Price Transparencybeta Hospital negotiated rates

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

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Hospital

ASCENSION ST JOHN NOWATA

Nowata, OK · CCN 371305 · Rates published

23,960 distinct procedures filed
39 distinct payers
719,680 rate rows
2026-01-01 last MRF observed
Data quality

704,820 of 719,680 rate rows are consumer-grade (97.9%)

14,860 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
per-diem day rate — not a per-procedure price 9,907
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 4,720
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 86
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 78
placeholder amount (≤ $0.02) — excluded from medians 50
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 19
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://healthcare.ascension.org/-/media/project/ascension/healthcare/price-transparency-files/ok-csv/731440267_jane-phillips-nowata-hospital-inc_standardcharges.csv
Found on page https://healthcare.ascension.org/price-transparency
Discovered viaCMS hospital list
Last fetch not_modified · 2026-11-15
Content fingerprint 66cb908d5e18843b… · 214,129,855 bytes · first seen 2026-05-15

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
652
MS_DRG 		Kidney Transplant 16 $6,781.00 $70,000.00 $70,000.00 nat. median
$29,902
outlier · 2.3×
0051T
OTHER 		Implant Total Heart System 6 $56,085.13 $56,085.13 $56,085.13 nat. median
$8,862
outlier · 6.3×
0053T
OTHER 		Replace Implantable Hrt Syst 6 $56,085.13 $56,085.13 $56,085.13 nat. median
$7,703
outlier · 7.3×
0052T
OTHER 		Replace Thrc Unit Hrt Syst 6 $56,085.13 $56,085.13 $56,085.13 nat. median
$8,861
outlier · 6.3×
781025040
CDM 		Glucarpidase 1000 Unit Inj 25040 31 $22,987.80 $120,988.40 $53,234.90 nat. median
$54,445
1.0× median
0283T
OTHER 		Periph Field Stimul Perm 5 $48,150.35 $48,150.35 $48,150.35 nat. median
$13,385
outlier · 3.6×
0266T
OTHER 		Implt/rpl Crtd Sns Dev Total 5 $39,738.26 $39,738.26 $39,738.26 nat. median
$36,929
1.1× median
0268T
OTHER 		Implt/rpl Crtd Sns Dev Gen 5 $39,738.26 $39,738.26 $39,738.26 nat. median
$27,559
1.4× median
0313T
OTHER 		Laps Rmvl Nstim Array Vagus 5 $39,738.26 $39,738.26 $39,738.26 nat. median
$2,444
outlier · 16.3×
0312T
OTHER 		Laps Impltj Nstim Vagus 5 $39,738.26 $39,738.26 $39,738.26 nat. median
$17,950
outlier · 2.2×
781051937
CDM 		Ravulizumab 1100mg/11ml 51937 31 $15,840.06 $83,368.75 $36,682.25 nat. median
$37,516
1.0× median
34842
CPT 		Endovasc Visc Aorta 2 Graft 5 $34,254.64 $34,254.64 $34,254.64 nat. median
$5,370
outlier · 6.4×
34841
CPT 		Endovasc Visc Aorta 1 Graft 5 $34,254.64 $34,254.64 $34,254.64 nat. median
$4,922
outlier · 7.0×
34848
CPT 		Visc & Infraren Abd 4+ Prost 5 $34,254.64 $34,254.64 $34,254.64 nat. median
$5,917
outlier · 5.8×
34844
CPT 		Endovasc Visc Aorta 4 Graft 5 $34,254.64 $34,254.64 $34,254.64 nat. median
$5,305
outlier · 6.5×
34846
CPT 		Visc & Infraren Abd 2 Prosth 5 $34,254.64 $34,254.64 $34,254.64 nat. median
$5,721
outlier · 6.0×
34847
CPT 		Visc & Infraren Abd 3 Prosth 5 $34,254.64 $34,254.64 $34,254.64 nat. median
$5,686
outlier · 6.0×
0304T
OTHER 		Icar Ischm Mntrng Sys Device 5 $34,254.64 $34,254.64 $34,254.64 nat. median
$5,876
outlier · 5.8×
0302T
OTHER 		Icar Ischm Mntrng Sys Compl 5 $34,254.64 $34,254.64 $34,254.64 nat. median
$6,405
outlier · 5.3×
34843
CPT 		Endovasc Visc Aorta 3 Graft 5 $34,254.64 $34,254.64 $34,254.64 nat. median
$5,195
outlier · 6.6×
34845
