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 →

Export CSV
Hospital

OKEENE MUNICIPAL HOSPITAL

Okeene, OK · CCN 371327 · Rates published

3,622 distinct procedures filed
34 distinct payers
78,458 rate rows
2026-07-31 last MRF observed
Data quality

77,399 of 78,458 rate rows are consumer-grade (98.7%)

1,059 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 433
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 190
exceeds 10× this hospital's gross charge — excluded from medians 188
exceeds 3× this hospital's gross charge for a DRG stay — excluded 117
percent-of-charges filed in the dollar field — excluded from medians 75
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 32
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 24
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbOMHOKEENEOK&type=CDMWithoutLabel&fileType=CSV
Found on page https://www.okeenehospital.com/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-08-14
Content fingerprint 450ab3444d85de12… · 23,517,048 bytes · first seen 2026-08-13

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
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 17 $5,563.72 $107,070.97 $27,131.22 nat. median
$12,892
outlier · 2.1×
64
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Mcc 13 $14,513.23 $153,562.40 $24,306.96 nat. median
$20,032
1.2× median
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 28 $9.95 $37,065.24 $23,351.10 nat. median
$150
outlier · 155.9×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 28 $93.33 $32,857.15 $20,700.01 nat. median
$3,475
outlier · 6.0×
592
MS_DRG 		Skin Ulcers With Mcc 17 $11,002.65 $66,274.00 $20,147.40 nat. median
$19,351
1.0× median
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 14 $6,770.95 $76,530.58 $15,688.94 nat. median
$12,112
1.3× median
J0517
HCPCS 		Injection, Benralizumab, 1 Mg 28 $93.33 $23,154.32 $14,587.22 nat. median
$801
outlier · 18.2×
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 17 $5,107.65 $43,063.78 $13,814.34 nat. median
$13,455
1.0× median
949
MS_DRG 		Aftercare With Cc/mcc 14 $8,334.15 $58,693.80 $13,675.26 nat. median
$12,344
1.1× median
559
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 12 $8,354.35 $22,541.05 $13,650.90 nat. median
$18,860
0.7× median
65
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 14 $6,176.54 $63,992.05 $12,682.31 nat. median
$11,101
1.1× median
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 16 $3,537.18 $48,906.20 $12,613.62 nat. median
$8,869
1.4× median
372
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections With Cc 14 $4,520.50 $58,389.20 $12,562.51 nat. median
$11,013
1.1× median
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 16 $6,241.14 $27,077.93 $11,734.56 nat. median
$19,136
0.6× median
J2356
HCPCS 		Injection, Tezepelumab-ekko, 1 Mg 24 $1,500.00 $17,301.08 $11,638.44 nat. median
$75
outlier · 154.8×
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 14 $5,013.33 $42,285.20 $10,673.33 nat. median
$10,806
1.0× median
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 16 $6,502.88 $28,856.03 $10,529.92 nat. median
$16,167
0.7× median
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 14 $4,158.75 $41,023.74 $10,192.33 nat. median
$9,038
1.1× median
191
MS_DRG 		Chronic Obstructive Pulmonary Disease With Cc 12 $4,294.48 $17,458.40 $9,524.64 nat. median
$9,352
1.0× median
561
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 14 $4,301.32 $43,407.58 $9,328.29 nat. median
$9,110
1.0× median
J1437
HCPCS 		Injection, Ferric Derisomaltose, 10 Mg 28 $9.95 $14,462.65 $9,111.47 nat. median
$44
outlier · 205.9×
69
MS_DRG 		Transient Ischemia Without Thrombolytic 12 $4,577.36 $13,728.60 $8,865.42 nat. median
$8,926
1.0× median
93
MS_DRG 		Other Disorders Of Nervous System Without Cc/mcc 14 $4,172.08 $34,932.70 $8,846.82 nat. median
$8,905
1.0× median
689
MS_DRG 		Kidney And Urinary Tract Infections With Mcc 17 $3,145.07 $15,267.00 $8,536.33 nat. median
$12,008
0.7× median
300
