Price Transparencybeta Hospital negotiated rates

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

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Hospital

WAYNE COUNTY HOSPITAL

Corydon, IA · CCN 161358 · Rates published

Your selected procedure

You selected 93306 (HCPCS)

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

This hospital’s price: $526 across 6 payers · range $293-$907

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbWCHCORYDONIA&type=CDMWithoutLabel&fileType=CSV · observed 2026-03-03

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

6,378 distinct procedures filed
10 distinct payers
33,221 rate rows
2026-03-03 last MRF observed
Data quality

32,412 of 33,221 rate rows are consumer-grade (97.6%)

809 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 399
per-diem day rate — not a per-procedure price 267
exceeds 3× this hospital's gross charge for a DRG stay — excluded 67
exceeds 10× this hospital's gross charge — excluded from medians 38
percent-of-charges filed in the dollar field — excluded from medians 32
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 6
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbWCHCORYDONIA&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Wayne_County.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-20
Content fingerprint d6aeeb1f51a25b02… · 12,276,880 bytes · first seen 2026-05-08

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
56
MS_DRG 		Degenerative Nervous System Disorders With Mcc 3 $23,552.89 $128,322.00 $128,322.00 nat. median
$21,152
outlier · 6.1×
699
MS_DRG 		Other Kidney And Urinary Tract Diagnoses With Cc 3 $8,708.78 $38,870.28 $38,870.28 nat. median
$10,325
outlier · 3.8×
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 3 $13,947.29 $35,816.00 $35,816.00 nat. median
$11,478
outlier · 3.1×
949
MS_DRG 		Aftercare With Cc/mcc 3 $10,049.01 $34,110.00 $34,110.00 nat. median
$11,791
outlier · 2.9×
J2507
HCPCS 		Injection, Pegloticase, 1 Mg 4 $17,780.67 $51,402.22 $32,081.06 nat. median
$9,200
outlier · 3.5×
521
MS_DRG 		Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 1 $29,722.66 $29,722.66 $29,722.66 nat. median
$27,642
1.1× median
02544965
CDM 		Lgn Ox Constrained Fem 4 Lt 4 $13,158.75 $38,678.75 $26,915.62 nat. median
$26,916
1.0× median
689
MS_DRG 		Kidney And Urinary Tract Infections With Mcc 3 $9,555.72 $23,644.38 $23,644.38 nat. median
$11,515
outlier · 2.1×
02544713
CDM 		Redapt Slvls Mono Stem 2400mm 4 $11,111.43 $32,660.87 $22,727.92 nat. median
$22,728
1.0× median
372
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections With Cc 3 $8,646.21 $22,463.00 $22,463.00 nat. median
$10,422
outlier · 2.2×
02545613
CDM 		Full Implant Neurostimulator 4 $10,894.62 $32,023.58 $22,284.45 nat. median
$22,284
1.0× median
02545577
CDM 		Full Implant Neurostimulator 4 $10,637.55 $31,267.95 $21,758.62 nat. median
$21,759
1.0× median
522
MS_DRG 		Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 1 $20,451.67 $20,451.67 $20,451.67 nat. median
$20,545
1.0× median
480
MS_DRG 		Hip And Femur Procedures Except Major Joint With Mcc 1 $20,218.63 $20,218.63 $20,218.63 nat. median
$27,846
0.7× median
481
MS_DRG 		Hip And Femur Procedures Except Major Joint With Cc 1 $19,692.69 $19,692.69 $19,692.69 nat. median
$20,312
1.0× median
559
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 2 $13,947.29 $25,353.00 $19,650.15 nat. median
$18,115
1.1× median
02545873
CDM 		Disposable Insertion Tool 4 $9,260.13 $27,219.17 $18,941.17 nat. median
$18,941
1.0× median
470
MS_DRG 		Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without… 1 $18,681.63 $18,681.63 $18,681.63 nat. median
$18,831
1.0× median
469
MS_DRG 		Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 1 $18,681.63 $18,681.63 $18,681.63 nat. median
$29,492
0.6× median
02543848
CDM 		Lgn Ox Constrained Fem 8 Rt 4 $9,129.45 $26,835.05 $18,673.88 nat. median
$18,674
1.0× median
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 3 $7,634.24 $18,279.00 $18,279.00 nat. median
$10,207
1.8× median
330
MS_DRG 		Major Small And Large Bowel Procedures With Cc 1 $17,780.28 $17,780.28 $17,780.28 nat. median
$22,965
0.8× median
02544932
CDM 		Cpcs Cocr Prim Ho 12/14 Sz2 4 $8,414.34 $24,733.06 $17,211.15 nat. median
$17,211
1.0× median
02542971
CDM 		Legion Narrow Ps Sz 4n Lt 4 $8,076.75 $23,740.75 $16,520.62 nat. median
$16,521
1.0× median
02544428
CDM 		Syn Por Plus Ha So Stem Sz11 4 $7,786.35 $22,887.15 $15,926.62 nat. median
$15,927
1.0× median
02544917
CDM 		Interstim Ii Neurostimulator 4 $7,623.00 $22,407.00 $15,592.50 nat. median
$15,592
1.0× median
475
MS_DRG 		Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc 1 $15,273.92 $15,273.92 $15,273.92 nat. median
$21,232
0.7× median
02542396
CDM 		Syn Por Plus Ha Stem Sz15 4 $7,267.26 $21,361.34 $14,864.85 nat. median
$14,865
1.0× median
02542951
CDM 		Syn Por Plus Sz13 4 $7,267.26 $21,361.34 $14,864.85 nat. median
$14,865
1.0× median
617
MS_DRG 		Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 1 $14,120.49 $14,120.49 $14,120.49 nat. median
$18,303
0.8× median
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 $14,031.62 $14,031.62 $14,031.62 nat. median
$18,659
0.8× median
439
MS_DRG 		Disorders Of Pancreas Except Malignancy With Cc 3 $7,615.20 $13,476.50 $13,476.50 nat. median
$8,941
1.5× median
02543733
CDM 		Syn Por Fem Comp Sz 8 4 $6,559.41 $19,280.69 $13,416.97 nat. median
$13,417
1.0× median
02544834
CDM 		Nexgen Femoral Size F Left 4 $6,534.00 $19,206.00 $13,365.00 nat. median
$13,365
1.0× median
02544835
CDM 		Nexgen Femoral Size F Right 4 $6,534.00 $19,206.00 $13,365.00 nat. median
$13,365
1.0× median
02545174
CDM 		Nexgen Lps-flex Sz G-rt 4 $6,534.00 $19,206.00 $13,365.00 nat. median
$13,365
1.0× median
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 1 $13,057.73 $13,057.73 $13,057.73 nat. median
$15,405
0.8× median
02545493
CDM 		Angle Cylinder Set 4 $6,346.23 $18,654.07 $12,980.92 nat. median
$12,981
1.0× median
02545209
CDM 		Ams 700 Cx Ms Pump Iz 4 $6,262.74 $18,408.66 $12,810.15 nat. median
$12,810
1.0× median
02542734
CDM 		Cylinder Pump 18 Cm 4 $6,262.74 $18,408.66 $12,810.15 nat. median
$12,810
1.0× median
02542532
CDM 		Legion Ps Oxin Fem Sz5 Rt 4 $6,229.08 $18,309.72 $12,741.30 nat. median
$12,741
1.0× median
280
MS_DRG 		Acute Myocardial Infarction, Discharged Alive With Mcc 1 $12,511.85 $12,511.85 $12,511.85 nat. median
$15,670
0.8× median
841
MS_DRG 		Lymphoma And Non-acute Leukemia With Cc 1 $12,494.62 $12,494.62 $12,494.62 nat. median
$15,885
0.8× median
562
MS_DRG 		Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 1 $12,353.16 $12,353.16 $12,353.16 nat. median
$13,965
0.9× median
811
MS_DRG 		Red Blood Cell Disorders With Mcc 1 $12,271.55 $12,271.55 $12,271.55 nat. median
$13,626
0.9× median
02543630
CDM 		Titan Scrotal Cylinder Set With Pump 4 $5,953.20 $17,498.80 $12,177.00 nat. median
$12,177
1.0× median
02543791
CDM 		Cx 700 18cm 4 $5,914.92 $17,386.28 $12,098.70 nat. median
$12,099
1.0× median
281
MS_DRG 		Acute Myocardial Infarction, Discharged Alive With Cc 3 $7,528.15 $11,932.00 $11,932.00 nat. median
$9,717
1.2× median
186
MS_DRG 		Pleural Effusion With Mcc 1 $11,805.46 $11,805.46 $11,805.46 nat. median
$15,136
0.8× median
02543434
CDM 		Syn Por Plus Ha So Stem Sz16 4 $5,674.02 $16,678.18 $11,605.95 nat. median
$11,606
1.0× median

