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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

INTEGRIS SOUTHWEST MEDICAL CENTER

Oklahoma City, OK · CCN 370106 · Rates published

16,448 distinct procedures filed
36 distinct payers
168,753 rate rows
2026-04-01 last MRF observed
Data quality

118,206 of 168,753 rate rows are consumer-grade (70.0%)

50,547 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 35,899
professional (physician) fee — not the facility price 12,975
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 1,594
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 50
placeholder amount (≤ $0.02) — excluded from medians 29
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://HospitalPriceDisclosure.com/download.aspx?pi=5WT9HTDTVJjg8fpR4CruzQ*-*
Found on page https://HospitalPriceDisclosure.com/default.aspx?pi=5WT9HTDTVJjg8fpR4CruzQ*-*
Discovered viaCMS hospital list
Last fetch success · 2026-11-08
Content fingerprint a9e2bdf3eabecb4f… · 46,074,908 bytes · first seen 2026-10-05

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
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 2 $3,408,903.61 $6,121,500.00 $5,217,301.20 nat. median
$3,710,000
1.4× median
H2000
HCPCS 		Comp Multidisipln Evaluation 1 $4,165,959.00 $4,165,959.00 $4,165,959.00 nat. median
$136
outlier · 30670.4×
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 3 $13.04 $6,080,690.01 $3,923,624.41 nat. median
$3,691,450
1.1× median
H2010
HCPCS 		Comprehensive Medication Services, Per 15 Minutes 1 $3,807,119.13 $3,807,119.13 $3,807,119.13 nat. median
$35
outlier · 108930.4×
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 3 $3,334.25 $5,482,080.95 $3,533,525.67 nat. median
$3,324,572
1.1× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 3 $89.91 $5,421,900.00 $3,475,840.79 nat. median
$3,286,000
1.1× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 3 $42.45 $4,864,551.99 $3,129,654.46 nat. median
$2,983,626
1.0× median
J3391
HCPCS 		Inj, Atidarsagene Autotemcel 3 $79.40 $4,595,100.00 $3,033,393.13 nat. median
$4,505,000
0.7× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 3 $38.88 $3,998,166.53 $2,682,009.49 nat. median
$2,467,989
1.1× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 3 $141.40 $3,847,800.00 $2,468,714.57 nat. median
$2,401,960
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 2 $813,967.38 $1,271,523.00 $1,046,815.03 nat. median
$813,967
1.3× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 2 $587,977.76 $912,729.35 $753,293.44 nat. median
$646,415
1.2× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 2 $567,977.78 $870,577.06 $722,117.31 nat. median
$621,967
1.2× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 2 $579,570.61 $852,129.78 $718,748.05 nat. median
$637,620
1.1× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 2 $562,500.89 $829,687.20 $698,906.55 nat. median
$607,251
1.2× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 2 $510,103.92 $807,508.61 $661,356.79 nat. median
$589,091
1.1× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 3 $1,284.99 $954,972.35 $629,369.98 nat. median
$739,658
0.9× median
M1107
HCPCS 		Docu Dx Degen Neuro 1 $578,544.93 $578,544.93 $578,544.93 nat. median
$260
outlier · 2222.4×
18
MS_DRG 		Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 15 $336,225.73 $1,018,662.39 $559,395.35 nat. median
$360,195
1.6× median
M1106
HCPCS 		Start Eoc Doc Med Rec 1 $552,546.94 $552,546.94 $552,546.94 nat. median
$260
outlier · 2122.5×
M1070
HCPCS 		Pt Not Scrn Fut Fall No Rsn 1 $540,429.11 $540,429.11 $540,429.11 nat. median
$260
outlier · 2075.9×
M1058
HCPCS 		Pt Prm Nurs Hm Res In Pp 1 $523,694.85 $523,694.85 $523,694.85 nat. median
$260
outlier · 2011.7×
M1069
HCPCS 		Pt Scr Ft Fall Rsk 1 $512,361.60 $512,361.60 $512,361.60 nat. median
$260
outlier · 1968.1×
C9301
HCPCS 		Obecabtagene Car Pos T 1 $459,112.50 $459,112.50 $459,112.50 nat. median
$459,112
1.0× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 15 $218,904.15 $690,542.33 $368,284.75 nat. median
$247,805
1.5× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 15 $167,255.70 $503,648.47 $269,389.09 nat. median
$197,664
1.4× median
J3403
HCPCS 		Revakinagene, Per Implant 3 $61.30 $266,811.24 $176,150.73 nat. median
$265,000
0.7× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 15 $89,716.45 $413,705.64 $169,566.11 nat. median
$103,911
1.6× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 15 $109,216.77 $326,748.15 $166,640.02 nat. median
$126,240
1.3× median
7
MS_DRG 		Lung Transplant 15 $102,241.98 $305,489.26 $162,609.99 nat. median
$117,943
1.4× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 15 $95,026.49 $315,723.87 $161,331.62 nat. median
$109,875
1.5× median
215
MS_DRG 		Other Heart Assist System Implant 15 $79,076.25 $349,663.78 $156,832.05 nat. median
