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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

Rehabilitation Institute Of Michigan

Detroit, MI · CCN 233027 · Rates published

20,591 distinct procedures filed
24 distinct payers
1,030,812 rate rows
2025-01-31 last MRF observed · ⚠ 21 mo old
Data quality

443,066 of 1,030,812 rate rows are consumer-grade (43.0%)

587,746 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 574,018
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 11,730
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 1,061
template filing: same amount across many unrelated codes — excluded 436
per-diem day rate — not a per-procedure price 214
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 181
placeholder amount (≤ $0.02) — excluded from medians 93
exceeds 10× this hospital's gross charge — excluded from medians 13

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 21 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://mrfs.hyvehealthcare.com/TenetHealth/473740774_rim---rehabilitation-institute-of-michigan_standardcharges.json
Discovered viaPublic MRF directory
Last fetch not_modified · 2026-10-01
Content fingerprint 05c6cd753845c129… · 1,651,016 bytes · first seen 2026-06-08

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
J1411
HCPCS 		Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 2 $104.79 $4,200,000.00 $4,200,000.00 nat. median
$3,685,267
1.1× median
J3399
HCPCS 		Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10^15 Vector Ge… 3 $104.79 $3,924,096.50 $2,705,294.50 nat. median
$2,455,111
1.1× median
Q2056
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 3 $104.79 $857,004.31 $492,900.00 nat. median
$599,737
0.8× median
Q2042
HCPCS 		Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 3 $104.79 $844,967.25 $466,069.91 nat. median
$621,313
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel, Up To 460 Million Autologous B-cell Maturation Antigen (… 3 $104.79 $795,911.75 $460,226.56 nat. median
$574,037
0.8× median
Q2054
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 3 $104.79 $790,219.69 $454,489.31 nat. median
$579,571
0.8× median
Q2053
HCPCS 		Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 3 $104.79 $781,440.50 $449,440.00 nat. median
$513,770
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 3 $104.79 $781,440.50 $449,440.00 nat. median
$562,501
0.8× median
C9081
HCPCS 		Idecabtagene Vicleucel, Up To 460 Million Autologous Anti-bcma Car-positive Viab… 1 $104.79 $542,564.50 $271,334.64 nat. median
$422,856
0.6× median
C9098
HCPCS 		Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 1 $104.79 $531,247.63 $265,676.21 nat. median
$2,313,353
outlier · 0.1×
C9076
HCPCS 		Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 1 $104.79 $530,665.63 $265,385.21 nat. median
$1,000,529
outlier · 0.3×
K0743
HCPCS 		Suction Pump, Home Model, Portable, For Use On Wounds 24 $167,932.80 $167,932.80 $167,932.80 nat. median
$1,018
outlier · 165.0×
L5969
HCPCS 		Addition, Endoskeletal Ankle-foot Or Ankle System, Power Assist, Includes Any Ty… 24 $109,629.25 $109,629.25 $109,629.25 nat. median
$13,709
outlier · 8.0×
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 $102,963.53 $105,001.64 $103,982.58 nat. median
$69,822
1.5× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 3 $15,709.00 $91,197.68 $89,427.51 nat. median
$59,651
1.5× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 3 $15,709.00 $87,798.35 $86,094.16 nat. median
$60,505
1.4× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 3 $15,709.00 $84,383.88 $82,745.95 nat. median
$55,935
1.5× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 $15,709.00 $83,427.48 $81,808.12 nat. median
$55,923
1.5× median
A9543
HCPCS 		Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 2 $104.79 $70,570.66 $65,476.58 nat. median
$65,477
1.0× median
Q2043
HCPCS 		Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 3 $104.79 $92,259.55 $53,062.44 nat. median
$63,499
0.8× median
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 3 $12,565.00 $76,120.32 $45,175.90 nat. median
$51,518
0.9× median
Q0480
HCPCS 		Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 1 $104.79 $89,457.36 $44,781.08 nat. median
$108,243
outlier · 0.4×
J9226
HCPCS 		Histrelin Implant (supprelin La), 50 Mg 2 $104.79 $48,172.38 $44,362.52 nat. median
$57,036
0.8× median
268
MS_DRG 		Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 3 $12,565.00 $74,161.00 $44,215.26 nat. median
$49,569
0.9× median
217
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 $12,565.00 $68,866.18 $41,619.24 nat. median
$47,458
0.9× median
573
MS_DRG 		Skin Graft For Skin Ulcer Or Cellulitis With Mcc 3 $12,565.00 $67,273.63 $40,838.41 nat. median
$43,299
0.9× median
276
MS_DRG 		Cardiac Defibrillator Implant With Mcc 3 $12,565.00 $67,188.16 $40,796.51 nat. median
$43,533
0.9× median
S1034
HCPCS 		Artificial Pancreas Device System (e.g., Low Glucose Suspend (lgs) Feature) Incl… 24 $39,984.00 $39,984.00 $39,984.00 nat. median
$6,133
outlier · 6.5×
232
MS_DRG 		Coronary Bypass With Ptca Without Mcc 3 $12,565.00 $64,357.90 $39,408.85 nat. median
$43,803
0.9× median
218
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 3 $12,565.00 $61,632.60 $38,072.65 nat. median
$45,446
0.8× median
E0770
