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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

ADVENTHEALTH REDMOND

Rome, GA · CCN 110168 · Rates published

27,232 distinct procedures filed
29 distinct payers
673,222 rate rows
2026-04-01 last MRF observed
Data quality

654,469 of 673,222 rate rows are consumer-grade (97.2%)

18,753 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 15,718
per-diem day rate — not a per-procedure price 1,539
template filing: same amount across many unrelated codes — excluded 605
exceeds 10× this hospital's gross charge — excluded from medians 598
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 236
placeholder amount (≤ $0.02) — excluded from medians 35
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 22
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://urldefense.com/v3/__https://hospitalpricedisclosure.com/download.aspx?pi=*_*mqQcPyDoMWlMVqThx9H*_*Q*-*__;KioqKioq!!OwHQNGuS!NNxzc3gzcCDbWC_3aBKJU3Bm28st5mdzWI_DoAkJmDmhsUhsHjB8niD15jvlGIrs7b_d4aR0fJBjowy6rVbgBT5yUbMrRw$
Found on page https://urldefense.com/v3/__https://HospitalPriceDisclosure.com/Default.aspx?ci=RsbcVwMa5jfnDZuYpIqAxQ*-*__;Kio!!OwHQNGuS!NNxzc3gzcCDbWC_3aBKJU3Bm28st5mdzWI_DoAkJmDmhsUhsHjB8niD15jvlGIrs7b_d4aR0fJBjowy6rVbgBT5sJPyOLA$
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-12
Content fingerprint 7e94540128bcf4d6… · 28,789,709 bytes · first seen 2026-05-05

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
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 4 $3,685,266.67 $4,200,000.00 $3,832,677.33 nat. median
$3,685,267
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel 460000000 Cells IV Susp 21 $444,670.00 $4,927,392.00 $1,334,010.00 nat. median
$574,037
outlier · 2.3×
Q2054
HCPCS 		Lisocabtagene Maraleucel 70000000 Cells/ml IV Susp 21 $434,918.00 $4,819,364.00 $1,304,754.00 nat. median
$579,571
outlier · 2.3×
Q2042
HCPCS 		Tisagenlecleucel IV Infusion (wrapped) 21 $468,441.50 $4,221,941.00 $1,223,751.00 nat. median
$621,313
2.0× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 6 $492,900.00 $1,573,115.67 $588,503.70 nat. median
$599,737
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 6 $449,245.86 $1,482,379.88 $554,559.38 nat. median
$562,501
1.0× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 6 $448,752.40 $1,360,266.81 $508,876.80 nat. median
$513,770
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 21 $6,000.00 $913,575.32 $376,324.91 nat. median
$168,055
outlier · 2.2×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 21 $8,700.00 $620,519.00 $246,567.99 nat. median
$186,516
1.3× median
1614
APR_DRG 		Implantable Heart Assist Systems 3 $205,744.00 $230,186.00 $211,916.00 nat. median
$202,242
1.0× median
5834
APR_DRG 		Neonate With Ecmo 3 $196,462.00 $219,802.00 $202,356.00 nat. median
$390,362
0.5× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 21 $8,700.00 $522,590.00 $197,204.00 nat. median
$131,925
1.5× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 21 $1,875.00 $472,117.00 $184,971.12 nat. median
$145,435
1.3× median
A9520
HCPCS 		Technetium-99 (tc-99) Tilmanocept (lymphoseek) Radio-isotope Injection 18 $10.00 $684,396.00 $182,493.00 nat. median
$767
outlier · 237.8×
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 3 $177,111.00 $198,152.00 $182,424.00 nat. median
$152,792
1.2× median
5833
APR_DRG 		Neonate With Ecmo 3 $155,602.00 $174,087.00 $160,270.00 nat. median
$268,208
0.6× median
1613
APR_DRG 		Implantable Heart Assist Systems 3 $150,623.00 $168,517.00 $155,142.00 nat. median
$155,539
1.0× median
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 3 $148,269.00 $165,884.00 $152,717.00 nat. median
$135,630
1.1× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 3 $148,116.00 $165,712.00 $152,559.00 nat. median
$187,567
0.8× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 3 $145,183.00 $162,431.00 $149,539.00 nat. median
$286,698
0.5× median
52427-273-75
NDC 		Naproxen Sodium ER 500 Mg Po Tb24 18 $37,242.00 $301,989.00 $139,155.00 —
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 21 $8,700.00 $311,270.00 $121,871.40 nat. median
$97,418
1.3× median
58468-0132-2
NDC 		Sevelamer Carbonate 0.8 G Po Pack 18 $32,299.00 $261,906.00 $120,685.00 —
58468-0132-1
NDC 		Sevelamer Carbonate 0.8 G Po Pack 18 $32,299.00 $261,906.00 $120,685.00 —
24
APR_DRG 		Heart And/or Lung Transplant 3 $116,808.00 $130,685.00 $120,312.00 nat. median
$225,531
0.5× median
5832
APR_DRG 		Neonate With Ecmo 3 $114,741.00 $128,373.00 $118,184.00 nat. median
$201,678
0.6× median
7
MS_DRG 		Lung Transplant 21 $8,700.00 $287,893.00 $113,942.20 nat. median
$70,649
1.6× median
68382-395-04
NDC 		Ribavirin 6 G In Solr 18 $30,157.00 $244,542.00 $112,684.00 —
68382-395-01
NDC 		Ribavirin 6 G In Solr 18 $30,157.00 $244,542.00 $112,684.00 —
13925-522-01
NDC 		Pentamidine Isethionate 300 Mg In Solr 18 $29,989.00 $243,174.00 $112,053.50 —
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 3 $108,659.00 $121,567.00 $111,918.00 nat. median
$173,018
0.6× median
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 3 $106,384.00 $119,023.00 $109,576.00 nat. median