$93,531
1.7× median
209
MS_DRG 		Complex Aortic Arch Procedures 15 $89,615.84 $307,135.64 $153,459.79 nat. median
$92,760
1.7× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 15 $87,312.58 $284,418.22 $147,249.88 nat. median
$93,094
1.6× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 15 $86,174.10 $292,262.94 $147,041.14 nat. median
$97,029
1.5× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 15 $81,812.15 $283,262.27 $140,383.48 nat. median
$94,844
1.5× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 3 $422.01 $207,732.96 $137,271.58 nat. median
$209,753
0.7× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 15 $61,184.19 $199,268.59 $135,449.82 nat. median
$71,672
1.9× median
453
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Mcc 15 — — $131,695.73 nat. median
$70,514
1.9× median
850
MS_DRG 		Acute Leukemia With Other Procedures 15 $69,034.31 $249,948.63 $119,838.73 nat. median
$78,028
1.5× median
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 15 $71,743.89 $226,305.90 $119,589.72 nat. median
$77,933
1.5× median
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection Wi… 15 $67,052.24 $249,761.39 $117,398.80 nat. median
$77,595
1.5× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 15 $62,914.73 $271,325.58 $115,598.54 nat. median
$74,260
1.6× median
146
MS_DRG 		Ear, Nose, Mouth And Throat Malignancy With Mcc 15 $18,402.05 $52,172.46 $106,081.05 nat. median
$20,502
outlier · 5.2×
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 15 $60,988.38 $198,175.05 $102,283.06 nat. median
$67,850
1.5× median
40
MS_DRG 		Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 15 $31,898.10 $103,324.65 $98,272.84 nat. median
$35,776
outlier · 2.7×
427
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 15 $57,882.54 $192,623.22 $97,671.14 nat. median
$63,446
1.5× median
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 15 $57,199.92 $190,916.43 $96,584.53 nat. median
$66,553
1.5× median
454
MS_DRG 		Combined Anterior And Posterior Spinal Fusion With Cc 15 — — $94,960.68 nat. median
$49,393
1.9× median
19
MS_DRG 		Simultaneous Pancreas, Islet Cell And Kidney Transplant With Hemodialysis 15 $57,232.42 $180,770.66 $94,856.95 nat. median
$66,332
1.4× median

Other procedures at this hospital

Browse this hospital's 16,448 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
             
0266T OTHER Implt/rpl Crtd Sns Dev Total 6 3 — — $11,888.00 $76,500.85 $30,122.16 2026-04-01
0268T OTHER Implt/rpl Crtd Sns Dev Gen 6 3 — — $11,888.00 $51,805.10 $26,006.20 2026-04-01
0896T OTHER Connj Lvr Algrft Prfu Dev Ea 1 1 — — $31,961.30 $31,961.30 $31,961.30 2026-04-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 64 15 — — $218,904.15 $690,542.33 $368,284.75 2026-04-01
10 MS_DRG Pancreas Or Islet Cell Transplant 64 15 — — $38,601.00 $169,271.46 $84,185.06 2026-04-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 64 15 — — $44,226.27 $133,479.78 $72,183.38 2026-04-01
113 MS_DRG Orbital Procedures With Cc/Mcc 64 15 — — $20,210.76 $59,346.96 $31,842.18 2026-04-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 64 15 — — $34,644.06 $99,453.50 $54,844.15 2026-04-01
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc 64 15 — — $24,318.08 $67,980.34 $37,742.31 2026-04-01
135 MS_DRG Sinus And Mastoid Procedures With Cc/Mcc 64 15 — — $18,809.14 $61,658.86 $30,456.94 2026-04-01
14 MS_DRG Allogeneic Bone Marrow Transplant 64 15 — — $95,026.49 $315,723.87 $161,331.62 2026-04-01
140 MS_DRG Major Head And Neck Procedures With Mcc 64 15 — — $35,025.61 $108,013.58 $57,168.35 2026-04-01
141 MS_DRG Major Head And Neck Procedures With Cc 64 15 — — $18,895.05 $59,900.51 $30,324.22 2026-04-01
146 MS_DRG Ear, Nose, Mouth And Throat Malignancy With Mcc 64 15 — — $18,402.05 $52,172.46 $106,081.05 2026-04-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/Mcc 64 15 — — $47,907.16 $174,860.65 $82,868.84 2026-04-01
163 MS_DRG Major Chest Procedures With Mcc 64 15 — — $36,701.20 $134,106.60 $44,945.05 2026-04-01
164 MS_DRG Major Chest Procedures With Cc 64 15 — — $21,548.91 $69,943.18 $32,244.55 2026-04-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 64 15 — — $30,942.28 $96,247.85 $28,051.34 2026-04-01
167 MS_DRG Other Respiratory System O.r. Procedures With Cc 64 15 — — $15,971.86 $50,191.61 $26,025.24 2026-04-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/Mcc 64 15 — — $44,057.55 $128,145.46 $70,099.10 2026-04-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 64 15 — — $25,050.23 $83,440.13 $41,344.52 2026-04-01
18 MS_DRG Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 64 15 — — $336,225.73 $1,018,662.39 $559,395.35 2026-04-01