CPT 		Visc & Infraren Abd 1 Prosth 5 $34,254.64 $34,254.64 $34,254.64 nat. median
$5,220
outlier · 6.6×
781024837
CDM 		Alemtuzumab 12mg/1.2ml 24837 31 $13,996.96 $73,668.20 $32,414.01 nat. median
$33,151
1.0× median
781014212
CDM 		Supprelin La Implant 50 Mg 14212 31 $13,275.69 $69,872.05 $30,743.70 nat. median
$31,442
1.0× median
J9226
HCPCS 		Supprelin La Implant 50 Mg 14212 5 $26,360.19 $28,243.06 $26,360.19 nat. median
$55,159
outlier · 0.5×
781051946
CDM 		Polatuzumab 140mg Inj 51946 31 $11,164.90 $58,762.65 $25,855.57 nat. median
$26,443
1.0× median
0333
RC 		1 $23,879.00 $25,230.00 $24,554.50 nat. median
$782
outlier · 31.4×
781024982
CDM 		Emicizumab 150mg/ml Soln 24982 31 $10,392.51 $54,697.40 $24,066.86 nat. median
$24,614
1.0× median
781024852
CDM 		Ocrelizumab 300mg/10ml 24852 31 $10,198.25 $53,675.00 $23,617.00 nat. median
$24,154
1.0× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 5 $18,736.00 $18,736.00 $18,736.00 nat. median
$90,525
outlier · 0.2×
213
MS_DRG 		Endovascular Abdominal Aorta With Iliac Branch Procedures 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$48,616
outlier · 0.4×
268
MS_DRG 		Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 6 $13,440.00 $18,736.00 $18,736.00 nat. median
$63,879
outlier · 0.3×
326
MS_DRG 		Stomach, Esophageal And Duodenal Procedures With Mcc 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$46,315
outlier · 0.4×
218
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 6 $13,440.00 $18,736.00 $18,736.00 nat. median
$59,582
outlier · 0.3×
270
MS_DRG 		Other Major Cardiovascular Procedures With Mcc 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$49,265
outlier · 0.4×
471
MS_DRG 		Cervical Spinal Fusion With Mcc 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$44,824
outlier · 0.4×
234
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$51,539
outlier · 0.4×
799
MS_DRG 		Splenic Procedures With Mcc 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$43,208
outlier · 0.4×
457
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$55,180
outlier · 0.3×
233
MS_DRG 		Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 6 $16,493.00 $18,736.00 $18,736.00 nat. median
$71,682
outlier · 0.3×
573
MS_DRG 		Skin Graft For Skin Ulcer Or Cellulitis With Mcc 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$58,244
outlier · 0.3×
217
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 6 $13,440.00 $18,736.00 $18,736.00 nat. median
$62,022
outlier · 0.3×
405
MS_DRG 		Pancreas, Liver And Shunt Procedures With Mcc 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$50,653
outlier · 0.4×
232
MS_DRG 		Coronary Bypass With Ptca Without Mcc 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$57,694
outlier · 0.3×
266
MS_DRG 		Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$58,208
outlier · 0.3×
275
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 6 $13,440.00 $18,736.00 $18,736.00 nat. median
$66,583
outlier · 0.3×
235
MS_DRG 		Coronary Bypass Without Cardiac Catheterization With Mcc 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$55,355
outlier · 0.3×
447
MS_DRG 		Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 6 $13,440.00 $18,736.00 $18,736.00 nat. median
$60,366
outlier · 0.3×
220
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$50,481
outlier · 0.4×
276
MS_DRG 		Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 8 $11,000.00 $18,736.00 $18,736.00 nat. median
$56,612
outlier · 0.3×
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 6 $13,440.00 $18,736.00 $18,736.00 nat. median
$72,172
outlier · 0.3×

