Hospital

LIVINGSTON HEALTHCARE

Livingston, MT · CCN 271317 · Rates published

4,572 distinct procedures filed

14 distinct payers

93,518 rate rows

2026-06-04 last MRF observed

Data quality

92,246 of 93,518 rate rows are consumer-grade (98.6%)

1,272 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 — reason	Rows
per-diem day rate — not a per-procedure price	644
template filing: same amount across many unrelated codes — excluded	560
percent-of-charges filed in the dollar field — excluded from medians	50
exceeds 10× this hospital's gross charge — excluded from medians	18

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbLivingstonHCMT&type=CDMWithoutLabel&fileType=CSV
Found on page	https://www.livingstonhealthcare.org/cms-hpt.txt
Discovered via	Discovered by HANK (automated)
Last fetch	success · 2026-06-08
Content fingerprint	bf9a371a44f5bc03… · 52,175,409 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
455 MS_DRG	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	10	$133,092.80	$147,880.89	$140,486.84	nat. median $48,483 outlier · 2.9×
454 MS_DRG	Combined Anterior And Posterior Spinal Fusion With Cc	10	$130,143.00	$144,603.33	$137,373.17	nat. median $62,270 outlier · 2.2×
329 MS_DRG	Major Small And Large Bowel Procedures With Mcc	10	$92,403.85	$102,670.95	$97,537.40	nat. median $44,810 outlier · 2.2×
208 MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	10	$91,130.17	$101,255.75	$96,192.96	nat. median $26,748 outlier · 3.6×
457 MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	10	$75,621.20	$84,023.55	$79,822.37	nat. median $58,024 1.4× median
519 MS_DRG	Back And Neck Procedures Except Spinal Fusion With Cc	10	$67,829.11	$75,365.68	$71,597.40	nat. median $20,499 outlier · 3.5×
330 MS_DRG	Major Small And Large Bowel Procedures With Cc	10	$66,625.34	$74,028.16	$70,326.75	nat. median $24,346 outlier · 2.9×
473 MS_DRG	Cervical Spinal Fusion Without Cc/mcc	10	$66,607.94	$74,008.82	$70,308.38	nat. median $24,796 outlier · 2.8×
622 MS_DRG	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…	10	$63,303.03	$70,336.70	$66,819.87	nat. median $35,325 1.9× median
468 MS_DRG	Revision Of Hip Or Knee Replacement Without Cc/mcc	10	$62,214.08	$69,126.75	$65,670.42	nat. median $27,218 outlier · 2.4×
472 MS_DRG	Cervical Spinal Fusion With Cc	10	$58,169.31	$64,632.57	$61,400.94	nat. median $29,860 outlier · 2.1×
335 MS_DRG	Peritoneal Adhesiolysis With Mcc	10	$56,693.84	$62,993.15	$59,843.49	nat. median $35,058 1.7× median
460 MS_DRG	Spinal Fusion Except Cervical Without Mcc	10	$55,961.19	$62,179.10	$59,070.15	nat. median $39,075 1.5× median
539 MS_DRG	Osteomyelitis With Mcc	10	$55,050.48	$61,167.20	$58,108.84	nat. median $19,718 outlier · 2.9×
J2350 HCPCS	Injection, Ocrelizumab, 1 Mg	14	$26,330.59	$49,680.35	$47,196.33	nat. median $712 outlier · 66.3×
470 MS_DRG	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without…	10	$44,468.33	$49,409.25	$46,938.79	nat. median $20,059 outlier · 2.3×
467 MS_DRG	Revision Of Hip Or Knee Replacement With Cc	10	$44,044.45	$48,938.28	$46,491.37	nat. median $34,721 1.3× median
637 MS_DRG	Diabetes With Mcc	10	$43,288.22	$48,098.03	$45,693.12	nat. median $14,789 outlier · 3.1×
418 MS_DRG	Laparoscopic Cholecystectomy Without C.d.e. With Cc	10	$40,609.58	$45,121.75	$42,865.66	nat. median $17,483 outlier · 2.5×
813 MS_DRG	Coagulation Disorders	10	$40,546.15	$45,051.28	$42,798.71	nat. median $15,711 outlier · 2.7×
J2507 HCPCS	Injection, Pegloticase, 1 Mg	14	$23,704.59	$44,725.65	$42,489.37	nat. median $8,558 outlier · 5.0×
949 MS_DRG	Aftercare With Cc/mcc	10	$38,917.04	$43,241.15	$41,079.09	nat. median $12,475 outlier · 3.3×
315 MS_DRG	Other Circulatory System Diagnoses With Cc	10	$36,947.61	$41,052.90	$39,000.26	nat. median $10,515 outlier · 3.7×
J9334 HCPCS	Injection, Efgartigimod Alfa, 2 Mg And Hyaluronidase-qvfc	14	$21,066.44	$39,748.00	$37,760.60	nat. median $73 outlier · 514.7×
488 MS_DRG	Knee Procedures Without Principal Diagnosis Of Infection With Cc/mcc	10	$33,592.73	$37,325.25	$35,458.99	nat. median $19,302 1.8× median
417 MS_DRG	Laparoscopic Cholecystectomy Without C.d.e. With Mcc	10	$33,250.23	$36,944.70	$35,097.47	nat. median $23,832 1.5× median
489 MS_DRG	Knee Procedures Without Principal Diagnosis Of Infection Without Cc/mcc	10	$32,815.49	$36,461.65	$34,638.57	nat. median $12,955 outlier · 2.7×
J9043 HCPCS	Injection, Cabazitaxel, 1 Mg	14	$18,874.12	$35,611.55	$33,830.97	nat. median $739 outlier · 45.8×
552 MS_DRG	Medical Back Problems Without Mcc	10	$31,666.42	$35,184.91	$33,425.66	nat. median $10,424 outlier · 3.2×
742 MS_DRG	Uterine And Adnexa Procedures For Non-malignancy With Cc/mcc	10	$31,098.29	$34,553.65	$32,825.97	nat. median $18,902 1.7× median
264 MS_DRG	Other Circulatory System O.r. Procedures	10	$30,975.53	$34,417.25	$32,696.39	nat. median $33,061 1.0× median
J9228 HCPCS	Injection, Ipilimumab, 1 Mg	14	$10,528.16	$79,457.45	$30,988.45	nat. median $9,906 outlier · 3.1×
J3245 HCPCS	Injection, Tildrakizumab, 1 Mg	14	$17,135.22	$32,330.60	$30,714.07	nat. median $256 outlier · 119.9×
788 MS_DRG	Cesarean Section Without Sterilization Without Cc/mcc	10	$28,390.22	$31,544.69	$29,967.45	nat. median $10,164 outlier · 2.9×
308 MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Mcc	10	$26,243.15	$29,159.05	$27,701.10	nat. median $12,751 outlier · 2.2×
871 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	10	$25,251.88	$28,057.64	$26,654.76	nat. median $19,635 1.4× median