19 MS_DRG Simultaneous Pancreas, Islet Cell And Kidney Transplant With Hemodialysis 64 15 — — $57,232.42 $180,770.66 $94,856.95 2026-04-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 64 15 — — $89,716.45 $413,705.64 $169,566.11 2026-04-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 64 15 — — $62,914.73 $271,325.58 $115,598.54 2026-04-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 64 15 — — $51,815.58 $151,791.61 $71,122.15 2026-04-01
209 MS_DRG Complex Aortic Arch Procedures 64 15 — — $89,615.84 $307,135.64 $153,459.79 2026-04-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 64 15 — — $42,985.64 $204,497.50 $81,325.35 2026-04-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 64 15 — — $86,174.10 $292,262.94 $147,041.14 2026-04-01
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 64 15 — — $46,182.81 $154,856.73 $77,770.36 2026-04-01
215 MS_DRG Other Heart Assist System Implant 64 15 — — $79,076.25 $349,663.78 $156,832.05 2026-04-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 64 15 — — $77,728.04 $257,771.65 $71,166.30 2026-04-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 64 15 — — $52,903.75 $170,486.49 $88,292.70 2026-04-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 64 15 — — $52,903.75 $155,108.30 $85,855.27 2026-04-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 64 15 — — $61,440.36 $206,429.51 $53,272.40 2026-04-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 64 15 — — $26,605.86 $155,133.51 $53,940.89 2026-04-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 64 15 — — $43,287.48 $139,482.04 $71,941.31 2026-04-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 64 15 — — $41,022.91 $124,381.41 $66,920.85 2026-04-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 64 15 — — $40,304.69 $178,993.31 $49,586.88 2026-04-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 64 15 — — $46,363.91 $149,104.11 $77,127.91 2026-04-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 64 15 — — $67,257.33 $220,127.26 $61,535.98 2026-04-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 64 15 — — $48,935.73 $158,479.25 $81,663.45 2026-04-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 64 15 — — $61,184.19 $199,268.59 $135,449.82 2026-04-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 64 15 — — $44,292.83 $137,210.84 $65,755.14 2026-04-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 64 15 — — $47,434.28 $156,802.31 $79,584.96 2026-04-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 64 15 — — $40,105.79 $126,058.36 $36,071.57 2026-04-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 64 15 — — $32,290.49 $103,965.04 $53,232.99 2026-04-01
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 64 15 — — $24,075.84 $72,366.33 $31,095.35 2026-04-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 64 15 — — $26,725.05 $100,548.74 $26,181.42 2026-04-01
244 MS_DRG Permanent Cardiac Pacemaker Implant Without Cc/Mcc 64 15 — — $16,003.59 $58,055.33 $27,220.65 2026-04-01
245 MS_DRG Aicd Generator Procedures 64 15 — — $37,325.00 $147,950.87 $65,956.29 2026-04-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 64 15 — — $37,203.50 $116,854.16 $61,144.37 2026-04-01
252 MS_DRG Other Vascular Procedures With Mcc 64 15 — — $29,012.06 $87,738.31 $26,376.89 2026-04-01
253 MS_DRG Other Vascular Procedures With Cc 64 15 — — $22,103.05 $68,787.23 $45,089.64 2026-04-01
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 64 15 — — $22,890.93 $68,252.67 $36,439.16 2026-04-01
256 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Cc 64 15 — — $15,155.35 $47,299.02 $28,810.13 2026-04-01
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 64 15 — — $26,332.66 $83,613.79 $42,931.06 2026-04-01
259 MS_DRG Cardiac Pacemaker Device Replacement Without Mcc 64 15 — — $17,664.48 $56,628.03 $28,336.03 2026-04-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 64 15 — — $26,078.03 $81,326.31 $42,278.12 2026-04-01
263 MS_DRG Vein Ligation And Stripping 64 15 — — $25,677.13 $72,122.66 $39,103.40 2026-04-01
265 MS_DRG Aicd Lead Procedures 64 15 — — $30,017.41 $90,571.20 $48,458.20 2026-04-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 64 15 — — $49,444.99 $210,364.09 $90,065.10 2026-04-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 64 15 — — $38,860.51 $165,702.59 $70,487.18 2026-04-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 64 15 — — $55,245.71 $177,104.72 $41,350.25 2026-04-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 64 15 — — $34,699.78 $112,762.21 $31,077.30 2026-04-01
