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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

ALEXIAN BROTHERS BEHAVIORAL HLTH HOSP

Hoffman Estates, IL · CCN 144031 · Rates published

13,102 distinct procedures filed
37 distinct payers
51,065 rate rows
2026-01-01 last MRF observed
Data quality

47,568 of 51,065 rate rows are consumer-grade (93.2%)

3,497 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 1,881
per-diem day rate — not a per-procedure price 1,341
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 213
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 57
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 3
placeholder amount (≤ $0.02) — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://healthcare.ascension.org/-/media/project/ascension/healthcare/price-transparency-files/il-csv/364251848_alexian-brothers-behavioral-health-hospital_standardcharges.csv
Found on page https://healthcare.ascension.org/price-transparency
Discovered viaCMS hospital list
Last fetch not_modified · 2026-08-17
Content fingerprint 78f6dbc255924252… · 10,771,887 bytes · first seen 2026-05-15

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
215
MS_DRG 		Other Heart Assist System Implant 1 $1,920.00 $152,082.00 $77,001.00 nat. median
$98,002
0.8× median
69930
CPT 		Implant Cochlear Device 1 $71,638.00 $71,638.00 $71,638.00 nat. median
$29,361
outlier · 2.4×
583
MS_DRG 		Mastectomy For Malignancy Without Cc/mcc 3 $1,920.00 $117,715.01 $68,750.05 nat. median
$17,225
outlier · 4.0×
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 2 $64,898.00 $64,898.00 $64,898.00 nat. median
$68,581
0.9× median
218
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 $1,920.00 $101,893.00 $64,698.00 nat. median
$60,895
1.1× median
217
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 $1,920.00 $101,893.00 $64,698.00 nat. median
$63,840
1.0× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 $1,920.00 $101,893.00 $64,698.00 nat. median
$92,900
0.7× median
277
MS_DRG 		Cardiac Defibrillator Implant Without Mcc 2 $62,077.00 $62,077.00 $62,077.00 nat. median
$45,772
1.4× median
221
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 2 $1,920.00 $72,601.00 $59,256.00 nat. median
$48,280
1.2× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 2 $1,920.00 $72,601.00 $59,256.00 nat. median
$74,472
0.8× median
276
MS_DRG 		Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 2 $59,256.00 $59,256.00 $59,256.00 nat. median
$58,419
1.0× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 3 $1,920.00 $247,010.00 $56,953.59 nat. median
$261,939
outlier · 0.2×
235
MS_DRG 		Coronary Bypass Without Cardiac Catheterization With Mcc 2 $1,920.00 $53,633.00 $53,548.00 nat. median
$57,082
0.9× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 3 $1,920.00 $247,010.00 $47,989.49 nat. median
$108,240
outlier · 0.4×
236
MS_DRG 		Coronary Bypass Without Cardiac Catheterization Without Mcc 2 $1,920.00 $53,633.00 $47,276.00 nat. median
$41,718
1.1× median
272
MS_DRG 		Other Major Cardiovascular Procedures Without Cc/mcc 2 $1,920.00 $44,693.00 $44,188.00 nat. median
$24,796
1.8× median
269
MS_DRG 		Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 2 $1,920.00 $44,693.00 $44,188.00 nat. median
$41,285
1.1× median
271
MS_DRG 		Other Major Cardiovascular Procedures With Cc 2 $1,920.00 $44,693.00 $44,188.00 nat. median
$35,053
1.3× median
270
MS_DRG 		Other Major Cardiovascular Procedures With Mcc 2 $1,920.00 $50,784.00 $44,188.00 nat. median
$50,808
0.9× median
268
MS_DRG 		Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 2 $1,920.00 $50,784.00 $44,188.00 nat. median
$65,792
0.7× median
6
MS_DRG 		Liver Transplant Without Mcc 3 $1,920.00 $35,365.96 $30,701.10 nat. median
$46,106
0.7× median
619
MS_DRG 		O.r. Procedures For Obesity With Mcc 2 $28,162.00 $31,052.00 $29,607.00 nat. median
$27,710
1.1× median
620
MS_DRG 		O.r. Procedures For Obesity With Cc 2 $28,162.00 $31,052.00 $29,607.00 nat. median
$17,117
1.7× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 3 $1,920.00 $57,853.07 $27,218.63 nat. median
$132,706
outlier · 0.2×
303
MS_DRG 		Atherosclerosis Without Mcc 3 $1,920.00 $26,651.64 $26,651.64 nat. median
$7,759
outlier · 3.4×
61800
CPT 		Apply Srs Headframe Add-on 2 $25,254.00 $25,254.00 $25,254.00 nat. median
$1,345
outlier · 18.8×
61798
CPT 		Srs Cranial Lesion Complex 2 $25,254.00 $25,254.00 $25,254.00 nat. median
$3,902
outlier · 6.5×
63621
CPT 		Srs Spinal Lesion Addl 2 $25,254.00 $25,254.00 $25,254.00 nat. median