445 MS_DRG	Disorders Of The Biliary Tract With Cc	10	$25,012.42	$27,791.58	$26,402.00	nat. median $11,641 outlier · 2.3×
J9144 HCPCS	Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj	14	$14,119.81	$26,641.15	$25,309.09	nat. median $233 outlier · 108.6×
82 MS_DRG	Traumatic Stupor And Coma >1 Hour With Mcc	10	$23,910.44	$26,567.15	$25,238.79	nat. median $22,770 1.1× median
328 MS_DRG	Stomach, Esophageal And Duodenal Procedures Without Cc/mcc	10	$23,835.83	$26,484.25	$25,160.04	nat. median $16,642 1.5× median
958 MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Cc	10	$23,615.73	$26,239.70	$24,927.72	nat. median $41,228 0.6× median
J3590 HCPCS	Unclassified Biologics	14	$13,853.80	$26,139.25	$24,832.29	nat. median $682 outlier · 36.4×
784 MS_DRG	Cesarean Section With Sterilization With Cc	10	$22,788.09	$25,320.10	$24,054.10	nat. median $11,116 outlier · 2.2×
743 MS_DRG	Uterine And Adnexa Procedures For Non-malignancy Without Cc/mcc	10	$20,870.48	$23,189.43	$22,029.95	nat. median $13,187 1.7× median
543 MS_DRG	Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With…	10	$20,523.33	$22,803.70	$21,663.52	nat. median $11,222 1.9× median
638 MS_DRG	Diabetes With Cc	10	$20,388.66	$22,654.07	$21,521.37	nat. median $9,826 outlier · 2.2×
806 MS_DRG	Vaginal Delivery Without Sterilization Or D&c With Cc	10	$20,301.63	$22,557.37	$21,429.50	nat. median $8,000 outlier · 2.7×
377 MS_DRG	Gastrointestinal Hemorrhage With Mcc	10	$19,970.51	$22,189.45	$21,079.98	nat. median $18,249 1.2× median
178 MS_DRG	Respiratory Infections And Inflammations With Cc	10	$19,925.69	$22,139.65	$21,032.67	nat. median $10,875 1.9× median
768 MS_DRG	Vaginal Delivery With O.r. Procedures Except Sterilization And/or D&c	10	$19,844.30	$22,049.23	$20,946.76	nat. median $10,536 2.0× median

Other procedures at this hospital

Browse this hospital's 4,572 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

125	MS_DRG	Other Disorders Of The Eye Without Mcc	10	10	$18,619.75	$17,688.76	$16,757.78	$18,619.75	$17,688.76	2026-06-04
152	MS_DRG	Otitis Media And Uri With Mcc	10	10	$9,462.00	$8,988.90	$8,515.80	$9,462.00	$8,988.90	2026-06-04
175	MS_DRG	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	10	10	$8,105.47	$7,700.20	$7,294.93	$8,105.47	$7,700.20	2026-06-04
176	MS_DRG	Pulmonary Embolism Without Mcc	10	10	$13,672.05	$12,988.45	$12,304.85	$13,672.05	$12,988.45	2026-06-04
177	MS_DRG	Respiratory Infections And Inflammations With Mcc	10	10	$17,089.30	$16,234.83	$15,380.37	$17,089.30	$16,234.83	2026-06-04
178	MS_DRG	Respiratory Infections And Inflammations With Cc	10	10	$22,139.65	$21,032.67	$19,925.69	$22,139.65	$21,032.67	2026-06-04
181	MS_DRG	Respiratory Neoplasms With Cc	10	10	$18,097.15	$17,192.29	$16,287.44	$18,097.15	$17,192.29	2026-06-04
186	MS_DRG	Pleural Effusion With Mcc	10	10	$11,633.10	$11,051.45	$10,469.79	$11,633.10	$11,051.45	2026-06-04
187	MS_DRG	Pleural Effusion With Cc	10	10	$17,100.15	$16,245.14	$15,390.14	$17,100.15	$16,245.14	2026-06-04
189	MS_DRG	Pulmonary Edema And Respiratory Failure	10	10	$19,360.76	$18,392.72	$17,424.68	$19,360.76	$18,392.72	2026-06-04
190	MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	10	10	$12,170.95	$11,562.40	$10,953.85	$12,170.95	$11,562.40	2026-06-04
191	MS_DRG	Chronic Obstructive Pulmonary Disease With Cc	10	10	$8,295.10	$7,880.35	$7,465.59	$8,295.10	$7,880.34	2026-06-04
193	MS_DRG	Simple Pneumonia And Pleurisy With Mcc	10	10	$16,679.68	$15,845.70	$15,011.71	$16,679.68	$15,845.70	2026-06-04
194	MS_DRG	Simple Pneumonia And Pleurisy With Cc	10	10	$18,002.53	$17,102.40	$16,202.27	$18,002.53	$17,102.40	2026-06-04
195	MS_DRG	Simple Pneumonia And Pleurisy Without Cc/mcc	10	10	$7,088.63	$6,734.19	$6,379.76	$7,088.63	$6,734.19	2026-06-04
203	MS_DRG	Bronchitis And Asthma Without Cc/mcc	10	10	$6,827.13	$6,485.78	$6,144.42	$6,827.13	$6,485.78	2026-06-04
208	MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	10	10	$101,255.75	$96,192.96	$91,130.17	$101,255.75	$96,192.96	2026-06-04
264	MS_DRG	Other Circulatory System O.r. Procedures	10	10	$34,417.25	$32,696.39	$30,975.53	$34,417.25	$32,696.39	2026-06-04
280	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Mcc	10	10	$19,028.50	$18,077.08	$17,125.65	$19,028.50	$18,077.08	2026-06-04
281	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Cc	10	10	$9,256.50	$8,793.68	$8,330.85	$9,256.50	$8,793.68	2026-06-04
282	MS_DRG	Acute Myocardial Infarction, Discharged Alive Without Cc/mcc	10	10	$14,124.80	$13,418.56	$12,712.32	$14,124.80	$13,418.56	2026-06-04
291	MS_DRG	Heart Failure And Shock With Mcc	10	10	$20,087.49	$19,083.12	$18,078.74	$20,087.49	$19,083.12	2026-06-04
292	MS_DRG	Heart Failure And Shock With Cc	10	10	$21,495.67	$20,420.89	$19,346.10	$21,495.67	$20,420.89	2026-06-04
301	MS_DRG	Peripheral Vascular Disorders Without Cc/mcc	10	10	$7,524.10	$7,147.90	$6,771.69	$7,524.10	$7,147.90	2026-06-04
303	MS_DRG	Atherosclerosis Without Mcc	10	10	$6,673.50	$6,339.83	$6,006.15	$6,673.50	$6,339.83	2026-06-04
308	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Mcc	10	10	$29,159.05	$27,701.10	$26,243.15	$29,159.05	$27,701.10	2026-06-04
310	MS_DRG	Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc	10	10	$19,403.58	$18,433.40	$17,463.22	$19,403.58	$18,433.40	2026-06-04
312	MS_DRG	Syncope And Collapse	10	10	$14,090.45	$13,385.93	$12,681.41	$14,090.45	$13,385.93	2026-06-04
