Price Transparency 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

AVERA CREIGHTON HOSPITAL

Creighton, NE · CCN 281331 · Rates published

849 distinct procedures filed
5 distinct payers
12,532 rate rows
2026-05-09 last MRF observed
Data quality

12,507 of 12,532 rate rows are consumer-grade (99.8%)

25 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
exceeds 10× this hospital's gross charge — excluded from medians 12
percent-of-charges filed in the dollar field — excluded from medians 10
placeholder amount (≤ $0.02) — excluded from medians 2
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.avera.org/app/files/public/94f0fb48-c0d0-4b65-b98b-5628b62587c7/460225483_avera-creighton-hospital_standardcharges.csv
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-05-17
Content fingerprint 171b7afa1de13e22… · 3,257,546 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
862
OTHER 		Ms-DRG 862 1 $207,498.78 $207,498.78 $207,498.78 nat. median
$15,153
outlier · 13.7×
325
OTHER 		Ms-DRG 325 1 $145,735.46 $145,735.46 $145,735.46 nat. median
$24,525
outlier · 5.9×
182
OTHER 		Ms-DRG 182 1 $115,441.39 $115,441.39 $115,441.39 nat. median
$8,573
outlier · 13.5×
192
OTHER 		Ms-DRG 192 1 $107,374.00 $107,374.00 $107,374.00 nat. median
$6,927
outlier · 15.5×
344
OTHER 		Ms-DRG 344 1 $99,886.82 $99,886.82 $99,886.82 nat. median
$22,960
outlier · 4.4×
308
OTHER 		Ms-DRG 308 1 $95,496.45 $95,496.45 $95,496.45 nat. median
$11,836
outlier · 8.1×
314
OTHER 		Ms-DRG 314 1 $87,150.74 $87,150.74 $87,150.74 nat. median
$20,076
outlier · 4.3×
305
OTHER 		Ms-DRG 305 1 $77,600.30 $77,600.30 $77,600.30 nat. median
$56
outlier · 1379.6×
323
OTHER 		Ms-DRG 323 1 $74,695.78 $74,695.78 $74,695.78 nat. median
$31,081
outlier · 2.4×
322
OTHER 		Ms-DRG 322 1 $70,206.18 $70,206.18 $70,206.18 nat. median
$15,755
outlier · 4.5×
247
OTHER 		Ms-DRG 247 1 $54,967.72 $54,967.72 $54,967.72 nat. median
$2,024
outlier · 27.2×
469
OTHER 		Ms-DRG 469 1 $54,290.65 $54,290.65 $54,290.65 nat. median
$28,227
1.9× median
263
OTHER 		Ms-DRG 263 1 $50,527.23 $50,527.23 $50,527.23 nat. median
$26,524
1.9× median
463
OTHER 		Ms-DRG 463 1 $42,795.71 $42,795.71 $42,795.71 nat. median
$48,651
0.9× median
231
OTHER 		Ms-DRG 231 1 $41,103.34 $41,103.34 $41,103.34 nat. median
$74,989
0.5× median
721
OTHER 		Ms-DRG 721 1 $40,151.46 $40,151.46 $40,151.46 nat. median
$24
outlier · 1661.9×
720
OTHER 		Ms-DRG 720 1 $36,767.75 $36,767.75 $36,767.75 nat. median
$2,844
outlier · 12.9×
45
OTHER 		Ms-DRG 45 1 $35,125.14 $35,125.14 $35,125.14 nat. median
$10,377
outlier · 3.4×
24
OTHER 		Ms-DRG 24 1 $30,625.87 $30,625.87 $30,625.87 nat. median
$27,988
1.1× median
201
OTHER 		Ms-DRG 201 1 $29,389.50 $29,389.50 $29,389.50 nat. median
$7,601
outlier · 3.9×
347
OTHER 		Ms-DRG 347 1 $26,942.76 $26,942.76 $26,942.76 nat. median
$24,311
1.1× median
J3101
OTHER 		Tenecteplase 50 Mg/10 Ml Syrng 5 $0.41 $30,005.60 $25,662.68 nat. median
$195
outlier · 131.6×
241
OTHER 		Ms-DRG 241 1 $24,609.82 $24,609.82 $24,609.82 nat. median
$14,138
1.7× median
140
OTHER 		Ms-DRG 140 1 $22,251.15 $22,251.15 $22,251.15 nat. median
$37,242
0.6× median
139
OTHER 		Ms-DRG 139 1 $20,574.99 $20,574.99 $20,574.99 nat. median
$12,273
1.7× median
254
OTHER 		Ms-DRG 254 1 $20,563.02 $20,563.02 $20,563.02 nat. median
$16,771
1.2× median
351
OTHER 		Ms-DRG 351 1 $19,825.07 $19,825.07 $19,825.07 nat. median
$11,639
1.7× median
383
OTHER 		Ms-DRG 383 1 $17,831.06 $17,831.06 $17,831.06 nat. median
$12,462
1.4× median
244
OTHER 		Ms-DRG 244 1 $17,722.14 $17,722.14 $17,722.14 nat. median
$18,624
1.0× median
248
OTHER 		Ms-DRG 248 1 $16,120.10 $16,120.10 $16,120.10 nat. median
$2,024
outlier · 8.0×
420
OTHER 		Ms-DRG 420 1 $14,219.69 $14,219.69 $14,219.69 nat. median
$150
outlier · 95.0×
194
OTHER 		Ms-DRG 194 1 $13,663.36 $13,663.36 $13,663.36 nat. median
$8,630
1.6× median
603
OTHER 		Ms-DRG 603 1 $12,610.84 $12,610.84 $12,610.84 nat. median
$9,288
1.4× median
638
OTHER 		Ms-DRG 638 1 $12,610.84 $12,610.84 $12,610.84 nat. median
$9,351
1.3× median
Q5130
OTHER 		Pegfilgrastim-pbbk 6 Mg/0.6 Ml 5 $0.54 $9,625.01 $8,231.92 nat. median
$186
outlier · 44.2×
392
OTHER 		Ms-DRG 392 1 $7,416.84 $7,416.84 $7,416.84 nat. median