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc 64 15 — — $21,540.39 $64,214.98 $34,190.22 2026-04-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 64 15 — — $42,850.20 $134,076.75 $35,783.72 2026-04-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 64 15 — — $33,943.64 $97,318.65 $54,217.74 2026-04-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 64 15 — — $27,490.48 $77,649.69 $43,066.04 2026-04-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 64 15 — — $57,199.92 $190,916.43 $96,584.53 2026-04-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 64 15 — — $48,502.32 $168,513.78 $82,641.11 2026-04-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 64 15 — — $37,759.19 $129,770.42 $35,250.45 2026-04-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 64 15 — — $45,093.87 $131,304.10 $39,431.18 2026-04-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 64 15 — — $29,926.09 $86,848.28 $52,999.78 2026-04-01
28 MS_DRG Spinal Procedures With Mcc 64 15 — — $48,515.48 $150,832.61 $80,005.19 2026-04-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 64 15 — — $22,959.03 $73,484.29 $37,306.71 2026-04-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 64 15 — — $28,418.44 $88,831.85 $46,251.67 2026-04-01
30 MS_DRG Spinal Procedures Without Cc/Mcc 64 15 — — $19,004.17 $57,887.10 $30,155.01 2026-04-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 64 15 — — $36,691.14 $110,553.42 $59,575.93 2026-04-01
3141F OTHER Upper Gi Endo Not Barrtts 1 1 — — $34,595.10 $34,595.10 $34,595.10 2026-04-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 64 15 — — $53,764.37 $167,857.11 $88,945.55 2026-04-01
318 MS_DRG Percutaneous Coronary Atherectomy Without Intraluminal Device 64 15 — — $20,761.03 $65,726.40 $33,468.58 2026-04-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 64 15 — — $36,554.93 $111,272.49 $59,518.05 2026-04-01
32 MS_DRG Ventricular Shunt Procedures With Cc 64 15 — — $18,507.30 $57,732.43 $29,527.22 2026-04-01
320 MS_DRG Other Endovascular Cardiac Valve Procedures Without Mcc 64 15 — — $20,630.23 $63,704.84 $33,006.21 2026-04-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 64 15 — — $23,072.03 $78,004.98 $30,826.01 2026-04-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 64 15 — — $35,506.23 $112,338.90 $32,331.93 2026-04-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 64 15 — — $26,861.27 $75,731.86 $41,795.35 2026-04-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 64 15 — — $40,614.27 $123,404.55 $47,499.65 2026-04-01
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 64 15 — — $20,931.30 $57,657.55 $36,676.53 2026-04-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 64 15 — — $37,588.92 $133,322.40 $40,572.03 2026-04-01
332 MS_DRG Rectal Resection With Mcc 64 15 — — $30,036.76 $103,692.60 $50,449.78 2026-04-01
333 MS_DRG Rectal Resection With Cc 64 15 — — $20,141.87 $55,251.42 $30,966.29 2026-04-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 64 15 — — $29,651.34 $111,085.26 $27,780.46 2026-04-01
336 MS_DRG Peritoneal Adhesiolysis With Cc 64 15 — — $18,334.71 $63,487.76 $27,225.86 2026-04-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 64 15 — — $31,971.63 $108,317.49 $28,031.14 2026-04-01
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 64 15 — — $22,003.99 $74,697.23 $36,326.51 2026-04-01
345 MS_DRG Minor Small And Large Bowel Procedures With Cc 64 15 — — $13,660.08 $42,365.88 $34,314.88 2026-04-01
347 MS_DRG Anal And Stomal Procedures With Mcc 64 15 — — $19,781.22 $71,354.20 $33,120.42 2026-04-01
350 MS_DRG Inguinal And Femoral Hernia Procedures With Mcc 64 15 — — $21,300.47 $66,771.09 $33,789.04 2026-04-01
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 64 15 — — $24,474.42 $81,673.64 $40,378.93 2026-04-01
354 MS_DRG Hernia Procedures Except Inguinal And Femoral With Cc 64 15 — — $15,035.38 $46,775.31 $27,289.07 2026-04-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 64 15 — — $36,012.39 $103,624.13 $35,556.67 2026-04-01
357 MS_DRG Other Digestive System O.r. Procedures With Cc 64 15 — — $20,012.63 $56,983.50 $26,951.55 2026-04-01
359 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc 64 15 — — $28,627.41 $93,306.41 $47,177.08 2026-04-01
360 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc 64 15 — — $20,699.89 $65,512.03 $33,362.01 2026-04-01
385 MS_DRG Inflammatory Bowel Disease With Mcc 64 15 — — $14,260.66 $44,862.30 $25,654.26 2026-04-01
397 MS_DRG Appendix Procedures With Mcc 64 15 — — $20,549.74 $60,961.49 $32,496.79 2026-04-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 64 15 — — $109,216.77 $326,748.15 $166,640.02 2026-04-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 64 15 — — $31,898.10 $103,324.65 $98,272.84 2026-04-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 64 15 — — $33,131.00 $106,618.84 $54,653.77 2026-04-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 64 15 — — $44,353.20 $143,473.60 $73,836.75 2026-04-01
407 MS_DRG Pancreas, Liver And Shunt Procedures Without Cc/Mcc 64 15 — — $19,193.02 $54,772.00 $29,917.59 2026-04-01
409 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 64 15 — — $18,865.64 $63,238.12 $30,789.02 2026-04-01