MS_DRG 		Peripheral Vascular Disorders With Cc 16 $4,936.58 $22,265.80 $7,885.62 nat. median
$11,280
0.7× median
291
MS_DRG 		Heart Failure And Shock With Mcc 14 $3,959.95 $18,970.50 $6,470.50 nat. median
$13,359
outlier · 0.5×
392
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 14 $3,373.09 $20,048.10 $6,264.41 nat. median
$8,659
0.7× median
683
MS_DRG 		Renal Failure With Cc 16 $3,908.48 $15,501.60 $6,095.51 nat. median
$9,596
0.6× median
556
MS_DRG 		Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 12 $4,052.79 $10,039.46 $5,962.44 nat. median
$9,097
0.7× median
66
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 12 $4,605.76 $8,272.34 $5,644.32 nat. median
$8,021
0.7× median
312
MS_DRG 		Syncope And Collapse 14 $3,789.23 $16,191.55 $5,572.40 nat. median
$9,409
0.6× median
195
MS_DRG 		Simple Pneumonia And Pleurisy Without Cc/mcc 14 $3,130.84 $21,763.50 $5,568.51 nat. median
$7,228
0.8× median
884
MS_DRG 		Organic Disturbances And Intellectual Disability 10 $3,331.12 $14,372.30 $5,170.85 nat. median
$14,657
outlier · 0.4×
308
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Mcc 12 $3,105.90 $14,552.75 $5,075.00 nat. median
$12,590
outlier · 0.4×
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 13 $3,064.28 $14,037.16 $5,007.00 nat. median
$13,243
outlier · 0.4×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 24 $1,081.35 $7,209.00 $4,849.50 nat. median
$1,555
outlier · 3.1×
J1568
HCPCS 		Injection, Immune Globulin, (octagam), Intravenous, Non-lyophilized (e.g., Liqui… 28 $20.53 $7,692.30 $4,846.15 nat. median
$722
outlier · 6.7×
J3032
HCPCS 		Injection, Eptinezumab-jjmr, 1 Mg 28 $9.95 $7,682.67 $4,840.08 nat. median
$69
outlier · 70.0×
950
MS_DRG 		Aftercare Without Cc/mcc 13 $2,849.56 $11,856.15 $4,656.15 nat. median
$7,484
0.6× median
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 16 $2,263.30 $10,450.20 $4,526.80 nat. median
$8,588
0.5× median
310
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 12 $3,264.03 $6,842.45 $4,415.25 nat. median
$6,645
0.7× median
303
MS_DRG 		Atherosclerosis Without Mcc 12 $3,230.14 $8,136.97 $4,354.35 nat. median
$7,759
0.6× median
948
MS_DRG 		Signs And Symptoms Without Mcc 12 $2,850.54 $9,675.64 $4,301.75 nat. median
$8,463
0.5× median
J1439
HCPCS 		Injection, Ferric Carboxymaltose, 1 Mg 28 $0.94 $6,378.13 $4,018.22 nat. median
$11
outlier · 370.0×
J0129
HCPCS 		Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 28 $20.53 $6,138.00 $3,866.94 nat. median
$842
outlier · 4.6×
J2357
HCPCS 		Injection, Omalizumab, 5 Mg 28 $20.53 $5,832.13 $3,674.24 nat. median
$1,217
outlier · 3.0×
J0840
HCPCS 		Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 28 $863.46 $5,756.40 $3,626.53 nat. median
$3,427
1.1× median
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 15 $2,177.99 $10,310.80 $3,558.80 nat. median
$11,029
outlier · 0.3×
Q0138
HCPCS 		Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd… 28 $0.94 $4,726.71 $3,031.45 nat. median
$169
outlier · 17.9×
8101515
CDM 		Specialty Services - Treatment Room 22 $704.25 $4,225.50 $3,021.18 nat. median
$3,021
1.0× median

Other procedures at this hospital

Browse this hospital's 3,622 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
             
10140 HCPCS Drainage Of Blood Or Fluid Accumulation 92 28 $1,890.00 $1,512.00 20% off $39.15 $3,614.00 $709.17 2026-03-18
10180 HCPCS Complex Drainage Of Wound Infection After Surgery 28 28 $3,255.00 $2,604.00 20% off $488.25 $3,255.00 $2,112.49 2026-03-18
110377 OTHER Ed Emergent Level IV 5 2 $899.00 $719.20 $674.25 $876.53 $680.99 2026-07-31
110378 OTHER Ed Emergent Level V 5 2 $899.00 $719.20 $674.25 $876.53 $680.99 2026-07-31
11044 HCPCS Removal Of Bone, 20.0 Sq Cm Or Less 28 28 $966.00 $772.80 20% off $144.90 $2,493.88 $701.32 2026-03-18
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 28 28 $946.00 $756.80 20% off $141.90 $4,880.25 $686.80 2026-03-18
11646 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 28 28 $914.00 $731.20 $137.10 $4,880.25 $663.56 2026-03-18