$2,340
outlier · 10.8×
61799
CPT 		Srs Cran Les Complex Addl 2 $25,254.00 $25,254.00 $25,254.00 nat. median
$2,050
outlier · 12.3×
61796
CPT 		Srs Cranial Lesion Simple 2 $25,254.00 $25,254.00 $25,254.00 nat. median
$3,830
outlier · 6.6×
63620
CPT 		Srs Spinal Lesion 2 $25,254.00 $25,254.00 $25,254.00 nat. median
$3,830
outlier · 6.6×
61797
CPT 		Srs Cran Les Simple Addl 2 $25,254.00 $25,254.00 $25,254.00 nat. median
$1,633
outlier · 15.5×
7
MS_DRG 		Lung Transplant 3 $1,920.00 $26,924.62 $23,974.22 nat. median
$122,690
outlier · 0.2×
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 3 $1,920.00 $23,023.15 $23,023.15 nat. median
$10,806
outlier · 2.1×
33263
CPT 		Rmvl & Rplcmt Dfb Gen 2 Lead 1 $22,794.00 $22,794.00 $22,794.00 nat. median
$23,228
1.0× median
33249
CPT 		Insj/rplcmt Defib W/lead(s) 1 $22,794.00 $22,794.00 $22,794.00 nat. median
$31,420
0.7× median
33231
CPT 		Insrt Pulse Gen W/mult Leads 1 $22,794.00 $22,794.00 $22,794.00 nat. median
$29,955
0.8× median
33271
CPT 		Insj Subq Impltbl Dfb Elctrd 1 $22,794.00 $22,794.00 $22,794.00 nat. median
$8,498
outlier · 2.7×
33230
CPT 		Insrt Pulse Gen W/dual Leads 1 $22,794.00 $22,794.00 $22,794.00 nat. median
$22,374
1.0× median
33262
CPT 		Rmvl& Replc Pulse Gen 1 Lead 1 $22,794.00 $22,794.00 $22,794.00 nat. median
$23,104
1.0× median
33264
CPT 		Rmvl & Rplcmt Dfb Gen Mlt Ld 1 $22,794.00 $22,794.00 $22,794.00 nat. median
$31,464
0.7× median
33270
CPT 		Ins/rep Subq Defibrillator 1 $22,794.00 $22,794.00 $22,794.00 nat. median
$31,963
0.7× median
33272
CPT 		Rmvl Of Subq Defibrillator 1 $22,794.00 $22,794.00 $22,794.00 nat. median
$4,265
outlier · 5.3×
33240
CPT 		Insrt Pulse Gen W/singl Lead 1 $22,794.00 $22,794.00 $22,794.00 nat. median
$21,987
1.0× median
220
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 4 $1,920.00 $72,601.00 $21,366.23 nat. median
$52,372
outlier · 0.4×
607
MS_DRG 		Minor Skin Disorders Without Mcc 3 $1,920.00 $26,972.63 $20,885.73 nat. median
$9,529
outlier · 2.2×
163
MS_DRG 		Major Chest Procedures With Mcc 3 $1,920.00 $20,857.17 $20,857.17 nat. median
$44,914
outlier · 0.5×
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 3 $1,920.00 $20,609.58 $20,609.58 nat. median
$8,869
outlier · 2.3×
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 3 $1,920.00 $28,075.66 $20,550.86 nat. median
$99,646
outlier · 0.2×
823
MS_DRG 		Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 2 $1,920.00 $38,902.00 $20,411.00 nat. median
$44,650
outlier · 0.5×

Other procedures at this hospital

Browse this hospital's 13,102 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
             
215 MS_DRG Other Heart Assist System Implant 2 1 — — $1,920.00 $152,082.00 $77,001.00 2026-01-01
69930 CPT Implant Cochlear Device 1 1 — — $71,638.00 $71,638.00 $71,638.00 2026-01-01
583 MS_DRG Mastectomy For Malignancy Without Cc/mcc 3 3 — — $1,920.00 $117,715.01 $68,750.05 2026-01-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 2 2 — — $64,898.00 $64,898.00 $64,898.00 2026-01-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 2 — — $1,920.00 $101,893.00 $64,698.00 2026-01-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 2 — — $1,920.00 $101,893.00 $64,698.00 2026-01-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 2 — — $1,920.00 $101,893.00 $64,698.00 2026-01-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 2 2 — — $62,077.00 $62,077.00 $62,077.00 2026-01-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 2 2 — — $59,256.00 $59,256.00 $59,256.00 2026-01-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 2 — — $1,920.00 $72,601.00 $59,256.00 2026-01-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 2 — — $1,920.00 $72,601.00 $59,256.00 2026-01-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 4 3 — — $1,920.00 $247,010.00 $56,953.59 2026-01-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 3 2 — — $1,920.00 $53,633.00 $53,548.00 2026-01-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 4 3 — — $1,920.00 $247,010.00 $47,989.49 2026-01-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 3 2 — — $1,920.00 $53,633.00 $47,276.00 2026-01-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 3 2 — — $1,920.00 $44,693.00 $44,188.00 2026-01-01
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/mcc 3 2 — — $1,920.00 $44,693.00 $44,188.00 2026-01-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 3 2 — — $1,920.00 $50,784.00 $44,188.00 2026-01-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 3 2 — — $1,920.00 $50,784.00 $44,188.00 2026-01-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 3 2 — — $1,920.00 $44,693.00 $44,188.00 2026-01-01
