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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

ST BERNARD HOSPITAL

Chicago, IL · CCN 140103 · Rates published

3,148 distinct procedures filed
19 distinct payers
5,226 rate rows
2026-05-28 last MRF observed
Data quality

397 of 5,226 rate rows are consumer-grade (7.6%)

4,829 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 4,829
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.stbh.org/wp-content/uploads/362264414_st-bernard-hospital_standardcharges.csv
Found on page https://www.stbh.org/patients/financial-services/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-22
Content fingerprint acb3de56a1c4ffeb… · 468,775 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
870
MS_DRG 		Septicemia Or Severe Sepsis With Mv >96 Hours 2 $47,477.18 $47,477.18 $47,477.18 nat. median
$62,655
0.8× median
377
MS_DRG 		Gastrointestinal Hemorrhage With Mcc 2 $46,740.53 $46,740.53 $46,740.53 nat. median
$17,298
outlier · 2.7×
327
MS_DRG 		Stomach, Esophageal And Duodenal Procedures With Cc 1 $31,246.59 $31,246.59 $31,246.59 nat. median
$23,572
1.3× median
673
MS_DRG 		Other Kidney And Urinary Tract Procedures With Mcc 1 $31,140.05 $31,140.05 $31,140.05 nat. median
$38,022
0.8× median
987
MS_DRG 		Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 1 $28,832.43 $28,832.43 $28,832.43 nat. median
$31,879
0.9× median
481
MS_DRG 		Hip And Femur Procedures Except Major Joint With Cc 1 $28,166.79 $28,166.79 $28,166.79 nat. median
$20,302
1.4× median
853
MS_DRG 		Infectious And Parasitic Diseases With O.r. Procedures With Mcc 3 $26,435.99 $26,435.99 $26,435.99 nat. median
$45,430
0.6× median
854
MS_DRG 		Infectious And Parasitic Diseases With O.r. Procedures With Cc 1 $24,082.79 $24,082.79 $24,082.79 nat. median
$19,218
1.3× median
438
MS_DRG 		Disorders Of Pancreas Except Malignancy With Mcc 2 $24,016.51 $24,016.51 $24,016.51 nat. median
$15,974
1.5× median
329
MS_DRG 		Major Small And Large Bowel Procedures With Mcc 1 $22,900.21 $22,900.21 $22,900.21 nat. median
$42,641
0.5× median
856
MS_DRG 		Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 1 $22,829.49 $22,829.49 $22,829.49 nat. median
$41,685
0.5× median
208
MS_DRG 		Respiratory System Diagnosis With Ventilator Support <=96 Hours 3 $20,524.92 $20,524.92 $20,524.92 nat. median
$25,388
0.8× median
330
MS_DRG 		Major Small And Large Bowel Procedures With Cc 1 $20,329.56 $20,329.56 $20,329.56 nat. median
$22,949
0.9× median
522
MS_DRG 		Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 1 $18,834.05 $18,834.05 $18,834.05 nat. median
$20,545
0.9× median
876
MS_DRG 		O.r. Procedures With Principal Diagnosis Of Mental Illness 1 $18,817.36 $18,817.36 $18,817.36 nat. median
$33,082
0.6× median
314
MS_DRG 		Other Circulatory System Diagnoses With Mcc 1 $18,689.33 $18,689.33 $18,689.33 nat. median
$19,968
0.9× median
862
MS_DRG 		Postoperative And Post-traumatic Infections With Mcc 1 $16,942.14 $16,942.14 $16,942.14 nat. median
$17,345
1.0× median
100
MS_DRG 		Seizures With Mcc 1 $16,697.20 $16,697.20 $16,697.20 nat. median
$18,360
0.9× median
74
MS_DRG 		Cranial And Peripheral Nerve Disorders Without Mcc 2 $16,662.47 $16,662.47 $16,662.47 nat. median
$10,485
1.6× median
345
MS_DRG 		Minor Small And Large Bowel Procedures With Cc 1 $16,529.23 $16,529.23 $16,529.23 nat. median
$14,850
1.1× median
698
MS_DRG 		Other Kidney And Urinary Tract Diagnoses With Mcc 1 $15,294.81 $15,294.81 $15,294.81 nat. median
$15,903
1.0× median
897
MS_DRG 		Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 2 $13,301.52 $13,301.52 $13,301.52 nat. median
$8,349
1.6× median
417