41 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe… 64 15 — — $19,031.26 $63,254.40 $27,610.57 2026-04-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 64 15 — — $27,580.26 $89,502.08 $25,734.14 2026-04-01
412 MS_DRG Cholecystectomy With C.d.e. With Cc 64 15 — — $18,286.73 $64,426.63 $30,262.87 2026-04-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 64 15 — — $29,587.10 $96,242.42 $48,785.19 2026-04-01
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 64 15 — — $20,483.96 $64,885.21 $27,074.14 2026-04-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 64 15 — — $28,383.62 $110,121.97 $66,229.02 2026-04-01
4210F OTHER Ace/arb Thxpy For Mos/> 1 1 — — $27,069.16 $27,069.16 $27,069.16 2026-04-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 64 15 — — $34,156.47 $102,760.25 $61,906.10 2026-04-01
424 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Cc 64 15 — — $18,947.68 $60,657.58 $30,501.83 2026-04-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 64 15 — — $87,312.58 $284,418.22 $147,249.88 2026-04-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 64 15 — — $57,882.54 $192,623.22 $97,671.14 2026-04-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 64 15 — — $45,525.73 $149,383.60 $76,149.91 2026-04-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 64 15 — — $71,743.89 $226,305.90 $119,589.72 2026-04-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 64 15 — — $46,648.72 $148,431.16 $77,373.55 2026-04-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc 64 15 — — $53,726.45 $181,918.47 $91,008.38 2026-04-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 64 15 — — $34,836.00 $110,797.63 $57,355.20 2026-04-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc 64 15 — — $43,262.71 $139,737.11 $71,949.40 2026-04-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 64 15 — — $27,016.06 $83,733.18 $43,780.52 2026-04-01
453 MS_DRG Combined Anterior And Posterior Spinal Fusion With Mcc 38 15 — — — — $131,695.73 2026-04-01
454 MS_DRG Combined Anterior And Posterior Spinal Fusion With Cc 38 15 — — — — $94,960.68 2026-04-01
455 MS_DRG Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc 38 15 — — — — $29,786.85 2026-04-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection Wi… 64 15 — — $67,052.24 $249,761.39 $117,398.80 2026-04-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection Wi… 64 15 — — $48,165.65 $184,686.24 $84,657.07 2026-04-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection Wi… 64 15 — — $34,308.17 $145,598.27 $61,932.49 2026-04-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 64 15 — — $44,759.52 $132,757.99 $72,645.44 2026-04-01
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 64 15 — — $22,601.47 $88,568.64 $39,134.05 2026-04-01
463 MS_DRG Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective T… 64 15 — — $46,125.54 $136,139.01 $37,952.24 2026-04-01
464 MS_DRG Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective T… 64 15 — — $26,120.60 $77,166.51 $26,073.39 2026-04-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 64 15 — — $42,301.47 $136,841.81 $48,073.83 2026-04-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 64 15 — — $29,308.48 $94,370.10 $32,730.92 2026-04-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 64 15 — — $25,489.84 $86,859.14 $27,990.88 2026-04-01
470 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without … 64 15 — — $16,943.16 $55,743.43 $26,301.92 2026-04-01
471 MS_DRG Cervical Spinal Fusion With Mcc 64 15 — — $39,386.02 $133,468.92 $66,292.07 2026-04-01
472 MS_DRG Cervical Spinal Fusion With Cc 64 15 — — $24,815.73 $77,427.01 $40,157.29 2026-04-01
473 MS_DRG Cervical Spinal Fusion Without Cc/Mcc 64 15 — — $20,908.85 $62,182.57 $33,116.93 2026-04-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc O… 64 15 — — $35,239.22 $104,822.51 $43,457.06 2026-04-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 64 15 — — $26,990.51 $88,281.01 $44,431.56 2026-04-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc Or In… 64 15 — — $30,430.70 $89,567.21 $34,846.99 2026-04-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 64 15 — — $30,075.46 $85,528.60 $47,203.31 2026-04-01
496 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 64 15 — — $15,975.73 $53,580.77 $25,824.09 2026-04-01
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 64 15 — — $25,362.91 $71,164.92 $39,095.86 2026-04-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 64 15 — — $81,812.15 $283,262.27 $140,383.48 2026-04-01
500 MS_DRG Soft Tissue Procedures With Mcc 64 15 — — $26,508.35 $80,297.89 $41,581.53 2026-04-01
503 MS_DRG Foot Procedures With Mcc 64 15 — — $23,616.11 $67,498.31 $37,208.42 2026-04-01
5116 OTHER Level 6 Musculoskeletal Procedures 38 15 — — — — $26,601.41 2026-04-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 64 15 — — $30,939.18 $88,161.19 $47,769.57 2026-04-01