Other procedures at this hospital

Browse this hospital's 23,960 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
             
0333 RC — 2 1 — — $23,879.00 $25,230.00 $24,554.50 2026-01-01
632050593 CDM Ablat/ren/cryo 1 Or > Bil 50593 51 30 $38,439.50 $14,222.62 63% off $7,303.51 $38,439.50 $16,528.99 2026-01-01
289 MS_DRG Acute And Subacute Endocarditis With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
290 MS_DRG Acute And Subacute Endocarditis Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
121 MS_DRG Acute Major Eye Infections With Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
122 MS_DRG Acute Major Eye Infections Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
281 MS_DRG Acute Myocardial Infarction, Discharged Alive With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
282 MS_DRG Acute Myocardial Infarction, Discharged Alive Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
284 MS_DRG Acute Myocardial Infarction, Expired With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
283 MS_DRG Acute Myocardial Infarction, Expired With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
285 MS_DRG Acute Myocardial Infarction, Expired Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
245 MS_DRG Aicd Generator Procedures 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
781024837 CDM Alemtuzumab 12mg/1.2ml 24837 53 31 $73,668.20 $27,257.23 63% off $13,996.96 $73,668.20 $32,414.01 2026-01-01
14 MS_DRG Allogeneic Bone Marrow Transplant 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
241 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc… 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
348 MS_DRG Anal And Stomal Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
349 MS_DRG Anal And Stomal Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
311 MS_DRG Angina Pectoris 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 7 6 — — $13,440.00 $18,736.00 $18,736.00 2026-01-01
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 10 9 — — $8,300.00 $18,736.00 $17,614.50 2026-01-01
398 MS_DRG Appendix Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
397 MS_DRG Appendix Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
399 MS_DRG Appendix Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
302 MS_DRG Atherosclerosis With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
303 MS_DRG Atherosclerosis Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
409 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
202 MS_DRG Bronchitis And Asthma With Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
203 MS_DRG Bronchitis And Asthma Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
297 MS_DRG Cardiac Arrest, Unexplained With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
296 MS_DRG Cardiac Arrest, Unexplained With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
298 MS_DRG Cardiac Arrest, Unexplained Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
306 MS_DRG Cardiac Congenital And Valvular Disorders With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
307 MS_DRG Cardiac Congenital And Valvular Disorders Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 7 6 — — $13,440.00 $18,736.00 $18,736.00 2026-01-01
276 MS_DRG Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
277 MS_DRG Cardiac Defibrillator Implant Without Mcc 10 9 — — $8,300.00 $18,736.00 $17,614.50 2026-01-01
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
259 MS_DRG Cardiac Pacemaker Device Replacement Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
262 MS_DRG Cardiac Pacemaker Revision Except Device Replacement Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 5 5 — — $18,736.00 $18,736.00 $18,736.00 2026-01-01
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 7 6 — — $13,440.00 $18,736.00 $18,736.00 2026-01-01
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 7 6 — — $13,440.00 $18,736.00 $18,736.00 2026-01-01
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 7 6 — — $13,440.00 $18,736.00 $18,736.00 2026-01-01
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 10 9 — — $8,300.00 $18,736.00 $17,614.50 2026-01-01
35 MS_DRG Carotid Artery Stent Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
34 MS_DRG Carotid Artery Stent Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
36 MS_DRG Carotid Artery Stent Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
792061272 CDM Catheter Ion Eup 61272 53 31 $40,809.60 $15,099.55 63% off $7,753.82 $40,809.60 $17,956.22 2026-01-01
471 MS_DRG Cervical Spinal Fusion With Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
313 MS_DRG Chest Pain 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
415 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
412 MS_DRG Cholecystectomy With C.d.e. With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
413 MS_DRG Cholecystectomy With C.d.e. Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
192 MS_DRG Chronic Obstructive Pulmonary Disease Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
286 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
287 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
209 MS_DRG Complex Aortic Arch Procedures 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