MS_DRG 		Laparoscopic Cholecystectomy Without C.d.e. With Mcc 1 $12,944.59 $12,944.59 $12,944.59 nat. median
$22,568
0.6× median
433
MS_DRG 		Cirrhosis And Alcoholic Hepatitis With Cc 1 $12,751.21 $12,751.21 $12,751.21 nat. median
$10,764
1.2× median
482
MS_DRG 		Hip And Femur Procedures Except Major Joint Without Cc/Mcc 1 $12,549.88 $12,549.88 $12,549.88 nat. median
$15,989
0.8× median
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 5 $12,546.20 $12,546.20 $12,546.20 nat. median
$18,642
0.7× median
397
MS_DRG 		Appendix Procedures With Mcc 1 $12,274.76 $12,274.76 $12,274.76 nat. median
$22,960
0.5× median
682
MS_DRG 		Renal Failure With Mcc 3 $11,728.38 $11,728.38 $11,728.38 nat. median
$14,434
0.8× median
373
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc 1 $11,702.14 $11,702.14 $11,702.14 nat. median
$7,839
1.5× median
445
MS_DRG 		Disorders Of The Biliary Tract With Cc 1 $11,668.26 $11,668.26 $11,668.26 nat. median
$11,041
1.1× median
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 3 $11,481.23 $11,481.23 $11,481.23 nat. median
$10,401
1.1× median
419
MS_DRG 		Laparoscopic Cholecystectomy Without C.d.e. Without Cc/Mcc 1 $11,471.47 $11,471.47 $11,471.47 nat. median
$13,553
0.8× median
291
MS_DRG 		Heart Failure And Shock With Mcc 4 $11,374.41 $11,374.41 $11,374.41 nat. median
$12,770
0.9× median
917
MS_DRG 		Poisoning And Toxic Effects Of Drugs With Mcc 4 $11,243.53 $11,243.53 $11,243.53 nat. median
$14,580
0.8× median
605
MS_DRG 		Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc 1 $11,151.62 $11,151.62 $11,151.62 nat. median
$9,363
1.2× median
187
MS_DRG 		Pleural Effusion With Cc 1 $10,469.37 $10,469.37 $10,469.37 nat. median
$10,201
1.0× median
896
MS_DRG 		Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc 1 $9,634.35 $9,634.35 $9,634.35 nat. median
$15,476
0.6× median
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 2 $9,621.83 $9,621.83 $9,621.83 nat. median
$15,388
0.6× median
175
MS_DRG 		Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 1 $9,363.93 $9,363.93 $9,363.93 nat. median
$13,728
0.7× median
392
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 2 $9,167.49 $9,167.49 $9,167.49 nat. median
$8,177
1.1× median
125
MS_DRG 		Other Disorders Of The Eye Without Mcc 1 $9,134.70 $9,134.70 $9,134.70 nat. median
$8,280
1.1× median
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 6 $9,098.94 $9,098.94 $9,098.94 nat. median
$12,850
0.7× median
308
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Mcc 1 $9,054.76 $9,054.76 $9,054.76 nat. median
$11,986
0.8× median
190
MS_DRG 		Chronic Obstructive Pulmonary Disease With Mcc 6 $9,048.93 $9,048.93 $9,048.93 nat. median
$11,062
0.8× median
683
MS_DRG 		Renal Failure With Cc 2 $8,974.53 $8,974.53 $8,974.53 nat. median
$9,108
1.0× median
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 1 $8,967.36 $8,967.36 $8,967.36 nat. median
$11,479
0.8× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 4 $8,849.22 $8,849.22 $8,849.22 nat. median
$12,282
0.7× median
123
MS_DRG 		Neurological Eye Disorders 1 $8,780.30 $8,780.30 $8,780.30 nat. median
$8,514
1.0× median
742
MS_DRG 		Uterine And Adnexa Procedures For Non-malignancy With Cc/Mcc 1 $8,632.28 $8,632.28 $8,632.28 nat. median
$17,790
outlier · 0.5×
313
MS_DRG 		Chest Pain 1 $8,198.70 $8,198.70 $8,198.70 nat. median
$7,723
1.1× median

Other procedures at this hospital

Browse this hospital's 3,148 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 2 2 — — $47,477.18 $47,477.18 $47,477.18 2024-12-01
377 MS_DRG Gastrointestinal Hemorrhage With Mcc 2 2 — — $46,740.53 $46,740.53 $46,740.53 2024-12-01
