,656.80 44% off $25,913.00 $81,149.00 $27,226.00 2026-05-09
0816T OTHER Open Insj/rplcmt Integrated Nstimj Sys Ptn Subq 3 1 $69,030.00 $38,656.80 44% off $25,913.00 $81,149.00 $27,226.00 2026-05-09
64590 OTHER Ins/rplc Perph Sac/gstrc Npg/rcvr Pckt Crtj&conn 3 1 $23,620.00 $13,227.20 44% off $25,913.00 $81,149.00 $27,226.00 2026-05-09
61891 OTHER Revj/rplcmt Skull-mntd Cranial Nstim Pg/receiver 3 1 $69,030.00 $38,656.80 44% off $25,913.00 $81,149.00 $27,226.00 2026-05-09
61885 OTHER Insj/rplcmt Cranial Neurostim Pulse Generator 3 1 $38,960.00 $21,817.60 44% off $25,913.00 $81,149.00 $27,226.00 2026-05-09
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 1 1 — — $26,914.18 $26,914.18 $26,914.18 2026-03-31
J9309 CPT Polivy 30mg Sdv 168 93 $27,747.50 — $4,000.00 $27,747.50 $26,637.60 2026-03-31
323 MS_DRG Coronary Intravascular Lithotripsy With Intralumin 1 1 — — $26,513.48 $26,513.48 $26,513.48 2026-03-31
230 MS_DRG Other Cardiothoracic Procedures Without Cc/mcc 1 1 — — $26,356.63 $26,356.63 $26,356.63 2026-03-31
474 MS_DRG Amputation For Musculoskeletal System And Connecti 1 1 — — $26,302.11 $26,302.11 $26,302.11 2026-03-31
140 MS_DRG Major Head And Neck Procedures With Mcc 1 1 — — $26,133.00 $26,133.00 $26,133.00 2026-03-31
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Witho 1 1 — — $25,982.89 $25,982.89 $25,982.89 2026-03-31
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsatio 1 1 — — $25,875.06 $25,875.06 $25,875.06 2026-03-31
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or 1 1 — — $25,830.95 $25,830.95 $25,830.95 2026-03-31
958 MS_DRG Other O.r. Procedures For Multiple Significant Tra 1 1 — — $25,818.09 $25,818.09 $25,818.09 2026-03-31
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 1 1 — — $25,742.72 $25,742.72 $25,742.72 2026-03-31
901 MS_DRG Wound Debridements For Injuries With Mcc 1 1 — — $25,712.09 $25,712.09 $25,712.09 2026-03-31
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Wi 1 1 — — $25,664.30 $25,664.30 $25,664.30 2026-03-31
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvatur 1 1 — — $25,565.05 $25,565.05 $25,565.05 2026-03-31
54416 OTHER Rmvl & Rplcmt Non-nfltbl/nfltbl Penile Prosthesi 3 1 $76,890.00 $43,058.40 44% off $24,323.00 $76,169.00 $25,556.00 2026-05-09
53444 OTHER Insertion Tandem Cuff 3 1 $53,070.00 $29,719.20 44% off $24,323.00 $76,169.00 $25,556.00 2026-05-09
53445 OTHER Insj Inflatable Urethral/bladder Neck Sphincter 3 1 $57,680.00 $32,300.80 44% off $24,323.00 $76,169.00 $25,556.00 2026-05-09
54410 OTHER Rmvl & Rplcmt Inflatable Penile Prosth Same Sess 3 1 $52,850.00 $29,596.00 44% off $24,323.00 $76,169.00 $25,556.00 2026-05-09
53447 OTHER Rmvl & Rplcmt Nfltl Urethral/bladder Neck Sphinc 3 1 $65,900.00 $36,904.00 44% off $24,323.00 $76,169.00 $25,556.00 2026-05-09
54401 OTHER Insj Penile Prosthesos Inflatable Self-contained 3 1 $69,750.00 $39,060.00 44% off $24,323.00 $76,169.00 $25,556.00 2026-05-09
54405 OTHER Insj Multi-component Inflatable Penile Prosth 3 1 $45,890.00 $25,698.40 44% off $24,323.00 $76,169.00 $25,556.00 2026-05-09
54411 OTHER Rmvl & Rplcmt Nfltbl Penile Prosth Infected Fiel 3 1 $73,480.00 $41,148.80 44% off $24,323.00 $76,169.00 $25,556.00 2026-05-09
793 MS_DRG Full Term Neonate With Major Problems 1 1 — — $25,546.66 $25,546.66 $25,546.66 2026-03-31
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures Wi 1 1 — — $25,444.96 $25,444.96 $25,444.96 2026-03-31