13100 HCPCS Complicated Repair Of Wound Of Trunk, 1.1-2.5 Cm 44 28 $1,364.00 $1,091.20 $145.88 $1,861.80 $777.48 2026-03-18
13101 HCPCS Complicated Repair Of Wound Of Trunk, 2.6-7.5 Cm 44 28 $1,364.00 $1,091.20 $178.43 $1,861.80 $777.48 2026-03-18
13120 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 1.1-2.5 Cm 44 28 $1,364.00 $1,091.20 $168.26 $1,364.00 $738.96 2026-03-18
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 68 28 $1,301.00 $1,040.80 20% off $145.50 $1,301.00 $684.34 2026-03-18
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 28 28 $962.00 $769.60 20% off $144.30 $1,861.80 $698.41 2026-03-18
15271 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 28 28 $3,224.00 $2,579.20 20% off $483.60 $4,847.23 $2,340.62 2026-03-18
15822 HCPCS Removal Of Excessive Skin Of Upper Eyelid 28 28 $1,097.00 $877.60 20% off $164.55 $4,847.23 $796.42 2026-03-18
15830 HCPCS Removal Of Extra Skin And Tissue Of Abdomen 16 16 $4,263.00 $3,410.40 20% off $899.65 $2,536.50 $1,316.10 2026-03-18
177 MS_DRG Respiratory Infections And Inflammations With Mcc 16 16 $10,625.63 $8,500.50 20% off $6,502.88 $28,856.03 $10,529.92 2026-03-18
178 MS_DRG Respiratory Infections And Inflammations With Cc 14 14 $14,785.20 $11,828.16 20% off $5,013.33 $42,285.20 $10,673.33 2026-03-18
189 MS_DRG Pulmonary Edema And Respiratory Failure 17 17 $36,174.97 $28,939.97 20% off $5,563.72 $107,070.97 $27,131.22 2026-03-18
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 12 12 $19,398.23 $15,518.58 20% off $4,294.48 $17,458.40 $9,524.64 2026-03-18
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 17 17 $15,718.18 $12,574.54 20% off $5,107.65 $43,063.78 $13,814.34 2026-03-18
19303 HCPCS Simple Complete Removal Of Breast 16 16 $3,766.00 $3,012.80 $770.05 $5,979.50 $1,102.09 2026-03-18
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 14 14 $17,391.74 $13,913.39 20% off $4,158.75 $41,023.74 $10,192.33 2026-03-18
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 14 14 $7,363.50 $5,890.80 20% off $3,130.84 $21,763.50 $5,568.51 2026-03-18
21011 HCPCS Removal Of Growth Under Skin Of Face Or Scalp, Less Than 2.0 Cm 28 28 $1,005.00 $804.00 20% off $150.75 $4,228.57 $729.63 2026-03-18
21315 HCPCS Closed Treatment Of Broken Nose Bone With Manipulation 44 28 $4,587.00 $3,669.60 20% off $45.68 $4,587.00 $2,614.59 2026-03-18
21320 HCPCS Closed Treatment Of Broken Nose Bone With Placement Of Stabilizing Device 44 28 $4,587.00 $3,669.60 20% off $69.95 $4,587.00 $2,614.59 2026-03-18
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 68 28 $1,454.00 $1,163.20 $207.90 $4,653.00 $1,039.50 2026-03-18
24301 HCPCS Relocation Of Muscle Or Tendon Of Upper Arm Or Elbow 28 28 $978.00 $782.40 20% off $146.70 $7,837.37 $710.03 2026-03-18
24605 HCPCS Repair Of Dislocated Elbow Under Anesthesia 44 28 $3,637.00 $2,909.60 20% off $398.72 $3,637.00 $2,073.09 2026-03-18
25565 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation 28 28 $939.00 $751.20 $140.85 $1,477.51 $681.71 2026-03-18
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 28 28 $1,061.00 $848.80 20% off $159.15 $1,477.51 $770.29 2026-03-18
26115 HCPCS Removal (less Than 1.5 Centimeters) Tissue Beneath The Skin Growth Of Hand Or Fi… 28 28 $982.00 $785.60 20% off $147.30 $4,880.25 $712.93 2026-03-18
26160 HCPCS Removal Of Growth Of Tendon Finger Or Hand 28 28 $951.00 $760.80 20% off $142.65 $4,442.65 $690.42 2026-03-18
26350 HCPCS Repair Of Finger Tendon Of Under Side Of Hand Other Than Upper Most Part Of Palm… 28 28 $1,209.00 $967.20 $181.35 $4,442.65 $877.74 2026-03-18
26410 HCPCS Repair Of Tendon On Top Of Hand 28 28 $966.00 $772.80 20% off $144.90 $4,442.65 $701.32 2026-03-18
27372 HCPCS Removal Of Foreign Body Deep In Tissue Of Thigh Or Knee 28 28 $1,115.00 $892.00 20% off $167.25 $4,880.25 $809.50 2026-03-18
27752 HCPCS Closed Treatment Of Middle Part Of Broken Shin Bone With Manipulation 28 28 $971.00 $776.80 20% off $145.65 $1,477.51 $704.94 2026-03-18