$8,098
0.9× median
Q5111
OTHER 		Pegfilgrastim-cbqv 6 Mg/0.6 Ml 5 $1,112.40 $8,478.75 $7,251.56 nat. median
$164
outlier · 44.3×
74178
OTHER 		CT Abd & Pelv Wwo Contrast 5 $104.00 $7,679.00 $6,550.19 nat. median
$495
outlier · 13.2×
Q5122
OTHER 		Pegfilgrastim 6 Mg/0.6 Ml Syr 5 $3,939.75 $7,636.19 $6,530.95 nat. median
$146
outlier · 44.6×
Q5108
OTHER 		Pegfilgrastim-jmdb 6 Mg/0.6 Ml 5 $5,224.56 $7,635.89 $6,530.70 nat. median
$137
outlier · 47.8×
J0897
OTHER 		Denosumab 60 Mg/ml Syringe 5 $9.69 $7,258.46 $6,207.89 nat. median
$32
outlier · 195.2×
95811
OTHER 		Polysomnogram W CPap 5 $4,550.65 $6,650.95 $6,152.75 nat. median
$996
outlier · 6.2×
74177
OTHER 		CT Abd & Pelv W Contrast 5 $227.52 $6,591.00 $5,903.61 nat. median
$458
outlier · 12.9×
95810
OTHER 		Polysomnogram 5 $3,965.00 $6,100.00 $5,468.65 nat. median
$979
outlier · 5.6×
72158
OTHER 		MRI Lumbar Spine Wwo Dye 5 $340.96 $6,346.95 $5,428.31 nat. median
$576
outlier · 9.4×
72157
OTHER 		MRI Chest Spine Wwo Dye 5 $535.35 $6,317.50 $5,403.12 nat. median
$630
outlier · 8.6×
249
OTHER 		Ms-DRG 249 1 $5,398.38 $5,398.38 $5,398.38 nat. median
$2,024
outlier · 2.7×
70553
OTHER 		MRI Brain Wwo Contrast 5 $76.50 $5,938.00 $5,318.45 nat. median
$596
outlier · 8.9×
78452
OTHER 		Myocard Perf Spect Rest Stress 5 $289.80 $5,842.00 $5,233.15 nat. median
$1,353
outlier · 3.9×
72156
OTHER 		MRI Neck Spine Wwo Dye 5 $340.05 $5,544.20 $4,741.75 nat. median
$564
outlier · 8.4×

Other procedures at this hospital

Browse this hospital's 849 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
             
70100 OTHER X-ray Mandible < 4 Views 6 5 $364.00 $353.08 $236.60 $345.80 $326.33 2026-05-09
86870 OTHER Rbc Antibody Identif Panel 9 5 $367.00 $355.99 $238.55 $348.65 $313.05 2026-05-09
86645 OTHER Cmv Antibody IgM 9 5 $370.00 $358.90 $240.50 $351.50 $315.61 2026-05-09
70250 OTHER X-ray Skull < 4 Views 9 5 $374.00 $362.78 $94.25 $355.30 $319.02 2026-05-09
24650 OTHER Fx Radial Head/Neck Wo Man Bi 19 5 $377.00 $365.69 $245.05 $358.15 $321.58 2026-05-09
93005 OTHER EKG Tracing 12 5 $381.00 $369.57 $105.63 $361.95 $312.99 2026-05-09
83498 OTHER 17Oh Progesterone 8 5 $382.00 $370.54 $248.30 $362.90 $313.81 2026-05-09
87103 OTHER Culture Fungus Blood 8 5 $392.00 $380.24 $254.80 $372.40 $322.03 2026-05-09
73070 OTHER X-ray Elbow Rt 8 5 $392.00 $380.24 $41.69 $372.40 $318.50 2026-05-09
93798 OTHER Cardiac Rehab Ii Monitored 11 5 $392.00 $380.24 $254.80 $373.00 $368.48 2026-05-09
73120 OTHER X-ray Hand Rt 17 5 $394.00 $382.18 $198.99 $374.30 $336.08 2026-05-09
27786 OTHER Fx Distal Fibula Lt 18 5 $396.00 $384.12 $257.40 $376.20 $337.79 2026-05-09
25600 OTHER Fx Distal Radius Lt 19 5 $396.00 $384.12 $257.40 $376.20 $337.79 2026-05-09
23600 OTHER Fx Prox Humeral Wo Man Lt 16 5 $396.00 $384.12 $257.40 $376.20 $325.31 2026-05-09
70030 OTHER X-ray Eye Fb Detection 6 5 $397.00 $385.09 $258.05 $377.15 $355.91 2026-05-09
86480 OTHER Tbint Quantiferon 11 5 $397.00 $385.09 $61.98 $377.15 $338.64 2026-05-09
87631 OTHER Influ And Rsv Amp Probe 10 5 $397.00 $385.09 $214.00 $377.15 $326.13 2026-05-09
73620 OTHER X-ray Foot 2 Views Rt 9 5 $400.00 $388.00 $212.82 $380.00 $341.20 2026-05-09
70360 OTHER X-ray Neck Soft Tissue 9 5 $400.00 $388.00 $70.19 $380.00 $341.20 2026-05-09
J0703 OTHER Cefepime/D5W 1000mg/50ml Bag 14 5 $370.00 $359.09 $1.22 $382.21 $329.49 2026-05-09
87338 OTHER H Pylori Antigen Stool 8 5 $403.00 $390.91 $261.95 $382.85 $331.06 2026-05-09
73000 OTHER X-ray Collar Bone Rt 18 5 $407.00 $394.79 $187.03 $386.65 $347.17 2026-05-09
87040 OTHER Culture Blood 12 5 $409.00 $396.73 $265.85 $389.00 $359.22 2026-05-09
82306 OTHER Vitamin D 25 Oh 12 5 $413.00 $400.61 $116.70 $392.35 $339.28 2026-05-09
82523 OTHER Cross Linked C Teleop 8 5 $415.00 $402.55 $269.75 $394.25 $340.93 2026-05-09
27520 OTHER Treat Kneecap Fracture Rt 8 5 $416.00 $403.52 $270.40 $395.20 $341.75 2026-05-09
26600 OTHER Fx Metacarpal 8 5 $416.00 $403.52 $270.40 $395.20 $341.75 2026-05-09
82652 OTHER Vitamin D 125 Dihydroxy 8 5 $417.00 $404.49 $271.05 $396.15 $342.56 2026-05-09
82671 OTHER Estrogen Fractionated 8 5 $421.00 $408.37 $273.65 $399.95 $345.85 2026-05-09
