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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

LAKESIDE WOMEN'S HOSPITAL, A MEMBER OF INTEGRIS HE

Oklahoma City, OK · CCN 370199 · Rates published

16,194 distinct procedures filed
34 distinct payers
152,619 rate rows
2026-04-01 last MRF observed
Data quality

118,021 of 152,619 rate rows are consumer-grade (77.3%)

34,598 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 33,901
template filing: same amount across many unrelated codes — excluded 685
placeholder amount (≤ $0.02) — excluded from medians 12
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://hospitalpricedisclosure.com/Download.aspx?pxi=Jd8dxaq5YxQQS4ceW8qokg*-*&f=1Uqk9sV2mcxtBmvoqWiwog*-*
Found on page https://hospitalpricedisclosure.com/default.aspx?ci=fFJE38ye7xsB8Of*_*qxAfVQ*-*
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint a3d3b13e708bb650… · 42,857,323 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
J3391
HCPCS 		Inj, Atidarsagene Autotemcel 4 $79.40 $4,640,150.00 $4,550,050.00 nat. median
$4,505,000
1.0× median
H2000
HCPCS 		Comp Multidisipln Evaluation 1 $4,165,959.00 $4,165,959.00 $4,165,959.00 nat. median
$176
outlier · 23611.2×
H2010
HCPCS 		Comprehensive Medication Services, Per 15 Minutes 1 $3,807,119.13 $3,807,119.13 $3,807,119.13 nat. median
$32
outlier · 118601.8×
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 4 $13.04 $3,795,824.67 $3,722,119.33 nat. median
$3,710,000
1.0× median
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 1 $3,408,903.61 $3,408,903.61 $3,408,903.61 nat. median
$3,710,000
0.9× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 4 $3,334.25 $3,415,956.47 $3,349,627.21 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 4 $89.91 $3,345,899.09 $3,280,930.17 nat. median
$3,286,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 4 $42.45 $3,034,112.20 $2,975,197.40 nat. median
$3,004,655
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 4 $38.88 $2,528,763.92 $2,479,661.71 nat. median
$2,468,984
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 4 $141.40 $2,401,960.00 $2,355,320.00 nat. median
$2,448,600
1.0× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 4 $1,284.99 $609,477.99 $597,643.46 nat. median
$753,246
0.8× median
M1107
HCPCS 		Docu Dx Degen Neuro 1 $578,544.93 $578,544.93 $578,544.93 nat. median
$260
outlier · 2222.4×
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×
18
MS_DRG 		Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 12 $263,356.10 $749,955.69 $336,221.28 nat. median
$370,174
0.9× median
J3403
HCPCS 		Revakinagene, Per Implant 4 $61.30 $265,225.00 $260,075.00 nat. median
$265,000
1.0× median
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 12 $179,538.46 $486,691.07 $218,194.09 nat. median
$265,286
0.8× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 4 $422.01 $211,809.20 $207,696.40 nat. median
$209,753
1.0× median
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 12 $119,496.18 $370,794.13 $166,234.99 nat. median
$206,474
0.8× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 12 $124,340.85 $368,618.05 $165,615.36 nat. median
$202,976
0.8× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 12 $78,072.75 $240,557.26 $111,190.03 nat. median
$133,161
0.8× median
7
MS_DRG 		Lung Transplant 12 $69,083.27 $224,906.12 $104,734.86 nat. median
$122,708
0.9× median
2
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System Without Mcc 12 $88,229.39 $196,799.37 $98,609.32 nat. median
$108,660
0.9× median
14
MS_DRG 		Allogeneic Bone Marrow Transplant 12 $82,087.04 $208,714.87 $98,056.94 nat. median
$117,357
0.8× median
209
MS_DRG 		Complex Aortic Arch Procedures 12 $79,854.13 $196,573.60 $93,961.64 nat. median
$98,047
1.0× median
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 $73,947.69 $191,405.18 $90,917.72 nat. median
$98,894
0.9× median
212
MS_DRG 		Concomitant Aortic And Mitral Valve Procedures 12 $75,987.29 $188,850.49 $89,864.07 nat. median
$102,358
0.9× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 12 $73,647.15 $179,062.45 $86,668.53 nat. median
$100,136
0.9× median
215
MS_DRG 		Other Heart Assist System Implant 12 $77,525.20 $172,923.22 $86,645.81 nat. median
$99,019
0.9× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 12 $67,019.68 $169,897.89 $82,047.25 nat. median
$93,672
0.9× median
429
MS_DRG 		Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 12 $58,838.70 $156,469.72 $76,508.94 nat. median
$82,711
0.9× median
850
MS_DRG 		Acute Leukemia With Other Procedures 12 $64,985.72 $150,389.54 $74,726.73 nat. median
$83,470
0.9× median
A5083
HCPCS 		Stoma Absorptive Cover 1 $74,643.30 $74,643.30 $74,643.30 nat. median