27786 HCPCS Closed Treatment Of Broken Outside Lower Leg Bone At Ankle 52 28 $883.00 $706.40 20% off $132.45 $1,477.51 $662.52 2026-03-18
28820 HCPCS Amputation Of Toe At Joint Between Forefoot And Toes 28 28 $1,122.00 $897.60 20% off $168.30 $5,815.26 $814.57 2026-03-18
291 MS_DRG Heart Failure And Shock With Mcc 14 14 $6,470.50 $5,176.40 20% off $3,959.95 $18,970.50 $6,470.50 2026-03-18
300 MS_DRG Peripheral Vascular Disorders With Cc 16 16 $8,761.80 $7,009.44 20% off $4,936.58 $22,265.80 $7,885.62 2026-03-18
303 MS_DRG Atherosclerosis Without Mcc 12 12 $5,278.00 $4,222.40 20% off $3,230.14 $8,136.97 $4,354.35 2026-03-18
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 12 12 $5,075.00 $4,060.00 20% off $3,105.90 $14,552.75 $5,075.00 2026-03-18
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 12 12 $5,887.00 $4,709.60 $3,264.03 $6,842.45 $4,415.25 2026-03-18
312 MS_DRG Syncope And Collapse 14 14 $6,191.55 $4,953.24 20% off $3,789.23 $16,191.55 $5,572.40 2026-03-18
31500 HCPCS Emergent Insertion Of Breathing Tube Into Windpipe Using An Endoscope 28 28 $927.00 $741.60 20% off $139.05 $2,214.19 $673.00 2026-03-18
32551 HCPCS Removal Of Fluid From Between Lung And Chest Cavity 28 28 $3,473.00 $2,778.40 20% off $520.95 $3,473.00 $2,187.99 2026-03-18
32555 HCPCS Aspiration Of Fluid From Chest Cavity Using Imaging Guidance 28 28 $1,917.00 $1,533.60 20% off $287.55 $1,999.25 $1,337.49 2026-03-18
36430 HCPCS Transfusion Of Blood Or Blood Products 28 28 $965.00 $772.00 20% off $144.75 $2,381.26 $700.60 2026-03-18
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 14 14 $20,889.20 $16,711.36 20% off $4,520.50 $58,389.20 $12,562.51 2026-03-18
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 14 14 $7,548.10 $6,038.48 20% off $3,373.09 $20,048.10 $6,264.41 2026-03-18
44960 HCPCS Removal Of Ruptured Infected Appendix 16 16 $3,263.00 $2,610.40 20% off $695.70 $1,315.83 $811.65 2026-03-18
45307 HCPCS Removal Of Foreign Bodies From Rectum And/or Lower Large Bowel Using A Rigid End… 51 28 $391.00 $312.80 20% off $58.65 $4,269.00 $1,100.00 2026-03-18
45910 HCPCS Dilation Of Narrowing Of Rectum Under Anesthesia 28 28 $926.00 $740.80 20% off $138.90 $4,594.12 $672.28 2026-03-18
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 12 12 $7,752.21 $6,201.77 $4,052.79 $10,039.46 $5,962.44 2026-03-18
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 12 12 $13,650.90 $10,920.72 20% off $8,354.35 $22,541.05 $13,650.90 2026-03-18
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 14 14 $29,030.58 $23,224.46 20% off $6,770.95 $76,530.58 $15,688.94 2026-03-18
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 14 14 $14,607.58 $11,686.06 20% off $4,301.32 $43,407.58 $9,328.29 2026-03-18
58150 HCPCS Removal Of Uterus And Cervix Through Abdomen 16 16 $3,657.00 $2,925.60 20% off $792.43 $1,505.79 $924.50 2026-03-18
592 MS_DRG Skin Ulcers With Mcc 17 17 $22,386.00 $17,908.80 20% off $11,002.65 $66,274.00 $20,147.40 2026-03-18
60004860 OTHER Lchg Respiratory Virus Pnl Pcr 7 2 $1,470.00 $1,176.00 20% off $955.50 $1,433.25 $1,102.50 2026-07-31
60038250 OTHER Lchg Platelet Pheresis 7 2 $1,981.00 $1,584.80 20% off $1,287.65 $1,931.48 $1,485.75 2026-07-31
60038540 OTHER Lchg Platelet Pheresis Lr 7 2 $1,981.00 $1,584.80 20% off $1,287.65 $1,931.48 $1,485.75 2026-07-31
60038850 OTHER Rbc Lr Irrad 7 2 $918.00 $734.40 20% off $596.70 $895.05 $688.50 2026-07-31
603 MS_DRG Cellulitis Without Mcc 12 12 $2,639.20 $2,111.36 $1,615.19 $7,779.75 $2,639.20 2026-03-18
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 13 13 $59,962.40 $47,969.92 20% off $14,513.23 $153,562.40 $24,306.96 2026-03-18
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 13 13 $5,007.00 $4,005.60 20% off $3,064.28 $14,037.16 $5,007.00 2026-03-18
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 16 16 $3,698.20 $2,958.56 20% off $2,263.30 $10,450.20 $4,526.80 2026-03-18
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 14 14 $21,492.05 $17,193.64 20% off $6,176.54 $63,992.05 $12,682.31 2026-03-18
