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

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Hospital

SAINT ROSE DOMINICAN HOSPITALS - SAN MARTIN CAMPUS

Las Vegas, NV · CCN 290053 · Rates published

10,049 distinct procedures filed
14 distinct payers
164,475 rate rows
2026-02-28 last MRF observed
Data quality

156,537 of 164,475 rate rows are consumer-grade (95.2%)

7,938 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 6,605
template filing: same amount across many unrelated codes — excluded 872
per-diem day rate — not a per-procedure price 330
exceeds 10× this hospital's gross charge — excluded from medians 125
placeholder amount (≤ $0.02) — excluded from medians 6
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.dignityhealth.org/content/dam/dignity-health/documents/mrf-json/southwest/json/941196203_st-rose-dominican-hospital-san-martin_standardcharges.json?target=%22_blank%22
Found on page https://www.dignityhealth.org/las-vegas/patients-and-visitors/for-patients/billing-and-payment/hospital-pricing-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-18
Content fingerprint 68672ac1b773083e… · 47,307,076 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
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 8 $298,828.47 $1,081,528.00 $304,805.04 nat. median
$370,174
0.8× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 8 $223,425.68 $807,811.00 $227,894.20 nat. median
$265,286
0.9× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 8 $188,305.65 $680,322.00 $192,071.77 nat. median
$206,474
0.9× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face Mouth… 8 $4,139.00 $690,698.00 $170,204.87 nat. median
$202,976
0.8× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face Mouth And Neck… 8 $4,139.00 $455,382.00 $112,521.28 nat. median
$133,161
0.8× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 8 $104,398.37 $375,733.00 $106,486.34 nat. median
$117,357
0.9× median
7
MS_DRG 		Lung Transplant 8 $104,137.66 $374,787.00 $106,220.42 nat. median
$122,708
0.9× median
215
MS_DRG 		Other Heart Assist System Implant 8 $64,648.00 $303,838.00 $97,926.30 nat. median
$99,019
1.0× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 8 $64,648.00 $276,774.00 $94,124.07 nat. median
$93,672
1.0× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 8 $87,949.51 $316,023.00 $89,708.51 nat. median
$108,660
0.8× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 8 $64,648.00 $243,015.00 $89,381.05 nat. median
$79,312
1.1× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 8 $86,955.67 $312,415.00 $88,694.79 nat. median
$102,358
0.9× median
232
MS_DRG 		Coronary Bypass With Ptca Without Mcc 8 $49,151.97 $175,185.00 $87,108.00 nat. median
$59,898
1.5× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 8 $62,019.70 $221,896.00 $87,108.00 nat. median
$74,915
1.2× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 8 $62,643.02 $224,159.00 $87,108.00 nat. median
$73,807
1.2× median
217
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 8 $51,910.69 $185,200.00 $87,108.00 nat. median
$64,508
1.4× median
230
MS_DRG 		No Active Code Description 4 $64,648.00 $109,568.00 $87,108.00 nat. median
$29,847
outlier · 2.9×
218
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 8 $47,892.69 $170,614.00 $86,950.67 nat. median