Other procedures at this hospital

Browse this hospital's 6,378 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
             
56 MS_DRG Degenerative Nervous System Disorders With Mcc 3 3 $54,852.00 $54,852.00 $23,552.89 $128,322.00 $128,322.00 2026-03-03
699 MS_DRG Other Kidney And Urinary Tract Diagnoses With Cc 3 3 $17,540.28 $17,540.28 $8,708.78 $38,870.28 $38,870.28 2026-03-03
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 3 3 $16,856.00 $16,856.00 $13,947.29 $35,816.00 $35,816.00 2026-03-03
949 MS_DRG Aftercare With Cc/mcc 3 3 $15,150.00 $15,150.00 $10,049.01 $34,110.00 $34,110.00 2026-03-03
J2507 HCPCS Injection, Pegloticase, 1 Mg 4 4 $135,269.00 $135,269.00 $17,780.67 $51,402.22 $32,081.06 2026-03-03
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 1 1 $73,162.00 $73,162.00 $29,722.66 $29,722.66 $29,722.66 2026-03-03
02544965 CDM Lgn Ox Constrained Fem 4 Lt 4 4 $39,875.00 $39,875.00 $13,158.75 $38,678.75 $26,915.62 2026-03-03
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 3 3 $11,794.38 $11,794.38 $9,555.72 $23,644.38 $23,644.38 2026-03-03
02544713 CDM Redapt Slvls Mono Stem 2400mm 4 4 $33,671.00 $33,671.00 $11,111.43 $32,660.87 $22,727.92 2026-03-03
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 3 3 $10,613.00 $10,613.00 $8,646.21 $22,463.00 $22,463.00 2026-03-03
02545613 CDM Full Implant Neurostimulator 4 4 $33,014.00 $33,014.00 $10,894.62 $32,023.58 $22,284.45 2026-03-03
02545577 CDM Full Implant Neurostimulator 4 4 $32,235.00 $32,235.00 $10,637.55 $31,267.95 $21,758.62 2026-03-03
522 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 1 1 $65,639.00 $65,639.00 $20,451.67 $20,451.67 $20,451.67 2026-03-03
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 1 1 $29,472.00 $29,472.00 $20,218.63 $20,218.63 $20,218.63 2026-03-03
481 MS_DRG Hip And Femur Procedures Except Major Joint With Cc 1 1 $57,640.50 $57,640.50 $19,692.69 $19,692.69 $19,692.69 2026-03-03
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 2 2 $11,133.00 $11,133.00 $13,947.29 $25,353.00 $19,650.15 2026-03-03
02545873 CDM Disposable Insertion Tool 4 4 $28,061.00 $28,061.00 $9,260.13 $27,219.17 $18,941.17 2026-03-03
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 1 1 $46,577.00 $46,577.00 $18,681.63 $18,681.63 $18,681.63 2026-03-03
470 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without … 1 1 $37,395.31 $37,395.31 $18,681.63 $18,681.63 $18,681.63 2026-03-03
02543848 CDM Lgn Ox Constrained Fem 8 Rt 4 4 $27,665.00 $27,665.00 $9,129.45 $26,835.05 $18,673.88 2026-03-03
178 MS_DRG Respiratory Infections And Inflammations With Cc 3 3 $8,799.00 $8,799.00 $7,634.24 $18,279.00 $18,279.00 2026-03-03
330 MS_DRG Major Small And Large Bowel Procedures With Cc 1 1 $56,647.00 $56,647.00 $17,780.28 $17,780.28 $17,780.28 2026-03-03
02544932 CDM Cpcs Cocr Prim Ho 12/14 Sz2 4 4 $25,498.00 $25,498.00 $8,414.34 $24,733.06 $17,211.15 2026-03-03
02542971 CDM Legion Narrow Ps Sz 4n Lt 4 4 $24,475.00 $24,475.00 $8,076.75 $23,740.75 $16,520.62 2026-03-03
02544428 CDM Syn Por Plus Ha So Stem Sz11 4 4 $23,595.00 $23,595.00 $7,786.35 $22,887.15 $15,926.62 2026-03-03
02544917 CDM Interstim Ii Neurostimulator 4 4 $23,100.00 $23,100.00 $7,623.00 $22,407.00 $15,592.50 2026-03-03
475 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc 1 1 $29,030.00 $29,030.00 $15,273.92 $15,273.92 $15,273.92 2026-03-03
02542396 CDM Syn Por Plus Ha Stem Sz15 4 4 $22,022.00 $22,022.00 $7,267.26 $21,361.34 $14,864.85 2026-03-03
02542951 CDM Syn Por Plus Sz13 4 4 $22,022.00 $22,022.00 $7,267.26 $21,361.34 $14,864.85 2026-03-03
617 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 1 1 $22,577.00 $22,577.00 $14,120.49 $14,120.49 $14,120.49 2026-03-03
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 1 $12,744.39 $12,744.39 $14,031.62 $14,031.62 $14,031.62 2026-03-03
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 3 3 $6,366.50 $6,366.50 $7,615.20 $13,476.50 $13,476.50 2026-03-03
02543733 CDM Syn Por Fem Comp Sz 8 4 4 $19,877.00 $19,877.00 $6,559.41 $19,280.69 $13,416.97 2026-03-03
02545174 CDM Nexgen Lps-flex Sz G-rt 4 4 $19,800.00 $19,800.00 $6,534.00 $19,206.00 $13,365.00 2026-03-03
02544835 CDM Nexgen Femoral Size F Right 4 4 $19,800.00 $19,800.00 $6,534.00 $19,206.00 $13,365.00 2026-03-03
02544834 CDM Nexgen Femoral Size F Left 4 4 $19,800.00 $19,800.00 $6,534.00 $19,206.00 $13,365.00 2026-03-03
177 MS_DRG Respiratory Infections And Inflammations With Mcc 1 1 $5,732.00 $5,732.00 $13,057.73 $13,057.73 $13,057.73 2026-03-03
02545493 CDM Angle Cylinder Set 4 4 $19,231.00 $19,231.00 $6,346.23 $18,654.07 $12,980.92 2026-03-03
02542734 CDM Cylinder Pump 18 Cm 4 4 $18,978.00 $18,978.00 $6,262.74 $18,408.66 $12,810.15 2026-03-03
