Price Transparencybeta Hospital negotiated rates

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

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Hospital

SANFORD BEHAVIORAL HEALTH CENTER

Thief River Falls, MN · CCN 244018 · Rates published

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You selected 29806 (CPT)

SHO ARTHRS SRG CAPSULORRAPHY

This hospital’s price: $7,501 across 2 payers

Source: https://sthpiprd.blob.core.windows.net/machine-readable-files/13728/450409348_sanford-behavioral-health-thief-river-falls_standardcharges.csv · observed 2026-03-04

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

8,016 distinct procedures filed
13 distinct payers
163,872 rate rows
2026-03-04 last MRF observed
Data quality

163,620 of 163,872 rate rows are consumer-grade (99.8%)

252 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
percent-of-charges filed in the dollar field — excluded from medians 198
per-diem day rate — not a per-procedure price 48
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 6
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/13728/450409348_sanford-behavioral-health-thief-river-falls_standardcharges.csv
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-10-22
Content fingerprint 2e26ed9aefb8cebb… · 154,228,417 bytes · first seen 2026-05-13

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
5834
APR_DRG 		Neonate With Ecmo 2 $182,097.58 $182,097.58 $182,097.58 nat. median
$309,665
0.6× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $115,092.49 $115,092.49 $115,092.49 nat. median
$249,123
outlier · 0.5×
5833
APR_DRG 		Neonate With Ecmo 2 $109,945.81 $109,945.81 $109,945.81 nat. median
$244,017
outlier · 0.5×
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 $103,131.42 $103,131.42 $103,131.42 nat. median
$122,909
0.8× median
24
APR_DRG 		Heart And/or Lung Transplant 2 $93,658.59 $93,658.59 $93,658.59 nat. median
$243,231
outlier · 0.4×
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 $80,933.59 $80,933.59 $80,933.59 nat. median
$165,846
outlier · 0.5×
113
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 $80,494.01 $80,494.01 $80,494.01 nat. median
$67,440
1.2× median
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 2 $79,190.61 $79,190.61 $79,190.61 nat. median
$165,334
outlier · 0.5×
1614
APR_DRG 		Implantable Heart Assist Systems 2 $77,875.22 $77,875.22 $77,875.22 nat. median
$202,660
outlier · 0.4×
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 2 $74,947.39 $74,947.39 $74,947.39 nat. median
$165,169
outlier · 0.5×
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $74,503.48 $74,503.48 $74,503.48 nat. median
$177,531
outlier · 0.4×
5882
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $71,854.05 $71,854.05 $71,854.05 nat. median
$145,336
outlier · 0.5×
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 2 $69,902.28 $69,902.28 $69,902.28 nat. median
$152,569
outlier · 0.5×
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 $69,076.41 $69,076.41 $69,076.41 nat. median
$138,094
0.5× median
5832
APR_DRG 		Neonate With Ecmo 2 $68,993.49 $68,993.49 $68,993.49 nat. median
$159,829
outlier · 0.4×
112
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 $68,020.43 $68,020.43 $68,020.43 nat. median
$67,645
1.0× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 2 $66,622.12 $66,622.12 $66,622.12 nat. median
$160,390
outlier · 0.4×
1613
APR_DRG 		Implantable Heart Assist Systems 2 $62,664.29 $62,664.29 $62,664.29 nat. median
$121,888
0.5× median
38240
CPT 		Transplt Allo Hct/donor 2 $62,099.45 $62,099.45 $62,099.45 nat. median
$12,901
outlier · 4.8×
5893
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 2 $61,127.11 $61,127.11 $61,127.11 nat. median