6 MS_DRG Liver Transplant Without Mcc 3 3 — — $1,920.00 $35,365.96 $30,701.10 2026-01-01
619 MS_DRG O.r. Procedures For Obesity With Mcc 3 2 — — $28,162.00 $31,052.00 $29,607.00 2026-01-01
620 MS_DRG O.r. Procedures For Obesity With Cc 3 2 — — $28,162.00 $31,052.00 $29,607.00 2026-01-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 3 3 — — $1,920.00 $57,853.07 $27,218.63 2026-01-01
303 MS_DRG Atherosclerosis Without Mcc 3 3 — — $1,920.00 $26,651.64 $26,651.64 2026-01-01
63620 CPT Srs Spinal Lesion 2 2 — — $25,254.00 $25,254.00 $25,254.00 2026-01-01
61800 CPT Apply Srs Headframe Add-on 2 2 — — $25,254.00 $25,254.00 $25,254.00 2026-01-01
61799 CPT Srs Cran Les Complex Addl 2 2 — — $25,254.00 $25,254.00 $25,254.00 2026-01-01
61798 CPT Srs Cranial Lesion Complex 2 2 — — $25,254.00 $25,254.00 $25,254.00 2026-01-01
61796 CPT Srs Cranial Lesion Simple 2 2 — — $25,254.00 $25,254.00 $25,254.00 2026-01-01
61797 CPT Srs Cran Les Simple Addl 2 2 — — $25,254.00 $25,254.00 $25,254.00 2026-01-01
63621 CPT Srs Spinal Lesion Addl 2 2 — — $25,254.00 $25,254.00 $25,254.00 2026-01-01
7 MS_DRG Lung Transplant 3 3 — — $1,920.00 $26,924.62 $23,974.22 2026-01-01
178 MS_DRG Respiratory Infections And Inflammations With Cc 3 3 — — $1,920.00 $23,023.15 $23,023.15 2026-01-01
33272 CPT Rmvl Of Subq Defibrillator 1 1 — — $22,794.00 $22,794.00 $22,794.00 2026-01-01
33270 CPT Ins/rep Subq Defibrillator 1 1 — — $22,794.00 $22,794.00 $22,794.00 2026-01-01
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 1 1 — — $22,794.00 $22,794.00 $22,794.00 2026-01-01
33231 CPT Insrt Pulse Gen W/mult Leads 1 1 — — $22,794.00 $22,794.00 $22,794.00 2026-01-01
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 1 1 — — $22,794.00 $22,794.00 $22,794.00 2026-01-01
33249 CPT Insj/rplcmt Defib W/lead(s) 1 1 — — $22,794.00 $22,794.00 $22,794.00 2026-01-01
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 1 1 — — $22,794.00 $22,794.00 $22,794.00 2026-01-01
33271 CPT Insj Subq Impltbl Dfb Elctrd 1 1 — — $22,794.00 $22,794.00 $22,794.00 2026-01-01
33230 CPT Insrt Pulse Gen W/dual Leads 1 1 — — $22,794.00 $22,794.00 $22,794.00 2026-01-01
33240 CPT Insrt Pulse Gen W/singl Lead 1 1 — — $22,794.00 $22,794.00 $22,794.00 2026-01-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 5 4 — — $1,920.00 $72,601.00 $21,366.23 2026-01-01
607 MS_DRG Minor Skin Disorders Without Mcc 3 3 — — $1,920.00 $26,972.63 $20,885.73 2026-01-01
163 MS_DRG Major Chest Procedures With Mcc 3 3 — — $1,920.00 $20,857.17 $20,857.17 2026-01-01
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 3 3 — — $1,920.00 $20,609.58 $20,609.58 2026-01-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 3 3 — — $1,920.00 $28,075.66 $20,550.86 2026-01-01
824 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Cc 2 2 — — $1,920.00 $38,902.00 $20,411.00 2026-01-01
825 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures Without Cc/mcc 2 2 — — $1,920.00 $38,902.00 $20,411.00 2026-01-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 2 2 — — $1,920.00 $38,902.00 $20,411.00 2026-01-01
830 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 2 2 — — $1,920.00 $38,902.00 $20,411.00 2026-01-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 2 2 — — $1,920.00 $38,902.00 $20,411.00 2026-01-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 3 2 — — $1,920.00 $36,518.00 $19,219.00 2026-01-01
290 MS_DRG Acute And Subacute Endocarditis Without Cc/mcc 2 1 — — $1,920.00 $36,518.00 $19,219.00 2026-01-01
289 MS_DRG Acute And Subacute Endocarditis With Cc 2 1 — — $1,920.00 $36,518.00 $19,219.00 2026-01-01
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 3 3 — — $1,920.00 $19,143.11 $19,143.11 2026-01-01
265 MS_DRG Aicd Lead Procedures 4 3 — — $1,920.00 $28,382.00 $19,003.00 2026-01-01
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/mcc 3 3 — — $1,920.00 $22,057.40 $18,917.74 2026-01-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 3 3 — — $1,920.00 $29,546.10 $18,604.69 2026-01-01
304 MS_DRG Hypertension With Mcc 3 3 — — $1,920.00 $18,258.30 $18,258.30 2026-01-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 3 3 — — $17,729.40 $26,261.00 $17,729.40 2026-01-01
165 MS_DRG Major Chest Procedures Without Cc/mcc 3 3 — — $1,920.00 $21,160.30 $17,599.26 2026-01-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 3 3 — — $1,920.00 $25,825.95 $17,592.52 2026-01-01
