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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

AULTMAN ORRVILLE HOSPITAL

Orrville, OH · CCN 361323 · Rates published

Your selected procedure

You selected 482 (MS_DRG)

Hip And Femur Procedures Except Major Joint Without Cc/Mcc

This facility filed a payer-negotiated range for this code ($10,524 to $26,275), not a single rate. The comparison board shows the midpoint estimate.

353 distinct procedures filed
23 distinct payers
11,521 rate rows
2026-04-01 last MRF observed
Data quality

2,737 of 11,521 rate rows are consumer-grade (23.8%)

8,784 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 8,576
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 208
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://aultman.org/pricing-transparency/2025/1891718375_aultman-orrville-hospital_standardcharges.json
Found on page https://aultman.org/home/patients-and-visitors/insurance-and-billing/pricing#/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-11-02
Content fingerprint 6d9a4b2673016485… · 7,141,911 bytes · first seen 2026-05-08

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
540
MS_DRG 		Osteomyelitis With Cc 1 $112,471.81 $112,471.81 $112,471.81 nat. median
$12,755
outlier · 8.8×
57
MS_DRG 		Degenerative Nervous System Disorders Without Mcc 1 $32,078.05 $32,078.05 $32,078.05 nat. median
$12,544
outlier · 2.6×
468
MS_DRG 		Revision Of Hip Or Knee Replacement Without Cc/Mcc 3 $31,346.52 $31,346.52 $31,346.52 nat. median
$25,650
1.2× median
561
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 1 $30,630.84 $30,630.84 $30,630.84 nat. median
$8,652
outlier · 3.5×
5116
OTHER 		Level 6 Musculoskeletal Procedures 3 $30,343.75 $30,343.75 $30,343.75 nat. median
$18,671
1.6× median
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 2 $29,359.30 $29,359.30 $29,359.30 nat. median
$11,475
outlier · 2.6×
947
MS_DRG 		Signs And Symptoms With Mcc 3 $24,936.46 $24,936.46 $24,936.46 nat. median
$12,107
outlier · 2.1×
5465
OTHER 		Level 5 Neurostimulator And Related Procedures 3 $23,855.68 $23,855.68 $23,855.68 nat. median
$31,925
0.7× median
480
MS_DRG 		Hip And Femur Procedures Except Major Joint With Mcc 1 $23,734.90 $23,734.90 $23,734.90 nat. median
$27,794
0.9× median
948
MS_DRG 		Signs And Symptoms Without Mcc 6 $19,058.60 $19,058.60 $19,058.60 nat. median
$7,968
outlier · 2.4×
482
MS_DRG 		Hip And Femur Procedures Except Major Joint Without Cc/Mcc 2 $18,399.69 $18,399.69 $18,399.69 nat. median
$15,979
1.2× median
463
MS_DRG 		Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective… 1 $17,221.00 $17,221.00 $17,221.00 nat. median
$49,873
outlier · 0.3×
5092
OTHER 		Level 2 Breast/Lymphatic Surgery And Related Procedures 1 $16,567.78 $16,567.78 $16,567.78 nat. median
$7,071
outlier · 2.3×
988
MS_DRG 		Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 1 $16,324.45 $16,324.45 $16,324.45 nat. median
$16,226
1.0× median
5362
OTHER 		Level 2 Laparoscopy And Related Services 8 $16,322.86 $16,322.86 $16,322.86 nat. median
$11,101
1.5× median
787
MS_DRG 		Cesarean Section Without Sterilization With Cc 3 $15,222.85 $15,222.85 $15,222.85 nat. median
$10,903
1.4× median
768
MS_DRG 		Vaginal Delivery With O.r. Procedures Except Sterilization And/Or D&c 2 $15,193.62 $15,193.62 $15,193.62 nat. median
$10,169
1.5× median
470
MS_DRG 		Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without… 4 $14,959.01 $14,959.01 $14,959.01 nat. median
$18,811
0.8× median
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 4 $14,362.03 $14,362.03 $14,362.03 nat. median
$15,375
0.9× median
5374
OTHER 		Level 4 Urology And Related Services 6 $14,274.39 $14,274.39 $14,274.39 nat. median
$3,718
outlier · 3.8×
5464
OTHER 		Level 4 Neurostimulator And Related Procedures 1 $13,963.26 $13,963.26 $13,963.26 nat. median
$20,791
0.7× median
798
MS_DRG 		Vaginal Delivery With Sterilization And/Or D&c Without Cc/Mcc 2 $13,758.12 $13,758.12 $13,758.12 nat. median
$9,232
1.5× median
558
MS_DRG 		Tendonitis, Myositis And Bursitis Without Mcc 2 $12,970.18 $12,970.18 $12,970.18 nat. median
$9,054
1.4× median
5114
OTHER 		Level 4 Musculoskeletal Procedures 10 $12,220.70 $12,220.70 $12,220.70 nat. median
$7,727
1.6× median
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 4 $12,115.30 $12,115.30 $12,115.30 nat. median
$18,625
0.7× median
644