$1
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 12 $64,937.04 $145,941.85 $72,874.33 nat. median
$81,118
0.9× median
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 12 $57,232.28 $146,402.07 $72,356.64 nat. median
$79,312
0.9× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 12 $61,266.48 $136,657.45 $69,007.54 nat. median
$77,570
0.9× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 12 $53,670.91 $133,349.04 $66,801.21 nat. median
$74,915
0.9× median
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 12 $51,809.10 $132,774.19 $66,513.24 nat. median
$73,807
0.9× median
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 12 $51,524.78 $132,334.80 $66,293.13 nat. median
$72,135
0.9× median
J9029
HCPCS 		Inj, Adstiladrin, Per Tx Dos 4 $938.10 $65,242.55 $63,975.71 nat. median
$69,774
0.9× median
M1060
HCPCS 		Pt Died In Pp 1 $63,217.07 $63,217.07 $63,217.07 nat. median
$260
outlier · 242.8×
427
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 12 $50,081.33 $125,365.43 $62,801.82 nat. median
$68,090
0.9× median
10
MS_DRG 		Pancreas Transplant 12 $30,845.87 $124,620.38 $62,130.38 nat. median
$68,884
0.9× median
928
MS_DRG 		Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 12 $40,237.49 $124,568.28 $62,109.31 nat. median
$64,023
1.0× median
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 12 $46,999.70 $123,906.60 $62,071.02 nat. median
$71,271
0.9× median
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 12 $49,637.57 $123,833.66 $62,034.48 nat. median
$68,886
0.9× median
870
MS_DRG 		Septicemia Or Severe Sepsis With Mv >96 Hours 12 $42,962.13 $120,037.23 $60,277.17 nat. median
$66,526
0.9× median
268
MS_DRG 		Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 12 $46,046.57 $119,448.49 $60,039.11 nat. median
$65,950
0.9× median

Other procedures at this hospital

Browse this hospital's 16,194 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
             
J3391 HCPCS Inj, Atidarsagene Autotemcel 4 4 — — $79.40 $4,640,150.00 $4,550,050.00 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 4 4 — — $13.04 $3,795,824.67 $3,722,119.33 2026-04-01
J1414 HCPCS Inj, Beqvez, Per Tx Dose 1 1 — — $3,408,903.61 $3,408,903.61 $3,408,903.61 2026-04-01
J1413 HCPCS Inj Delandistrogene Mox Rokl 4 4 — — $3,334.25 $3,415,956.47 $3,349,627.21 2026-04-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 4 4 — — $89.91 $3,345,899.09 $3,280,930.17 2026-04-01
J3393 HCPCS Inj, Betibeglogene Autotemce 4 4 — — $42.45 $3,034,112.20 $2,975,197.40 2026-04-01
J3399 HCPCS Inj Onase Abepar-xioi Treat 4 4 — — $38.88 $2,528,763.92 $2,479,661.71 2026-04-01
J3392 HCPCS Inj, Exagamglogene Autotem 4 4 — — $141.40 $2,401,960.00 $2,355,320.00 2026-04-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 4 4 — — $1,284.99 $609,477.99 $597,643.46 2026-04-01
M1107 HCPCS Docu Dx Degen Neuro 1 1 — — $578,544.93 $578,544.93 $578,544.93 2026-04-01
M1106 HCPCS Start Eoc Doc Med Rec 1 1 — — $552,546.94 $552,546.94 $552,546.94 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
M1058 HCPCS Pt Prm Nurs Hm Res In Pp 1 1 — — $523,694.85 $523,694.85 $523,694.85 2026-04-01
M1069 HCPCS Pt Scr Ft Fall Rsk 1 1 — — $512,361.60 $512,361.60 $512,361.60 2026-04-01
18 MS_DRG Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies 25 12 — — $263,356.10 $749,955.69 $336,221.28 2026-04-01
J3403 HCPCS Revakinagene, Per Implant 4 4 — — $61.30 $265,225.00 $260,075.00 2026-04-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 25 12 — — $179,538.46 $486,691.07 $218,194.09 2026-04-01
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 4 4 — — $422.01 $211,809.20 $207,696.40 2026-04-01
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 25 12 — — $119,496.18 $370,794.13 $166,234.99 2026-04-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 25 12 — — $124,340.85 $368,618.05 $165,615.36 2026-04-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 25 12 — — $78,072.75 $240,557.26 $111,190.03 2026-04-01
7 MS_DRG Lung Transplant 25 12 — — $69,083.27 $224,906.12 $104,734.86 2026-04-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 25 12 — — $88,229.39 $196,799.37 $98,609.32 2026-04-01
14 MS_DRG Allogeneic Bone Marrow Transplant 25 12 — — $82,087.04 $208,714.87 $98,056.94 2026-04-01
209 MS_DRG Complex Aortic Arch Procedures 25 12 — — $79,854.13 $196,573.60 $93,961.64 2026-04-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 25 12 — — $73,947.69 $191,405.18 $90,917.72 2026-04-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 25 12 — — $75,987.29 $188,850.49 $89,864.07 2026-04-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 25 12 — — $73,647.15 $179,062.45 $86,668.53 2026-04-01