519 MS_DRG Back And Neck Procedures Except Spinal Fusion With Cc 64 15 — — $17,494.98 $48,946.11 $26,977.63 2026-04-01
5232 OTHER Level 2 Icd And Similar Procedures 38 15 — — — — $29,560.72 2026-04-01
5465 OTHER Level 5 Neurostimulator And Related Procedures 38 15 — — — — $40,862.12 2026-04-01
56 MS_DRG Degenerative Nervous System Disorders With Mcc 64 15 — — $19,994.05 $54,800.86 $31,911.06 2026-04-01
5626 OTHER Level 6 Radiation Therapy 38 15 — — — — $26,578.97 2026-04-01
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 64 15 — — $11,784.78 $30,800.94 $26,650.15 2026-04-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 64 15 — — $52,718.77 $154,544.51 $79,034.99 2026-04-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 64 15 — — $39,947.13 $123,000.24 $65,404.70 2026-04-01
584 MS_DRG Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc 64 15 — — $18,582.37 $50,498.13 $28,512.39 2026-04-01
595 MS_DRG Major Skin Disorders With Mcc 64 15 — — $18,427.59 $57,499.07 $29,395.25 2026-04-01
6 MS_DRG Liver Transplant Without Mcc 64 15 — — $37,902.37 $122,156.34 $62,790.04 2026-04-01
61 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 64 15 — — $23,352.97 $75,921.02 $38,151.53 2026-04-01
614 MS_DRG Adrenal And Pituitary Procedures With Cc/Mcc 64 15 — — $18,977.86 $63,740.12 $31,000.89 2026-04-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 64 15 — — $29,005.09 $109,706.81 $56,960.43 2026-04-01
62 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 64 15 — — $15,614.29 $52,427.53 $31,050.78 2026-04-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 64 15 — — $29,560.79 $97,998.05 $30,248.55 2026-04-01
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 64 15 — — $25,388.45 $72,947.02 $40,182.27 2026-04-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc Or Insertion… 64 15 — — $30,857.92 $97,042.90 $36,965.13 2026-04-01
629 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Cc 64 15 — — $18,877.25 $62,836.52 $30,742.92 2026-04-01
64654 HCPCS 1st Opn Implt Bat Modulj Sys 3 2 — — $8,513.00 $43,209.82 $31,361.80 2026-04-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 64 15 — — $38,400.79 $122,462.97 $63,442.48 2026-04-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 64 15 — — $30,695.39 $100,225.84 $50,731.24 2026-04-01
652 MS_DRG Kidney Transplant 64 15 — — $27,009.09 $90,080.06 $44,723.99 2026-04-01
653 MS_DRG Major Bladder Procedures With Mcc 64 15 — — $42,231.82 $150,056.55 $72,242.79 2026-04-01
654 MS_DRG Major Bladder Procedures With Cc 64 15 — — $23,679.58 $75,234.50 $38,445.96 2026-04-01
655 MS_DRG Major Bladder Procedures Without Cc/Mcc 64 15 — — $18,395.85 $55,615.90 $29,074.17 2026-04-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 64 15 — — $26,655.40 $88,313.57 $44,028.65 2026-04-01
657 MS_DRG Kidney And Ureter Procedures For Neoplasm With Cc 64 15 — — $16,177.73 $53,675.74 $26,084.12 2026-04-01
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 64 15 — — $21,679.70 $92,609.04 $26,186.48 2026-04-01
665 MS_DRG Prostatectomy With Mcc 64 15 — — $26,170.91 $84,750.75 $26,348.61 2026-04-01
668 MS_DRG Transurethral Procedures With Mcc 64 15 — — $24,613.73 $71,500.73 $39,022.65 2026-04-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 64 15 — — $34,532.61 $99,113.81 $38,417.22 2026-04-01
7 MS_DRG Lung Transplant 64 15 — — $102,241.98 $305,489.26 $162,609.99 2026-04-01
707 MS_DRG Major Male Pelvic Procedures With Cc/Mcc 64 15 — — $17,495.76 $48,899.98 $26,971.65 2026-04-01
709 MS_DRG Penis Procedures With Cc/Mcc 64 15 — — $20,025.01 $62,000.76 $32,014.19 2026-04-01
711 MS_DRG Testes Procedures With Cc/Mcc 64 15 — — $18,142.00 $54,807.27 $28,644.01 2026-04-01
717 MS_DRG Other Male Reproductive System O.r. Procedures With Cc/Mcc 64 15 — — $16,645.96 $52,348.84 $52,998.82 2026-04-01
722 MS_DRG Malignancy, Male Reproductive System With Mcc 64 15 — — $16,020.62 $47,122.64 $30,217.68 2026-04-01
734 MS_DRG Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc 64 15 — — $18,499.56 $59,028.39 $29,712.20 2026-04-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 64 15 — — $29,679.20 $106,578.14 $50,447.48 2026-04-01
737 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc 64 15 — — $17,962.44 $53,176.46 $28,180.92 2026-04-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 64 15 — — $29,743.44 $96,093.18 $48,925.73 2026-04-01
742 MS_DRG Uterine And Adnexa Procedures For Non-malignancy With Cc/Mcc 64 15 — — $16,214.88 $44,471.55 $26,811.52 2026-04-01
749 MS_DRG Other Female Reproductive System O.r. Procedures With Cc/Mcc 64 15 — — $21,886.35 $69,929.61 $35,468.29 2026-04-01
75 MS_DRG Viral Meningitis With Cc/Mcc 64 15 — — $16,854.93 $45,232.94 $42,197.20 2026-04-01
799 MS_DRG Splenic Procedures With Mcc 64 15 — — $37,065.73 $132,334.68 $63,298.58 2026-04-01