55875 CPT Transperi Needle Place Pros 1 1 — — $17,486.00 $17,486.00 $17,486.00 2026-01-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 5 4 — — $1,920.00 $93,616.00 $16,849.76 2026-01-01
621 MS_DRG O.r. Procedures For Obesity Without Cc/mcc 5 4 — — $1,575.19 $31,052.00 $16,313.59 2026-01-01
250 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc 4 3 — — $1,920.00 $26,748.00 $16,310.50 2026-01-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 5 4 — — $1,920.00 $93,616.00 $15,732.05 2026-01-01
951 MS_DRG Other Factors Influencing Health Status 3 3 — — $1,920.00 $15,617.78 $15,617.78 2026-01-01
183 MS_DRG Major Chest Trauma With Mcc 3 3 — — $1,920.00 $15,575.32 $15,575.32 2026-01-01
92980 CPT Insert Intracoronary Stent 1 1 — — $15,528.00 $15,528.00 $15,528.00 2026-01-01
92981 CPT Insert Intracoronary Stent 1 1 — — $15,528.00 $15,528.00 $15,528.00 2026-01-01
623 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 3 3 — — $1,920.00 $14,973.02 $14,973.02 2026-01-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 4 3 — — $1,920.00 $22,270.47 $14,696.33 2026-01-01
92934 CPT Prq Card Stent/ath/angio 4 4 — — $7,607.00 $17,154.00 $14,685.25 2026-01-01
92941 CPT Prq Card Revasc Mi 1 Vsl 4 4 — — $7,607.00 $17,154.00 $14,685.25 2026-01-01
92944 CPT Prq Card Revasc Chronic Addl 4 4 — — $7,607.00 $17,154.00 $14,685.25 2026-01-01
92928 CPT Prq Card Stent W/angio 1 Vsl 4 4 — — $7,607.00 $17,154.00 $14,685.25 2026-01-01
92937 CPT Prq Revasc Byp Graft 1 Vsl 4 4 — — $7,607.00 $17,154.00 $14,685.25 2026-01-01
92933 CPT Prq Card Stent/ath/angio 4 4 — — $7,607.00 $17,154.00 $14,685.25 2026-01-01
92929 CPT Prq Card Stent W/angio Addl 4 4 — — $7,607.00 $17,154.00 $14,685.25 2026-01-01
92943 CPT Prq Card Revasc Chronic 1vsl 4 4 — — $7,607.00 $17,154.00 $14,685.25 2026-01-01
92938 CPT Prq Revasc Byp Graft Addl 4 4 — — $7,607.00 $17,154.00 $14,685.25 2026-01-01
92920 CPT Prq Cardiac Angioplast 1 Art 4 4 — — $6,903.00 $17,154.00 $14,509.25 2026-01-01
92925 CPT Prq Card Angio/athrect Addl 4 4 — — $6,903.00 $17,154.00 $14,509.25 2026-01-01
92921 CPT Prq Cardiac Angio Addl Art 4 4 — — $6,903.00 $17,154.00 $14,509.25 2026-01-01
92924 CPT Prq Card Angio/athrect 1 Art 4 4 — — $6,903.00 $17,154.00 $14,509.25 2026-01-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 3 3 — — $1,920.00 $22,557.34 $14,458.01 2026-01-01
261 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Cc 4 3 — — $1,920.00 $19,575.19 $13,937.10 2026-01-01
43770 CPT Lap Place Gastr Adj Device 4 4 — — $4,414.00 $16,933.00 $13,722.25 2026-01-01
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 3 3 — — $5,811.14 $26,261.00 $13,560.51 2026-01-01
444 MS_DRG Disorders Of The Biliary Tract With Mcc 3 3 — — $1,920.00 $13,393.87 $13,393.87 2026-01-01
30 MS_DRG Spinal Procedures Without Cc/mcc 3 3 — — $1,920.00 $13,330.78 $13,330.78 2026-01-01
179 MS_DRG Respiratory Infections And Inflammations Without Cc/mcc 3 3 — — $1,920.00 $18,487.64 $13,291.90 2026-01-01
33824 CPT Repair Pda Div 18 Yrs&older 1 1 — — $12,760.20 $12,760.20 $12,760.20 2026-01-01
77424 CPT Io Rad Tx Delivery By X-ray 2 2 — — $12,230.53 $12,230.53 $12,230.53 2026-01-01
77425 CPT Io Rad Tx Deliver By Elctrns 2 2 — — $12,230.53 $12,230.53 $12,230.53 2026-01-01
81416 CPT Exome Sequence Analysis 9 5 — — $950.00 $28,080.00 $12,000.00 2026-01-01
316 MS_DRG Other Circulatory System Diagnoses Without Cc/mcc 3 3 — — $1,920.00 $11,944.45 $11,944.45 2026-01-01
312 MS_DRG Syncope And Collapse 3 3 — — $1,920.00 $23,998.42 $11,833.36 2026-01-01
33213 CPT Insert Pulse Gen Dual Leads 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33229 CPT Remv&replc Pm Gen Mult Leads 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33228 CPT Remv&replc Pm Gen Dual Lead 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33221 CPT Insert Pulse Gen Mult Leads 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33212 CPT Insert Pulse Gen Sngl Lead 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33224 CPT Insert Pacing Lead & Connect 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33208 CPT Insrt Heart Pm Atrial & Vent 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33225 CPT L Ventric Pacing Lead Add-on 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33207 CPT Insert Heart Pm Ventricular 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33227 CPT Remove&replace Pm Gen Singl 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33214 CPT Upgrade Of Pacemaker System 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