J3489 OTHER Zoledron Ac/Man/H2O 5mg/100ml 8 5 $432.00 $419.18 $17.25 $410.53 $351.12 2026-05-09
76706 OTHER Aaa Screening Medicare 8 5 $437.00 $423.89 $284.05 $415.15 $359.00 2026-05-09
77067 OTHER Mammography Screening Digital 20 5 $445.00 $431.65 $81.96 $422.75 $365.56 2026-05-09
94762 OTHER Desaturation And Hr Study 8 5 $446.00 $432.62 $289.90 $423.70 $366.39 2026-05-09
86334 OTHER Immunofix Electroph Serum 11 5 $447.00 $433.59 $152.77 $424.65 $381.29 2026-05-09
83880 OTHER B Type Natriuretic Peptide 12 5 $448.00 $434.56 $125.05 $425.60 $382.14 2026-05-09
32551 OTHER Insertion Chest Tube Rt 6 5 $399.00 $387.03 $297.55 $426.94 $321.27 2026-05-09
87636 OTHER Influ & CoV2 Pcr Ceph 11 5 $450.00 $436.50 $216.80 $427.50 $383.85 2026-05-09
73110 OTHER X-ray Wrist 3 Views Lt 24 5 $451.00 $437.47 $58.22 $429.00 $393.98 2026-05-09
73090 OTHER X-ray Forearm 2 Views Lt 22 5 $433.00 $420.01 $281.45 $433.00 $369.35 2026-05-09
73010 OTHER X-ray Shoulder Blade Rt 8 5 $456.00 $442.32 $174.16 $433.20 $370.50 2026-05-09
73590 OTHER X-ray Lower Leg Rt 21 5 $459.00 $445.23 $73.88 $436.05 $391.53 2026-05-09
92610 OTHER Swallow Eval Non Radiol 10 5 $461.00 $447.17 $16.53 $437.95 $378.71 2026-05-09
84305 OTHER Somatomedin 9 5 $469.00 $454.93 $304.85 $445.55 $400.06 2026-05-09
73130 OTHER X-ray Hand Lt 24 5 $469.00 $454.93 $59.16 $446.00 $400.06 2026-05-09
82024 OTHER Acth Adrenocorticotropic Hor 10 5 $470.00 $455.90 $38.62 $446.50 $386.11 2026-05-09
93270 OTHER Cardiac Event Hookup Only 12 5 $471.00 $456.87 $306.15 $448.00 $422.25 2026-05-09
99235 OTHER Admit/Discharge Same Day Mod 6 5 $480.00 $465.60 $247.05 $451.20 $330.05 2026-05-09
73080 OTHER X-ray Elbow Lt 22 5 $475.00 $460.75 $38.91 $451.25 $405.18 2026-05-09
J0289 OTHER Amphotericin B Liposome 50 Mg 9 5 $477.00 $462.96 $7.63 $453.42 $407.12 2026-05-09
30901 OTHER Control Anterior Hemorrhage Rt 16 5 $480.00 $465.60 $109.69 $456.00 $344.88 2026-05-09
65220 OTHER Remove Foreign Body Eye Lt 14 5 $480.00 $465.60 $81.33 $456.00 $344.88 2026-05-09
96125 OTHER Cognitive Performance Test St 8 5 $488.00 $473.36 $317.20 $463.60 $400.89 2026-05-09
J0283 OTHER Amiodarone/D5W 150mg/100ml Bag 14 5 $443.00 $429.86 $173.21 $466.05 $397.64 2026-05-09
51705 OTHER Suprapubic Cath Change 9 5 $492.00 $477.24 $319.80 $467.40 $419.68 2026-05-09
73630 OTHER X-ray Foot 3 Views Lt 24 5 $492.00 $477.24 $65.59 $468.00 $419.68 2026-05-09
73060 OTHER X-ray Humerus Lt 21 5 $469.00 $454.93 $67.44 $469.00 $400.06 2026-05-09
72220 OTHER X-ray Sacrum Tailbone 9 5 $495.00 $480.15 $321.75 $470.25 $447.69 2026-05-09
73610 OTHER X-ray Ankle 3 Views Rt 23 5 $495.00 $480.15 $99.63 $471.00 $422.24 2026-05-09
81241 OTHER Factor V Leiden Mutation 8 5 $502.00 $486.94 $326.30 $476.90 $412.39 2026-05-09
73552 OTHER X-ray Femur 2 Views Lt 20 5 $503.00 $487.91 $130.00 $477.85 $429.06 2026-05-09
12005 OTHER Repair Lac Simple 12.6-20.0 Cm 14 5 $504.00 $488.88 $179.19 $478.80 $347.59 2026-05-09
73030 OTHER X-ray Shoulder Lt 24 5 $507.00 $491.79 $237.65 $482.00 $432.47 2026-05-09
87637 OTHER Influ/RSV/CoV2 Pcr Ceph 13 5 $509.00 $493.73 $189.18 $483.55 $434.18 2026-05-09
97550 OTHER Caregiver Training 1st 30 Min. 8 5 $515.00 $499.55 $334.75 $489.25 $423.08 2026-05-09
96105 OTHER Aphasia Evaluation Per Hour 8 5 $515.00 $499.55 $334.75 $489.25 $423.08 2026-05-09
70220 OTHER X-ray Sinuses 3 Views 8 5 $517.00 $501.49 $94.13 $491.15 $420.06 2026-05-09
77065 OTHER Mammography Dx Digital Lt 18 5 $523.00 $507.31 $339.95 $496.85 $446.12 2026-05-09
76010 OTHER X-ray Nose To Rectum 10 5 $400.00 $388.00 $260.00 $499.96 $378.00 2026-05-09
96360 OTHER Inf Therapy Hyd Initial 32 5 $432.00 $419.04 $49.18 $501.60 $343.07 2026-05-09
12011 OTHER Repair Lac Simple <2.5 Cm 18 5 $530.00 $514.10 $99.67 $503.50 $380.81 2026-05-09
92523 OTHER Speech Sound Lang Comp Or Expr 8 5 $532.00 $516.04 $345.80 $505.40 $437.04 2026-05-09
24530 OTHER Fx Supra/Transcondylar Hum Lt 8 5 $534.00 $517.98 $347.10 $507.30 $438.68 2026-05-09
84445 OTHER Tsi 8 5 $540.00 $523.80 $351.00 $513.00 $443.61 2026-05-09
64400 OTHER Inj Trigeminal N Block Lt 28 5 $481.00 $466.57 $100.07 $516.06 $345.60 2026-05-09
99223 OTHER IP/Obs Initial High Comp 6 5 $551.00 $534.47 $270.04 $517.94 $365.74 2026-05-09