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 1 1 — — $31,246.59 $31,246.59 $31,246.59 2024-12-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 1 1 — — $31,140.05 $31,140.05 $31,140.05 2024-12-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 1 1 — — $28,832.43 $28,832.43 $28,832.43 2024-12-01
481 MS_DRG Hip And Femur Procedures Except Major Joint With Cc 1 1 — — $28,166.79 $28,166.79 $28,166.79 2024-12-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 3 3 — — $26,435.99 $26,435.99 $26,435.99 2024-12-01
854 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Cc 1 1 — — $24,082.79 $24,082.79 $24,082.79 2024-12-01
438 MS_DRG Disorders Of Pancreas Except Malignancy With Mcc 2 2 — — $24,016.51 $24,016.51 $24,016.51 2024-12-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 1 1 — — $22,900.21 $22,900.21 $22,900.21 2024-12-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 1 1 — — $22,829.49 $22,829.49 $22,829.49 2024-12-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 3 3 — — $20,524.92 $20,524.92 $20,524.92 2024-12-01
330 MS_DRG Major Small And Large Bowel Procedures With Cc 1 1 — — $20,329.56 $20,329.56 $20,329.56 2024-12-01
522 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 1 1 — — $18,834.05 $18,834.05 $18,834.05 2024-12-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 1 1 — — $18,817.36 $18,817.36 $18,817.36 2024-12-01
314 MS_DRG Other Circulatory System Diagnoses With Mcc 1 1 — — $18,689.33 $18,689.33 $18,689.33 2024-12-01
862 MS_DRG Postoperative And Post-traumatic Infections With Mcc 1 1 — — $16,942.14 $16,942.14 $16,942.14 2024-12-01
100 MS_DRG Seizures With Mcc 1 1 — — $16,697.20 $16,697.20 $16,697.20 2024-12-01
74 MS_DRG Cranial And Peripheral Nerve Disorders Without Mcc 2 2 — — $16,662.47 $16,662.47 $16,662.47 2024-12-01
345 MS_DRG Minor Small And Large Bowel Procedures With Cc 1 1 — — $16,529.23 $16,529.23 $16,529.23 2024-12-01
698 MS_DRG Other Kidney And Urinary Tract Diagnoses With Mcc 1 1 — — $15,294.81 $15,294.81 $15,294.81 2024-12-01
897 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 2 2 — — $13,301.52 $13,301.52 $13,301.52 2024-12-01
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 1 1 — — $12,944.59 $12,944.59 $12,944.59 2024-12-01
433 MS_DRG Cirrhosis And Alcoholic Hepatitis With Cc 1 1 — — $12,751.21 $12,751.21 $12,751.21 2024-12-01
482 MS_DRG Hip And Femur Procedures Except Major Joint Without Cc/Mcc 1 1 — — $12,549.88 $12,549.88 $12,549.88 2024-12-01
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 5 5 — — $12,546.20 $12,546.20 $12,546.20 2024-12-01
397 MS_DRG Appendix Procedures With Mcc 1 1 — — $12,274.76 $12,274.76 $12,274.76 2024-12-01
682 MS_DRG Renal Failure With Mcc 3 3 — — $11,728.38 $11,728.38 $11,728.38 2024-12-01
373 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc 1 1 — — $11,702.14 $11,702.14 $11,702.14 2024-12-01
445 MS_DRG Disorders Of The Biliary Tract With Cc 1 1 — — $11,668.26 $11,668.26 $11,668.26 2024-12-01
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 3 3 — — $11,481.23 $11,481.23 $11,481.23 2024-12-01
419 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. Without Cc/Mcc 1 1 — — $11,471.47 $11,471.47 $11,471.47 2024-12-01
291 MS_DRG Heart Failure And Shock With Mcc 4 4 — — $11,374.41 $11,374.41 $11,374.41 2024-12-01
917 MS_DRG Poisoning And Toxic Effects Of Drugs With Mcc 4 4 — — $11,243.53 $11,243.53 $11,243.53 2024-12-01
605 MS_DRG Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc 1 1 — — $11,151.62 $11,151.62 $11,151.62 2024-12-01
187 MS_DRG Pleural Effusion With Cc 1 1 — — $10,469.37 $10,469.37 $10,469.37 2024-12-01
896 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc 1 1 — — $9,634.35 $9,634.35 $9,634.35 2024-12-01
