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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

MAHASKA HEALTH PARTNERSHIP

Oskaloosa, IA · CCN 161379 · Rates published

2,986 distinct procedures filed
15 distinct payers
55,110 rate rows
2026-02-04 last MRF observed
Data quality

54,077 of 55,110 rate rows are consumer-grade (98.1%)

1,033 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
per-diem day rate — not a per-procedure price 623
exceeds 10× this hospital's gross charge — excluded from medians 169
template filing: same amount across many unrelated codes — excluded 136
percent-of-charges filed in the dollar field — excluded from medians 91
exceeds 3× this hospital's gross charge for a DRG stay — excluded 14
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbMHPOSKALOOSAIA&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Mahaska_V2.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-16
Content fingerprint f670c3cda95bcd9c… · 20,179,471 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
853
MS_DRG 		Infectious And Parasitic Diseases With O.r. Procedures With Mcc 9 $18,165.60 $54,186.02 $35,418.36 nat. median
$48,170
0.7× median
867
MS_DRG 		Other Infectious And Parasitic Diseases Diagnoses With Mcc 9 $20,820.43 $68,957.61 $35,367.43 nat. median
$21,263
1.7× median
349
MS_DRG 		Anal And Stomal Procedures Without Cc/mcc 9 $12,109.70 $68,515.45 $35,140.65 nat. median
$9,879
outlier · 3.6×
481
MS_DRG 		Hip And Femur Procedures Except Major Joint With Cc 9 $17,433.63 $33,991.19 $32,276.20 nat. median
$21,529
1.5× median
522
MS_DRG 		Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 9 $16,531.06 $33,520.16 $32,231.42 nat. median
$21,760
1.5× median
483
MS_DRG 		Major Joint Or Limb Reattachment Procedures Of Upper Extremities 9 $18,289.44 $35,659.82 $31,295.29 nat. median
$26,699
1.2× median
330
MS_DRG 		Major Small And Large Bowel Procedures With Cc 9 $29,141.76 $60,764.92 $31,165.51 nat. median
$24,346
1.3× median
470
MS_DRG 		Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without… 9 $30,619.06 $60,396.06 $30,976.33 nat. median
$20,055
1.5× median
377
MS_DRG 		Gastrointestinal Hemorrhage With Mcc 9 $21,303.45 $53,513.14 $27,446.17 nat. median
$18,249
1.5× median
357
MS_DRG 		Other Digestive System O.r. Procedures With Cc 9 $15,928.32 $31,056.22 $25,007.10 nat. median
$22,940
1.1× median
70
MS_DRG 		Other Cerebrovascular Disorders With Mcc 9 $13,117.83 $25,576.48 $24,005.39 nat. median
$17,281
1.4× median
854
MS_DRG 		Infectious And Parasitic Diseases With O.r. Procedures With Cc 9 $14,493.29 $28,258.28 $23,189.46 nat. median
$20,421
1.1× median
57
MS_DRG 		Degenerative Nervous System Disorders Without Mcc 9 $13,721.25 $26,752.99 $22,541.47 nat. median
$13,201
1.7× median
SUP-27100153
CDM 		Rhc Misc Implant Charge Level 32 15 $16,400.00 $38,800.00 $22,000.00 nat. median
$22,000
1.0× median
HB-27100153
CDM 		Rhc Misc Implant Charge Level 32 15 $16,400.00 $38,800.00 $22,000.00 nat. median
$22,000
1.0× median
398
MS_DRG 		Appendix Procedures With Cc 9 $20,582.25 $40,130.21 $21,719.59 nat. median
$15,921
1.4× median
331
MS_DRG 		Major Small And Large Bowel Procedures Without Cc/mcc 9 $20,467.93 $39,907.32 $20,973.51 nat. median
$17,703
1.2× median
661
MS_DRG 		Kidney And Ureter Procedures For Non-neoplasm Without Cc/mcc 9 $12,082.95 $40,292.81 $20,665.64 nat. median
$11,382
1.8× median
813
MS_DRG 		Coagulation Disorders 9 $15,703.38 $39,378.87 $20,196.89 nat. median
$15,711
1.3× median
280
MS_DRG 		Acute Myocardial Infarction, Discharged Alive With Mcc 9 $10,030.04 $20,506.84 $19,556.06 nat. median
$16,529
1.2× median
371
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 9 $11,651.57 $22,717.64 $18,738.24 nat. median
$17,807
1.1× median
482
MS_DRG 		Hip And Femur Procedures Except Major Joint Without Cc/mcc 9 $9,621.21 $18,758.95 $18,232.92 nat. median
$17,025
1.1× median
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 9 $9,338.46 $21,401.54 $18,207.66 nat. median
$16,234
1.1× median
862
MS_DRG 		Postoperative And Post-traumatic Infections With Mcc 9 $13,838.46 $26,981.52 $18,160.10 nat. median
$18,227
1.0× median
175
MS_DRG 		Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 9 $12,731.02 $24,822.29 $17,885.15 nat. median
$14,623
1.2× median
HB-27100152
CDM 		Rhc Misc Implant Charge Level 31 15 $13,120.00 $31,040.00 $17,600.00 nat. median
$17,600
1.0× median
SUP-27100152
CDM 		Rhc Misc Implant Charge Level 31 15 $13,120.00 $31,040.00 $17,600.00 nat. median
$17,600
1.0× median
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 9 $8,914.37 $22,997.74 $17,380.78 nat. median
$19,634
0.9× median
637
MS_DRG 		Diabetes With Mcc 9 $14,974.29 $29,196.11 $17,011.25 nat. median
$14,787
1.2× median
SUP-27100151
CDM 		Rhc Misc Implant Charge Level 30 15 $12,300.00 $29,100.00 $16,500.00 nat. median
$16,500
1.0× median
HB-27100151
CDM 		Rhc Misc Implant Charge Level 30 15 $12,300.00 $29,100.00 $16,500.00 nat. median
$16,500
1.0× median
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 9 $8,911.27 $17,374.74 $16,288.95 nat. median
$13,648
1.2× median
983
MS_DRG 		Extensive O.r. Procedures Unrelated To Principal Diagnosis Without Cc/mcc 9 $14,293.66 $27,869.04 $16,158.16 nat. median
$17,513
0.9× median
786
MS_DRG 		Cesarean Section Without Sterilization With Mcc 9 $10,956.06 $21,361.56 $16,074.93 nat. median
$15,316
1.0× median
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 9 $8,180.69 $17,671.13 $15,950.30 nat. median
$13,400
1.2× median
HB-27100150