97605 OTHER Neg Pressure Wound Dme <50 Cm 10 5 $546.00 $529.62 $42.56 $518.70 $448.54 2026-05-09
11750 OTHER Exc Nail Matrix Part/Complete 17 5 $547.00 $530.59 $81.38 $519.65 $363.75 2026-05-09
74018 OTHER X-ray Abdomen 12 5 $424.00 $411.28 $275.60 $523.39 $398.56 2026-05-09
12004 OTHER Repair Lac Simple 7.6-12.5 Cm 16 5 $530.00 $514.10 $140.14 $530.00 $380.81 2026-05-09
P9016 OTHER Red Blood Cells Lekoreduced 12 5 $560.00 $543.20 $38.98 $533.00 $477.68 2026-05-09
73560 OTHER X-ray Knee 1-2 Views Rt 21 5 $504.00 $488.88 $84.00 $533.00 $429.91 2026-05-09
30903 OTHER Control Anterior Hemorrhage Lt 14 5 $480.00 $465.60 $149.60 $535.80 $344.88 2026-05-09
72202 OTHER X-ray Si Joints 3 Views 8 5 $353.00 $342.41 $229.45 $542.46 $333.59 2026-05-09
94060 OTHER Pft Pre & Post Screen Spirome 8 5 $572.00 $554.84 $371.80 $543.40 $469.90 2026-05-09
73564 OTHER X-ray Knee 4 Lt 19 5 $579.00 $561.63 $129.06 $550.05 $493.89 2026-05-09
73562 OTHER X-ray Knee 3 Views Lt 24 5 $524.00 $508.28 $109.75 $551.00 $446.97 2026-05-09
99236 OTHER Admit/Discharge Same Day High 6 5 $599.00 $581.03 $322.41 $563.06 $427.62 2026-05-09
90739 OTHER HepB Adult 2 Dose IM 10 5 $596.00 $578.51 $137.37 $566.58 $484.58 2026-05-09
74250 OTHER Gastrografin Challenge 10 5 $599.00 $581.03 $38.14 $569.05 $486.69 2026-05-09
96365 OTHER Inf Therapy Med Initial 32 5 $502.00 $486.94 $45.13 $574.75 $394.91 2026-05-09
83993 OTHER Calprotectin 12 5 $606.00 $587.82 $19.63 $575.70 $497.83 2026-05-09
70150 OTHER X-ray Facial Bones 3 Views 8 5 $607.00 $588.79 $82.17 $576.65 $493.19 2026-05-09
G0379 OTHER Observation Assess Direct Adm 8 5 $609.00 $590.73 $395.85 $578.55 $500.30 2026-05-09
71045 OTHER X-ray Chest 1 View 13 5 $388.00 $376.36 $252.20 $593.33 $364.72 2026-05-09
72170 OTHER X-ray Pelvis 1-2 Views 12 5 $447.00 $433.59 $290.55 $615.00 $400.74 2026-05-09
12013 OTHER Repair Lac Simple 2.6-5.0 Cm 14 5 $530.00 $514.10 $109.90 $625.10 $380.81 2026-05-09
P9040 OTHER Rbc Packed Leuko-reduc Irrad 9 5 $664.00 $644.08 $431.60 $630.80 $566.39 2026-05-09
72190 OTHER X-ray Pelvis 3 Views 10 5 $672.00 $651.84 $436.80 $640.00 $602.45 2026-05-09
90619 OTHER Menacwy-tt IM 8 5 $674.00 $654.56 $160.69 $641.06 $548.28 2026-05-09
23500 OTHER Fx Clavicle Lt 8 5 $679.00 $658.63 $441.35 $645.05 $557.80 2026-05-09
99283 OTHER Emergency Room Visit Level 3 19 5 $688.00 $667.36 $108.68 $653.60 $531.14 2026-05-09
10061 OTHER I&d Abscess Comp/Multiple 14 5 $691.00 $670.27 $373.43 $656.45 $483.79 2026-05-09
72110 OTHER X-ray Lumbosacral 4 Views 8 5 $695.00 $674.15 $67.44 $660.25 $564.69 2026-05-09
74019 OTHER X-ray Abdomen 12 5 $599.00 $581.03 $389.35 $660.48 $563.06 2026-05-09
72100 OTHER X-ray Lumbosacral 2-3 Views 13 5 $671.00 $650.87 $90.44 $661.00 $630.74 2026-05-09
86053 OTHER Neuromyelitis Optic Antibody 8 5 $699.00 $678.03 $454.35 $664.05 $574.23 2026-05-09
70160 OTHER X-ray Facial Bones 3 Views 8 5 $716.00 $694.52 $86.75 $680.20 $581.75 2026-05-09
72072 OTHER X-ray Spine Thoracic 3 Views 8 5 $676.00 $655.72 $439.40 $697.54 $638.82 2026-05-09
73501 OTHER X-ray Hip Uni 1 View Lt 11 5 $338.00 $327.86 $219.70 $711.09 $317.72 2026-05-09
96413 OTHER Chemotherapy Inf Initial 11 5 $748.00 $725.56 $71.05 $712.00 $638.04 2026-05-09
81256 OTHER Hemochromat Mutation 8 5 $764.00 $741.08 $496.60 $725.80 $627.62 2026-05-09
73523 OTHER X-ray Hips 5 Views Bi 8 5 $774.00 $750.78 $503.10 $735.30 $690.20 2026-05-09
76882 OTHER US Extremity Nonvasc Limit Lt 21 5 $710.00 $688.70 $461.50 $739.00 $605.63 2026-05-09
76604 OTHER Ultrasound Chest 10 5 $651.00 $631.47 $423.15 $741.00 $583.62 2026-05-09
12014 OTHER Repair Lac Simple 5.1-7.5 Cm 16 5 $530.00 $514.10 $141.36 $752.94 $413.93 2026-05-09
93225 OTHER Holter Monitor Hook Up <48 Hrs 12 5 $798.00 $774.06 $518.70 $760.00 $701.35 2026-05-09
A9585 OTHER Gadobutrol Inj 10 Mm/10 Ml Vl 11 5 $800.00 $776.00 $2.69 $760.00 $682.40 2026-05-09
Q9950 OTHER Sulf Hexaflr Microsphre 5ml Vl 11 5 $802.00 $778.42 $187.95 $762.38 $684.53 2026-05-09
12042 OTHER Repair Lac Interm 2.6-7.5 Cm 14 5 $566.00 $549.02 $367.90 $766.10 $445.62 2026-05-09
11403 OTHER Exc Ben Lesion 2.1-3.0 Trunk 14 5 $813.00 $788.61 $305.50 $772.35 $534.55 2026-05-09
71046 OTHER X-ray Chest 2v PA/Lateral 12 5 $499.00 $484.03 $132.75 $783.13 $469.06 2026-05-09