177 MS_DRG Respiratory Infections And Inflammations With Mcc 2 2 — — $9,621.83 $9,621.83 $9,621.83 2024-12-01
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 1 1 — — $9,363.93 $9,363.93 $9,363.93 2024-12-01
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 2 2 — — $9,167.49 $9,167.49 $9,167.49 2024-12-01
125 MS_DRG Other Disorders Of The Eye Without Mcc 1 1 — — $9,134.70 $9,134.70 $9,134.70 2024-12-01
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 6 6 — — $9,098.94 $9,098.94 $9,098.94 2024-12-01
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 1 1 — — $9,054.76 $9,054.76 $9,054.76 2024-12-01
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 6 6 — — $9,048.93 $9,048.93 $9,048.93 2024-12-01
683 MS_DRG Renal Failure With Cc 2 2 — — $8,974.53 $8,974.53 $8,974.53 2024-12-01
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 1 1 — — $8,967.36 $8,967.36 $8,967.36 2024-12-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 4 4 — — $8,849.22 $8,849.22 $8,849.22 2024-12-01
123 MS_DRG Neurological Eye Disorders 1 1 — — $8,780.30 $8,780.30 $8,780.30 2024-12-01
742 MS_DRG Uterine And Adnexa Procedures For Non-malignancy With Cc/Mcc 1 1 — — $8,632.28 $8,632.28 $8,632.28 2024-12-01
313 MS_DRG Chest Pain 1 1 — — $8,198.70 $8,198.70 $8,198.70 2024-12-01
101 MS_DRG Seizures Without Mcc 2 2 — — $8,073.10 $8,073.10 $8,073.10 2024-12-01
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 1 1 — — $8,047.40 $8,047.40 $8,047.40 2024-12-01
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 1 1 — — $8,015.32 $8,015.32 $8,015.32 2024-12-01
204 MS_DRG Respiratory Signs And Symptoms 1 1 — — $8,004.74 $8,004.74 $8,004.74 2024-12-01
197 MS_DRG Interstitial Lung Disease With Cc 1 1 — — $7,491.78 $7,491.78 $7,491.78 2024-12-01
304 MS_DRG Hypertension With Mcc 2 2 — — $7,445.80 $7,445.80 $7,445.80 2024-12-01
761 MS_DRG Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc 1 1 — — $7,181.17 $7,181.17 $7,181.17 2024-12-01
684 MS_DRG Renal Failure Without Cc/Mcc 1 1 — — $7,001.18 $7,001.18 $7,001.18 2024-12-01
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 1 1 — — $6,978.43 $6,978.43 $6,978.43 2024-12-01
638 MS_DRG Diabetes With Cc 2 2 — — $6,937.90 $6,937.90 $6,937.90 2024-12-01
880 MS_DRG Acute Adjustment Reaction And Psychosocial Dysfunction 1 1 — — $6,925.55 $6,925.55 $6,925.55 2024-12-01
743 MS_DRG Uterine And Adnexa Procedures For Non-malignancy Without Cc/Mcc 1 1 — — $6,892.78 $6,892.78 $6,892.78 2024-12-01
379 MS_DRG Gastrointestinal Hemorrhage Without Cc/Mcc 1 1 — — $6,816.09 $6,816.09 $6,816.09 2024-12-01
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 2 2 — — $6,812.48 $6,812.48 $6,812.48 2024-12-01
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc 1 1 — — $6,514.28 $6,514.28 $6,514.28 2024-12-01
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 1 1 — — $6,507.11 $6,507.11 $6,507.11 2024-12-01
639 MS_DRG Diabetes Without Cc/Mcc 2 2 — — $6,454.56 $6,454.56 $6,454.56 2024-12-01
5114 OTHER Level 4 Musculoskeletal Procedures 3 3 — — $6,435.27 $6,435.27 $6,435.27 2024-12-01
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 3 3 — — $6,293.19 $6,293.19 $6,293.19 2024-12-01
812 MS_DRG Red Blood Cell Disorders Without Mcc 2 2 — — $6,283.30 $6,283.30 $6,283.30 2024-12-01
881 MS_DRG Depressive Neuroses 4 4 — — $6,262.91 $6,262.91 $6,262.91 2024-12-01
442 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc 1 1 — — $6,034.65 $6,034.65 $6,034.65 2024-12-01
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 2 2 — — $5,941.09 $5,941.09 $5,941.09 2024-12-01
395 MS_DRG Other Digestive System Diagnoses Without Cc/Mcc 1 1 — — $5,925.52 $5,925.52 $5,925.52 2024-12-01