02545209 CDM Ams 700 Cx Ms Pump Iz 4 4 $18,978.00 $18,978.00 $6,262.74 $18,408.66 $12,810.15 2026-03-03
02542532 CDM Legion Ps Oxin Fem Sz5 Rt 4 4 $18,876.00 $18,876.00 $6,229.08 $18,309.72 $12,741.30 2026-03-03
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 1 1 $4,822.00 $4,822.00 $12,511.85 $12,511.85 $12,511.85 2026-03-03
841 MS_DRG Lymphoma And Non-acute Leukemia With Cc 1 1 $6,039.00 $6,039.00 $12,494.62 $12,494.62 $12,494.62 2026-03-03
562 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 1 1 $9,157.20 $9,157.20 $12,353.16 $12,353.16 $12,353.16 2026-03-03
811 MS_DRG Red Blood Cell Disorders With Mcc 1 1 $12,822.50 $12,822.50 $12,271.55 $12,271.55 $12,271.55 2026-03-03
02543630 CDM Titan Scrotal Cylinder Set With Pump 4 4 $18,040.00 $18,040.00 $5,953.20 $17,498.80 $12,177.00 2026-03-03
02543791 CDM Cx 700 18cm 4 4 $17,924.00 $17,924.00 $5,914.92 $17,386.28 $12,098.70 2026-03-03
281 MS_DRG Acute Myocardial Infarction, Discharged Alive With Cc 3 3 $4,822.00 $4,822.00 $7,528.15 $11,932.00 $11,932.00 2026-03-03
186 MS_DRG Pleural Effusion With Mcc 1 1 $7,887.00 $7,887.00 $11,805.46 $11,805.46 $11,805.46 2026-03-03
02543434 CDM Syn Por Plus Ha So Stem Sz16 4 4 $17,194.00 $17,194.00 $5,674.02 $16,678.18 $11,605.95 2026-03-03
371 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 1 1 $4,124.80 $4,124.80 $11,432.77 $11,432.77 $11,432.77 2026-03-03
02543571 CDM Ultra Pourous Bipfoam Shell 62mm 4 4 $16,916.00 $16,916.00 $5,582.28 $16,408.52 $11,418.30 2026-03-03
02544276 CDM Titan Cylinder Set Sz 16 4 4 $16,500.00 $16,500.00 $5,445.00 $16,005.00 $11,137.50 2026-03-03
02543321 CDM Titan Otr Scrot Zero Ang 18cm 4 4 $16,324.00 $16,324.00 $5,386.92 $15,834.28 $11,018.70 2026-03-03
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 2 2 $3,833.16 $3,833.16 $10,943.16 $10,943.16 $10,943.16 2026-03-03
02544975 CDM Shoulder Stem 15mmx83mm 4 4 $15,994.00 $15,994.00 $5,278.02 $15,514.18 $10,795.95 2026-03-03
02544548 CDM Primary Stem 9mm 4 4 $15,994.00 $15,994.00 $5,278.02 $15,514.18 $10,795.95 2026-03-03
02544640 CDM Comp Primary Stem 12mm 4 4 $15,994.00 $15,994.00 $5,278.02 $15,514.18 $10,795.95 2026-03-03
02545006 CDM Primary Shoulder Stem 14mm 4 4 $15,994.00 $15,994.00 $5,278.02 $15,514.18 $10,795.95 2026-03-03
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 1 1 $8,866.00 $8,866.00 $10,781.70 $10,781.70 $10,781.70 2026-03-03
02544961 CDM Lgn Rev Tibia Base Sz 3 Lt 4 4 $15,939.00 $15,939.00 $5,259.87 $15,460.83 $10,758.83 2026-03-03
02545233 CDM Evolution Femoural Size 3 Left 4 4 $15,790.00 $15,790.00 $5,210.70 $15,316.30 $10,658.25 2026-03-03
J9228 HCPCS Injection, Ipilimumab, 1 Mg 4 4 $35,378.00 $35,378.00 $8,582.90 $13,443.64 $10,549.42 2026-03-03
291 MS_DRG Heart Failure And Shock With Mcc 1 1 $5,935.30 $5,935.30 $10,409.91 $10,409.91 $10,409.91 2026-03-03
637 MS_DRG Diabetes With Mcc 1 1 $9,369.00 $9,369.00 $10,379.08 $10,379.08 $10,379.08 2026-03-03
196 MS_DRG Interstitial Lung Disease With Mcc 1 1 $3,847.50 $3,847.50 $10,314.70 $10,314.70 $10,314.70 2026-03-03
723 MS_DRG Malignancy, Male Reproductive System With Cc 1 1 $4,766.80 $4,766.80 $10,182.31 $10,182.31 $10,182.31 2026-03-03
02543933 CDM Tl Plasma Varus 8 Size 6 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02544370 CDM Tl Plasma Str Long Sz 7 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02544883 CDM Tl Plasma Varus Long Sz 9 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02544052 CDM Tl Plasma Straight Long Sz 3 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02543551 CDM Perfecta Imc Cemented Stem 12 Std 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02543708 CDM Tl Primary Hip Stem Sz 6 Std 122m 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02543782 CDM Tl Primary Hip Stem W/long Neck Sz 1 Str 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02544694 CDM Tl Plasma Straight Long Sz 5 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02543821 CDM Tl Primary Hip Stem Sz3 Std 114mm 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02544293 CDM Tl Plasma Varus 8 Degree Long Sz 8 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02544354 CDM Tl Plasma Str Large Sz 4 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02543932 CDM Tl Plasma Varus 8 Size 3 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02543882 CDM Tl Plasma Varus 8 Degree Shrt Size 2 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02544654 CDM Tl Plasma Varus Size 3 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02543920 CDM Tl Plasma Straight Shrt Sz 4 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02544959 CDM Tl Primary Hip Stem Sz 5 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02544741 CDM Tl Plasma Straight Shrt Size 2 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02544466 CDM Tl Plasma Varus 8 Long Sz4 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