MS_DRG 		Endocrine Disorders With Cc 2 $11,894.95 $11,894.95 $11,894.95 nat. median
$10,443
1.1× median
5361
OTHER 		Level 1 Laparoscopy And Related Services 13 $11,683.29 $11,683.29 $11,683.29 nat. median
$6,439
1.8× median
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 2 $11,359.33 $11,359.33 $11,359.33 nat. median
$10,397
1.1× median
190
MS_DRG 		Chronic Obstructive Pulmonary Disease With Mcc 3 $11,353.77 $11,353.77 $11,353.77 nat. median
$11,057
1.0× median
439
MS_DRG 		Disorders Of Pancreas Except Malignancy With Cc 2 $11,266.68 $11,266.68 $11,266.68 nat. median
$8,925
1.3× median
788
MS_DRG 		Cesarean Section Without Sterilization Without Cc/Mcc 4 $11,264.57 $11,264.57 $11,264.57 nat. median
$9,598
1.2× median
9211
OTHER 		Inj, Morphine (fresenius) 5 $11,226.90 $11,226.90 $11,226.90 nat. median
$12
outlier · 966.2×
786
MS_DRG 		Cesarean Section Without Sterilization With Mcc 1 $11,025.18 $11,025.18 $11,025.18 nat. median
$14,836
0.7× median
785
MS_DRG 		Cesarean Section With Sterilization Without Cc/Mcc 4 $10,811.75 $10,811.75 $10,811.75 nat. median
$9,457
1.1× median
9282
OTHER 		Inj, Acetaminophen (hikma) 2 $10,768.11 $10,768.11 $10,768.11 nat. median
$0
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 5 $10,702.88 $10,702.88 $10,702.88 nat. median
$10,189
1.1× median
522
MS_DRG 		Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 2 $10,662.17 $10,662.17 $10,662.17 nat. median
$20,537
0.5× median
784
MS_DRG 		Cesarean Section With Sterilization With Cc 1 $10,587.01 $10,587.01 $10,587.01 nat. median
$10,574
1.0× median
440
MS_DRG 		Disorders Of Pancreas Except Malignancy Without Cc/Mcc 1 $10,474.09 $10,474.09 $10,474.09 nat. median
$6,861
1.5× median
807
MS_DRG 		Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc 6 $10,386.88 $10,386.88 $10,386.88 nat. median
$6,987
1.5× median
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 3 $10,332.13 $10,332.13 $10,332.13 nat. median
$8,103
1.3× median
64
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Mcc 1 $9,698.30 $9,698.30 $9,698.30 nat. median
$19,223
0.5× median
5155
OTHER 		Level 5 Airway Endoscopy 3 $9,241.54 $9,241.54 $9,241.54 nat. median
$7,420
1.2× median
5341
OTHER 		Level 1 Abdominal/Peritoneal/Biliary And Related Procedures 2 $9,121.34 $9,121.34 $9,121.34 nat. median
$3,824
outlier · 2.4×
742
MS_DRG 		Uterine And Adnexa Procedures For Non-malignancy With Cc/Mcc 1 $8,962.97 $8,962.97 $8,962.97 nat. median
$17,778
0.5× median
668
MS_DRG 		Transurethral Procedures With Mcc 1 $8,957.30 $8,957.30 $8,957.30 nat. median
$27,351
outlier · 0.3×
5183
OTHER 		Level 3 Vascular Procedures 6 $8,785.33 $8,785.33 $8,785.33 nat. median
$3,363
outlier · 2.6×
391
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 1 $8,528.53 $8,528.53 $8,528.53 nat. median
$12,524
0.7× median
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 8 $8,524.30 $8,524.30 $8,524.30 nat. median
$8,373
1.0× median
605
MS_DRG 		Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc 2 $8,176.52 $8,176.52 $8,176.52 nat. median
$9,359
0.9× median

Other procedures at this hospital

Browse this hospital's 353 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
540 MS_DRG Osteomyelitis With Cc 2 1 — — $112,471.81 $112,471.81 $112,471.81 2025-01-01
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 2 1 — — $32,078.05 $32,078.05 $32,078.05 2025-01-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/Mcc 6 3 — — $31,346.52 $31,346.52 $31,346.52 2025-01-01
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 4 1 — — $30,630.84 $30,630.84 $30,630.84 2025-01-01
5116 OTHER Level 6 Musculoskeletal Procedures 6 3 — — $30,343.75 $30,343.75 $30,343.75 2025-01-01
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 4 2 — — $29,359.30 $29,359.30 $29,359.30 2025-01-01
947 MS_DRG Signs And Symptoms With Mcc 6 3 — — $24,936.46 $24,936.46 $24,936.46 2025-01-01
5465 OTHER Level 5 Neurostimulator And Related Procedures 8 3 — — $23,855.68 $23,855.68 $23,855.68 2025-01-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 2 1 — — $23,734.90 $23,734.90 $23,734.90 2025-01-01
948 MS_DRG Signs And Symptoms Without Mcc 20 6 — — $19,058.60 $19,058.60 $19,058.60 2025-01-01
482 MS_DRG Hip And Femur Procedures Except Major Joint Without Cc/Mcc 4 2 — — $18,399.69 $18,399.69 $18,399.69 2025-01-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 2 1 — — $17,221.00 $17,221.00 $17,221.00 2025-01-01