$61,920
1.4× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 8 $85,024.09 $305,403.00 $86,724.58 nat. median
$100,136
0.9× median
235
MS_DRG 		Coronary Bypass Without Cardiac Catheterization With Mcc 8 $47,378.39 $168,747.00 $86,355.35 nat. median
$57,424
1.5× median
61799
CPT 		Srs Cran Les Complex Addl 3 $286.69 $96,332.00 $84,724.00 nat. median
$2,389
outlier · 35.5×
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 7 $4,139.00 $300,414.00 $83,649.47 nat. median
$98,894
0.8× median
234
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 8 $42,922.71 $152,573.00 $81,197.93 nat. median
$53,268
1.5× median
220
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 8 $42,737.06 $151,899.00 $80,983.01 nat. median
$52,879
1.5× median
228
MS_DRG 		Other Cardiothoracic Procedures With Mcc 8 $40,261.16 $142,911.00 $78,117.04 nat. median
$50,672
1.5× median
61800
CPT 		Apply Srs Headframe Add-on 4 $145.56 $96,332.00 $77,208.50 nat. median
$1,636
outlier · 47.2×
850
MS_DRG 		Acute Leukemia With Other Procedures 8 $73,667.65 $264,179.00 $75,141.01 nat. median
$83,470
0.9× median
221
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 8 $37,174.58 $131,707.00 $74,544.39 nat. median
$48,732
1.5× median
J7330
HCPCS 		Maci Imp 42112x-46323 10 $29,353.10 $173,430.44 $72,118.90 nat. median
$76,329
0.9× median
236
MS_DRG 		Coronary Bypass Without Cardiac Catheterization Without Mcc 8 $33,378.57 $117,927.00 $70,150.39 nat. median
$42,002
1.7× median
63621
CPT 		Srs Spinal Lesion Addl 4 $238.35 $96,332.00 $69,693.00 nat. median
$2,835
outlier · 24.6×
63620
CPT 		Srs Spinal Lesion 4 $1,056.67 $96,332.00 $69,693.00 nat. median
$4,487
outlier · 15.5×
61796
CPT 		Srs Cranial Lesion Simple 4 $958.35 $96,332.00 $69,693.00 nat. median
$4,503
outlier · 15.5×
61798
CPT 		Srs Cranial Lesion Complex 4 $1,308.68 $96,332.00 $69,693.00 nat. median
$4,345
outlier · 16.0×
61797
CPT 		Srs Cran Les Simple Addl 4 $208.05 $96,332.00 $69,693.00 nat. median
$2,141
outlier · 32.6×
DB20HZZ
OTHER 		Cyber Knife Radiosurgery Ip 5 $46,280.00 $91,773.00 $69,026.50 nat. median
$47,022
1.5× median
DB20JZZ
OTHER 		Gamma Knife - Ip 5 $46,280.00 $91,773.00 $69,026.50 nat. median
$47,022
1.5× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature Malignancy Infection Or Exte… 8 $16,657.00 $242,880.00 $67,800.22 nat. median
$81,118
0.8× median
D026JZZ
OTHER 		Gamma Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D720HZZ
OTHER 		Cyber Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D020JZZ
OTHER 		Gamma Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D720JZZ
OTHER 		Gamma Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D021HZZ
OTHER 		Cyber Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D026HZZ
OTHER 		Cyber Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D027JZZ
OTHER 		Gamma Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D721HZZ
OTHER 		Cyber Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D721JZZ
OTHER 		Gamma Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D020HZZ
OTHER 		Cyber Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D021JZZ
OTHER 		Gamma Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median
D027HZZ
OTHER 		Cyber Knife - Ip 5 $46,280.00 $91,773.00 $66,894.00 nat. median
$46,280
1.4× median