02543983 CDM Tl Plasma Straight Long Sz 9 4 4 $14,850.00 $14,850.00 $4,900.50 $14,404.50 $10,023.75 2026-03-03
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 1 1 $12,140.97 $12,140.97 $9,938.39 $9,938.39 $9,938.39 2026-03-03
02545392 CDM Redapt Slvls Mono Stem Sz14 4 4 $14,717.00 $14,717.00 $4,856.61 $14,275.49 $9,933.97 2026-03-03
315 MS_DRG Other Circulatory System Diagnoses With Cc 1 1 $4,351.00 $4,351.00 $9,924.78 $9,924.78 $9,924.78 2026-03-03
J1930 HCPCS Injection, Lanreotide, 1 Mg 4 4 $42,072.00 $42,072.00 $5,379.35 $15,987.36 $9,895.17 2026-03-03
02544991 CDM Humeral Comp 46mmx42mm 4 4 $14,578.00 $14,578.00 $4,810.74 $14,140.66 $9,840.15 2026-03-03
02544691 CDM Humeral Component 48mmx44mm 4 4 $14,578.00 $14,578.00 $4,810.74 $14,140.66 $9,840.15 2026-03-03
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 1 1 $4,803.87 $4,803.87 $9,828.66 $9,828.66 $9,828.66 2026-03-03
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 4 4 $41,184.00 $41,184.00 $5,379.35 $15,649.92 $9,748.65 2026-03-03
55 MS_DRG Nervous System Neoplasms Without Mcc 1 1 $3,901.00 $3,901.00 $9,732.54 $9,732.54 $9,732.54 2026-03-03
02544716 CDM Standard Trochanteric Grip 4 4 $14,410.00 $14,410.00 $4,755.30 $13,977.70 $9,726.75 2026-03-03
02545449 CDM Lgn Ox Constrained Fem 5rt 4 4 $14,306.00 $14,306.00 $4,720.98 $13,876.82 $9,656.55 2026-03-03
783 MS_DRG Cesarean Section With Sterilization With Mcc 1 1 $16,930.50 $16,930.50 $9,609.22 $9,609.22 $9,609.22 2026-03-03
02545543 CDM Eclipse Trunion 43mm 4 4 $14,144.00 $14,144.00 $4,667.52 $13,719.68 $9,547.20 2026-03-03
917 MS_DRG Poisoning And Toxic Effects Of Drugs With Mcc 1 1 $8,470.00 $8,470.00 $9,492.25 $9,492.25 $9,492.25 2026-03-03
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 2 2 $26,732.00 $26,732.00 $8,821.56 $10,158.16 $9,489.86 2026-03-03
02543575 CDM Ultra Porous Biofoam Shell 70mm 4 4 $13,980.00 $13,980.00 $4,613.40 $13,560.60 $9,436.50 2026-03-03
02543568 CDM Ultra Porous Biofoam Shell 56mm 4 4 $13,980.00 $13,980.00 $4,613.40 $13,560.60 $9,436.50 2026-03-03
02543574 CDM Ultra Porous Biofoam Shell 68mm 4 4 $13,980.00 $13,980.00 $4,613.40 $13,560.60 $9,436.50 2026-03-03
02543572 CDM Ultra Porous Biofoam Shell 64mm 4 4 $13,980.00 $13,980.00 $4,613.40 $13,560.60 $9,436.50 2026-03-03
02543564 CDM Ultra Porous Biofoam Shell 48mm 4 4 $13,980.00 $13,980.00 $4,613.40 $13,560.60 $9,436.50 2026-03-03
02543573 CDM Ultra Porous Biofoam Shell 66mm 4 4 $13,980.00 $13,980.00 $4,613.40 $13,560.60 $9,436.50 2026-03-03
02543563 CDM Ultra Porous Biofoam Shell 46mm 4 4 $13,980.00 $13,980.00 $4,613.40 $13,560.60 $9,436.50 2026-03-03
02545542 CDM Eclipse Cage Screw M 35mm 4 4 $13,909.00 $13,909.00 $4,589.97 $13,491.73 $9,388.58 2026-03-03
74 MS_DRG Cranial And Peripheral Nerve Disorders Without Mcc 1 1 $3,762.80 $3,762.80 $9,379.80 $9,379.80 $9,379.80 2026-03-03
300 MS_DRG Peripheral Vascular Disorders With Cc 1 1 $9,090.50 $9,090.50 $9,328.12 $9,328.12 $9,328.12 2026-03-03
02543405 CDM Gladiator Plasma Stem Sz 3 4 4 $13,750.00 $13,750.00 $4,537.50 $13,337.50 $9,281.25 2026-03-03
123 MS_DRG Neurological Eye Disorders 1 1 $3,901.00 $3,901.00 $9,185.75 $9,185.75 $9,185.75 2026-03-03
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 2 2 $4,467.69 $4,467.69 $9,037.04 $9,207.69 $9,122.37 2026-03-03
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 1 1 $13,470.00 $13,470.00 $9,050.64 $9,050.64 $9,050.64 2026-03-03
J9271 HCPCS Injection, Pembrolizumab, 1 Mg 4 4 $25,441.00 $25,441.00 $8,395.53 $9,667.58 $9,003.50 2026-03-03
02545237 CDM Cs Primary Knee Left Size 8 4 4 $13,291.00 $13,291.00 $4,386.03 $12,892.27 $8,971.42 2026-03-03
02544683 CDM Cs Primary Knee Femur Sz 2 Right 4 4 $13,291.00 $13,291.00 $4,386.03 $12,892.27 $8,971.42 2026-03-03
02545234 CDM Evolution Tibial Size 3 Left 4 4 $13,154.00 $13,154.00 $4,340.82 $12,759.38 $8,878.95 2026-03-03
02545355 CDM Univers Apex Humeral Stem 6mm 4 4 $13,123.00 $13,123.00 $4,330.59 $12,729.31 $8,858.02 2026-03-03
787 MS_DRG Cesarean Section Without Sterilization With Cc 1 1 $18,457.00 $18,457.00 $8,747.77 $8,747.77 $8,747.77 2026-03-03
784 MS_DRG Cesarean Section With Sterilization With Cc 1 1 $16,243.67 $16,243.67 $8,606.32 $8,606.32 $8,606.32 2026-03-03
J0491 HCPCS Injection, Anifrolumab-fnia, 1 Mg 2 2 $23,939.00 $23,939.00 $7,899.87 $9,096.82 $8,498.34 2026-03-03
809 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 1 $9,291.67 $9,291.67 $8,494.78 $8,494.78 $8,494.78 2026-03-03
547 MS_DRG Connective Tissue Disorders Without Cc/mcc 1 1 $7,224.70 $7,224.70 $8,468.48 $8,468.48 $8,468.48 2026-03-03