273 MS_DRG Percutaneous And Other Intracardiac Procedures Wit 1 1 — — $25,276.47 $25,276.47 $25,276.47 2026-03-31
791 MS_DRG Prematurity With Major Problems 1 1 — — $24,869.03 $24,869.03 $24,869.03 2026-03-31
402 MS_DRG Single Level Combined Anterior And Posterior Spina 1 1 — — $24,633.15 $24,633.15 $24,633.15 2026-03-31
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Formi 1 1 — — $24,410.12 $24,410.12 $24,410.12 2026-03-31
76128015575 OTHER Porfimer 75 Mg Recon Soln 1 Each Vial 3 1 $67,175.24 $37,618.13 44% off $24,229.00 $40,704.00 $24,229.00 2026-05-09
J9600 OTHER Porfimer Sodium Injection 3 1 — — $24,229.00 $40,704.00 $24,229.00 2026-05-09
0795T OTHER Tcat Ins 2chmbr Ldls Pm Cmpl 3 1 — — $23,045.00 $72,168.00 $24,213.00 2026-05-09
0801T OTHER Tcat Rmv&rpl 2chmbr Ldls Pm 3 1 — — $23,045.00 $72,168.00 $24,213.00 2026-05-09
0525T OTHER Insertion/replacement Complete Iims 3 1 $40,460.00 $22,657.60 44% off $23,045.00 $72,168.00 $24,213.00 2026-05-09
0802T OTHER Tcat Rmv&rpl2chmb Ldls Pm Ra 3 1 — — $23,045.00 $72,168.00 $24,213.00 2026-05-09
0825T OTHER Tcat Rmvl&rplcmt Perm 1chmbr Ldls Pm R Atrial 3 1 $61,490.00 $34,434.40 44% off $23,045.00 $72,168.00 $24,213.00 2026-05-09
33274 OTHER Tcat Insj/rpl Perm Leadless Pacemaker Rv W/img 3 1 $62,890.00 $35,218.40 44% off $23,045.00 $72,168.00 $24,213.00 2026-05-09
0797T OTHER Tcat Insj Perm 2chmbr Ldls Pm R Ventr Pm Compnt 3 1 $56,830.00 $31,824.80 44% off $23,045.00 $72,168.00 $24,213.00 2026-05-09
33221 OTHER Ins Pacemaker Pulse Gen Only W/exist Mult Leads 3 1 $35,220.00 $19,723.20 44% off $23,045.00 $72,168.00 $24,213.00 2026-05-09
33229 OTHER Remvl Perm Pm Pls Gen W/repl Plse Gen Mult Lead 3 1 $26,660.00 $14,929.60 44% off $23,045.00 $72,168.00 $24,213.00 2026-05-09
0823T OTHER Tcat Insj Perm 1chmbr Ldls Pacemaker R Atrial 3 1 $61,490.00 $34,434.40 44% off $23,045.00 $72,168.00 $24,213.00 2026-05-09
0803T OTHER Tcat Rmvl&rplcmt Prm 2chmbr Ldls Pm R Vntr Cmpnt 3 1 $56,830.00 $31,824.80 44% off $23,045.00 $72,168.00 $24,213.00 2026-05-09
0796T OTHER Tcat Ins 2chmbr Ldls Pm Ra 3 1 — — $23,045.00 $72,168.00 $24,213.00 2026-05-09
68403110006 OTHER Botulism Immune Globulin (human) 100 Mg Recon Soln 1 Each Vial 3 1 $137,525.00 $77,014.00 44% off $22,966.68 $68,762.50 $24,204.40 2026-05-09
99999015868 OTHER Botulism Immune Globulin (human) 100 Mg Recon Soln 1 Each Vial 3 1 $137,525.00 $77,014.00 44% off $22,966.68 $68,762.50 $24,204.40 2026-05-09
24 MS_DRG Craniotomy With Major Device Implant Or Acute Comp 1 1 — — $23,967.76 $23,967.76 $23,967.76 2026-03-31
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >9 1 1 — — $23,859.31 $23,859.31 $23,859.31 2026-03-31
37286 OTHER Revsc Evasc Tpvt St Plmt Uni Cplx Les 1st Vsl 3 1 $58,059.00 $32,513.04 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
37277 OTHER Revsc Evasc Fpvt St Athrc Uni Cplx Les 1st Vsl 3 1 $58,059.00 $32,513.04 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
37294 OTHER Revsc Evasc Tpvt St Athrc Uni Cplx Les 1st Vsl 3 1 $58,059.00 $32,513.04 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
37290 OTHER Revsc Evasc Tpvt Athrc Uni Cplx Les 1st Vsl 3 1 $58,059.00 $32,513.04 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
37273 OTHER Revsc Evasc Fpvt Athrc Uni Cplx Les 1st Vsl 3 1 $58,059.00 $32,513.04 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
37275 OTHER Revsc Evasc Fpvt St Athrc Uni Sf Les 1st Vsl 3 1 $58,059.00 $32,513.04 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