314	MS_DRG	Other Circulatory System Diagnoses With Mcc	10	10	$7,951.37	$7,553.80	$7,156.23	$7,951.37	$7,553.80	2026-06-04
315	MS_DRG	Other Circulatory System Diagnoses With Cc	10	10	$41,052.90	$39,000.26	$36,947.61	$41,052.90	$39,000.26	2026-06-04
316	MS_DRG	Other Circulatory System Diagnoses Without Cc/mcc	10	10	$17,091.50	$16,236.93	$15,382.35	$17,091.50	$16,236.93	2026-06-04
328	MS_DRG	Stomach, Esophageal And Duodenal Procedures Without Cc/mcc	10	10	$26,484.25	$25,160.04	$23,835.83	$26,484.25	$25,160.04	2026-06-04
329	MS_DRG	Major Small And Large Bowel Procedures With Mcc	10	10	$102,670.95	$97,537.40	$92,403.85	$102,670.95	$97,537.40	2026-06-04
330	MS_DRG	Major Small And Large Bowel Procedures With Cc	10	10	$74,028.16	$70,326.75	$66,625.34	$74,028.16	$70,326.75	2026-06-04
335	MS_DRG	Peritoneal Adhesiolysis With Mcc	10	10	$62,993.15	$59,843.49	$56,693.84	$62,993.15	$59,843.49	2026-06-04
346	MS_DRG	Minor Small And Large Bowel Procedures Without Cc/mcc	10	10	$18,793.00	$17,853.35	$16,913.70	$18,793.00	$17,853.35	2026-06-04
372	MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	10	10	$7,996.77	$7,596.93	$7,197.09	$7,996.77	$7,596.93	2026-06-04
373	MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/mcc	10	10	$21,870.67	$20,777.13	$19,683.60	$21,870.67	$20,777.13	2026-06-04
375	MS_DRG	Digestive Malignancy With Cc	10	10	$17,980.80	$17,081.76	$16,182.72	$17,980.80	$17,081.76	2026-06-04
376	MS_DRG	Digestive Malignancy Without Cc/mcc	10	10	$21,410.20	$20,339.69	$19,269.18	$21,410.20	$20,339.69	2026-06-04
377	MS_DRG	Gastrointestinal Hemorrhage With Mcc	10	10	$22,189.45	$21,079.98	$19,970.51	$22,189.45	$21,079.98	2026-06-04
378	MS_DRG	Gastrointestinal Hemorrhage With Cc	10	10	$10,345.55	$9,828.27	$9,311.00	$10,345.55	$9,828.27	2026-06-04
379	MS_DRG	Gastrointestinal Hemorrhage Without Cc/mcc	10	10	$12,298.05	$11,683.15	$11,068.25	$12,298.05	$11,683.15	2026-06-04
384	MS_DRG	Uncomplicated Peptic Ulcer Without Mcc	10	10	$21,589.45	$20,509.98	$19,430.51	$21,589.45	$20,509.98	2026-06-04
388	MS_DRG	Gastrointestinal Obstruction With Mcc	10	10	$11,012.95	$10,462.30	$9,911.66	$11,012.95	$10,462.30	2026-06-04
389	MS_DRG	Gastrointestinal Obstruction With Cc	10	10	$11,259.99	$10,696.99	$10,133.99	$11,259.99	$10,696.99	2026-06-04
391	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	10	10	$11,020.85	$10,469.81	$9,918.77	$11,020.85	$10,469.81	2026-06-04
392	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	10	10	$10,278.93	$9,764.98	$9,251.04	$10,278.93	$9,764.98	2026-06-04
399	MS_DRG	Appendix Procedures Without Cc/mcc	10	10	$17,164.80	$16,306.56	$15,448.32	$17,164.80	$16,306.56	2026-06-04
417	MS_DRG	Laparoscopic Cholecystectomy Without C.d.e. With Mcc	10	10	$36,944.70	$35,097.47	$33,250.23	$36,944.70	$35,097.47	2026-06-04
418	MS_DRG	Laparoscopic Cholecystectomy Without C.d.e. With Cc	10	10	$45,121.75	$42,865.66	$40,609.58	$45,121.75	$42,865.66	2026-06-04
438	MS_DRG	Disorders Of Pancreas Except Malignancy With Mcc	10	10	$20,124.65	$19,118.42	$18,112.19	$20,124.65	$19,118.42	2026-06-04
439	MS_DRG	Disorders Of Pancreas Except Malignancy With Cc	10	10	$6,912.45	$6,566.83	$6,221.21	$6,912.45	$6,566.83	2026-06-04
441	MS_DRG	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc	10	10	$13,093.97	$12,439.27	$11,784.57	$13,093.97	$12,439.27	2026-06-04
442	MS_DRG	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc	10	10	$15,689.06	$14,904.61	$14,120.15	$15,689.06	$14,904.61	2026-06-04
443	MS_DRG	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without C…	10	10	$11,376.12	$10,807.31	$10,238.50	$11,376.12	$10,807.31	2026-06-04
444	MS_DRG	Disorders Of The Biliary Tract With Mcc	10	10	$10,192.60	$9,682.97	$9,173.34	$10,192.60	$9,682.97	2026-06-04
445	MS_DRG	Disorders Of The Biliary Tract With Cc	10	10	$27,791.58	$26,402.00	$25,012.42	$27,791.58	$26,402.00	2026-06-04
454	MS_DRG	Combined Anterior And Posterior Spinal Fusion With Cc	10	10	$144,603.33	$137,373.17	$130,143.00	$144,603.33	$137,373.17	2026-06-04
455	MS_DRG	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	10	10	$147,880.89	$140,486.84	$133,092.80	$147,880.89	$140,486.84	2026-06-04
457	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	10	10	$84,023.55	$79,822.37	$75,621.20	$84,023.55	$79,822.37	2026-06-04
458	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	10	10	$9,976.00	$9,477.20	$8,978.40	$9,976.00	$9,477.20	2026-06-04
460	MS_DRG	Spinal Fusion Except Cervical Without Mcc	10	10	$62,179.10	$59,070.15	$55,961.19	$62,179.10	$59,070.15	2026-06-04
467	MS_DRG	Revision Of Hip Or Knee Replacement With Cc	10	10	$48,938.28	$46,491.37	$44,044.45	$48,938.28	$46,491.37	2026-06-04
468	MS_DRG	Revision Of Hip Or Knee Replacement Without Cc/mcc	10	10	$69,126.75	$65,670.42	$62,214.08	$69,126.75	$65,670.42	2026-06-04
470	MS_DRG	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without …	10	10	$49,409.25	$46,938.79	$44,468.33	$49,409.25	$46,938.79	2026-06-04
472	MS_DRG	Cervical Spinal Fusion With Cc	10	10	$64,632.57	$61,400.94	$58,169.31	$64,632.57	$61,400.94	2026-06-04
473	MS_DRG	Cervical Spinal Fusion Without Cc/mcc	10	10	$74,008.82	$70,308.38	$66,607.94	$74,008.82	$70,308.38	2026-06-04
488	MS_DRG	Knee Procedures Without Principal Diagnosis Of Infection With Cc/mcc	10	10	$37,325.25	$35,458.99	$33,592.73	$37,325.25	$35,458.99	2026-06-04
489	MS_DRG	Knee Procedures Without Principal Diagnosis Of Infection Without Cc/mcc	10	10	$36,461.65	$34,638.57	$32,815.49	$36,461.65	$34,638.57	2026-06-04