215 MS_DRG Other Heart Assist System Implant 25 12 — — $77,525.20 $172,923.22 $86,645.81 2026-04-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 25 12 — — $67,019.68 $169,897.89 $82,047.25 2026-04-01
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 25 12 — — $58,838.70 $156,469.72 $76,508.94 2026-04-01
850 MS_DRG Acute Leukemia With Other Procedures 25 12 — — $64,985.72 $150,389.54 $74,726.73 2026-04-01
A5083 HCPCS Stoma Absorptive Cover 1 1 — — $74,643.30 $74,643.30 $74,643.30 2026-04-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 25 12 — — $64,937.04 $145,941.85 $72,874.33 2026-04-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 25 12 — — $57,232.28 $146,402.07 $72,356.64 2026-04-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 25 12 — — $61,266.48 $136,657.45 $69,007.54 2026-04-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 25 12 — — $53,670.91 $133,349.04 $66,801.21 2026-04-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 25 12 — — $51,809.10 $132,774.19 $66,513.24 2026-04-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 25 12 — — $51,524.78 $132,334.80 $66,293.13 2026-04-01
J9029 HCPCS Inj, Adstiladrin, Per Tx Dos 4 4 — — $938.10 $65,242.55 $63,975.71 2026-04-01
M1060 HCPCS Pt Died In Pp 1 1 — — $63,217.07 $63,217.07 $63,217.07 2026-04-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 25 12 — — $50,081.33 $125,365.43 $62,801.82 2026-04-01
10 MS_DRG Pancreas Transplant 25 12 — — $30,845.87 $124,620.38 $62,130.38 2026-04-01
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc 25 12 — — $40,237.49 $124,568.28 $62,109.31 2026-04-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 25 12 — — $46,999.70 $123,906.60 $62,071.02 2026-04-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 25 12 — — $49,637.57 $123,833.66 $62,034.48 2026-04-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 25 12 — — $42,962.13 $120,037.23 $60,277.17 2026-04-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 25 12 — — $46,046.57 $119,448.49 $60,039.11 2026-04-01
955 MS_DRG Craniotomy For Multiple Significant Trauma 25 12 — — $42,543.06 $116,899.01 $59,008.22 2026-04-01
J1812 HCPCS Inj. Insulin (fiasp) 1 1 — — $58,979.55 $58,979.55 $58,979.55 2026-04-01
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 25 12 — — $43,642.23 $116,124.45 $58,695.02 2026-04-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 25 12 — — $47,298.13 $116,039.35 $58,660.61 2026-04-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 25 12 — — $44,325.86 $114,193.24 $57,914.13 2026-04-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 25 12 — — $40,100.62 $114,193.24 $57,914.13 2026-04-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 25 12 — — $28,667.99 $113,778.16 $57,746.29 2026-04-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 25 12 — — $38,693.15 $111,751.43 $56,926.78 2026-04-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 25 12 — — $47,715.72 $106,431.92 $55,871.34 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 4 4 — — $1,732.50 $56,930.49 $55,825.04 2026-04-01
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 25 12 — — $38,407.42 $106,308.62 $54,725.96 2026-04-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 25 12 — — $41,204.02 $105,289.17 $54,313.74 2026-04-01
28 MS_DRG Spinal Procedures With Mcc 25 12 — — $39,215.92 $104,346.15 $53,932.43 2026-04-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 25 12 — — $43,812.96 $104,316.62 $53,920.49 2026-04-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 25 12 — — $46,428.70 $103,561.16 $53,615.01 2026-04-01
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 28 13 — — $13,303.23 $103,220.76 $53,477.38 2026-04-01
16 MS_DRG Autologous Bone Marrow Transplant With Cc/Mcc 25 12 — — $45,463.13 $102,981.10 $53,380.47 2026-04-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 25 12 — — $40,768.02 $101,919.98 $52,951.40 2026-04-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 25 12 — — $38,221.17 $101,853.98 $52,924.71 2026-04-01
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 25 12 — — $38,591.56 $100,157.23 $52,238.62 2026-04-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 25 12 — — $38,766.52 $99,518.12 $51,980.20 2026-04-01
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 25 12 — — $40,262.18 $99,111.73 $51,815.87 2026-04-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 25 12 — — $35,395.64 $98,983.22 $51,763.91 2026-04-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 25 12 — — $38,839.19 $97,637.27 $51,219.67 2026-04-01
8 MS_DRG Simultaneous Pancreas And Kidney Transplant 25 12 — — $35,712.41 $97,335.09 $51,097.48 2026-04-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 25 12 — — $31,468.12 $96,668.20 $50,827.82 2026-04-01
J3105 HCPCS Terbutaline Sulfate Inj 1 1 — — $50,819.78 $50,819.78 $50,819.78 2026-04-01
461 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc 25 12 — — $34,516.59 $95,917.94 $50,524.46 2026-04-01
834 MS_DRG Acute Leukemia With Mcc 25 12 — — $38,759.46 $95,343.09 $50,292.01 2026-04-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 25 12 — — $37,302.61 $95,006.17 $50,155.78 2026-04-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 25 12 — — $35,674.31 $94,870.71 $50,101.00 2026-04-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 25 12 — — $34,704.25 $94,721.35 $50,040.61 2026-04-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 25 12 — — $41,217.53 $91,937.42 $49,893.22 2026-04-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/Mcc 25 12 — — $31,945.04 $94,342.75 $49,887.52 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
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 25 12 — — $36,264.82 $92,614.74 $49,188.79 2026-04-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 25 12 — — $36,331.13 $92,559.16 $49,166.32 2026-04-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 25 12 — — $34,859.46 $91,633.50 $48,792.03 2026-04-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 25 12 — — $35,578.37 $90,402.18 $48,294.14 2026-04-01
653 MS_DRG Major Bladder Procedures With Mcc 25 12 — — $39,014.15 $90,245.88 $48,230.94 2026-04-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 25 12 — — $32,338.71 $87,533.15 $47,134.04 2026-04-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 25 12 — — $32,084.73 $86,616.18 $46,763.26 2026-04-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 25 12 — — $38,520.46 $85,921.50 $46,537.60 2026-04-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 25 12 — — $36,177.33 $85,768.67 $46,420.56 2026-04-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 25 12 — — $32,774.71 $85,475.16 $46,301.89 2026-04-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 25 12 — — $31,979.61 $85,119.14 $46,157.93 2026-04-01
471 MS_DRG Cervical Spinal Fusion With Mcc 25 12 — — $34,701.43 $83,860.03 $45,648.80 2026-04-01
837 MS_DRG Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot… 25 12 — — $37,406.28 $83,436.28 $45,477.46 2026-04-01
J9226 HCPCS Supprelin La Implant 4 4 — — $1,296.38 $46,371.27 $45,470.85 2026-04-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 25 12 — — $37,067.59 $82,680.81 $45,171.98 2026-04-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 25 12 — — $31,839.92 $81,649.21 $44,754.85 2026-04-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 25 12 — — $30,405.64 $81,482.49 $44,687.43 2026-04-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 25 12 — — $36,421.35 $81,239.35 $44,589.12 2026-04-01
6 MS_DRG Liver Transplant Without Mcc 25 12 — — $31,760.20 $80,530.78 $44,302.61 2026-04-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 25 12 — — $33,739.83 $80,209.49 $44,172.69 2026-04-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 26 12 — — $34,663.33 $79,827.42 $44,018.20 2026-04-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 25 12 — — $30,425.39 $79,624.22 $43,936.04 2026-04-01
245 MS_DRG Aicd Generator Procedures 25 12 — — $35,522.85 $79,235.20 $43,778.74 2026-04-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 25 12 — — $31,403.92 $78,997.27 $43,682.53 2026-04-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 25 12 — — $30,381.65 $78,962.54 $43,668.48 2026-04-01
799 MS_DRG Splenic Procedures With Mcc 25 12 — — $34,406.53 $78,653.41 $43,543.49 2026-04-01
163 MS_DRG Major Chest Procedures With Mcc 25 12 — — $34,867.22 $77,835.42 $43,212.73 2026-04-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 25 12 — — $28,743.48 $77,812.84 $43,203.60 2026-04-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 25 12 — — $28,930.44 $77,507.18 $43,080.01 2026-04-01
64654 HCPCS 1st Opn Implt Bat Modulj Sys 4 3 — — $8,520.00 $43,633.45 $42,786.19 2026-04-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 25 12 — — $26,852.04 $76,289.76 $42,587.74 2026-04-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 25 12 — — $29,207.70 $75,153.96 $42,128.47 2026-04-01
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 25 12 — — $27,253.47 $74,554.79 $41,886.20 2026-04-01
140 MS_DRG Major Head And Neck Procedures With Mcc 25 12 — — $28,083.13 $74,075.47 $41,692.38 2026-04-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 25 12 — — $28,806.98 $73,649.97 $41,520.33 2026-04-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 25 12 — — $29,317.76 $73,344.31 $41,396.74 2026-04-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 25 12 — — $24,859.00 $73,219.27 $41,346.18 2026-04-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 25 12 — — $30,024.67 $73,182.80 $41,331.43 2026-04-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 25 12 — — $24,863.23 $72,969.19 $41,245.05 2026-04-01