72040 OTHER X-ray Spine Cervical 2-3 Views 11 5 $499.00 $484.03 $324.35 $791.00 $474.05 2026-05-09
73522 OTHER X-ray Hips 3-4 Views Bi 8 5 $738.00 $715.86 $479.70 $793.90 $697.41 2026-05-09
45384 OTHER Colonoscopy W Lesion Removal 6 5 $873.00 $846.81 $443.33 $820.62 $480.72 2026-05-09
J2997 OTHER Alteplase 2 Mg Vial 8 5 $879.00 $852.77 $37.08 $835.18 $714.31 2026-05-09
76536 OTHER Ultrasound Head And Neck 12 5 $885.00 $858.45 $575.25 $842.00 $793.40 2026-05-09
G0121 OTHER Screen Colonoscopy Not Hi Risk 6 5 $897.00 $870.09 $171.02 $843.18 $381.66 2026-05-09
G0105 OTHER Screening Colonoscopy Hi Risk 6 5 $897.00 $870.09 $170.90 $843.18 $381.44 2026-05-09
93226 OTHER ECG Monit/Report Up To 48 Hour 12 5 $890.00 $863.30 $578.50 $847.00 $781.91 2026-05-09
76775 OTHER Ultrasound Limited 11 5 $900.00 $873.00 $22.78 $855.00 $767.70 2026-05-09
11402 OTHER Exc Ben Lesion 1.1-2.0 Trunk 15 5 $953.00 $924.41 $236.15 $905.35 $633.75 2026-05-09
0202U OTHER Respir Path 22 Targets Biofire 8 5 $960.00 $931.20 $624.00 $912.00 $788.64 2026-05-09
77066 OTHER Mammography Diagnostic Digital 13 5 $609.00 $590.73 $395.85 $918.00 $572.46 2026-05-09
45378 OTHER Colonoscopy Diagnostic 6 5 $997.00 $967.09 $362.29 $937.18 $393.28 2026-05-09
76801 OTHER OB US < 14 Wks Single Fetus 8 5 $992.00 $962.24 $644.80 $942.40 $814.93 2026-05-09
J2020 OTHER Linezolid 600 Mg/300 Ml Bag 8 5 $333.00 $323.04 $216.47 $968.84 $314.72 2026-05-09
G0399 OTHER Sleep Study Type Iii Portable 11 5 $1,033.00 $1,002.01 $671.45 $981.35 $881.15 2026-05-09
76705 OTHER Ultrasound Abdomen Limited 12 5 $1,038.00 $1,006.86 $674.70 $986.10 $885.41 2026-05-09
99284 OTHER Emergency Room Visit Level 4 20 5 $1,047.00 $1,015.59 $91.22 $994.65 $752.26 2026-05-09
76770 OTHER Ultrasound Abdo Back Wall Comp 11 5 $1,058.00 $1,026.26 $687.70 $1,005.10 $902.47 2026-05-09
76830 OTHER Ultrasound Transvaginal 11 5 $1,069.00 $1,036.93 $694.85 $1,015.55 $911.86 2026-05-09
72070 OTHER X-ray Spine Thoracic 2 Views 12 5 $533.00 $517.01 $346.45 $1,015.90 $501.02 2026-05-09
93976 OTHER Vascular Study 10 5 $1,070.00 $1,037.90 $113.83 $1,016.50 $879.00 2026-05-09
76641 OTHER Ultrasound Breast Complete Rt 10 5 $1,089.00 $1,056.33 $707.85 $1,034.55 $898.13 2026-05-09
73502 OTHER X-ray Hip Uni 2-3 Views Lt 40 5 $479.00 $464.63 $311.35 $1,047.00 $518.70 2026-05-09
L3808 OTHER Ortho Wrist Hand Fngr Static 8 5 $1,113.00 $1,080.39 $723.97 $1,058.11 $914.99 2026-05-09
90677 OTHER Pneumo 20 Valent Vacc 0.5 Ml 20 5 $965.00 $936.39 $326.00 $1,058.40 $907.43 2026-05-09
J1447 OTHER Tbo-filgrastim 300mcg/0.5ml Sy 14 5 $752.00 $730.32 $247.20 $1,059.23 $715.26 2026-05-09
94660 OTHER CPap/BiPap First Day 8 5 $1,119.00 $1,085.43 $727.35 $1,063.05 $919.26 2026-05-09
Q0138 OTHER Ferumoxy 510mg/17ml (non-esrd) 8 5 $1,145.00 $1,111.35 $7.28 $1,088.43 $930.90 2026-05-09
76856 OTHER Ultrasound Pelvic Complete 10 5 $1,167.00 $1,131.99 $758.55 $1,108.65 $1,046.22 2026-05-09
87497 OTHER Cmv Quant By Pcr 10 5 $1,167.00 $1,131.99 $267.50 $1,108.65 $958.69 2026-05-09
45380 OTHER Colonoscopy W Biopsy(s) 6 5 $1,196.00 $1,160.12 $393.92 $1,124.24 $427.84 2026-05-09
J0561 OTHER Pen G Benzathine 1200000Un/2ML 10 5 $1,191.00 $1,155.52 $216.00 $1,131.70 $967.89 2026-05-09
92950 OTHER Heart/Lung Resuscitation Cpr 14 5 $944.00 $915.68 $275.08 $1,135.52 $678.26 2026-05-09
20605 OTHER Asp/Inj Intermediate Joint Lt 22 5 $351.00 $340.47 $72.99 $1,148.55 $314.67 2026-05-09
C1726 OTHER Dil Pebax 180Cm Od15-18 10 5 $1,148.00 $1,114.26 $746.67 $1,148.72 $1,029.83 2026-05-09
76700 OTHER Ultrasound Abdomen Complete 11 5 $1,221.00 $1,184.37 $728.69 $1,159.95 $1,041.51 2026-05-09
J1610 OTHER Glucagon 1 Mg Emergency Kit 8 5 $1,327.00 $1,287.61 $98.91 $1,261.06 $1,078.54 2026-05-09
45385 OTHER Colonoscopy W Lesion Removal 6 5 $1,350.00 $1,309.50 $497.75 $1,269.00 $540.97 2026-05-09
90675 OTHER Rabies Vax Pcec/Pf 2.5Unit Vl 8 5 $1,347.00 $1,307.03 $125.23 $1,280.08 $1,094.80 2026-05-09
93925 OTHER Arterial Duplex Le Bi 11 5 $1,353.00 $1,312.41 $51.78 $1,285.35 $1,154.11 2026-05-09
360 OTHER Or Level 1 32 5 $1,106.00 $1,072.82 $555.10 $1,292.95 $849.40 2026-05-09
36430 OTHER Blood Administration 12 5 $453.00 $439.41 $93.64 $1,293.00 $386.41 2026-05-09