519	MS_DRG	Back And Neck Procedures Except Spinal Fusion With Cc	10	10	$75,365.68	$71,597.40	$67,829.11	$75,365.68	$71,597.40	2026-06-04
537	MS_DRG	Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/mcc	10	10	$14,857.80	$14,114.91	$13,372.02	$14,857.80	$14,114.91	2026-06-04
539	MS_DRG	Osteomyelitis With Mcc	10	10	$61,167.20	$58,108.84	$55,050.48	$61,167.20	$58,108.84	2026-06-04
543	MS_DRG	Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With…	10	10	$22,803.70	$21,663.52	$20,523.33	$22,803.70	$21,663.52	2026-06-04
544	MS_DRG	Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With…	10	10	$15,561.55	$14,783.47	$14,005.40	$15,561.55	$14,783.47	2026-06-04
552	MS_DRG	Medical Back Problems Without Mcc	10	10	$35,184.91	$33,425.66	$31,666.42	$35,184.91	$33,425.66	2026-06-04
556	MS_DRG	Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc	10	10	$16,143.40	$15,336.23	$14,529.06	$16,143.40	$15,336.23	2026-06-04
563	MS_DRG	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…	10	10	$10,543.22	$10,016.06	$9,488.90	$10,543.22	$10,016.06	2026-06-04
57	MS_DRG	Degenerative Nervous System Disorders Without Mcc	10	10	$18,634.28	$17,702.56	$16,770.85	$18,634.28	$17,702.56	2026-06-04
603	MS_DRG	Cellulitis Without Mcc	10	10	$11,082.63	$10,528.50	$9,974.37	$11,082.63	$10,528.50	2026-06-04
605	MS_DRG	Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc	10	10	$8,272.05	$7,858.45	$7,444.85	$8,272.05	$7,858.45	2026-06-04
622	MS_DRG	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…	10	10	$70,336.70	$66,819.87	$63,303.03	$70,336.70	$66,819.87	2026-06-04
629	MS_DRG	Other Endocrine, Nutritional And Metabolic O.r. Procedures With Cc	10	10	$14,261.90	$13,548.81	$12,835.71	$14,261.90	$13,548.81	2026-06-04
637	MS_DRG	Diabetes With Mcc	10	10	$48,098.03	$45,693.12	$43,288.22	$48,098.03	$45,693.12	2026-06-04
638	MS_DRG	Diabetes With Cc	10	10	$22,654.07	$21,521.37	$20,388.66	$22,654.07	$21,521.37	2026-06-04
639	MS_DRG	Diabetes Without Cc/mcc	10	10	$12,802.40	$12,162.28	$11,522.16	$12,802.40	$12,162.28	2026-06-04
640	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…	10	10	$11,740.30	$11,153.29	$10,566.27	$11,740.30	$11,153.29	2026-06-04
641	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	10	10	$11,131.36	$10,574.80	$10,018.23	$11,131.36	$10,574.80	2026-06-04
645	MS_DRG	Endocrine Disorders Without Cc/mcc	10	10	$16,705.35	$15,870.08	$15,034.82	$16,705.35	$15,870.08	2026-06-04
65	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	10	10	$13,116.49	$12,460.66	$11,804.84	$13,116.49	$12,460.66	2026-06-04
66	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc	10	10	$15,154.55	$14,396.82	$13,639.10	$15,154.55	$14,396.82	2026-06-04
683	MS_DRG	Renal Failure With Cc	10	10	$11,428.13	$10,856.72	$10,285.32	$11,428.13	$10,856.72	2026-06-04
689	MS_DRG	Kidney And Urinary Tract Infections With Mcc	10	10	$10,862.10	$10,318.99	$9,775.89	$10,862.10	$10,318.99	2026-06-04
699	MS_DRG	Other Kidney And Urinary Tract Diagnoses With Cc	10	10	$7,032.20	$6,680.59	$6,328.98	$7,032.20	$6,680.59	2026-06-04
700	MS_DRG	Other Kidney And Urinary Tract Diagnoses Without Cc/mcc	10	10	$11,679.20	$11,095.24	$10,511.28	$11,679.20	$11,095.24	2026-06-04
722	MS_DRG	Malignancy, Male Reproductive System With Mcc	10	10	$8,194.90	$7,785.16	$7,375.41	$8,194.90	$7,785.16	2026-06-04
7334810_1	CDM	Aeq Rev Ii Glenoid 36x35__dwd182	14	14	$12,053.90	$11,451.21	$6,388.57	$12,053.90	$11,451.21	2026-06-04
7334811_1	CDM	Flex Shoulder Sys Rev Tray 6__dwf521	14	14	$7,025.20	$6,673.94	$3,723.36	$7,025.20	$6,673.94	2026-06-04
7334812_1	CDM	Aeq Ascend Flex Std Sz 6b__dwf606b	14	14	$15,663.00	$14,879.85	$8,301.39	$15,663.00	$14,879.85	2026-06-04
7334820_1	CDM	Aeq Rev Ii Thread Bp 29__dwe840	14	14	$8,321.40	$7,905.33	$4,410.34	$8,321.40	$7,905.33	2026-06-04
7334821_1	CDM	Aeq Rev Ctr Glen Sz 42__dwd193	14	14	$11,699.70	$11,114.72	$6,200.84	$11,699.70	$11,114.72	2026-06-04
7334823_1	CDM	Aeq Ascend Flex Std Size 8b__dwf608b	14	14	$15,663.00	$14,879.85	$8,301.39	$15,663.00	$14,879.85	2026-06-04
7334824_1	CDM	Affiniti Cortiloc Glen Size 56__0020064	14	14	$7,795.20	$7,405.44	$4,131.46	$7,795.20	$7,405.44	2026-06-04
7334825_1	CDM	Flex Shoulder Sys Head 52x23__dwf153	14	14	$12,171.60	$11,563.02	$6,450.95	$12,171.60	$11,563.02	2026-06-04
7334826_1	CDM	Aeq Ascend Flex Sz 6c__dwf606c	14	14	$15,663.00	$14,879.85	$8,301.39	$15,663.00	$14,879.85	2026-06-04
7334828_1	CDM	Aeq Rev Ii Thread Bp 29__dwe835	14	14	$8,321.40	$7,905.33	$4,410.34	$8,321.40	$7,905.33	2026-06-04
7334829_1	CDM	Aeq Asc Flex Ptc Hum Std,7b__dwf607b	14	14	$15,663.00	$14,879.85	$8,301.39	$15,663.00	$14,879.85	2026-06-04
7364460_1	CDM	Affiniti Cort Glen Size 40__0020060	14	14	$7,795.20	$7,405.44	$4,131.46	$7,795.20	$7,405.44	2026-06-04
7364462_1	CDM	Aequalis Hum Head Shoulder__dwf146	14	14	$12,171.60	$11,563.02	$6,450.95	$12,171.60	$11,563.02	2026-06-04
7364467_1	CDM	Affiniti Cortiloc Glen Size 52__0020063	14	14	$7,795.20	$7,405.44	$4,131.46	$7,795.20	$7,405.44	2026-06-04
7364468_1	CDM	Aeq Ascend Flex Ptc 6a 127.5__dwf606a	14	14	$15,663.00	$14,879.85	$8,301.39	$15,663.00	$14,879.85	2026-06-04
7364474_1	CDM	Aeq Rev Ii Glenoid Bp 36__dwd180	14	14	$11,699.70	$11,114.72	$6,200.84	$11,699.70	$11,114.72	2026-06-04
7364476_1	CDM	Flex Shoulder Sys Rev Tray__dwf520	14	14	$7,025.20	$6,673.94	$3,723.36	$7,025.20	$6,673.94	2026-06-04