381 MS_DRG Complicated Peptic Ulcer With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
380 MS_DRG Complicated Peptic Ulcer With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
382 MS_DRG Complicated Peptic Ulcer Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 6 6 — — $16,493.00 $18,736.00 $18,736.00 2026-01-01
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
231 MS_DRG Coronary Bypass With Ptca With Mcc 6 6 — — $16,493.00 $18,736.00 $18,736.00 2026-01-01
232 MS_DRG Coronary Bypass With Ptca Without Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 10 9 — — $8,300.00 $18,736.00 $17,614.50 2026-01-01
323 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
324 MS_DRG Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
158 MS_DRG Dental And Oral Diseases With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
157 MS_DRG Dental And Oral Diseases With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
159 MS_DRG Dental And Oral Diseases Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
375 MS_DRG Digestive Malignancy With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
374 MS_DRG Digestive Malignancy With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
376 MS_DRG Digestive Malignancy Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
149 MS_DRG Dysequilibrium 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
147 MS_DRG Ear, Nose, Mouth And Throat Malignancy With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
146 MS_DRG Ear, Nose, Mouth And Throat Malignancy With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
148 MS_DRG Ear, Nose, Mouth And Throat Malignancy Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
781024981 CDM Emicizumab 105mg/0.7ml Soln 24981 53 31 $38,291.20 $14,167.74 63% off $7,275.33 $38,291.20 $16,848.13 2026-01-01
781024982 CDM Emicizumab 150mg/ml Soln 24982 53 31 $54,697.40 $20,238.04 63% off $10,392.51 $54,697.40 $24,066.86 2026-01-01
34841 CPT Endovasc Visc Aorta 1 Graft 5 5 — — $34,254.64 $34,254.64 $34,254.64 2026-01-01
34842 CPT Endovasc Visc Aorta 2 Graft 5 5 — — $34,254.64 $34,254.64 $34,254.64 2026-01-01
34843 CPT Endovasc Visc Aorta 3 Graft 5 5 — — $34,254.64 $34,254.64 $34,254.64 2026-01-01
34844 CPT Endovasc Visc Aorta 4 Graft 5 5 — — $34,254.64 $34,254.64 $34,254.64 2026-01-01
213 MS_DRG Endovascular Abdominal Aorta With Iliac Branch Procedures 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 10 9 — — $8,300.00 $18,736.00 $17,614.50 2026-01-01
150 MS_DRG Epistaxis With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
151 MS_DRG Epistaxis Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
38 MS_DRG Extracranial Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
37 MS_DRG Extracranial Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
39 MS_DRG Extracranial Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
115 MS_DRG Extraocular Procedures Except Orbit 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
378 MS_DRG Gastrointestinal Hemorrhage With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
377 MS_DRG Gastrointestinal Hemorrhage With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
379 MS_DRG Gastrointestinal Hemorrhage Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
389 MS_DRG Gastrointestinal Obstruction With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
388 MS_DRG Gastrointestinal Obstruction With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
781025040 CDM Glucarpidase 1000 Unit Inj 25040 53 31 $120,988.40 $44,765.71 63% off $22,987.80 $120,988.40 $53,234.90 2026-01-01
292 MS_DRG Heart Failure And Shock With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
291 MS_DRG Heart Failure And Shock With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
293 MS_DRG Heart Failure And Shock Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
354 MS_DRG Hernia Procedures Except Inguinal And Femoral With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
355 MS_DRG Hernia Procedures Except Inguinal And Femoral Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
304 MS_DRG Hypertension With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
305 MS_DRG Hypertension Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
0302T OTHER Icar Ischm Mntrng Sys Compl 5 5 — — $34,254.64 $34,254.64 $34,254.64 2026-01-01
0304T OTHER Icar Ischm Mntrng Sys Device 5 5 — — $34,254.64 $34,254.64 $34,254.64 2026-01-01
0051T OTHER Implant Total Heart System 6 6 — — $56,085.13 $56,085.13 $56,085.13 2026-01-01
0268T OTHER Implt/rpl Crtd Sns Dev Gen 5 5 — — $39,738.26 $39,738.26 $39,738.26 2026-01-01
0266T OTHER Implt/rpl Crtd Sns Dev Total 5 5 — — $39,738.26 $39,738.26 $39,738.26 2026-01-01
386 MS_DRG Inflammatory Bowel Disease With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
385 MS_DRG Inflammatory Bowel Disease With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
387 MS_DRG Inflammatory Bowel Disease Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
351 MS_DRG Inguinal And Femoral Hernia Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
350 MS_DRG Inguinal And Femoral Hernia Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
197 MS_DRG Interstitial Lung Disease With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
196 MS_DRG Interstitial Lung Disease With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