CDM 		Rhc Misc Implant Charge Level 29 15 $11,480.00 $27,160.00 $15,400.00 nat. median
$15,400
1.0× median
SUP-27100150
CDM 		Rhc Misc Implant Charge Level 29 15 $11,480.00 $27,160.00 $15,400.00 nat. median
$15,400
1.0× median
378
MS_DRG 		Gastrointestinal Hemorrhage With Cc 9 $7,838.99 $15,284.06 $15,172.80 nat. median
$10,712
1.4× median
832
MS_DRG 		Other Antepartum Diagnoses Without O.r. Procedures With Cc 9 $7,640.65 $29,381.76 $15,069.51 nat. median
$8,034
1.9× median
844
MS_DRG 		Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 12 $9,016.19 $40,509.00 $15,010.44 nat. median
$12,709
1.2× median
388
MS_DRG 		Gastrointestinal Obstruction With Mcc 9 $7,919.07 $15,440.19 $14,875.56 nat. median
$15,091
1.0× median
65
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 9 $7,686.13 $14,986.02 $14,833.94 nat. median
$11,174
1.3× median
787
MS_DRG 		Cesarean Section Without Sterilization With Cc 9 $13,185.10 $25,707.63 $14,337.55 nat. median
$11,413
1.3× median
HB-27100149
CDM 		Rhc Misc Implant Charge Level 28 15 $10,660.00 $25,220.00 $14,300.00 nat. median
$14,300
1.0× median
SUP-27100149
CDM 		Rhc Misc Implant Charge Level 28 15 $10,660.00 $25,220.00 $14,300.00 nat. median
$14,300
1.0× median
699
MS_DRG 		Other Kidney And Urinary Tract Diagnoses With Cc 9 $7,576.12 $14,771.53 $14,273.64 nat. median
$10,935
1.3× median
372
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections With Cc 9 $7,298.14 $14,229.54 $14,171.09 nat. median
$11,087
1.3× median
784
MS_DRG 		Cesarean Section With Sterilization With Cc 9 $10,327.63 $20,136.28 $14,105.70 nat. median
$11,116
1.3× median
660
MS_DRG 		Kidney And Ureter Procedures For Non-neoplasm With Cc 9 $10,485.99 $20,445.05 $13,686.58 nat. median
$14,195
1.0× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 9 $10,453.19 $20,381.10 $13,320.97 nat. median
$13,017
1.0× median

Other procedures at this hospital

Browse this hospital's 2,986 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
             
10121 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Complex 28 15 $4,498.00 $3,823.30 $158.09 $4,363.06 $1,844.18 2026-02-04
11422 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2… 33 15 $4,117.00 $3,499.45 $114.71 $3,993.49 $1,687.97 2026-02-04
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 9 9 $25,589.99 $21,751.49 $12,731.02 $24,822.29 $17,885.15 2026-02-04
177 MS_DRG Respiratory Infections And Inflammations With Mcc 9 9 $18,770.78 $15,955.16 $9,338.46 $21,401.54 $18,207.66 2026-02-04
181 MS_DRG Respiratory Neoplasms With Cc 9 9 $18,313.83 $15,566.76 $9,111.13 $17,764.42 $12,912.26 2026-02-04
186 MS_DRG Pleural Effusion With Mcc 9 9 $10,100.50 $8,585.43 $5,025.00 $19,349.07 $9,797.49 2026-02-04
189 MS_DRG Pulmonary Edema And Respiratory Failure 9 9 $21,011.44 $17,859.72 $10,453.19 $20,381.10 $13,320.97 2026-02-04
19081 HCPCS Biopsy Of Breast And Placement Of Locating Device Using X-ray With Needle, First… 28 15 $4,117.00 $3,499.45 $129.58 $3,993.49 $1,687.97 2026-02-04
19281 HCPCS Placement Of Locating Device In Breast Using Imaging Guidance, First Growth 28 15 $4,860.00 $4,131.00 $78.35 $4,714.20 $1,992.60 2026-02-04
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 9 9 $17,912.11 $15,225.29 $8,911.27 $17,374.74 $16,288.95 2026-02-04
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 9 9 $18,356.61 $15,603.12 $9,132.41 $17,805.91 $11,772.33 2026-02-04
200 MS_DRG Pneumothorax With Cc 9 9 $21,368.25 $18,163.01 $10,630.70 $20,727.20 $11,118.40 2026-02-04
20225 HCPCS Deep Biopsy Of Bone Using Needle Or Trocar 28 15 $4,860.00 $4,131.00 $105.89 $4,714.20 $1,992.60 2026-02-04
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 7 7 $5,791.00 $4,922.35 $2,881.02 $5,791.00 $5,327.72 2026-02-04
21315 HCPCS Closed Treatment Of Broken Nose Bone With Manipulation 28 15 $4,300.00 $3,655.00 $49.11 $4,171.00 $1,763.00 2026-02-04
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 28 15 $4,268.00 $3,627.80 $378.77 $4,139.96 $1,749.88 2026-02-04
24505 HCPCS Closed Treatment Of Broken Middle Part Of Upper Arm Bone With Manipulation 28 15 $4,801.00 $4,080.85 $427.71 $4,656.97 $1,945.22 2026-02-04
24605 HCPCS Repair Of Dislocated Elbow Under Anesthesia 28 15 $4,268.00 $3,627.80 $433.42 $4,139.96 $1,804.00 2026-02-04
25565 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation 28 15 $4,303.00 $3,657.55 $459.89 $4,173.91 $1,764.23 2026-02-04
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 32 15 $2,865.00 $2,435.25 $496.33 $4,139.96 $1,605.94 2026-02-04
26645 HCPCS Closed Treatment Of Broken Thumb At Wrist With Manipulation 28 15 $4,801.00 $4,080.85 $354.57 $4,656.97 $1,945.22 2026-02-04
27365 HCPCS Extensive Removal Of Growth Of Thigh Or Knee Bone 13 13 $5,734.00 $4,873.90 $1,653.95 $5,734.00 $1,653.95 2026-02-04
27603 HCPCS Drainage Of Deep Abscess Or Blood Accumulation Of Leg Or Ankle 28 15 $7,265.00 $6,175.25 $338.41 $7,047.05 $2,978.65 2026-02-04
27810 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation 28 15 $4,801.00 $4,080.85 $419.30 $4,656.97 $1,945.22 2026-02-04
27818 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation 28 15 $4,304.00 $3,658.40 $429.94 $4,174.88 $1,764.64 2026-02-04
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 9 9 $20,160.89 $17,136.76 $10,030.04 $20,506.84 $19,556.06 2026-02-04
281 MS_DRG Acute Myocardial Infarction, Discharged Alive With Cc 9 9 $9,870.83 $8,390.21 $4,910.74 $12,338.58 $9,574.71 2026-02-04
284 MS_DRG Acute Myocardial Infarction, Expired With Cc 9 9 $15,010.08 $12,758.57 $7,467.51 $14,559.78 $11,012.88 2026-02-04