HCPCS 		Functional Electrical Stimulator, Transcutaneous Stimulation Of Nerve And/or Mus… 24 $36,785.28 $36,785.28 $36,785.28 nat. median
$135
outlier · 271.7×
J9029
HCPCS 		Injection, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 1 $104.79 $68,548.08 $34,326.44 nat. median
$66,211
0.5× median
J7330
HCPCS 		Autologous Cultured Chondrocytes, Implant 1 $104.79 $64,173.57 $32,139.18 nat. median
$92,809
outlier · 0.3×
C9150
HCPCS 		Xenon Xe-129 Hyperpolarized Gas, Diagnostic, Per Study Dose 1 $104.79 $59,408.34 $29,756.56 nat. median
$77,438
outlier · 0.4×
J9266
HCPCS 		Injection, Pegaspargase, Per Single Dose Vial 3 $104.79 $44,793.13 $25,762.46 nat. median
$31,084
0.8× median
J9600
HCPCS 		Injection, Porfimer Sodium, 75 Mg 3 $104.79 $36,598.43 $22,490.02 nat. median
$26,416
0.9× median
33249
CPT 		Insertion Or Replacement Of Single Or Dual Chamber Pacing Defibrillator Leads 3 $1,049.24 $34,826.00 $20,130.50 nat. median
$32,069
0.6× median
0333
RC 		Radiology Therapeutic And/of Chemotherapy Administration Radiation Therapy 3 $12,530.00 $26,332.00 $19,431.00 nat. median
$2,043
outlier · 9.5×
L7181
HCPCS 		Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 1 $104.79 $37,674.43 $18,889.61 nat. median
$48,410
outlier · 0.4×
0D160JA
OTHER 		Bypass Stomach To Jejunum With Synthetic Substitute, Open Approach 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$28,033
0.7× median
0D160JB
OTHER 		Bypass Stomach To Ileum With Synthetic Substitute, Open Approach 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$30,040
0.6× median
0D1607L
OTHER 		Bypass Stomach To Transverse Colon With Autologous Tissue Substitute, Open Appro… 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$28,033
0.7× median
0D160J9
OTHER 		Bypass Stomach To Duodenum With Synthetic Substitute, Open Approach 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$29,045
0.6× median
0D160KA
OTHER 		Bypass Stomach To Jejunum With Nonautologous Tissue Substitute, Open Approach 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$28,033
0.7× median
0D16079
OTHER 		Bypass Stomach To Duodenum With Autologous Tissue Substitute, Open Approach 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$31,036
0.6× median
0D1607A
OTHER 		Bypass Stomach To Jejunum With Autologous Tissue Substitute, Open Approach 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$30,040
0.6× median
0D160JL
OTHER 		Bypass Stomach To Transverse Colon With Synthetic Substitute, Open Approach 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$30,040
0.6× median
0D1607B
OTHER 		Bypass Stomach To Ileum With Autologous Tissue Substitute, Open Approach 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$28,539
0.7× median
0D160K9
OTHER 		Bypass Stomach To Duodenum With Nonautologous Tissue Substitute, Open Approach 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$30,040
0.6× median
0D160KB
OTHER 		Bypass Stomach To Ileum With Nonautologous Tissue Substitute, Open Approach 1 $18,858.00 $18,858.00 $18,858.00 nat. median
$28,539
0.7× median

Other procedures at this hospital

Browse this hospital's 20,591 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J1411 HCPCS Injection, Etranacogene Dezaparvovec-drlb, Per Therapeutic Dose 6 2 — — $104.79 $4,200,000.00 $4,200,000.00 2025-01-31
J3399 HCPCS Injection, Onasemnogene Abeparvovec-xioi, Per Treatment, Up To 5x10^15 Vector Ge… 7 3 — — $104.79 $3,924,096.50 $2,705,294.50 2025-01-31
Q2056 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 7 3 — — $104.79 $857,004.31 $492,900.00 2025-01-31
Q2042 HCPCS Tisagenlecleucel, Up To 600 Million Car-positive Viable T Cells, Including Leuka… 7 3 — — $104.79 $844,967.25 $466,069.91 2025-01-31
Q2055 HCPCS Idecabtagene Vicleucel, Up To 460 Million Autologous B-cell Maturation Antigen (… 7 3 — — $104.79 $795,911.75 $460,226.56 2025-01-31
Q2054 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 7 3 — — $104.79 $790,219.69 $454,489.31 2025-01-31
Q2041 HCPCS Axicabtagene Ciloleucel, Up To 200 Million Autologous Anti-cd19 Car Positive Via… 7 3 — — $104.79 $781,440.50 $449,440.00 2025-01-31
Q2053 HCPCS Brexucabtagene Autoleucel, Up To 200 Million Autologous Anti-cd19 Car Positive V… 7 3 — — $104.79 $781,440.50 $449,440.00 2025-01-31
C9081 HCPCS Idecabtagene Vicleucel, Up To 460 Million Autologous Anti-bcma Car-positive Viab… 2 1 — — $104.79 $542,564.50 $271,334.64 2025-01-31
C9098 HCPCS Ciltacabtagene Autoleucel, Up To 100 Million Autologous B-cell Maturation Antige… 2 1 — — $104.79 $531,247.63 $265,676.21 2025-01-31
C9076 HCPCS Lisocabtagene Maraleucel, Up To 110 Million Autologous Anti-cd19 Car-positive Vi… 2 1 — — $104.79 $530,665.63 $265,385.21 2025-01-31
K0743 HCPCS Suction Pump, Home Model, Portable, For Use On Wounds 49 24 — — $167,932.80 $167,932.80 $167,932.80 2025-01-31
L5969 HCPCS Addition, Endoskeletal Ankle-foot Or Ankle System, Power Assist, Includes Any Ty… 49 24 — — $109,629.25 $109,629.25 $109,629.25 2025-01-31
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 2 2 — — $102,963.53 $105,001.64 $103,982.58 2025-01-31
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 3 3 — — $15,709.00 $91,197.68 $89,427.51 2025-01-31
231 MS_DRG Coronary Bypass With Ptca With Mcc 3 3 — — $15,709.00 $87,798.35 $86,094.16 2025-01-31
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 3 3 — — $15,709.00 $84,383.88 $82,745.95 2025-01-31