$71,594
0.9× median
5892
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 2 $61,127.11 $61,127.11 $61,127.11 nat. median
$90,073
0.7× median
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 2 $61,127.11 $61,127.11 $61,127.11 nat. median
$95,269
0.6× median
5913
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 2 $60,170.37 $60,170.37 $60,170.37 nat. median
$103,993
0.6× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 2 $58,743.27 $58,743.27 $58,743.27 nat. median
$65,318
0.9× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 $58,696.47 $58,696.47 $58,696.47 nat. median
$154,211
outlier · 0.4×
5831
APR_DRG 		Neonate With Ecmo 2 $58,213.27 $58,213.27 $58,213.27 nat. median
$148,245
outlier · 0.4×
74
APR_DRG 		Allogeneic Bone Marrow Transplant 2 $57,695.77 $57,695.77 $57,695.77 nat. median
$171,358
outlier · 0.3×
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 2 $57,255.86 $57,255.86 $57,255.86 nat. median
$122,016
outlier · 0.5×
14
APR_DRG 		Liver Transplant And/or Intestinal Transplant 2 $53,099.89 $53,099.89 $53,099.89 nat. median
$137,215
outlier · 0.4×
6024
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 $51,055.87 $51,055.87 $51,055.87 nat. median
$119,800
outlier · 0.4×
23
APR_DRG 		Heart And/or Lung Transplant 2 $50,647.26 $50,647.26 $50,647.26 nat. median
$111,079
outlier · 0.5×
5933
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 2 $49,936.95 $49,936.95 $49,936.95 nat. median
$109,393
outlier · 0.5×
5912
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 2 $48,857.66 $48,857.66 $48,857.66 nat. median
$83,372
0.6× median
5881
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $47,791.03 $47,791.03 $47,791.03 nat. median
$122,978
outlier · 0.4×
93
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 2 $42,399.26 $42,399.26 $42,399.26 nat. median
$79,816
0.5× median
1611
APR_DRG 		Implantable Heart Assist Systems 2 $42,353.30 $42,353.30 $42,353.30 nat. median
$77,137
0.5× median
1612
APR_DRG 		Implantable Heart Assist Systems 2 $42,353.30 $42,353.30 $42,353.30 nat. median
$85,665
outlier · 0.5×
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 2 $41,172.78 $41,172.78 $41,172.78 nat. median
$99,544
outlier · 0.4×
54
APR_DRG 		Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 $40,728.87 $40,728.87 $40,728.87 nat. median
$82,146
outlier · 0.5×
22
APR_DRG 		Heart And/or Lung Transplant 2 $39,092.79 $39,092.79 $39,092.79 nat. median
$93,125
outlier · 0.4×
5932
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 2 $38,826.72 $38,826.72 $38,826.72 nat. median
$86,338
outlier · 0.4×
6074
APR_DRG 		Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 $38,003.85 $38,003.85 $38,003.85 nat. median
$96,980
outlier · 0.4×
43
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 2 $37,953.90 $37,953.90 $37,953.90 nat. median
$75,127
0.5× median
6034
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 $36,926.56 $36,926.56 $36,926.56 nat. median
$107,562
outlier · 0.3×
J9347
HCPCS 		Tremelimumab-actl Soln For IV Infusion 300 Mg/15ml 13 $18,747.36 $46,671.07 $36,552.43 nat. median
$3,185
outlier · 11.5×
64
APR_DRG 		Pancreas Transplant 2 $35,808.31 $35,808.31 $35,808.31 nat. median
$92,076
outlier · 0.4×
8424
APR_DRG 		Burns With Skin Graft Except Extensive Third Degree Burns 2 $35,627.48 $35,627.48 $35,627.48 nat. median
$83,417
outlier · 0.4×
6023
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 $35,589.19 $35,589.19 $35,589.19 nat. median
$89,743
outlier · 0.4×
73
APR_DRG 		Allogeneic Bone Marrow Transplant 2 $34,375.36 $34,375.36 $34,375.36 nat. median
$89,273
outlier · 0.4×
33270
CPT 		Ins/rep Subq Defibrillator 2 $33,664.66 $33,664.66 $33,664.66 nat. median
$32,114
1.0× median