76870 OTHER Ultrasound Scrotum 10 5 $1,099.00 $1,066.03 $714.35 $1,338.00 $985.25 2026-05-09
10120 OTHER I&r Foreign Body Simple 25 5 $437.00 $423.89 $215.90 $1,389.85 $410.78 2026-05-09
76642 OTHER Ultrasound Breast Limited Lt 27 5 $990.00 $960.30 $643.50 $1,410.75 $930.60 2026-05-09
P9037 OTHER Platelet Pheresis Leuk Red Irr 8 5 $1,550.00 $1,503.50 $1,007.50 $1,472.50 $1,273.33 2026-05-09
11043 OTHER Debride Muscle/Fascia 20 Cm 14 5 $1,565.00 $1,518.05 $302.96 $1,486.75 $1,028.99 2026-05-09
93970 OTHER Venous Duplex 12 5 $1,566.00 $1,519.02 $1,017.90 $1,487.70 $1,403.92 2026-05-09
93971 OTHER Extremity Study Rt 23 5 $1,490.00 $1,445.30 $73.61 $1,490.00 $1,270.97 2026-05-09
87799 OTHER Bk Virus Quant Pcr, Serum 10 5 $1,619.00 $1,570.43 $160.67 $1,538.05 $1,330.01 2026-05-09
23675 OTHER Clsd Tx Shldr Disloc W Man Rt 14 5 $1,643.00 $1,593.71 $1,028.83 $1,560.85 $1,211.52 2026-05-09
A9500 OTHER Radiophar Tc99M Sestamibi Dose 12 5 $801.00 $776.97 $520.65 $1,602.00 $718.10 2026-05-09
129 OTHER Room Swing Bed Skilled 6 5 $1,704.00 $1,652.88 $1,107.60 $1,618.80 $1,527.63 2026-05-09
P9035 OTHER Platelet Pheresis Leuko Reduc 8 5 $1,714.00 $1,662.58 $1,114.10 $1,628.30 $1,408.05 2026-05-09
93351 OTHER Stress Tte Complete 14 5 $1,824.00 $1,769.28 $126.80 $1,732.80 $1,199.28 2026-05-09
99285 OTHER Emergency Room Visit Level 5 18 5 $1,865.00 $1,809.05 $32.05 $1,771.75 $1,340.00 2026-05-09
27096 OTHER Inject Sacroiliac Joint Bi 20 5 $1,686.00 $1,635.42 $167.26 $1,880.94 $588.49 2026-05-09
270 OTHER Cellulos Hemost W Thromb 10ml 8 5 $2,034.00 $1,973.40 $1,322.38 $1,932.71 $1,671.28 2026-05-09
C8930 OTHER Stress Echo W Contrast 9 5 $2,042.00 $1,980.74 $1,327.30 $1,939.90 $1,741.83 2026-05-09
120 OTHER Room Medical Unit Semi Private 6 5 $2,043.00 $1,981.71 $1,327.95 $1,940.85 $1,831.55 2026-05-09
93880 OTHER Extracranial Bilat Study 12 5 $2,049.00 $1,987.53 $249.67 $1,951.00 $1,747.80 2026-05-09
87154 OTHER Culture Id By Amp Prb 6 Or 6+ 8 5 $2,074.00 $2,011.78 $1,348.10 $1,970.30 $1,703.79 2026-05-09
11042 OTHER Debride Skin Subq 20 Cm 29 5 $775.00 $751.75 $9.57 $1,970.30 $661.08 2026-05-09
78227 OTHER Hida With Ef w/Pharm 8 5 $2,076.00 $2,013.72 $1,349.40 $1,972.20 $1,705.43 2026-05-09
93017 OTHER Cardiovascular Stress Test 12 5 $1,529.00 $1,483.13 $993.85 $1,988.00 $1,370.75 2026-05-09
J1745 OTHER Infliximab (Gen) 100 Mg Vial 8 5 $2,120.00 $2,056.89 $1.46 $2,014.48 $1,722.91 2026-05-09
J7325 OTHER Hylan Polymer A&b 48mg/6ml Syr 8 5 $2,141.00 $2,077.42 $1,392.09 $2,034.59 $1,781.01 2026-05-09
111 OTHER Room Medical Unit Priv 12 5 $1,241.00 $1,203.77 $219.05 $2,037.75 $857.20 2026-05-09
72192 OTHER CT Pelvis Wo Dye 8 5 $2,218.00 $2,151.46 $597.01 $2,107.10 $1,802.12 2026-05-09
86362 OTHER Mog Antibody Ref 8 5 $2,221.00 $2,154.37 $1,443.65 $2,109.95 $1,824.55 2026-05-09
G0390 OTHER Trauma Team Level 4 8 5 $2,233.00 $2,166.01 $1,451.45 $2,121.35 $1,834.41 2026-05-09
684 OTHER Trauma Team Evaluation Level 4 8 5 $2,233.00 $2,166.01 $1,451.45 $2,121.35 $1,834.41 2026-05-09
761 OTHER Anoscopy 64 5 $494.00 $479.18 $22.10 $2,185.00 $364.60 2026-05-09
99291 OTHER Critical Care 1st 30-74 Min 14 5 $2,376.00 $2,304.72 $329.00 $2,257.20 $1,562.22 2026-05-09
J9217 OTHER Leuprolide Acetate 22.5 Mg Syr 8 5 $2,391.00 $2,319.99 $1.47 $2,272.15 $1,943.29 2026-05-09
74160 OTHER CT Abdomen W Dye 10 5 $2,510.00 $2,434.70 $37.51 $2,384.50 $2,039.38 2026-05-09
J0248 OTHER Remdesivir 100 Mg Vial 8 5 $2,797.00 $2,713.73 $70.71 $2,657.78 $2,273.10 2026-05-09
70486 OTHER CT Maxillofacial Wo Contrast 11 5 $2,817.00 $2,732.49 $187.95 $2,676.15 $2,402.90 2026-05-09
70498 OTHER CT Angiography Neck W Cont 12 5 $2,884.00 $2,797.48 $278.38 $2,817.00 $2,460.05 2026-05-09
74170 OTHER CT Abdomen Wwo Dye 8 5 $2,971.00 $2,881.87 $58.22 $2,822.45 $2,413.94 2026-05-09
70450 OTHER CT Head/Brain Wo Contrast 12 5 $3,013.00 $2,922.61 $24.20 $2,869.00 $2,570.09 2026-05-09
73200 OTHER CT Ue Wo Dye Rt 19 5 $2,869.00 $2,782.93 $70.19 $2,869.00 $2,447.26 2026-05-09
Q5101 OTHER Filgrastim-sndz 300 Mcg/0.5 Ml 8 5 $1,046.00 $1,015.41 $680.43 $2,902.39 $989.24 2026-05-09
J3304 OTHER Triamcinolone Acetonide 32 Mg 8 5 $3,065.00 $2,973.28 $520.65 $2,911.98 $2,490.51 2026-05-09