33206 CPT Insert Heart Pm Atrial 1 1 — — $11,749.00 $11,749.00 $11,749.00 2026-01-01
513 MS_DRG Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/mcc 3 3 — — $1,920.00 $11,536.57 $11,536.57 2026-01-01
27487 CPT Revise/replace Knee Joint 1 1 — — $11,494.80 $11,494.80 $11,494.80 2026-01-01
285 MS_DRG Acute Myocardial Infarction, Expired Without Cc/mcc 3 2 — — $1,920.00 $20,504.00 $11,212.00 2026-01-01
167 MS_DRG Other Respiratory System O.r. Procedures With Cc 3 3 — — $1,920.00 $11,626.64 $11,185.43 2026-01-01
33968 CPT Remove Aortic Assist Device 1 1 — — $11,119.73 $11,119.73 $11,119.73 2026-01-01
33967 CPT Insert I-aort Percut Device 1 1 — — $11,119.73 $11,119.73 $11,119.73 2026-01-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 5 4 — — $1,920.00 $72,117.00 $11,114.41 2026-01-01
16684473 CDM Paliperidone 351 Mg/2.25 Ml Syringe 2 2 $13,851.58 $5,679.15 59% off $8,310.95 $13,851.58 $11,081.26 2026-01-01
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 3 3 — — $1,920.00 $10,897.37 $10,897.37 2026-01-01
33820 CPT Repair Pda By Ligation 1 1 — — $10,844.10 $10,844.10 $10,844.10 2026-01-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 4 4 — — $1,920.00 $38,902.00 $10,768.82 2026-01-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 3 3 — — $1,920.00 $15,835.21 $10,672.00 2026-01-01
92984 CPT Coronary Artery Dilation 1 1 — — $10,534.00 $10,534.00 $10,534.00 2026-01-01
92982 CPT Coronary Artery Dilation 1 1 — — $10,534.00 $10,534.00 $10,534.00 2026-01-01
92995 CPT Coronary Atherectomy 1 1 — — $10,534.00 $10,534.00 $10,534.00 2026-01-01
121 MS_DRG Acute Major Eye Infections With Cc/mcc 3 3 — — $1,920.00 $16,937.05 $10,199.05 2026-01-01
33822 CPT Repair Pda Div<18 Years 1 1 — — $10,143.90 $10,143.90 $10,143.90 2026-01-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 3 3 — — $1,920.00 $18,287.00 $10,103.50 2026-01-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 3 3 — — $1,920.00 $18,287.00 $10,103.50 2026-01-01
322 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc 3 3 — — $7,642.64 $26,261.00 $10,035.98 2026-01-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 4 3 — — $1,920.00 $78,232.00 $10,027.04 2026-01-01
792 MS_DRG Prematurity Without Major Problems 3 3 — — $1,920.00 $18,793.95 $10,011.77 2026-01-01
14681488 CDM Myeloid Neoplasia Panel Ngs 2 2 $11,501.00 $4,715.41 59% off $8,395.73 $11,501.00 $9,948.36 2026-01-01
262 MS_DRG Cardiac Pacemaker Revision Except Device Replacement Without Cc/mcc 2 1 — — $1,920.00 $17,597.00 $9,758.50 2026-01-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 3 3 — — $1,920.00 $9,728.87 $9,728.87 2026-01-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 3 3 — — $6,499.54 $26,261.00 $9,713.40 2026-01-01
750 MS_DRG Other Female Reproductive System O.r. Procedures Without Cc/mcc 3 3 — — $1,920.00 $9,654.28 $9,654.28 2026-01-01
243 MS_DRG Permanent Cardiac Pacemaker Implant With Cc 6 5 — — $1,920.00 $22,855.00 $9,591.12 2026-01-01
710 MS_DRG Penis Procedures Without Cc/mcc 3 3 — — $1,920.00 $9,397.97 $9,397.97 2026-01-01
511 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc 3 3 — — $1,920.00 $9,382.89 $9,382.89 2026-01-01
660 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Cc 3 3 — — $1,920.00 $9,359.48 $9,359.48 2026-01-01
93528 CPT Rt & Lt Heart Catheters 5 5 — — $9,358.47 $9,481.50 $9,358.47 2026-01-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 3 3 — — $1,920.00 $9,288.85 $9,288.85 2026-01-01
27486 CPT Revise/replace Knee Joint 1 1 — — $9,156.60 $9,156.60 $9,156.60 2026-01-01
93524 CPT Left Heart Catheterization 5 5 — — $9,090.29 $9,458.28 $9,090.29 2026-01-01
93529 CPT Rt, Lt Heart Catheterization 5 5 — — $8,568.18 $9,082.70 $9,082.70 2026-01-01
177 MS_DRG Respiratory Infections And Inflammations With Mcc 3 3 — — $1,920.00 $12,367.41 $8,963.50 2026-01-01
245 MS_DRG Aicd Generator Procedures 6 5 — — $1,920.00 $28,382.00 $8,956.86 2026-01-01
512 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/… 3 3 — — $1,920.00 $15,345.20 $8,956.75 2026-01-01
441 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc 3 3 — — $1,920.00 $22,553.37 $8,754.80 2026-01-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 2 2 — — $8,075.92 $9,401.14 $8,738.53 2026-01-01
22510 CPT Perq Cervicothoracic Inject 5 5 — — $8,736.09 $8,908.74 $8,736.09 2026-01-01
630 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures Without Cc/mcc 3 3 — — $1,920.00 $21,485.26 $8,523.08 2026-01-01