Other procedures at this hospital

Browse this hospital's 8,016 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
5834 APR_DRG Neonate With Ecmo 2 2 — — $182,097.58 $182,097.58 $182,097.58 2026-03-04
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $115,092.49 $115,092.49 $115,092.49 2026-03-04
5833 APR_DRG Neonate With Ecmo 2 2 — — $109,945.81 $109,945.81 $109,945.81 2026-03-04
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $103,131.42 $103,131.42 $103,131.42 2026-03-04
24 APR_DRG Heart And/or Lung Transplant 2 2 — — $93,658.59 $93,658.59 $93,658.59 2026-03-04
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $80,933.59 $80,933.59 $80,933.59 2026-03-04
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $80,494.01 $80,494.01 $80,494.01 2026-03-04
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $79,190.61 $79,190.61 $79,190.61 2026-03-04
1614 APR_DRG Implantable Heart Assist Systems 2 2 — — $77,875.22 $77,875.22 $77,875.22 2026-03-04
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $74,947.39 $74,947.39 $74,947.39 2026-03-04
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $74,503.48 $74,503.48 $74,503.48 2026-03-04
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $71,854.05 $71,854.05 $71,854.05 2026-03-04
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $69,902.28 $69,902.28 $69,902.28 2026-03-04
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $69,076.41 $69,076.41 $69,076.41 2026-03-04
5832 APR_DRG Neonate With Ecmo 2 2 — — $68,993.49 $68,993.49 $68,993.49 2026-03-04
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $68,020.43 $68,020.43 $68,020.43 2026-03-04
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $66,622.12 $66,622.12 $66,622.12 2026-03-04
1613 APR_DRG Implantable Heart Assist Systems 2 2 — — $62,664.29 $62,664.29 $62,664.29 2026-03-04
38240 CPT Transplt Allo Hct/donor 2 2 — — $62,099.45 $62,099.45 $62,099.45 2026-03-04
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 2 2 — — $61,127.11 $61,127.11 $61,127.11 2026-03-04
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 2 2 — — $61,127.11 $61,127.11 $61,127.11 2026-03-04
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 2 2 — — $61,127.11 $61,127.11 $61,127.11 2026-03-04
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $60,170.37 $60,170.37 $60,170.37 2026-03-04
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 2 2 — — $58,743.27 $58,743.27 $58,743.27 2026-03-04
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $58,696.47 $58,696.47 $58,696.47 2026-03-04
5831 APR_DRG Neonate With Ecmo 2 2 — — $58,213.27 $58,213.27 $58,213.27 2026-03-04
74 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $57,695.77 $57,695.77 $57,695.77 2026-03-04
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $57,255.86 $57,255.86 $57,255.86 2026-03-04
14 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $53,099.89 $53,099.89 $53,099.89 2026-03-04
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $51,055.87 $51,055.87 $51,055.87 2026-03-04
23 APR_DRG Heart And/or Lung Transplant 2 2 — — $50,647.26 $50,647.26 $50,647.26 2026-03-04
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $49,936.95 $49,936.95 $49,936.95 2026-03-04
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $48,857.66 $48,857.66 $48,857.66 2026-03-04
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $47,791.03 $47,791.03 $47,791.03 2026-03-04
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $42,399.26 $42,399.26 $42,399.26 2026-03-04
1611 APR_DRG Implantable Heart Assist Systems 2 2 — — $42,353.30 $42,353.30 $42,353.30 2026-03-04
1612 APR_DRG Implantable Heart Assist Systems 2 2 — — $42,353.30 $42,353.30 $42,353.30 2026-03-04
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $41,172.78 $41,172.78 $41,172.78 2026-03-04
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $40,728.87 $40,728.87 $40,728.87 2026-03-04
22 APR_DRG Heart And/or Lung Transplant 2 2 — — $39,092.79 $39,092.79 $39,092.79 2026-03-04
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $38,826.72 $38,826.72 $38,826.72 2026-03-04
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $38,003.85 $38,003.85 $38,003.85 2026-03-04
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $37,953.90 $37,953.90 $37,953.90 2026-03-04
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $36,926.56 $36,926.56 $36,926.56 2026-03-04
J9347 HCPCS Tremelimumab-actl Soln For IV Infusion 300 Mg/15ml 30 13 $49,335.17 $39,468.14 $18,747.36 $46,671.07 $36,552.43 2026-03-04
64 APR_DRG Pancreas Transplant 2 2 — — $35,808.31 $35,808.31 $35,808.31 2026-03-04
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 2 2 — — $35,627.48 $35,627.48 $35,627.48 2026-03-04
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $35,589.19 $35,589.19 $35,589.19 2026-03-04
73 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $34,375.36 $34,375.36 $34,375.36 2026-03-04