5092 OTHER Level 2 Breast/Lymphatic Surgery And Related Procedures 2 1 — — $16,567.78 $16,567.78 $16,567.78 2025-01-01
988 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 2 1 — — $16,324.45 $16,324.45 $16,324.45 2025-01-01
5362 OTHER Level 2 Laparoscopy And Related Services 20 8 — — $16,322.86 $16,322.86 $16,322.86 2025-01-01
787 MS_DRG Cesarean Section Without Sterilization With Cc 6 3 — — $15,222.85 $15,222.85 $15,222.85 2025-01-01
768 MS_DRG Vaginal Delivery With O.r. Procedures Except Sterilization And/Or D&c 4 2 — — $15,193.62 $15,193.62 $15,193.62 2025-01-01
470 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without … 10 4 — — $14,959.01 $14,959.01 $14,959.01 2025-01-01
177 MS_DRG Respiratory Infections And Inflammations With Mcc 8 4 — — $14,362.03 $14,362.03 $14,362.03 2025-01-01
5374 OTHER Level 4 Urology And Related Services 18 6 — — $14,274.39 $14,274.39 $14,274.39 2025-01-01
5464 OTHER Level 4 Neurostimulator And Related Procedures 2 1 — — $13,963.26 $13,963.26 $13,963.26 2025-01-01
798 MS_DRG Vaginal Delivery With Sterilization And/Or D&c Without Cc/Mcc 4 2 — — $13,758.12 $13,758.12 $13,758.12 2025-01-01
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 4 2 — — $12,970.18 $12,970.18 $12,970.18 2025-01-01
5114 OTHER Level 4 Musculoskeletal Procedures 30 10 — — $12,220.70 $12,220.70 $12,220.70 2025-01-01
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 12 4 — — $12,115.30 $12,115.30 $12,115.30 2025-01-01
644 MS_DRG Endocrine Disorders With Cc 6 2 — — $11,894.95 $11,894.95 $11,894.95 2025-01-01
5361 OTHER Level 1 Laparoscopy And Related Services 38 13 — — $11,683.29 $11,683.29 $11,683.29 2025-01-01
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 4 2 — — $11,359.33 $11,359.33 $11,359.33 2025-01-01
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 10 3 — — $11,353.77 $11,353.77 $11,353.77 2025-01-01
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 4 2 — — $11,266.68 $11,266.68 $11,266.68 2025-01-01
788 MS_DRG Cesarean Section Without Sterilization Without Cc/Mcc 8 4 — — $11,264.57 $11,264.57 $11,264.57 2025-01-01
9211 OTHER Inj, Morphine (fresenius) 10 5 — — $11,226.90 $11,226.90 $11,226.90 2025-01-01
786 MS_DRG Cesarean Section Without Sterilization With Mcc 2 1 — — $11,025.18 $11,025.18 $11,025.18 2025-01-01
785 MS_DRG Cesarean Section With Sterilization Without Cc/Mcc 8 4 — — $10,811.75 $10,811.75 $10,811.75 2025-01-01
9282 OTHER Inj, Acetaminophen (hikma) 4 2 — — $10,768.11 $10,768.11 $10,768.11 2025-01-01
178 MS_DRG Respiratory Infections And Inflammations With Cc 10 5 — — $10,702.88 $10,702.88 $10,702.88 2025-01-01
522 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 4 2 — — $10,662.17 $10,662.17 $10,662.17 2025-01-01
784 MS_DRG Cesarean Section With Sterilization With Cc 2 1 — — $10,587.01 $10,587.01 $10,587.01 2025-01-01
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/Mcc 2 1 — — $10,474.09 $10,474.09 $10,474.09 2025-01-01
807 MS_DRG Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc 14 6 — — $10,386.88 $10,386.88 $10,386.88 2025-01-01
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 6 3 — — $10,332.13 $10,332.13 $10,332.13 2025-01-01
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 2 1 — — $9,698.30 $9,698.30 $9,698.30 2025-01-01
5155 OTHER Level 5 Airway Endoscopy 6 3 — — $9,241.54 $9,241.54 $9,241.54 2025-01-01
5341 OTHER Level 1 Abdominal/Peritoneal/Biliary And Related Procedures 4 2 — — $9,121.34 $9,121.34 $9,121.34 2025-01-01
742 MS_DRG Uterine And Adnexa Procedures For Non-malignancy With Cc/Mcc 2 1 — — $8,962.97 $8,962.97 $8,962.97 2025-01-01
668 MS_DRG Transurethral Procedures With Mcc 2 1 — — $8,957.30 $8,957.30 $8,957.30 2025-01-01
5183 OTHER Level 3 Vascular Procedures 14 6 — — $8,785.33 $8,785.33 $8,785.33 2025-01-01
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 4 1 — — $8,528.53 $8,528.53 $8,528.53 2025-01-01
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 18 8 — — $8,524.30 $8,524.30 $8,524.30 2025-01-01
605 MS_DRG Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc 4 2 — — $8,176.52 $8,176.52 $8,176.52 2025-01-01
683 MS_DRG Renal Failure With Cc 16 6 — — $8,119.81 $8,119.81 $8,119.81 2025-01-01
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 10 5 — — $8,077.90 $8,077.90 $8,077.90 2025-01-01
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 16 7 — — $8,039.17 $8,039.17 $8,039.17 2025-01-01