292 MS_DRG Heart Failure And Shock With Cc 11 11 $11,390.00 $9,681.50 $5,666.53 $24,182.00 $11,048.30 2026-02-04
29999 HCPCS Other Procedure On Joint Using An Endoscope 4 4 $3,012.00 $2,560.20 $76.98 $3,012.00 $3,012.00 2026-02-04
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 9 9 $10,062.25 $8,552.91 $5,005.97 $9,764.45 $9,760.38 2026-02-04
312 MS_DRG Syncope And Collapse 9 9 $10,467.00 $8,896.95 $5,207.33 $10,590.79 $10,152.99 2026-02-04
314 MS_DRG Other Circulatory System Diagnoses With Mcc 9 9 $10,056.00 $8,547.60 $5,002.86 $28,235.17 $9,754.32 2026-02-04
32400 HCPCS Needle Biopsy Of Lining Of Lung 28 15 $4,860.00 $4,131.00 $68.09 $4,714.20 $1,647.18 2026-02-04
32408 HCPCS Core Needle Biopsy Of Lung Or Center Cavity Of Chest (mediastinum), Accessed Thr… 28 15 $4,861.00 $4,131.85 $122.42 $4,715.17 $1,647.18 2026-02-04
32551 HCPCS Removal Of Fluid From Between Lung And Chest Cavity 28 15 $4,893.00 $4,159.05 $129.69 $4,746.21 $1,647.18 2026-02-04
330 MS_DRG Major Small And Large Bowel Procedures With Cc 9 9 $62,644.25 $53,247.61 $29,141.76 $60,764.92 $31,165.51 2026-02-04
331 MS_DRG Major Small And Large Bowel Procedures Without Cc/mcc 9 9 $41,141.56 $34,970.33 $20,467.93 $39,907.32 $20,973.51 2026-02-04
349 MS_DRG Anal And Stomal Procedures Without Cc/mcc 9 9 $70,634.48 $60,039.31 $12,109.70 $68,515.45 $35,140.65 2026-02-04
357 MS_DRG Other Digestive System O.r. Procedures With Cc 9 9 $32,016.72 $27,214.21 $15,928.32 $31,056.22 $25,007.10 2026-02-04
36573 HCPCS Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, … 15 15 $3,052.00 $2,594.20 $1,251.32 $3,164.96 $1,678.60 2026-02-04
371 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 9 9 $23,420.25 $19,907.21 $11,651.57 $22,717.64 $18,738.24 2026-02-04
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 9 9 $14,669.63 $12,469.18 $7,298.14 $14,229.54 $14,171.09 2026-02-04
375 MS_DRG Digestive Malignancy With Cc 9 9 $23,664.15 $20,114.52 $11,772.91 $22,954.22 $12,785.93 2026-02-04
377 MS_DRG Gastrointestinal Hemorrhage With Mcc 9 9 $55,168.19 $46,892.96 $21,303.45 $53,513.14 $27,446.17 2026-02-04
378 MS_DRG Gastrointestinal Hemorrhage With Cc 9 9 $15,756.76 $13,393.25 $7,838.99 $15,284.06 $15,172.80 2026-02-04
379 MS_DRG Gastrointestinal Hemorrhage Without Cc/mcc 9 9 $10,048.50 $8,541.23 $4,999.13 $9,747.05 $6,742.97 2026-02-04
38222 HCPCS Biopsy And Aspiration Of Bone Marrow Sample For Diagnosis 28 15 $8,586.00 $7,298.10 $58.88 $8,328.42 $1,829.86 2026-02-04
384 MS_DRG Uncomplicated Peptic Ulcer Without Mcc 9 9 $15,725.29 $13,366.49 $7,823.33 $15,253.53 $11,693.56 2026-02-04
388 MS_DRG Gastrointestinal Obstruction With Mcc 9 9 $15,917.72 $13,530.06 $7,919.07 $15,440.19 $14,875.56 2026-02-04
389 MS_DRG Gastrointestinal Obstruction With Cc 9 9 $11,417.20 $9,704.62 $5,680.06 $11,895.69 $11,074.68 2026-02-04
390 MS_DRG Gastrointestinal Obstruction Without Cc/mcc 11 11 $5,220.00 $4,437.00 $2,596.95 $11,616.00 $5,063.40 2026-02-04
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 10 10 $4,734.50 $4,024.33 $2,355.41 $11,130.50 $4,592.47 2026-02-04
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 12 12 $7,897.24 $6,712.65 $3,928.87 $17,491.24 $7,778.78 2026-02-04
394 MS_DRG Other Digestive System Diagnoses With Cc 9 9 $16,003.40 $13,602.89 $7,961.69 $15,523.30 $12,490.18 2026-02-04
398 MS_DRG Appendix Procedures With Cc 9 9 $41,371.35 $35,165.65 $20,582.25 $40,130.21 $21,719.59 2026-02-04
41008 HCPCS Drainage Of Abscess, Cyst, Or Blood Accumulation Under Jaw Bone From Inside Mout… 28 15 $8,382.00 $7,124.70 $225.11 $8,130.54 $3,163.44 2026-02-04
433 MS_DRG Cirrhosis And Alcoholic Hepatitis With Cc 9 9 $10,182.00 $8,654.70 $5,065.55 $13,686.58 $9,876.54 2026-02-04
438 MS_DRG Disorders Of Pancreas Except Malignancy With Mcc 7 7 $6,593.58 $5,604.54 $3,280.31 $6,593.58 $6,066.09 2026-02-04
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 9 9 $13,882.00 $11,799.70 $6,906.30 $13,465.54 $12,481.26 2026-02-04
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/mcc 12 12 $8,442.75 $7,176.34 $4,200.27 $18,036.75 $8,316.11 2026-02-04
45499 HCPCS Other Procedure On Rectum Using An Endoscope 4 4 $2,327.00 $1,977.95 $76.98 $2,327.00 $2,327.00 2026-02-04
470 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without … 9 9 $62,263.98 $52,924.38 $30,619.06 $60,396.06 $30,976.33 2026-02-04
47000 HCPCS Needle Biopsy Of Liver Through Skin 28 15 $4,860.00 $4,131.00 $71.62 $4,714.20 $1,666.01 2026-02-04
47531 HCPCS Injection Of Bile Duct For X-ray Through Already Existing Skin Access Using Imag… 15 15 $6,499.00 $5,524.15 $2,664.59 $6,304.03 $3,574.45 2026-02-04
481 MS_DRG Hip And Femur Procedures Except Major Joint With Cc 9 9 $35,042.47 $29,786.10 $17,433.63 $33,991.19 $32,276.20 2026-02-04
482 MS_DRG Hip And Femur Procedures Except Major Joint Without Cc/mcc 9 9 $19,339.12 $16,438.25 $9,621.21 $18,758.95 $18,232.92 2026-02-04
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 9 9 $36,762.70 $31,248.30 $18,289.44 $35,659.82 $31,295.29 2026-02-04
49405 HCPCS Drainage Of Fluid Collection By Tube Through Skin Using Imaging Guidance 28 15 $4,860.00 $4,131.00 $156.31 $4,714.20 $1,666.01 2026-02-04
49406 HCPCS Drainage Of Fluid Collection Of Abdominal Cavity By Tube Using Imaging Guidance 28 15 $4,860.00 $4,131.00 $156.31 $4,714.20 $1,666.01 2026-02-04
49423 HCPCS Exchange Of Abdominal Cavity Drainage Tube Using Imaging Guidance 28 15 $5,691.00 $4,837.35 $56.89 $5,520.27 $1,666.01 2026-02-04
50200 HCPCS Needle Biopsy Of Kidney 28 15 $4,860.00 $4,131.00 $103.29 $4,714.20 $1,992.60 2026-02-04