33270 CPT Ins/rep Subq Defibrillator 2 2 — — $33,664.66 $33,664.66 $33,664.66 2026-03-04
33231 CPT Insrt Pulse Gen W/mult Leads 2 2 — — $33,664.66 $33,664.66 $33,664.66 2026-03-04
33249 CPT Insj/rplcmt Defib W/lead(s) 2 2 — — $33,664.66 $33,664.66 $33,664.66 2026-03-04
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 2 2 — — $33,664.66 $33,664.66 $33,664.66 2026-03-04
69930 CPT Implant Cochlear Device 2 2 — — $33,398.21 $33,398.21 $33,398.21 2026-03-04
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 2 2 — — $32,025.64 $32,025.64 $32,025.64 2026-03-04
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 2 2 — — $31,997.27 $31,997.27 $31,997.27 2026-03-04
61886 CPT Implant Neurostim Arrays 2 2 — — $31,997.27 $31,997.27 $31,997.27 2026-03-04
64568 CPT Opn Impltj Crnl Nrv Nea&pg 2 2 — — $31,997.27 $31,997.27 $31,997.27 2026-03-04
63685 CPT Ins/rplc Spi Npg/rcvr Pocket 2 2 — — $31,997.27 $31,997.27 $31,997.27 2026-03-04
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $31,878.12 $31,878.12 $31,878.12 2026-03-04
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $31,101.53 $31,101.53 $31,101.53 2026-03-04
8634 APR_DRG Neonatal Aftercare 2 2 — — $30,555.40 $30,555.40 $30,555.40 2026-03-04
63 APR_DRG Pancreas Transplant 2 2 — — $30,475.47 $30,475.47 $30,475.47 2026-03-04
21 APR_DRG Heart And/or Lung Transplant 2 2 — — $29,967.30 $29,967.30 $29,967.30 2026-03-04
33289 CPT Tcat Impl Wrls P-art Prs Snr 2 2 — — $29,849.75 $29,849.75 $29,849.75 2026-03-04
4404 APR_DRG Kidney Transplant 2 2 — — $29,609.65 $29,609.65 $29,609.65 2026-03-04
C1722 HCPCS Icd Dynagen Mini Vr Df4 30 13 $39,732.00 $31,785.60 20% off $15,098.16 $37,586.47 $29,437.44 2026-03-04
13 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $29,324.26 $29,324.26 $29,324.26 2026-03-04
C9760 HCPCS Non-blind Interatrial Shunt 2 2 — — $28,875.53 $28,875.53 $28,875.53 2026-03-04
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $28,735.49 $28,735.49 $28,735.49 2026-03-04
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $28,734.49 $28,734.49 $28,734.49 2026-03-04
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $28,512.04 $28,512.04 $28,512.04 2026-03-04
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $27,341.51 $27,341.51 $27,341.51 2026-03-04
8514 APR_DRG Gender Related Procedures 2 2 — — $26,802.03 $26,802.03 $26,802.03 2026-03-04
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $26,689.14 $26,689.14 $26,689.14 2026-03-04
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $26,017.46 $26,017.46 $26,017.46 2026-03-04
2994 APR_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 2 2 — — $25,796.01 $25,796.01 $25,796.01 2026-03-04
62 APR_DRG Pancreas Transplant 2 2 — — $25,770.37 $25,770.37 $25,770.37 2026-03-04
93656 CPT Compre Ep Eval Abltj Atr Fib 2 2 — — $25,758.92 $25,758.92 $25,758.92 2026-03-04
93654 CPT Compre Ep Eval Tx Vt 2 2 — — $25,758.92 $25,758.92 $25,758.92 2026-03-04
93653 CPT Compre Ep Eval Tx Svt 2 2 — — $25,758.92 $25,758.92 $25,758.92 2026-03-04
72 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $25,585.55 $25,585.55 $25,585.55 2026-03-04
1784 APR_DRG External Heart Assist Devices 2 2 — — $25,501.96 $25,501.96 $25,501.96 2026-03-04
84 APR_DRG Autologous Bone Marrow Transplant 2 2 — — $25,070.38 $25,070.38 $25,070.38 2026-03-04
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $24,853.92 $24,853.92 $24,853.92 2026-03-04
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $24,512.58 $24,512.58 $24,512.58 2026-03-04
J2350 HCPCS Ocrelizumab Soln For IV Infusion 300 Mg/10ml 31 13 $32,695.53 $26,156.43 $60.94 $30,929.97 $24,224.12 2026-03-04
J0638 HCPCS Canakinumab Subcutaneous Inj 150 Mg/ml 31 13 $32,069.85 $25,655.88 $130.24 $30,338.08 $23,760.56 2026-03-04
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $23,669.07 $23,669.07 $23,669.07 2026-03-04
12 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $23,660.41 $23,660.41 $23,660.41 2026-03-04
33240 CPT Insrt Pulse Gen W/singl Lead 2 2 — — $23,568.50 $23,568.50 $23,568.50 2026-03-04
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 2 2 — — $23,568.50 $23,568.50 $23,568.50 2026-03-04
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 2 2 — — $23,568.50 $23,568.50 $23,568.50 2026-03-04
33230 CPT Insrt Pulse Gen W/dual Leads 2 2 — — $23,568.50 $23,568.50 $23,568.50 2026-03-04
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $23,469.60 $23,469.60 $23,469.60 2026-03-04
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $23,266.79 $23,266.79 $23,266.79 2026-03-04
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 2 2 — — $22,974.74 $22,974.74 $22,974.74 2026-03-04
1834 APR_DRG Percutaneous Structural Cardiac Procedures 2 2 — — $22,629.41 $22,629.41 $22,629.41 2026-03-04
64580 CPT Opn Impltj Nea Neuromuscular 2 2 — — $22,516.61 $22,516.61 $22,516.61 2026-03-04