$171,497
0.6× median
A9588
HCPCS 		Fluciclovine F 18 9-221 Mci/ml IV Soln 18 $82.00 $408,754.00 $108,993.50 nat. median
$547
outlier · 199.2×
14
MS_DRG 		Allogeneic Bone Marrow Transplant 21 $6,000.00 $288,620.00 $108,913.00 nat. median
$72,715
1.5× median
59385-027-60
NDC 		Buprenorphine Hcl 900 Mcg Bu Film 18 $29,008.00 $235,218.00 $108,388.00 —
59385-027-01
NDC 		Buprenorphine Hcl 900 Mcg Bu Film 18 $29,008.00 $235,218.00 $108,388.00 —
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 3 $103,820.00 $116,154.00 $106,935.00 nat. median
$173,134
0.6× median
54
APR_DRG 		Tracheostomy With Mv >96 Hours Without Extensive Procedure 3 $102,764.00 $114,972.00 $105,847.00 nat. median
$91,350
1.2× median
58914-501-56
NDC 		Mesalamine 1000 Mg Re Supp 18 $28,181.00 $228,518.00 $105,300.00 nat. median
$47
outlier · 2232.8×
5882
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 3 $101,660.00 $113,737.00 $104,710.00 nat. median
$152,383
0.7× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 $101,363.00 $113,405.00 $104,404.00 nat. median
$135,803
0.8× median
209
MS_DRG 		Complex Aortic Arch Procedures 11 $74,096.94 $239,460.53 $104,308.34 nat. median
$2,110
outlier · 49.4×
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 $100,845.00 $112,826.00 $103,871.00 nat. median
$198,578
0.5× median
5831
APR_DRG 		Neonate With Ecmo 3 $99,157.00 $110,937.00 $102,132.00 nat. median
$173,909
0.6× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 20 $65,310.00 $233,164.51 $101,565.82 nat. median
$2,736
outlier · 37.1×
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 21 $8,700.00 $242,753.00 $101,093.00 nat. median
$65,418
1.5× median
C1831
HCPCS 		Kit Imp Aprevo Spine Lvl 1 18 $21,444.00 $334,400.00 $97,666.00 nat. median
$5,834
outlier · 16.7×
1612
APR_DRG 		Implantable Heart Assist Systems 3 $94,777.00 $106,036.00 $97,620.00 nat. median
$109,992
0.9× median
215
MS_DRG 		Other Heart Assist System Implant 21 $8,700.00 $353,253.89 $97,029.90 nat. median
$73,023
1.3× median
74
APR_DRG 		Allogeneic Bone Marrow Transplant 3 $93,542.00 $104,655.00 $96,348.00 nat. median
$149,836
0.6× median

Other procedures at this hospital

Browse this hospital's 27,232 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
             
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 4 4 — — $3,685,266.67 $4,200,000.00 $3,832,677.33 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel 460000000 Cells IV Susp 29 21 — $3,967,304.24 $444,670.00 $4,927,392.00 $1,334,010.00 2026-04-01
Q2054 HCPCS Lisocabtagene Maraleucel 70000000 Cells/ml IV Susp 29 21 — $3,880,325.32 $434,918.00 $4,819,364.00 $1,304,754.00 2026-04-01
Q2042 HCPCS Tisagenlecleucel IV Infusion (wrapped) 29 21 — $3,399,308.09 $468,441.50 $4,221,941.00 $1,223,751.00 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 6 6 — — $492,900.00 $1,573,115.67 $588,503.70 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 6 6 — — $449,245.86 $1,482,379.88 $554,559.38 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 6 6 — — $448,752.40 $1,360,266.81 $508,876.80 2026-04-01
18 MS_DRG Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 38 21 $0.01 — $6,000.00 $913,575.32 $376,324.91 2026-04-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 39 21 $0.01 — $8,700.00 $620,519.00 $246,567.99 2026-04-01
1614 APR_DRG Implantable Heart Assist Systems 3 3 $0.01 — $205,744.00 $230,186.00 $211,916.00 2024-12-15
5834 APR_DRG Neonate With Ecmo 3 3 $0.01 — $196,462.00 $219,802.00 $202,356.00 2024-12-15
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 39 21 $0.01 — $8,700.00 $522,590.00 $197,204.00 2026-04-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 40 21 $0.01 — $1,875.00 $472,117.00 $184,971.12 2026-04-01
A9520 HCPCS Technetium-99 (tc-99) Tilmanocept (lymphoseek) Radio-isotope Injection 24 18 $777,723.00 $388,861.50 50% off $10.00 $684,396.00 $182,493.00 2024-12-15
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 3 3 $0.01 — $177,111.00 $198,152.00 $182,424.00 2024-12-15
5833 APR_DRG Neonate With Ecmo 3 3 $0.01 — $155,602.00 $174,087.00 $160,270.00 2024-12-15
1613 APR_DRG Implantable Heart Assist Systems 3 3 $0.01 — $150,623.00 $168,517.00 $155,142.00 2024-12-15
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 3 3 $0.01 — $148,269.00 $165,884.00 $152,717.00 2024-12-15
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 3 3 $0.01 — $148,116.00 $165,712.00 $152,559.00 2024-12-15
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 $0.01 — $145,183.00 $162,431.00 $149,539.00 2024-12-15
52427-273-75 NDC Naproxen Sodium ER 500 Mg Po Tb24 24 18 $343,168.76 $171,584.38 50% off $37,242.00 $301,989.00 $139,155.00 2024-12-15
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 39 21 $0.01 — $8,700.00 $311,270.00 $121,871.40 2026-04-01
58468-0132-1 NDC Sevelamer Carbonate 0.8 G Po Pack 24 18 $297,620.11 $148,810.05 50% off $32,299.00 $261,906.00 $120,685.00 2024-12-15
58468-0132-2 NDC Sevelamer Carbonate 0.8 G Po Pack 24 18 $297,620.11 $148,810.05 50% off $32,299.00 $261,906.00 $120,685.00 2024-12-15
24 APR_DRG Heart And/or Lung Transplant 3 3 $0.01 — $116,808.00 $130,685.00 $120,312.00 2024-12-15