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 12 12 $7,525.76 $6,020.61 $4,605.76 $8,272.34 $5,644.32 2026-03-18
683 MS_DRG Renal Failure With Cc 16 16 $6,386.40 $5,109.12 20% off $3,908.48 $15,501.60 $6,095.51 2026-03-18
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 17 17 $5,139.00 $4,111.20 20% off $3,145.07 $15,267.00 $8,536.33 2026-03-18
69 MS_DRG Transient Ischemia Without Thrombolytic 12 12 $15,254.00 $12,203.20 $4,577.36 $13,728.60 $8,865.42 2026-03-18
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 16 16 $18,522.20 $14,817.76 20% off $3,537.18 $48,906.20 $12,613.62 2026-03-18
70460 HCPCS CT Scan Head Or Brain With Contrast 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $716.31 2026-03-18
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 28 28 $1,508.00 $1,206.40 $181.06 $1,508.00 $950.04 2026-03-18
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 28 28 $1,253.00 $1,002.40 20% off $187.95 $1,253.00 $789.39 2026-03-18
70487 HCPCS CT Scan Of Face With Contrast 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $716.31 2026-03-18
70488 HCPCS CT Scan Of Face Before And After Contrast 28 28 $1,450.00 $1,160.00 20% off $217.50 $1,450.00 $913.50 2026-03-18
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 28 28 $1,253.00 $1,002.40 20% off $187.95 $1,253.00 $789.39 2026-03-18
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $950.04 2026-03-18
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 28 28 $1,389.00 $1,111.20 $208.35 $1,389.00 $875.07 2026-03-18
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 28 28 $1,389.00 $1,111.20 $208.35 $1,389.00 $875.07 2026-03-18
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 28 28 $1,986.00 $1,588.80 20% off $297.90 $1,986.00 $1,305.32 2026-03-18
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,102.37 2026-03-18
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 28 28 $1,898.00 $1,518.40 $284.70 $1,898.00 $1,274.88 2026-03-18
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,537.20 2026-03-18
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,102.37 2026-03-18
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 28 28 $1,898.00 $1,518.40 $284.70 $1,898.00 $1,274.88 2026-03-18
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,537.20 2026-03-18
70551 HCPCS MRI Scan Of Brain Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,040.00 2026-03-18
70552 HCPCS MRI Scan Of Brain With Contrast 28 28 $1,716.00 $1,372.80 20% off $257.40 $1,716.00 $1,084.06 2026-03-18
70553 HCPCS MRI Scan Of Brain Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,537.20 2026-03-18
71260 HCPCS CT Scan Of Chest With Contrast 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $716.31 2026-03-18
71270 HCPCS CT Scan Of Chest Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $1,012.92 2026-03-18
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 28 28 $1,175.00 $940.00 20% off $176.25 $1,175.00 $789.25 2026-03-18
71552 HCPCS MRI Scan Of Chest Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,537.20 2026-03-18
72126 HCPCS CT Scan Of Upper Spine With Contrast 28 28 $1,246.00 $996.80 20% off $186.90 $1,246.00 $784.98 2026-03-18
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $950.04 2026-03-18
72129 HCPCS CT Scan Of Middle Spine With Contrast 28 28 $1,246.00 $996.80 20% off $186.90 $1,246.00 $784.98 2026-03-18
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 28 28 $1,509.00 $1,207.20 20% off $226.35 $1,509.00 $950.67 2026-03-18
72132 HCPCS CT Scan Of Lower Spine With Contrast 28 28 $1,287.00 $1,029.60 20% off $193.05 $1,287.00 $810.81 2026-03-18
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $950.04 2026-03-18
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $995.40 2026-03-18
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 28 28 $1,716.00 $1,372.80 20% off $257.40 $1,716.00 $1,081.08 2026-03-18
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $995.40 2026-03-18