7364477_1	CDM	Aeq Ascend Flex Sz 5b__dwf605b	14	14	$15,663.00	$14,879.85	$8,301.39	$15,663.00	$14,879.85	2026-06-04
7364478_1	CDM	Aeq Rev Ii Thread Bp 25__dwe730	14	14	$8,321.40	$7,905.33	$4,410.34	$8,321.40	$7,905.33	2026-06-04
7365869_1	CDM	Cruciate Retain Journey Sz 6 L__74021166	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7365874_1	CDM	Bi Cruciate Stab Jrny Bcs Sz 4__74022114	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7365877_1	CDM	Cruciate Retain Journey Sz 6 R__74021156	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7365878_1	CDM	Bi Cruciate Stab Jrny Bcs Sz 7__74022117	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7365886_1	CDM	Polarstem Lateral Sz 5__75 100 478	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7365890_1	CDM	Bi Cruciate Stab Jrny Bcs Sz 5__74022125	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7365893_1	CDM	Polarstem Std Ti Ha Sz 3__75 100 466	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7365895_1	CDM	Bi Cruciate Stab Jrny Sz 5__74022115	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7365897_1	CDM	Journey Ii Cr Oxi Fem Sz 4 L__74021164	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7366122_1	CDM	Journey Ii Cr Femoral Oxi Sz8__74021158	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7366124_1	CDM	Journey Ii Bcs Femoral Oxi Sz7__74022127	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7366128_1	CDM	Polarstem Lateral 126deg Sz9__75100482	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7366133_1	CDM	Polarstem Lateral Ccd 126dg S3__75100476	14	14	$9,760.00	$9,272.00	$5,172.80	$9,760.00	$9,272.00	2026-06-04
7367952_1	CDM	Integra Matrix Wound Dress__54051	14	14	$12,598.50	$11,968.58	$6,677.21	$12,598.50	$11,968.58	2026-06-04
7367953_1	CDM	Primatrix 8x8__607-001-880	14	14	$8,087.80	$7,683.41	$4,286.53	$8,087.80	$7,683.41	2026-06-04
7400060_1	CDM	Jrny2 Cr Fem Ox Np R Sz 10__74021150	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400061_1	CDM	Jrny2 Cr Fem Ox Np R Sz 1__74021151	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400062_1	CDM	Jrny2 Cr Fem Ox Np R Sz 2__74021152	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400063_1	CDM	Jrny2 Cr Fem Ox Np R Sz 3__74021153	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400064_1	CDM	Jrny2 Cr Fem Ox Np R Sz 4__74021154	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400065_1	CDM	Jrny2 Cr Fem Ox Np R Sz5__74021155	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400066_1	CDM	Jrny2 Cr Fem Ox Np R Sz 7__74021157	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400067_1	CDM	Jrny2 Cr Fem Ox Np R Sz 9__74021159	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400068_1	CDM	Jrny2 Cr Fem Ox Np Lf Sz 10__74021160	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400069_1	CDM	Jrny2 Cr Fem Ox Np Lf Sz 1__74021161	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400070_1	CDM	Jrny2 Cr Fem Ox Np Lf Sz 2__74021162	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400071_1	CDM	Jrny2 Cr Fem Ox Np Lf Sz 3__74021163	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400072_1	CDM	Jrny2 Cr Fem Ox Np Lf Sz 5__74021165	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400073_1	CDM	Jrny2 Cr Fem Ox Np Lf Sz 7__74021167	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400074_1	CDM	Jrny2 Cr Fem Ox Np Lf Sz 8__74021168	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400075_1	CDM	Jrny2 Cr Fem Ox Np Lf Sz 9__74021169	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400076_1	CDM	Jrny2 Bcs Fem Oxin R Sz 10__74022110	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400077_1	CDM	Jrny2 Bcs Fem Oxin R Sz 1__74022111	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400078_1	CDM	Jrny2 Bcs Fem Oxin R Sz 2__74022112	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400079_1	CDM	Jrny2 Bcs Fem Oxin R Sz 3__74022113	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400080_1	CDM	Jrny2 Bcs Fem Oxin R Sz 6__74022116	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400081_1	CDM	Jrny2 Bcs Fem Oxin R Sz 8__74022118	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400082_1	CDM	Jrny2 Bcs Fem Oxin R Sz 9__74022119	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400083_1	CDM	Jrny2 Bcs Fem Oxin Lf Sz 10__74022120	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400084_1	CDM	Jrny2 Bcs Fem Oxin Lf Sz 1__74022121	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400085_1	CDM	Jrny2 Bcs Fem Oxin Lf Sz 2__74022122	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400086_1	CDM	Jrny2 Bcs Fem Oxin Lf Sz 3__74022123	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400087_1	CDM	Jrny2 Bcs Fem Oxin Lf Sz 4__74022124	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400088_1	CDM	Jrny2 Bcs Fem Oxin Lf Sz 6__74022126	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400089_1	CDM	Jrny2 Bcs Fem Oxin Lf Sz 8__74022128	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400090_1	CDM	Jrny2 Bcs Fem Oxin Lf Sz 9__74022129	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400091_1	CDM	Journey Tibia Base Np R Sz 1__74022211	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400092_1	CDM	Journey Tibia Base Np R Sz 2__74022212	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400093_1	CDM	Journey Tibia Base Np R Sz 7__74022217	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400094_1	CDM	Journey Tibia Base Np R Sz 8__74022218	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400095_1	CDM	Journey Tibia Base Np Lf Sz 1__74022221	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400096_1	CDM	Journey Tibia Base Np Lf Sz 2__74022222	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400097_1	CDM	Journey Tibia Base Np Lf Sz 4__74022224	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400098_1	CDM	Journey Tibia Base Np Lf Sz 6__74022226	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400099_1	CDM	Journey Tibia Base Np Lf Sz 7__74022227	14	14	$10,194.60	$9,684.87	$5,403.14	$10,194.60	$9,684.87	2026-06-04