176 MS_DRG Pulmonary Embolism Without Mcc 2 2 — — $5,891.84 $5,891.84 $5,891.84 2024-12-01
885 MS_DRG Psychoses 9 9 — — $5,875.27 $5,875.27 $5,875.27 2024-12-01
811 MS_DRG Red Blood Cell Disorders With Mcc 1 1 — — $5,852.28 $5,852.28 $5,852.28 2024-12-01
202 MS_DRG Bronchitis And Asthma With Cc/Mcc 1 1 — — $5,760.59 $5,760.59 $5,760.59 2024-12-01
832 MS_DRG Other Antepartum Diagnoses Without O.r. Procedures With Cc 1 1 — — $5,652.72 $5,652.72 $5,652.72 2024-12-01
5361 OTHER Level 1 Laparoscopy And Related Services 3 3 — — $5,570.73 $5,570.73 $5,570.73 2024-12-01
201 MS_DRG Pneumothorax Without Cc/Mcc 1 1 — — $5,504.49 $5,504.49 $5,504.49 2024-12-01
446 MS_DRG Disorders Of The Biliary Tract Without Cc/Mcc 1 1 — — $5,502.71 $5,502.71 $5,502.71 2024-12-01
5341 OTHER Level 1 Abdominal/Peritoneal/Biliary And Related Procedures 1 1 — — $5,263.28 $5,263.28 $5,263.28 2024-12-01
894 MS_DRG Alcohol, Drug Abuse Or Dependence, Left Ama 2 2 — — $5,250.53 $5,250.53 $5,250.53 2024-12-01
5401 OTHER Dialysis 2 2 — — $5,203.04 $5,203.04 $5,203.04 2024-12-01
5113 OTHER Level 3 Musculoskeletal Procedures 2 2 — — $5,089.56 $5,089.56 $5,089.56 2024-12-01
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/Mcc 1 1 — — $5,075.90 $5,075.90 $5,075.90 2024-12-01
831 MS_DRG Other Antepartum Diagnoses Without O.r. Procedures With Mcc 1 1 — — $4,910.14 $4,910.14 $4,910.14 2024-12-01
390 MS_DRG Gastrointestinal Obstruction Without Cc/Mcc 1 1 — — $4,879.54 $4,879.54 $4,879.54 2024-12-01
603 MS_DRG Cellulitis Without Mcc 2 2 — — $4,445.38 $4,445.38 $4,445.38 2024-12-01
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/Mcc 2 2 — — $4,310.07 $4,310.07 $4,310.07 2024-12-01
305 MS_DRG Hypertension Without Mcc 1 1 — — $3,945.37 $3,945.37 $3,945.37 2024-12-01
918 MS_DRG Poisoning And Toxic Effects Of Drugs Without Mcc 1 1 — — $3,825.45 $3,825.45 $3,825.45 2024-12-01
5163 OTHER Level 3 ENT Procedures 2 2 — — $3,165.99 $3,165.99 $3,165.99 2024-12-01
5414 OTHER Level 4 Gynecologic Procedures 2 2 — — $2,835.28 $2,835.28 $2,835.28 2024-12-01
5415 OTHER Level 5 Gynecologic Procedures 2 2 — — $2,835.28 $2,835.28 $2,835.28 2024-12-01
5313 OTHER Level 3 Lower Gi Procedures 1 1 — — $2,744.26 $2,744.26 $2,744.26 2024-12-01
5073 OTHER Level 3 Excision/ Biopsy/ Incision And Drainage 1 1 — — $2,180.78 $2,180.78 $2,180.78 2024-12-01
5503 OTHER Level 3 Extraocular, Repair, And Plastic Eye Procedures 1 1 — — $2,165.71 $2,165.71 $2,165.71 2024-12-01
5112 OTHER Level 2 Musculoskeletal Procedures 3 3 — — $1,754.84 $1,754.84 $1,754.84 2024-12-01
5072 OTHER Level 2 Excision/ Biopsy/ Incision And Drainage 4 4 — — $1,525.02 $1,525.02 $1,525.02 2024-12-01
5301 OTHER Level 1 Upper Gi Procedures 6 6 — — $1,515.33 $1,515.33 $1,515.33 2024-12-01
5025 OTHER Level 5 Type A Ed Visits 15 15 — — $1,426.68 $1,426.68 $1,426.68 2024-12-01
5071 OTHER Level 1 Excision/ Biopsy/ Incision And Drainage 2 2 — — $1,265.51 $1,265.51 $1,265.51 2024-12-01
5054 OTHER Level 4 Skin Procedures 1 1 — — $1,238.92 $1,238.92 $1,238.92 2024-12-01
5312 OTHER Level 2 Lower Gi Procedures 5 5 — — $1,202.22 $1,202.22 $1,202.22 2024-12-01
5024 OTHER Level 4 Type A Ed Visits 13 13 — — $1,008.30 $1,008.30 $1,008.30 2024-12-01
5311 OTHER Level 1 Lower Gi Procedures 7 7 — — $853.42 $853.42 $853.42 2024-12-01
5413 OTHER Level 3 Gynecologic Procedures 1 1 — — $823.06 $823.06 $823.06 2024-12-01
5593 OTHER Level 3 Nuclear Medicine And Related Services 3 3 — — $739.04 $739.04 $739.04 2024-12-01
5571 OTHER Level 1 Imaging With Contrast 4 4 — — $679.50 $679.50 $679.50 2024-12-01
5572 OTHER Level 2 Imaging With Contrast 5 5 — — $653.63 $653.63 $653.63 2024-12-01
5053 OTHER Level 3 Skin Procedures 4 4 — — $648.72 $648.72 $648.72 2024-12-01