37271 OTHER Revsc Evasc Fpvt Athrc Uni Sf Les 1st Vsl 3 1 $58,059.00 $32,513.04 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
37284 OTHER Revsc Evasc Tpvt St Plmt Uni Sf Les 1st Vsl 3 1 $58,059.00 $32,513.04 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
37182 OTHER Insj Transvns Intrahepatc Portosysic Shunt 3 1 $18,410.00 $10,309.60 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
37288 OTHER Revsc Evasc Tpvt Athrc Uni Sf Les 1st Vsl 3 1 $58,059.00 $32,513.04 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
37292 OTHER Revsc Evasc Tpvt St Athrc Uni Sf Les 1st Vsl 3 1 $58,059.00 $32,513.04 44% off $22,632.00 $70,872.00 $23,779.00 2026-05-09
34 MS_DRG Carotid Artery Stent Procedures With Mcc 1 1 — — $23,715.34 $23,715.34 $23,715.34 2026-03-31
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental 1 1 — — $23,679.80 $23,679.80 $23,679.80 2026-03-31
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System 1 1 — — $23,657.12 $23,657.12 $23,657.12 2026-03-31
33746 OTHER Tis Crtj St Congenital Cardiac Anomal Ea Addl 3 1 $79,300.00 $44,408.00 44% off $22,519.01 $67,332.60 $23,641.22 2026-05-09
33745 OTHER Tis Crtj St Congenital Cardiac Anomal 1st Shunt 3 1 $79,300.00 $44,408.00 44% off $22,519.01 $67,332.60 $23,641.22 2026-05-09
33741 OTHER Tas Congenital Cardiac Anomalies Any Method 3 1 $79,300.00 $44,408.00 44% off $22,519.01 $67,332.60 $23,641.22 2026-05-09
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 1 1 — — $23,522.95 $23,522.95 $23,522.95 2026-03-31
22633 OTHER Arthrodesis Combined Tq 1ntrspc Lumbar 3 1 $27,450.00 $15,372.00 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
20696 OTHER Xtrnl Fixj W/stereotactic Adjustment 1st & Subq 3 1 $65,490.00 $36,674.40 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
23616 OTHER Open Prox Humeral Fracture Prosthetic Rplcmt 3 1 $29,260.00 $16,385.60 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
22630 OTHER Arthrd Pst Tq 1ntrspc Lum 3 1 — — $22,222.00 $69,590.00 $23,348.00 2026-05-09
24363 OTHER Arthrp Elbow W/distal Hum&prox Ur Prostc Rplcm 3 1 $61,450.00 $34,412.00 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
23472 OTHER Arthroplasty Glenohumeral Joint Total Shoulder 3 1 $20,250.00 $11,340.00 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
22612 OTHER Arthrodesis Posterior/pstlat Tq 1ntrspc Lumbar 3 1 $31,510.00 $17,645.60 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
22867 OTHER Insj Stablj Dev W/dcmprn Lumbar Single Level 3 1 $78,590.00 $44,010.40 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
22856 OTHER Tot Disc Arthrp Art Disc Ant Appro 1 Ntrspc Crv 3 1 $35,990.00 $20,154.40 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
28705 OTHER Arthrodesis Pantalar 3 1 $27,450.00 $15,372.00 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
27278 OTHER Arthrd Si Jt Plmt I-artic Dev Wo Cortcl Piercing 3 1 $58,810.00 $32,933.60 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
27702 OTHER Reconstruct Ankle Joint 3 1 — — $22,222.00 $69,590.00 $23,348.00 2026-05-09
24371 OTHER Revis Elbow Arthrplsty Humeral&ulna Compnt 3 1 $51,200.00 $28,672.00 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
25446 OTHER Arthrp W/prostc Rplcmt Dstl Rds&prtl/carpus 3 1 $36,000.00 $20,160.00 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
21243 OTHER Arthrp Tmprmand Joint W/prosthetic Replacement 3 1 $27,450.00 $15,372.00 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