198 MS_DRG Interstitial Lung Disease Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
116 MS_DRG Intraocular Procedures With Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
117 MS_DRG Intraocular Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
652 MS_DRG Kidney Transplant 24 16 — — $6,781.00 $70,000.00 $70,000.00 2026-01-01
418 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
0312T OTHER Laps Impltj Nstim Vagus 5 5 — — $39,738.26 $39,738.26 $39,738.26 2026-01-01
0313T OTHER Laps Rmvl Nstim Array Vagus 5 5 — — $39,738.26 $39,738.26 $39,738.26 2026-01-01
653 MS_DRG Major Bladder Procedures With Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
164 MS_DRG Major Chest Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
163 MS_DRG Major Chest Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
184 MS_DRG Major Chest Trauma With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
183 MS_DRG Major Chest Trauma With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
185 MS_DRG Major Chest Trauma Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
369 MS_DRG Major Esophageal Disorders With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
368 MS_DRG Major Esophageal Disorders With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
370 MS_DRG Major Esophageal Disorders Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
371 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
373 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
141 MS_DRG Major Head And Neck Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
140 MS_DRG Major Head And Neck Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
142 MS_DRG Major Head And Neck Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
330 MS_DRG Major Small And Large Bowel Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 10 9 — — $8,300.00 $18,736.00 $17,614.50 2026-01-01
331 MS_DRG Major Small And Large Bowel Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
345 MS_DRG Minor Small And Large Bowel Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
346 MS_DRG Minor Small And Large Bowel Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
138 MS_DRG Mouth Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 7 6 — — $13,440.00 $18,736.00 $18,736.00 2026-01-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 10 9 — — $8,300.00 $18,736.00 $17,614.50 2026-01-01
123 MS_DRG Neurological Eye Disorders 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
795 MS_DRG Normal Newborn 10 10 — — $6,781.00 $18,736.00 $17,614.50 2026-01-01
781024852 CDM Ocrelizumab 300mg/10ml 24852 53 31 $53,675.00 $19,859.75 63% off $10,198.25 $53,675.00 $23,617.00 2026-01-01
114 MS_DRG Orbital Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
315 MS_DRG Other Circulatory System Diagnoses With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
314 MS_DRG Other Circulatory System Diagnoses With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
316 MS_DRG Other Circulatory System Diagnoses Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
264 MS_DRG Other Circulatory System O.r. Procedures 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
394 MS_DRG Other Digestive System Diagnoses With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
393 MS_DRG Other Digestive System Diagnoses With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
395 MS_DRG Other Digestive System Diagnoses Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
357 MS_DRG Other Digestive System O.r. Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
358 MS_DRG Other Digestive System O.r. Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
125 MS_DRG Other Disorders Of The Eye Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
155 MS_DRG Other Ear, Nose, Mouth And Throat Diagnoses With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
154 MS_DRG Other Ear, Nose, Mouth And Throat Diagnoses With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
156 MS_DRG Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
145 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
320 MS_DRG Other Endovascular Cardiac Valve Procedures Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
215 MS_DRG Other Heart Assist System Implant 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 10 9 — — $8,300.00 $18,736.00 $17,614.50 2026-01-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
205 MS_DRG Other Respiratory System Diagnoses With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
206 MS_DRG Other Respiratory System Diagnoses Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
167 MS_DRG Other Respiratory System O.r. Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
168 MS_DRG Other Respiratory System O.r. Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
253 MS_DRG Other Vascular Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
252 MS_DRG Other Vascular Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
254 MS_DRG Other Vascular Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
152 MS_DRG Otitis Media And Uri With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
153 MS_DRG Otitis Media And Uri Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
10 MS_DRG Pancreas Transplant 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