863 MS_DRG Postoperative And Post-traumatic Infections Without Mcc 3 3 — — $1,920.00 $16,573.60 $8,503.64 2026-01-01
0315U OTHER Onc Cutan Sq Cll Ca Mrna 40 2 2 — — $8,500.00 $8,500.00 $8,500.00 2026-01-01
81545 CPT Oncology Thyroid 3 3 — — $3,634.00 $8,424.00 $8,424.00 2026-01-01
93508 CPT Cath Placement, Angiography 5 5 — — $4,223.46 $8,402.13 $8,402.13 2026-01-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 3 3 — — $1,920.00 $9,501.52 $8,378.26 2026-01-01
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 3 3 — — $1,920.00 $8,284.22 $8,284.22 2026-01-01
757 MS_DRG Infections, Female Reproductive System With Mcc 3 3 — — $1,920.00 $8,263.99 $8,263.99 2026-01-01
244 MS_DRG Permanent Cardiac Pacemaker Implant Without Cc/mcc 6 5 — — $1,920.00 $22,855.00 $8,192.09 2026-01-01
22548 CPT Arthrd Ant Toral/xoral C1-c2 1 1 — — $8,121.60 $8,121.60 $8,121.60 2026-01-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 3 3 — — $1,920.00 $8,110.83 $8,110.83 2026-01-01
89 MS_DRG Concussion With Cc 3 3 — — $1,920.00 $21,221.80 $8,067.98 2026-01-01
27138 CPT Revise Hip Joint Replacement 1 1 — — $7,968.60 $7,968.60 $7,968.60 2026-01-01
27132 CPT Total Hip Arthroplasty 1 1 — — $7,968.60 $7,968.60 $7,968.60 2026-01-01
27134 CPT Revise Hip Joint Replacement 1 1 — — $7,968.60 $7,968.60 $7,968.60 2026-01-01
27137 CPT Revise Hip Joint Replacement 1 1 — — $7,968.60 $7,968.60 $7,968.60 2026-01-01
93655 CPT Icar Cath Abltj Dscrt Arrhyt 1 1 — — $7,947.00 $7,947.00 $7,947.00 2026-01-01
93657 CPT Tx L/r Atrial Fib Addl 1 1 — — $7,947.00 $7,947.00 $7,947.00 2026-01-01
251 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc 6 5 — — $1,920.00 $23,687.00 $7,941.83 2026-01-01
788 MS_DRG Cesarean Section Without Sterilization Without Cc/mcc 4 3 — — $1,920.00 $15,007.00 $7,919.00 2026-01-01
783 MS_DRG Cesarean Section With Sterilization With Mcc 4 3 — — $1,920.00 $15,007.00 $7,919.00 2026-01-01
784 MS_DRG Cesarean Section With Sterilization With Cc 4 3 — — $1,920.00 $15,007.00 $7,919.00 2026-01-01
785 MS_DRG Cesarean Section With Sterilization Without Cc/mcc 4 3 — — $1,920.00 $15,007.00 $7,919.00 2026-01-01
786 MS_DRG Cesarean Section Without Sterilization With Mcc 4 3 — — $1,920.00 $15,007.00 $7,919.00 2026-01-01
787 MS_DRG Cesarean Section Without Sterilization With Cc 4 3 — — $1,920.00 $15,007.00 $7,919.00 2026-01-01
182 MS_DRG Respiratory Neoplasms Without Cc/mcc 3 3 — — $1,920.00 $16,979.90 $7,833.09 2026-01-01
180 MS_DRG Respiratory Neoplasms With Mcc 3 3 — — $1,920.00 $14,382.62 $7,814.05 2026-01-01
286 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc 4 3 — — $1,920.00 $16,139.00 $7,714.25 2026-01-01
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 3 3 — — $1,920.00 $7,597.41 $7,597.41 2026-01-01
12403183 CDM Cytogen M Array Additional 2 2 $8,775.00 $3,597.75 59% off $6,405.75 $8,775.00 $7,590.38 2026-01-01
12399023 CDM Chromosome Microarray Acl 2 2 $8,775.00 $3,597.75 59% off $6,405.75 $8,775.00 $7,590.38 2026-01-01
10730813 CDM Cytogen M Array Cnv & Snp 2 2 $8,775.00 $3,597.75 59% off $6,405.75 $8,775.00 $7,590.38 2026-01-01
81552 CPT Onc Uveal Mlnma Mrna 15 Gene 7 4 — — $5,832.00 $9,331.20 $7,581.60 2026-01-01
27445 CPT Revision Of Knee Joint 1 1 — — $7,497.00 $7,497.00 $7,497.00 2026-01-01
77301 CPT Radiotherapy Dose Plan Imrt 7 7 — — $3,499.61 $7,582.62 $7,435.67 2026-01-01
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc 3 3 — — $1,920.00 $12,059.12 $7,421.64 2026-01-01
0094U OTHER Genome Rapid Sequence Alys 7 4 — — $5,686.65 $9,098.64 $7,392.65 2026-01-01
287 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc 4 3 — — $1,920.00 $14,659.00 $7,344.25 2026-01-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 6 5 — — $1,920.00 $23,177.00 $7,342.56 2026-01-01
95957 CPT EEG Digital Analysis 5 5 — — $918.48 $7,293.99 $7,293.99 2026-01-01
93650 CPT Icar Cath Abltj Av Node Func 6 6 — — $2,360.70 $7,947.00 $7,225.68 2026-01-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 3 3 — — $1,920.00 $9,759.43 $7,223.65 2026-01-01
93352 CPT Admin ECG Contrast Agent 5 5 — — $154.80 $7,142.19 $7,142.19 2026-01-01
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 3 3 — — $1,920.00 $15,991.94 $7,029.63 2026-01-01
81529 CPT Onc Cutan Mlnma Mrna 31 Gene 7 4 — — $5,394.75 $8,631.60 $7,013.18 2026-01-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 4 3 — — $1,920.00 $78,232.00 $7,002.65 2026-01-01
841 MS_DRG Lymphoma And Non-acute Leukemia With Cc 3 3 — — $1,920.00 $23,892.88 $6,994.71 2026-01-01
93651 CPT Ablate Heart Dysrhythm Focus 5 5 — — $3,591.36 $6,914.49 $6,914.49 2026-01-01
