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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

LIFECARE MEDICAL CENTER

Roseau, MN · CCN 241344 · Rates published

4,959 distinct procedures filed
18 distinct payers
79,390 rate rows
2026-02-03 last MRF observed
Data quality

77,119 of 79,390 rate rows are consumer-grade (97.1%)

2,271 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 1,104
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 930
percent-of-charges filed in the dollar field — excluded from medians 187
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 30
exceeds 3× this hospital's gross charge for a DRG stay — excluded 10
placeholder amount (≤ $0.02) — excluded from medians 5
exceeds 10× this hospital's gross charge — excluded from medians 4
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbRoseau&type=CDMWithoutLabel
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/LifeCare_V3.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-13
Content fingerprint 1ee63369f0ae2844… · 25,935,844 bytes · first seen 2026-05-07

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
J9357
HCPCS 		Injection, Valrubicin, Intravesical, 200 Mg 15 $1,462.14 $976,811.00 $444,005.00 nat. median
$1,502
outlier · 295.7×
885
MS_DRG 		Psychoses 3 $5,965.73 $115,696.97 $115,696.97 nat. median
$8,240
outlier · 14.0×
561
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 3 $3,433.46 $85,419.80 $85,419.80 nat. median
$5,841
outlier · 14.6×
947
MS_DRG 		Signs And Symptoms With Mcc 3 $5,421.61 $84,994.37 $84,994.37 nat. median
$8,698
outlier · 9.8×
602
MS_DRG 		Cellulitis With Mcc 3 $6,070.37 $81,151.94 $81,151.94 nat. median
$10,595
outlier · 7.7×
92
MS_DRG 		Other Disorders Of Nervous System With Cc 3 $4,369.23 $78,480.90 $78,480.90 nat. median
$7,741
outlier · 10.1×
948
MS_DRG 		Signs And Symptoms Without Mcc 3 $3,418.94 $77,336.05 $77,336.05 nat. median
$5,562
outlier · 13.9×
559
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 3 $7,964.99 $74,239.15 $74,239.15 nat. median
$13,403
outlier · 5.5×
949
MS_DRG 		Aftercare With Cc/mcc 3 $5,081.21 $65,301.36 $65,301.36 nat. median
$8,367
outlier · 7.8×
436
MS_DRG 		Malignancy Of Hepatobiliary System Or Pancreas With Cc 3 $4,830.93 $64,386.25 $64,386.25 nat. median
$8,433
outlier · 7.6×
310
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 3 $2,417.81 $62,462.39 $62,462.39 nat. median
$4,383
outlier · 14.3×
372
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections With Cc 3 $4,360.69 $43,069.67 $43,069.67 nat. median
$7,653
outlier · 5.6×
J9298
HCPCS 		Injection, Nivolumab And Relatlimab-rmbw, 3 Mg/1 Mg 13 $34,949.38 $83,212.80 $37,824.00 nat. median
$446
outlier · 84.7×
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 1 $36,004.10 $36,004.10 $36,004.10 nat. median
$60,505
0.6× median
109950_ERX
CDM 		Krystexxa 8 Mg/ml Vial 14 $25,524.11 $69,566.95 $34,783.48 —
192
MS_DRG 		Chronic Obstructive Pulmonary Disease Without Cc/mcc 3 $2,741.98 $34,554.27 $34,554.27 nat. median
$5,010
outlier · 6.9×
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 $32,652.65 $32,652.65 $32,652.65 nat. median
$55,935
0.6× median
132317_ERX
CDM 		Varizig 125 Unit/1.2 Ml Vial 14 $21,247.91 $57,912.00 $28,956.00 —
551
MS_DRG 		Medical Back Problems With Mcc 2 $7,158.62 $47,615.52 $27,387.07 nat. median
$11,966
outlier · 2.3×
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 15 $58.77 $56,817.75 $25,826.25 nat. median
$133
outlier · 194.2×
56
MS_DRG 		Degenerative Nervous System Disorders With Mcc 2 $9,921.96 $40,925.77 $25,423.86 nat. median
$14,194
1.8× median
463
MS_DRG 		Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective… 1 $24,342.56 $24,342.56 $24,342.56 nat. median
$38,795
0.6× median
234
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 1 $23,331.19 $23,331.19 $23,331.19 nat. median
$39,159
0.6× median
853
MS_DRG 		Infectious And Parasitic Diseases With O.r. Procedures With Mcc 1 $21,092.76 $21,092.76 $21,092.76 nat. median
$34,733
0.6× median
282
MS_DRG 		Acute Myocardial Infarction, Discharged Alive Without Cc/mcc 3 $3,088.36 $19,710.86 $19,710.86 nat. median
$5,680
outlier · 3.5×
140
MS_DRG 		Major Head And Neck Procedures With Mcc 1 $18,217.10 $18,217.10 $18,217.10 nat. median
$28,105
0.6× median
673
MS_DRG 		Other Kidney And Urinary Tract Procedures With Mcc 1 $17,945.03 $17,945.03 $17,945.03 nat. median
$29,327
0.6× median
J9043
HCPCS 		Injection, Cabazitaxel, 1 Mg 15 $235.29 $38,195.17 $17,361.44 nat. median
$509
outlier · 34.1×
J9307
HCPCS 		Injection, Pralatrexate, 1 Mg 15 $392.46 $37,331.36 $16,968.80 nat. median
$1,097
outlier · 15.5×
907
MS_DRG 		Other O.r. Procedures For Injuries With Mcc 1 $16,397.65 $16,397.65 $16,397.65 nat. median
$27,194
0.6× median
166
MS_DRG 		Other Respiratory System O.r. Procedures With Mcc 1 $15,963.72 $15,963.72 $15,963.72 nat. median
$26,952
0.6× median
97
MS_DRG 		Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 1 $15,426.00 $15,426.00 $15,426.00 nat. median
$24,748
0.6× median
792
MS_DRG 		Prematurity Without Major Problems 3 $495.00 $15,350.73 $15,350.73 nat. median
$14,273
1.1× median
420
MS_DRG 		Hepatobiliary Diagnostic Procedures With Mcc 1 $14,551.72 $14,551.72 $14,551.72 nat. median
$23,398
0.6× median
229
MS_DRG 		Other Cardiothoracic Procedures Without Mcc 1 $13,451.51 $13,451.51 $13,451.51 nat. median
$22,934
0.6× median
J2327