407 MS_DRG Pancreas, Liver And Shunt Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 10 9 — — $8,300.00 $18,736.00 $17,614.50 2026-01-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
322 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
250 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
251 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
359 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
360 MS_DRG Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
318 MS_DRG Percutaneous Coronary Atherectomy Without Intraluminal Device 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
0283T OTHER Periph Field Stimul Perm 5 5 — — $48,150.35 $48,150.35 $48,150.35 2026-01-01
300 MS_DRG Peripheral Vascular Disorders With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
299 MS_DRG Peripheral Vascular Disorders With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
301 MS_DRG Peripheral Vascular Disorders Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
41 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe… 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
336 MS_DRG Peritoneal Adhesiolysis With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
243 MS_DRG Permanent Cardiac Pacemaker Implant With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
244 MS_DRG Permanent Cardiac Pacemaker Implant Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
187 MS_DRG Pleural Effusion With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
186 MS_DRG Pleural Effusion With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
188 MS_DRG Pleural Effusion Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
200 MS_DRG Pneumothorax With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
199 MS_DRG Pneumothorax With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
201 MS_DRG Pneumothorax Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
781051946 CDM Polatuzumab 140mg Inj 51946 53 31 $58,762.65 $21,742.18 63% off $11,164.90 $58,762.65 $25,855.57 2026-01-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
176 MS_DRG Pulmonary Embolism Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
781051937 CDM Ravulizumab 1100mg/11ml 51937 53 31 $83,368.75 $30,846.44 63% off $15,840.06 $83,368.75 $36,682.25 2026-01-01
333 MS_DRG Rectal Resection With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
332 MS_DRG Rectal Resection With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
334 MS_DRG Rectal Resection Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
0053T OTHER Replace Implantable Hrt Syst 6 6 — — $56,085.13 $56,085.13 $56,085.13 2026-01-01
0052T OTHER Replace Thrc Unit Hrt Syst 6 6 — — $56,085.13 $56,085.13 $56,085.13 2026-01-01
178 MS_DRG Respiratory Infections And Inflammations With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
177 MS_DRG Respiratory Infections And Inflammations With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
180 MS_DRG Respiratory Neoplasms With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
182 MS_DRG Respiratory Neoplasms Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
204 MS_DRG Respiratory Signs And Symptoms 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
139 MS_DRG Salivary Gland Procedures 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
100 MS_DRG Seizures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
101 MS_DRG Seizures Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
135 MS_DRG Sinus And Mastoid Procedures With Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 7 6 — — $13,440.00 $18,736.00 $18,736.00 2026-01-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 10 9 — — $8,300.00 $18,736.00 $17,614.50 2026-01-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
28 MS_DRG Spinal Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
30 MS_DRG Spinal Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
799 MS_DRG Splenic Procedures With Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 9 8 — — $11,000.00 $18,736.00 $18,736.00 2026-01-01
781014212 CDM Supprelin La Implant 50 Mg 14212 53 31 $69,872.05 $25,852.66 63% off $13,275.69 $69,872.05 $30,743.70 2026-01-01
J9226 HCPCS Supprelin La Implant 50 Mg 14212 5 5 $69,872.05 $25,852.66 63% off $26,360.19 $28,243.06 $26,360.19 2026-01-01
312 MS_DRG Syncope And Collapse 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
384 MS_DRG Uncomplicated Peptic Ulcer Without Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
257 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
263 MS_DRG Vein Ligation And Stripping 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
32 MS_DRG Ventricular Shunt Procedures With Cc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
33 MS_DRG Ventricular Shunt Procedures Without Cc/mcc 11 10 — — $6,781.00 $18,736.00 $16,493.00 2026-01-01
34845 CPT Visc & Infraren Abd 1 Prosth 5 5 — — $34,254.64 $34,254.64 $34,254.64 2026-01-01
34846 CPT Visc & Infraren Abd 2 Prosth 5 5 — — $34,254.64 $34,254.64 $34,254.64 2026-01-01
34847 CPT Visc & Infraren Abd 3 Prosth 5 5 — — $34,254.64 $34,254.64 $34,254.64 2026-01-01
34848 CPT Visc & Infraren Abd 4+ Prost 5 5 — — $34,254.64 $34,254.64 $34,254.64 2026-01-01
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