27279 OTHER Arthrd Si Jt Plmt Transarticular&/i-artic Device 3 1 $27,450.00 $15,372.00 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
25442 OTHER Arthroplasty W/prosthetic Rplcmt Distal Ulna 3 1 $51,200.00 $28,672.00 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
24361 OTHER Arthroplasty Elbow W/distal Humrl Prostc Rplcmt 3 1 $61,450.00 $34,412.00 44% off $22,222.00 $69,590.00 $23,348.00 2026-05-09
61624 OTHER Tcat Perm Occls/embolization Perq Cns 2 1 $4,080.00 $2,284.80 44% off $22,632.00 $23,779.00 $23,205.50 2026-05-09
187001050 OTHER Sodium Benzoate-sod Phenylacet 10-10 % Soln 50 Ml Vial 3 1 $131,507.84 $73,644.39 44% off $21,961.81 $65,753.92 $23,145.38 2026-05-09
69488001061 OTHER "lutetium Lu-177 Vipivotide Tetraxetan 27 mCi/mL (1,000 MBq/mL) Soln 1 Each Vial… 3 1 $147,409.21 $82,549.16 44% off $21,899.61 $65,567.70 $23,079.83 2026-05-09
68875010201 OTHER Teduglutide 5 Mg Kit 1 Each Kit 3 1 $135,055.95 $75,631.33 44% off $21,897.44 $65,561.21 $23,077.54 2026-05-09
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Mu 1 1 — — $23,055.47 $23,055.47 $23,055.47 2026-03-31
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures 1 1 — — $22,954.99 $22,954.99 $22,954.99 2026-03-31
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 1 1 — — $22,900.45 $22,900.45 $22,900.45 2026-03-31
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With 1 1 — — $22,898.00 $22,898.00 $22,898.00 2026-03-31
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Pr 1 1 — — $22,833.67 $22,833.67 $22,833.67 2026-03-31
0793T OTHER Perq Tcat Thrm Abltj Nerves Innervating P-art 3 1 $56,830.00 $31,824.80 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
C9767 OTHER Rev Evar Any Ves;iv Litho&tl Stnt Plcmt&atherect 3 1 $84,130.00 $47,112.80 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
37242 OTHER Vascular Embolization Or Occlusion Arterial Rs&i 3 1 $54,280.00 $30,396.80 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
36837 OTHER Perq Av Fistula Creation Uxtr Sep Access Sites 3 1 $64,790.00 $36,282.40 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
36906 OTHER Perq Thrmbc/nfs Dial Circuit Tcat Plmt IV Stent 3 1 $35,640.00 $19,958.40 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
33902 OTHER Perq P-art Revsc St 1st Abnor Connj Unilateral 3 1 $64,790.00 $36,282.40 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
36836 OTHER Perq Av Fistula Creation Uxtr Single Access 3 1 $64,790.00 $36,282.40 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
37184 OTHER Prim Prq Trluml Mchnl Thrmbc N-cor N-icra 1st 3 1 $21,310.00 $11,933.60 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
C9797 OTHER Vascular Emb/occl Proc Use Of Press-gen Cath 3 1 $20,660.00 $11,569.60 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
0238T OTHER Trluml Peripheral Atherectomy Iliac Artery Ea 3 1 $91,180.00 $51,060.80 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
C9773 OTHER Revasc Lithotr-stent Tib/per 3 1 $19,780.00 $11,076.80 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
C9774 OTHER Revasc Lithotr-ather Tib/per 3 1 $25,070.00 $14,039.20 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
C9607 OTHER Pc Tl Rev Chrn Tot Occl Ca Ca Br/cabg; 1 Ves 3 1 $48,860.00 $27,361.60 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
0632T OTHER Perq Tcat US Ablation Nerves Innervating P-art 3 1 $21,530.00 $12,056.80 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
0645T OTHER Tcat Impltj C Sins Rdctj Dev 3 1 — — $21,698.00 $67,950.00 $22,798.00 2026-05-09