522 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 9 9 $33,228.27 $28,244.03 $16,531.06 $33,520.16 $32,231.42 2026-02-04
535 MS_DRG Fractures Of Hip And Pelvis With Mcc 12 12 $11,323.50 $9,624.98 $5,633.44 $27,313.50 $11,153.65 2026-02-04
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 12 12 $8,037.56 $6,831.92 $3,998.68 $20,829.56 $7,917.00 2026-02-04
540 MS_DRG Osteomyelitis With Cc 7 7 $3,627.30 $3,083.21 $1,804.58 $3,627.30 $3,337.12 2026-02-04
54150 HCPCS Removal Of Foreskin Using Clamp Or Device 28 15 $5,314.00 $4,516.90 $78.12 $5,154.58 $2,178.74 2026-02-04
543 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 11 11 $10,115.89 $8,598.51 $5,032.66 $26,105.89 $9,812.41 2026-02-04
549 MS_DRG Septic Arthritis With Cc 12 12 $5,312.00 $4,515.20 $2,642.72 $12,353.44 $5,232.32 2026-02-04
552 MS_DRG Medical Back Problems Without Mcc 11 11 $8,952.57 $7,609.69 $4,453.90 $21,744.57 $8,683.99 2026-02-04
555 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc 9 9 $1,980.38 $1,683.32 $985.24 $5,178.38 $1,920.97 2026-02-04
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 12 12 $13,934.25 $11,844.11 $6,932.29 $39,518.25 $10,903.55 2026-02-04
55700 HCPCS Biopsy Of Prostate Gland 22 15 $7,315.00 $6,217.75 $284.38 $7,095.55 $3,234.01 2026-02-04
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 9 9 $10,940.19 $9,299.16 $5,442.75 $10,611.99 $9,455.32 2026-02-04
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 9 9 $10,508.00 $8,931.80 $5,227.73 $22,859.52 $10,192.76 2026-02-04
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 9 9 $27,580.40 $23,443.34 $13,721.25 $26,752.99 $22,541.47 2026-02-04
59412 HCPCS Turning Of Fetus Through External Manipulation 28 15 $4,996.00 $4,246.60 $81.70 $4,846.12 $2,048.36 2026-02-04
602 MS_DRG Cellulitis With Mcc 9 9 $10,491.50 $8,917.78 $5,219.52 $18,869.02 $10,176.76 2026-02-04
603 MS_DRG Cellulitis Without Mcc 9 9 $13,597.25 $11,557.66 $6,764.63 $13,189.33 $12,059.17 2026-02-04
605 MS_DRG Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc 11 11 $6,072.50 $5,161.63 $3,021.07 $15,666.50 $5,890.33 2026-02-04
637 MS_DRG Diabetes With Mcc 9 9 $30,099.08 $25,584.22 $14,974.29 $29,196.11 $17,011.25 2026-02-04
638 MS_DRG Diabetes With Cc 9 9 $10,475.29 $8,904.00 $5,211.46 $11,006.93 $10,161.03 2026-02-04
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 9 9 $12,787.80 $10,869.63 $6,361.93 $26,190.13 $12,404.17 2026-02-04
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 9 9 $16,443.61 $13,977.07 $8,180.69 $17,671.13 $15,950.30 2026-02-04
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 11 11 $5,317.50 $4,519.87 $2,645.46 $14,911.50 $5,157.97 2026-02-04
64624 HCPCS Destruction Of Nerve Branches Of Knee Using Imaging Guidance 28 15 $5,157.00 $4,383.45 $125.06 $5,002.29 $2,114.37 2026-02-04
64625 HCPCS Destruction Of Nerves Supplying Joint Between Spine And Pelvis Using Imaging Gui… 28 15 $5,157.00 $4,383.45 $165.36 $5,002.29 $2,114.37 2026-02-04
64633 HCPCS Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 56 15 $5,157.00 $4,383.45 $162.01 $7,137.26 $2,114.37 2026-02-04
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 56 15 $5,157.00 $4,383.45 $162.49 $10,004.58 $2,114.37 2026-02-04
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 9 9 $15,449.50 $13,132.08 $7,686.13 $14,986.02 $14,833.94 2026-02-04
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 9 9 $18,574.50 $15,788.33 $9,240.81 $18,017.27 $9,875.92 2026-02-04
660 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Cc 9 9 $21,077.37 $17,915.76 $10,485.99 $20,445.05 $13,686.58 2026-02-04
661 MS_DRG Kidney And Ureter Procedures For Non-neoplasm Without Cc/mcc 9 9 $41,538.98 $35,308.13 $12,082.95 $40,292.81 $20,665.64 2026-02-04
683 MS_DRG Renal Failure With Cc 9 9 $17,983.47 $15,285.95 $8,946.77 $17,443.96 $11,075.30 2026-02-04
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 12 12 $7,280.87 $6,188.74 $3,622.23 $16,874.87 $7,171.66 2026-02-04
69205 HCPCS Removal Of Foreign Body In Ear Canal Under Anesthesia 28 15 $4,311.00 $3,664.35 $80.48 $4,181.67 $1,767.51 2026-02-04
698 MS_DRG Other Kidney And Urinary Tract Diagnoses With Mcc 12 12 $13,370.41 $11,364.85 $6,651.78 $32,558.41 $13,169.85 2026-02-04
699 MS_DRG Other Kidney And Urinary Tract Diagnoses With Cc 9 9 $15,228.38 $12,944.12 $7,576.12 $14,771.53 $14,273.64 2026-02-04
70 MS_DRG Other Cerebrovascular Disorders With Mcc 9 9 $26,367.50 $22,412.38 $13,117.83 $25,576.48 $24,005.39 2026-02-04
700 MS_DRG Other Kidney And Urinary Tract Diagnoses Without Cc/mcc 9 9 $7,068.00 $6,007.80 $3,516.33 $8,331.74 $6,855.96 2026-02-04
707 MS_DRG Major Male Pelvic Procedures With Cc/mcc 10 10 $7,328.54 $6,229.26 $3,645.95 $16,922.54 $7,108.68 2026-02-04
71 MS_DRG Other Cerebrovascular Disorders With Cc 9 9 $7,873.80 $6,692.73 $3,917.22 $17,483.87 $7,637.59 2026-02-04
724 MS_DRG Malignancy, Male Reproductive System Without Cc/mcc 9 9 $10,660.00 $9,061.00 $5,303.35 $10,830.07 $10,340.20 2026-02-04
728 MS_DRG Inflammation Of The Male Reproductive System Without Mcc 9 9 $18,460.76 $15,691.65 $9,051.07 $17,906.94 $9,184.23 2026-02-04
74182 HCPCS MRI Scan Of Abdomen With Contrast 15 15 $3,200.00 $2,720.00 $1,067.46 $3,104.00 $1,760.00 2026-02-04
768 MS_DRG Vaginal Delivery With O.r. Procedures Except Sterilization And/or D&c 9 9 $10,884.25 $9,251.62 $5,414.92 $10,557.73 $9,733.24 2026-02-04
769 MS_DRG Postpartum And Post Abortion Diagnoses With O.r. Procedures 9 9 $19,349.46 $16,447.04 $9,626.36 $18,768.98 $12,417.35 2026-02-04