5722 OTHER Level 2 Diagnostic Tests And Related Services 2 2 — — $621.30 $621.30 $621.30 2024-12-01
5524 OTHER Level 4 Imaging Without Contrast 5 5 — — $534.92 $534.92 $534.92 2024-12-01
5023 OTHER Level 3 Type A Ed Visits 15 15 — — $507.29 $507.29 $507.29 2024-12-01
5052 OTHER Level 2 Skin Procedures 5 5 — — $498.03 $498.03 $498.03 2024-12-01
5411 OTHER Level 1 Gynecologic Procedures 4 4 — — $464.95 $464.95 $464.95 2024-12-01
5522 OTHER Level 2 Imaging Without Contrast 11 11 — — $411.32 $411.32 $411.32 2024-12-01
5523 OTHER Level 3 Imaging Without Contrast 6 6 — — $387.39 $387.39 $387.39 2024-12-01
5022 OTHER Level 2 Type A Ed Visits 14 14 — — $368.20 $368.20 $368.20 2024-12-01
5412 OTHER Level 2 Gynecologic Procedures 2 2 — — $327.87 $327.87 $327.87 2024-12-01
9042 OTHER Glucagon Hydrochloride 1 1 — — $315.47 $315.47 $315.47 2024-12-01
5673 OTHER Level 3 Pathology 1 1 — — $302.64 $302.64 $302.64 2024-12-01
5733 OTHER Level 3 Minor Procedures 11 11 — — $287.15 $287.15 $287.15 2024-12-01
5721 OTHER Level 1 Diagnostic Tests And Related Services 3 3 — — $256.41 $256.41 $256.41 2024-12-01
5102 OTHER Level 2 Strapping And Cast Application 2 2 — — $246.85 $246.85 $246.85 2024-12-01
5012 OTHER Clinic Visits And Related Services 11 11 — — $204.31 $204.31 $204.31 2024-12-01
N903 OTHER Influenza Vaccines & Pneumococcal Pneumonia Vaccines 2 2 — — $204.18 $204.18 $204.18 2024-12-01
5501 OTHER Level 1 Extraocular, Repair, And Plastic Eye Procedures 1 1 — — $193.00 $193.00 $193.00 2024-12-01
5101 OTHER Level 1 Strapping And Cast Application 1 1 — — $148.99 $148.99 $148.99 2024-12-01
5021 OTHER Level 1 Type A Ed Visits 9 9 — — $145.96 $145.96 $145.96 2024-12-01
5051 OTHER Level 1 Skin Procedures 7 7 — — $113.46 $113.46 $113.46 2024-12-01
5734 OTHER Level 4 Minor Procedures 7 7 — — $109.36 $109.36 $109.36 2024-12-01
N804 OTHER Mammography Services 9 9 — — $86.63 $86.63 $86.63 2024-12-01
5521 OTHER Level 1 Imaging Without Contrast 10 10 — — $82.66 $82.66 $82.66 2024-12-01
5731 OTHER Level 1 Minor Procedures 5 5 — — $60.49 $60.49 $60.49 2024-12-01
5692 OTHER Level 2 Drug Administration 3 3 — — $59.86 $59.86 $59.86 2024-12-01
5732 OTHER Level 2 Minor Procedures 4 4 — — $53.24 $53.24 $53.24 2024-12-01
N907 OTHER Not Billable To Fi 1 1 — — $31.00 $31.00 $31.00 2024-12-01
N902 OTHER Packaged Services 1 1 — — $25.93 $25.93 $25.93 2024-12-01
00006911754A NDC — 0 0 $84,602.00 — — — — 2026-05-28
00121058104B NDC — 0 0 $42,541.00 — — — — 2026-05-28
00006498100A NDC — 0 0 $8,110.00 — — — — 2026-05-28
00121057616B NDC — 0 0 $32,708.00 — — — — 2026-05-28
00121050416A NDC — 0 0 $44,794.00 — — — — 2026-05-28
00006351659A NDC — 0 0 $31,510.00 — — — — 2026-05-28
00006007231A NDC — 0 0 $46,989.00 — — — — 2026-05-28
00006003144A NDC — 0 0 $84,649.00 — — — — 2026-05-28
00115262201A NDC — 0 0 $6,298.00 — — — — 2026-05-28
00004082205A NDC — 0 0 $89,924.00 — — — — 2026-05-28
00115175701A NDC — 0 0 $29,845.00 — — — — 2026-05-28
00093874001A NDC — 0 0 $25,603.00 — — — — 2026-05-28
00003089431R NDC — 0 0 $41,873.00 — — — — 2026-05-28
00003089331R NDC — 0 0 $84,928.00 — — — — 2026-05-28
C8932 HCPCS — 0 0 $10,698.00 — — — — 2026-05-28
00002441530A NDC — 0 0 $8,061.00 — — — — 2026-05-28
00093816301A NDC — 0 0 $84,961.00 — — — — 2026-05-28
00002411530A NDC — 0 0 $41,877.00 — — — — 2026-05-28
00093731405A NDC — 0 0 $47,987.00 — — — — 2026-05-28
00093722298A NDC — 0 0 $46,344.00 — — — — 2026-05-28
00093715598A NDC — 0 0 $45,080.00 — — — — 2026-05-28
U0002 HCPCS Covid-19 Lab Test Non-cdc 0 0 $84,001.00 — — — — 2026-05-28
00093417773B NDC — 0 0 $22,659.00 — — — — 2026-05-28
00093417773A NDC — 0 0 $22,618.00 — — — — 2026-05-28