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 3 3 — — $15,709.00 $83,427.48 $81,808.12 2025-01-31
A9543 HCPCS Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic, Per Treatment Dose, Up To 40 Mil… 6 2 — — $104.79 $70,570.66 $65,476.58 2025-01-31
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 7 3 — — $104.79 $92,259.55 $53,062.44 2025-01-31
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 4 3 — — $12,565.00 $76,120.32 $45,175.90 2025-01-31
Q0480 HCPCS Driver For Use With Pneumatic Ventricular Assist Device, Replacement Only 2 1 — — $104.79 $89,457.36 $44,781.08 2025-01-31
J9226 HCPCS Histrelin Implant (supprelin La), 50 Mg 3 2 — — $104.79 $48,172.38 $44,362.52 2025-01-31
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 4 3 — — $12,565.00 $74,161.00 $44,215.26 2025-01-31
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 4 3 — — $12,565.00 $68,866.18 $41,619.24 2025-01-31
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 4 3 — — $12,565.00 $67,273.63 $40,838.41 2025-01-31
276 MS_DRG Cardiac Defibrillator Implant With Mcc 4 3 — — $12,565.00 $67,188.16 $40,796.51 2025-01-31
S1034 HCPCS Artificial Pancreas Device System (e.g., Low Glucose Suspend (lgs) Feature) Incl… 49 24 — — $39,984.00 $39,984.00 $39,984.00 2025-01-31
232 MS_DRG Coronary Bypass With Ptca Without Mcc 4 3 — — $12,565.00 $64,357.90 $39,408.85 2025-01-31
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 4 3 — — $12,565.00 $61,632.60 $38,072.65 2025-01-31
E0770 HCPCS Functional Electrical Stimulator, Transcutaneous Stimulation Of Nerve And/or Mus… 49 24 — — $36,785.28 $36,785.28 $36,785.28 2025-01-31
J9029 HCPCS Injection, Nadofaragene Firadenovec-vncg, Per Therapeutic Dose 2 1 — — $104.79 $68,548.08 $34,326.44 2025-01-31
J7330 HCPCS Autologous Cultured Chondrocytes, Implant 2 1 — — $104.79 $64,173.57 $32,139.18 2025-01-31
C9150 HCPCS Xenon Xe-129 Hyperpolarized Gas, Diagnostic, Per Study Dose 2 1 — — $104.79 $59,408.34 $29,756.56 2025-01-31
J9266 HCPCS Injection, Pegaspargase, Per Single Dose Vial 7 3 — — $104.79 $44,793.13 $25,762.46 2025-01-31
J9600 HCPCS Injection, Porfimer Sodium, 75 Mg 7 3 — — $104.79 $36,598.43 $22,490.02 2025-01-31
33249 CPT Insertion Or Replacement Of Single Or Dual Chamber Pacing Defibrillator Leads 6 3 — — $1,049.24 $34,826.00 $20,130.50 2025-01-31
0333 RC Radiology Therapeutic And/of Chemotherapy Administration Radiation Therapy 7 3 — — $12,530.00 $26,332.00 $19,431.00 2025-01-31
L7181 HCPCS Electronic Elbow, Microprocessor Simultaneous Control Of Elbow And Terminal Devi… 2 1 — — $104.79 $37,674.43 $18,889.61 2025-01-31
0D164ZL OTHER Bypass Stomach To Transverse Colon, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DN64ZZ OTHER Release Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168JA OTHER Bypass Stomach To Jejunum With Synthetic Substitute, Via Natural Or Artificial O… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164ZA OTHER Bypass Stomach To Jejunum, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D764ZZ OTHER Dilation Of Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164JB OTHER Bypass Stomach To Ileum With Synthetic Substitute, Percutaneous Endoscopic Appro… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D16879 OTHER Bypass Stomach To Duodenum With Autologous Tissue Substitute, Via Natural Or Art… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168ZB OTHER Bypass Stomach To Ileum, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DN60ZZ OTHER Release Stomach, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DN63ZZ OTHER Release Stomach, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160KL OTHER Bypass Stomach To Transverse Colon With Nonautologous Tissue Substitute, Open Ap… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DH67DZ OTHER Insertion Of Intraluminal Device Into Stomach, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D764DZ OTHER Dilation Of Stomach With Intraluminal Device, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164KB OTHER Bypass Stomach To Ileum With Nonautologous Tissue Substitute, Percutaneous Endos… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D1687A OTHER Bypass Stomach To Jejunum With Autologous Tissue Substitute, Via Natural Or Arti… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL73CZ OTHER Occlusion Of Stomach, Pylorus With Extraluminal Device, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DQ68ZZ OTHER Repair Stomach, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DP64CZ OTHER Removal Of Extraluminal Device From Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164JL OTHER Bypass Stomach To Transverse Colon With Synthetic Substitute, Percutaneous Endos… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DN67ZZ OTHER Release Stomach, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D16479 OTHER Bypass Stomach To Duodenum With Autologous Tissue Substitute, Percutaneous Endos… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D1687B OTHER Bypass Stomach To Ileum With Autologous Tissue Substitute, Via Natural Or Artifi… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164KL OTHER Bypass Stomach To Transverse Colon With Nonautologous Tissue Substitute, Percuta… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DB60ZZ OTHER Excision Of Stomach, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D767DZ OTHER Dilation Of Stomach With Intraluminal Device, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D768DZ OTHER Dilation Of Stomach With Intraluminal Device, Via Natural Or Artificial Opening … 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DQ64ZZ OTHER Repair Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU607Z OTHER Supplement Stomach With Autologous Tissue Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL67DZ OTHER Occlusion Of Stomach With Intraluminal Device, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160ZB OTHER Bypass Stomach To Ileum, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DQ67ZZ OTHER Repair Stomach, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU67KZ OTHER Supplement Stomach With Nonautologous Tissue Substitute, Via Natural Or Artifici… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168KA OTHER Bypass Stomach To Jejunum With Nonautologous Tissue Substitute, Via Natural Or A… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168KB OTHER Bypass Stomach To Ileum With Nonautologous Tissue Substitute, Via Natural Or Art… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168K9 OTHER Bypass Stomach To Duodenum With Nonautologous Tissue Substitute, Via Natural Or … 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D1647L OTHER Bypass Stomach To Transverse Colon With Autologous Tissue Substitute, Percutaneo… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DF60ZZ OTHER Fragmentation In Stomach, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DF64ZZ OTHER Fragmentation In Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DB60Z3 OTHER Excision Of Stomach, Open Approach, Vertical 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL78DZ OTHER Occlusion Of Stomach, Pylorus With Intraluminal Device, Via Natural Or Artificia… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168KL OTHER Bypass Stomach To Transverse Colon With Nonautologous Tissue Substitute, Via Nat… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DB64Z3 OTHER Excision Of Stomach, Percutaneous Endoscopic Approach, Vertical 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D16079 OTHER Bypass Stomach To Duodenum With Autologous Tissue Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168Z9 OTHER Bypass Stomach To Duodenum, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV63DZ OTHER Restriction Of Stomach With Intraluminal Device, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL70DZ OTHER Occlusion Of Stomach, Pylorus With Intraluminal Device, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV63CZ OTHER Restriction Of Stomach With Extraluminal Device, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160K9 OTHER Bypass Stomach To Duodenum With Nonautologous Tissue Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DP643Z OTHER Removal Of Infusion Device From Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160JA OTHER Bypass Stomach To Jejunum With Synthetic Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL60CZ OTHER Occlusion Of Stomach With Extraluminal Device, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DM64ZZ OTHER Reattachment Of Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL64CZ OTHER Occlusion Of Stomach With Extraluminal Device, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160Z9 OTHER Bypass Stomach To Duodenum, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL63ZZ OTHER Occlusion Of Stomach, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL77DZ OTHER Occlusion Of Stomach, Pylorus With Intraluminal Device, Via Natural Or Artificia… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DQ60ZZ OTHER Repair Stomach, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DB67ZZ OTHER Excision Of Stomach, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU60KZ OTHER Supplement Stomach With Nonautologous Tissue Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160KA OTHER Bypass Stomach To Jejunum With Nonautologous Tissue Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160ZL OTHER Bypass Stomach To Transverse Colon, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D763ZZ OTHER Dilation Of Stomach, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160JB OTHER Bypass Stomach To Ileum With Synthetic Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DH64DZ OTHER Insertion Of Intraluminal Device Into Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV64ZZ OTHER Restriction Of Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160J9 OTHER Bypass Stomach To Duodenum With Synthetic Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D1607B OTHER Bypass Stomach To Ileum With Autologous Tissue Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DM60ZZ OTHER Reattachment Of Stomach, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D760DZ OTHER Dilation Of Stomach With Intraluminal Device, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL68DZ OTHER Occlusion Of Stomach With Intraluminal Device, Via Natural Or Artificial Opening… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D760ZZ OTHER Dilation Of Stomach, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DB63ZZ OTHER Excision Of