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 28 28 $1,716.00 $1,372.80 20% off $257.40 $1,716.00 $1,081.08 2026-03-18
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $995.40 2026-03-18
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 28 28 $1,209.00 $967.20 $181.35 $1,209.00 $761.67 2026-03-18
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $362.73 $2,440.00 $1,537.20 2026-03-18
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 28 28 $2,323.00 $1,858.40 $348.45 $2,323.00 $1,463.49 2026-03-18
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $362.73 $2,440.00 $1,537.20 2026-03-18
72193 HCPCS CT Scan Of Pelvis With Contrast 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $753.56 2026-03-18
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $950.04 2026-03-18
72195 HCPCS MRI Scan Of Pelvis Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,102.37 2026-03-18
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,537.20 2026-03-18
73218 HCPCS MRI Scan Of Arm Without Contrast 28 28 $1,519.00 $1,215.20 20% off $227.85 $1,519.00 $1,059.80 2026-03-18
73220 HCPCS MRI Scan Of Arm Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,537.20 2026-03-18
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $995.40 2026-03-18
73222 HCPCS MRI Scan Of Arm Joint With Contrast 28 28 $1,860.00 $1,488.00 20% off $279.00 $1,860.00 $1,171.80 2026-03-18
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 28 28 $1,986.00 $1,588.80 20% off $297.90 $1,986.00 $1,251.18 2026-03-18
73701 HCPCS CT Scan Of Leg With Contrast Material 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $716.31 2026-03-18
73702 HCPCS CT Scan Of Leg Before And After Contrast 28 28 $1,128.00 $902.40 20% off $169.20 $1,128.00 $710.64 2026-03-18
73718 HCPCS MRI Scan Of Leg Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,106.00 2026-03-18
73719 HCPCS MRI Scan Of Leg With Contrast 28 28 $1,716.00 $1,372.80 20% off $257.40 $1,716.00 $1,197.26 2026-03-18
73720 HCPCS MRI Scan Of Leg Before And After Contrast 28 28 $2,323.00 $1,858.40 $348.45 $2,323.00 $1,502.65 2026-03-18
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,061.29 2026-03-18
73722 HCPCS MRI Scan Of Leg Joint With Contrast 28 28 $1,716.00 $1,372.80 20% off $257.40 $1,716.00 $1,152.64 2026-03-18
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 28 28 $2,301.00 $1,840.80 20% off $345.15 $2,301.00 $1,495.53 2026-03-18
74160 HCPCS CT Scan Of Abdomen With Contrast 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $753.56 2026-03-18
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $950.04 2026-03-18
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 28 28 $1,389.00 $1,111.20 $208.35 $1,389.00 $932.99 2026-03-18
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 28 28 $1,304.00 $1,043.20 $195.60 $1,304.00 $821.52 2026-03-18
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $950.04 2026-03-18
74181 HCPCS MRI Scan Of Abdomen Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,114.69 2026-03-18
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,579.92 2026-03-18
800250 OTHER CT Head With Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800251 OTHER CT Head With And Without Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800256 OTHER CT Maxillofacial W Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800258 OTHER CT Maxillofacial W & Wo Contrast 6 2 $1,216.00 $972.80 20% off $300.00 $1,185.60 $916.56 2026-07-31
800260 OTHER CT Soft Tissue Neck With Contrast 6 2 $1,050.00 $840.00 20% off $300.00 $1,023.75 $791.44 2026-07-31
800261 OTHER CT Soft Tissue Neck With And Wo Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800267 OTHER CT Chest With Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800268 OTHER CT Chest With And Without Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800271 OTHER CT Cervical Spine With Contrast 6 2 $1,045.00 $836.00 20% off $300.00 $1,018.88 $787.67 2026-07-31