291 MS_DRG Heart Failure And Shock With Mcc 12 4 — — $7,902.57 $7,902.57 $7,902.57 2025-01-01
5375 OTHER Level 5 Urology And Related Services 12 5 — — $7,800.94 $7,800.94 $7,800.94 2025-01-01
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 8 3 — — $7,493.81 $7,493.81 $7,493.81 2025-01-01
682 MS_DRG Renal Failure With Mcc 6 3 — — $7,174.91 $7,174.91 $7,174.91 2025-01-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 6 3 — — $7,157.35 $7,157.35 $7,157.35 2025-01-01
5113 OTHER Level 3 Musculoskeletal Procedures 24 10 — — $7,111.02 $7,111.02 $7,111.02 2025-01-01
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 8 3 — — $7,099.67 $7,099.67 $7,099.67 2025-01-01
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 2 1 — — $6,958.37 $6,958.37 $6,958.37 2025-01-01
442 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc 2 1 — — $6,922.56 $6,922.56 $6,922.56 2025-01-01
5414 OTHER Level 4 Gynecologic Procedures 32 12 — — $6,828.59 $6,828.59 $6,828.59 2025-01-01
743 MS_DRG Uterine And Adnexa Procedures For Non-malignancy Without Cc/Mcc 2 1 — — $6,808.08 $6,808.08 $6,808.08 2025-01-01
5154 OTHER Level 4 Airway Endoscopy 20 8 — — $6,652.40 $6,652.40 $6,652.40 2025-01-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 8 4 — — $6,635.34 $6,635.34 $6,635.34 2025-01-01
5415 OTHER Level 5 Gynecologic Procedures 14 6 — — $6,573.51 $6,573.51 $6,573.51 2025-01-01
537 MS_DRG Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc 2 1 — — $6,476.93 $6,476.93 $6,476.93 2025-01-01
5313 OTHER Level 3 Lower Gi Procedures 12 5 — — $6,452.70 $6,452.70 $6,452.70 2025-01-01
5073 OTHER Level 3 Excision/ Biopsy/ Incision And Drainage 14 6 — — $6,442.51 $6,442.51 $6,442.51 2025-01-01
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/Mcc 2 1 — — $6,437.15 $6,437.15 $6,437.15 2025-01-01
5153 OTHER Level 3 Airway Endoscopy 8 3 — — $6,400.32 $6,400.32 $6,400.32 2025-01-01
5165 OTHER Level 5 ENT Procedures 10 5 — — $6,321.40 $6,321.40 $6,321.40 2025-01-01
5091 OTHER Level 1 Breast/Lymphatic Surgery And Related Procedures 4 2 — — $6,311.77 $6,311.77 $6,311.77 2025-01-01
603 MS_DRG Cellulitis Without Mcc 4 2 — — $6,211.03 $6,211.03 $6,211.03 2025-01-01
5164 OTHER Level 4 ENT Procedures 12 5 — — $6,062.71 $6,062.71 $6,062.71 2025-01-01
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 8 3 — — $6,048.77 $6,048.77 $6,048.77 2025-01-01
5054 OTHER Level 4 Skin Procedures 4 2 — — $6,039.88 $6,039.88 $6,039.88 2025-01-01
812 MS_DRG Red Blood Cell Disorders Without Mcc 2 1 — — $6,038.11 $6,038.11 $6,038.11 2025-01-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 2 1 — — $5,860.90 $5,860.90 $5,860.90 2025-01-01
292 MS_DRG Heart Failure And Shock With Cc 8 2 — — $5,815.64 $5,815.64 $5,815.64 2025-01-01
5241 OTHER Level 1 Blood Product Exchange And Related Services 8 4 — — $5,749.77 $5,749.77 $5,749.77 2025-01-01
660 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Cc 2 1 — — $5,565.91 $5,565.91 $5,565.91 2025-01-01
868 MS_DRG Other Infectious And Parasitic Diseases Diagnoses With Cc 2 1 — — $5,546.62 $5,546.62 $5,546.62 2025-01-01
386 MS_DRG Inflammatory Bowel Disease With Cc 2 1 — — $5,439.57 $5,439.57 $5,439.57 2025-01-01
179 MS_DRG Respiratory Infections And Inflammations Without Cc/Mcc 4 2 — — $5,401.14 $5,401.14 $5,401.14 2025-01-01
8011 OTHER Comprehensive Observation Services 46 16 — — $5,400.98 $5,400.98 $5,400.98 2025-01-01
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 4 2 — — $5,274.37 $5,274.37 $5,274.37 2025-01-01
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc 2 1 — — $5,260.90 $5,260.90 $5,260.90 2025-01-01
5182 OTHER Level 2 Vascular Procedures 8 2 — — $5,177.49 $5,177.49 $5,177.49 2025-01-01
684 MS_DRG Renal Failure Without Cc/Mcc 2 1 — — $5,064.08 $5,064.08 $5,064.08 2025-01-01
638 MS_DRG Diabetes With Cc 4 2 — — $4,921.27 $4,921.27 $4,921.27 2025-01-01
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 14 5 — — $4,818.66 $4,818.66 $4,818.66 2025-01-01
5072 OTHER Level 2 Excision/ Biopsy/ Incision And Drainage 12 5 — — $4,517.30 $4,517.30 $4,517.30 2025-01-01
5163 OTHER Level 3 ENT Procedures 16 7 — — $4,333.83 $4,333.83 $4,333.83 2025-01-01
192 MS_DRG Chronic Obstructive Pulmonary Disease Without Cc/Mcc 2 1 — — $4,283.30 $4,283.30 $4,283.30 2025-01-01
831 MS_DRG Other Antepartum Diagnoses Without O.r. Procedures With Mcc 2 1 — — $4,009.48 $4,009.48 $4,009.48 2025-01-01