Stomach, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DQ63ZZ OTHER Repair Stomach, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL67ZZ OTHER Occlusion Of Stomach, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL68ZZ OTHER Occlusion Of Stomach, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL70ZZ OTHER Occlusion Of Stomach, Pylorus, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL74ZZ OTHER Occlusion Of Stomach, Pylorus, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DF67ZZ OTHER Fragmentation In Stomach, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164Z9 OTHER Bypass Stomach To Duodenum, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DY60Z1 OTHER Transplantation Of Stomach, Syngeneic, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D1687L OTHER Bypass Stomach To Transverse Colon With Autologous Tissue Substitute, Via Natura… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL63CZ OTHER Occlusion Of Stomach With Extraluminal Device, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168ZL OTHER Bypass Stomach To Transverse Colon, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DF68ZZ OTHER Fragmentation In Stomach, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL74CZ OTHER Occlusion Of Stomach, Pylorus With Extraluminal Device, Percutaneous Endoscopic … 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D1607A OTHER Bypass Stomach To Jejunum With Autologous Tissue Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D763DZ OTHER Dilation Of Stomach With Intraluminal Device, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DB63Z3 OTHER Excision Of Stomach, Percutaneous Approach, Vertical 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV68ZZ OTHER Restriction Of Stomach, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DW643Z OTHER Revision Of Infusion Device In Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160ZA OTHER Bypass Stomach To Jejunum, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL60ZZ OTHER Occlusion Of Stomach, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DW64CZ OTHER Revision Of Extraluminal Device In Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D1647A OTHER Bypass Stomach To Jejunum With Autologous Tissue Substitute, Percutaneous Endosc… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D768ZZ OTHER Dilation Of Stomach, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D1607L OTHER Bypass Stomach To Transverse Colon With Autologous Tissue Substitute, Open Appro… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL60DZ OTHER Occlusion Of Stomach With Intraluminal Device, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV60ZZ OTHER Restriction Of Stomach, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168ZA OTHER Bypass Stomach To Jejunum, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU68KZ OTHER Supplement Stomach With Nonautologous Tissue Substitute, Via Natural Or Artifici… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV60CZ OTHER Restriction Of Stomach With Extraluminal Device, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV63ZZ OTHER Restriction Of Stomach, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DF63ZZ OTHER Fragmentation In Stomach, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV60DZ OTHER Restriction Of Stomach With Intraluminal Device, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL63DZ OTHER Occlusion Of Stomach With Intraluminal Device, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DB67Z3 OTHER Excision Of Stomach, Via Natural Or Artificial Opening, Vertical 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DH68DZ OTHER Insertion Of Intraluminal Device Into Stomach, Via Natural Or Artificial Opening… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DH63DZ OTHER Insertion Of Intraluminal Device Into Stomach, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV67ZZ OTHER Restriction Of Stomach, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168JL OTHER Bypass Stomach To Transverse Colon With Synthetic Substitute, Via Natural Or Art… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU687Z OTHER Supplement Stomach With Autologous Tissue Substitute, Via Natural Or Artificial … 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168J9 OTHER Bypass Stomach To Duodenum With Synthetic Substitute, Via Natural Or Artificial … 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL70CZ OTHER Occlusion Of Stomach, Pylorus With Extraluminal Device, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU68JZ OTHER Supplement Stomach With Synthetic Substitute, Via Natural Or Artificial Opening … 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DY60Z0 OTHER Transplantation Of Stomach, Allogeneic, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D168JB OTHER Bypass Stomach To Ileum With Synthetic Substitute, Via Natural Or Artificial Ope… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DY60Z2 OTHER Transplantation Of Stomach, Zooplastic, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV64CZ OTHER Restriction Of Stomach With Extraluminal Device, Percutaneous Endoscopic Approac… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DN68ZZ OTHER Release Stomach, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU64KZ OTHER Supplement Stomach With