5832 APR_DRG Neonate With Ecmo 3 3 $0.01 — $114,741.00 $128,373.00 $118,184.00 2024-12-15
7 MS_DRG Lung Transplant 39 21 $0.01 — $8,700.00 $287,893.00 $113,942.20 2026-04-01
68382-395-01 NDC Ribavirin 6 G In Solr 24 18 $277,888.20 $138,944.10 50% off $30,157.00 $244,542.00 $112,684.00 2024-12-15
68382-395-04 NDC Ribavirin 6 G In Solr 24 18 $277,888.20 $138,944.10 50% off $30,157.00 $244,542.00 $112,684.00 2024-12-15
13925-522-01 NDC Pentamidine Isethionate 300 Mg In Solr 24 18 $276,334.37 $138,167.18 50% off $29,989.00 $243,174.00 $112,053.50 2024-12-15
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 3 3 $0.01 — $108,659.00 $121,567.00 $111,918.00 2024-12-15
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 3 3 $0.01 — $106,384.00 $119,023.00 $109,576.00 2024-12-15
A9588 HCPCS Fluciclovine F 18 9-221 Mci/ml IV Soln 24 18 $464,493.00 $232,246.50 50% off $82.00 $408,754.00 $108,993.50 2024-12-15
14 MS_DRG Allogeneic Bone Marrow Transplant 39 21 $0.01 — $6,000.00 $288,620.00 $108,913.00 2026-04-01
59385-027-01 NDC Buprenorphine Hcl 900 Mcg Bu Film 24 18 $267,293.74 $133,646.87 50% off $29,008.00 $235,218.00 $108,388.00 2024-12-15
59385-027-60 NDC Buprenorphine Hcl 900 Mcg Bu Film 24 18 $267,293.74 $133,646.87 50% off $29,008.00 $235,218.00 $108,388.00 2024-12-15
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 $0.01 — $103,820.00 $116,154.00 $106,935.00 2024-12-15
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 3 3 $0.01 — $102,764.00 $114,972.00 $105,847.00 2024-12-15
58914-501-56 NDC Mesalamine 1000 Mg Re Supp 24 18 $259,679.27 $129,839.64 50% off $28,181.00 $228,518.00 $105,300.00 2024-12-15
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 $0.01 — $101,660.00 $113,737.00 $104,710.00 2024-12-15
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 3 $0.01 — $101,363.00 $113,405.00 $104,404.00 2024-12-15
209 MS_DRG Complex Aortic Arch Procedures 20 11 — — $74,096.94 $239,460.53 $104,308.34 2026-04-01
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 3 $0.01 — $100,845.00 $112,826.00 $103,871.00 2024-12-15
5831 APR_DRG Neonate With Ecmo 3 3 $0.01 — $99,157.00 $110,937.00 $102,132.00 2024-12-15
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 36 20 $0.01 — $65,310.00 $233,164.51 $101,565.82 2026-04-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 39 21 $0.01 — $8,700.00 $242,753.00 $101,093.00 2026-04-01
C1831 HCPCS Kit Imp Aprevo Spine Lvl 1 105 18 $288,800.00 $144,400.00 50% off $21,444.00 $334,400.00 $97,666.00 2024-12-15
1612 APR_DRG Implantable Heart Assist Systems 3 3 $0.01 — $94,777.00 $106,036.00 $97,620.00 2024-12-15
215 MS_DRG Other Heart Assist System Implant 40 21 $0.01 — $8,700.00 $353,253.89 $97,029.90 2026-04-01
74 APR_DRG Allogeneic Bone Marrow Transplant 3 3 $0.01 — $93,542.00 $104,655.00 $96,348.00 2024-12-15
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 39 22 $0.01 — $8,700.00 $239,982.00 $95,675.65 2026-04-01
1611 APR_DRG Implantable Heart Assist Systems 3 3 $0.01 — $90,038.00 $100,734.00 $92,739.00 2024-12-15
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 3 3 $0.01 — $88,103.00 $98,570.00 $90,746.00 2024-12-15
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 39 21 $0.01 — $8,700.00 $234,596.00 $90,716.83 2026-04-01
C1825 HCPCS System Neo Barostim Includes 2104 Ipg 1036 Csl Kt 25 18 $212,800.00 $106,400.00 50% off $23,094.00 $187,264.00 $90,227.00 2024-12-15
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 39 20 $0.01 — $60,171.00 $212,604.00 $88,537.00 2026-04-01
63323-877-15 NDC Pentamidine Isethionate 300 Mg In Solr 24 18 $216,733.22 $108,366.61 50% off $23,521.00 $190,725.00 $87,885.50 2024-12-15
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 3 3 $0.01 — $84,484.00 $94,521.00 $87,019.00 2024-12-15
64 APR_DRG Pancreas Transplant 3 3 $0.01 — $83,943.00 $93,916.00 $86,461.00 2024-12-15
0187-0007-14 NDC Ribavirin 6 G In Solr 24 18 $213,127.92 $106,563.96 50% off $23,129.00 $187,553.00 $86,423.50 2024-12-15
0781-5893-31 NDC Nevirapine ER 400 Mg Po Tb24 24 18 $208,954.92 $104,477.46 50% off $22,676.00 $183,880.00 $84,731.50 2024-12-15
850 MS_DRG Acute Leukemia With Other Procedures 36 20 $0.01 — $56,688.20 $202,929.00 $83,960.32 2026-04-01
C1824 HCPCS Generator Ipg Optimizer Crdc Smart Mn 25 18 $197,600.00 $98,800.00 50% off $21,444.00 $173,888.00 $83,782.00 2024-12-15
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 36 20 $0.01 — $52,001.00 $190,607.10 $83,027.92 2026-04-01
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 3 3 $0.01 — $80,233.00 $89,765.00 $82,640.00 2024-12-15
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 3 3 $0.01 — $78,220.00 $87,513.00 $80,567.00 2024-12-15
12 APR_DRG Liver Transplant And/or Intestinal Transplant 3 3 $0.01 — $77,170.00 $86,337.00 $79,485.00 2024-12-15
13 APR_DRG Liver Transplant And/or Intestinal Transplant 3 3 $0.01 — $77,170.00 $86,337.00 $79,485.00 2024-12-15
14 APR_DRG Liver Transplant And/or Intestinal Transplant 3 3 $0.01 — $77,170.00 $86,337.00 $79,485.00 2024-12-15
231 MS_DRG Coronary Bypass With Ptca With Mcc 38 20 $0.01 — $52,832.00 $186,672.00 $79,469.51 2026-04-01