HCPCS 		Injection, Risankizumab-rzaa, Intravenous, 1 Mg 13 $11,980.47 $28,524.93 $12,965.88 nat. median
$48
outlier · 270.3×
469
MS_DRG 		Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 1 $12,954.80 $12,954.80 $12,954.80 nat. median
$22,918
0.6× median
J9022
HCPCS 		Injection, Atezolizumab, 10 Mg 15 $92.63 $28,353.38 $12,887.90 nat. median
$1,229
outlier · 10.5×
789
MS_DRG 		Neonates, Died Or Transferred To Another Acute Care Facility 3 $495.00 $12,436.66 $12,436.66 nat. median
$12,349
1.0× median
J1930
HCPCS 		Injection, Lanreotide, 1 Mg 15 $44.98 $26,295.50 $11,952.50 nat. median
$261
outlier · 45.7×
468
MS_DRG 		Revision Of Hip Or Knee Replacement Without Cc/mcc 1 $11,736.71 $11,736.71 $11,736.71 nat. median
$19,904
0.6× median
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 15 $21.67 $25,794.76 $11,724.89 nat. median
$59
outlier · 199.4×
J9144
HCPCS 		Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj 15 $53.96 $25,131.29 $11,423.32 nat. median
$114
outlier · 99.8×
253
MS_DRG 		Other Vascular Procedures With Cc 1 $11,085.81 $11,085.81 $11,085.81 nat. median
$19,118
0.6× median
793
MS_DRG 		Full Term Neonate With Major Problems 3 $495.00 $10,967.96 $10,967.96 nat. median
$15,882
0.7× median
J0896
HCPCS 		Injection, Luspatercept-aamt, 0.25 Mg 15 $41.28 $31,404.18 $10,637.79 nat. median
$228
outlier · 46.7×
J9228
HCPCS 		Injection, Ipilimumab, 1 Mg 15 $189.05 $22,932.75 $10,423.98 nat. median
$6,073
1.7× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 15 $162.43 $22,817.47 $10,371.58 nat. median
$498
outlier · 20.8×
794
MS_DRG 		Neonate With Other Significant Problems 3 $495.00 $10,345.60 $10,345.60 nat. median
$5,568
1.9× median
956
MS_DRG 		Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 3 $495.00 $10,288.84 $10,288.84 nat. median
$27,340
outlier · 0.4×

Other procedures at this hospital

Browse this hospital's 4,959 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
             
J9357 HCPCS Injection, Valrubicin, Intravesical, 200 Mg 15 15 $888,010.00 $781,448.80 $1,462.14 $976,811.00 $444,005.00 2026-02-03
885 MS_DRG Psychoses 3 3 $53,141.75 $46,764.74 $5,965.73 $115,696.97 $115,696.97 2026-02-03
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 3 3 $36,034.10 $31,710.01 $3,433.46 $85,419.80 $85,419.80 2026-02-03
947 MS_DRG Signs And Symptoms With Mcc 3 3 $38,901.05 $34,232.92 $5,421.61 $84,994.37 $84,994.37 2026-02-03
602 MS_DRG Cellulitis With Mcc 3 3 $38,351.00 $33,748.88 $6,070.37 $81,151.94 $81,151.94 2026-02-03
92 MS_DRG Other Disorders Of Nervous System With Cc 3 3 $32,387.58 $28,501.07 $4,369.23 $78,480.90 $78,480.90 2026-02-03
948 MS_DRG Signs And Symptoms Without Mcc 3 3 $34,535.11 $30,390.89 $3,418.94 $77,336.05 $77,336.05 2026-02-03
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 3 3 $34,730.59 $30,562.92 $7,964.99 $74,239.15 $74,239.15 2026-02-03
949 MS_DRG Aftercare With Cc/mcc 3 3 $29,085.18 $25,594.96 $5,081.21 $65,301.36 $65,301.36 2026-02-03
436 MS_DRG Malignancy Of Hepatobiliary System Or Pancreas With Cc 3 3 $24,877.69 $21,892.37 $4,830.93 $64,386.25 $64,386.25 2026-02-03
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 3 3 $29,538.59 $25,993.96 $2,417.81 $62,462.39 $62,462.39 2026-02-03
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 3 3 $20,023.01 $17,620.25 $4,360.69 $43,069.67 $43,069.67 2026-02-03
J9298 HCPCS Injection, Nivolumab And Relatlimab-rmbw, 3 Mg/1 Mg 13 13 $75,648.00 $66,570.24 $34,949.38 $83,212.80 $37,824.00 2026-02-03
231 MS_DRG Coronary Bypass With Ptca With Mcc 1 1 $33,189.03 $29,206.35 $36,004.10 $36,004.10 $36,004.10 2026-02-03
109950_ERX CDM Krystexxa 8 Mg/ml Vial 14 14 $69,566.95 $61,218.92 $25,524.11 $69,566.95 $34,783.48 2026-02-03
192 MS_DRG Chronic Obstructive Pulmonary Disease Without Cc/mcc 3 3 $14,799.99 $13,023.99 $2,741.98 $34,554.27 $34,554.27 2026-02-03
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 1 1 $26,601.50 $23,409.32 $32,652.65 $32,652.65 $32,652.65 2026-02-03
132317_ERX CDM Varizig 125 Unit/1.2 Ml Vial 14 14 $57,912.00 $50,962.56 $21,247.91 $57,912.00 $28,956.00 2026-02-03
551 MS_DRG Medical Back Problems With Mcc 2 2 $21,276.48 $18,723.30 $7,158.62 $47,615.52 $27,387.07 2026-02-03
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 15 15 $51,652.50 $45,454.20 $58.77 $56,817.75 $25,826.25 2026-02-03
56 MS_DRG Degenerative Nervous System Disorders With Mcc 2 2 $17,879.11 $15,733.62 $9,921.96 $40,925.77 $25,423.86 2026-02-03
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 1 1 $44,912.70 $39,523.17 $24,342.56 $24,342.56 $24,342.56 2026-02-03
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 1 1 $33,989.51 $29,910.77 $23,331.19 $23,331.19 $23,331.19 2026-02-03
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 1 1 $18,819.61 $16,561.26 $21,092.76 $21,092.76 $21,092.76 2026-02-03
282 MS_DRG Acute Myocardial Infarction, Discharged Alive Without Cc/mcc 3 3 $9,833.72 $8,653.67 $3,088.36 $19,710.86 $19,710.86 2026-02-03
140 MS_DRG Major Head And Neck Procedures With Mcc 1 1 $25,238.20 $22,209.61 $18,217.10 $18,217.10 $18,217.10 2026-02-03
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 1 1 $117,749.37 $103,619.45 $17,945.03 $17,945.03 $17,945.03 2026-02-03
J9043 HCPCS Injection, Cabazitaxel, 1 Mg 15 15 $34,722.88 $30,556.13 $235.29 $38,195.17 $17,361.44 2026-02-03
J9307 HCPCS Injection, Pralatrexate, 1 Mg 15 15 $33,937.60 $29,865.09 $392.46 $37,331.36 $16,968.80 2026-02-03