5373 OTHER Level 3 Urology And Related Services 2 1 — — $3,988.08 $3,988.08 $3,988.08 2025-01-01
5303 OTHER Level 3 Upper Gi Procedures 10 4 — — $3,950.42 $3,950.42 $3,950.42 2025-01-01
5112 OTHER Level 2 Musculoskeletal Procedures 14 6 — — $3,912.57 $3,912.57 $3,912.57 2025-01-01
832 MS_DRG Other Antepartum Diagnoses Without O.r. Procedures With Cc 4 2 — — $3,833.53 $3,833.53 $3,833.53 2025-01-01
5331 OTHER Complex Gi Procedures 6 3 — — $3,803.24 $3,803.24 $3,803.24 2025-01-01
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 2 1 — — $3,770.65 $3,770.65 $3,770.65 2025-01-01
759 MS_DRG Infections, Female Reproductive System Without Cc/Mcc 2 1 — — $3,695.56 $3,695.56 $3,695.56 2025-01-01
497 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 2 1 — — $3,668.10 $3,668.10 $3,668.10 2025-01-01
488 MS_DRG Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc 2 1 — — $3,651.39 $3,651.39 $3,651.39 2025-01-01
8008 OTHER MRI And MRA With Contrast Composite 32 10 — — $3,609.34 $3,609.34 $3,609.34 2025-01-01
833 MS_DRG Other Antepartum Diagnoses Without O.r. Procedures Without Cc/Mcc 2 1 — — $3,528.20 $3,528.20 $3,528.20 2025-01-01
794 MS_DRG Neonate With Other Significant Problems 10 5 — — $3,514.70 $3,514.70 $3,514.70 2025-01-01
5431 OTHER Level 1 Nerve Procedures 6 2 — — $3,340.58 $3,340.58 $3,340.58 2025-01-01
5724 OTHER Level 4 Diagnostic Tests And Related Services 32 10 — — $3,333.28 $3,333.28 $3,333.28 2025-01-01
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 2 1 — — $3,238.67 $3,238.67 $3,238.67 2025-01-01
563 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 2 1 — — $3,238.47 $3,238.47 $3,238.47 2025-01-01
8007 OTHER MRI And MRA Without Contrast Composite 26 9 — — $3,160.96 $3,160.96 $3,160.96 2025-01-01
312 MS_DRG Syncope And Collapse 2 1 — — $3,141.64 $3,141.64 $3,141.64 2025-01-01
5041 OTHER Critical Care 52 15 — — $3,013.14 $3,013.14 $3,013.14 2025-01-01
8006 OTHER CT And CTA With Contrast Composite 46 13 — — $2,882.88 $2,882.88 $2,882.88 2025-01-01
5593 OTHER Level 3 Nuclear Medicine And Related Services 50 15 — — $2,682.28 $2,682.28 $2,682.28 2025-01-01
793 MS_DRG Full Term Neonate With Major Problems 6 3 — — $2,679.14 $2,679.14 $2,679.14 2025-01-01
791 MS_DRG Prematurity With Major Problems 2 1 — — $2,609.49 $2,609.49 $2,609.49 2025-01-01
69 MS_DRG Transient Ischemia Without Thrombolytic 2 1 — — $2,547.36 $2,547.36 $2,547.36 2025-01-01
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 4 2 — — $2,507.79 $2,507.79 $2,507.79 2025-01-01
5302 OTHER Level 2 Upper Gi Procedures 12 5 — — $2,358.62 $2,358.62 $2,358.62 2025-01-01
5443 OTHER Level 3 Nerve Injections 6 3 — — $2,329.56 $2,329.56 $2,329.56 2025-01-01
5312 OTHER Level 2 Lower Gi Procedures 44 12 — — $2,276.38 $2,276.38 $2,276.38 2025-01-01
5111 OTHER Level 1 Musculoskeletal Procedures 10 5 — — $2,241.61 $2,241.61 $2,241.61 2025-01-01
5781 OTHER Resuscitation And Cardioversion 6 3 — — $2,148.93 $2,148.93 $2,148.93 2025-01-01
9272 OTHER Inj, Denosumab 6 3 — — $2,095.84 $2,095.84 $2,095.84 2025-01-01
5572 OTHER Level 2 Imaging With Contrast 56 16 — — $2,022.02 $2,022.02 $2,022.02 2025-01-01
5052 OTHER Level 2 Skin Procedures 16 7 — — $2,018.16 $2,018.16 $2,018.16 2025-01-01
5771 OTHER Cardiac Rehabilitation 20 8 — — $2,016.42 $2,016.42 $2,016.42 2025-01-01
792 MS_DRG Prematurity Without Major Problems 6 3 — — $1,831.19 $1,831.19 $1,831.19 2025-01-01
795 MS_DRG Normal Newborn 14 6 — — $1,784.20 $1,784.20 $1,784.20 2025-01-01
5311 OTHER Level 1 Lower Gi Procedures 52 16 — — $1,771.75 $1,771.75 $1,771.75 2025-01-01
92953 HCPCS Temporary External Pacing 2 1 — — $1,250.60 $2,257.43 $1,754.01 2026-04-01
92960 HCPCS Cardioversion 2 1 — — $1,250.60 $2,257.43 $1,754.01 2026-04-01
92961 HCPCS Cardioversion Electric Int 2 1 — — $1,250.60 $2,257.43 $1,754.01 2026-04-01
99465 HCPCS Nb Resuscitation 2 1 — — $1,250.60 $2,257.43 $1,754.01 2026-04-01
94003 HCPCS Vent Mgmt Inpat Subq Day 2 1 — — $1,168.95 $2,110.03 $1,639.49 2026-04-01
94002 HCPCS Vent Mgmt Inpat Init Day 2 1 — — $1,168.95 $2,110.03 $1,639.49 2026-04-01
5051 OTHER Level 1 Skin Procedures 32 10 — — $1,590.26 $1,590.26 $1,590.26 2025-01-01
552 MS_DRG Medical Back Problems Without Mcc 2 1 — — $1,450.91 $1,450.91 $1,450.91 2025-01-01
5102 OTHER Level 2 Strapping And Cast Application 2 1 — — $1,329.30 $1,329.30 $1,329.30 2025-01-01