901 MS_DRG Wound Debridements For Injuries With Mcc 25 12 — — $29,307.18 $72,882.35 $41,209.94 2026-04-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 25 12 — — $27,400.21 $72,746.89 $41,155.17 2026-04-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 25 12 — — $32,487.86 $72,465.54 $41,041.40 2026-04-01
793 MS_DRG Full Term Neonate With Major Problems 29 13 — — $1,011.64 $72,413.44 $41,020.34 2026-04-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 25 12 — — $26,717.29 $72,125.15 $40,903.76 2026-04-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 25 12 — — $25,250.55 $71,647.56 $40,710.65 2026-04-01
791 MS_DRG Prematurity With Major Problems 26 12 — — $15,730.83 $70,492.65 $40,243.66 2026-04-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 25 12 — — $27,720.51 $69,824.02 $39,973.30 2026-04-01
L2006 HCPCS Kaf Sng/dbl Swg/stn Mcpr Cus 4 4 — — $843.93 $40,711.39 $39,920.88 2026-04-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 25 12 — — $22,956.26 $69,191.86 $39,717.68 2026-04-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 25 12 — — $27,030.53 $67,937.97 $39,210.66 2026-04-01
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 25 12 — — $22,968.96 $67,630.57 $39,086.37 2026-04-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 25 12 — — $28,162.15 $67,222.45 $38,921.34 2026-04-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 25 12 — — $24,758.82 $67,121.72 $38,880.61 2026-04-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 25 12 — — $26,864.03 $67,057.46 $38,854.63 2026-04-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 25 12 — — $29,434.17 $66,677.12 $38,700.84 2026-04-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 25 12 — — $27,561.06 $65,352.02 $38,165.03 2026-04-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 25 12 — — $20,909.61 $65,067.20 $38,049.86 2026-04-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 25 12 — — $25,024.09 $64,912.64 $37,987.36 2026-04-01
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 25 12 — — $20,410.12 $64,905.69 $37,984.55 2026-04-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 25 12 — — $25,230.80 $64,723.34 $37,910.82 2026-04-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 25 12 — — $26,058.35 $64,358.63 $37,763.35 2026-04-01
904 MS_DRG Skin Grafts For Injuries With Cc/Mcc 25 12 — — $22,935.10 $63,790.73 $37,533.71 2026-04-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 25 12 — — $23,287.14 $63,764.68 $37,523.18 2026-04-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 25 12 — — $24,566.22 $63,016.16 $37,220.51 2026-04-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 25 12 — — $21,250.37 $62,967.53 $37,200.85 2026-04-01
332 MS_DRG Rectal Resection With Mcc 25 12 — — $26,959.69 $62,880.70 $37,165.74 2026-04-01
265 MS_DRG Aicd Lead Procedures 25 12 — — $23,548.18 $62,837.28 $37,148.18 2026-04-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 25 12 — — $24,015.93 $62,726.13 $37,103.24 2026-04-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 25 12 — — $22,580.23 $62,632.35 $37,065.32 2026-04-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 25 12 — — $24,983.87 $62,222.49 $36,899.59 2026-04-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 25 12 — — $27,709.92 $62,078.34 $36,841.31 2026-04-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 25 12 — — $27,803.03 $62,015.82 $36,816.02 2026-04-01
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 25 12 — — $27,761.76 $61,923.78 $36,778.81 2026-04-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 25 12 — — $25,022.67 $61,871.67 $36,757.74 2026-04-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 25 12 — — $25,479.13 $61,812.63 $36,733.86 2026-04-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 25 12 — — $23,871.30 $61,762.26 $36,713.50 2026-04-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 25 12 — — $24,535.88 $61,246.46 $36,504.93 2026-04-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 25 12 — — $24,079.42 $61,121.42 $36,454.37 2026-04-01
252 MS_DRG Other Vascular Procedures With Mcc 25 12 — — $22,811.64 $60,581.31 $36,235.97 2026-04-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 25 12 — — $27,152.90 $60,565.68 $36,229.65 2026-04-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 25 12 — — $20,878.57 $60,287.80 $36,117.30 2026-04-01