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 3 3 $0.01 — $76,079.00 $85,117.00 $78,361.00 2024-12-15
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 2 2 — — $70,712.42 $82,927.29 $76,819.85 2026-04-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 38 20 $0.01 — $49,024.00 $186,568.00 $75,816.11 2026-04-01
23 APR_DRG Heart And/or Lung Transplant 3 3 $0.01 — $73,017.00 $81,691.00 $75,207.00 2024-12-15
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 3 3 $0.01 — $72,797.00 $81,445.00 $74,981.00 2024-12-15
81416 CPT Hc Exome Sequence Analysis Each Comparator Exome 23 18 $606,744.00 $303,372.00 50% off $10,800.00 $533,935.00 $74,741.00 2024-12-15
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 39 21 $0.01 — $8,700.00 $177,578.00 $73,951.00 2026-04-01
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 3 3 $0.01 — $70,600.00 $78,987.00 $72,718.00 2024-12-15
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 3 3 $0.01 — $70,043.00 $78,364.00 $72,144.00 2024-12-15
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 39 20 $0.01 — $48,732.00 $172,187.00 $71,706.00 2026-04-01
47781-153-01 NDC Naproxen Sodium ER 375 Mg Po Tb24 24 18 $173,307.46 $86,653.73 50% off $18,808.00 $152,511.00 $70,276.00 2024-12-15
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 3 3 $0.01 — $66,917.00 $74,867.00 $68,924.00 2024-12-15
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 3 3 $0.01 — $66,528.00 $74,432.00 $68,524.00 2024-12-15
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 3 3 $0.01 — $66,166.00 $74,026.00 $68,150.00 2024-12-15
C1822 HCPCS Construct Neuromod Nevro Pain Mgmt Omnia With Ipg Rm 65 18 $168,910.00 $84,455.00 50% off $16,908.00 $173,888.00 $67,564.00 2024-12-15
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 39 20 $0.01 — $48,240.00 $170,449.00 $67,557.44 2026-04-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 36 20 $0.01 — $44,283.00 $156,465.00 $67,346.08 2026-04-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 38 21 $0.01 — $8,700.00 $174,630.00 $67,311.01 2026-04-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 39 21 $0.01 — $8,700.00 $164,429.00 $67,043.61 2026-04-01
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 3 3 $0.01 — $65,038.00 $72,764.00 $66,989.00 2024-12-15
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 36 20 $0.01 — $44,060.00 $155,679.00 $66,757.29 2026-04-01
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 3 3 $0.01 — $64,533.00 $72,200.00 $66,469.00 2024-12-15
10 MS_DRG Pancreas Transplant 39 21 $0.01 — $8,700.00 $175,637.00 $66,278.00 2026-04-01
C2624 HCPCS System Cardiomems Hrt Failure Ptnt 25 18 $151,620.00 $75,810.00 50% off $16,454.00 $133,426.00 $64,287.00 2024-12-15
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 3 3 $0.01 — $62,351.00 $69,758.00 $64,221.00 2024-12-15
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 36 20 $0.01 — $41,801.00 $147,698.00 $62,934.26 2026-04-01
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $62,726.36 $62,726.36 $62,726.36 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 1 1 — — $62,702.40 $62,702.40 $62,702.40 2026-04-01
A9543 HCPCS Y90 Ibritumomab, Rx 6 6 — — $56,824.55 $157,972.25 $62,571.18 2026-04-01
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 3 3 $0.01 — $60,595.00 $67,793.00 $62,413.00 2024-12-15
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 39 21 $0.01 — $8,700.00 $151,745.64 $61,906.85 2026-04-01
9104 APR_DRG Craniotomy For Multiple Significant Trauma 3 3 $0.01 — $60,002.00 $67,130.00 $61,802.00 2024-12-15
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 36 20 $0.01 — $38,570.00 $141,459.59 $61,619.40 2026-04-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 38 20 $0.01 — $40,263.00 $142,261.00 $61,290.29 2026-04-01
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 3 3 $0.01 — $59,460.00 $66,524.00 $61,244.00 2024-12-15
J2326 HCPCS Nusinersen 12 Mg/5ml It Soln 24 18 $300,493.02 $150,246.51 50% off $1,211.00 $264,434.00 $61,195.50 2024-12-15
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 37 20 $0.01 — $41,570.00 $146,881.00 $61,167.00 2026-04-01
A9595 HCPCS Piflufolastat F 18 9 Mci IV Sosy 30 22 $479,623.55 $239,811.77 50% off $346.49 $422,069.00 $60,932.00 2026-04-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 39 21 $0.01 — $6,000.00 $153,245.00 $60,813.40 2026-04-01
A9572 HCPCS Indium In-111 Pentetreotide IV Kit 30 22 $390,363.81 $195,181.90 50% off $58.00 $343,520.00 $60,682.00 2026-04-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 38 20 $0.01 — $37,092.00 $139,107.05 $60,594.65 2026-04-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 39 21 $0.01 — $8,700.00 $150,421.00 $59,223.51 2026-04-01
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 3 3 $0.01 — $56,368.00 $63,065.00 $58,059.00 2024-12-15
0187-3013-30 NDC Pyridostigmine Bromide ER 180 Mg Po Tbcr 24 18 $143,111.57 $71,555.78 50% off $15,531.00 $125,938.00 $58,031.50 2024-12-15
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 3 3 $0.01 — $56,114.00 $62,780.00 $57,797.00 2024-12-15