00093412774B NDC — 0 0 $43,820.00 — — — — 2026-05-28
00093412574B NDC — 0 0 $84,943.00 — — — — 2026-05-28
00093412574A NDC — 0 0 $43,812.00 — — — — 2026-05-28
00093312701A NDC — 0 0 $28,581.00 — — — — 2026-05-28
G0483 HCPCS Drug Test Def 22+ Classes 0 0 $14,786.00 — — — — 2026-05-28
C8931 HCPCS — 0 0 $10,697.00 — — — — 2026-05-28
C8908 HCPCS — 0 0 $10,793.00 — — — — 2026-05-28
00093310701A NDC — 0 0 $84,838.00 — — — — 2026-05-28
00093227434A NDC — 0 0 $4,186.00 — — — — 2026-05-28
00093221001A NDC — 0 0 $7,270.00 — — — — 2026-05-28
00093106101A NDC — 0 0 $41,402.00 — — — — 2026-05-28
00093081001A NDC — 0 0 $29,266.00 — — — — 2026-05-28
00093075701A NDC — 0 0 $15,315.00 — — — — 2026-05-28
G0482 HCPCS Drug Test Def 15-21 Classes 0 0 $14,785.00 — — — — 2026-05-28
00093075210A NDC — 0 0 $84,906.00 — — — — 2026-05-28
00093031401A NDC — 0 0 $84,613.00 — — — — 2026-05-28
00093026292A NDC — 0 0 $43,168.00 — — — — 2026-05-28
00093026215A NDC — 0 0 $43,143.00 — — — — 2026-05-28
00093002801A NDC — 0 0 $39,067.00 — — — — 2026-05-28
00093002701A NDC — 0 0 $39,059.00 — — — — 2026-05-28
G0481 HCPCS Drug Test Def 8-14 Classes 0 0 $14,784.00 — — — — 2026-05-28
C8920 HCPCS — 0 0 $10,763.00 — — — — 2026-05-28
00087607005A NDC — 0 0 $84,958.00 — — — — 2026-05-28
00087040501B NDC — 0 0 $84,952.00 — — — — 2026-05-28
00087040501A NDC — 0 0 $46,799.00 — — — — 2026-05-28
00087040203A NDC — 0 0 $30,781.00 — — — — 2026-05-28
00085432001A NDC — 0 0 $7,957.00 — — — — 2026-05-28
00085331535A NDC — 0 0 $84,605.00 — — — — 2026-05-28
G0480 HCPCS Drug Test Def 1-7 Classes 0 0 $2,060.00 — — — — 2026-05-28
00085113201B NDC — 0 0 $46,732.00 — — — — 2026-05-28
00085092401A NDC — 0 0 $84,822.00 — — — — 2026-05-28
00078065920A NDC — 0 0 $8,153.00 — — — — 2026-05-28
00078035752B NDC — 0 0 $84,758.00 — — — — 2026-05-28
00078035752A NDC — 0 0 $84,757.00 — — — — 2026-05-28
00078024115A NDC — 0 0 $89,892.00 — — — — 2026-05-28
00078024015A NDC — 0 0 $89,891.00 — — — — 2026-05-28
00087040203B NDC — 0 0 $30,777.00 — — — — 2026-05-28
00078011022A NDC — 0 0 $48,291.00 — — — — 2026-05-28
G0411 HCPCS Interactive Grp Psyc Php/iop 0 0 $90,004.00 — — — — 2026-05-28
C8919 HCPCS — 0 0 $10,760.00 — — — — 2026-05-28
00087607111A NDC — 0 0 $80,115.00 — — — — 2026-05-28
C8907 HCPCS — 0 0 $10,789.00 — — — — 2026-05-28
C8901 HCPCS — 0 0 $10,727.00 — — — — 2026-05-28
00074929619A NDC — 0 0 $48,225.00 — — — — 2026-05-28
00093026230A NDC — 0 0 $43,150.00 — — — — 2026-05-28
00074706811A NDC — 0 0 $35,297.00 — — — — 2026-05-28
00074659419A NDC — 0 0 $84,905.00 — — — — 2026-05-28
00074366303A NDC — 0 0 $1,802.00 — — — — 2026-05-28
00093075506A NDC — 0 0 $13,955.00 — — — — 2026-05-28
00074364203A NDC — 0 0 $46,534.00 — — — — 2026-05-28
00074364103A NDC — 0 0 $84,844.00 — — — — 2026-05-28
00074333330A NDC — 0 0 $994.00 — — — — 2026-05-28
00093206301A NDC — 0 0 $84,465.00 — — — — 2026-05-28
00071221420A NDC — 0 0 $47,631.00 — — — — 2026-05-28
G0378 HCPCS Hospital Observation Per Hr 0 0 $90,055.00 — — — — 2026-05-28
00071073720A NDC — 0 0 $23,160.00 — — — — 2026-05-28
00093312301A NDC — 0 0 $42,145.00 — — — — 2026-05-28
00069600121A NDC — 0 0 $84,651.00 — — — — 2026-05-28
00069542066A NDC — 0 0 $39,802.00 — — — — 2026-05-28
00069314019A NDC — 0 0 $84,766.00 — — — — 2026-05-28
00093412774A NDC — 0 0 $29,670.00 — — — — 2026-05-28
00069265066A NDC — 0 0 $31,635.00 — — — — 2026-05-28
00069006201A NDC — 0 0 $19,630.00 — — — — 2026-05-28
00065079515A NDC — 0 0 $4,947.00 — — — — 2026-05-28
00093715410A NDC — 0 0 $84,475.00 — — — — 2026-05-28
00065065605B NDC — 0 0 $41,691.00 — — — — 2026-05-28
G0328 HCPCS Fecal Blood Scrn Immunoassay 0 0 $8,696.00 — — — — 2026-05-28
C8918 HCPCS — 0 0 $10,762.00 — — — — 2026-05-28