776 MS_DRG Postpartum And Post Abortion Diagnoses Without O.r. Procedures 12 12 $2,113.50 $1,796.48 $1,051.47 $5,793.28 $2,081.80 2026-02-04
784 MS_DRG Cesarean Section With Sterilization With Cc 9 9 $20,759.05 $17,645.19 $10,327.63 $20,136.28 $14,105.70 2026-02-04
785 MS_DRG Cesarean Section With Sterilization Without Cc/mcc 12 12 $5,388.50 $4,580.23 $2,680.78 $11,920.95 $5,307.68 2026-02-04
786 MS_DRG Cesarean Section Without Sterilization With Mcc 9 9 $22,022.23 $18,718.90 $10,956.06 $21,361.56 $16,074.93 2026-02-04
78608 HCPCS Nuclear Medicine Study Of Brain With Metabolic Evaluation 28 15 $4,329.00 $3,679.65 $64.06 $4,199.13 $1,774.89 2026-02-04
787 MS_DRG Cesarean Section Without Sterilization With Cc 9 9 $26,502.71 $22,527.30 $13,185.10 $25,707.63 $14,337.55 2026-02-04
788 MS_DRG Cesarean Section Without Sterilization Without Cc/mcc 9 9 $19,999.55 $16,999.62 $9,949.78 $19,399.57 $12,268.73 2026-02-04
78812 HCPCS Nuclear Medicine Study From Skull Base To Mid-thigh 28 15 $4,472.00 $3,801.20 $82.94 $4,337.84 $1,833.52 2026-02-04
78813 HCPCS Nuclear Medicine Study Whole Body 28 15 $4,621.00 $3,927.85 $84.97 $4,482.37 $1,894.61 2026-02-04
78814 HCPCS Nuclear Medicine Study Limited Area With CT Scan 28 15 $4,770.00 $4,054.50 $94.36 $4,626.90 $1,955.70 2026-02-04
78815 HCPCS Nuclear Medicine Study From Skull Base To Mid-thigh With CT Scan 28 15 $4,920.00 $4,182.00 $104.92 $4,772.40 $2,017.20 2026-02-04
78816 HCPCS Nuclear Medicine Study Whole Body With CT Scan 28 15 $5,120.00 $4,352.00 $106.62 $4,966.40 $2,099.20 2026-02-04
798 MS_DRG Vaginal Delivery With Sterilization And/or D&c Without Cc/mcc 9 9 $14,628.57 $12,434.28 $7,277.71 $14,189.71 $11,720.32 2026-02-04
805 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Mcc 9 9 $10,591.29 $9,002.60 $5,269.17 $10,273.55 $9,666.36 2026-02-04
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 9 9 $8,918.52 $7,580.74 $4,436.96 $8,728.56 $8,650.96 2026-02-04
807 MS_DRG Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc 9 9 $8,272.68 $7,031.78 $4,115.66 $8,024.50 $7,720.90 2026-02-04
809 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 9 9 $11,485.50 $9,762.68 $5,714.04 $13,922.89 $11,140.94 2026-02-04
813 MS_DRG Coagulation Disorders 9 9 $40,596.77 $34,507.25 $15,703.38 $39,378.87 $20,196.89 2026-02-04
832 MS_DRG Other Antepartum Diagnoses Without O.r. Procedures With Cc 9 9 $30,290.47 $25,746.90 $7,640.65 $29,381.76 $15,069.51 2026-02-04
844 MS_DRG Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 12 12 $18,123.00 $15,404.55 $9,016.19 $40,509.00 $15,010.44 2026-02-04
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 9 9 $36,513.77 $31,036.70 $18,165.60 $54,186.02 $35,418.36 2026-02-04
854 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Cc 9 9 $29,132.25 $24,762.41 $14,493.29 $28,258.28 $23,189.46 2026-02-04
862 MS_DRG Postoperative And Post-traumatic Infections With Mcc 9 9 $27,816.00 $23,643.60 $13,838.46 $26,981.52 $18,160.10 2026-02-04
867 MS_DRG Other Infectious And Parasitic Diseases Diagnoses With Mcc 9 9 $71,090.32 $60,426.77 $20,820.43 $68,957.61 $35,367.43 2026-02-04
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 9 9 $17,918.33 $15,230.58 $8,914.37 $22,997.74 $17,380.78 2026-02-04
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 9 9 $19,256.64 $16,368.15 $9,580.18 $18,678.94 $12,785.93 2026-02-04
897 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 9 9 $10,767.25 $9,152.16 $5,356.71 $10,444.23 $9,739.19 2026-02-04
918 MS_DRG Poisoning And Toxic Effects Of Drugs Without Mcc 9 9 $8,205.00 $6,974.25 $4,081.99 $8,666.14 $7,958.85 2026-02-04
948 MS_DRG Signs And Symptoms Without Mcc 9 9 $14,578.33 $12,391.58 $7,252.72 $14,140.98 $9,935.37 2026-02-04
983 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis Without Cc/mcc 9 9 $28,730.97 $24,421.32 $14,293.66 $27,869.04 $16,158.16 2026-02-04
A9596 HCPCS Gallium Ga-68 Gozetotide, Diagnostic, (illuccix), 1 Millicurie 13 13 $9,840.00 $8,364.00 $4,034.40 $9,544.80 $5,412.00 2026-02-04
C1776 HCPCS Joint Device (implantable) 273 13 $9,000.00 $7,650.00 $246.00 $46,560.00 $6,790.00 2026-02-04
C1783 HCPCS Ocular Implant, Aqueous Drainage Assist Device 143 13 $3,000.00 $2,550.00 $246.00 $5,820.00 $1,650.00 2026-02-04
HB-10010102 CDM Operating Room Services - General Classification 15 15 $3,465.81 $2,945.94 $1,420.98 $3,361.84 $1,906.20 2026-02-04
HB-10010103 CDM Operating Room Services - General Classification 15 15 $4,941.12 $4,199.95 $2,025.86 $4,792.89 $2,717.62 2026-02-04
HB-10010104 CDM Operating Room Services - General Classification 15 15 $6,328.53 $5,379.25 $2,594.70 $6,138.67 $3,480.69 2026-02-04
HB-10010105 CDM Operating Room Services - General Classification 15 15 $7,807.32 $6,636.22 $3,201.00 $7,573.10 $4,294.03 2026-02-04
HB-10010106 CDM Operating Room Services - General Classification 15 15 $9,249.88 $7,862.40 $3,792.45 $8,972.38 $5,087.43 2026-02-04
HB-27002250 CDM Hc Misc Implant Charge Lvl2 15 15 $3,000.00 $2,550.00 $1,230.00 $2,910.00 $1,650.00 2026-02-04
HB-27002251 CDM Hc Misc Implant Charge Lvl3 15 15 $4,000.00 $3,400.00 $1,640.00 $3,880.00 $2,200.00 2026-02-04
HB-27002252 CDM Hc Misc Implant Charge Lvl4 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
HB-27002253 CDM Hc Misc Implant Charge Lvl5 15 15 $4,800.00 $4,080.00 $1,968.00 $4,656.00 $2,640.00 2026-02-04
HB-27002264 CDM Hc Misc Supply Charge Lvl 6 15 15 $3,000.00 $2,550.00 $1,230.00 $2,910.00 $1,650.00 2026-02-04
HB-27002265 CDM Hc Misc Supply Charge Lvl 7 15 15 $4,000.00 $3,400.00 $1,640.00 $3,880.00 $2,200.00 2026-02-04