740 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Cc 3 3 — — $1,920.00 $21,985.19 $6,818.94 2026-01-01
63081 CPT Remove Vert Body Dcmprn Crvl 1 1 — — $6,760.80 $6,760.80 $6,760.80 2026-01-01
0267U OTHER Rare Do Id Opt Gen Mapg&seq 3 3 — — $6,739.33 $6,739.33 $6,739.33 2026-01-01
115 MS_DRG Extraocular Procedures Except Orbit 3 3 — — $1,920.00 $6,703.88 $6,703.88 2026-01-01
313 MS_DRG Chest Pain 3 3 — — $1,920.00 $9,754.27 $6,685.63 2026-01-01
10684389 CDM Aripiprazole 400 Mg/2 Ml ER Susp-inj 1 1 $6,589.44 $2,701.67 59% off $6,589.44 $6,589.44 $6,589.44 2026-01-01
32656 CPT Thoracoscopy W/pleurectomy 1 1 — — $6,564.60 $6,564.60 $6,564.60 2026-01-01
32651 CPT Thoracoscopy Remove Cortex 1 1 — — $6,564.60 $6,564.60 $6,564.60 2026-01-01
32650 CPT Thoracoscopy W/pleurodesis 1 1 — — $6,564.60 $6,564.60 $6,564.60 2026-01-01
32652 CPT Thoracoscopy Rem Totl Cortex 1 1 — — $6,564.60 $6,564.60 $6,564.60 2026-01-01
32655 CPT Thoracoscopy Resect Bullae 1 1 — — $6,564.60 $6,564.60 $6,564.60 2026-01-01
43645 CPT Lap Gastr Bypass Incl Smll I 3 3 — — $6,551.10 $6,551.10 $6,551.10 2026-01-01
93642 CPT Ep Evl 1/2chmb Trnsvns Cvdfb 6 6 — — $1,878.24 $6,914.49 $6,497.24 2026-01-01
850 MS_DRG Acute Leukemia With Other Procedures 2 2 — — $6,491.21 $6,491.21 $6,491.21 2026-01-01
0081U OTHER Onc Uveal Mlnma Mrna 15 Gene 2 2 — — $6,480.00 $6,480.00 $6,480.00 2026-01-01
176 MS_DRG Pulmonary Embolism Without Mcc 3 3 — — $1,920.00 $19,633.92 $6,449.94 2026-01-01
0211U OTHER Onc Pan-tum Dna&rna Gnrj Seq 6 3 — — $4,410.00 $8,455.00 $6,341.25 2026-01-01
45123 CPT Partial Proctectomy 1 1 — — $6,299.10 $6,299.10 $6,299.10 2026-01-01
93505 CPT Endomyocardial Biopsy 8 8 — — $2,941.20 $9,297.75 $6,266.50 2026-01-01
93503 CPT Insert/place Heart Catheter 8 8 — — $441.18 $9,274.98 $6,266.50 2026-01-01
92 MS_DRG Other Disorders Of Nervous System With Cc 3 3 — — $1,920.00 $9,819.34 $6,263.46 2026-01-01
442 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc 3 3 — — $1,920.00 $9,078.56 $6,248.78 2026-01-01
43644 CPT Lap Gastric Bypass/roux-en-y 3 3 — — $6,129.90 $6,129.90 $6,129.90 2026-01-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 5 4 — — $1,920.00 $67,762.00 $6,113.48 2026-01-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 3 3 — — $1,920.00 $6,085.31 $6,085.31 2026-01-01
93644 CPT Ep Eval Subq Impl Dfb 1 1 — — $6,080.00 $6,080.00 $6,080.00 2026-01-01
93600 CPT Bundle Of His Recording 1 1 — — $6,080.00 $6,080.00 $6,080.00 2026-01-01
93616 CPT Esophageal Recording W/pacg 1 1 — — $6,080.00 $6,080.00 $6,080.00 2026-01-01
807 MS_DRG Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc 4 3 — — $1,920.00 $10,789.00 $6,020.50 2026-01-01
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 4 3 — — $1,920.00 $10,789.00 $6,020.50 2026-01-01
768 MS_DRG Vaginal Delivery With O.r. Procedures Except Sterilization And/or D&c 4 3 — — $1,920.00 $10,789.00 $6,020.50 2026-01-01
798 MS_DRG Vaginal Delivery With Sterilization And/or D&c Without Cc/mcc 4 3 — — $1,920.00 $10,789.00 $6,020.50 2026-01-01
805 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Mcc 4 3 — — $1,920.00 $10,789.00 $6,020.50 2026-01-01
796 MS_DRG Vaginal Delivery With Sterilization And/or D&c With Mcc 4 3 — — $1,920.00 $10,789.00 $6,020.50 2026-01-01
797 MS_DRG Vaginal Delivery With Sterilization And/or D&c With Cc 4 3 — — $1,920.00 $10,789.00 $6,020.50 2026-01-01
137 MS_DRG Mouth Procedures With Cc/mcc 3 3 — — $1,920.00 $6,000.79 $6,000.79 2026-01-01
22846 CPT Insert Spine Fixation Device 1 1 — — $5,998.50 $5,998.50 $5,998.50 2026-01-01
22847 CPT Insert Spine Fixation Device 1 1 — — $5,998.50 $5,998.50 $5,998.50 2026-01-01
63290 CPT Bx/exc Xdrl/idrl Lsn Any Lvl 1 1 — — $5,987.70 $5,987.70 $5,987.70 2026-01-01
63282 CPT Bx/exc Idrl Spine Lesn Lmbr 1 1 — — $5,987.70 $5,987.70 $5,987.70 2026-01-01
63277 CPT Bx/exc Xdrl Spine Lesn Lmbr 1 1 — — $5,987.70 $5,987.70 $5,987.70 2026-01-01
63287 CPT Bx/exc Idrl Imed Lesn Thrlmb 1 1 — — $5,987.70 $5,987.70 $5,987.70 2026-01-01
63200 CPT Release Spinal Cord Lumbar 1 1 — — $5,987.70 $5,987.70 $5,987.70 2026-01-01
63191 CPT Incise Spine Accessory Nerve 1 1 — — $5,987.70 $5,987.70 $5,987.70 2026-01-01
63252 CPT Revise Spine Cord Vsl Thrlmb 1 1 — — $5,987.70 $5,987.70 $5,987.70 2026-01-01
63185 CPT Incise Spine Nrv Half Segmnt 1 1 — — $5,987.70 $5,987.70 $5,987.70 2026-01-01
63190 CPT Incise Spine Nrv >2 Segmnts 1 1 — — $5,987.70 $5,987.70 $5,987.70 2026-01-01
63272 CPT Excise Intrspinl Lesion Lmbr 1 1 — — $5,987.70 $5,987.70 $5,987.70 2026-01-01