5442 OTHER Level 2 Nerve Injections 36 10 — — $1,290.44 $1,290.44 $1,290.44 2025-01-01
5732 OTHER Level 2 Minor Procedures 4 2 — — $1,237.43 $1,237.43 $1,237.43 2025-01-01
789 MS_DRG Neonates, Died Or Transferred To Another Acute Care Facility 8 4 — — $1,226.18 $1,226.18 $1,226.18 2025-01-01
5523 OTHER Level 3 Imaging Without Contrast 58 15 — — $1,214.98 $1,214.98 $1,214.98 2025-01-01
8004 OTHER Ultrasound Composite 26 10 — — $955.41 $955.41 $955.41 2025-01-01
5592 OTHER Level 2 Nuclear Medicine And Related Services 32 9 — — $910.88 $910.88 $910.88 2025-01-01
5053 OTHER Level 3 Skin Procedures 8 4 — — $899.87 $899.87 $899.87 2025-01-01
5591 OTHER Level 1 Nuclear Medicine And Related Services 38 10 — — $883.80 $883.80 $883.80 2025-01-01
5524 OTHER Level 4 Imaging Without Contrast 60 17 — — $818.24 $818.24 $818.24 2025-01-01
5012 OTHER Clinic Visits And Related Services 6 3 — — $782.35 $782.35 $782.35 2025-01-01
5412 OTHER Level 2 Gynecologic Procedures 2 1 — — $765.72 $765.72 $765.72 2025-01-01
8005 OTHER CT And CTA Without Contrast Composite 10 4 — — $752.41 $752.41 $752.41 2025-01-01
5023 OTHER Level 3 Type A Ed Visits 60 15 — — $726.55 $726.55 $726.55 2025-01-01
N801 OTHER Therapy Services 56 17 — — $700.20 $700.20 $700.20 2025-01-01
5791 OTHER Pulmonary Treatment 8 4 — — $691.86 $691.86 $691.86 2025-01-01
7048 OTHER Alteplase Recombinant 2 1 — — $614.36 $614.36 $614.36 2025-01-01
5691 OTHER Level 1 Drug Administration 2 1 — — $609.48 $609.48 $609.48 2025-01-01
5522 OTHER Level 2 Imaging Without Contrast 68 19 — — $590.41 $590.41 $590.41 2025-01-01
94640 HCPCS Airway Inhalation Treatment 2 1 — — $414.34 $747.91 $581.12 2026-04-01
31720 HCPCS Clearance Of Airways 2 1 — — $414.34 $747.91 $581.12 2026-04-01
94669 HCPCS Mechanical Chest Wall Oscill 2 1 — — $414.34 $747.91 $581.12 2026-04-01
94664 HCPCS Asthma Inhaler-COPD Training 2 1 — — $414.34 $747.91 $581.12 2026-04-01
94660 HCPCS Pos Airway Pressure Cpap 2 1 — — $414.34 $747.91 $581.12 2026-04-01
94642 HCPCS Aerosol Inhalation Treatment 2 1 — — $414.34 $747.91 $581.12 2026-04-01
94610 HCPCS Surfactant Admin Thru Tube 2 1 — — $414.34 $747.91 $581.12 2026-04-01
5721 OTHER Level 1 Diagnostic Tests And Related Services 42 13 — — $579.92 $579.92 $579.92 2025-01-01
5573 OTHER Level 3 Imaging With Contrast 12 6 — — $556.27 $556.27 $556.27 2025-01-01
5673 OTHER Level 3 Pathology 14 6 — — $527.63 $527.63 $527.63 2025-01-01
5441 OTHER Level 1 Nerve Injections 22 11 — — $525.53 $525.53 $525.53 2025-01-01
5722 OTHER Level 2 Diagnostic Tests And Related Services 42 12 — — $524.18 $524.18 $524.18 2025-01-01
5411 OTHER Level 1 Gynecologic Procedures 22 9 — — $522.21 $522.21 $522.21 2025-01-01
5071 OTHER Level 1 Excision/ Biopsy/ Incision And Drainage 10 4 — — $520.98 $520.98 $520.98 2025-01-01
5571 OTHER Level 1 Imaging With Contrast 52 14 — — $494.29 $494.29 $494.29 2025-01-01
5734 OTHER Level 4 Minor Procedures 58 16 — — $453.93 $453.93 $453.93 2025-01-01
5733 OTHER Level 3 Minor Procedures 46 14 — — $388.15 $388.15 $388.15 2025-01-01
92520 HCPCS Laryngeal Function Studies 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0198T CPT Ocular Blood Flow Measure 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0207T CPT Clear Eyelid Gland W/heat 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0559T CPT Antmc Mdl 3d Print 1st Cmpnt 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0561T CPT Antmc Guide 3d Print 1st Gd 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0615T CPT Eye Mvmt Alys Without Calbrj I&r 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0764T CPT Asstv Alg ECG Rsk Asmt Cncrt 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0765T CPT Asstv Alg ECG Rsk Asmt Prev 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0780T CPT Instlj Fecal Microbiota Ssp 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0893T CPT N-invas Assmt Bld Oxygnation 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0902T CPT Qtc Ntrvl Augmnt Alg Aly ECG 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0962T CPT Asstv Alg Alys Acous&ecg Rec 2 1 — — $251.75 $454.42 $353.09 2026-04-01
1004T CPT Elec Alys S-scl EEG Wo Prgrm 2 1 — — $251.75 $454.42 $353.09 2026-04-01
1010T CPT Cptr Oph Alys Monoc Eye Mvmt 2 1 — — $251.75 $454.42 $353.09 2026-04-01
11740 HCPCS Drain Blood From Under Nail 2 1 — — $251.75 $454.42 $353.09 2026-04-01