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 1 1 $60,998.29 $53,678.50 $16,397.65 $16,397.65 $16,397.65 2026-02-03
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 1 1 $45,460.83 $40,005.53 $15,963.72 $15,963.72 $15,963.72 2026-02-03
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 1 1 $27,640.38 $24,323.53 $15,426.00 $15,426.00 $15,426.00 2026-02-03
792 MS_DRG Prematurity Without Major Problems 3 3 $5,473.59 $4,816.76 $495.00 $15,350.73 $15,350.73 2026-02-03
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 1 1 $14,613.96 $12,860.28 $14,551.72 $14,551.72 $14,551.72 2026-02-03
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 1 1 $27,000.03 $23,760.03 $13,451.51 $13,451.51 $13,451.51 2026-02-03
J2327 HCPCS Injection, Risankizumab-rzaa, Intravenous, 1 Mg 13 13 $25,931.75 $22,819.94 $11,980.47 $28,524.93 $12,965.88 2026-02-03
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 1 1 $22,020.00 $19,377.60 $12,954.80 $12,954.80 $12,954.80 2026-02-03
J9022 HCPCS Injection, Atezolizumab, 10 Mg 15 15 $25,775.80 $22,682.70 $92.63 $28,353.38 $12,887.90 2026-02-03
789 MS_DRG Neonates, Died Or Transferred To Another Acute Care Facility 3 3 $5,851.90 $5,149.67 $495.00 $12,436.66 $12,436.66 2026-02-03
J1930 HCPCS Injection, Lanreotide, 1 Mg 15 15 $23,905.00 $21,036.40 $44.98 $26,295.50 $11,952.50 2026-02-03
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 1 1 $19,430.93 $17,099.22 $11,736.71 $11,736.71 $11,736.71 2026-02-03
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 15 15 $23,449.78 $20,635.81 $21.67 $25,794.76 $11,724.89 2026-02-03
J9144 HCPCS Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj 15 15 $22,846.63 $20,105.03 $53.96 $25,131.29 $11,423.32 2026-02-03
253 MS_DRG Other Vascular Procedures With Cc 1 1 $22,518.00 $19,815.84 $11,085.81 $11,085.81 $11,085.81 2026-02-03
793 MS_DRG Full Term Neonate With Major Problems 3 3 $4,383.20 $3,857.22 $495.00 $10,967.96 $10,967.96 2026-02-03
J0896 HCPCS Injection, Luspatercept-aamt, 0.25 Mg 28 15 $10,131.23 $8,915.48 $41.28 $31,404.18 $10,637.79 2026-02-03
J9228 HCPCS Injection, Ipilimumab, 1 Mg 15 15 $20,847.95 $18,346.20 $189.05 $22,932.75 $10,423.98 2026-02-03
J3101 HCPCS Injection, Tenecteplase, 1 Mg 28 15 $20,743.15 $18,253.97 $162.43 $22,817.47 $10,371.58 2026-02-03
794 MS_DRG Neonate With Other Significant Problems 3 3 $3,760.84 $3,309.54 $495.00 $10,345.60 $10,345.60 2026-02-03
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 3 3 $3,704.08 $3,259.59 $495.00 $10,288.84 $10,288.84 2026-02-03
330 MS_DRG Major Small And Large Bowel Procedures With Cc 1 1 $49,891.81 $43,904.79 $10,238.44 $10,238.44 $10,238.44 2026-02-03
J9223 HCPCS Injection, Lurbinectedin, 0.1 Mg 15 15 $19,925.00 $17,534.00 $215.14 $21,917.50 $9,962.50 2026-02-03
475 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc 1 1 $38,280.38 $33,686.73 $9,719.51 $9,719.51 $9,719.51 2026-02-03
J9301 HCPCS Injection, Obinutuzumab, 10 Mg 15 15 $19,381.40 $17,055.63 $78.57 $21,319.54 $9,690.70 2026-02-03
141 MS_DRG Major Head And Neck Procedures With Cc 1 1 $13,356.65 $11,753.85 $9,315.48 $9,315.48 $9,315.48 2026-02-03
867 MS_DRG Other Infectious And Parasitic Diseases Diagnoses With Mcc 1 1 $24,965.06 $21,969.25 $8,940.06 $8,940.06 $8,940.06 2026-02-03
314 MS_DRG Other Circulatory System Diagnoses With Mcc 1 1 $19,966.11 $17,570.18 $8,905.89 $8,905.89 $8,905.89 2026-02-03
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 1 1 $24,102.04 $21,209.80 $8,588.98 $8,588.98 $8,588.98 2026-02-03
539 MS_DRG Osteomyelitis With Mcc 1 1 $38,002.36 $33,442.07 $8,412.59 $8,412.59 $8,412.59 2026-02-03
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 1 $22,423.44 $19,732.63 $8,296.42 $8,296.42 $8,296.42 2026-02-03
617 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 1 1 $25,515.95 $22,454.04 $7,988.05 $7,988.05 $7,988.05 2026-02-03
J9306 HCPCS Injection, Pertuzumab, 1 Mg 15 15 $15,804.59 $13,908.04 $14.41 $17,385.05 $7,902.30 2026-02-03
377 MS_DRG Gastrointestinal Hemorrhage With Mcc 1 1 $35,791.66 $31,496.66 $7,807.39 $7,807.39 $7,807.39 2026-02-03
862 MS_DRG Postoperative And Post-traumatic Infections With Mcc 1 1 $28,804.23 $25,347.72 $7,789.02 $7,789.02 $7,789.02 2026-02-03
244 MS_DRG Permanent Cardiac Pacemaker Implant Without Cc/mcc 1 1 $22,910.00 $20,160.80 $7,719.83 $7,719.83 $7,719.83 2026-02-03
441 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc 1 1 $15,676.22 $13,795.07 $7,665.16 $7,665.16 $7,665.16 2026-02-03
542 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 1 1 $16,012.46 $14,090.96 $7,544.72 $7,544.72 $7,544.72 2026-02-03
91 MS_DRG Other Disorders Of Nervous System With Mcc 1 1 $44,245.69 $38,936.21 $7,500.73 $7,500.73 $7,500.73 2026-02-03
LC1900084 CDM Lc Lapiplasty System 3 14 14 $14,990.00 $13,191.20 $5,499.83 $14,990.00 $7,495.00 2026-02-03
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 26 13 $11,557.25 $10,170.38 $3,266.09 $17,649.56 $7,476.99 2026-02-03
501 MS_DRG Soft Tissue Procedures With Cc 1 1 $56,313.89 $49,556.22 $7,466.14 $7,466.14 $7,466.14 2026-02-03
817 MS_DRG Other Antepartum Diagnoses With O.r. Procedures With Mcc 1 1 $13,979.00 $12,301.52 $7,209.45 $7,209.45 $7,209.45 2026-02-03
331 MS_DRG Major Small And Large Bowel Procedures Without Cc/mcc 1 1 $37,117.33 $32,663.25 $7,187.67 $7,187.67 $7,187.67 2026-02-03
J0717 HCPCS Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 15 15 $14,297.98 $12,582.22 $3.90 $15,727.78 $7,148.99 2026-02-03