61885 CPT Insrt/redo Neurostim 1 Array 2 2 — — $22,516.61 $22,516.61 $22,516.61 2026-03-04
64590 CPT Ins/rpl Prph Sac/gstr Npg/r 2 2 — — $22,516.61 $22,516.61 $22,516.61 2026-03-04
63655 CPT Implant Neuroelectrodes 2 2 — — $22,516.61 $22,516.61 $22,516.61 2026-03-04
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $22,277.08 $22,277.08 $22,277.08 2026-03-04
9104 APR_DRG Craniotomy For Multiple Significant Trauma 2 2 — — $21,944.07 $21,944.07 $21,944.07 2026-03-04
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 2 2 — — $21,926.76 $21,926.76 $21,926.76 2026-03-04
C1767 HCPCS Ipg Spectra*nlu* 74 13 $28,000.00 $22,400.00 20% off $10,307.50 $27,977.95 $21,912.12 2026-03-04
71 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $21,297.37 $21,297.37 $21,297.37 2026-03-04
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 2 2 — — $21,196.13 $21,196.13 $21,196.13 2026-03-04
1794 APR_DRG Defibrillator Implants 2 2 — — $21,175.48 $21,175.48 $21,175.48 2026-03-04
54401 CPT Insert Self-contd Prosthesis 2 2 — — $21,134.99 $21,134.99 $21,134.99 2026-03-04
54405 CPT Insert Multi-comp Penis Pros 2 2 — — $21,134.99 $21,134.99 $21,134.99 2026-03-04
54410 CPT Remove/replace Penis Prosth 2 2 — — $21,134.99 $21,134.99 $21,134.99 2026-03-04
54411 CPT Remov/replc Penis Pros Comp 2 2 — — $21,134.99 $21,134.99 $21,134.99 2026-03-04
54416 CPT Remv/repl Penis Contain Pros 2 2 — — $21,134.99 $21,134.99 $21,134.99 2026-03-04
53444 CPT Insert Tandem Cuff 2 2 — — $21,134.99 $21,134.99 $21,134.99 2026-03-04
53445 CPT Insert Uro/ves Nck Sphincter 2 2 — — $21,134.99 $21,134.99 $21,134.99 2026-03-04
53447 CPT Remove/replace Ur Sphincter 2 2 — — $21,134.99 $21,134.99 $21,134.99 2026-03-04
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 2 2 — — $21,069.92 $21,069.92 $21,069.92 2026-03-04
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 2 2 — — $20,957.36 $20,957.36 $20,957.36 2026-03-04
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 2 2 — — $20,804.51 $20,804.51 $20,804.51 2026-03-04
61 APR_DRG Pancreas Transplant 2 2 — — $20,795.52 $20,795.52 $20,795.52 2026-03-04
914 APR_DRG Other Major Head And Neck Procedures 2 2 — — $20,733.91 $20,733.91 $20,733.91 2026-03-04
1783 APR_DRG External Heart Assist Devices 2 2 — — $20,679.63 $20,679.63 $20,679.63 2026-03-04
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 2 2 — — $20,440.53 $20,440.53 $20,440.53 2026-03-04
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 2 2 — — $20,405.23 $20,405.23 $20,405.23 2026-03-04
2993 APR_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 2 2 — — $20,224.07 $20,224.07 $20,224.07 2026-03-04
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $20,146.48 $20,146.48 $20,146.48 2026-03-04
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 2 2 — — $20,114.85 $20,114.85 $20,114.85 2026-03-04
C1820 HCPCS Stim Restor Sens Surscan*obs* 96 13 $28,525.00 $22,820.00 20% off $10,307.50 $30,461.20 $20,096.92 2026-03-04
33274 CPT Tcat Insj/rpl Perm Ldls Pm 2 2 — — $20,024.72 $20,024.72 $20,024.72 2026-03-04
33229 CPT Remv&replc Pm Gen Mult Leads 2 2 — — $20,024.72 $20,024.72 $20,024.72 2026-03-04
33221 CPT Insert Pulse Gen Mult Leads 2 2 — — $20,024.72 $20,024.72 $20,024.72 2026-03-04
4403 APR_DRG Kidney Transplant 2 2 — — $19,710.57 $19,710.57 $19,710.57 2026-03-04
3004 APR_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 2 2 — — $19,505.44 $19,505.44 $19,505.44 2026-03-04
11 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $19,441.83 $19,441.83 $19,441.83 2026-03-04
C8003 HCPCS Imp Extar Knee Shck Absrb 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
22633 CPT Arthrd Cmbn 1ntrspc Lumbar 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
22856 CPT Tot Disc Arthrp 1ntrspc Crv 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
22612 CPT Arthrd Pst Tq 1ntrspc Lumbar 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
23616 CPT Optx Prx Hmrl Fx Fix Rpr Rpl 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
22630 CPT Arthrd Pst Tq 1ntrspc Lum 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
27702 CPT Reconstruct Ankle Joint 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
23472 CPT Reconstruct Shoulder Joint 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
20696 CPT App Mltpln Uni Xtrnl Fix 1st 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
28705 CPT Arthrodesis Pantalar 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
24371 CPT Revise Reconst Elbow Joint 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
27279 CPT Arthrd Si Jt Plmt Tartclr Dv 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
24363 CPT Replace Elbow Joint 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
25446 CPT Arthrp W/prostc Dst Rds&crps 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