7400369_1	CDM	Polarstem Collar Lat Ti/ha 6__75018417	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400370_1	CDM	Polarstem Collar Lat Ti/ha 7__75018418	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400371_1	CDM	Polarstem Collar Lat Ti/ha 8__75018419	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400372_1	CDM	Polrstm Stem Std Ti/ha 01 No-c__75100462	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400373_1	CDM	Polrstm Stem Std Ti/ha 0 No-c__75100463	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400374_1	CDM	Polrstm Stem Std Ti/ha 1 No-c__75100464	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400375_1	CDM	Polrstm Stem Std Ti/ha 2 No-c__75100465	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400376_1	CDM	Polrstm Stem Std Ti/ha 3 No-c__75100466	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400377_1	CDM	Polrstm Stem Std Ti/ha 4 No-c__75100467	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400378_1	CDM	Polrstm Stem Std Ti/ha 5 No-c__75100468	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400379_1	CDM	Polrstm Stem Std Ti/ha 6 No-c__75100469	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400380_1	CDM	Polrstm Stem Std Ti/ha 7 No-c__75100470	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400381_1	CDM	Polrstm Stem Std Ti/ha 8 No-c__75100471	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400382_1	CDM	Polrstm Stem Std Ti/ha 9 No-c__75100472	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400383_1	CDM	Polrstm Stem Std Ti/ha 10 No-c__75100473	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400384_1	CDM	Polrstm Stem Latti/ha 1 No-c__75100474	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400385_1	CDM	Polrstm Stem Latti/ha 2 No-c__75100475	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400386_1	CDM	Polrstm Stem Latti/ha 4 No-c__75100477	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400387_1	CDM	Polrstm Stem Latti/ha 5 No-c__75100478	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400388_1	CDM	Polrstm Stem Latti/ha 6 No-c__75100479	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400389_1	CDM	Polrstm Stem Latti/ha 7 No-c__75100480	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400390_1	CDM	Polrstm Stem Latti/ha 8 No-c__75100481	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400391_1	CDM	Polrstm Stem Latti/ha 10 No-c__75100483	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400392_1	CDM	Polrstm Stem Std Ti/ha 11 No-c__75100509	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400393_1	CDM	Polrstm Stem Latti/ha 11 No-c__75100510	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400394_1	CDM	Polarstem Valgus Ti/ha 0__75102072	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400395_1	CDM	Polarstem Valgus Ti/ha 1__75102073	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400396_1	CDM	Polarstem Valgus Ti/ha 2__75102074	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400397_1	CDM	Polarstem Valgus Ti/ha 3__75102075	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400398_1	CDM	Polarstem Valgus Ti/ha 4__75102076	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400399_1	CDM	Polarstem Valgus Ti/ha 5__75102077	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400400_1	CDM	Polarstem Valgus Ti/ha 6__75102078	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400401_1	CDM	Polarstem Valgus Ti/ha 7__75102079	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400402_1	CDM	Polarstem Collar Lat Ti/ha 9__75102209	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400403_1	CDM	Polarstem Collar Lat Ti/ha 10__75102210	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
7400404_1	CDM	Polarstem Collar Lat Ti/ha 11__75102211	14	14	$10,474.20	$9,950.49	$5,551.33	$10,474.20	$9,950.49	2026-06-04
742	MS_DRG	Uterine And Adnexa Procedures For Non-malignancy With Cc/mcc	10	10	$34,553.65	$32,825.97	$31,098.29	$34,553.65	$32,825.97	2026-06-04
7422078_1	CDM	Affiniti Cortiloc Pegged Glen__20062	14	14	$7,795.20	$7,405.44	$4,131.46	$7,795.20	$7,405.44	2026-06-04
7422079_1	CDM	Aequalis Hum Head 46mmx17mm__dwf046	14	14	$11,525.80	$10,949.51	$6,108.67	$11,525.80	$10,949.51	2026-06-04
743	MS_DRG	Uterine And Adnexa Procedures For Non-malignancy Without Cc/mcc	10	10	$23,189.43	$22,029.95	$20,870.48	$23,189.43	$22,029.95	2026-06-04
768	MS_DRG	Vaginal Delivery With O.r. Procedures Except Sterilization And/or D&c	10	10	$22,049.23	$20,946.76	$19,844.30	$22,049.23	$20,946.76	2026-06-04
776	MS_DRG	Postpartum And Post Abortion Diagnoses Without O.r. Procedures	10	10	$6,930.25	$6,583.74	$6,237.23	$6,930.25	$6,583.74	2026-06-04
784	MS_DRG	Cesarean Section With Sterilization With Cc	10	10	$25,320.10	$24,054.10	$22,788.09	$25,320.10	$24,054.10	2026-06-04