Nonautologous Tissue Substitute, Percutaneous Endoscopic… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164ZB OTHER Bypass Stomach To Ileum, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160KB OTHER Bypass Stomach To Ileum With Nonautologous Tissue Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU647Z OTHER Supplement Stomach With Autologous Tissue Substitute, Percutaneous Endoscopic Ap… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU64JZ OTHER Supplement Stomach With Synthetic Substitute, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DH60DZ OTHER Insertion Of Intraluminal Device Into Stomach, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DB68Z3 OTHER Excision Of Stomach, Via Natural Or Artificial Opening Endoscopic, Vertical 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU677Z OTHER Supplement Stomach With Autologous Tissue Substitute, Via Natural Or Artificial … 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164JA OTHER Bypass Stomach To Jejunum With Synthetic Substitute, Percutaneous Endoscopic App… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU67JZ OTHER Supplement Stomach With Synthetic Substitute, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164J9 OTHER Bypass Stomach To Duodenum With Synthetic Substitute, Percutaneous Endoscopic Ap… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DU60JZ OTHER Supplement Stomach With Synthetic Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL64DZ OTHER Occlusion Of Stomach With Intraluminal Device, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164KA OTHER Bypass Stomach To Jejunum With Nonautologous Tissue Substitute, Percutaneous End… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D767ZZ OTHER Dilation Of Stomach, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL77ZZ OTHER Occlusion Of Stomach, Pylorus, Via Natural Or Artificial Opening 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DV64DZ OTHER Restriction Of Stomach With Intraluminal Device, Percutaneous Endoscopic Approac… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL73DZ OTHER Occlusion Of Stomach, Pylorus With Intraluminal Device, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL64ZZ OTHER Occlusion Of Stomach, Percutaneous Endoscopic Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL73ZZ OTHER Occlusion Of Stomach, Pylorus, Percutaneous Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL74DZ OTHER Occlusion Of Stomach, Pylorus With Intraluminal Device, Percutaneous Endoscopic … 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D1647B OTHER Bypass Stomach To Ileum With Autologous Tissue Substitute, Percutaneous Endoscop… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D164K9 OTHER Bypass Stomach To Duodenum With Nonautologous Tissue Substitute, Percutaneous En… 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0D160JL OTHER Bypass Stomach To Transverse Colon With Synthetic Substitute, Open Approach 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
0DL78ZZ OTHER Occlusion Of Stomach, Pylorus, Via Natural Or Artificial Opening Endoscopic 1 1 — — $18,858.00 $18,858.00 $18,858.00 2025-01-31
L7180 HCPCS Electronic Elbow, Microprocessor Sequential Control Of Elbow And Terminal Device 2 1 — — $104.79 $36,591.55 $18,348.17 2025-01-31
E1510 HCPCS Kidney, Dialysate Delivery Syst Kidney Machine, Pump Recirculating, Air Removal … 49 24 — — $17,546.58 $17,546.58 $17,546.58 2025-01-31
A9604 HCPCS Samarium Sm-153 Lexidronam, Therapeutic, Per Treatment Dose, Up To 150 Millicuri… 6 2 — — $104.79 $18,602.67 $17,259.85 2025-01-31
33270 CPT Insertion Or Replacement Of Defibrillator With Electrode 7 3 — — $104.79 $34,826.00 $16,571.00 2025-01-31
33272 CPT Removal Of Defibrillator Electrode 7 3 — — $104.79 $34,826.00 $16,571.00 2025-01-31
33264 CPT Removal And Replacement Of Defibrillator Pulse Generator, Multiple Wires (leads) 7 3 — — $104.79 $34,826.00 $16,571.00 2025-01-31
33263 CPT Removal And Replacement Of Defibrillator Pulse Generator, Two Wires (leads) 7 3 — — $104.79 $34,826.00 $16,571.00 2025-01-31
33230 CPT Insertion Of Pacing Defibrillator Pulse Generator With Existing Dual Leads 7 3 — — $104.79 $34,826.00 $16,571.00 2025-01-31
33231 CPT Insertion Of Pacing Defibrillator Pulse Generator With Existing Multiple Leads 7 3 — — $104.79 $34,826.00 $16,571.00 2025-01-31
33240 CPT Insertion Of Pacing Defibrillator Pulse Generator With Existing Single Lead 7 3 — — $104.79 $34,826.00 $16,571.00 2025-01-31
33262 CPT Removal And Replacement Of Defibrillator Pulse Generator, Single Wire (lead) 7 3 — — $104.79 $34,826.00 $16,571.00 2025-01-31
33271 CPT Insertion Of Defibrillator Electrode 7 3 — — $104.79 $34,826.00 $16,571.00 2025-01-31
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 5 3 — — $10,625.00 $59,560.76 $15,709.00 2025-01-31
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 5 3 — — $10,625.00 $50,293.20 $15,709.00 2025-01-31
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 5 3 — — $10,625.00 $63,622.21 $15,709.00 2025-01-31
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 5 3 — — $10,625.00 $56,741.33 $15,709.00 2025-01-31
653 MS_DRG Major Bladder Procedures With Mcc 5 3 — — $10,625.00 $58,569.74 $15,709.00 2025-01-31
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 5 3 — — $10,625.00 $67,576.55 $15,709.00 2025-01-31