Other procedures at this hospital

Browse this hospital's 10,049 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
             
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 11 8 — — $223,425.68 $807,811.00 $227,894.20 2026-02-28
10 MS_DRG Pancreas Transplant 11 8 — — $63,880.18 $228,650.00 $65,157.79 2026-02-28
11 MS_DRG Tracheostomy For Face Mouth And Neck Diagnoses Or Laryngectomy With Mcc 11 8 — — $43,520.75 $154,744.00 $44,391.17 2026-02-28
14 MS_DRG Allogeneic Bone Marrow Transplant 11 8 — — $104,398.37 $375,733.00 $106,486.34 2026-02-28
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 11 8 — — $48,576.84 $173,098.00 $49,548.38 2026-02-28
163 MS_DRG Major Chest Procedures With Mcc 11 8 — — $37,305.72 $132,183.00 $38,051.84 2026-02-28
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 11 8 — — $48,576.84 $173,098.00 $49,548.38 2026-02-28
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 11 8 — — $298,828.47 $1,081,528.00 $304,805.04 2026-02-28
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 11 8 — — $63,519.14 $227,339.00 $64,789.53 2026-02-28
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 11 8 — — $87,949.51 $316,023.00 $89,708.51 2026-02-28
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 11 8 — — $64,576.18 $259,793.00 $65,867.71 2026-02-28
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 9 8 — — $4,139.00 $185,466.00 $51,984.16 2026-02-28
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 11 8 — — $44,558.83 $178,134.00 $45,450.01 2026-02-28
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 11 8 — — $86,955.67 $312,415.00 $88,694.79 2026-02-28
215 MS_DRG Other Heart Assist System Implant 14 8 — — $64,648.00 $303,838.00 $97,926.30 2026-02-28
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 14 8 — — $64,648.00 $276,774.00 $94,124.07 2026-02-28
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 14 8 — — $51,910.69 $185,200.00 $87,108.00 2026-02-28
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 14 8 — — $47,892.69 $170,614.00 $86,950.67 2026-02-28
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 14 8 — — $62,019.70 $221,896.00 $87,108.00 2026-02-28
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 14 8 — — $42,737.06 $151,899.00 $80,983.01 2026-02-28
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 14 8 — — $37,174.58 $131,707.00 $74,544.39 2026-02-28
228 MS_DRG Other Cardiothoracic Procedures With Mcc 14 8 — — $40,261.16 $142,911.00 $78,117.04 2026-02-28
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 11 8 — — $45,963.47 $183,864.00 $46,882.74 2026-02-28
230 MS_DRG No Active Code Description 7 4 — — $64,648.00 $109,568.00 $87,108.00 2026-02-28
231 MS_DRG Coronary Bypass With Ptca With Mcc 14 8 — — $64,648.00 $243,015.00 $89,381.05 2026-02-28
232 MS_DRG Coronary Bypass With Ptca Without Mcc 14 8 — — $49,151.97 $175,185.00 $87,108.00 2026-02-28
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 14 8 — — $62,643.02 $224,159.00 $87,108.00 2026-02-28
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 14 8 — — $42,922.71 $152,573.00 $81,197.93 2026-02-28
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 14 8 — — $47,378.39 $168,747.00 $86,355.35 2026-02-28
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 14 8 — — $33,378.57 $117,927.00 $70,150.39 2026-02-28
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 11 8 — — $40,684.61 $144,448.00 $41,498.31 2026-02-28
245 MS_DRG Aicd Generator Procedures 9 8 — — $4,139.00 $140,144.00 $39,498.80 2026-02-28
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 11 8 — — $36,224.19 $144,133.00 $36,948.68 2026-02-28
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 11 8 — — $48,220.54 $171,804.00 $49,184.96 2026-02-28
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 11 8 — — $38,060.18 $134,921.00 $38,821.39 2026-02-28
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 11 8 — — $53,567.35 $191,213.00 $54,638.70 2026-02-28
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 11 8 — — $41,443.81 $147,204.00 $42,272.69 2026-02-28
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 15 9 — — $12,295.00 $202,667.00 $61,783.00 2026-02-28
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 15 9 — — $12,048.00 $177,643.00 $64,648.00 2026-02-28
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 15 9 — — $12,295.00 $133,407.00 $60,689.00 2026-02-28
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 11 8 — — $40,419.16 $143,485.00 $41,227.55 2026-02-28
28 MS_DRG Spinal Procedures With Mcc 11 8 — — $48,921.28 $195,930.00 $49,899.71 2026-02-28
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face Mouth … 9 8 — — $4,139.00 $690,698.00 $170,204.87 2026-02-28
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 11 8 — — $49,765.81 $177,414.00 $50,761.13 2026-02-28
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 11 8 — — $35,596.13 $125,977.00 $36,308.06 2026-02-28
32136293 CDM Inst/supp Ste13419x-14761 4 3 $65,659.00 $13,460.10 79% off $19,697.70 $47,274.48 $39,067.10 2026-02-28
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 14 8 — — $33,349.00 $122,151.00 $40,627.56 2026-02-28
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 14 8 — — $26,134.15 $91,629.00 $47,145.50 2026-02-28
326 MS_DRG Stomach Esophageal And Duodenal Procedures With Mcc 11 8 — — $41,017.20 $145,656.00 $41,837.55 2026-02-28
32701 CPT Thorax Stereo Rad Targetw/tx 4 3 — — $212.09 $91,924.00 $47,339.50 2026-02-28
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 11 8 — — $37,169.05 $131,687.00 $37,912.44 2026-02-28
38240 CPT Transplt Allo Hct/donor 9 7 — — $212.54 $66,670.18 $65,362.92 2026-02-28
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face Mouth And Neck… 9 8 — — $4,139.00 $455,382.00 $112,521.28 2026-02-28
405 MS_DRG Pancreas Liver And Shunt Procedures With Mcc 11 8 — — $43,779.88 $155,684.00 $44,655.48 2026-02-28
41024381 CDM Carmustine Polife 7.7mg 6 4 $57,648.00 $11,817.84 80% off $17,294.40 $41,506.56 $35,741.76 2026-02-28
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 8 7 — — $4,139.00 $300,414.00 $83,649.47 2026-02-28
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 8 7 — — $4,139.00 $203,691.00 $57,004.70 2026-02-28
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 8 7 — — $4,139.00 $157,847.00 $44,375.55 2026-02-28
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 8 7 — — $4,139.00 $239,192.00 $66,784.27 2026-02-28
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 8 7 — — $4,139.00 $156,883.00 $44,110.10 2026-02-28
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 8 7 — — $4,139.00 $192,277.00 $53,860.44 2026-02-28
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 8 7 — — $4,139.00 $147,695.00 $41,578.90 2026-02-28
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature Malignancy Infection Or Exte… 13 8 — — $16,657.00 $242,880.00 $67,800.22 2026-02-28
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature Malignancy Infection Or Exte… 13 8 — — $16,657.00 $164,595.00 $46,234.45 2026-02-28
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 11 8 — — $49,373.17 $175,988.00 $50,360.64 2026-02-28
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 11 8 — — $43,561.05 $154,890.00 $44,432.28 2026-02-28
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 9 8 — — $4,139.00 $146,103.00 $41,140.45 2026-02-28
471 MS_DRG Cervical Spinal Fusion With Mcc 13 8 — — $16,657.00 $156,541.00 $39,265.74 2026-02-28
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 11 8 — — $36,322.16 $128,612.00 $37,048.61 2026-02-28
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 11 8 — — $85,024.09 $305,403.00 $86,724.58 2026-02-28