51167-331-01 NDC Elexacaf-tezacaf-ivacaf&ivacaf 100-50-75 (trikafta Kit Morning Dose) 24 18 $142,428.31 $71,214.15 50% off $15,457.00 $125,337.00 $57,755.00 2024-12-15
22 APR_DRG Heart And/or Lung Transplant 3 3 $0.01 — $55,825.00 $62,457.00 $57,500.00 2024-12-15
21 APR_DRG Heart And/or Lung Transplant 3 3 $0.01 — $55,825.00 $62,457.00 $57,500.00 2024-12-15
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 6 6 — — $53,630.37 $153,657.06 $57,483.21 2026-04-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 38 20 $0.01 — $38,085.00 $134,569.00 $57,218.99 2026-04-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 38 20 $0.01 — $12,321.00 $138,601.42 $57,093.46 2026-04-01
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 3 3 $0.01 — $55,227.00 $61,787.00 $56,883.00 2024-12-15
C9089 HCPCS Bupivacaine Hcl (300 Mg Dose) 3 X 100 Mg Il Impl 43 18 $171,993.77 $85,996.88 50% off $18,665.00 $155,590.00 $56,172.00 2024-12-15
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 3 3 $0.01 — $54,486.00 $60,959.00 $56,121.00 2024-12-15
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 40 22 $0.01 — $6,000.00 $142,466.00 $56,076.44 2026-04-01
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 3 3 $0.01 — $54,346.00 $60,802.00 $55,976.00 2024-12-15
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $55,597.24 $55,597.24 $55,597.24 2026-04-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 39 20 $0.01 — $37,350.00 $131,971.00 $54,958.00 2026-04-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 38 20 $0.01 — $12,321.00 $136,456.00 $54,837.51 2026-04-01
7114 APR_DRG Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 3 3 $0.01 — $53,169.00 $59,486.00 $54,764.00 2024-12-15
214 APR_DRG Open Craniotomy Except Trauma 3 3 $0.01 — $52,990.00 $59,286.00 $54,580.00 2024-12-15
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 39 21 $0.01 — $8,700.00 $139,318.00 $53,858.20 2026-04-01
C2616 HCPCS Sphere Embol Sir Msphre 90 39 17 $139,422.00 $69,711.00 50% off $14,842.00 $122,691.00 $53,290.00 2024-12-15
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 3 3 $0.01 — $51,671.00 $57,809.00 $53,221.00 2024-12-15
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 36 20 $0.01 — $34,107.00 $122,008.77 $53,146.68 2026-04-01
73 APR_DRG Allogeneic Bone Marrow Transplant 3 3 $0.01 — $51,379.00 $57,483.00 $52,921.00 2024-12-15
28 MS_DRG Spinal Procedures With Mcc 39 21 $0.01 — $8,700.00 $133,925.00 $52,863.96 2026-04-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 40 20 $0.01 — $36,686.00 $138,181.21 $52,807.90 2026-04-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 39 21 $0.01 — $33,169.00 $117,199.00 $52,619.46 2026-04-01
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 20 11 — — $37,359.42 $120,735.18 $52,591.90 2026-04-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 38 20 $0.01 — $35,783.00 $126,433.00 $52,559.13 2026-04-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 36 20 $0.01 — $34,316.00 $121,250.00 $52,323.96 2026-04-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/Mcc 39 21 $0.01 — $6,000.00 $132,965.00 $52,172.40 2026-04-01
38240 CPT Hc Trnsplj Allogeneic Hematopoietic Cells Per Donor 23 18 $538,958.42 $269,479.21 50% off $1,856.00 $474,283.00 $52,066.00 2024-12-15
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 39 21 $0.01 — $8,700.00 $128,259.00 $51,601.38 2026-04-01
83 APR_DRG Autologous Bone Marrow Transplant 3 3 $0.01 — $50,065.00 $56,013.00 $51,567.00 2024-12-15
84 APR_DRG Autologous Bone Marrow Transplant 3 3 $0.01 — $50,065.00 $56,013.00 $51,567.00 2024-12-15
459 MS_DRG Spinal Fusion Except Cervical With Mcc 1 1 — — $51,506.48 $51,506.48 $51,506.48 2026-04-01
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 3 $0.01 — $49,894.00 $55,821.00 $51,391.00 2024-12-15
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 39 20 $0.01 — $33,023.00 $248,291.65 $51,368.20 2026-04-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 37 21 $0.01 — $6,000.00 $130,958.00 $51,297.75 2026-04-01
0078-0697-19 NDC Eltrombopag Olamine 25 Mg Po Pack 24 18 $125,834.16 $62,917.08 50% off $13,656.00 $110,734.00 $51,026.00 2024-12-15
0078-0697-61 NDC Eltrombopag Olamine 25 Mg Po Pack 24 18 $125,834.16 $62,917.08 50% off $13,656.00 $110,734.00 $51,026.00 2024-12-15
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 39 21 $0.01 — $8,700.00 $135,185.00 $51,013.00 2026-04-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 39 21 $0.01 — $8,700.00 $121,761.00 $50,992.53 2026-04-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 39 21 $0.01 — $8,700.00 $125,678.00 $50,417.99 2026-04-01
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 3 3 $0.01 — $48,875.00 $54,682.00 $50,342.00 2024-12-15
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 1 1 — — $50,271.44 $50,271.44 $50,271.44 2026-04-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/Mcc 39 21 $0.01 — $6,000.00 $132,965.00 $50,175.00 2026-04-01
A9569 HCPCS Technetium-99 (tc-99) Exametazime White Blood Cells Radio-isotope Injection 30 22 $320,392.36 $160,196.18 50% off $56.00 $281,945.00 $49,805.00 2026-04-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 39 21 $0.01 — $8,700.00 $120,578.62 $49,548.00 2026-04-01