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 25 12 — — $22,810.23 $59,996.04 $35,999.32 2026-04-01
359 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc 25 12 — — $24,259.32 $59,718.17 $35,886.96 2026-04-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 25 12 — — $22,831.39 $59,541.02 $35,815.33 2026-04-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 25 12 — — $23,095.95 $59,249.26 $35,697.36 2026-04-01
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 25 12 — — $26,527.68 $59,171.11 $35,665.76 2026-04-01
L8701 HCPCS Pow Ue Rom Dev Ewh Uprt Cust 4 4 — — $0.62 $36,019.23 $35,319.83 2026-04-01
264 MS_DRG Other Circulatory System O.r. Procedures 25 12 — — $22,700.87 $58,016.20 $35,198.77 2026-04-01
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 25 12 — — $23,270.21 $57,368.41 $34,936.83 2026-04-01
37 MS_DRG Extracranial Procedures With Mcc 25 12 — — $22,356.59 $57,173.90 $34,858.18 2026-04-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 25 12 — — $19,531.06 $57,166.95 $34,855.37 2026-04-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 25 12 — — $24,739.24 $64,460.30 $34,646.37 2026-04-01
3141F HCPCS Upper Gi Endo Not Barrtts 1 1 — — $34,595.10 $34,595.10 $34,595.10 2026-04-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 25 12 — — $25,309.81 $56,491.38 $34,582.20 2026-04-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 25 12 — — $18,770.53 $56,243.03 $34,481.78 2026-04-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 25 12 — — $21,724.46 $56,180.51 $34,456.50 2026-04-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 25 12 — — $21,770.32 $56,102.36 $34,424.90 2026-04-01
652 MS_DRG Kidney Transplant 25 12 — — $23,420.48 $56,086.73 $34,418.58 2026-04-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 25 12 — — $22,952.74 $56,045.05 $34,401.72 2026-04-01
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc 25 12 — — $18,588.51 $55,935.63 $34,357.48 2026-04-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 25 12 — — $18,655.54 $55,755.02 $34,284.45 2026-04-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 25 12 — — $24,859.14 $55,449.36 $34,160.85 2026-04-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 25 12 — — $20,597.07 $55,346.89 $34,119.42 2026-04-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 25 12 — — $22,961.20 $55,293.05 $34,097.65 2026-04-01
500 MS_DRG Soft Tissue Procedures With Mcc 25 12 — — $20,877.16 $54,963.08 $33,964.23 2026-04-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 25 12 — — $22,087.79 $54,879.72 $33,930.52 2026-04-01
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 25 12 — — $20,943.47 $54,723.42 $33,867.32 2026-04-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 25 12 — — $24,522.01 $54,697.37 $33,856.78 2026-04-01
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 25 12 — — $21,739.28 $54,568.85 $33,804.82 2026-04-01
665 MS_DRG Prostatectomy With Mcc 25 12 — — $22,034.88 $54,205.88 $33,658.05 2026-04-01
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 25 12 — — $20,063.01 $54,092.99 $33,612.40 2026-04-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 25 12 — — $21,144.54 $53,997.48 $33,573.78 2026-04-01
662 MS_DRG Minor Bladder Procedures With Mcc 25 12 — — $21,486.71 $53,169.07 $33,238.81 2026-04-01
263 MS_DRG Vein Ligation And Stripping 25 12 — — $16,486.83 $53,097.87 $33,210.02 2026-04-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 25 12 — — $22,583.06 $52,677.58 $33,040.08 2026-04-01
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 25 12 — — $17,552.13 $52,457.02 $32,950.89 2026-04-01
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 25 12 — — $18,965.96 $52,450.08 $32,948.09 2026-04-01
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 25 12 — — $17,136.60 $52,392.77 $32,924.91 2026-04-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 25 12 — — $21,694.13 $51,691.14 $32,641.21 2026-04-01
472 MS_DRG Cervical Spinal Fusion With Cc 25 12 — — $20,130.74 $51,164.92 $32,428.43 2026-04-01
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/Mcc 25 12 — — $19,010.40 $51,130.18 $32,414.38 2026-04-01
570 MS_DRG Skin Debridement With Mcc 25 12 — — $18,306.31 $51,078.08 $32,393.32 2026-04-01
668 MS_DRG Transurethral Procedures With Mcc 25 12 — — $18,589.93 $50,711.64 $32,245.14 2026-04-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 25 12 — — $21,305.39 $50,577.91 $32,191.07 2026-04-01
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 25 12 — — $21,234.84 $50,399.03 $32,118.74 2026-04-01
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 25 12 — — $19,724.37 $50,367.77 $32,106.10 2026-04-01
619 MS_DRG O.r. Procedures For Obesity With Mcc 25 12 — — $21,989.73 $50,145.48 $32,016.21 2026-04-01