8 MS_DRG Simultaneous Pancreas, Islet Cell And Kidney Transplant 64 15 — — $45,391.06 $137,357.37 $74,182.28 2026-04-01
800 MS_DRG Splenic Procedures With Cc 64 15 — — $23,757.75 $72,909.03 $38,192.29 2026-04-01
801 MS_DRG Splenic Procedures Without Cc/Mcc 64 15 — — $16,788.37 $46,205.48 $25,706.76 2026-04-01
803 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Cc 64 15 — — $16,401.40 $50,479.24 $25,876.88 2026-04-01
813 MS_DRG Coagulation Disorders 64 15 — — $13,819.52 $46,970.69 $36,954.88 2026-04-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 64 15 — — $47,404.87 $147,006.58 $78,079.95 2026-04-01
821 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Cc 64 15 — — $19,340.07 $63,373.79 $31,386.67 2026-04-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 64 15 — — $37,498.37 $117,022.40 $30,773.47 2026-04-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 64 15 — — $38,218.14 $141,506.31 $35,458.35 2026-04-01
834 MS_DRG Acute Leukemia With Mcc 64 15 — — $44,503.35 $149,076.98 $31,413.73 2026-04-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 64 15 — — $39,197.18 $154,769.90 $69,257.10 2026-04-01
838 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Che… 64 15 — — $18,169.86 $63,821.52 $36,495.98 2026-04-01
849 MS_DRG Radiotherapy 64 15 — — $22,984.57 $63,915.86 $28,568.87 2026-04-01
85 MS_DRG Traumatic Stupor And Coma <1 Hour With Mcc 64 15 — — $19,597.79 $55,567.05 $30,529.38 2026-04-01
850 MS_DRG Acute Leukemia With Other Procedures 64 15 — — $69,034.31 $249,948.63 $119,838.73 2026-04-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 64 15 — — $40,236.59 $139,145.57 $63,586.87 2026-04-01
857 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Cc 64 15 — — $18,588.57 $53,947.09 $25,807.89 2026-04-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 64 15 — — $55,508.07 $165,241.30 $66,351.17 2026-04-01
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 64 15 — — $17,048.42 $49,464.39 $26,373.82 2026-04-01
901 MS_DRG Wound Debridements For Injuries With Mcc 64 15 — — $34,493.91 $112,721.50 $32,823.21 2026-04-01
904 MS_DRG Skin Grafts For Injuries With Cc/Mcc 64 15 — — $30,442.31 $88,213.17 $48,621.58 2026-04-01
90695 HCPCS H5n8 Vacc Drv Cll Cul Adj IM 1 1 — — $49,500.90 $49,500.90 $49,500.90 2026-04-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 64 15 — — $31,728.61 $113,209.93 $30,443.66 2026-04-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 64 15 — — $167,255.70 $503,648.47 $269,389.09 2026-04-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 64 15 — — $57,527.30 $169,200.69 $91,560.23 2026-04-01
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc 64 15 — — $26,941.76 $75,977.19 $41,854.60 2026-04-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 64 15 — — $32,153.50 $91,862.39 $50,685.81 2026-04-01
934 MS_DRG Full Thickness Burn Without Skin Graft Or Inhalation Injury 64 15 — — $19,123.36 $52,147.04 $28,712.41 2026-04-01
935 MS_DRG Non-extensive Burns 64 15 — — $17,957.80 $48,594.45 $27,069.06 2026-04-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 64 15 — — $29,252.76 $92,614.47 $43,459.25 2026-04-01
941 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/… 64 15 — — $17,707.82 $50,419.54 $27,457.58 2026-04-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 64 15 — — $54,109.55 $163,629.48 $88,731.49 2026-04-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 64 15 — — $31,138.09 $106,005.59 $52,136.79 2026-04-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 64 15 — — $60,988.38 $198,175.05 $102,283.06 2026-04-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 64 15 — — $34,627.81 $115,481.13 $57,804.33 2026-04-01
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/Mcc 64 15 — — $24,800.25 $73,117.97 $39,492.17 2026-04-01
963 MS_DRG Other Multiple Significant Trauma With Mcc 64 15 — — $23,172.64 $72,681.10 $37,446.16 2026-04-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 64 15 — — $49,390.04 $147,722.94 $80,602.97 2026-04-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 64 15 — — $29,967.88 $92,370.25 $43,837.78 2026-04-01
970 MS_DRG HIV With Extensive O.r. Procedures Without Mcc 64 15 — — $22,426.56 $69,720.67 $36,094.31 2026-04-01
975 MS_DRG HIV With Major Related Condition With Cc 64 15 — — $11,779.32 $36,890.03 $28,703.52 2026-04-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 64 15 — — $38,326.49 $116,946.42 $48,741.06 2026-04-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 64 15 — — $28,548.47 $87,814.29 $38,279.76 2026-04-01
99 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc 64 15 — — $12,392.39 $32,722.10 $30,661.46 2026-04-01
A5083 HCPCS Stoma Absorptive Cover 1 1 — — $74,643.30 $74,643.30 $74,643.30 2026-04-01
A7523 HCPCS Tracheostomy Shower Protect 1 1 — — $30,918.62 $30,918.62 $30,918.62 2026-04-01