800272 OTHER CT Cervical Spine With And Wo Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800275 OTHER CT Thoracic Spine With Contrast 6 2 $1,045.00 $836.00 20% off $300.00 $1,018.88 $787.67 2026-07-31
800276 OTHER CT Thoracic Spine With And Wo Contrast 6 2 $1,266.00 $1,012.80 20% off $300.00 $1,234.35 $954.25 2026-07-31
800278 OTHER CT Lumbar Spine With Contrast 6 2 $1,080.00 $864.00 20% off $300.00 $1,053.00 $814.05 2026-07-31
800279 OTHER CT Lumbar Spine With And Without Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800282 OTHER CT Pelvis With IV Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800283 OTHER CT Pelvis With And Without IV Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800296 OTHER CT Lower Extremity With Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800298 OTHER CT Lower Extremity W And Wo Contrast 6 2 $946.00 $756.80 20% off $300.00 $922.35 $713.05 2026-07-31
800303 OTHER CT Abdomen With IV Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800304 OTHER CT Abdomen With And Without IV Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800325 OTHER MRI Orbit Face Neck With And Wo Contrast 6 2 $1,665.00 $1,332.00 20% off $410.00 $1,623.38 $1,254.99 2026-07-31
800326 OTHER MRA Angio Head Non Contrast 7 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $993.75 2026-07-31
800327 OTHER MRA Angio Head With Contrast 7 2 $1,592.00 $1,273.60 20% off $410.00 $1,552.20 $1,194.00 2026-07-31
800328 OTHER MRA Angio Head With And Without Contrast 7 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,535.25 2026-07-31
800329 OTHER MRA Angio Neck Non Contrast 7 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $993.75 2026-07-31
800330 OTHER MRA Angio Neck With Contrast 7 2 $1,592.00 $1,273.60 20% off $410.00 $1,552.20 $1,194.00 2026-07-31
800331 OTHER MRA Angio Neck With And Without Contrast 7 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,535.25 2026-07-31
800332 OTHER MRI Brain Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800334 OTHER MRI Brain With Contrast 6 2 $1,439.00 $1,151.20 $410.00 $1,403.03 $1,084.64 2026-07-31
800335 OTHER MRI Brain With And Without Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800338 OTHER MRI Chest With And Without Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800340 OTHER MRI Spine Cervical Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800342 OTHER MRI Spine Cervical With Contrast 6 2 $1,439.00 $1,151.20 $410.00 $1,403.03 $1,084.64 2026-07-31
800343 OTHER MRI Spine Thoracic Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800344 OTHER MRI Spine Thoracic With Contrast 6 2 $1,439.00 $1,151.20 $410.00 $1,403.03 $1,084.64 2026-07-31
800345 OTHER MRI Spine Lumbar Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800346 OTHER MRI Spine Lumbar With Contrast 6 2 $1,014.00 $811.20 $410.00 $988.65 $764.31 2026-07-31
800347 OTHER MRI Spine Cervical With And Wo Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800348 OTHER MRI Spine Thoracic With And Wo Contrast 6 2 $1,949.00 $1,559.20 20% off $410.00 $1,900.28 $1,469.06 2026-07-31
800349 OTHER MRI Spine Lumbar With And Without Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800351 OTHER MRI Pelvis Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800353 OTHER MRI Pelvis With And Without Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800355 OTHER MRI Upper Ext Non Joint Non Contrast 6 2 $1,274.00 $1,019.20 $410.00 $1,242.15 $960.28 2026-07-31
800359 OTHER MRI Upper Ext Non Jnt W And Wo Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800361 OTHER MRI Upper Ext Any Joint Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800365 OTHER MRI Upper Ext Any Joint With Contrast 6 2 $1,560.00 $1,248.00 20% off $410.00 $1,521.00 $1,175.85 2026-07-31
800367 OTHER MRI Upper Ext Any Jnt W And Wo Contrast 6 2 $1,665.00 $1,332.00 20% off $410.00 $1,623.38 $1,254.99 2026-07-31
800370 OTHER MRI Lower Ext Non Joint Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800375 OTHER MRI Lower Ext Non Jnt W And Wo Contrast 6 2 $1,949.00 $1,559.20 20% off $410.00 $1,900.28 $1,469.06 2026-07-31