974 MS_DRG HIV With Major Related Condition With Mcc 25 12 — — $19,565.63 $50,121.16 $32,006.38 2026-04-01
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc 25 12 — — $16,994.08 $50,048.22 $31,976.89 2026-04-01
0896T HCPCS Connj Lvr Algrft Prfu Dev Ea 1 1 — — $31,961.30 $31,961.30 $31,961.30 2026-04-01
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 25 12 — — $21,612.29 $49,846.76 $31,895.43 2026-04-01
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 25 12 — — $18,814.98 $49,504.63 $31,757.09 2026-04-01
B5200 HCPCS Parenteral Sol Hepatic Fream 1 1 — — $31,500.90 $31,500.90 $31,500.90 2026-04-01
800 MS_DRG Splenic Procedures With Cc 25 12 — — $18,956.08 $48,790.85 $31,468.47 2026-04-01
654 MS_DRG Major Bladder Procedures With Cc 25 12 — — $19,560.69 $48,615.44 $31,397.54 2026-04-01
503 MS_DRG Foot Procedures With Mcc 25 12 — — $17,549.31 $48,473.03 $31,339.96 2026-04-01
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 25 12 — — $17,120.37 $48,139.59 $31,205.13 2026-04-01
61 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 25 12 — — $19,739.18 $47,882.56 $31,101.19 2026-04-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 25 12 — — $16,704.83 $47,736.67 $31,042.21 2026-04-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/Mcc 25 12 — — $19,873.94 $47,724.52 $31,037.29 2026-04-01
963 MS_DRG Other Multiple Significant Trauma With Mcc 25 12 — — $18,896.82 $47,477.90 $30,937.57 2026-04-01
A7523 HCPCS Tracheostomy Shower Protect 1 1 — — $30,918.62 $30,918.62 $30,918.62 2026-04-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 25 12 — — $20,281.01 $47,252.13 $30,846.28 2026-04-01
849 MS_DRG Radiotherapy 25 12 — — $12,698.29 $47,055.89 $30,766.93 2026-04-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 25 12 — — $19,105.65 $46,998.58 $30,743.75 2026-04-01
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 25 12 — — $17,745.44 $46,845.75 $30,681.96 2026-04-01
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 25 12 — — $20,710.76 $46,196.22 $30,419.32 2026-04-01
577 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 25 12 — — $17,231.84 $46,034.71 $30,354.01 2026-04-01
970 MS_DRG HIV With Extensive O.r. Procedures Without Mcc 25 12 — — $18,127.12 $45,803.73 $30,260.61 2026-04-01
B4178 HCPCS Parenteral Sol Amino Acid > 1 1 — — $30,073.16 $30,073.16 $30,073.16 2026-04-01
C1715 HCPCS Brachytherapy Needle 1 1 — — $30,073.16 $30,073.16 $30,073.16 2026-04-01
C1724 HCPCS Cath, Trans Atherec,rotation 1 1 — — $30,073.16 $30,073.16 $30,073.16 2026-04-01
90715 HCPCS Tdap Vaccine 7 Yrs/> IM 1 1 — — $30,073.16 $30,073.16 $30,073.16 2026-04-01
C1725 HCPCS Cath, Translumin Non-laser 1 1 — — $30,073.16 $30,073.16 $30,073.16 2026-04-01
C1722 HCPCS Aicd, Single Chamber 1 1 — — $30,073.16 $30,073.16 $30,073.16 2026-04-01
C1714 HCPCS Cath, Trans Atherectomy, Dir 1 1 — — $30,073.16 $30,073.16 $30,073.16 2026-04-01
B4164 HCPCS Parenteral 50% Dextrose Solu 1 1 — — $30,073.16 $30,073.16 $30,073.16 2026-04-01
64656 HCPCS Revj/rplcmt Bat Mod Sys Pg 4 3 — — $6,774.00 $30,568.34 $29,974.78 2026-04-01
253 MS_DRG Other Vascular Procedures With Cc 25 12 — — $17,884.43 $45,077.79 $29,967.08 2026-04-01
846 MS_DRG Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc 25 12 — — $16,793.72 $45,023.95 $29,945.31 2026-04-01
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 25 12 — — $19,421.00 $44,855.49 $29,877.19 2026-04-01
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 25 12 — — $16,589.13 $44,792.97 $29,851.91 2026-04-01
96 MS_DRG Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc 25 12 — — $15,649.40 $44,792.97 $29,851.91 2026-04-01
749 MS_DRG Other Female Reproductive System O.r. Procedures With Cc/Mcc 25 12 — — $18,181.44 $44,591.51 $29,770.45 2026-04-01
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/Mcc 25 12 — — $17,311.56 $44,337.95 $29,667.92 2026-04-01
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 25 12 — — $19,783.45 $44,127.81 $29,582.95 2026-04-01
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 25 12 — — $15,546.40 $44,044.45 $29,549.24 2026-04-01
164 MS_DRG Major Chest Procedures With Cc 25 12 — — $18,184.97 $43,834.31 $29,464.27 2026-04-01
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc 25 12 — — $16,695.66 $43,815.20 $29,456.55 2026-04-01
J3265 HCPCS Injection Torsemide 10 Mg/ml 1 1 — — $29,390.86 $29,390.86 $29,390.86 2026-04-01
350 MS_DRG Inguinal And Femoral Hernia Procedures With Mcc 25 12 — — $17,360.24 $43,276.83 $29,238.85 2026-04-01
545 MS_DRG Connective Tissue Disorders With Mcc 25 12 — — $16,673.79 $43,099.68 $29,167.22 2026-04-01