787	MS_DRG	Cesarean Section Without Sterilization With Cc	10	10	$20,906.28	$19,860.97	$18,815.65	$20,906.28	$19,860.97	2026-06-04
788	MS_DRG	Cesarean Section Without Sterilization Without Cc/mcc	10	10	$31,544.69	$29,967.45	$28,390.22	$31,544.69	$29,967.45	2026-06-04
8024989_1	CDM	Labor Room/delivery - Delivery Room	14	14	$8,038.00	$7,636.10	$4,260.14	$8,038.00	$7,636.10	2026-06-04
8024990_1	CDM	Labor Room/delivery - Delivery Room	14	14	$13,779.00	$13,090.05	$7,302.87	$13,779.00	$13,090.05	2026-06-04
8028195_1	CDM	Intensive Care Unit - Medical	10	10	$8,930.25	$8,483.74	$8,037.23	$8,930.25	$8,483.74	2026-06-04
805	MS_DRG	Vaginal Delivery Without Sterilization Or D&c With Mcc	10	10	$16,001.20	$15,201.14	$14,401.08	$16,001.20	$15,201.14	2026-06-04
806	MS_DRG	Vaginal Delivery Without Sterilization Or D&c With Cc	10	10	$22,557.37	$21,429.50	$20,301.63	$22,557.37	$21,429.50	2026-06-04
807	MS_DRG	Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc	10	10	$16,893.43	$16,048.76	$15,204.09	$16,893.43	$16,048.76	2026-06-04
812	MS_DRG	Red Blood Cell Disorders Without Mcc	10	10	$7,574.60	$7,195.87	$6,817.14	$7,574.60	$7,195.87	2026-06-04
813	MS_DRG	Coagulation Disorders	10	10	$45,051.28	$42,798.71	$40,546.15	$45,051.28	$42,798.71	2026-06-04
82	MS_DRG	Traumatic Stupor And Coma >1 Hour With Mcc	10	10	$26,567.15	$25,238.79	$23,910.44	$26,567.15	$25,238.79	2026-06-04
8339183_1	CDM	Ryanodex 250 Mg Vial	14	14	$7,106.50	$6,751.18	$3,766.45	$7,106.50	$6,751.18	2026-06-04
8402091_1	CDM	Labor Room/delivery - Delivery Room	14	14	$8,038.00	$7,636.10	$4,260.14	$8,038.00	$7,636.10	2026-06-04
8410218_1	CDM	Operating Room Services - General Classification	14	14	$9,393.00	$8,923.35	$4,978.29	$9,393.00	$8,923.35	2026-06-04
8410219_1	CDM	Operating Room Services - General Classification	14	14	$12,580.00	$11,951.00	$6,667.40	$12,580.00	$11,951.00	2026-06-04
858	MS_DRG	Postoperative Or Post-traumatic Infections With O.r. Procedures Without Cc/mcc	10	10	$20,653.65	$19,620.97	$18,588.29	$20,653.65	$19,620.97	2026-06-04
865	MS_DRG	Viral Illness With Mcc	10	10	$6,873.75	$6,530.06	$6,186.38	$6,873.75	$6,530.06	2026-06-04
871	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	10	10	$28,057.64	$26,654.76	$25,251.88	$28,057.64	$26,654.76	2026-06-04
872	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	10	10	$9,921.93	$9,425.84	$8,929.74	$9,921.93	$9,425.84	2026-06-04
880	MS_DRG	Acute Adjustment Reaction And Psychosocial Dysfunction	10	10	$7,051.85	$6,699.26	$6,346.67	$7,051.85	$6,699.26	2026-06-04
884	MS_DRG	Organic Disturbances And Intellectual Disability	10	10	$14,757.30	$14,019.44	$13,281.57	$14,757.30	$14,019.44	2026-06-04
8917770_1	CDM	Labor Room/delivery - Delivery Room	14	14	$8,165.00	$7,756.75	$4,327.45	$8,165.00	$7,756.75	2026-06-04
8919460_1	CDM	Labor Room/delivery - Delivery Room	14	14	$8,737.00	$8,300.15	$4,630.61	$8,737.00	$8,300.15	2026-06-04
8920784_1	CDM	Labor Room/delivery - Delivery Room	14	14	$13,997.00	$13,297.15	$7,418.41	$13,997.00	$13,297.15	2026-06-04
8928709_1	CDM	Strand Plus Fibers Large__02-7300-100	14	14	$7,042.50	$6,690.38	$3,732.53	$7,042.50	$6,690.38	2026-06-04
8929634_1	CDM	Trinity Elite Large 10.6cc__410003	14	14	$7,899.20	$7,504.24	$4,186.58	$7,899.20	$7,504.24	2026-06-04
8929635_1	CDM	Trinity Elite Extra Large 16cc__410004	14	14	$10,274.60	$9,760.87	$5,445.54	$10,274.60	$9,760.87	2026-06-04
8948124_1	CDM	Operating Room Services - General Classification	14	14	$14,000.00	$13,300.00	$7,420.00	$14,000.00	$13,300.00	2026-06-04
897	MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	10	10	$13,560.31	$12,882.30	$12,204.28	$13,560.31	$12,882.30	2026-06-04
908	MS_DRG	Other O.r. Procedures For Injuries With Cc	10	10	$21,064.60	$20,011.37	$18,958.14	$21,064.60	$20,011.37	2026-06-04
91	MS_DRG	Other Disorders Of Nervous System With Mcc	10	10	$15,661.35	$14,878.28	$14,095.22	$15,661.35	$14,878.28	2026-06-04
918	MS_DRG	Poisoning And Toxic Effects Of Drugs Without Mcc	10	10	$15,469.50	$14,696.03	$13,922.55	$15,469.50	$14,696.03	2026-06-04
921	MS_DRG	Complications Of Treatment Without Cc/mcc	10	10	$11,864.95	$11,271.70	$10,678.46	$11,864.95	$11,271.70	2026-06-04
923	MS_DRG	Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc	10	10	$9,469.45	$8,995.98	$8,522.51	$9,469.45	$8,995.98	2026-06-04
93	MS_DRG	Other Disorders Of Nervous System Without Cc/mcc	10	10	$11,209.48	$10,649.00	$10,088.53	$11,209.48	$10,649.00	2026-06-04
947	MS_DRG	Signs And Symptoms With Mcc	10	10	$6,649.63	$6,317.14	$5,984.66	$6,649.63	$6,317.14	2026-06-04
948	MS_DRG	Signs And Symptoms Without Mcc	10	10	$6,889.43	$6,544.95	$6,200.48	$6,889.43	$6,544.95	2026-06-04
949	MS_DRG	Aftercare With Cc/mcc	10	10	$43,241.15	$41,079.09	$38,917.04	$43,241.15	$41,079.09	2026-06-04
950	MS_DRG	Aftercare Without Cc/mcc	10	10	$9,011.15	$8,560.59	$8,110.04	$9,011.15	$8,560.59	2026-06-04
951	MS_DRG	Other Factors Influencing Health Status	10	10	$8,967.21	$8,518.85	$8,070.49	$8,967.21	$8,518.85	2026-06-04
958	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Cc	10	10	$26,239.70	$24,927.72	$23,615.73	$26,239.70	$24,927.72	2026-06-04
C1763	HCPCS	Connective Tissue, Non-human (includes Synthetic)	14	14	$11,100.00	$10,545.00	$5,883.00	$11,100.00	$10,545.00	2026-06-04
C1832	HCPCS	Autograft Suspension, Including Cell Processing And Application, And All System …	14	14	$13,750.00	$13,062.50	$7,287.50	$13,750.00	$13,062.50	2026-06-04