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 3 3 $0.01 — $47,931.00 $53,625.00 $49,369.00 2024-12-15
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 39 21 $0.01 — $8,700.00 $119,862.00 $49,312.01 2026-04-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 36 20 $0.01 — $32,109.00 $113,452.00 $49,291.68 2026-04-01
1784 APR_DRG External Heart Assist Systems 3 3 $0.01 — $47,746.00 $53,418.00 $49,179.00 2024-12-15
C1767 HCPCS Stimulator Pul Gen 1pin L Vagus 7mm 14ml 25gm Ea 525 18 $125,400.00 $62,700.00 50% off $8,458.00 $261,802.00 $49,085.00 2024-12-15
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 38 20 $0.01 — $12,321.00 $119,589.00 $48,967.07 2026-04-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 38 21 $0.01 — $8,700.00 $117,758.53 $48,507.73 2026-04-01
834 MS_DRG Acute Leukemia With Mcc 39 21 $0.01 — $6,000.00 $121,761.00 $48,302.82 2026-04-01
653 MS_DRG Major Bladder Procedures With Mcc 38 20 $0.01 — $12,321.00 $122,803.00 $48,197.66 2026-04-01
J3357 HCPCS Ustekinumab 45 Mg/0.5ml Sc Sosy 25 19 $260,252.42 $130,126.21 50% off $153.77 $229,022.00 $48,147.00 2026-04-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 39 21 $0.01 — $8,700.00 $118,866.00 $47,987.85 2026-04-01
1303 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 3 3 $0.01 — $46,243.00 $51,737.00 $47,631.00 2024-12-15
A9699 HCPCS Radiopharm Rx Agent Noc 1 1 — — $47,374.98 $47,374.98 $47,374.98 2026-04-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 39 21 $0.01 — $8,700.00 $109,777.00 $47,254.12 2026-04-01
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 3 3 $0.01 — $45,814.00 $51,256.00 $47,188.00 2024-12-15
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 3 3 $0.01 — $45,560.00 $50,973.00 $46,927.00 2024-12-15
J9226 HCPCS Supprelin La Implant 6 6 — — $43,541.00 $125,157.41 $46,821.47 2026-04-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 38 20 $0.01 — $12,321.00 $113,075.00 $46,756.24 2026-04-01
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 3 3 $0.01 — $45,214.00 $50,586.00 $46,571.00 2024-12-15
0955-1052-01 NDC Sevelamer Carbonate 0.8 G Po Pack 24 18 $114,052.63 $57,026.31 50% off $12,377.00 $100,366.00 $46,248.00 2024-12-15
0955-1052-90 NDC Sevelamer Carbonate 0.8 G Po Pack 24 18 $114,052.63 $57,026.31 50% off $12,377.00 $100,366.00 $46,248.00 2024-12-15
C1882 HCPCS Defibrillator Promote+ 2chb Is1 Df1 36jl 43ml 82gm 1,205 18 $121,167.80 $60,583.90 50% off $8.00 $216,248.00 $46,241.00 2024-12-15
4404 APR_DRG Kidney Transplant 3 3 $0.01 — $44,714.00 $50,026.00 $46,055.00 2024-12-15
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 39 21 $0.01 — $8,700.00 $112,229.00 $45,799.66 2026-04-01
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 3 3 $0.01 — $44,115.00 $49,356.00 $45,439.00 2024-12-15
1674 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 3 3 $0.01 — $43,989.00 $49,215.00 $45,309.00 2024-12-15
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 3 3 $0.01 — $43,974.00 $49,198.00 $45,293.00 2024-12-15
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 3 3 $0.01 — $43,963.00 $49,186.00 $45,282.00 2024-12-15
3032 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 3 3 $0.01 — $43,891.00 $49,105.00 $45,207.00 2024-12-15
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 3 3 $0.01 — $43,891.00 $49,105.00 $45,207.00 2024-12-15
3031 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 3 3 $0.01 — $43,891.00 $49,105.00 $45,207.00 2024-12-15
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $45,123.80 $45,123.80 $45,123.80 2026-04-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 39 21 $0.01 — $6,000.00 $110,304.00 $45,032.84 2026-04-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 2 2 — — $44,000.00 $46,041.63 $45,020.82 2026-04-01
63 APR_DRG Pancreas Transplant 3 3 $0.01 — $43,686.00 $48,875.00 $44,996.00 2024-12-15
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 3 3 $0.01 — $43,569.00 $48,744.00 $44,876.00 2024-12-15
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 39 21 $0.01 — $8,700.00 $118,853.00 $44,850.00 2026-04-01
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 3 $0.01 — $43,376.00 $48,529.00 $44,677.00 2024-12-15
8634 APR_DRG Neonatal Aftercare 3 3 $0.01 — $43,110.00 $48,232.00 $44,404.00 2024-12-15
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 39 21 $0.01 — $8,700.00 $106,630.47 $44,346.15 2026-04-01
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 3 3 $0.01 — $42,846.00 $47,936.00 $44,132.00 2024-12-15
1794 APR_DRG Defibrillator Implants 3 3 $0.01 — $42,785.00 $47,868.00 $44,068.00 2024-12-15
4403 APR_DRG Kidney Transplant 3 3 $0.01 — $42,708.00 $47,781.00 $43,989.00 2024-12-15
245 MS_DRG Aicd Generator Procedures 39 21 $0.01 — $8,700.00 $107,651.00 $43,947.32 2026-04-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 39 21 $0.01 — $8,700.00 $111,885.00 $43,881.59 2026-04-01
1824 APR_DRG Other Peripheral Vascular And Related Procedures 3 3 $0.01 — $42,588.00 $47,648.00 $43,866.00 2024-12-15