21243 CPT Reconstruction Of Jaw Joint 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
25442 CPT Arthrp W/prostc Dstl Ulna 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
24361 CPT Reconstruct Elbow Joint 2 2 — — $19,309.55 $19,309.55 $19,309.55 2026-03-04
5931 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $19,247.35 $19,247.35 $19,247.35 2026-03-04
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $19,242.36 $19,242.36 $19,242.36 2026-03-04
1694 APR_DRG Major Abdominal Vascular Procedures 2 2 — — $19,138.12 $19,138.12 $19,138.12 2026-03-04
214 APR_DRG Open Craniotomy Except Trauma 2 2 — — $19,114.81 $19,114.81 $19,114.81 2026-03-04
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $19,103.49 $19,103.49 $19,103.49 2026-03-04
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $19,034.56 $19,034.56 $19,034.56 2026-03-04
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
C9602 HCPCS Perc D-e Cor Stent Ather S 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
C9765 HCPCS Revasc Intra Lithotrip-stent 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
C9766 HCPCS Revasc Intra Lithotrip-ather 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
93590 CPT Perq Transcath Cls Mitral 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
93581 CPT Transcath Closure Of Vsd 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
93591 CPT Perq Transcath Cls Aortic 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
92933 CPT Prq Trlml C Athrc St Angiop1 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
C9606 HCPCS Perc D-e Cor Revasc W Ami S 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
C9767 HCPCS Revasc Lithotrip-stent-ather 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
93582 CPT Perq Transcath Closure Pda 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
C9775 HCPCS Revasc Lith-sten-ath Tib/per 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
C9773 HCPCS Revasc Lithotr-stent Tib/per 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
C9774 HCPCS Revasc Lithotr-ather Tib/per 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
93580 CPT Transcath Closure Of Asd 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
37242 CPT Vasc Embolize/occlude Artery 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
37230 CPT Outpatient Services - Cpt/hcpcs 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
37231 CPT Outpatient Services - Cpt/hcpcs 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
37227 CPT Outpatient Services - Cpt/hcpcs 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
37225 CPT Outpatient Services - Cpt/hcpcs 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
36906 CPT Thrmbc/nfs Dialysis Circuit 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
33902 CPT Perq P-art Revsc 1 Abnor Uni 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
37229 CPT Outpatient Services - Cpt/hcpcs 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
37184 CPT Prim Art M-thrmbc 1st Vsl 2 2 — — $18,854.56 $18,854.56 $18,854.56 2026-03-04
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $18,824.76 $18,824.76 $18,824.76 2026-03-04
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $18,689.89 $18,689.89 $18,689.89 2026-03-04
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 2 2 — — $18,610.30 $18,610.30 $18,610.30 2026-03-04
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 2 2 — — $18,610.30 $18,610.30 $18,610.30 2026-03-04
62362 CPT Implant Spine Infusion Pump 2 2 — — $18,557.83 $18,557.83 $18,557.83 2026-03-04
62360 CPT Insert Spine Infusion Device 2 2 — — $18,557.83 $18,557.83 $18,557.83 2026-03-04
62361 CPT Implant Spine Infusion Pump 2 2 — — $18,557.83 $18,557.83 $18,557.83 2026-03-04
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 2 2 — — $18,459.12 $18,459.12 $18,459.12 2026-03-04
234 APR_DRG Spinal Procedures 2 2 — — $18,443.13 $18,443.13 $18,443.13 2026-03-04
C9758 HCPCS Blind Interatrial Shunt Ide 2 2 — — $18,375.53 $18,375.53 $18,375.53 2026-03-04
C8005 HCPCS Pef Bronch Ablt 3d Nav Ebus 2 2 — — $18,375.53 $18,375.53 $18,375.53 2026-03-04
19357 CPT Tiss Xpndr Plmt Brst Rcnstj 2 2 — — $18,268.26 $18,268.26 $18,268.26 2026-03-04
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $18,178.72 $18,178.72 $18,178.72 2026-03-04
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 2 2 — — $18,159.41 $18,159.41 $18,159.41 2026-03-04
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $18,097.13 $18,097.13 $18,097.13 2026-03-04
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 2 2 — — $18,082.81 $18,082.81 $18,082.81 2026-03-04
1653 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $18,071.49 $18,071.49 $18,071.49 2026-03-04
894 APR_DRG Major Cranial Or Facial Bone Procedures 2 2 — — $17,649.90 $17,649.90 $17,649.90 2026-03-04