70 MS_DRG Other Cerebrovascular Disorders With Mcc 1 1 $21,927.28 $19,296.00 $7,110.36 $7,110.36 $7,110.36 2026-02-03
643 MS_DRG Endocrine Disorders With Mcc 1 1 $10,204.87 $8,980.29 $7,030.49 $7,030.49 $7,030.49 2026-02-03
J9271 HCPCS Injection, Pembrolizumab, 1 Mg 15 15 $13,943.80 $12,270.54 $60.48 $15,338.18 $6,971.90 2026-02-03
J0517 HCPCS Injection, Benralizumab, 1 Mg 15 15 $13,778.53 $12,125.11 $165.89 $15,156.38 $6,889.27 2026-02-03
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 1 1 $32,341.75 $28,460.74 $6,851.11 $6,851.11 $6,851.11 2026-02-03
177 MS_DRG Respiratory Infections And Inflammations With Mcc 1 1 $12,504.16 $11,003.66 $6,674.29 $6,674.29 $6,674.29 2026-02-03
186 MS_DRG Pleural Effusion With Mcc 1 1 $14,085.35 $12,395.11 $6,656.35 $6,656.35 $6,656.35 2026-02-03
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 3 3 $3,247.42 $2,857.73 $495.00 $6,539.80 $6,539.80 2026-02-03
351 MS_DRG Inguinal And Femoral Hernia Procedures With Cc 1 1 $38,441.34 $33,828.37 $6,511.14 $6,511.14 $6,511.14 2026-02-03
663 MS_DRG Minor Bladder Procedures With Cc 1 1 $30,536.22 $26,871.87 $6,492.77 $6,492.77 $6,492.77 2026-02-03
398 MS_DRG Appendix Procedures With Cc 1 1 $43,148.63 $37,970.79 $6,464.59 $6,464.59 $6,464.59 2026-02-03
425 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures Without Cc/mcc 1 1 $21,811.18 $19,193.84 $6,407.78 $6,407.78 $6,407.78 2026-02-03
137 MS_DRG Mouth Procedures With Cc/mcc 1 1 $37,559.25 $33,052.14 $6,377.46 $6,377.46 $6,377.46 2026-02-03
342 MS_DRG Appendectomy Without Complicated Principal Diagnosis With Cc 1 1 $20,465.28 $18,009.45 $6,206.62 $6,206.62 $6,206.62 2026-02-03
637 MS_DRG Diabetes With Mcc 1 1 $52,370.94 $46,086.42 $6,136.15 $6,136.15 $6,136.15 2026-02-03
811 MS_DRG Red Blood Cell Disorders With Mcc 1 1 $20,275.72 $17,842.63 $5,997.77 $5,997.77 $5,997.77 2026-02-03
83 MS_DRG Traumatic Stupor And Coma >1 Hour With Cc 1 1 $35,104.68 $30,892.12 $5,961.46 $5,961.46 $5,961.46 2026-02-03
241 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc… 1 1 $31,586.36 $27,796.00 $5,912.77 $5,912.77 $5,912.77 2026-02-03
383 MS_DRG Uncomplicated Peptic Ulcer With Mcc 1 1 $8,317.00 $7,318.96 $5,896.97 $5,896.97 $5,896.97 2026-02-03
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 1 1 $16,667.02 $14,666.98 $5,866.65 $5,866.65 $5,866.65 2026-02-03
59510 HCPCS Cesarean Delivery With Care Before And After Delivery 10 10 $8,033.00 $7,069.04 $152.00 $8,836.30 $5,823.93 2026-02-03
J1162 HCPCS Injection, Digoxin Immune Fab (ovine), Per Vial 15 15 $11,547.50 $10,161.80 $5,069.98 $12,702.25 $5,773.75 2026-02-03
660 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Cc 1 1 $13,325.57 $11,726.50 $5,644.98 $5,644.98 $5,644.98 2026-02-03
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 1 1 $26,231.55 $23,083.76 $5,613.80 $5,613.80 $5,613.80 2026-02-03
540 MS_DRG Osteomyelitis With Cc 1 1 $29,029.60 $25,546.05 $5,536.50 $5,536.50 $5,536.50 2026-02-03
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 1 1 $29,971.19 $26,374.65 $5,533.51 $5,533.51 $5,533.51 2026-02-03
59610 HCPCS Vaginal Delivery And Care Before And After Delivery After Previous Cesarean Deli… 10 10 $7,575.00 $6,666.00 $152.00 $8,332.50 $5,491.88 2026-02-03
291 MS_DRG Heart Failure And Shock With Mcc 1 1 $28,331.22 $24,931.48 $5,483.11 $5,483.11 $5,483.11 2026-02-03
J2356 HCPCS Injection, Tezepelumab-ekko, 1 Mg 13 13 $10,922.38 $9,611.69 $5,046.14 $12,014.62 $5,461.19 2026-02-03
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 1 1 $31,295.35 $27,539.91 $5,416.91 $5,416.91 $5,416.91 2026-02-03
809 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 1 $9,776.95 $8,603.71 $5,406.66 $5,406.66 $5,406.66 2026-02-03
LC1900267 CDM Lc Lapiplasty System 4 14 14 $10,800.00 $9,504.00 $3,962.52 $10,800.00 $5,400.00 2026-02-03
189 MS_DRG Pulmonary Edema And Respiratory Failure 1 1 $23,631.98 $20,796.14 $5,276.39 $5,276.39 $5,276.39 2026-02-03
59400 HCPCS Vaginal Delivery With Care Before And After Delivery 10 10 $7,232.00 $6,364.16 $152.00 $7,955.20 $5,243.20 2026-02-03
844 MS_DRG Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 1 1 $57,172.83 $50,312.09 $5,199.52 $5,199.52 $5,199.52 2026-02-03
Q5111 HCPCS Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 15 15 $10,380.10 $9,134.49 $135.55 $11,418.11 $5,190.05 2026-02-03
LCL1900187 CDM Lc Mesh 15cm Phasix St 14 14 $10,380.00 $9,134.40 $3,808.42 $10,380.00 $5,190.00 2026-02-03
139 MS_DRG Salivary Gland Procedures 1 1 $18,230.84 $16,043.14 $5,161.93 $5,161.93 $5,161.93 2026-02-03
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 1 1 $29,383.54 $25,857.52 $5,142.28 $5,142.28 $5,142.28 2026-02-03
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 1 1 $17,879.26 $15,733.75 $4,955.64 $4,955.64 $4,955.64 2026-02-03
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 1 1 $11,979.55 $10,542.01 $4,809.57 $4,809.57 $4,809.57 2026-02-03
787 MS_DRG Cesarean Section Without Sterilization With Cc 1 1 $26,874.93 $23,649.94 $4,769.85 $4,769.85 $4,769.85 2026-02-03
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 1 1 $16,425.44 $14,454.39 $4,730.99 $4,730.99 $4,730.99 2026-02-03
J2182 HCPCS Injection, Mepolizumab, 1 Mg 28 15 $7,529.58 $6,626.03 $30.69 $10,503.60 $4,728.89 2026-02-03
200 MS_DRG Pneumothorax With Cc 1 1 $13,781.80 $12,127.98 $4,695.11 $4,695.11 $4,695.11 2026-02-03
755 MS_DRG Malignancy, Female Reproductive System With Cc 1 1 $15,827.00 $13,927.76 $4,645.99 $4,645.99 $4,645.99 2026-02-03