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 3 3 $0.01 — $42,445.00 $47,487.00 $43,718.00 2024-12-15
72 APR_DRG Allogeneic Bone Marrow Transplant 3 3 $0.01 — $42,104.00 $47,106.00 $43,367.00 2024-12-15
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 39 21 $0.01 — $8,700.00 $110,958.00 $43,303.52 2026-04-01
914 APR_DRG Other Major Head And Neck Procedures 3 3 $0.01 — $41,922.00 $46,903.00 $43,180.00 2024-12-15
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 41 21 $0.01 — $8,700.00 $154,570.08 $43,160.00 2026-04-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 44 22 $0.01 — $8,700.00 $189,735.84 $43,038.39 2026-04-01
913 APR_DRG Other Major Head And Neck Procedures 3 3 $0.01 — $41,373.00 $46,289.00 $42,615.00 2024-12-15
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 3 3 $0.01 — $41,256.00 $46,158.00 $42,494.00 2024-12-15
471 MS_DRG Cervical Spinal Fusion With Mcc 39 21 $0.01 — $8,700.00 $107,001.00 $42,485.27 2026-04-01
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $42,462.03 $42,462.03 $42,462.03 2026-04-01
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 3 3 $0.01 — $41,113.00 $45,997.00 $42,347.00 2024-12-15
11 APR_DRG Liver Transplant And/or Intestinal Transplant 3 3 $0.01 — $40,893.00 $45,751.00 $42,120.00 2024-12-15
1834 APR_DRG Percutaneous Structural Cardiac Procedures 3 3 $0.01 — $40,839.00 $45,690.00 $42,064.00 2024-12-15
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 3 3 $0.01 — $40,730.00 $45,569.00 $41,952.00 2024-12-15
61958-1004-1 NDC Ranolazine ER 1000 Mg Po Tb12 24 18 $103,287.70 $51,643.85 50% off $11,209.00 $90,893.00 $41,883.00 2024-12-15
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 38 21 $0.01 — $8,700.00 $101,494.00 $41,815.61 2026-04-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 38 21 $0.01 — $8,700.00 $102,477.00 $41,655.91 2026-04-01
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 3 3 $0.01 — $40,330.00 $45,121.00 $41,540.00 2024-12-15
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc 3 3 — — $36,181.58 $41,907.92 $41,508.79 2026-04-01
3124 APR_DRG Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 3 3 $0.01 — $40,053.00 $44,811.00 $41,255.00 2024-12-15
71 APR_DRG Allogeneic Bone Marrow Transplant 3 3 $0.01 — $40,013.00 $44,766.00 $41,213.00 2024-12-15
1833 APR_DRG Percutaneous Structural Cardiac Procedures 3 3 $0.01 — $39,988.00 $44,738.00 $41,187.00 2024-12-15
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 39 21 $0.01 — $8,700.00 $105,199.00 $41,157.57 2026-04-01
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 3 3 $0.01 — $39,876.00 $44,614.00 $41,073.00 2024-12-15
893 APR_DRG Major Cranial Or Facial Bone Procedures 3 3 $0.01 — $39,797.00 $44,525.00 $40,991.00 2024-12-15
894 APR_DRG Major Cranial Or Facial Bone Procedures 3 3 $0.01 — $39,797.00 $44,525.00 $40,991.00 2024-12-15
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 40 21 $0.01 — $8,700.00 $104,724.00 $40,887.60 2026-04-01
6 MS_DRG Liver Transplant Without Mcc 39 21 $0.01 — $8,700.00 $106,823.00 $40,798.60 2026-04-01
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 3 3 $0.01 — $39,373.00 $44,050.00 $40,554.00 2024-12-15
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 43 21 $0.01 — $8,700.00 $142,790.38 $40,348.62 2026-04-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 39 21 $0.01 — $8,700.00 $103,085.00 $40,339.31 2026-04-01
6903 APR_DRG Acute Leukemia 3 3 $0.01 — $39,124.00 $43,772.00 $40,298.00 2024-12-15
6904 APR_DRG Acute Leukemia 3 3 $0.01 — $39,124.00 $43,772.00 $40,298.00 2024-12-15
1783 APR_DRG External Heart Assist Systems 3 3 $0.01 — $38,979.00 $43,610.00 $40,149.00 2024-12-15
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 3 3 $0.01 — $38,928.00 $43,553.00 $40,096.00 2024-12-15
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 40 21 $0.01 — $8,700.00 $101,155.00 $40,057.08 2026-04-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 39 21 $0.01 — $8,700.00 $99,386.00 $40,021.68 2026-04-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 41 21 $0.01 — $8,700.00 $98,520.00 $40,004.10 2026-04-01
61 APR_DRG Pancreas Transplant 3 3 $0.01 — $38,813.00 $43,424.00 $39,977.00 2024-12-15
62 APR_DRG Pancreas Transplant 3 3 $0.01 — $38,813.00 $43,424.00 $39,977.00 2024-12-15
0008-0423-03 NDC Antivenin Micrurus Fulvius IV Solr 24 18 $98,393.34 $49,196.67 50% off $10,678.00 $86,586.00 $39,898.50 2024-12-15
0008-0423-01 NDC Antivenin Micrurus Fulvius IV Solr 24 18 $98,393.34 $49,196.67 50% off $10,678.00 $86,586.00 $39,898.50 2024-12-15
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 3 3 $0.01 — $38,706.00 $43,304.00 $39,867.00 2024-12-15
799 MS_DRG Splenic Procedures With Mcc 39 21 $0.01 — $8,700.00 $104,743.00 $39,847.48 2026-04-01
64568 HCPCS Inc For Vagus N Elect Impl 13 7 — — $2,434.00 $127,263.14 $39,811.08 2026-04-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 39 21 $0.01 — $8,700.00 $95,121.00 $39,613.00 2026-04-01
1653 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 3 3 $0.01 — $38,319.00 $42,871.00 $39,468.00 2024-12-15
31 MS_DRG Ventricular Shunt Procedures With Mcc 39 21 $0.01 — $8,700.00 $94,789.46 $39,421.63 2026-04-01