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 2 2 — — $17,576.97 $17,576.97 $17,576.97 2026-03-04
7404 APR_DRG Mental Illness Diagnosis With O.r. Procedure 2 2 — — $17,533.35 $17,533.35 $17,533.35 2026-03-04
4014 APR_DRG Adrenal Procedures 2 2 — — $17,441.10 $17,441.10 $17,441.10 2026-03-04
6904 APR_DRG Acute Leukemia 2 2 — — $17,357.85 $17,357.85 $17,357.85 2026-03-04
1204 APR_DRG Major Respiratory And Chest Procedures 2 2 — — $17,324.55 $17,324.55 $17,324.55 2026-03-04
66683 CPT Implantation Iris Prosthesis 2 2 — — $17,237.25 $17,237.25 $17,237.25 2026-03-04
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 2 2 — — $17,229.31 $17,229.31 $17,229.31 2026-03-04
1622 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $17,048.82 $17,048.82 $17,048.82 2026-03-04
4402 APR_DRG Kidney Transplant 2 2 — — $17,013.18 $17,013.18 $17,013.18 2026-03-04
204 APR_DRG Open Craniotomy For Trauma 2 2 — — $16,936.26 $16,936.26 $16,936.26 2026-03-04
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $16,769.42 $16,769.42 $16,769.42 2026-03-04
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 2 2 — — $16,740.45 $16,740.45 $16,740.45 2026-03-04
4414 APR_DRG Major Bladder Procedures 2 2 — — $16,732.46 $16,732.46 $16,732.46 2026-03-04
1782 APR_DRG External Heart Assist Devices 2 2 — — $16,670.52 $16,670.52 $16,670.52 2026-03-04
5204 APR_DRG Other GYN Procedures For Malignancy 2 2 — — $16,549.63 $16,549.63 $16,549.63 2026-03-04
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 2 2 — — $16,494.35 $16,494.35 $16,494.35 2026-03-04
83 APR_DRG Autologous Bone Marrow Transplant 2 2 — — $16,444.07 $16,444.07 $16,444.07 2026-03-04
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $16,239.27 $16,239.27 $16,239.27 2026-03-04
67027 CPT Implant Eye Drug System 2 2 — — $16,133.07 $16,133.07 $16,133.07 2026-03-04
2614 APR_DRG Major Biliary Tract Procedures 2 2 — — $16,017.48 $16,017.48 $16,017.48 2026-03-04
4854 APR_DRG Prostatectomy Procedures 2 2 — — $15,968.86 $15,968.86 $15,968.86 2026-03-04
1833 APR_DRG Percutaneous Structural Cardiac Procedures 2 2 — — $15,944.89 $15,944.89 $15,944.89 2026-03-04
6092 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $15,914.91 $15,914.91 $15,914.91 2026-03-04
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 2 2 — — $15,763.06 $15,763.06 $15,763.06 2026-03-04
1793 APR_DRG Defibrillator Implants 2 2 — — $15,632.52 $15,632.52 $15,632.52 2026-03-04
4401 APR_DRG Kidney Transplant 2 2 — — $15,543.27 $15,543.27 $15,543.27 2026-03-04
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 2 2 — — $15,472.68 $15,472.68 $15,472.68 2026-03-04
3214 APR_DRG Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 2 2 — — $15,429.72 $15,429.72 $15,429.72 2026-03-04
1663 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 2 2 — — $15,387.43 $15,387.43 $15,387.43 2026-03-04
1781 APR_DRG External Heart Assist Devices 2 2 — — $15,294.85 $15,294.85 $15,294.85 2026-03-04
6021 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $15,256.22 $15,256.22 $15,256.22 2026-03-04
2992 APR_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical 2 2 — — $15,152.32 $15,152.32 $15,152.32 2026-03-04
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $15,113.02 $15,113.02 $15,113.02 2026-03-04
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 2 2 — — $15,087.38 $15,087.38 $15,087.38 2026-03-04
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 2 2 — — $15,073.06 $15,073.06 $15,073.06 2026-03-04
2304 APR_DRG Major Small Bowel Procedures 2 2 — — $15,033.10 $15,033.10 $15,033.10 2026-03-04
6954 APR_DRG Chemotherapy For Acute Leukemia 2 2 — — $15,027.11 $15,027.11 $15,027.11 2026-03-04
274 APR_DRG Other Open Craniotomy 2 2 — — $15,016.12 $15,016.12 $15,016.12 2026-03-04
65770 CPT Keratoprosthesis 2 2 — — $15,003.78 $15,003.78 $15,003.78 2026-03-04
1814 APR_DRG Lower Extremity Vascular Procedures 2 2 — — $15,003.13 $15,003.13 $15,003.13 2026-03-04
3043 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 2 2 — — $14,969.83 $14,969.83 $14,969.83 2026-03-04
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 2 2 — — $14,920.21 $14,920.21 $14,920.21 2026-03-04
1652 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $14,850.28 $14,850.28 $14,850.28 2026-03-04
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 2 2 — — $14,833.96 $14,833.96 $14,833.96 2026-03-04
5114 APR_DRG Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 2 2 — — $14,761.70 $14,761.70 $14,761.70 2026-03-04
5124 APR_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy 2 2 — — $14,689.43 $14,689.43 $14,689.43 2026-03-04
1621 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $14,648.81 $14,648.81 $14,648.81 2026-03-04
1214 APR_DRG Other Respiratory And Chest Procedures 2 2 — — $14,647.48 $14,647.48 $14,647.48 2026-03-04
J9272 HCPCS Dostarlimab-gxly IV Soln 500 Mg/10ml (50 Mg/ml) 31 13 $19,493.48 $15,594.79 $283.24 $18,440.83 $14,442.72 2026-03-04