02545303 CDM Mbt Rev Tib Tray Size 3 4 4 $12,436.00 $12,436.00 $4,103.88 $12,062.92 $8,394.30 2026-03-03
53 MS_DRG Spinal Disorders And Injuries Without Cc/mcc 1 1 $7,112.20 $7,112.20 $8,355.14 $8,355.14 $8,355.14 2026-03-03
J3101 HCPCS Injection, Tenecteplase, 1 Mg 4 4 $32,719.00 $32,719.00 $5,379.35 $12,433.22 $8,351.92 2026-03-03
433 MS_DRG Cirrhosis And Alcoholic Hepatitis With Cc 1 1 $5,049.00 $5,049.00 $8,350.60 $8,350.60 $8,350.60 2026-03-03
660 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Cc 1 1 $29,172.00 $29,172.00 $8,350.60 $8,350.60 $8,350.60 2026-03-03
644 MS_DRG Endocrine Disorders With Cc 1 1 $7,940.33 $7,940.33 $8,260.83 $8,260.83 $8,260.83 2026-03-03
189 MS_DRG Pulmonary Edema And Respiratory Failure 1 1 $4,045.51 $4,045.51 $8,127.53 $8,127.53 $8,127.53 2026-03-03
947 MS_DRG Signs And Symptoms With Mcc 1 1 $10,263.00 $10,263.00 $8,104.86 $8,104.86 $8,104.86 2026-03-03
02542391 CDM Gns Ii Cmt Tib Sz 2 Left 4 4 $11,990.00 $11,990.00 $3,956.70 $11,630.30 $8,093.25 2026-03-03
445 MS_DRG Disorders Of The Biliary Tract With Cc 1 1 $11,044.00 $11,044.00 $8,066.78 $8,066.78 $8,066.78 2026-03-03
436 MS_DRG Malignancy Of Hepatobiliary System Or Pancreas With Cc 1 1 $5,979.33 $5,979.33 $8,017.81 $8,017.81 $8,017.81 2026-03-03
02546092 CDM Tibial Cone Sz 2 4 4 $11,847.00 $11,847.00 $3,909.51 $11,491.59 $7,996.73 2026-03-03
35189 HCPCS Repair Of Abnormal Artery-vein Connection In Chest And Abdomen 4 4 $4,467.00 $4,467.00 $4,332.99 $12,735.00 $7,965.62 2026-03-03
02545857 CDM 24mm Baseplate 4 4 $11,735.00 $11,735.00 $3,872.55 $11,382.95 $7,921.12 2026-03-03
02545347 CDM Or3o Dual Mobility Liner 4 4 $11,700.00 $11,700.00 $3,861.00 $11,349.00 $7,897.50 2026-03-03
181 MS_DRG Respiratory Neoplasms With Cc 1 1 $7,009.00 $7,009.00 $7,878.17 $7,878.17 $7,878.17 2026-03-03
304 MS_DRG Hypertension With Mcc 1 1 $16,605.00 $16,605.00 $7,877.26 $7,877.26 $7,877.26 2026-03-03
376 MS_DRG Digestive Malignancy Without Cc/mcc 1 1 $3,557.50 $3,557.50 $7,801.09 $7,801.09 $7,801.09 2026-03-03
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 1 1 $9,884.46 $9,884.46 $7,801.09 $7,801.09 $7,801.09 2026-03-03
375 MS_DRG Digestive Malignancy With Cc 1 1 $8,485.50 $8,485.50 $7,801.09 $7,801.09 $7,801.09 2026-03-03
02542622 CDM Oxinium Modular Head 40mm 4 4 $11,495.00 $11,495.00 $3,793.35 $11,150.15 $7,759.12 2026-03-03
599 MS_DRG Malignant Breast Disorders Without Cc/mcc 1 1 $4,237.50 $4,237.50 $7,752.12 $7,752.12 $7,752.12 2026-03-03
02545448 CDM Primary Hip Stem Extended 7 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545409 CDM Primary Hip Stem Gladiator 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545279 CDM Primary Hip Stem Standard 4 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545122 CDM Primary Hip Stem Standard 1 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545246 CDM Primary Hip Stem Standard 3 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545558 CDM Profemur Gladiator Cemented 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02546009 CDM Stem Sz Extended 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545159 CDM Hip Stem Gladiator Sz6 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545373 CDM Gladiator Plasma Stem 6 St 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545123 CDM Profemur Gladiator Size 4 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545821 CDM Primary Hip Stem 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545444 CDM Profemur Gladitor Stem Sz 6 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545336 CDM Primary Hip Stem 5 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
02545468 CDM Profemur Gladiator Sz 4 4 4 $11,380.00 $11,380.00 $3,755.40 $11,038.60 $7,681.50 2026-03-03
387 MS_DRG Inflammatory Bowel Disease Without Cc/mcc 1 1 $3,764.00 $3,764.00 $7,623.36 $7,623.36 $7,623.36 2026-03-03
394 MS_DRG Other Digestive System Diagnoses With Cc 1 1 $7,016.33 $7,016.33 $7,620.64 $7,620.64 $7,620.64 2026-03-03
797 MS_DRG Vaginal Delivery With Sterilization And/or D&c With Cc 1 1 $22,241.00 $22,241.00 $7,614.29 $7,614.29 $7,614.29 2026-03-03
182 MS_DRG Respiratory Neoplasms Without Cc/mcc 1 1 $4,585.80 $4,585.80 $7,594.34 $7,594.34 $7,594.34 2026-03-03
02544440 CDM Gns Ii Con Ins Sz3-4 13mm 4 4 $11,176.00 $11,176.00 $3,688.08 $10,840.72 $7,543.80 2026-03-03
788 MS_DRG Cesarean Section Without Sterilization Without Cc/mcc 1 1 $16,034.05 $16,034.05 $7,485.53 $7,485.53 $7,485.53 2026-03-03
02543851 CDM Lgn Rev Tibia Base Sz 7 Rt 4 4 $11,055.00 $11,055.00 $3,648.15 $10,723.35 $7,462.12 2026-03-03
02544447 CDM Glenojet Graft 4 4 $11,000.00 $11,000.00 $3,630.00 $10,670.00 $7,425.00 2026-03-03
02545228 CDM Humeral Head Comp 54x50mm 4 4 $11,000.00 $11,000.00 $3,630.00 $10,670.00 $7,425.00 2026-03-03