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 5 3 — — $10,625.00 $54,949.70 $15,709.00 2025-01-31
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 5 3 — — $10,625.00 $48,867.26 $15,709.00 2025-01-31
799 MS_DRG Splenectomy With Mcc 5 3 — — $10,625.00 $53,603.82 $15,709.00 2025-01-31
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 5 3 — — $10,625.00 $65,728.67 $15,709.00 2025-01-31
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 5 3 — — $10,625.00 $54,710.60 $15,709.00 2025-01-31
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 5 3 — — $10,625.00 $51,740.79 $15,709.00 2025-01-31
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 5 3 — — $10,625.00 $52,798.88 $15,709.00 2025-01-31
471 MS_DRG Cervical Spinal Fusion With Mcc 5 3 — — $10,625.00 $53,218.66 $15,709.00 2025-01-31
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 5 3 — — $10,625.00 $43,721.74 $15,709.00 2025-01-31
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 5 3 — — $10,625.00 $56,236.08 $15,709.00 2025-01-31
L2006 HCPCS Knee Ankle Foot Device, Any Material, Single Or Double Upright, Swing And Stance… 2 1 — — $104.79 $30,363.55 $15,234.17 2025-01-31
C9760 HCPCS Non-randomized, Non-blinded Procedure For Nyha Class Ii, Iii, IV Heart Failure; … 53 24 — — $9,748.00 $20,485.00 $15,116.50 2025-01-31
E1615 HCPCS Deionizer Water Purification System, For Hemodialysis 49 24 — — $14,250.30 $14,250.30 $14,250.30 2025-01-31
322 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc 6 3 — — $7,433.00 $19,727.37 $14,137.00 2025-01-31
709 MS_DRG Penis Procedures With Cc/mcc 6 3 — — $7,433.00 $22,936.28 $14,137.00 2025-01-31
711 MS_DRG Testes Procedures With Cc/mcc 6 3 — — $7,433.00 $22,967.65 $14,137.00 2025-01-31
347 MS_DRG Anal And Stomal Procedures With Mcc 6 3 — — $7,433.00 $27,578.71 $14,137.00 2025-01-31
671 MS_DRG Urethral Procedures With Cc/mcc 6 3 — — $7,433.00 $18,521.05 $14,137.00 2025-01-31
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 6 3 — — $7,433.00 $31,238.78 $14,137.00 2025-01-31
669 MS_DRG Transurethral Procedures With Cc 6 3 — — $7,433.00 $16,602.84 $14,137.00 2025-01-31
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 6 3 — — $7,433.00 $31,164.13 $14,137.00 2025-01-31
330 MS_DRG Major Small And Large Bowel Procedures With Cc 6 3 — — $7,433.00 $25,663.75 $14,137.00 2025-01-31
144 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Cc 6 3 — — $7,433.00 $18,722.28 $14,137.00 2025-01-31
668 MS_DRG Transurethral Procedures With Mcc 6 3 — — $7,433.00 $30,487.94 $14,137.00 2025-01-31
662 MS_DRG Minor Bladder Procedures With Mcc 6 3 — — $7,433.00 $32,421.30 $14,137.00 2025-01-31
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 6 3 — — $7,433.00 $28,009.31 $14,137.00 2025-01-31
657 MS_DRG Kidney And Ureter Procedures For Neoplasm With Cc 6 3 — — $7,433.00 $19,952.40 $14,137.00 2025-01-31
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 6 3 — — $7,433.00 $35,979.67 $14,137.00 2025-01-31
412 MS_DRG Cholecystectomy With C.d.e. With Cc 6 3 — — $7,433.00 $22,130.26 $14,137.00 2025-01-31
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 6 3 — — $7,433.00 $33,945.70 $14,137.00 2025-01-31
626 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Cc 6 3 — — $7,433.00 $16,140.87 $14,137.00 2025-01-31
655 MS_DRG Major Bladder Procedures Without Cc/mcc 6 3 — — $7,433.00 $22,804.29 $14,137.00 2025-01-31
331 MS_DRG Major Small And Large Bowel Procedures Without Cc/mcc 6 3 — — $7,433.00 $18,089.37 $14,137.00 2025-01-31
167 MS_DRG Other Respiratory System O.r. Procedures With Cc 6 3 — — $7,433.00 $19,688.42 $14,137.00 2025-01-31
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 6 3 — — $7,433.00 $31,604.46 $14,137.00 2025-01-31
619 MS_DRG O.r. Procedures For Obesity With Mcc 6 3 — — $7,433.00 $28,004.98 $14,137.00 2025-01-31
314 MS_DRG Other Circulatory System Diagnoses With Mcc 6 3 — — $7,433.00 $22,649.58 $14,137.00 2025-01-31
654 MS_DRG Major Bladder Procedures With Cc 6 3 — — $7,433.00 $29,617.01 $14,137.00 2025-01-31
137 MS_DRG Mouth Procedures With Cc/mcc 6 3 — — $7,433.00 $16,279.35 $14,137.00 2025-01-31
620 MS_DRG O.r. Procedures For Obesity With Cc 6 3 — — $7,433.00 $17,993.00 $14,137.00 2025-01-31
621 MS_DRG O.r. Procedures For Obesity Without Cc/mcc 6 3 — — $7,433.00 $17,993.00 $14,137.00 2025-01-31
243 MS_DRG Permanent Cardiac Pacemaker Implant With Cc 6 3 — — $7,433.00 $24,641.35 $14,137.00 2025-01-31
584 MS_DRG Breast Biopsy, Local Excision And Other Breast Procedures With Cc/mcc 6 3 — — $7,433.00 $21,190.09 $14,137.00 2025-01-31
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 6 3 — — $7,433.00 $27,019.37 $14,137.00 2025-01-31
744 MS_DRG D&c, Conization, Laparoscopy And Tubal Interruption With Cc/mcc 6 3 — — $7,433.00 $20,365.69 $14,137.00 2025-01-31
614 MS_DRG Adrenal And Pituitary Procedures With Cc/mcc 6 3 — — $7,433.00 $24,368.71 $14,137.00 2025-01-31
244 MS_DRG Permanent Cardiac Pacemaker Implant Without Cc/mcc 6 3 — — $7,433.00 $19,793.36 $14,137.00 2025-01-31
135 MS_DRG Sinus And Mastoid Procedures With Cc/mcc 6 3 — — $7,433.00 $28,693.07 $14,137.00 2025-01-31
585 MS_DRG Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/mcc 6 3 — — $7,433.00 $18,219.20 $14,137.00 2025-01-31
583 MS_DRG Mastectomy For Malignancy Without Cc/mcc 6 3 — — $7,433.00 $16,465.44 $14,137.00 2025-01-31