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 2 2 — — $14,427.02 $14,427.02 $14,427.02 2026-03-04
3032 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $14,227.22 $14,227.22 $14,227.22 2026-03-04
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 2 2 — — $14,209.23 $14,209.23 $14,209.23 2026-03-04
1632 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $14,205.24 $14,205.24 $14,205.24 2026-03-04
8633 APR_DRG Neonatal Aftercare 2 2 — — $14,144.63 $14,144.63 $14,144.63 2026-03-04
4054 APR_DRG Other Procedures For Endocrine, Nutritional And Metabolic Disorders 2 2 — — $14,143.63 $14,143.63 $14,143.63 2026-03-04
1602 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $14,127.98 $14,127.98 $14,127.98 2026-03-04
1704 APR_DRG Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock 2 2 — — $14,044.73 $14,044.73 $14,044.73 2026-03-04
4284 APR_DRG Genetic Disorders 2 2 — — $14,037.40 $14,037.40 $14,037.40 2026-03-04
4034 APR_DRG Procedures For Obesity 2 2 — — $14,034.74 $14,034.74 $14,034.74 2026-03-04
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 2 2 — — $13,922.18 $13,922.18 $13,922.18 2026-03-04
1754 APR_DRG Percutaneous Cardiac Intervention Without Ami 2 2 — — $13,884.22 $13,884.22 $13,884.22 2026-03-04
2644 APR_DRG Other Hepatobiliary, Pancreas And Abdominal Procedures 2 2 — — $13,836.26 $13,836.26 $13,836.26 2026-03-04
1303 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 2 2 — — $13,804.29 $13,804.29 $13,804.29 2026-03-04
294 APR_DRG Other Percutaneous Intracranial Procedures 2 2 — — $13,793.64 $13,793.64 $13,793.64 2026-03-04
224 APR_DRG Ventricular Shunt Procedures 2 2 — — $13,783.31 $13,783.31 $13,783.31 2026-03-04
7114 APR_DRG Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 2 2 — — $13,737.02 $13,737.02 $13,737.02 2026-03-04
6224 APR_DRG Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $13,707.05 $13,707.05 $13,707.05 2026-03-04
54400 CPT Insert Semi-rigid Prosthesis 2 2 — — $13,642.04 $13,642.04 $13,642.04 2026-03-04
53451 CPT Tprnl Balo Cntnc Dev Bi 2 2 — — $13,642.04 $13,642.04 $13,642.04 2026-03-04
54417 CPT Remv/replc Penis Pros Compl 2 2 — — $13,642.04 $13,642.04 $13,642.04 2026-03-04
53440 CPT Male Sling Procedure 2 2 — — $13,642.04 $13,642.04 $13,642.04 2026-03-04
1651 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $13,557.53 $13,557.53 $13,557.53 2026-03-04
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 2 2 — — $13,546.88 $13,546.88 $13,546.88 2026-03-04
C9757 HCPCS Spine Device Implant Surgery 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
25391 CPT Lengthen Radius Or Ulna 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
27709 CPT Osteotomy Tibia & Fibula 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
25365 CPT Revise Radius & Ulna 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
23680 CPT Optx Sho Dislc Neck Fx Fixj 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
24346 CPT Reconstruct Elbow Med Ligmnt 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
23802 CPT Arthrd Glenohumeral Jt W/grf 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
69730 CPT Rplc Oi Implt Sk Tc Esp>=100 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
69729 CPT Impl Oi Implt Sk Tc Esp>=100 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
69714 CPT Impl Oi Implt Skull Perq Esp 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
69716 CPT Impl Oi Implt Sk Tc Esp<100 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
25810 CPT Arthrd Wrst Iliac/oth Agrft 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
69719 CPT Rplcm Oi Implt Sk Tc Esp<100 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
23615 CPT Optx Prox Humrl Fx W/int Fix 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
24666 CPT Optx Radial Head/nck Fx Rplc 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
23491 CPT Reinforce Shoulder Bones 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
24802 CPT Arthrd Elbow Jt Autog Graft 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
24587 CPT Optx Partclr Fx&/dslc Elbw W 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
24586 CPT Optx Partclr Fx&/dislc Elbow 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
22551 CPT Arthrd Ant Ntrbdy Cervical 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
22554 CPT Arthrd Ant Ntrbd Min Dsc Crv 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
64628 CPT Trml Dstrj Ios Bvn 1st 2 L/s 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
27441 CPT Revision Of Knee Joint 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
23470 CPT Reconstruct Shoulder Joint 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
24545 CPT Optx Hum Fx Wo Ntrcndylr Xtn 2 2 — — $13,510.16 $13,510.16 $13,510.16 2026-03-04
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