C9765 OTHER Rev Evar Any Ves;iv Lithotripsy & Tl Stent Plcmt 3 1 $63,280.00 $35,436.80 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
C9775 OTHER Revasc Lith-sten-ath Tib/per 3 1 $25,070.00 $14,039.20 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
C9766 OTHER Rev Evar Any Ves);iv Lithotripsy And Atherectomy 3 1 $48,240.00 $27,014.40 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
C9602 OTHER Pc Tl Cor Atherect W/rx Elut Ic Stent; 1 Mca/br 3 1 $49,980.00 $27,988.80 44% off $21,698.00 $67,950.00 $22,798.00 2026-05-09
22586 OTHER Arthrodesis Presacral Intrbdy W/instrument L5-s1 3 1 $13,740.00 $7,694.40 44% off $21,646.00 $67,787.00 $22,743.00 2026-05-09
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 1 1 — — $22,705.01 $22,705.01 $22,705.01 2026-03-31
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 1 1 — — $22,504.66 $22,504.66 $22,504.66 2026-03-31
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, 1 1 — — $22,495.47 $22,495.47 $22,495.47 2026-03-31
62361 OTHER Impltj/rplcmt Fs Non-prgrbl Pump 3 1 $32,180.00 $18,020.80 44% off $21,357.00 $66,881.00 $22,439.00 2026-05-09
62360 OTHER Impltj/rplcmt Ithcl/edrl Drug Nfs Subq Rsvr 3 1 $28,430.00 $15,920.80 44% off $21,357.00 $66,881.00 $22,439.00 2026-05-09
62362 OTHER Impltj/rplcmt Ithcl/edrl Drug Nfs Prgrbl Pump 3 1 $30,840.00 $17,270.40 44% off $21,357.00 $66,881.00 $22,439.00 2026-05-09
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 1 1 — — $22,411.53 $22,411.53 $22,411.53 2026-03-31
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact Wi 1 1 — — $22,231.40 $22,231.40 $22,231.40 2026-03-31
0888T OTHER Histotripsy Mal Renal Tissue 3 1 — — $21,147.00 $66,224.00 $22,219.00 2026-05-09
C9758 OTHER Bi Proc Nyha Cl Iii/iv Hf;trnscath Impl Ias/pc 3 1 $87,750.00 $49,140.00 44% off $21,147.00 $66,224.00 $22,219.00 2026-05-09
0686T OTHER Histotripsy Mal Hepatocellular Tiss W/img Gdn 3 1 $86,550.00 $48,468.00 44% off $21,147.00 $66,224.00 $22,219.00 2026-05-09
C9782 OTHER Bl P Nyha Ii/iii Hf/ccs Iii/iv Cra 3 1 — — $21,147.00 $66,224.00 $22,219.00 2026-05-09
495 MS_DRG Local Excision And Removal Of Internal Fixation De 1 1 — — $22,214.24 $22,214.24 $22,214.24 2026-03-31
332 MS_DRG Rectal Resection With Mcc 1 1 — — $22,183.62 $22,183.62 $22,183.62 2026-03-31
265 MS_DRG Aicd Lead Procedures 1 1 — — $22,168.29 $22,168.29 $22,168.29 2026-03-31
97 MS_DRG Non-bacterial Infection Of Nervous System Except V 1 1 — — $22,129.08 $22,129.08 $22,129.08 2026-03-31
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of P 1 1 — — $22,095.99 $22,095.99 $22,095.99 2026-03-31
19357 OTHER Tissue Expander Placement Breast Reconstruction 3 1 $21,380.00 $11,972.80 44% off $21,024.00 $65,838.00 $22,089.00 2026-05-09
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And 1 1 — — $21,951.40 $21,951.40 $21,951.40 2026-03-31
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnex 1 1 — — $21,900.55 $21,900.55 $21,900.55 2026-03-31
335 MS_DRG Peritoneal Adhesiolysis With Mcc 1 1 — — $21,878.49 $21,878.49 $21,878.49 2026-03-31
408 MS_DRG Biliary Tract Procedures Except Only Cholecystecto 1 1 — — $21,846.01 $21,846.01 $21,846.01 2026-03-31
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d. 1 1 — — $21,827.64 $21,827.64 $21,827.64 2026-03-31
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, N 1 1 — — $21,806.81 $21,806.81 $21,806.81 2026-03-31
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