2000000 CDM Intensive Care Unit - General Classification 6 6 $4,835.00 $4,254.80 $1,773.96 $4,835.00 $4,639.66 2026-02-03
596 MS_DRG Major Skin Disorders Without Mcc 1 1 $20,276.36 $17,843.20 $4,623.36 $4,623.36 $4,623.36 2026-02-03
805 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Mcc 1 1 $11,844.53 $10,423.19 $4,609.26 $4,609.26 $4,609.26 2026-02-03
LC1909838 CDM Lc Lapiplasty System 2 14 14 $9,200.00 $8,096.00 $3,375.48 $9,200.00 $4,600.00 2026-02-03
768 MS_DRG Vaginal Delivery With O.r. Procedures Except Sterilization And/or D&c 1 1 $12,687.30 $11,164.82 $4,576.80 $4,576.80 $4,576.80 2026-02-03
300 MS_DRG Peripheral Vascular Disorders With Cc 1 1 $21,238.83 $18,690.17 $4,559.29 $4,559.29 $4,559.29 2026-02-03
433 MS_DRG Cirrhosis And Alcoholic Hepatitis With Cc 1 1 $15,642.00 $13,764.96 $4,511.03 $4,511.03 $4,511.03 2026-02-03
J9047 HCPCS Injection, Carfilzomib, 1 Mg 15 15 $8,892.98 $7,825.82 $54.56 $9,782.28 $4,446.49 2026-02-03
LC1909837 CDM Lc Aminion 3x8 Thick 14 14 $8,800.00 $7,744.00 $3,228.72 $8,800.00 $4,400.00 2026-02-03
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 1 1 $24,215.55 $21,309.68 $4,370.51 $4,370.51 $4,370.51 2026-02-03
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 106 15 $4,866.90 $4,282.87 $189.83 $32,121.93 $4,345.55 2026-02-03
699 MS_DRG Other Kidney And Urinary Tract Diagnoses With Cc 1 1 $21,275.65 $18,722.57 $4,335.07 $4,335.07 $4,335.07 2026-02-03
J0139 HCPCS Injection, Adalimumab, 1 Mg 13 13 $8,653.28 $7,614.89 $3,997.82 $9,518.61 $4,326.64 2026-02-03
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 1 1 $12,401.77 $10,913.55 $4,314.99 $4,314.99 $4,314.99 2026-02-03
90378 HCPCS Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle 15 15 $8,597.53 $7,565.83 $1,753.34 $9,457.28 $4,298.77 2026-02-03
LC1909902 CDM Lc Fibula Nailleft 3.0x130mm 14 14 $8,558.00 $7,531.04 $3,139.93 $8,558.00 $4,279.00 2026-02-03
863 MS_DRG Postoperative And Post-traumatic Infections Without Mcc 1 1 $27,232.31 $23,964.43 $4,262.03 $4,262.03 $4,262.03 2026-02-03
90375 HCPCS Rabies Immune Globulin For Injection 15 15 $8,506.13 $7,485.39 $280.37 $9,356.74 $4,253.07 2026-02-03
44208 HCPCS Partial Removal Of Large Bowel And Reattachment To Rectum And Creation Of Openin… 10 10 $5,833.00 $5,133.04 $152.00 $6,416.30 $4,228.93 2026-02-03
378 MS_DRG Gastrointestinal Hemorrhage With Cc 1 1 $24,213.57 $21,307.95 $4,188.57 $4,188.57 $4,188.57 2026-02-03
J0897 HCPCS Injection, Denosumab, 1 Mg 28 15 $8,624.36 $7,589.44 $27.66 $9,486.80 $4,182.82 2026-02-03
53 MS_DRG Spinal Disorders And Injuries Without Cc/mcc 1 1 $14,716.38 $12,950.41 $4,182.16 $4,182.16 $4,182.16 2026-02-03
202 MS_DRG Bronchitis And Asthma With Cc/mcc 1 1 $6,661.62 $5,862.23 $4,148.00 $4,148.00 $4,148.00 2026-02-03
442 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc 1 1 $28,448.24 $25,034.45 $4,122.80 $4,122.80 $4,122.80 2026-02-03
552 MS_DRG Medical Back Problems Without Mcc 1 1 $10,746.20 $9,456.66 $4,105.71 $4,105.71 $4,105.71 2026-02-03
788 MS_DRG Cesarean Section Without Sterilization Without Cc/mcc 1 1 $23,030.97 $20,267.25 $4,095.03 $4,095.03 $4,095.03 2026-02-03
785 MS_DRG Cesarean Section With Sterilization Without Cc/mcc 1 1 $22,669.00 $19,948.72 $4,090.76 $4,090.76 $4,090.76 2026-02-03
798 MS_DRG Vaginal Delivery With Sterilization And/or D&c Without Cc/mcc 1 1 $22,966.75 $20,210.74 $4,087.77 $4,087.77 $4,087.77 2026-02-03
49418 HCPCS Insertion Of Abdominal Tube Using Imaging Guidance With Review By Radiologist 15 15 $8,165.00 $7,185.20 $2,995.74 $8,981.50 $4,082.50 2026-02-03
J9303 HCPCS Injection, Panitumumab, 10 Mg 28 15 $3,875.18 $3,410.16 $174.00 $16,885.72 $4,068.94 2026-02-03
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 51 15 $4,365.00 $3,841.20 $46.46 $14,404.50 $3,983.25 2026-02-03
281 MS_DRG Acute Myocardial Infarction, Discharged Alive With Cc 1 1 $15,282.71 $13,448.78 $3,925.48 $3,925.48 $3,925.48 2026-02-03
812 MS_DRG Red Blood Cell Disorders Without Mcc 1 1 $15,159.78 $13,340.60 $3,921.63 $3,921.63 $3,921.63 2026-02-03
605 MS_DRG Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc 1 1 $16,020.00 $14,097.60 $3,912.24 $3,912.24 $3,912.24 2026-02-03
44141 HCPCS Partial Removal Of Large Bowel With Creation Of Opening To Skin 10 10 $5,390.00 $4,743.20 $152.00 $5,929.00 $3,907.75 2026-02-03
44207 HCPCS Partial Removal Of Large Bowel And Reattachment To Rectum Using An Endoscope 10 10 $5,366.00 $4,722.08 $152.00 $5,902.60 $3,890.35 2026-02-03
607 MS_DRG Minor Skin Disorders Without Mcc 1 1 $15,585.05 $13,714.84 $3,871.23 $3,871.23 $3,871.23 2026-02-03
638 MS_DRG Diabetes With Cc 1 1 $28,457.42 $25,042.53 $3,827.67 $3,827.67 $3,827.67 2026-02-03
J9299 HCPCS Injection, Nivolumab, 1 Mg 41 15 $7,651.88 $6,733.65 $33.91 $21,470.68 $3,825.94 2026-02-03
864 MS_DRG Fever And Inflammatory Conditions 1 1 $14,648.20 $12,890.42 $3,791.37 $3,791.37 $3,791.37 2026-02-03
138 MS_DRG Mouth Procedures Without Cc/mcc 1 1 $6,199.98 $5,455.98 $3,784.96 $3,784.96 $3,784.96 2026-02-03
914 MS_DRG Traumatic Injury Without Mcc 1 1 $33,741.49 $29,692.51 $3,781.97 $3,781.97 $3,781.97 2026-02-03
897 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 1 1 $25,926.75 $22,815.54 $3,770.44 $3,770.44 $3,770.44 2026-02-03
44206 HCPCS Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin… 10 10 $5,163.00 $4,543.44 $152.00 $5,679.30 $3,743.18 2026-02-03