HB-27002267 CDM Hc Misc Supply Charge Lvl 9 15 15 $4,800.00 $4,080.00 $1,968.00 $4,656.00 $2,640.00 2026-02-04
HB-27002268 CDM Hc Misc Supply Charge Lvl 10 15 15 $5,600.00 $4,760.00 $2,296.00 $5,432.00 $3,080.00 2026-02-04
HB-27002269 CDM Hc Misc Supply Charge Lvl 11 15 15 $6,400.00 $5,440.00 $2,624.00 $6,208.00 $3,520.00 2026-02-04
HB-27002270 CDM Hc Misc Supply Charge Lvl 12 15 15 $7,200.00 $6,120.00 $2,952.00 $6,984.00 $3,960.00 2026-02-04
HB-27002272 CDM Hc Misc Supply Charge Lvl 14 15 15 $8,800.00 $7,480.00 $3,608.00 $8,536.00 $4,840.00 2026-02-04
HB-27100038 CDM Rhc Med/surg Supply Level 38 15 15 $3,000.00 $2,550.00 $1,230.00 $2,910.00 $1,650.00 2026-02-04
HB-27100039 CDM Rhc Med/surg Supply Level 39 15 15 $3,250.00 $2,762.50 $1,332.50 $3,152.50 $1,787.50 2026-02-04
HB-27100040 CDM Rhc Med/surg Supply Level 40 15 15 $3,500.00 $2,975.00 $1,435.00 $3,395.00 $1,925.00 2026-02-04
HB-27100041 CDM Rhc Med/surg Supply Level 41 15 15 $3,750.00 $3,187.50 $1,537.50 $3,637.50 $2,062.50 2026-02-04
HB-27100042 CDM Rhc Med/surg Supply Level 42 15 15 $4,000.00 $3,400.00 $1,640.00 $3,880.00 $2,200.00 2026-02-04
HB-27100043 CDM Rhc Med/surg Supply Level 43 15 15 $4,250.00 $3,612.50 $1,742.50 $4,122.50 $2,337.50 2026-02-04
HB-27100044 CDM Rhc Med/surg Supply Level 44 15 15 $4,500.00 $3,825.00 $1,845.00 $4,365.00 $2,475.00 2026-02-04
HB-27100045 CDM Rhc Med/surg Supply Level 45 15 15 $4,750.00 $4,037.50 $1,947.50 $4,607.50 $2,612.50 2026-02-04
HB-27100083 CDM Rhc Sterile Med/surg Supply Level 38 15 15 $3,000.00 $2,550.00 $1,230.00 $2,910.00 $1,650.00 2026-02-04
HB-27100084 CDM Rhc Sterile Med/surg Supply Level 39 15 15 $3,250.00 $2,762.50 $1,332.50 $3,152.50 $1,787.50 2026-02-04
HB-27100085 CDM Rhc Sterile Med/surg Supply Level 40 15 15 $3,500.00 $2,975.00 $1,435.00 $3,395.00 $1,925.00 2026-02-04
HB-27100086 CDM Rhc Sterile Med/surg Supply Level 41 15 15 $3,750.00 $3,187.50 $1,537.50 $3,637.50 $2,062.50 2026-02-04
HB-27100087 CDM Rhc Sterile Med/surg Supply Level 42 15 15 $4,000.00 $3,400.00 $1,640.00 $3,880.00 $2,200.00 2026-02-04
HB-27100088 CDM Rhc Sterile Med/surg Supply Level 43 15 15 $4,250.00 $3,612.50 $1,742.50 $4,122.50 $2,337.50 2026-02-04
HB-27100089 CDM Rhc Sterile Med/surg Supply Level 44 15 15 $4,500.00 $3,825.00 $1,845.00 $4,365.00 $2,475.00 2026-02-04
HB-27100090 CDM Rhc Sterile Med/surg Supply Level 45 15 15 $4,750.00 $4,037.50 $1,947.50 $4,607.50 $2,612.50 2026-02-04
HB-27100114 CDM Rhc Misc Implant Charge Level 8 15 15 $3,750.00 $3,187.50 $1,537.50 $3,637.50 $2,062.50 2026-02-04
HB-27100116 CDM Rhc Misc Implant Charge Level 10 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
HB-27100117 CDM Rhc Misc Implant Charge Level 11 15 15 $6,000.00 $5,100.00 $2,460.00 $5,820.00 $3,300.00 2026-02-04
HB-27100118 CDM Rhc Misc Implant Charge Level 12 15 15 $7,000.00 $5,950.00 $2,870.00 $6,790.00 $3,850.00 2026-02-04
HB-27100119 CDM Rhc Misc Implant Charge Level 13 15 15 $8,000.00 $6,800.00 $3,280.00 $7,760.00 $4,400.00 2026-02-04
HB-27100132 CDM Rhc Med/surg Supply Level 46 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
HB-27100133 CDM Rhc Med/surg Supply Level 47 15 15 $4,200.00 $3,570.00 $1,722.00 $4,074.00 $2,310.00 2026-02-04
HB-27100135 CDM Rhc Misc Implant Charge Level 14 15 15 $9,000.00 $7,650.00 $3,690.00 $8,730.00 $4,950.00 2026-02-04
HB-27100136 CDM Rhc Misc Implant Charge Level 15 15 15 $10,000.00 $8,500.00 $4,100.00 $9,700.00 $5,500.00 2026-02-04
HB-27100137 CDM Rhc Misc Implant Charge Level 16 15 15 $11,000.00 $9,350.00 $4,510.00 $10,670.00 $6,050.00 2026-02-04
HB-27100138 CDM Rhc Misc Implant Charge Level 17 15 15 $12,000.00 $10,200.00 $4,920.00 $11,640.00 $6,600.00 2026-02-04
HB-27100139 CDM Rhc Misc Implant Charge Level 18 15 15 $13,000.00 $11,050.00 $5,330.00 $12,610.00 $7,150.00 2026-02-04
HB-27100140 CDM Rhc Misc Implant Charge Level 19 15 15 $14,000.00 $11,900.00 $5,740.00 $13,580.00 $7,700.00 2026-02-04
HB-27100141 CDM Rhc Misc Implant Charge Level 20 15 15 $15,000.00 $12,750.00 $6,150.00 $14,550.00 $8,250.00 2026-02-04
HB-27100142 CDM Rhc Misc Implant Charge Level 21 15 15 $16,000.00 $13,600.00 $6,560.00 $15,520.00 $8,800.00 2026-02-04
HB-27100143 CDM Rhc Misc Implant Charge Level 22 15 15 $17,000.00 $14,450.00 $6,970.00 $16,490.00 $9,350.00 2026-02-04
HB-27100144 CDM Rhc Misc Implant Charge Level 23 15 15 $18,000.00 $15,300.00 $7,380.00 $17,460.00 $9,900.00 2026-02-04
HB-27100145 CDM Rhc Misc Implant Charge Level 24 15 15 $19,000.00 $16,150.00 $7,790.00 $18,430.00 $10,450.00 2026-02-04
HB-27100146 CDM Rhc Misc Implant Charge Level 25 15 15 $20,000.00 $17,000.00 $8,200.00 $19,400.00 $11,000.00 2026-02-04
HB-27100147 CDM Rhc Misc Implant Charge Level 26 15 15 $22,000.00 $18,700.00 $9,020.00 $21,340.00 $12,100.00 2026-02-04
HB-27100148 CDM Rhc Misc Implant Charge Level 27 15 15 $24,000.00 $20,400.00 $9,840.00 $23,280.00 $13,200.00 2026-02-04
HB-27100149 CDM Rhc Misc Implant Charge Level 28 15 15 $26,000.00 $22,100.00 $10,660.00 $25,220.00 $14,300.00 2026-02-04
HB-27100150 CDM Rhc Misc Implant Charge Level 29 15 15 $28,000.00 $23,800.00 $11,480.00 $27,160.00 $15,400.00 2026-02-04
HB-27100151 CDM Rhc Misc Implant Charge Level 30 15 15 $30,000.00 $25,500.00 $12,300.00 $29,100.00 $16,500.00 2026-02-04
HB-27100152 CDM Rhc Misc Implant Charge Level 31 15 15 $32,000.00 $27,200.00 $13,120.00 $31,040.00 $17,600.00 2026-02-04
HB-27100153 CDM Rhc Misc Implant Charge Level 32 15 15 $40,000.00 $34,000.00 $16,400.00 $38,800.00 $22,000.00 2026-02-04