70496 OTHER CT Angiography Head W Cont 12 5 $3,101.00 $3,007.97 $93.21 $2,945.95 $2,519.56 2026-05-09
70480 OTHER CT Orbit Wo Contrast 8 5 $3,152.00 $3,057.44 $192.56 $2,994.40 $2,561.00 2026-05-09
70487 OTHER CT Maxillofacial W Contrast 8 5 $3,164.00 $3,069.08 $268.29 $3,005.80 $2,570.75 2026-05-09
73201 OTHER CT Ue W Dye Rt 8 5 $3,218.00 $3,121.46 $90.44 $3,057.10 $2,614.62 2026-05-09
70481 OTHER CT Orbit W Contrast 8 5 $3,247.00 $3,149.59 $80.31 $3,084.65 $2,638.18 2026-05-09
73700 OTHER CT Le Wo Dye Lt 22 5 $3,247.00 $3,149.59 $76.65 $3,092.00 $2,853.55 2026-05-09
P9047 OTHER Albumin Human 25% 25gr/100ml 8 5 $618.00 $600.27 $402.24 $3,118.50 $584.80 2026-05-09
73701 OTHER CT Le W Dye Lt 8 5 $3,310.00 $3,210.70 $268.00 $3,144.50 $2,689.38 2026-05-09
93306 OTHER Tte W Doppler Complete 18 5 $3,351.00 $3,250.47 $105.90 $3,183.45 $2,407.69 2026-05-09
73218 OTHER MRI Ue Wo Dye Rt 8 5 $3,399.00 $3,297.03 $79.39 $3,229.05 $2,761.69 2026-05-09
71271 OTHER Ldct For Lung Cancer Screen 11 5 $3,417.00 $3,314.49 $101.47 $3,246.15 $2,914.70 2026-05-09
73202 OTHER CT Ue Wwo Dye Rt 8 5 $3,417.00 $3,314.49 $286.41 $3,246.15 $2,776.31 2026-05-09
71250 OTHER CT Thorax Wo Contrast 12 5 $3,480.00 $3,375.60 $22.78 $3,314.00 $2,968.44 2026-05-09
72131 OTHER CT Lumbar Spine Wo Contrast 11 5 $3,588.00 $3,480.36 $93.21 $3,408.60 $3,060.56 2026-05-09
72128 OTHER CT Thoracic Spine Wo Contrast 8 5 $3,588.00 $3,480.36 $107.92 $3,408.60 $2,915.25 2026-05-09
71101 OTHER X-ray Ribs Uni W Chest Rt 18 5 $600.00 $582.00 $390.00 $3,427.98 $564.00 2026-05-09
J7327 OTHER Hyaluronate Sodium 88Mg/4Ml 8 5 $3,627.00 $3,518.39 $1,488.18 $3,445.85 $2,947.11 2026-05-09
C8929 OTHER Echo M Mode 2d W Contrast 12 5 $3,663.00 $3,553.11 $169.24 $3,488.00 $3,124.54 2026-05-09
73721 OTHER MRI Joint Le Wo Dye Lt 24 5 $3,723.00 $3,611.31 $315.18 $3,545.00 $3,175.72 2026-05-09
72125 OTHER CT Cervical Spine Wo Contrast 12 5 $3,588.00 $3,480.36 $172.57 $3,588.00 $3,153.36 2026-05-09
73221 OTHER MRI Joint Ue Wo Dye Rt 23 5 $3,552.00 $3,445.44 $51.78 $3,593.00 $3,029.86 2026-05-09
71100 OTHER X-ray Ribs 2 Views Lt 16 5 $528.00 $512.16 $343.20 $3,616.49 $498.96 2026-05-09
193 OTHER Ms-DRG 193 2 1 — — $3,725.18 $3,725.18 $3,725.18 2026-05-09
73718 OTHER MRI Le Wo Dye Lt 16 5 $3,939.00 $3,820.83 $56.38 $3,742.05 $3,200.44 2026-05-09
71260 OTHER CT Thorax W Contrast 12 5 $4,013.00 $3,892.61 $80.31 $3,821.00 $3,423.09 2026-05-09
70482 OTHER CT Orbit Wwo Contrast 10 5 $3,503.00 $3,397.91 $261.57 $3,872.00 $3,140.44 2026-05-09
70544 OTHER MRA Head Wo Contrast 8 5 $4,152.00 $4,027.44 $408.12 $3,944.40 $3,373.50 2026-05-09
72195 OTHER MRI Pelvis Wo Dye 8 5 $4,165.00 $4,040.05 $53.64 $3,956.75 $3,384.06 2026-05-09
70492 OTHER CT Soft Tissue Neck Wwo Cont 8 5 $4,194.00 $4,068.18 $422.85 $3,984.30 $3,407.62 2026-05-09
70491 OTHER CT Soft Tissue Neck W Cont 11 5 $3,778.00 $3,664.66 $357.52 $3,984.30 $3,222.63 2026-05-09
72146 OTHER MRI Chest Spine Wo Dye 8 5 $4,234.00 $4,106.98 $390.63 $4,022.30 $3,440.12 2026-05-09
J1439 OTHER Ferric Carboxymalt 750mg/15ml 8 5 $4,349.00 $4,219.29 $11.91 $4,132.29 $3,534.20 2026-05-09
71270 OTHER CT Thorax Wwo Contrast 8 5 $4,385.00 $4,253.45 $82.17 $4,165.75 $3,562.81 2026-05-09
70470 OTHER CT Head/Brain Wwo Contrast 10 5 $4,376.00 $4,244.72 $241.32 $4,167.00 $3,923.09 2026-05-09
74182 OTHER MRI Abdomen W Dye 8 5 $4,446.00 $4,312.62 $776.70 $4,223.70 $3,612.38 2026-05-09
377 OTHER Ms-DRG 377 2 1 — — $4,225.96 $4,225.96 $4,225.96 2026-05-09
113 OTHER Ms-DRG 113 2 1 — — $4,232.63 $4,232.63 $4,232.63 2026-05-09
71275 OTHER CTA Chest Wwo Contrast 10 5 $4,857.00 $4,711.29 $65.59 $4,614.15 $4,268.39 2026-05-09
72148 OTHER MRI Lumbar Spine Wo Dye 12 5 $4,896.00 $4,749.12 $51.78 $4,662.00 $4,176.29 2026-05-09
74176 OTHER CT Abd & Pelvis Wo Contrast 12 5 $5,114.00 $4,960.58 $95.04 $4,870.00 $4,362.24 2026-05-09
72141 OTHER MRI Neck Spine Wo Dye 10 5 $5,174.00 $5,018.78 $233.96 $4,915.30 $4,547.03 2026-05-09
70551 OTHER MRI Brain Wo Contrast 10 5 $4,391.00 $4,259.27 $447.03 $5,090.00 $3,936.53 2026-05-09
74181 OTHER MRI Abdomen Wo Dye 10 5 $3,929.00 $3,811.13 $544.29 $5,363.00 $3,522.35 2026-05-09
249 OTHER Ms-DRG 249 2 1 — — $5,398.38 $5,398.38 $5,398.38 2026-05-09