02544966 CDM Legion Scw Lwdg S4 10dx10p 4 4 $10,989.00 $10,989.00 $3,626.37 $10,659.33 $7,417.57 2026-03-03
02545038 CDM 3.0x130mm Fibula Nail Left 4 4 $10,983.00 $10,983.00 $3,624.39 $10,653.51 $7,413.52 2026-03-03
02545745 CDM Fibulock Implant System 4 4 $10,983.00 $10,983.00 $3,624.39 $10,653.51 $7,413.52 2026-03-03
02545852 CDM 3.0 X 180mm Fibula Nail 4 4 $10,983.00 $10,983.00 $3,624.39 $10,653.51 $7,413.52 2026-03-03
02545408 CDM 3.0x130mm Fibula Nail Right 4 4 $10,983.00 $10,983.00 $3,624.39 $10,653.51 $7,413.52 2026-03-03
603 MS_DRG Cellulitis Without Mcc 1 1 $6,666.58 $6,666.58 $7,357.67 $7,357.67 $7,357.67 2026-03-03
557 MS_DRG Tendonitis, Myositis And Bursitis With Mcc 1 1 $2,891.00 $2,891.00 $7,355.86 $7,355.86 $7,355.86 2026-03-03
02543300 CDM Primary Knee Femur Sz 3 Left 4 4 $10,873.00 $10,873.00 $3,588.09 $10,546.81 $7,339.27 2026-03-03
02543297 CDM Primary Knee Femur 2 Right 4 4 $10,873.00 $10,873.00 $3,588.09 $10,546.81 $7,339.27 2026-03-03
02543156 CDM Femoral Sz 3 Right 4 4 $10,873.00 $10,873.00 $3,588.09 $10,546.81 $7,339.27 2026-03-03
02543299 CDM Primary Knee Femur 2 Left Femur 4 4 $10,873.00 $10,873.00 $3,588.09 $10,546.81 $7,339.27 2026-03-03
02543298 CDM Primary Knee Femur 4 Right 4 4 $10,872.00 $10,872.00 $3,587.76 $10,545.84 $7,338.60 2026-03-03
02543301 CDM Primary Knee Femur Sz 4 Left 4 4 $10,872.00 $10,872.00 $3,587.76 $10,545.84 $7,338.60 2026-03-03
02543143 CDM Knee Femur Sz3 Left 4 4 $10,872.00 $10,872.00 $3,587.76 $10,545.84 $7,338.60 2026-03-03
02543146 CDM Knee Femur Sz 5 Rt 4 4 $10,872.00 $10,872.00 $3,587.76 $10,545.84 $7,338.60 2026-03-03
785 MS_DRG Cesarean Section With Sterilization Without Cc/mcc 1 1 $14,509.00 $14,509.00 $7,273.34 $7,273.34 $7,273.34 2026-03-03
389 MS_DRG Gastrointestinal Obstruction With Cc 1 1 $8,826.17 $8,826.17 $7,257.92 $7,257.92 $7,257.92 2026-03-03
02545363 CDM Intertan 10s 10mmx36cm 4 4 $10,648.00 $10,648.00 $3,513.84 $10,328.56 $7,187.40 2026-03-03
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 1 1 $8,949.83 $8,949.83 $7,182.66 $7,182.66 $7,182.66 2026-03-03
02545779 CDM Es Troch Nail Left 4 4 $10,615.00 $10,615.00 $3,502.95 $10,296.55 $7,165.12 2026-03-03
02545765 CDM Es Troch Nail Left 4 4 $10,615.00 $10,615.00 $3,502.95 $10,296.55 $7,165.12 2026-03-03
02545875 CDM Es Troch Nail Right 4 4 $10,615.00 $10,615.00 $3,502.95 $10,296.55 $7,165.12 2026-03-03
02545788 CDM Es Troch Nail Right 4 4 $10,615.00 $10,615.00 $3,502.95 $10,296.55 $7,165.12 2026-03-03
02545770 CDM Es Trouch Nail Right 4 4 $10,615.00 $10,615.00 $3,502.95 $10,296.55 $7,165.12 2026-03-03
02545261 CDM 4.5mm L-d Fem Lk Pl13h 286mm 4 4 $10,538.00 $10,538.00 $3,477.54 $10,221.86 $7,113.15 2026-03-03
842 MS_DRG Lymphoma And Non-acute Leukemia Without Cc/mcc 1 1 $6,787.75 $6,787.75 $7,067.50 $7,067.50 $7,067.50 2026-03-03
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 1 1 $4,154.33 $4,154.33 $7,027.60 $7,027.60 $7,027.60 2026-03-03
02545710 CDM Legion Narrow Ps Sz 5n Lt 4 4 $10,395.00 $10,395.00 $3,430.35 $10,083.15 $7,016.62 2026-03-03
02546144 CDM Legion Fem Sz6 Lt 4 4 $10,395.00 $10,395.00 $3,430.35 $10,083.15 $7,016.62 2026-03-03
02542401 CDM Legion Ps Oxin Fem Sz8 Lt 4 4 $10,395.00 $10,395.00 $3,430.35 $10,083.15 $7,016.62 2026-03-03
02545248 CDM Advance Ii Modular Tibial Size 2 4 4 $10,312.00 $10,312.00 $3,402.96 $10,002.64 $6,960.60 2026-03-03
J9306 HCPCS Injection, Pertuzumab, 1 Mg 4 4 $30,010.00 $30,010.00 $3,633.95 $11,403.80 $6,946.70 2026-03-03
02545845 CDM Lapiplasty System 4 4 $10,230.00 $10,230.00 $3,375.90 $9,923.10 $6,905.25 2026-03-03
02544923 CDM Oxinium Fem Hd 12/14 36mm-3 4 4 $10,208.00 $10,208.00 $3,368.64 $9,901.76 $6,890.40 2026-03-03
02542929 CDM Oxinium Fem Hd 12/14 36mm 4 4 $10,208.00 $10,208.00 $3,368.64 $9,901.76 $6,890.40 2026-03-03
02543557 CDM Perfecta Imc Cemented Stem 12.0 Inc 4 4 $10,200.00 $10,200.00 $3,366.00 $9,894.00 $6,885.00 2026-03-03
02543559 CDM Perfecta Imc Cemented Stem 15 Inc 4 4 $10,200.00 $10,200.00 $3,366.00 $9,894.00 $6,885.00 2026-03-03
02543558 CDM Perfecta Imc Cemented Stem 13.5 Inc 4 4 $10,200.00 $10,200.00 $3,366.00 $9,894.00 $6,885.00 2026-03-03
02543550 CDM Perfecta Imc Cemented Stem 10.5 Std 4 4 $10,200.00 $10,200.00 $3,366.00 $9,894.00 $6,885.00 2026-03-03
02543554 CDM Perfecta Imc Cemented Stem 16.5 Std 4 4 $10,200.00 $10,200.00 $3,366.00 $9,894.00 $6,885.00 2026-03-03
02543556 CDM Perfecta Imc Cemented Stem 10.5 Inc 4 4 $10,200.00 $10,200.00 $3,366.00 $9,894.00 $6,885.00 2026-03-03
02543553 CDM Perfectea Imc Cemented Stem 15 Std 4 4 $10,200.00 $10,200.00 $3,366.00 $9,894.00 $6,885.00 2026-03-03
02543552 CDM Perfecta Imc Cemented Stem 13.5 Std 4 4 $10,200.00 $10,200.00 $3,366.00 $9,894.00 $6,885.00 2026-03-03