00093735056A NDC — 0 0 $89,942.00 — — — — 2026-05-28
00065065435A NDC — 0 0 $41,690.00 — — — — 2026-05-28
00093816401A NDC — 0 0 $84,759.00 — — — — 2026-05-28
00093834301A NDC — 0 0 $19,119.00 — — — — 2026-05-28
00093873901A NDC — 0 0 $25,595.00 — — — — 2026-05-28
00065041130B NDC — 0 0 $8,173.00 — — — — 2026-05-28
00096072808A NDC — 0 0 $40,651.00 — — — — 2026-05-28
00065008515A NDC — 0 0 $27,088.00 — — — — 2026-05-28
00115261101A NDC — 0 0 $6,280.00 — — — — 2026-05-28
00056017075A NDC — 0 0 $84,597.00 — — — — 2026-05-28
00116200116A NDC — 0 0 $47,169.00 — — — — 2026-05-28
00116200116B NDC — 0 0 $5,456.00 — — — — 2026-05-28
00121043130A NDC — 0 0 $25,777.00 — — — — 2026-05-28
00056016970A NDC — 0 0 $10,613.00 — — — — 2026-05-28
00121057616A NDC — 0 0 $84,897.00 — — — — 2026-05-28
00054852725A NDC — 0 0 $8,160.00 — — — — 2026-05-28
00121058104A NDC — 0 0 $19,416.00 — — — — 2026-05-28
00054817925A NDC — 0 0 $12,247.00 — — — — 2026-05-28
00121063805A NDC — 0 0 $33,201.00 — — — — 2026-05-28
00121064616A NDC — 0 0 $44,604.00 — — — — 2026-05-28
00121065304A NDC — 0 0 $44,075.00 — — — — 2026-05-28
00054319446A NDC — 0 0 $43,200.00 — — — — 2026-05-28
G0257 HCPCS Unsched Dialysis Esrd Pt Hos 0 0 $12,557.00 — — — — 2026-05-28
00054317644A NDC — 0 0 $8,064.00 — — — — 2026-05-28
00054023763A NDC — 0 0 $84,878.00 — — — — 2026-05-28
00054023524A NDC — 0 0 $43,424.00 — — — — 2026-05-28
00054005746B NDC — 0 0 $43,101.00 — — — — 2026-05-28
00054005746A NDC — 0 0 $43,093.00 — — — — 2026-05-28
00054002025A NDC — 0 0 $84,847.00 — — — — 2026-05-28
00054001920A NDC — 0 0 $31,288.00 — — — — 2026-05-28
00054001820A NDC — 0 0 $31,270.00 — — — — 2026-05-28
G0176 HCPCS Opps/php/iop; Activity Thrpy 0 0 $90,002.00 — — — — 2026-05-28
C8911 HCPCS — 0 0 $10,720.00 — — — — 2026-05-28
C8906 HCPCS — 0 0 $10,792.00 — — — — 2026-05-28
00054001720A NDC — 0 0 $31,262.00 — — — — 2026-05-28
00054001120A NDC — 0 0 $84,468.00 — — — — 2026-05-28
00049399060A NDC — 0 0 $89,946.00 — — — — 2026-05-28
00049052083A NDC — 0 0 $29,712.00 — — — — 2026-05-28
00049005460A NDC — 0 0 $89,944.00 — — — — 2026-05-28
00049001483A NDC — 0 0 $38,499.00 — — — — 2026-05-28
00049001383A NDC — 0 0 $38,481.00 — — — — 2026-05-28
00046110281A NDC — 0 0 $31,387.00 — — — — 2026-05-28
G0129 HCPCS Php/iop Ot Service 0 0 $90,001.00 — — — — 2026-05-28
00046110081A NDC — 0 0 $31,379.00 — — — — 2026-05-28
00168003501A NDC — 0 0 $84,959.00 — — — — 2026-05-28
00046087221A NDC — 0 0 $31,429.00 — — — — 2026-05-28
00168001631A NDC — 0 0 $89,860.00 — — — — 2026-05-28
00168001231A NDC — 0 0 $27,864.00 — — — — 2026-05-28
00037682410B NDC — 0 0 $31,692.00 — — — — 2026-05-28
00037682410A NDC — 0 0 $42,178.00 — — — — 2026-05-28
00031869412B NDC — 0 0 $84,760.00 — — — — 2026-05-28
00168000415A NDC — 0 0 $22,717.00 — — — — 2026-05-28
00031869412A NDC — 0 0 $44,067.00 — — — — 2026-05-28
00143997922A NDC — 0 0 $40,685.00 — — — — 2026-05-28
00143989701A NDC — 0 0 $22,642.00 — — — — 2026-05-28
00143988815A NDC — 0 0 $8,136.00 — — — — 2026-05-28
00143988601A NDC — 0 0 $8,134.00 — — — — 2026-05-28
00025145120A NDC — 0 0 $8,103.00 — — — — 2026-05-28
00168000480A NDC — 0 0 $3,188.00 — — — — 2026-05-28
00168000615A NDC — 0 0 $22,741.00 — — — — 2026-05-28
00168000680A NDC — 0 0 $3,246.00 — — — — 2026-05-28
00025006131A NDC — 0 0 $24,002.00 — — — — 2026-05-28
00168001431A NDC — 0 0 $10,449.00 — — — — 2026-05-28
G0127 HCPCS Trim Nail(s) 0 0 $11,054.00 — — — — 2026-05-28
00168003315A NDC — 0 0 $38,671.00 — — — — 2026-05-28
C8910 HCPCS — 0 0 $10,706.00 — — — — 2026-05-28
00143987201A NDC — 0 0 $21,149.00 — — — — 2026-05-28
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