582 MS_DRG Mastectomy For Malignancy With Cc/mcc 6 3 — — $7,433.00 $18,036.36 $14,137.00 2025-01-31
397 MS_DRG Appendix Procedures With Mcc 6 3 — — $7,433.00 $24,305.96 $14,137.00 2025-01-31
707 MS_DRG Major Male Pelvic Procedures With Cc/mcc 6 3 — — $7,433.00 $21,225.80 $14,137.00 2025-01-31
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 6 3 — — $7,433.00 $36,847.35 $14,137.00 2025-01-31
575 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis Without Cc/mcc 6 3 — — $7,433.00 $22,135.67 $14,137.00 2025-01-31
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 6 3 — — $7,433.00 $36,159.26 $14,137.00 2025-01-31
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 6 3 — — $7,433.00 $43,901.34 $14,137.00 2025-01-31
580 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Cc 6 3 — — $7,433.00 $18,896.46 $14,137.00 2025-01-31
746 MS_DRG Vagina, Cervix And Vulva Procedures With Cc/mcc 6 3 — — $7,433.00 $18,133.73 $14,137.00 2025-01-31
413 MS_DRG Cholecystectomy With C.d.e. Without Cc/mcc 6 3 — — $7,433.00 $16,332.36 $14,137.00 2025-01-31
398 MS_DRG Appendix Procedures With Cc 6 3 — — $7,433.00 $16,372.39 $14,137.00 2025-01-31
328 MS_DRG Stomach, Esophageal And Duodenal Procedures Without Cc/mcc 6 3 — — $7,433.00 $17,281.19 $14,137.00 2025-01-31
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 6 3 — — $7,433.00 $25,076.28 $14,137.00 2025-01-31
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 6 3 — — $7,433.00 $39,508.82 $14,137.00 2025-01-31
517 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures Without Cc/mc… 6 3 — — $7,433.00 $16,167.91 $14,137.00 2025-01-31
519 MS_DRG Back And Neck Procedures Except Spinal Fusion With Cc 6 3 — — $7,433.00 $21,298.28 $14,137.00 2025-01-31
516 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Cc 6 3 — — $7,433.00 $22,079.42 $14,137.00 2025-01-31
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 6 3 — — $7,433.00 $37,380.73 $14,137.00 2025-01-31
522 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 6 3 — — $7,433.00 $22,851.89 $14,137.00 2025-01-31
511 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc 6 3 — — $7,433.00 $21,570.92 $14,137.00 2025-01-31
512 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/… 6 3 — — $7,433.00 $17,459.70 $14,137.00 2025-01-31
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 6 3 — — $7,433.00 $29,434.17 $14,137.00 2025-01-31
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 6 3 — — $7,433.00 $34,204.27 $14,137.00 2025-01-31
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 6 3 — — $7,433.00 $32,394.25 $14,137.00 2025-01-31
505 MS_DRG Foot Procedures Without Cc/mcc 6 3 — — $7,433.00 $18,453.97 $14,137.00 2025-01-31
507 MS_DRG Major Shoulder Or Elbow Joint Procedures With Cc/mcc 6 3 — — $7,433.00 $23,062.86 $14,137.00 2025-01-31
504 MS_DRG Foot Procedures With Cc 6 3 — — $7,433.00 $18,685.49 $14,137.00 2025-01-31
500 MS_DRG Soft Tissue Procedures With Mcc 6 3 — — $7,433.00 $35,083.85 $14,137.00 2025-01-31
501 MS_DRG Soft Tissue Procedures With Cc 6 3 — — $7,433.00 $18,778.54 $14,137.00 2025-01-31
253 MS_DRG Other Vascular Procedures With Cc 6 3 — — $7,433.00 $27,600.35 $14,137.00 2025-01-31
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 6 3 — — $7,433.00 $38,745.00 $14,137.00 2025-01-31
496 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 6 3 — — $7,433.00 $21,502.76 $14,137.00 2025-01-31
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 6 3 — — $7,433.00 $31,638.00 $14,137.00 2025-01-31
742 MS_DRG Uterine And Adnexa Procedures For Non-malignancy With Cc/mcc 6 3 — — $7,433.00 $19,278.38 $14,137.00 2025-01-31
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 6 3 — — $7,433.00 $37,456.46 $14,137.00 2025-01-31
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 6 3 — — $7,433.00 $38,139.14 $14,137.00 2025-01-31
503 MS_DRG Foot Procedures With Mcc 6 3 — — $7,433.00 $29,015.48 $14,137.00 2025-01-31
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 6 3 — — $7,433.00 $25,983.99 $14,137.00 2025-01-31
494 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/mcc 6 3 — — $7,433.00 $20,222.88 $14,137.00 2025-01-31
254 MS_DRG Other Vascular Procedures Without Cc/mcc 6 3 — — $7,433.00 $18,772.05 $14,137.00 2025-01-31
354 MS_DRG Hernia Procedures Except Inguinal And Femoral With Cc 6 3 — — $7,433.00 $18,584.88 $14,137.00 2025-01-31
482 MS_DRG Hip And Femur Procedures Except Major Joint Without Cc/mcc 6 3 — — $7,433.00 $17,184.90 $14,137.00 2025-01-31
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 6 3 — — $7,433.00 $31,904.15 $14,137.00 2025-01-31
481 MS_DRG Hip And Femur Procedures Except Major Joint With Cc 6 3 — — $7,433.00 $22,448.34 $14,137.00 2025-01-31
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 6 3 — — $7,433.00 $26,876.56 $14,137.00 2025-01-31
801 MS_DRG Splenectomy Without Cc/mcc 6 3 — — $7,433.00 $19,362.76 $14,137.00 2025-01-31
350 MS_DRG Inguinal And Femoral Hernia Procedures With Mcc 6 3 — — $7,433.00 $25,965.60 $14,137.00 2025-01-31
488 MS_DRG Knee Procedures Without Principal Diagnosis Of Infection With Cc/mcc 6 3 — — $7,433.00 $22,791.30 $14,137.00 2025-01-31
472 MS_DRG Cervical Spinal Fusion With Cc 6 3 — — $7,433.00 $31,974.47 $14,137.00 2025-01-31
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