72156 OTHER MRI Neck Spine Wwo Dye 8 5 $5,836.00 $5,660.92 $340.05 $5,544.20 $4,741.75 2026-05-09
74183 OTHER MRI Abdomen Wwo Dye 10 5 $5,085.00 $4,932.45 $619.08 $5,632.00 $4,558.70 2026-05-09
78452 OTHER Myocard Perf Spect Rest Stress 12 5 $6,135.00 $5,950.95 $289.80 $5,842.00 $5,233.15 2026-05-09
70553 OTHER MRI Brain Wwo Contrast 20 5 $6,235.00 $6,047.95 $76.50 $5,938.00 $5,318.45 2026-05-09
95810 OTHER Polysomnogram 10 5 $6,100.00 $5,917.00 $3,965.00 $6,100.00 $5,468.65 2026-05-09
72157 OTHER MRI Chest Spine Wwo Dye 8 5 $6,650.00 $6,450.50 $535.35 $6,317.50 $5,403.12 2026-05-09
72158 OTHER MRI Lumbar Spine Wwo Dye 8 5 $6,681.00 $6,480.57 $340.96 $6,346.95 $5,428.31 2026-05-09
74177 OTHER CT Abd & Pelv W Contrast 12 5 $6,921.00 $6,713.37 $227.52 $6,591.00 $5,903.61 2026-05-09
95811 OTHER Polysomnogram W CPap 10 5 $7,001.00 $6,790.97 $4,550.65 $6,650.95 $6,152.75 2026-05-09
J0897 OTHER Denosumab 60 Mg/ml Syringe 8 5 $7,640.00 $7,411.27 $9.69 $7,258.46 $6,207.89 2026-05-09
392 OTHER Ms-DRG 392 2 1 — — $7,416.84 $7,416.84 $7,416.84 2026-05-09
Q5108 OTHER Pegfilgrastim-jmdb 6 Mg/0.6 Ml 8 5 $8,037.00 $7,796.65 $5,224.56 $7,635.89 $6,530.70 2026-05-09
Q5122 OTHER Pegfilgrastim 6 Mg/0.6 Ml Syr 8 5 $8,038.00 $7,796.96 $3,939.75 $7,636.19 $6,530.95 2026-05-09
74178 OTHER CT Abd & Pelv Wwo Contrast 11 5 $7,679.00 $7,448.63 $104.00 $7,679.00 $6,550.19 2026-05-09
Q5111 OTHER Pegfilgrastim-cbqv 6 Mg/0.6 Ml 8 5 $8,925.00 $8,657.25 $1,112.40 $8,478.75 $7,251.56 2026-05-09
Q5130 OTHER Pegfilgrastim-pbbk 6 Mg/0.6 Ml 8 5 $10,131.00 $9,827.64 $0.54 $9,625.01 $8,231.92 2026-05-09
638 OTHER Ms-DRG 638 1 1 — — $12,610.84 $12,610.84 $12,610.84 2026-05-09
603 OTHER Ms-DRG 603 2 1 — — $12,610.84 $12,610.84 $12,610.84 2026-05-09
194 OTHER Ms-DRG 194 2 1 — — $13,663.36 $13,663.36 $13,663.36 2026-05-09
420 OTHER Ms-DRG 420 2 1 — — $14,219.69 $14,219.69 $14,219.69 2026-05-09
248 OTHER Ms-DRG 248 2 1 — — $16,120.10 $16,120.10 $16,120.10 2026-05-09
244 OTHER Ms-DRG 244 2 1 — — $17,722.14 $17,722.14 $17,722.14 2026-05-09
383 OTHER Ms-DRG 383 2 1 — — $17,831.06 $17,831.06 $17,831.06 2026-05-09
351 OTHER Ms-DRG 351 2 1 — — $19,825.07 $19,825.07 $19,825.07 2026-05-09
254 OTHER Ms-DRG 254 2 1 — — $20,563.02 $20,563.02 $20,563.02 2026-05-09
139 OTHER Ms-DRG 139 2 1 — — $20,574.99 $20,574.99 $20,574.99 2026-05-09
140 OTHER Ms-DRG 140 2 1 — — $22,251.15 $22,251.15 $22,251.15 2026-05-09
241 OTHER Ms-DRG 241 2 1 — — $24,609.82 $24,609.82 $24,609.82 2026-05-09
347 OTHER Ms-DRG 347 2 1 — — $26,942.76 $26,942.76 $26,942.76 2026-05-09
201 OTHER Ms-DRG 201 2 1 — — $29,389.50 $29,389.50 $29,389.50 2026-05-09
J3101 OTHER Tenecteplase 50 Mg/10 Ml Syrng 8 5 $31,584.00 $30,637.29 $0.41 $30,005.60 $25,662.68 2026-05-09
24 OTHER Ms-DRG 24 2 1 — — $30,625.87 $30,625.87 $30,625.87 2026-05-09
45 OTHER Ms-DRG 45 2 1 — — $35,125.14 $35,125.14 $35,125.14 2026-05-09
720 OTHER Ms-DRG 720 2 1 — — $36,767.75 $36,767.75 $36,767.75 2026-05-09
721 OTHER Ms-DRG 721 2 1 — — $40,151.46 $40,151.46 $40,151.46 2026-05-09
231 OTHER Ms-DRG 231 2 1 — — $41,103.34 $41,103.34 $41,103.34 2026-05-09
463 OTHER Ms-DRG 463 2 1 — — $42,795.71 $42,795.71 $42,795.71 2026-05-09
263 OTHER Ms-DRG 263 2 1 — — $50,527.23 $50,527.23 $50,527.23 2026-05-09
469 OTHER Ms-DRG 469 2 1 — — $54,290.65 $54,290.65 $54,290.65 2026-05-09
247 OTHER Ms-DRG 247 2 1 — — $54,967.72 $54,967.72 $54,967.72 2026-05-09
322 OTHER Ms-DRG 322 2 1 — — $70,206.18 $70,206.18 $70,206.18 2026-05-09
323 OTHER Ms-DRG 323 2 1 — — $74,695.78 $74,695.78 $74,695.78 2026-05-09
305 OTHER Ms-DRG 305 2 1 — — $77,600.30 $77,600.30 $77,600.30 2026-05-09
314 OTHER Ms-DRG 314 2 1 — — $87,150.74 $87,150.74 $87,150.74 2026-05-09
308 OTHER Ms-DRG 308 2 1 — — $95,496.45 $95,496.45 $95,496.45 2026-05-09
344 OTHER Ms-DRG 344 2 1 — — $99,886.82 $99,886.82 $99,886.82 2026-05-09
192 OTHER Ms-DRG 192 2 1 — — $107,374.00 $107,374.00 $107,374.00 2026-05-09
182 OTHER Ms-DRG 182 2 1 — — $115,441.39 $115,441.39 $115,441.39 2026-05-09
325 OTHER Ms-DRG 325 2 1 — — $145,735.46 $145,735.46 $145,735.46 2026-05-09
862 OTHER Ms-DRG 862 2 1 — — $207,498.78 $207,498.78 $207,498.78 2026-05-09
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