478 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Cc 25 12 — — $15,793.32 $42,708.93 $29,009.22 2026-04-01
982 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 25 12 — — $17,523.91 $42,696.77 $29,004.30 2026-04-01
783 MS_DRG Cesarean Section With Sterilization With Mcc 25 12 — — $12,314.50 $42,637.72 $28,980.43 2026-04-01
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 25 12 — — $14,929.79 $42,448.42 $28,903.88 2026-04-01
M1005 HCPCS TB Scr No Perf 1 1 — — $28,897.68 $28,897.68 $28,897.68 2026-04-01
473 MS_DRG Cervical Spinal Fusion Without Cc/Mcc 25 12 — — $16,167.24 $42,398.06 $28,883.52 2026-04-01
318 MS_DRG Percutaneous Coronary Atherectomy Without Intraluminal Device 25 12 — — $17,088.62 $42,066.35 $28,749.39 2026-04-01
J9266 HCPCS Pegaspargase Injection 4 4 — — $144.18 $29,276.78 $28,708.30 2026-04-01
360 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc 25 12 — — $17,032.89 $41,929.15 $28,693.91 2026-04-01
320 MS_DRG Other Endovascular Cardiac Valve Procedures Without Mcc 25 12 — — $16,563.02 $41,772.85 $28,630.71 2026-04-01
330 MS_DRG Major Small And Large Bowel Procedures With Cc 25 12 — — $17,418.09 $41,632.17 $28,573.83 2026-04-01
397 MS_DRG Appendix Procedures With Mcc 25 12 — — $15,849.76 $41,592.23 $28,557.68 2026-04-01
35 MS_DRG Carotid Artery Stent Procedures With Cc 25 12 — — $15,717.13 $41,515.81 $28,526.78 2026-04-01
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 25 12 — — $16,869.92 $41,444.61 $28,497.99 2026-04-01
113 MS_DRG Orbital Procedures With Cc/Mcc 25 12 — — $15,429.99 $40,831.55 $28,250.10 2026-04-01
333 MS_DRG Rectal Resection With Cc 25 12 — — $14,056.95 $40,676.99 $28,187.60 2026-04-01
674 MS_DRG Other Kidney And Urinary Tract Procedures With Cc 25 12 — — $16,342.91 $40,614.47 $28,162.32 2026-04-01
940 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Cc 25 12 — — $16,529.16 $40,584.94 $28,150.38 2026-04-01
709 MS_DRG Penis Procedures With Cc/Mcc 25 12 — — $16,119.97 $40,414.75 $28,081.56 2026-04-01
357 MS_DRG Other Digestive System O.r. Procedures With Cc 25 12 — — $14,815.50 $40,386.96 $28,070.33 2026-04-01
56 MS_DRG Degenerative Nervous System Disorders With Mcc 25 12 — — $13,499.74 $40,345.28 $28,053.47 2026-04-01
827 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 25 12 — — $16,706.95 $40,138.61 $27,969.91 2026-04-01
347 MS_DRG Anal And Stomal Procedures With Mcc 25 12 — — $17,873.54 $39,867.69 $27,860.36 2026-04-01
98 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Cc 25 12 — — $13,218.25 $39,855.53 $27,855.44 2026-04-01
792 MS_DRG Prematurity Without Major Problems 28 12 — — $1,705.10 $42,535.26 $27,822.54 2026-04-01
82 MS_DRG Traumatic Stupor And Coma >1 Hour With Mcc 25 12 — — $15,193.65 $39,694.02 $27,790.13 2026-04-01
817 MS_DRG Other Antepartum Diagnoses With O.r. Procedures With Mcc 25 12 — — $17,764.54 $39,624.55 $27,762.04 2026-04-01
475 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc 25 12 — — $15,186.59 $39,522.08 $27,720.61 2026-04-01
85 MS_DRG Traumatic Stupor And Coma <1 Hour With Mcc 25 12 — — $14,447.23 $39,456.09 $27,693.92 2026-04-01
824 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Cc 25 12 — — $15,415.88 $39,346.68 $27,649.68 2026-04-01
821 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Cc 25 12 — — $16,476.95 $38,877.77 $27,460.08 2026-04-01
715 MS_DRG Other Male Reproductive System O.r. Procedures For Malignancy With Cc/Mcc 25 12 — — $15,347.45 $38,855.19 $27,450.95 2026-04-01
407 MS_DRG Pancreas, Liver And Shunt Procedures Without Cc/Mcc 25 12 — — $14,240.52 $38,547.79 $27,326.65 2026-04-01
286 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc 25 12 — — $15,719.95 $38,429.70 $27,278.90 2026-04-01
934 MS_DRG Full Thickness Burn Without Skin Graft Or Inhalation Injury 25 12 — — $12,298.28 $38,391.49 $27,263.45 2026-04-01
808 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 25 12 — — $15,017.27 $38,344.60 $27,244.49 2026-04-01
41 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe… 25 12 — — $16,445.91 $38,184.82 $27,179.88 2026-04-01
30 MS_DRG Spinal Procedures Without Cc/Mcc 25 12 — — $15,050.43 $38,124.04 $27,155.31 2026-04-01
614 MS_DRG Adrenal And Pituitary Procedures With Cc/Mcc 25 12 — — $16,572.20 $38,064.99 $27,131.43 2026-04-01
424 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Cc 25 12 — — $15,770.75 $37,997.26 $27,104.04 2026-04-01
4210F HCPCS Ace/arb Thxpy For Mos/> 1 1 — — $27,069.16 $27,069.16 $27,069.16 2026-04-01
250 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc 25 12 — — $16,992.95 $37,903.48 $27,066.12 2026-04-01
141 MS_DRG Major Head And Neck Procedures With Cc 25 12 — — $15,573.91 $37,879.16 $27,056.29 2026-04-01
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