181 MS_DRG Respiratory Neoplasms With Cc 3 3 — — $1,920.00 $19,985.85 $5,968.66 2026-01-01
639 MS_DRG Diabetes Without Cc/mcc 3 3 — — $1,920.00 $5,967.86 $5,967.86 2026-01-01
470 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without … 3 3 — — $1,920.00 $5,921.04 $5,921.04 2026-01-01
78433 CPT Myocrd Img PET 2rtracer CT 6 6 — — $5,825.20 $5,940.32 $5,853.98 2026-01-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 2 2 — — $5,853.59 $5,853.59 $5,853.59 2026-01-01
61500 CPT Crnec Exc Tum/bone Les Skull 1 1 — — $5,799.60 $5,799.60 $5,799.60 2026-01-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 3 3 — — $1,920.00 $11,430.24 $5,777.41 2026-01-01
43279 CPT Lap Myotomy Heller 3 3 — — $5,754.60 $5,754.60 $5,754.60 2026-01-01
43400 CPT Ligate Esophagus Veins 1 1 — — $5,754.60 $5,754.60 $5,754.60 2026-01-01
43775 CPT Lap Sleeve Gastrectomy 2 2 — — $4,414.00 $7,065.00 $5,739.50 2026-01-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 3 3 — — $1,920.00 $8,667.11 $5,706.39 2026-01-01
56634 CPT Vlvctmy Rad Comp Uni Lymphad 1 1 — — $5,706.17 $5,706.17 $5,706.17 2026-01-01
56633 CPT Vulvectomy Radical Complete 1 1 — — $5,706.17 $5,706.17 $5,706.17 2026-01-01
56637 CPT Vlvctmy Rad Comp Bi Lymphad 1 1 — — $5,706.17 $5,706.17 $5,706.17 2026-01-01
56631 CPT Vlvctmy Rad Prtl Uni Lymphad 1 1 — — $5,706.17 $5,706.17 $5,706.17 2026-01-01
56632 CPT Vlvctmy Rad Prtl Bi Lymphad 1 1 — — $5,706.17 $5,706.17 $5,706.17 2026-01-01
91 MS_DRG Other Disorders Of Nervous System With Mcc 3 3 — — $1,920.00 $15,237.27 $5,701.63 2026-01-01
320 MS_DRG Other Endovascular Cardiac Valve Procedures Without Mcc 3 3 — — $1,920.00 $14,113.22 $5,678.62 2026-01-01
93597 CPT R&l Hrt Cath Chd Abnl Nt Cnj 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93595 CPT L Hrt Cath Chd Nm/abn Nt Cnj 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93596 CPT R&l Hrt Cath Chd Nml Nt Cnj 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93459 CPT L Hrt Art/grft Angio 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
93594 CPT R Hrt Cath Chd Abnl Nt Cnj 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93453 CPT R&l Hrt Cath W/ventriclgrphy 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
93593 CPT R Hrt Cath Chd Nml Nt Cnj 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93451 CPT Right Heart Cath 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
0569T OTHER Ttvr Perq Appr 1st Prosth 2 2 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93460 CPT R&l Hrt Art/ventricle Angio 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
34718 CPT Evasc Rpr N/a A-iliac Ndgft 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
34717 CPT Evasc Rpr A-iliac Ndgft 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93455 CPT Coronary Art/grft Angio S&i 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
33289 CPT Tcat Impl Wrls P-art Prs Snr 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
0544U OTHER Nefro Trnsp Mntr 48vrnt Dpcr 2 2 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
33018 CPT Prcrd DRG 0-5yr Or W/anomly 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
33017 CPT Prcrd DRG 6yr+ Without Cgen Car 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
33019 CPT Perq Prcrd DRG Insj Cath CT 1 1 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93456 CPT R Hrt Coronary Artery Angio 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
93461 CPT R&l Hrt Art/ventricle Angio 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
93452 CPT Left Hrt Cath W/ventrclgrphy 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
0545F OTHER Follow Up Care Plan Mdd Docd 2 2 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93458 CPT L Hrt Artery/ventricle Angio 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
0543T OTHER Ta Mv Rpr W/artif Chord Tend 2 2 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93454 CPT Coronary Artery Angio S&i 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
0543U OTHER Onc Sol Tum Ngs DNA 517 Gens 2 2 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
93457 CPT R Hrt Art/grft Angio 3 3 — — $5,623.00 $6,855.00 $5,678.00 2026-01-01
0544T OTHER Tcat Mv Annulus Rcnstj 2 2 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
0545T OTHER Tcat Tv Annulus Rcnstj 2 2 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
0569U OTHER Onc Sol Tum Ngs Tmm>20000dmr 2 2 — — $5,678.00 $5,678.00 $5,678.00 2026-01-01
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