683 MS_DRG Renal Failure With Cc 1 1 $21,866.08 $19,242.15 $3,740.54 $3,740.54 $3,740.54 2026-02-03
312 MS_DRG Syncope And Collapse 1 1 $51,768.50 $45,556.28 $3,722.60 $3,722.60 $3,722.60 2026-02-03
603 MS_DRG Cellulitis Without Mcc 1 1 $28,830.17 $25,370.55 $3,719.61 $3,719.61 $3,719.61 2026-02-03
LC1909647 CDM Lc Amnion Thick 3x6 14 14 $7,400.00 $6,512.00 $2,715.06 $7,400.00 $3,700.00 2026-02-03
J9308 HCPCS Injection, Ramucirumab, 5 Mg 28 15 $3,497.50 $3,077.80 $76.56 $19,016.25 $3,672.38 2026-02-03
292 MS_DRG Heart Failure And Shock With Cc 1 1 $20,813.76 $18,316.11 $3,626.08 $3,626.08 $3,626.08 2026-02-03
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 1 1 $5,376.50 $4,731.32 $3,547.49 $3,547.49 $3,547.49 2026-02-03
J9177 HCPCS Injection, Enfortumab Vedotin-ejfv, 0.25 Mg 15 15 $7,036.68 $6,192.28 $38.48 $7,740.35 $3,518.34 2026-02-03
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 2 2 $3,246.93 $2,857.30 $495.00 $6,539.31 $3,517.16 2026-02-03
43880 HCPCS Closure Of Abnormal Drainage Tract From Stomach To Large Bowel 10 10 $4,810.00 $4,232.80 $152.00 $5,291.00 $3,487.25 2026-02-03
728 MS_DRG Inflammation Of The Male Reproductive System Without Mcc 1 1 $11,499.72 $10,119.75 $3,464.64 $3,464.64 $3,464.64 2026-02-03
J9205 HCPCS Injection, Irinotecan Liposome, 1 Mg 15 15 $6,926.98 $6,095.74 $67.43 $7,619.68 $3,463.49 2026-02-03
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 1 1 $18,833.30 $16,573.31 $3,457.37 $3,457.37 $3,457.37 2026-02-03
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 1 1 $21,615.85 $19,021.95 $3,449.26 $3,449.26 $3,449.26 2026-02-03
204 MS_DRG Respiratory Signs And Symptoms 1 1 $18,495.96 $16,276.44 $3,448.41 $3,448.41 $3,448.41 2026-02-03
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 1 1 $17,727.98 $15,600.62 $3,442.00 $3,442.00 $3,442.00 2026-02-03
J0401 HCPCS Injection, Aripiprazole (abilify Maintena), 1 Mg 15 15 $6,798.08 $5,982.31 $7.07 $7,477.89 $3,399.04 2026-02-03
LC1900093 CDM Lc Bc 3.9 Achilles Spdbrges 14 14 $6,755.00 $5,944.40 $2,478.41 $6,755.00 $3,377.50 2026-02-03
389 MS_DRG Gastrointestinal Obstruction With Cc 1 1 $32,022.29 $28,179.62 $3,373.24 $3,373.24 $3,373.24 2026-02-03
LC1909575 CDM Lc Plate 2h Impl Sys Dual Tr 14 14 $6,716.00 $5,910.08 $2,464.10 $6,716.00 $3,358.00 2026-02-03
694 MS_DRG Urinary Stones Without Mcc 1 1 $16,299.25 $14,343.34 $3,338.64 $3,338.64 $3,338.64 2026-02-03
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 1 1 $14,023.66 $12,340.82 $3,329.67 $3,329.67 $3,329.67 2026-02-03
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 1 $15,850.02 $13,948.02 $3,323.69 $3,323.69 $3,323.69 2026-02-03
J9358 HCPCS Injection, Fam-trastuzumab Deruxtecan-nxki, 1 Mg 15 15 $6,635.80 $5,839.50 $30.25 $7,299.38 $3,317.90 2026-02-03
163206_ERX CDM Glassia 4 Gm /200 Ml Vial 14 14 $6,600.00 $5,808.00 $2,421.54 $6,600.00 $3,300.00 2026-02-03
541 MS_DRG Osteomyelitis Without Cc/mcc 1 1 $17,788.00 $15,653.44 $3,295.08 $3,295.08 $3,295.08 2026-02-03
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 15 15 $6,572.30 $5,783.62 $11.49 $7,229.53 $3,286.15 2026-02-03
LC1900159 CDM Lc Staple 20wx20l Dynamite 14 14 $6,558.00 $5,771.04 $2,406.13 $6,558.00 $3,279.00 2026-02-03
LC1900072 CDM Lc Bc 3.9mm Achilles 14 14 $6,523.00 $5,740.24 $2,393.29 $6,523.00 $3,261.50 2026-02-03
J1950 HCPCS Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 28 15 $2,563.06 $2,255.49 $1,184.13 $13,477.81 $3,243.14 2026-02-03
72 MS_DRG Other Cerebrovascular Disorders Without Cc/mcc 1 1 $28,303.85 $24,907.38 $3,229.73 $3,229.73 $3,229.73 2026-02-03
305 MS_DRG Hypertension Without Mcc 1 1 $15,665.78 $13,785.89 $3,225.03 $3,225.03 $3,225.03 2026-02-03
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 1 1 $13,838.22 $12,177.63 $3,220.33 $3,220.33 $3,220.33 2026-02-03
566 MS_DRG Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/mcc 1 1 $13,545.03 $11,919.62 $3,200.26 $3,200.26 $3,200.26 2026-02-03
153 MS_DRG Otitis Media And Uri Without Mcc 1 1 $10,386.69 $9,140.29 $3,152.85 $3,152.85 $3,152.85 2026-02-03
LC1905000 CDM Lc Graft Jacket 4x7cm 14 14 $6,290.00 $5,535.20 $2,307.80 $6,290.00 $3,145.00 2026-02-03
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 1 1 $31,461.22 $27,685.87 $3,142.17 $3,142.17 $3,142.17 2026-02-03
LC1900166 CDM Lc Evans Wedge 18x18x8mm 14 14 $6,272.00 $5,519.36 $2,301.20 $6,272.00 $3,136.00 2026-02-03
LC1909580 CDM Lc Plate Locking Cross-plate Short 14 14 $6,272.00 $5,519.36 $2,301.20 $6,272.00 $3,136.00 2026-02-03
J9034 HCPCS Injection, Bendamustine Hcl (bendeka), 1 Mg 15 15 $6,234.50 $5,486.36 $14.13 $6,857.95 $3,117.25 2026-02-03
832 MS_DRG Other Antepartum Diagnoses Without O.r. Procedures With Cc 1 1 $11,476.95 $10,099.72 $3,081.95 $3,081.95 $3,081.95 2026-02-03
201 MS_DRG Pneumothorax Without Cc/mcc 1 1 $15,808.02 $13,911.06 $3,054.19 $3,054.19 $3,054.19 2026-02-03
LC1900188 CDM Lc Mesh 22.1cm X 27.1cm Oval 14 14 $6,099.00 $5,367.12 $2,237.72 $6,099.00 $3,049.50 2026-02-03
791 MS_DRG Prematurity With Major Problems 2 2 $2,243.00 $1,973.84 $495.00 $5,535.38 $3,015.19 2026-02-03
LC1909904 CDM Lc Articular Comp 15mm Toe 2.5mm 14 14 $6,012.00 $5,290.56 $2,205.80 $6,012.00 $3,006.00 2026-02-03
59622 HCPCS Cesarean Delivery With Care After Delivery Following Vaginal Delivery Attempt Af… 10 10 $4,141.00 $3,644.08 $152.00 $4,555.10 $3,002.22 2026-02-03
LC1900220 CDM Lc Stimulator Bone 14 14 $6,000.00 $5,280.00 $2,201.40 $6,000.00 $3,000.00 2026-02-03