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 1 1 — — $39,307.90 $39,307.90 $39,307.90 2026-04-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 39 21 $0.01 — $8,700.00 $96,769.00 $39,266.78 2026-04-01
163 MS_DRG Major Chest Procedures With Mcc 42 21 $0.01 — $8,700.00 $101,536.00 $39,200.84 2026-04-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 36 20 $0.01 — $25,459.00 $89,955.00 $39,155.26 2026-04-01
1302 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 3 3 $0.01 — $37,910.00 $42,413.00 $39,047.00 2024-12-15
69468-151-04 NDC Uridine Triacetate 10 G Po Pack 24 18 $95,786.80 $47,893.40 50% off $10,395.00 $84,292.00 $38,841.50 2024-12-15
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 3 3 $0.01 — $37,701.00 $42,180.00 $38,832.00 2024-12-15
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 39 21 $0.01 — $8,700.00 $93,969.00 $38,650.01 2026-04-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 38 21 $0.01 — $8,700.00 $93,830.00 $38,574.79 2026-04-01
140 MS_DRG Major Head And Neck Procedures With Mcc 38 21 $0.01 — $8,700.00 $93,165.00 $38,163.10 2026-04-01
7404 APR_DRG Mental Illness Diagnosis With O.r. Procedure 3 3 $0.01 — $36,693.00 $41,052.00 $37,793.00 2024-12-15
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 39 21 $0.01 — $8,700.00 $98,793.00 $37,771.03 2026-04-01
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 3 3 $0.01 — $36,639.00 $40,991.00 $37,738.00 2024-12-15
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 36 20 $0.01 — $24,391.00 $86,182.00 $37,308.74 2026-04-01
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 3 3 $0.01 — $36,136.00 $40,429.00 $37,220.00 2024-12-15
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 39 21 $0.01 — $8,700.00 $91,656.00 $37,157.78 2026-04-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 39 21 $0.01 — $8,700.00 $90,400.00 $37,094.43 2026-04-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 39 21 $0.01 — $8,700.00 $90,535.00 $37,075.95 2026-04-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 39 21 $0.01 — $8,700.00 $92,293.00 $36,967.73 2026-04-01
901 MS_DRG Wound Debridements For Injuries With Mcc 39 21 $0.01 — $8,700.00 $97,599.00 $36,923.74 2026-04-01
460 MS_DRG Spinal Fusion Except Cervical Without Mcc 4 4 — — $29,770.33 $69,737.88 $36,870.35 2026-04-01
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 3 3 $0.01 — $35,554.00 $39,778.00 $36,620.00 2024-12-15
67546-212-21 NDC Nitazoxanide 100 Mg/5ml Po Susr Bulk 24 18 $90,297.50 $45,148.75 50% off $9,799.00 $79,462.00 $36,615.50 2024-12-15
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 3 3 $0.01 — $35,545.00 $39,768.00 $36,611.00 2024-12-15
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 3 3 $0.01 — $35,522.00 $39,742.00 $36,588.00 2024-12-15
C1721 HCPCS Defibrillator Teligen Dr 2chb Bip Is1 Df1 31.5ml 7 996 18 $100,960.60 $50,480.30 50% off $14.00 $136,798.00 $36,569.50 2024-12-15
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 39 21 $0.01 — $8,700.00 $89,601.00 $36,540.13 2026-04-01
1782 APR_DRG External Heart Assist Systems 3 3 $0.01 — $35,130.00 $39,303.00 $36,184.00 2024-12-15
C1820 HCPCS Stimulator Activa Rc Octplr 2 Chan 54x54x9mm 22ml 365 18 $108,680.00 $54,340.00 50% off $779.00 $170,912.00 $36,045.00 2024-12-15
2304 APR_DRG Major Small Bowel Procedures 3 3 $0.01 — $34,951.00 $39,103.00 $35,999.00 2024-12-15
793 MS_DRG Full Term Neonate With Major Problems 37 21 $0.01 — $6,000.00 $91,872.00 $35,987.40 2026-04-01
69930 HCPCS Implant Cochlear Device 13 7 — — $4,733.00 $119,264.68 $35,981.80 2026-04-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 39 21 $0.01 — $6,000.00 $95,317.00 $35,969.00 2026-04-01
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 3 3 $0.01 — $34,893.00 $39,038.00 $35,940.00 2024-12-15
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 39 21 $0.01 — $8,700.00 $87,279.08 $35,872.00 2026-04-01
0310-0283-60 NDC Quetiapine Fumarate ER 300 Mg Po Tb24 24 18 $88,349.54 $44,174.77 50% off $9,588.00 $77,748.00 $35,825.50 2024-12-15
34 MS_DRG Carotid Artery Stent Procedures With Mcc 39 21 $0.01 — $8,700.00 $85,664.00 $35,674.00 2026-04-01
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 3 3 $0.01 — $34,497.00 $38,596.00 $35,532.00 2024-12-15
7594 APR_DRG Eating Disorders 3 3 $0.01 — $34,335.00 $38,414.00 $35,365.00 2024-12-15
J7311 HCPCS Fluocinolone Acetonide 0.59 Mg Iz Impl 30 22 $278,017.70 $139,008.85 50% off $316.00 $244,656.00 $35,320.00 2026-04-01
791 MS_DRG Prematurity With Major Problems 37 21 $0.01 — $6,000.00 $89,436.00 $35,032.82 2026-04-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 39 21 $0.01 — $8,700.00 $83,748.00 $34,876.00 2026-04-01
C1722 HCPCS Defibrillator Teligen Vr 1chb Bip Is1 Df1 31.5ml 7 965 18 $95,758.00 $47,879.00 50% off $4,447.00 $147,965.00 $34,724.00 2024-12-15
C1816 HCPCS System Stim Nerv Stimq-4 8 Elect Dl Transm Kt 65 18 $136,800.00 $68,400.00 50% off $1,650.00 $137,104.00 $34,634.00 2024-12-15
1673 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 3 3 $0.01 — $33,624.00 $37,618.00 $34,633.00 2024-12-15
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