11981 HCPCS Insert Drug Implant Device 2 1 — — $251.75 $454.42 $353.09 2026-04-01
29125 HCPCS Apply Forearm Splint 2 1 — — $251.75 $454.42 $353.09 2026-04-01
29126 HCPCS Apply Forearm Splint 2 1 — — $251.75 $454.42 $353.09 2026-04-01
29130 HCPCS Application Of Finger Splint 2 1 — — $251.75 $454.42 $353.09 2026-04-01
29240 HCPCS Strapping Of Shoulder 2 1 — — $251.75 $454.42 $353.09 2026-04-01
29520 HCPCS Strapping Of Hip 2 1 — — $251.75 $454.42 $353.09 2026-04-01
29530 HCPCS Strapping Of Knee 2 1 — — $251.75 $454.42 $353.09 2026-04-01
30300 HCPCS Rem Fb, Intranasal; 2 1 — — $251.75 $454.42 $353.09 2026-04-01
30901 HCPCS Control Of Nosebleed 2 1 — — $251.75 $454.42 $353.09 2026-04-01
30903 HCPCS Contrl Nasal Hemorr Ant Complx 2 1 — — $251.75 $454.42 $353.09 2026-04-01
30905 HCPCS Contrl Nasal Hemorr Post Init 2 1 — — $251.75 $454.42 $353.09 2026-04-01
36420 HCPCS Vein Access Cutdown < 1 Yr 2 1 — — $251.75 $454.42 $353.09 2026-04-01
36591 HCPCS Collect Blood/Comp Implant Dev 2 1 — — $251.75 $454.42 $353.09 2026-04-01
36592 HCPCS Collect Blood From Picc 2 1 — — $251.75 $454.42 $353.09 2026-04-01
36600 HCPCS Arterial Puncture Blood For Dx 2 1 — — $251.75 $454.42 $353.09 2026-04-01
41800 HCPCS Drain Abscess Dentoalveolar St 2 1 — — $251.75 $454.42 $353.09 2026-04-01
46600 HCPCS Anoscopy Diagnostic Without Hra 2 1 — — $251.75 $454.42 $353.09 2026-04-01
51701 HCPCS Insert Bladder Catheter 2 1 — — $251.75 $454.42 $353.09 2026-04-01
51702 HCPCS Insert Temp Bladder Cath 2 1 — — $251.75 $454.42 $353.09 2026-04-01
51736 HCPCS Urine Flow Measurement 2 1 — — $251.75 $454.42 $353.09 2026-04-01
53601 HCPCS Dilate Urethra Stricture 2 1 — — $251.75 $454.42 $353.09 2026-04-01
53661 HCPCS Dilation Of Urethra 2 1 — — $251.75 $454.42 $353.09 2026-04-01
65205 HCPCS Rem Fb Conjunctival Superficia 2 1 — — $251.75 $454.42 $353.09 2026-04-01
65222 HCPCS Fbr/Cornea With Slit Lamp 2 1 — — $251.75 $454.42 $353.09 2026-04-01
67820 HCPCS Revise Eyelashes 2 1 — — $251.75 $454.42 $353.09 2026-04-01
69200 HCPCS Clear Outer Ear Canal 2 1 — — $251.75 $454.42 $353.09 2026-04-01
76510 HCPCS Ophth US B & Quant A 2 1 — — $251.75 $454.42 $353.09 2026-04-01
91133 HCPCS Electrogastrography W/Test 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92020 HCPCS Special Eye Evaluation 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92083 HCPCS Visual Field Examination(s) 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92136 HCPCS Ophthalmic Biometry 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92250 HCPCS Eye Exam With Photos 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92270 HCPCS Electro-oculography 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92286 HCPCS Internal Eye Photography 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92287 HCPCS Internal Eye Photography 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92312 HCPCS Contact Lens Fitting 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92313 HCPCS Contact Lens Fitting 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92315 HCPCS Rx Cntact Lens Aphakia 1 Eye 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92316 HCPCS Rx Cntact Lens Aphakia 2 Eye 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92325 HCPCS Modification Of Contact Lens 2 1 — — $251.75 $454.42 $353.09 2026-04-01
0110T CPT Nos Quant Sensory Test 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92541 HCPCS Spontaneous Nystagmus Test 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92542 HCPCS Positional Nystagmus Test 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92548 HCPCS Posturography 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92549 HCPCS Cdp-sot 6 Cond W/i&r Mct&adt 2 1 — — $251.75 $454.42 $353.09 2026-04-01
92552 HCPCS Pure Tone Audiometry Air 2 1 — — $251.75 $454.42 $353.09 2026-04-01
93225 HCPCS ECG Monit/reprt Up To 48 Hrs 2 1 — — $251.75 $454.42 $353.09 2026-04-01
93243 HCPCS ECG >48Hrs < 7 Days Scan Anal 2 1 — — $251.75 $454.42 $353.09 2026-04-01
93247 HCPCS Ext Ecg>7d<15d Scan A/r 2 1 — — $251.75 $454.42 $353.09 2026-04-01
93701 HCPCS Bioimpedance Cv Analysis 2 1 — — $251.75 $454.42 $353.09 2026-04-01
93786 HCPCS Ambulatory Bp Recording 2 1 — — $251.75 $454.42 $353.09 2026-04-01
93788 HCPCS Ambulatory Bp Analysis 2 1 — — $251.75 $454.42 $353.09 2026-04-01
93922 HCPCS Extrem Arterial Single Level 2 1 — — $251.75 $454.42 $353.09 2026-04-01