311 MS_DRG Angina Pectoris 1 1 $14,167.71 $12,467.58 $2,997.81 $2,997.81 $2,997.81 2026-02-03
1220000 CDM Room & Board - Semi-private (two Beds) - Obstetrics (ob) 6 6 $3,100.00 $2,728.00 $1,137.39 $3,100.00 $2,974.76 2026-02-03
J2426 HCPCS Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 54 15 $4,461.38 $3,926.01 $14.73 $9,207.33 $2,974.37 2026-02-03
4040005 CDM Hc Nm PET CT Skull-thigh 14 14 $5,928.00 $5,216.64 $2,174.98 $5,928.00 $2,964.00 2026-02-03
J7168 HCPCS Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity 15 15 $5,905.93 $5,197.22 $3.04 $6,496.52 $2,952.97 2026-02-03
700 MS_DRG Other Kidney And Urinary Tract Diagnoses Without Cc/mcc 1 1 $14,837.92 $13,057.37 $2,946.56 $2,946.56 $2,946.56 2026-02-03
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 1 1 $26,179.00 $23,037.52 $2,923.07 $2,923.07 $2,923.07 2026-02-03
59515 HCPCS Cesarean Delivery With Care After Delivery 10 10 $4,003.00 $3,522.64 $152.00 $4,403.30 $2,902.18 2026-02-03
78816 HCPCS Nuclear Medicine Study Whole Body With CT Scan 15 15 $5,800.00 $5,104.00 $2,128.02 $6,380.00 $2,900.00 2026-02-03
807 MS_DRG Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc 1 1 $9,531.10 $8,387.37 $2,879.51 $2,879.51 $2,879.51 2026-02-03
303 MS_DRG Atherosclerosis Without Mcc 1 1 $6,592.00 $5,800.96 $2,875.24 $2,875.24 $2,875.24 2026-02-03
LC1900143 CDM Lc Plate Std 5-d Rt Max Force 14 14 $5,700.00 $5,016.00 $2,091.33 $5,700.00 $2,850.00 2026-02-03
LC1909615 CDM Lc Quick Set,8cc 14 14 $5,700.00 $5,016.00 $2,091.33 $5,700.00 $2,850.00 2026-02-03
LC1909864 CDM Lc Wedge 20x6.5mm Biosync 14 14 $5,700.00 $5,016.00 $2,091.33 $5,700.00 $2,850.00 2026-02-03
916 MS_DRG Allergic Reactions Without Mcc 1 1 $9,651.41 $8,493.24 $2,845.77 $2,845.77 $2,845.77 2026-02-03
J2783 HCPCS Injection, Rasburicase, 0.5 Mg 28 15 $2,659.70 $2,340.54 $369.97 $14,628.30 $2,792.68 2026-02-03
LC1909555 CDM Lc Arthrocell Abs 14 14 $5,430.00 $4,778.40 $1,992.27 $5,430.00 $2,715.00 2026-02-03
J9173 HCPCS Injection, Durvalumab, 10 Mg 28 15 $2,576.30 $2,267.14 $88.08 $11,129.80 $2,705.11 2026-02-03
379 MS_DRG Gastrointestinal Hemorrhage Without Cc/mcc 1 1 $14,001.80 $12,321.58 $2,692.44 $2,692.44 $2,692.44 2026-02-03
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 1 1 $26,191.65 $23,048.65 $2,684.32 $2,684.32 $2,684.32 2026-02-03
35840 HCPCS Exploration Of Abdomen For Bleeding, Blood Clot, Or Infection After Surgery 10 10 $3,625.00 $3,190.00 $152.00 $3,987.50 $2,628.12 2026-02-03
724 MS_DRG Malignancy, Male Reproductive System Without Cc/mcc 1 1 $24,102.68 $21,210.36 $2,612.57 $2,612.57 $2,612.57 2026-02-03
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 15 15 $5,218.76 $4,592.51 $125.30 $5,740.64 $2,609.38 2026-02-03
1210000 CDM Room & Board - Semi-private (two Beds) - Medical/surgical/gyn 6 6 $2,695.00 $2,371.60 $988.80 $2,695.00 $2,586.12 2026-02-03
J0490 HCPCS Injection, Belimumab, 10 Mg 15 15 $5,158.93 $4,539.86 $54.91 $5,674.82 $2,579.47 2026-02-03
684 MS_DRG Renal Failure Without Cc/mcc 1 1 $15,239.73 $13,410.96 $2,563.88 $2,563.88 $2,563.88 2026-02-03
LC1900269 CDM Lc Power Port 8fr 14 14 $5,104.00 $4,491.52 $1,872.66 $5,104.00 $2,552.00 2026-02-03
59614 HCPCS Vaginal Delivery And Care After Delivery After Prior Cesarean Delivery 10 10 $3,490.00 $3,071.20 $152.00 $3,839.00 $2,530.25 2026-02-03
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 15 15 $5,048.00 $4,442.24 $10.54 $5,552.80 $2,524.00 2026-02-03
66984 HCPCS Removal Of Cataract With Insertion Of Prosthetic Lens 15 15 $4,984.00 $4,385.92 $1,828.63 $5,482.40 $2,492.00 2026-02-03
J9395 HCPCS Injection, Fulvestrant, 25 Mg 15 15 $4,897.75 $4,310.02 $6.99 $5,387.53 $2,448.88 2026-02-03
J3358 HCPCS Ustekinumab, For Intravenous Injection, 1 Mg 15 15 $4,841.35 $4,260.39 $12.76 $5,325.49 $2,420.68 2026-02-03
293 MS_DRG Heart Failure And Shock Without Cc/mcc 1 1 $20,804.47 $18,307.93 $2,417.39 $2,417.39 $2,417.39 2026-02-03
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 15 15 $4,829.00 $4,249.52 $1,771.76 $5,311.90 $2,414.50 2026-02-03
J3032 HCPCS Injection, Eptinezumab-jjmr, 1 Mg 15 15 $4,770.38 $4,197.93 $19.32 $5,247.42 $2,385.19 2026-02-03
951 MS_DRG Other Factors Influencing Health Status 1 1 $2,828.00 $2,488.64 $2,374.68 $2,374.68 $2,374.68 2026-02-03
81162 HCPCS Gene Analysis (breast Cancer 1 And 2) Of Full Sequence And Analysis For Duplicat… 15 15 $4,725.00 $4,158.00 $1,733.60 $5,197.50 $2,362.50 2026-02-03
J2792 HCPCS Injection, Rho D Immune Globulin, Intravenous, Human, Solvent Detergent, 100 Iu 15 15 $4,712.35 $4,146.87 $32.86 $5,183.59 $2,356.18 2026-02-03
390 MS_DRG Gastrointestinal Obstruction Without Cc/mcc 1 1 $9,082.75 $7,992.82 $2,323.42 $2,323.42 $2,323.42 2026-02-03
LC1909863 CDM Lc Staple 18wx18l Dynamite 14 14 $4,590.00 $4,039.20 $1,684.07 $4,590.00 $2,295.00 2026-02-03
J9023 HCPCS Injection, Avelumab, 10 Mg 15 15 $4,587.15 $4,036.69 $101.80 $5,045.87 $2,293.58 2026-02-03
44604 HCPCS Suture Of Tear Or Hole In Large Bowel 10 10 $3,146.00 $2,768.48 $152.00 $3,460.60 $2,280.85 2026-02-03
J0894 HCPCS Injection, Decitabine, 1 Mg 15 15 $4,541.38 $3,996.41 $2.33 $4,995.52 $2,270.69 2026-02-03
49002 HCPCS Reopening Of Recent Abdominal Incision 10 10 $3,121.00 $2,746.48 $152.00 $3,433.10 $2,262.72 2026-02-03
J0875 HCPCS Injection, Dalbavancin, 5 Mg 15 15 $4,497.83 $3,958.09 $15.60 $4,947.61 $2,248.92 2026-02-03
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 15 15 $4,459.00 $3,923.92 $1,636.01 $4,904.90 $2,229.50 2026-02-03