J0517	HCPCS	Injection, Benralizumab, 1 Mg	14	14	$11,557.95	$10,980.05	$6,125.71	$11,557.95	$10,980.05	2026-06-04
J0630	HCPCS	Injection, Calcitonin Salmon, Up To 400 Units	14	14	$7,890.15	$7,495.64	$4,181.78	$7,890.15	$7,495.64	2026-06-04
J0896	HCPCS	Injection, Luspatercept-aamt, 0.25 Mg	28	14	$14,752.55	$14,014.92	$4,975.64	$20,117.10	$10,025.03	2026-06-04
J1162	HCPCS	Injection, Digoxin Immune Fab (ovine), Per Vial	14	14	$11,793.60	$11,203.92	$6,250.61	$11,793.60	$11,203.92	2026-06-04
J1299	HCPCS	Injection, Eculizumab, 2 Mg	14	14	$19,725.60	$18,739.32	$10,454.57	$19,725.60	$18,739.32	2026-06-04
J1306	HCPCS	Injection, Inclisiran, 1 Mg	14	14	$9,402.75	$8,932.61	$4,983.46	$9,402.75	$8,932.61	2026-06-04
J1459	HCPCS	Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui…	14	14	$14,926.80	$14,180.46	$7,911.20	$14,926.80	$14,180.46	2026-06-04
J1569	HCPCS	Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),…	70	14	$6,929.60	$6,583.12	$924.16	$20,758.70	$6,583.12	2026-06-04
J1930	HCPCS	Injection, Lanreotide, 1 Mg	14	14	$18,000.00	$17,100.00	$9,540.00	$18,000.00	$17,100.00	2026-06-04
J1932	HCPCS	Injection, Lanreotide, (cipla), 1 Mg	14	14	$18,000.00	$17,100.00	$9,540.00	$18,000.00	$17,100.00	2026-06-04
J2323	HCPCS	Injection, Natalizumab, 1 Mg	14	14	$21,515.15	$20,439.39	$11,403.03	$21,515.15	$20,439.39	2026-06-04
J2350	HCPCS	Injection, Ocrelizumab, 1 Mg	14	14	$49,680.35	$47,196.33	$26,330.59	$49,680.35	$47,196.33	2026-06-04
J2353	HCPCS	Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg	56	14	$11,066.55	$10,513.23	$4,523.18	$14,931.15	$9,877.35	2026-06-04
J2356	HCPCS	Injection, Tezepelumab-ekko, 1 Mg	14	14	$9,695.35	$9,210.58	$5,138.54	$9,695.35	$9,210.58	2026-06-04
J2427	HCPCS	Injection, Paliperidone Palmitate Extended Release (invega Hafyera, Or Invega Tr…	28	14	$18,522.25	$17,596.14	$7,853.54	$22,226.50	$14,077.10	2026-06-04
J2506	HCPCS	Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg	28	14	$17,086.67	$16,232.34	$8,571.88	$18,000.00	$15,364.68	2026-06-04
J2507	HCPCS	Injection, Pegloticase, 1 Mg	14	14	$44,725.65	$42,489.37	$23,704.59	$44,725.65	$42,489.37	2026-06-04
J2802	HCPCS	Injection, Romiplostim, 1 Microgram	42	14	$6,607.25	$6,276.89	$1,750.96	$13,214.50	$6,276.89	2026-06-04
J3101	HCPCS	Injection, Tenecteplase, 1 Mg	14	14	$14,935.10	$14,188.35	$7,915.60	$14,935.10	$14,188.35	2026-06-04
J3245	HCPCS	Injection, Tildrakizumab, 1 Mg	14	14	$32,330.60	$30,714.07	$17,135.22	$32,330.60	$30,714.07	2026-06-04
J3380	HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	14	14	$18,195.70	$17,285.92	$9,643.72	$18,195.70	$17,285.92	2026-06-04
J3590	HCPCS	Unclassified Biologics	14	14	$26,139.25	$24,832.29	$13,853.80	$26,139.25	$24,832.29	2026-06-04
J9022	HCPCS	Injection, Atezolizumab, 10 Mg	28	14	$25,569.08	$24,290.62	$11,160.16	$30,081.25	$20,004.06	2026-06-04
J9033	HCPCS	Injection, Bendamustine Hydrochloride, 1 Mg	14	14	$9,733.15	$9,246.49	$5,158.57	$9,733.15	$9,246.49	2026-06-04
J9034	HCPCS	Injection, Bendamustine Hcl (bendeka), 1 Mg	14	14	$7,421.40	$7,050.33	$3,933.34	$7,421.40	$7,050.33	2026-06-04
J9042	HCPCS	Injection, Brentuximab Vedotin, 1 Mg	14	14	$18,000.00	$17,100.00	$9,540.00	$18,000.00	$17,100.00	2026-06-04
J9043	HCPCS	Injection, Cabazitaxel, 1 Mg	14	14	$35,611.55	$33,830.97	$18,874.12	$35,611.55	$33,830.97	2026-06-04
J9144	HCPCS	Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj	14	14	$26,641.15	$25,309.09	$14,119.81	$26,641.15	$25,309.09	2026-06-04
J9217	HCPCS	Leuprolide Acetate (for Depot Suspension), 7.5 Mg	84	14	$10,716.48	$10,180.65	$1,809.84	$24,339.45	$7,284.68	2026-06-04
J9223	HCPCS	Injection, Lurbinectedin, 0.1 Mg	14	14	$15,195.60	$14,435.82	$8,053.67	$15,195.60	$14,435.82	2026-06-04
J9228	HCPCS	Injection, Ipilimumab, 1 Mg	28	14	$49,660.95	$47,177.90	$10,528.16	$79,457.45	$30,988.45	2026-06-04
J9271	HCPCS	Injection, Pembrolizumab, 1 Mg	14	14	$14,570.90	$13,842.36	$7,722.58	$14,570.90	$13,842.36	2026-06-04
J9299	HCPCS	Injection, Nivolumab, 1 Mg	56	14	$9,257.65	$8,794.77	$1,803.51	$20,417.05	$8,081.75	2026-06-04
J9301	HCPCS	Injection, Obinutuzumab, 10 Mg	14	14	$21,539.05	$20,462.10	$11,415.70	$21,539.05	$20,462.10	2026-06-04
J9303	HCPCS	Injection, Panitumumab, 10 Mg	28	14	$10,271.70	$9,758.12	$2,177.61	$16,434.70	$6,409.55	2026-06-04
J9306	HCPCS	Injection, Pertuzumab, 1 Mg	14	14	$17,187.55	$16,328.17	$9,109.40	$17,187.55	$16,328.17	2026-06-04
J9308	HCPCS	Injection, Ramucirumab, 5 Mg	28	14	$11,738.92	$11,151.98	$2,073.89	$19,564.85	$7,141.19	2026-06-04
J9317	HCPCS	Injection, Sacituzumab Govitecan-hziy, 2.5 Mg	14	14	$7,226.80	$6,865.46	$3,830.20	$7,226.80	$6,865.46	2026-06-04
J9332	HCPCS	Injection, Efgartigimod Alfa-fcab, 2mg	14	14	$15,911.70	$15,116.12	$8,433.20	$15,911.70	$15,116.12	2026-06-04
J9334	HCPCS	Injection, Efgartigimod Alfa, 2 Mg And Hyaluronidase-qvfc	14	14	$39,748.00	$37,760.60	$21,066.44	$39,748.00	$37,760.60	2026-06-04
J9354	HCPCS	Injection, Ado-trastuzumab Emtansine, 1 Mg	28	14	$10,293.03	$9,778.38	$4,600.85	$11,905.20	$8,246.81	2026-06-04
J9358	HCPCS	Injection, Fam-trastuzumab Deruxtecan-nxki, 1 Mg	14	14	$6,675.25	$6,341.49	$3,537.88	$6,675.25	$6,341.49	2026-06-04
J9999	HCPCS	Not Otherwise Classified, Antineoplastic Drugs	28	14	$12,113.47	$11,507.80	$3,300.28	$18,000.00	$7,883.48	2026-06-04
Q5111	HCPCS	Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg	28	14	$10,510.50	$9,984.98	$5,565.00	$10,521.00	$9,975.00	2026-06-04

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