02543555 CDM Perfecta Imc Cemented Stem 18 Std 4 4 $10,200.00 $10,200.00 $3,366.00 $9,894.00 $6,885.00 2026-03-03
292 MS_DRG Heart Failure And Shock With Cc 1 1 $3,798.57 $3,798.57 $6,851.68 $6,851.68 $6,851.68 2026-03-03
812 MS_DRG Red Blood Cell Disorders Without Mcc 1 1 $4,058.14 $4,058.14 $6,799.09 $6,799.09 $6,799.09 2026-03-03
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/mcc 1 1 $7,596.57 $7,596.57 $6,785.49 $6,785.49 $6,785.49 2026-03-03
683 MS_DRG Renal Failure With Cc 1 1 $7,785.83 $7,785.83 $6,757.38 $6,757.38 $6,757.38 2026-03-03
638 MS_DRG Diabetes With Cc 1 1 $5,686.00 $5,686.00 $6,715.66 $6,715.66 $6,715.66 2026-03-03
02543570 CDM Ultra Porous Biofoam Shell 60mm 4 4 $9,932.00 $9,932.00 $3,277.56 $9,634.04 $6,704.10 2026-03-03
02545447 CDM Dynasty Biofoam Shell 56mm 4 4 $9,931.00 $9,931.00 $3,277.23 $9,633.07 $6,703.42 2026-03-03
02543567 CDM Ultra Porous Biofoam Shell 54mm 4 4 $9,931.00 $9,931.00 $3,277.23 $9,633.07 $6,703.42 2026-03-03
02543569 CDM Ultra Porous Biofoam Shell 58mm 4 4 $9,931.00 $9,931.00 $3,277.23 $9,633.07 $6,703.42 2026-03-03
02543566 CDM Ultra Porous Biofoam Shell 52mm 4 4 $9,931.00 $9,931.00 $3,277.23 $9,633.07 $6,703.42 2026-03-03
02543565 CDM Ultra Porous Biofoam Shell 50mm 4 4 $9,931.00 $9,931.00 $3,277.23 $9,633.07 $6,703.42 2026-03-03
02543307 CDM Primary Knee Femur 6 Right 4 4 $9,884.00 $9,884.00 $3,261.72 $9,587.48 $6,671.70 2026-03-03
02545170 CDM Lgn Ps Xlpe Insert Sz 1-2 4 4 $9,878.00 $9,878.00 $3,259.74 $9,581.66 $6,667.65 2026-03-03
02545124 CDM Profemur Neck-short Straight 4 4 $9,804.00 $9,804.00 $3,235.32 $9,509.88 $6,617.70 2026-03-03
02545539 CDM Profemur Modular Neck 4 4 $9,804.00 $9,804.00 $3,235.32 $9,509.88 $6,617.70 2026-03-03
688 MS_DRG Kidney And Urinary Tract Neoplasms Without Cc/mcc 1 1 $6,195.00 $6,195.00 $6,567.86 $6,567.86 $6,567.86 2026-03-03
69 MS_DRG Transient Ischemia Without Thrombolytic 1 1 $4,328.00 $4,328.00 $6,555.16 $6,555.16 $6,555.16 2026-03-03
02545455 CDM Ech Cem Fem Sz 12 4 4 $9,663.00 $9,663.00 $3,188.79 $9,373.11 $6,522.52 2026-03-03
02545306 CDM Pfc Sigma Tc3 Fem Rt Sz 2.5 4 4 $9,631.00 $9,631.00 $3,178.23 $9,342.07 $6,500.92 2026-03-03
C1762 HCPCS Connective Tissue, Human (includes Fascia Lata) 8 4 $11,000.00 $11,000.00 $2,541.00 $13,871.00 $6,451.50 2026-03-03
202 MS_DRG Bronchitis And Asthma With Cc/mcc 1 1 $5,300.50 $5,300.50 $6,443.63 $6,443.63 $6,443.63 2026-03-03
02542623 CDM R3 3 Hole Acet Shell 56mm 4 4 $9,460.00 $9,460.00 $3,121.80 $9,176.20 $6,385.50 2026-03-03
02542873 CDM R3 3 Hole Acet Shell 58mm 4 4 $9,460.00 $9,460.00 $3,121.80 $9,176.20 $6,385.50 2026-03-03
02544500 CDM Subchondroplasty Knee Kit 4 4 $9,416.00 $9,416.00 $3,107.28 $9,133.52 $6,355.80 2026-03-03
02545011 CDM 3.0x130mm Fibula Nail Right 4 4 $9,414.00 $9,414.00 $3,106.62 $9,131.58 $6,354.45 2026-03-03
02544861 CDM 3.0x130mm Fibula Nail Right 4 4 $9,414.00 $9,414.00 $3,106.62 $9,131.58 $6,354.45 2026-03-03
02544941 CDM 3.0x130mm Fibula Nail Left 4 4 $9,414.00 $9,414.00 $3,106.62 $9,131.58 $6,354.45 2026-03-03
845 MS_DRG Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 1 1 $3,501.25 $3,501.25 $6,333.91 $6,333.91 $6,333.91 2026-03-03
950 MS_DRG Aftercare Without Cc/mcc 1 1 $4,236.40 $4,236.40 $6,258.64 $6,258.64 $6,258.64 2026-03-03
Q0222 HCPCS Injection, Bebtelovimab, 175 Mg 4 4 $9,240.00 $9,240.00 $3,049.20 $8,962.80 $6,237.00 2026-03-03
443 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without C… 1 1 $2,667.27 $2,667.27 $6,223.28 $6,223.28 $6,223.28 2026-03-03
02545563 CDM Supermx Niti Staple 20w X 15l 4 4 $9,150.00 $9,150.00 $3,019.50 $8,875.50 $6,176.25 2026-03-03
02545562 CDM Supermx Niti Staple 18w X 18l 4 4 $9,150.00 $9,150.00 $3,019.50 $8,875.50 $6,176.25 2026-03-03
02544931 CDM R3 0 Degree Xlpe Acet Lnr 40mmidx56od 4 4 $9,130.00 $9,130.00 $3,012.90 $8,856.10 $6,162.75 2026-03-03
02545849 CDM Univers Revers Humeral Stem Sz 8 4 4 $9,113.00 $9,113.00 $3,007.29 $8,839.61 $6,151.27 2026-03-03
02546075 CDM Humeral Stem 5mm 4 4 $9,113.00 $9,113.00 $3,007.29 $8,839.61 $6,151.27 2026-03-03
02545587 CDM Es Troch Nail Right 4 4 $9,100.00 $9,100.00 $3,003.00 $8,827.00 $6,142.50 2026-03-03
02545582 CDM Es Troch Nail Left 4 4 $9,100.00 $9,100.00 $3,003.00 $8,827.00 $6,142.50 2026-03-03
72 MS_DRG Other Cerebrovascular Disorders Without Cc/mcc 1 1 $8,700.50 $8,700.50 $6,106.30 $6,106.30 $6,106.30 2026-03-03
176 MS_DRG Pulmonary Embolism Without Mcc 1 1 $7,797.75 $7,797.75 $6,065.50 $6,065.50 $6,065.50 2026-03-03
948 MS_DRG Signs And Symptoms Without Mcc 1 1 $2,647.45 $2,647.45 $6,061.87 $6,061.87 $6,061.87 2026-03-03
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 1 1 $6,090.86 $6,090.86 $6,025.60 $6,025.60 $6,025.60 2026-03-03