J1451 HCPCS Injection, Fomepizole, 15 Mg 15 15 $4,379.04 $3,853.56 $12.89 $4,816.94 $2,189.52 2026-02-03
LC1900128 CDM Lc Ankle Distractor 14 14 $4,286.00 $3,771.68 $1,572.53 $4,286.00 $2,143.00 2026-02-03
J2315 HCPCS Injection, Naltrexone, Depot Form, 1 Mg 15 15 $4,275.85 $3,762.75 $4.12 $4,703.44 $2,137.93 2026-02-03
LC1909645 CDM Lc Implant Kit Pars W/suture 14 14 $4,272.00 $3,759.36 $1,567.40 $4,272.00 $2,136.00 2026-02-03
LC1900207 CDM Lc Internal Brace Repair Kit 14 14 $4,272.00 $3,759.36 $1,567.40 $4,272.00 $2,136.00 2026-02-03
LC1909892 CDM Lc Ib Kit,bc,w/cc Ft&jumestad 14 14 $4,272.00 $3,759.36 $1,567.40 $4,272.00 $2,136.00 2026-02-03
Q2050 HCPCS Injection, Doxorubicin Hydrochloride, Liposomal, Not Otherwise Specified, 10 Mg 15 15 $4,260.00 $3,748.80 $136.05 $4,686.00 $2,130.00 2026-02-03
J9305 HCPCS Injection, Pemetrexed, Not Otherwise Specified, 10 Mg 28 15 $9,904.83 $8,716.25 $5.54 $10,895.31 $2,122.03 2026-02-03
LC1900127 CDM Lc Mesh 19.6cmx24.6cm Oval 14 14 $4,200.00 $3,696.00 $1,540.98 $4,200.00 $2,100.00 2026-02-03
7500007 CDM Gastro - Intestinal (gi) Services - General Classification 14 14 $4,192.00 $3,688.96 $1,538.04 $4,192.00 $2,096.00 2026-02-03
3410036 CDM Hc Nm Thallium S/r 14 14 $4,109.00 $3,615.92 $1,507.59 $4,109.00 $2,054.50 2026-02-03
J9041 HCPCS Injection, Bortezomib, 0.1 Mg 15 15 $4,057.50 $3,570.60 $2.33 $4,463.25 $2,028.75 2026-02-03
59620 HCPCS Cesarean Delivery Following Vaginal Delivery Attempt After Previous Cesarean Del… 10 10 $2,796.00 $2,460.48 $152.00 $3,075.60 $2,027.10 2026-02-03
J9264 HCPCS Injection, Paclitaxel Protein-bound Particles, 1 Mg 15 15 $4,050.00 $3,564.00 $14.21 $4,455.00 $2,025.00 2026-02-03
66985 HCPCS Insertion Of Prosthetic Lens 15 15 $4,048.00 $3,562.24 $1,485.21 $4,452.80 $2,024.00 2026-02-03
LC1909578 CDM Lc Plate Locking T10 Short 14 14 $4,036.00 $3,551.68 $1,480.81 $4,036.00 $2,018.00 2026-02-03
LC1900334 CDM Lc Plate 0.0 Mtp Petite Max 14 14 $3,990.00 $3,511.20 $1,463.93 $3,990.00 $1,995.00 2026-02-03
LC1900282 CDM Lc Plate O-o Mtp Petite Rt 14 14 $3,990.00 $3,511.20 $1,463.93 $3,990.00 $1,995.00 2026-02-03
LC1900073 CDM Lc Screw Ti 3.o Mm 14 14 $3,990.00 $3,511.20 $1,463.93 $3,990.00 $1,995.00 2026-02-03
LC1900175 CDM Lc Implant Fore Foot Ib Peek 14 14 $3,986.00 $3,507.68 $1,462.46 $3,986.00 $1,993.00 2026-02-03
47562 HCPCS Removal Of Gallbladder Using An Endoscope 33 18 $1,992.00 $1,752.96 $70.00 $6,609.90 $1,992.00 2026-02-03
28309 HCPCS Incision Or Partial Removal Of Multiple Foot Bones To Straighten Toes 10 10 $2,735.00 $2,406.80 $152.00 $3,008.50 $1,982.88 2026-02-03
LC1700002 CDM Nursery - General Classification 7 7 $2,085.00 $1,834.80 $495.00 $2,085.00 $1,980.75 2026-02-03
J9355 HCPCS Injection, Trastuzumab, Excludes Biosimilar, 10 Mg 15 15 $3,924.63 $3,453.67 $80.90 $4,317.09 $1,962.32 2026-02-03
32408 HCPCS Core Needle Biopsy Of Lung Or Center Cavity Of Chest (mediastinum), Accessed Thr… 15 15 $3,873.00 $3,408.24 $1,421.00 $4,260.30 $1,936.50 2026-02-03
J1448 HCPCS Injection, Trilaciclib, 1mg 15 15 $3,834.08 $3,373.99 $5.37 $4,217.49 $1,917.04 2026-02-03
47480 HCPCS Drainage Or Removal Of Stone From Gallbladder 10 10 $2,643.00 $2,325.84 $152.00 $2,907.30 $1,916.17 2026-02-03
J7186 HCPCS Injection, Antihemophilic Factor Viii/von Willebrand Factor Complex (human), Per… 15 15 $3,820.83 $3,362.33 $1.20 $4,202.91 $1,910.42 2026-02-03
81432 HCPCS Test For Detecting Genes Associated With Inherited Breast Cancer-related Disorde… 15 15 $3,780.00 $3,326.40 $1,386.88 $4,158.00 $1,890.00 2026-02-03
Q5107 HCPCS Injection, Bevacizumab-awwb, Biosimilar, (mvasi), 10 Mg 28 15 $1,794.30 $1,578.98 $28.73 $7,729.92 $1,884.01 2026-02-03
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 22 15 $4,000.00 $3,520.00 $146.50 $4,400.00 $1,880.00 2026-02-03
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 15 15 $3,719.00 $3,272.72 $1,364.50 $4,090.90 $1,859.50 2026-02-03
LC1710001 CDM Nursery - Newborn - Level I 7 7 $1,950.00 $1,716.00 $495.00 $1,950.00 $1,852.50 2026-02-03
44389 HCPCS Biopsy Of Large Bowel Using An Endoscope Inserted Through Surgically Created Ope… 15 15 $3,677.00 $3,235.76 $1,349.09 $4,044.70 $1,838.50 2026-02-03
J9055 HCPCS Injection, Cetuximab, 10 Mg 28 15 $3,781.25 $3,327.50 $80.95 $4,159.38 $1,833.91 2026-02-03
58260 HCPCS Removal Of Uterus Through Vagina, 250.0 G Or Less 10 10 $2,509.00 $2,207.92 $152.00 $2,759.90 $1,819.03 2026-02-03
47531 HCPCS Injection Of Bile Duct For X-ray Through Already Existing Skin Access Using Imag… 15 15 $3,635.00 $3,198.80 $1,333.68 $3,998.50 $1,817.50 2026-02-03
7500031 CDM Gastro - Intestinal (gi) Services - General Classification 14 14 $3,620.00 $3,185.60 $1,328.18 $3,620.00 $1,810.00 2026-02-03
J9145 HCPCS Injection, Daratumumab, 10 Mg 28 15 $1,722.50 $1,515.80 $68.58 $7,414.00 $1,808.62 2026-02-03
J0882 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (for Esrd On Dialysis) 93 15 $1,935.00 $1,702.80 $2.97 $10,642.50 $1,787.94 2026-02-03
LC1909543 CDM Lc Suture Bridge (implant Delivery System) 14 14 $3,544.00 $3,118.72 $1,300.29 $3,544.00 $1,772.00 2026-02-03
43249 HCPCS Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 10 10 $2,432.00 $2,140.16 $152.00 $7,986.00 $1,763.20 2026-02-03
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 15 15 $3,520.25 $3,097.82 $1.11 $3,872.28 $1,760.13 2026-02-03
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