94452 HCPCS Hast W/report 2 1 — — $251.75 $454.42 $353.09 2026-04-01
94453 HCPCS Hast W/oxygen Titrate 2 1 — — $251.75 $454.42 $353.09 2026-04-01
94617 HCPCS Exercise Tst Brncspsm 2 1 — — $251.75 $454.42 $353.09 2026-04-01
94618 HCPCS Pulmonary Stress Testing 2 1 — — $251.75 $454.42 $353.09 2026-04-01
94644 HCPCS Cbt 1st Hour 2 1 — — $251.75 $454.42 $353.09 2026-04-01
94667 HCPCS Chest Physiothrpy Initial 2 1 — — $251.75 $454.42 $353.09 2026-04-01
94668 HCPCS Chest Physiotherapy Subsequent 2 1 — — $251.75 $454.42 $353.09 2026-04-01
95056 HCPCS Photosensitivity Tests 2 1 — — $251.75 $454.42 $353.09 2026-04-01
95060 HCPCS Eye Allergy Tests 2 1 — — $251.75 $454.42 $353.09 2026-04-01
95860 HCPCS Muscle Test One Limb 2 1 — — $251.75 $454.42 $353.09 2026-04-01
95861 HCPCS Muscle Test 2 Limbs 2 1 — — $251.75 $454.42 $353.09 2026-04-01
95865 HCPCS Muscle Test Larynx 2 1 — — $251.75 $454.42 $353.09 2026-04-01
95870 HCPCS Muscle Test Nonparaspinal 2 1 — — $251.75 $454.42 $353.09 2026-04-01
95919 HCPCS Quan Puplmtry Phy/qhp Uni/bi 2 1 — — $251.75 $454.42 $353.09 2026-04-01
95922 HCPCS Autonomic Nrv Adrenrg Inervj 2 1 — — $251.75 $454.42 $353.09 2026-04-01
95923 HCPCS Autonomic Nrv Syst Funj Test 2 1 — — $251.75 $454.42 $353.09 2026-04-01
95970 HCPCS Analyze Neurostim No Prog 2 1 — — $251.75 $454.42 $353.09 2026-04-01
96136 HCPCS Psycl/nrpsyc Tst Phy/qhp 1st 2 1 — — $251.75 $454.42 $353.09 2026-04-01
99195 HCPCS Phlebotomy 2 1 — — $251.75 $454.42 $353.09 2026-04-01
G0166 HCPCS Extrnl Counterpulse, Per Tx 2 1 — — $251.75 $454.42 $353.09 2026-04-01
93797 HCPCS Cardiac Rehab 2 1 — — $243.91 $440.28 $342.09 2026-04-01
G0423 HCPCS Intens Cardiac Rehab No Exer 2 1 — — $243.91 $440.28 $342.09 2026-04-01
G0422 HCPCS Intens Cardiac Rehab W/exerc 2 1 — — $243.91 $440.28 $342.09 2026-04-01
93798 HCPCS Cardiac Rehab/monitor 2 1 — — $243.91 $440.28 $342.09 2026-04-01
N700 OTHER Non-opps Clinic Services 62 18 — — $303.61 $303.61 $303.61 2025-01-01
5521 OTHER Level 1 Imaging Without Contrast 58 16 — — $288.01 $288.01 $288.01 2025-01-01
5371 OTHER Level 1 Urology And Related Services 2 1 — — $262.30 $262.30 $262.30 2025-01-01
N804 OTHER Mammography Services 60 16 — — $217.09 $217.09 $217.09 2025-01-01
5021 OTHER Level 1 Type A Ed Visits 16 8 — — $203.69 $203.69 $203.69 2025-01-01
11721 HCPCS Debride Nail 6 Or More 1 1 — — $201.49 $201.49 $201.49 2026-04-01
5101 OTHER Level 1 Strapping And Cast Application 2 1 — — $170.40 $170.40 $170.40 2025-01-01
9290 OTHER Inj, Bupivacaine, Nos, 0.5mg 2 1 — — $160.14 $160.14 $160.14 2025-01-01
95024 HCPCS Icut Allergy Test Drug/bug 2 1 — — $111.62 $201.49 $156.56 2026-04-01
94690 HCPCS Exhaled Air Analysis 2 1 — — $111.62 $201.49 $156.56 2026-04-01
94626 HCPCS Phy/qhp Op Pulm Rhb W/mntr 2 1 — — $111.62 $201.49 $156.56 2026-04-01
94625 HCPCS Phy/qhp Op Pulm Rhb Without Mntr 2 1 — — $111.62 $201.49 $156.56 2026-04-01
94619 HCPCS Exercise Tst Brncspsm Wo ECG 2 1 — — $111.62 $201.49 $156.56 2026-04-01
94200 HCPCS Lung Function Test (mbc/mvv) 2 1 — — $111.62 $201.49 $156.56 2026-04-01
93668 HCPCS Peripheral Vascular Rehab 2 1 — — $111.62 $201.49 $156.56 2026-04-01
93278 HCPCS Ecg/signal-averaged 2 1 — — $111.62 $201.49 $156.56 2026-04-01
93226 HCPCS ECG Monit/reprt Up To 48 Hrs 2 1 — — $111.62 $201.49 $156.56 2026-04-01
93041 HCPCS Rhythm ECG Tracing 2 1 — — $111.62 $201.49 $156.56 2026-04-01
93005 HCPCS EKG-tracing 12 Lead 2 1 — — $111.62 $201.49 $156.56 2026-04-01
92583 HCPCS Select Picture Audiometry 2 1 — — $111.62 $201.49 $156.56 2026-04-01
92565 HCPCS Stenger Test Pure Tone 2 1 — — $111.62 $201.49 $156.56 2026-04-01
92556 HCPCS Speech Audiometry Complete 2 1 — — $111.62 $201.49 $156.56 2026-04-01
92555 HCPCS Speech Threshold Audiometry 2 1 — — $111.62 $201.49 $156.56 2026-04-01
92371 HCPCS Repair & Adjust Spectacles 2 1 — — $111.62 $201.49 $156.56 2026-04-01
69210 HCPCS Remove Impacted Ear Wax 2 1 — — $111.62 $201.49 $156.56 2026-04-01
P9100 HCPCS Pathogen Test For Platelets 2 1 — — $111.62 $201.49 $156.56 2026-04-01
G0127 HCPCS Trim Nail(s) 2 1 — — $111.62 $201.49 $156.56 2026-04-01
96912 HCPCS Photochemotherapy With Uv-a 2 1 — — $111.62 $201.49 $156.56 2026-04-01
96910 HCPCS Photochemotherapy With Uv-b 2 1 — — $111.62 $201.49 $156.56 2026-04-01
96523 HCPCS Irrig Drug Delivery Device 2 1 — — $111.62 $201.49 $156.56 2026-04-01
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