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 11 8 — — $49,543.02 $176,605.00 $50,533.89 2026-02-28
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 11 8 — — $43,516.01 $154,726.00 $44,386.34 2026-02-28
6 MS_DRG Liver Transplant Without Mcc 11 8 — — $39,201.75 $139,065.00 $39,985.79 2026-02-28
61796 CPT Srs Cranial Lesion Simple 7 4 — — $958.35 $96,332.00 $69,693.00 2026-02-28
61797 CPT Srs Cran Les Simple Addl 7 4 — — $208.05 $96,332.00 $69,693.00 2026-02-28
61798 CPT Srs Cranial Lesion Complex 7 4 — — $1,308.68 $96,332.00 $69,693.00 2026-02-28
61799 CPT Srs Cran Les Complex Addl 5 3 — — $286.69 $96,332.00 $84,724.00 2026-02-28
61800 CPT Apply Srs Headframe Add-on 6 4 — — $145.56 $96,332.00 $77,208.50 2026-02-28
63620 CPT Srs Spinal Lesion 7 4 — — $1,056.67 $96,332.00 $69,693.00 2026-02-28
63621 CPT Srs Spinal Lesion Addl 7 4 — — $238.35 $96,332.00 $69,693.00 2026-02-28
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 11 8 — — $37,290.71 $132,128.00 $38,036.53 2026-02-28
653 MS_DRG Major Bladder Procedures With Mcc 11 8 — — $44,932.51 $159,868.00 $45,831.17 2026-02-28
7 MS_DRG Lung Transplant 11 8 — — $104,137.66 $374,787.00 $106,220.42 2026-02-28
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome Neonate 11 8 — — $47,857.14 $170,485.00 $48,814.29 2026-02-28
799 MS_DRG Splenic Procedures With Mcc 11 8 — — $38,455.98 $136,358.00 $39,225.10 2026-02-28
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 11 8 — — $43,877.84 $156,040.00 $44,755.40 2026-02-28
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 11 8 — — $46,889.37 $166,972.00 $47,827.16 2026-02-28
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 11 8 — — $37,861.10 $134,199.00 $38,618.33 2026-02-28
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 11 8 — — $38,619.51 $136,952.00 $39,391.91 2026-02-28
834 MS_DRG Acute Leukemia With Mcc 11 8 — — $44,558.83 $158,512.00 $45,450.01 2026-02-28
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 11 8 — — $40,449.97 $143,596.00 $41,258.97 2026-02-28
850 MS_DRG Acute Leukemia With Other Procedures 11 8 — — $73,667.65 $264,179.00 $75,141.01 2026-02-28
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 11 8 — — $40,403.36 $143,427.00 $41,211.43 2026-02-28
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 11 8 — — $36,534.67 $129,384.00 $37,265.37 2026-02-28
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 11 8 — — $55,849.70 $199,499.00 $56,966.70 2026-02-28
901 MS_DRG Wound Debridements For Injuries With Mcc 11 8 — — $35,893.97 $127,058.00 $36,611.85 2026-02-28
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 11 8 — — $188,305.65 $680,322.00 $192,071.77 2026-02-28
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 11 8 — — $53,656.62 $191,537.00 $54,729.76 2026-02-28
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 11 8 — — $35,075.52 $124,087.00 $35,777.04 2026-02-28
955 MS_DRG Craniotomy For Multiple Significant Trauma 11 8 — — $54,836.90 $220,062.00 $55,933.64 2026-02-28
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 11 8 — — $59,860.59 $240,556.00 $61,057.81 2026-02-28
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 11 8 — — $50,855.24 $181,368.00 $51,872.35 2026-02-28
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 11 8 — — $38,448.87 $136,332.00 $39,217.85 2026-02-28
C1605 HCPCS Pace Dl Ldles23772x-26149 16 10 $116,316.00 $23,844.78 80% off $34,894.80 $83,747.52 $45,944.82 2026-02-28
C1767 HCPCS Neurstm Nrec 10082x-11090 256 10 $83,421.00 $17,101.31 80% off $9,590.40 $122,612.40 $35,952.28 2026-02-28
C1822 HCPCS Nurstm Hf Rc 17861x-19647 112 10 $96,131.00 $19,706.86 79% off $1,171.20 $92,121.84 $37,491.09 2026-02-28
C1824 HCPCS Gener Ccm 23772x-26149 16 10 $116,316.00 $23,844.78 80% off $34,894.80 $83,747.52 $45,944.82 2026-02-28
C1825 HCPCS Nrstm Crsn Br26149x-28764 32 10 $134,344.00 $27,540.53 79% off $38,384.10 $101,333.52 $53,033.90 2026-02-28
C2624 HCPCS Wrless Sens 19647x-21611 32 10 $100,936.50 $20,691.99 79% off $28,839.30 $76,134.24 $39,845.89 2026-02-28
C9293 HCPCS Glucarpidase 1000unit Inj 18 10 $147,346.00 $30,205.93 80% off $622.41 $106,089.12 $46,413.99 2026-02-28
D020DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D020HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D020JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D021DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D021HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D021JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D026DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D026HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D026JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D027DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D027HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D027JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D720DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D720HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D720JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D721DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D721HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D721JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D722DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D722HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D722JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D723DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D723HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D723JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D724DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D724HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D724JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D725DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D725HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D725JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D726DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D726HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D726JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D727DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D727HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D727JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D728DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D728HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D728JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D820DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D820HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D820JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D920DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D920HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D920JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D921DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D921HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D921JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D924DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D924HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D924JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D925DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D925HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D925JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D926DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D926HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D926JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D927DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D927HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D927JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D928DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D928HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D928JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D929DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D929HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D929JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D92BDZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D92BHZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D92BJZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D92CDZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D92CHZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D92CJZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D92DDZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