HB-27100154 CDM Rhc Sterile Med/surg Supply Level 46 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
HB-27100155 CDM Rhc Sterile Med/surg Supply Level 47 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
HB-27100156 CDM Rhc Sterile Med/surg Supply Level 48 15 15 $6,000.00 $5,100.00 $2,460.00 $5,820.00 $3,300.00 2026-02-04
HB-27100157 CDM Rhc Sterile Med/surg Supply Level 49 15 15 $7,000.00 $5,950.00 $2,870.00 $6,790.00 $3,850.00 2026-02-04
HB-27100158 CDM Rhc Sterile Med/surg Supply Level 50 15 15 $8,000.00 $6,800.00 $3,280.00 $7,760.00 $4,400.00 2026-02-04
HB-27100159 CDM Rhc Sterile Med/surg Supply Level 51 15 15 $10,000.00 $8,500.00 $4,100.00 $9,700.00 $5,500.00 2026-02-04
HB-27100160 CDM Rhc Med/surg Supply Level 48 15 15 $4,400.00 $3,740.00 $1,804.00 $4,268.00 $2,420.00 2026-02-04
HB-27100161 CDM Rhc Med/surg Supply Level 49 15 15 $4,600.00 $3,910.00 $1,886.00 $4,462.00 $2,530.00 2026-02-04
HB-27100162 CDM Rhc Med/surg Supply Level 50 15 15 $4,800.00 $4,080.00 $1,968.00 $4,656.00 $2,640.00 2026-02-04
HB-27100163 CDM Rhc Med/surg Supply Level 51 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
HB-27100164 CDM Rhc Med/surg Supply Level 52 15 15 $5,200.00 $4,420.00 $2,132.00 $5,044.00 $2,860.00 2026-02-04
HB-27100165 CDM Rhc Med/surg Supply Level 53 15 15 $5,400.00 $4,590.00 $2,214.00 $5,238.00 $2,970.00 2026-02-04
HB-27100166 CDM Rhc Med/surg Supply Level 54 15 15 $5,600.00 $4,760.00 $2,296.00 $5,432.00 $3,080.00 2026-02-04
HB-27100167 CDM Rhc Med/surg Supply Level 55 15 15 $5,800.00 $4,930.00 $2,378.00 $5,626.00 $3,190.00 2026-02-04
HB-27100168 CDM Rhc Med/surg Supply Level 56 15 15 $6,000.00 $5,100.00 $2,460.00 $5,820.00 $3,300.00 2026-02-04
HB-27100169 CDM Rhc Med/surg Supply Level 57 15 15 $6,000.00 $5,100.00 $2,460.00 $5,820.00 $3,300.00 2026-02-04
HB-40000025 CDM Gastro - Intestinal (gi) Services - General Classification 15 15 $3,313.21 $2,816.23 $1,358.42 $3,213.81 $1,822.27 2026-02-04
HB-40000026 CDM Gastro - Intestinal (gi) Services - General Classification 15 15 $3,758.06 $3,194.35 $1,540.80 $3,645.32 $2,066.93 2026-02-04
HB-40000027 CDM Gastro - Intestinal (gi) Services - General Classification 15 15 $4,526.63 $3,847.64 $1,855.92 $4,390.83 $2,489.65 2026-02-04
HB-40000034 CDM Gastro - Intestinal (gi) Services - General Classification 15 15 $2,969.91 $2,524.42 $1,217.66 $2,880.81 $1,633.45 2026-02-04
HB-40000035 CDM Gastro - Intestinal (gi) Services - General Classification 15 15 $3,502.12 $2,976.80 $1,435.87 $3,397.06 $1,926.17 2026-02-04
HB-40000036 CDM Gastro - Intestinal (gi) Services - General Classification 15 15 $4,092.92 $3,478.98 $1,678.10 $3,970.13 $2,251.11 2026-02-04
HB-40000038 CDM Gastro - Intestinal (gi) Services - General Classification 15 15 $2,970.74 $2,525.13 $1,218.00 $2,881.62 $1,633.91 2026-02-04
HB-40000039 CDM Gastro - Intestinal (gi) Services - General Classification 15 15 $3,340.69 $2,839.59 $1,369.68 $3,240.47 $1,837.38 2026-02-04
HB-40000040 CDM Gastro - Intestinal (gi) Services - General Classification 15 15 $3,901.11 $3,315.94 $1,599.46 $3,784.08 $2,145.61 2026-02-04
HB-50000071 CDM Operating Room Services - General Classification 15 15 $5,733.60 $4,873.56 $2,350.78 $5,561.59 $3,153.48 2026-02-04
HB-50050007 CDM Intensive Care Unit - General Classification 9 9 $2,720.00 $2,312.00 $1,353.20 $2,638.40 $1,831.65 2026-02-04
HB-50050130 CDM Intensive Care Unit - General Classification 9 9 $2,720.00 $2,312.00 $1,353.20 $2,638.40 $1,831.65 2026-02-04
HB-60060095 CDM Labor Room/delivery - Delivery Room 15 15 $3,217.92 $2,735.23 $1,319.35 $3,121.38 $1,769.86 2026-02-04
HB-60060096 CDM Labor Room/delivery - Delivery Room 15 15 $4,623.47 $3,929.95 $1,895.62 $4,484.77 $2,542.91 2026-02-04
HB-60060097 CDM Labor Room/delivery - Delivery Room 15 15 $5,765.28 $4,900.49 $2,363.76 $5,592.32 $3,170.90 2026-02-04
HB-60060098 CDM Labor Room/delivery - Delivery Room 15 15 $7,393.57 $6,284.53 $3,031.36 $7,171.76 $4,066.46 2026-02-04
J7327 HCPCS Hyaluronan Or Derivative, Monovisc, For Intra-articular Injection, Per Dose 26 13 $2,998.75 $2,548.94 $1,193.10 $2,994.88 $1,698.13 2026-02-04
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 13 13 $4,307.25 $3,661.16 $1,765.97 $4,178.03 $2,368.99 2026-02-04
SUP-27100038 CDM Rhc Med/surg Supply Level 38 15 15 $3,000.00 $2,550.00 $1,230.00 $2,910.00 $1,650.00 2026-02-04
SUP-27100039 CDM Rhc Med/surg Supply Level 39 15 15 $3,250.00 $2,762.50 $1,332.50 $3,152.50 $1,787.50 2026-02-04
SUP-27100040 CDM Rhc Med/surg Supply Level 40 15 15 $3,500.00 $2,975.00 $1,435.00 $3,395.00 $1,925.00 2026-02-04
SUP-27100041 CDM Rhc Med/surg Supply Level 41 15 15 $3,750.00 $3,187.50 $1,537.50 $3,637.50 $2,062.50 2026-02-04
SUP-27100042 CDM Rhc Med/surg Supply Level 42 15 15 $4,000.00 $3,400.00 $1,640.00 $3,880.00 $2,200.00 2026-02-04
SUP-27100043 CDM Rhc Med/surg Supply Level 43 15 15 $4,250.00 $3,612.50 $1,742.50 $4,122.50 $2,337.50 2026-02-04
SUP-27100044 CDM Rhc Med/surg Supply Level 44 15 15 $4,500.00 $3,825.00 $1,845.00 $4,365.00 $2,475.00 2026-02-04
SUP-27100045 CDM Rhc Med/surg Supply Level 45 15 15 $4,750.00 $4,037.50 $1,947.50 $4,607.50 $2,612.50 2026-02-04
SUP-27100083 CDM Rhc Sterile Med/surg Supply Level 38 15 15 $3,000.00 $2,550.00 $1,230.00 $2,910.00 $1,650.00 2026-02-04
SUP-27100084 CDM Rhc Sterile Med/surg Supply Level 39 15 15 $3,250.00 $2,762.50 $1,332.50 $3,152.50 $1,787.50 2026-02-04
SUP-27100085 CDM Rhc Sterile Med/surg Supply Level 40 15 15 $3,500.00 $2,975.00 $1,435.00 $3,395.00 $1,925.00 2026-02-04