776 MS_DRG Postpartum And Post Abortion Diagnoses Without O.r. Procedures 3 3 $2,537.40 $2,537.40 $3,534.66 $6,024.40 $6,024.40 2026-03-03
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 1 1 $2,645.67 $2,645.67 $5,957.59 $5,957.59 $5,957.59 2026-03-03
J9061 HCPCS Injection, Amivantamab-vmjw, 2 Mg 2 2 $16,749.00 $16,749.00 $5,527.17 $6,364.62 $5,945.90 2026-03-03
897 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 1 1 $3,561.83 $3,561.83 $5,942.18 $5,942.18 $5,942.18 2026-03-03
02544053 CDM Cs Primary Knee Femur Right Sz 5 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02544355 CDM Cs Primary Knee Femur Rt Sz 4 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02544037 CDM Cs Knee Femur Right Sz 7 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02545226 CDM Cs Primary Knee Femur Right Sz 8 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02544041 CDM Cs Primary Knee Femur Left Sz 3 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02544469 CDM Cs Primary Knee Femur Left Sz 6 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02544227 CDM Cs Primary Knee Femur Sz 3 Rt 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02544389 CDM Cs Primary Knee Femur Left Sz 7 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02544113 CDM Cs Primary Knee Femur Right Sz6 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02544392 CDM Cs Primary Knee Femur Left Sz 5 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02544234 CDM Cs Primary Knee Femur Left Sz 4 4 4 $8,801.00 $8,801.00 $2,904.33 $8,536.97 $5,940.67 2026-03-03
02545230 CDM Humeral Head 48x44mm 4 4 $8,800.00 $8,800.00 $2,904.00 $8,536.00 $5,940.00 2026-03-03
02544776 CDM Humeral Component 50mm X 46mm 4 4 $8,800.00 $8,800.00 $2,904.00 $8,536.00 $5,940.00 2026-03-03
02545313 CDM Articular Component 46x42mm 4 4 $8,800.00 $8,800.00 $2,904.00 $8,536.00 $5,940.00 2026-03-03
02544645 CDM Humeral Componet 56mmx52mm 4 4 $8,800.00 $8,800.00 $2,904.00 $8,536.00 $5,940.00 2026-03-03
02544763 CDM Humeral Component 54mmx50mm 4 4 $8,800.00 $8,800.00 $2,904.00 $8,536.00 $5,940.00 2026-03-03
02543853 CDM Gns Ii Con Ins Sz7-8 18mm 4 4 $8,800.00 $8,800.00 $2,904.00 $8,536.00 $5,940.00 2026-03-03
02545276 CDM Articular Component 58 X 54mm 4 4 $8,800.00 $8,800.00 $2,904.00 $8,536.00 $5,940.00 2026-03-03
02545229 CDM Humeral Comp 52x48mm 4 4 $8,800.00 $8,800.00 $2,904.00 $8,536.00 $5,940.00 2026-03-03
02544945 CDM Humeral Component 52mmx48mm 4 4 $8,800.00 $8,800.00 $2,904.00 $8,536.00 $5,940.00 2026-03-03
02544461 CDM Articular 58mm X 54mm 4 4 $8,800.00 $8,800.00 $2,904.00 $8,536.00 $5,940.00 2026-03-03
768 MS_DRG Vaginal Delivery With O.r. Procedures Except Sterilization And/or D&c 1 1 $7,148.00 $7,148.00 $5,938.55 $5,938.55 $5,938.55 2026-03-03
02545863 CDM Prox Lateral Tibia Plate 4 4 $8,783.00 $8,783.00 $2,898.39 $8,519.51 $5,928.52 2026-03-03
805 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Mcc 1 1 $10,813.00 $10,813.00 $5,897.74 $5,897.74 $5,897.74 2026-03-03
02544445 CDM Side Accuport Knee Kit 4 4 $8,668.00 $8,668.00 $2,860.44 $8,407.96 $5,850.90 2026-03-03
02542397 CDM Oxinium Fem Hd 12/14 36mm 4 4 $8,646.00 $8,646.00 $2,853.18 $8,386.62 $5,836.05 2026-03-03
02542455 CDM Gns Ii Cmt Tib Sz 6 Rt 4 4 $8,624.00 $8,624.00 $2,845.92 $8,365.28 $5,821.20 2026-03-03
02545194 CDM 33/24 Glenosphere 4 4 $8,435.00 $8,435.00 $2,783.55 $8,181.95 $5,693.62 2026-03-03
02545968 CDM 36 +4 Glenosphere 4 4 $8,435.00 $8,435.00 $2,783.55 $8,181.95 $5,693.62 2026-03-03
02545963 CDM Glenosphere 39 + 4 4 4 $8,435.00 $8,435.00 $2,783.55 $8,181.95 $5,693.62 2026-03-03
395 MS_DRG Other Digestive System Diagnoses Without Cc/mcc 1 1 $3,572.83 $3,572.83 $5,668.33 $5,668.33 $5,668.33 2026-03-03
J9299 HCPCS Injection, Nivolumab, 1 Mg 6 4 $5,173.00 $5,173.00 $1,707.09 $11,793.30 $5,642.96 2026-03-03
282 MS_DRG Acute Myocardial Infarction, Discharged Alive Without Cc/mcc 1 1 $3,498.16 $3,498.16 $5,633.87 $5,633.87 $5,633.87 2026-03-03
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 1 $5,146.06 $5,146.06 $5,590.34 $5,590.34 $5,590.34 2026-03-03
J0717 HCPCS Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 4 4 $26,397.00 $26,397.00 $2,242.34 $10,030.86 $5,586.56 2026-03-03
02543750 CDM Vitoss Ba2x 10cc 4 4 $8,250.00 $8,250.00 $2,722.50 $8,002.50 $5,568.75 2026-03-03
02544523 CDM Intertan 10s 10mmx38cm 4 4 $8,239.00 $8,239.00 $2,718.87 $7,991.83 $5,561.33 2026-03-03
728 MS_DRG Inflammation Of The Male Reproductive System Without Mcc 1 1 $7,137.00 $7,137.00 $5,522.33 $5,522.33 $5,522.33 2026-03-03
02545713 CDM Galileotraochnail Right 4 4 $8,158.00 $8,158.00 $2,692.14 $7,913.26 $5,506.65 2026-03-03
02544055 CDM Primary Knee Tibia Base Sz 6 4 4 $8,141.00 $8,141.00 $2,686.53 $7,896.77 $5,495.18 2026-03-03
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