A9543 HCPCS Y90 Ibritumomab, Rx 4 2 — — $56,824.55 $93,760.51 $75,576.65 2026-04-01
A9699 HCPCS Radiopharm Rx Agent Noc 3 2 — — $1,373.18 $74,614.73 $50,200.88 2026-04-01
B4164 HCPCS Parenteral 50% Dextrose Solu 1 1 — — $30,073.16 $30,073.16 $30,073.16 2026-04-01
B4178 HCPCS Parenteral Sol Amino Acid > 1 1 — — $30,073.16 $30,073.16 $30,073.16 2026-04-01
B5200 HCPCS Parenteral Sol Hepatic Fream 1 1 — — $31,500.90 $31,500.90 $31,500.90 2026-04-01
C1714 HCPCS Hc Catheter Atherectomy Hawkone 3.5-7mm 7f 114cm Extended Tip 2 1 $35,940.00 $7,188.00 80% off $30,073.16 $30,073.16 $30,073.16 2026-04-01
C1715 HCPCS Hc Needle Brchtx 5cm 18ga 1 Loose Src Iod 125 2 1 $1,075.00 $215.00 80% off $30,073.16 $30,073.16 $30,073.16 2026-04-01
C1722 HCPCS Hc Defibrillator Cardiac Inogen El Single Chamber 35 J Df4 Is1 2 1 $92,025.00 $18,405.00 80% off $30,073.16 $30,073.16 $30,073.16 2026-04-01
C1724 HCPCS Hc Catheter Atherectomy Diamondback 360 Coronary Clssic 2 1 $41,363.00 $8,272.60 80% off $30,073.16 $30,073.16 $30,073.16 2026-04-01
C1725 HCPCS Hc Balloon Nc Emerge 2mm X 8mm 2 1 $641.00 $128.20 80% off $30,073.16 $30,073.16 $30,073.16 2026-04-01
C8007 HCPCS Opn Mplnt Hpgls Ns Ary Ps Gn 2 2 — — $29,678.00 $30,271.56 $29,974.78 2026-04-01
C8011 HCPCS Opn Mplnt Hpgls Ns Ary Rec 2 2 — — $29,678.00 $30,271.56 $29,974.78 2026-04-01
C9301 HCPCS Obecabtagene Car Pos T 2 1 — — $459,112.50 $459,112.50 $459,112.50 2026-04-01
H2000 HCPCS Comp Multidisipln Evaluation 1 1 — — $4,165,959.00 $4,165,959.00 $4,165,959.00 2026-04-01
H2010 HCPCS Comprehensive Medication Services, Per 15 Minutes 1 1 — — $3,807,119.13 $3,807,119.13 $3,807,119.13 2026-04-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 5 3 — — $13.04 $6,080,690.01 $3,923,624.41 2026-04-01
J1413 HCPCS Inj Delandistrogene Mox Rokl 5 3 — — $3,334.25 $5,482,080.95 $3,533,525.67 2026-04-01
J1414 HCPCS Inj, Beqvez, Per Tx Dose 3 2 — — $3,408,903.61 $6,121,500.00 $5,217,301.20 2026-04-01
J3265 HCPCS Pr Injection Torsemide 10 Mg/ml 2 1 $5.00 $3.50 30% off $29,390.86 $29,390.86 $29,390.86 2026-04-01
J3391 HCPCS Inj, Atidarsagene Autotemcel 3 3 — — $79.40 $4,595,100.00 $3,033,393.13 2026-04-01
J3392 HCPCS Inj, Exagamglogene Autotem 5 3 — — $141.40 $3,847,800.00 $2,468,714.57 2026-04-01
J3393 HCPCS Inj, Betibeglogene Autotemce 5 3 — — $42.45 $4,864,551.99 $3,129,654.46 2026-04-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 5 3 — — $89.91 $5,421,900.00 $3,475,840.79 2026-04-01
J3399 HCPCS Inj Onase Abepar-xioi Treat 5 3 — — $38.88 $3,998,166.53 $2,682,009.49 2026-04-01
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 3 3 — — $422.01 $207,732.96 $137,271.58 2026-04-01
J3403 HCPCS Revakinagene, Per Implant 3 3 — — $61.30 $266,811.24 $176,150.73 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 3 2 — — $490.71 $130,327.56 $87,048.61 2026-04-01
J9029 HCPCS Inj, Adstiladrin, Per Tx Dos 5 3 — — $938.10 $104,338.76 $67,913.10 2026-04-01
J9226 HCPCS Supprelin La Implant 5 3 — — $1,296.38 $74,599.87 $45,245.98 2026-04-01
J9266 HCPCS Pegaspargase Injection 5 3 — — $144.18 $44,666.37 $29,879.62 2026-04-01
J9600 HCPCS Pr Porfimer Sodium Injection 3 1 $30,133.00 $21,093.10 30% off $39,976.89 $39,976.89 $39,976.89 2026-04-01
L2006 HCPCS Kaf Sng/dbl Swg/stn Mcpr Cus 3 3 — — $843.93 $40,316.13 $26,895.23 2026-04-01
M0236 HCPCS Intrav Inf, Mon Anti, Sec Do 4 3 $2,015.00 $403.00 80% off $424.09 $149,999.94 $50,285.53 2026-04-01
M1005 HCPCS TB Scr No Perf 1 1 — — $28,897.68 $28,897.68 $28,897.68 2026-04-01
M1058 HCPCS Pt Prm Nurs Hm Res In Pp 1 1 — — $523,694.85 $523,694.85 $523,694.85 2026-04-01
M1060 HCPCS Pt Died In Pp 1 1 — — $63,217.07 $63,217.07 $63,217.07 2026-04-01
M1069 HCPCS Pt Scr Ft Fall Rsk 1 1 — — $512,361.60 $512,361.60 $512,361.60 2026-04-01
M1070 HCPCS Pt Not Scrn Fut Fall No Rsn 1 1 — — $540,429.11 $540,429.11 $540,429.11 2026-04-01
M1106 HCPCS Start Eoc Doc Med Rec 1 1 — — $552,546.94 $552,546.94 $552,546.94 2026-04-01
M1107 HCPCS Docu Dx Degen Neuro 1 1 — — $578,544.93 $578,544.93 $578,544.93 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 4 2 — — $562,500.89 $829,687.20 $698,906.55 2026-04-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 5 3 — — $1,284.99 $954,972.35 $629,369.98 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 5 3 — — $1,732.50 $94,078.22 $60,574.49 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 4 2 — — $510,103.92 $807,508.61 $661,356.79 2026-04-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 4 2 — — $579,570.61 $852,129.78 $718,748.05 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 4 2 — — $567,977.78 $870,577.06 $722,117.31 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 4 2 — — $587,977.76 $912,729.35 $753,293.44 2026-04-01
Q2057 HCPCS Afamitresgene Autoleucel 4 2 — — $813,967.38 $1,271,523.00 $1,046,815.03 2026-04-01
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