SUP-27100086 CDM Rhc Sterile Med/surg Supply Level 41 15 15 $3,750.00 $3,187.50 $1,537.50 $3,637.50 $2,062.50 2026-02-04
SUP-27100087 CDM Rhc Sterile Med/surg Supply Level 42 15 15 $4,000.00 $3,400.00 $1,640.00 $3,880.00 $2,200.00 2026-02-04
SUP-27100088 CDM Rhc Sterile Med/surg Supply Level 43 15 15 $4,250.00 $3,612.50 $1,742.50 $4,122.50 $2,337.50 2026-02-04
SUP-27100089 CDM Rhc Sterile Med/surg Supply Level 44 15 15 $4,500.00 $3,825.00 $1,845.00 $4,365.00 $2,475.00 2026-02-04
SUP-27100090 CDM Rhc Sterile Med/surg Supply Level 45 15 15 $4,750.00 $4,037.50 $1,947.50 $4,607.50 $2,612.50 2026-02-04
SUP-27100114 CDM Rhc Misc Implant Charge Level 8 15 15 $3,750.00 $3,187.50 $1,537.50 $3,637.50 $2,062.50 2026-02-04
SUP-27100116 CDM Rhc Misc Implant Charge Level 10 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
SUP-27100117 CDM Rhc Misc Implant Charge Level 11 15 15 $6,000.00 $5,100.00 $2,460.00 $5,820.00 $3,300.00 2026-02-04
SUP-27100118 CDM Rhc Misc Implant Charge Level 12 15 15 $7,000.00 $5,950.00 $2,870.00 $6,790.00 $3,850.00 2026-02-04
SUP-27100119 CDM Rhc Misc Implant Charge Level 13 15 15 $8,000.00 $6,800.00 $3,280.00 $7,760.00 $4,400.00 2026-02-04
SUP-27100132 CDM Rhc Med/surg Supply Level 46 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
SUP-27100133 CDM Rhc Med/surg Supply Level 47 15 15 $4,200.00 $3,570.00 $1,722.00 $4,074.00 $2,310.00 2026-02-04
SUP-27100135 CDM Rhc Misc Implant Charge Level 14 15 15 $9,000.00 $7,650.00 $3,690.00 $8,730.00 $4,950.00 2026-02-04
SUP-27100136 CDM Rhc Misc Implant Charge Level 15 15 15 $10,000.00 $8,500.00 $4,100.00 $9,700.00 $5,500.00 2026-02-04
SUP-27100137 CDM Rhc Misc Implant Charge Level 16 15 15 $11,000.00 $9,350.00 $4,510.00 $10,670.00 $6,050.00 2026-02-04
SUP-27100138 CDM Rhc Misc Implant Charge Level 17 15 15 $12,000.00 $10,200.00 $4,920.00 $11,640.00 $6,600.00 2026-02-04
SUP-27100139 CDM Rhc Misc Implant Charge Level 18 15 15 $13,000.00 $11,050.00 $5,330.00 $12,610.00 $7,150.00 2026-02-04
SUP-27100140 CDM Rhc Misc Implant Charge Level 19 15 15 $14,000.00 $11,900.00 $5,740.00 $13,580.00 $7,700.00 2026-02-04
SUP-27100141 CDM Rhc Misc Implant Charge Level 20 15 15 $15,000.00 $12,750.00 $6,150.00 $14,550.00 $8,250.00 2026-02-04
SUP-27100142 CDM Rhc Misc Implant Charge Level 21 15 15 $16,000.00 $13,600.00 $6,560.00 $15,520.00 $8,800.00 2026-02-04
SUP-27100143 CDM Rhc Misc Implant Charge Level 22 15 15 $17,000.00 $14,450.00 $6,970.00 $16,490.00 $9,350.00 2026-02-04
SUP-27100144 CDM Rhc Misc Implant Charge Level 23 15 15 $18,000.00 $15,300.00 $7,380.00 $17,460.00 $9,900.00 2026-02-04
SUP-27100145 CDM Rhc Misc Implant Charge Level 24 15 15 $19,000.00 $16,150.00 $7,790.00 $18,430.00 $10,450.00 2026-02-04
SUP-27100146 CDM Rhc Misc Implant Charge Level 25 15 15 $20,000.00 $17,000.00 $8,200.00 $19,400.00 $11,000.00 2026-02-04
SUP-27100147 CDM Rhc Misc Implant Charge Level 26 15 15 $22,000.00 $18,700.00 $9,020.00 $21,340.00 $12,100.00 2026-02-04
SUP-27100148 CDM Rhc Misc Implant Charge Level 27 15 15 $24,000.00 $20,400.00 $9,840.00 $23,280.00 $13,200.00 2026-02-04
SUP-27100149 CDM Rhc Misc Implant Charge Level 28 15 15 $26,000.00 $22,100.00 $10,660.00 $25,220.00 $14,300.00 2026-02-04
SUP-27100150 CDM Rhc Misc Implant Charge Level 29 15 15 $28,000.00 $23,800.00 $11,480.00 $27,160.00 $15,400.00 2026-02-04
SUP-27100151 CDM Rhc Misc Implant Charge Level 30 15 15 $30,000.00 $25,500.00 $12,300.00 $29,100.00 $16,500.00 2026-02-04
SUP-27100152 CDM Rhc Misc Implant Charge Level 31 15 15 $32,000.00 $27,200.00 $13,120.00 $31,040.00 $17,600.00 2026-02-04
SUP-27100153 CDM Rhc Misc Implant Charge Level 32 15 15 $40,000.00 $34,000.00 $16,400.00 $38,800.00 $22,000.00 2026-02-04
SUP-27100154 CDM Rhc Sterile Med/surg Supply Level 46 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
SUP-27100155 CDM Rhc Sterile Med/surg Supply Level 47 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
SUP-27100156 CDM Rhc Sterile Med/surg Supply Level 48 15 15 $6,000.00 $5,100.00 $2,460.00 $5,820.00 $3,300.00 2026-02-04
SUP-27100157 CDM Rhc Sterile Med/surg Supply Level 49 15 15 $7,000.00 $5,950.00 $2,870.00 $6,790.00 $3,850.00 2026-02-04
SUP-27100158 CDM Rhc Sterile Med/surg Supply Level 50 15 15 $8,000.00 $6,800.00 $3,280.00 $7,760.00 $4,400.00 2026-02-04
SUP-27100159 CDM Rhc Sterile Med/surg Supply Level 51 15 15 $10,000.00 $8,500.00 $4,100.00 $9,700.00 $5,500.00 2026-02-04
SUP-27100160 CDM Rhc Med/surg Supply Level 48 15 15 $4,400.00 $3,740.00 $1,804.00 $4,268.00 $2,420.00 2026-02-04
SUP-27100161 CDM Rhc Med/surg Supply Level 49 15 15 $4,600.00 $3,910.00 $1,886.00 $4,462.00 $2,530.00 2026-02-04
SUP-27100162 CDM Rhc Med/surg Supply Level 50 15 15 $4,800.00 $4,080.00 $1,968.00 $4,656.00 $2,640.00 2026-02-04
SUP-27100163 CDM Rhc Med/surg Supply Level 51 15 15 $5,000.00 $4,250.00 $2,050.00 $4,850.00 $2,750.00 2026-02-04
SUP-27100164 CDM Rhc Med/surg Supply Level 52 15 15 $5,200.00 $4,420.00 $2,132.00 $5,044.00 $2,860.00 2026-02-04
SUP-27100165 CDM Rhc Med/surg Supply Level 53 15 15 $5,400.00 $4,590.00 $2,214.00 $5,238.00 $2,970.00 2026-02-04
SUP-27100166 CDM Rhc Med/surg Supply Level 54 15 15 $5,600.00 $4,760.00 $2,296.00 $5,432.00 $3,080.00 2026-02-04
SUP-27100167 CDM Rhc Med/surg Supply Level 55 15 15 $5,800.00 $4,930.00 $2,378.00 $5,626.00 $3,190.00 2026-02-04
SUP-27100168 CDM Rhc Med/surg Supply Level 56 15 15 $6,000.00 $5,100.00 $2,460.00 $5,820.00 $3,300.00 2026-02-04
SUP-27100169 CDM Rhc Med/surg Supply Level 57 15 15 $6,000.00 $5,100.00 $2,460.00 $5,820.00 $3,300.00 2026-02-04
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