D92DHZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
D92DJZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB20DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DB20HZZ OTHER Cyber Knife Radiosurgery Ip 9 5 — — $46,280.00 $91,773.00 $69,026.50 2026-02-28
DB20JZZ OTHER Gamma Knife - Ip 9 5 — — $46,280.00 $91,773.00 $69,026.50 2026-02-28
DB21DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DB21HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB21JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB22DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DB22HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB22JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB25DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DB25HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB25JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB26DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DB26HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB26JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB27DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DB27HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB27JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB28DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DB28HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DB28JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD20DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DD20HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD20JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD21DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DD21HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD21JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD22DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DD22HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD22JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD23DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DD23HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD23JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD24DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DD24HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD24JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD25DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DD25HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD25JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD27DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DD27HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DD27JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DF20DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DF20HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DF20JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DF21DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DF21HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DF21JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DF22DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DF22HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DF22JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DF23DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DF23HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DF23JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DG20DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DG20HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DG20JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DG21DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DG21HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DG21JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DG22DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DG22HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DG22JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DG24DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DG24HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DG24JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DG25DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DG25HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DG25JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DM20DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DM20HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DM20JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DM21DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DM21HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DM21JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DT20DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DT20HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DT20JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DT21DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DT21HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DT21JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DT22DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DT22HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DT22JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DT23DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DT23HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DT23JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DU20DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DU20HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DU20JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DU21DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DU21HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DU21JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DU22DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DU22HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DU22JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DV20DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DV20HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DV20JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DV21DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DV21HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DV21JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DW21DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DW21HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DW21JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DW22DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DW22HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DW22JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DW23DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DW23HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DW23JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DW26DZZ OTHER Cyber Knife Radiosurgery Ip 6 4 — — $46,280.00 $46,280.00 $46,280.00 2026-02-28
DW26HZZ OTHER Cyber Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
DW26JZZ OTHER Gamma Knife - Ip 13 5 — — $46,280.00 $91,773.00 $66,894.00 2026-02-28
J7330 HCPCS Maci Imp 42112x-46323 23 10 $206,054.00 $42,241.07 80% off $29,353.10 $173,430.44 $72,118.90 2026-02-28
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