800377 OTHER MRI Lower Ext Any Joint Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800379 OTHER MRI Lower Ext Any Joint With Contrast 6 2 $1,439.00 $1,151.20 $410.00 $1,403.03 $1,084.64 2026-07-31
800381 OTHER MRI Lower Ext Any Jnt W And Wo Contrast 6 2 $1,930.00 $1,544.00 20% off $410.00 $1,881.75 $1,454.74 2026-07-31
800384 OTHER MRI Abdomen Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800387 OTHER MRI Abdomen With And Without Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800794 OTHER CT Abdomen Pelvis Wwo Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800803 OTHER CT Abdomen Pelvis W Contrast 6 2 $1,094.00 $875.20 $300.00 $1,066.65 $824.61 2026-07-31
801402 OTHER CT Angio Chest W/wo Contrast 6 2 $985.00 $788.00 20% off $300.00 $960.38 $742.44 2026-07-31
801523 OTHER MRI MRA Abd Without Fol W/contrast 7 2 $2,049.00 $1,639.20 20% off $1,331.85 $1,997.78 $1,536.75 2026-07-31
801531 OTHER MRI MRA Chest Without Fol W/contrast 7 2 $2,047.00 $1,637.60 20% off $1,330.55 $1,995.83 $1,535.25 2026-07-31
802888 OTHER US Art Doppler Abd Pelv Retrop 7 2 $1,222.00 $977.60 20% off $794.30 $1,191.45 $916.50 2026-07-31
803043 OTHER MRI Lower Ext Non Joint With Contrast 6 2 $1,439.00 $1,151.20 $410.00 $1,403.03 $1,084.64 2026-07-31
8100997 OTHER Ed Proctosigmoidscpy Remvl Foreign Body 5 2 $3,581.00 $2,864.80 $2,685.75 $3,491.48 $2,712.61 2026-07-31
8101013 CDM Specialty Services - Treatment Room 22 22 $1,005.00 $804.00 20% off $150.75 $904.50 $676.07 2026-03-18
8101015 CDM Specialty Services - Treatment Room 22 22 $1,476.00 $1,180.80 20% off $221.40 $1,328.40 $992.90 2026-03-18
8101015 OTHER Or Proc Room Level 3 7 2 $1,238.00 $990.40 20% off $804.70 $1,207.05 $928.50 2026-07-31
8101017 CDM Specialty Services - Treatment Room 22 22 $3,620.00 $2,896.00 20% off $543.00 $3,258.00 $2,349.38 2026-03-18
8101017 OTHER Or Proc Room Level 4 7 2 $3,037.00 $2,429.60 20% off $1,974.05 $2,961.08 $2,277.75 2026-07-31
8101515 CDM Specialty Services - Treatment Room 22 22 $4,695.00 $3,756.00 20% off $704.25 $4,225.50 $3,021.18 2026-03-18
8101515 OTHER Or Proc Room Level 5 7 2 $3,937.00 $3,149.60 20% off $2,559.05 $3,838.58 $2,952.75 2026-07-31
810713 CDM Gastro - Intestinal (gi) Services - General Classification 22 22 $2,415.00 $1,932.00 20% off $362.25 $2,173.50 $1,567.34 2026-03-18
810713 OTHER Endoscopy Services 1 7 2 $2,025.00 $1,620.00 20% off $1,316.25 $1,974.38 $1,518.75 2026-07-31
810714 CDM Gastro - Intestinal (gi) Services - General Classification 22 22 $3,219.00 $2,575.20 20% off $482.85 $3,000.00 $2,089.13 2026-03-18
810714 OTHER Endoscopy Services 2 7 2 $2,700.00 $2,160.00 20% off $1,755.00 $2,632.50 $2,025.00 2026-07-31
810715 CDM Gastro - Intestinal (gi) Services - General Classification 22 22 $4,025.00 $3,220.00 20% off $603.75 $3,622.50 $2,612.22 2026-03-18
810715 OTHER Endoscopy Services 3 7 2 $3,375.00 $2,700.00 20% off $2,193.75 $3,290.63 $2,531.25 2026-07-31
811302 OTHER Polysomn 4 Or More >=6yrs 7 2 $1,913.00 $1,530.40 $1,243.45 $1,865.18 $1,434.75 2026-07-31
811303 OTHER Polysomn W/cpap >=6yrs 7 2 $1,998.00 $1,598.40 $1,298.70 $1,948.05 $1,498.50 2026-07-31
811350 OTHER Duplex Artery Or Bypass Le Bilat 7 2 $963.00 $770.40 20% off $625.95 $938.93 $722.25 2026-07-31
812669 CDM Room & Board - Other - Sterile Environment 8 8 $1,206.00 $964.80 20% off $738.07 $1,089.02 $1,085.40 2026-03-18
812669 OTHER Med/surg Unit-isolation Med/justi 1 1 $1,012.00 $809.60 20% off $759.00 $759.00 $759.00 2026-07-31
812798 OTHER Tte 2d Wo Con W Doppler And Color Cmpl 7 2 $1,638.00 $1,310.40 $1,064.70 $1,597.05 $1,228.50 2026-07-31
814457 CDM Room & Board - Semi-private (two Beds) - General Classification 8 8 $739.00 $591.20 $452.27 $667.32 $665.10 2026-03-18
814735 CDM Room & Board - Private (one Bed) - Medical/surgical/gyn 8 8 $873.00 $698.40 20% off $534.28 $788.32 $785.70 2026-03-18
814747 CDM Intensive Care Unit - General Classification 8 8 $1,240.00 $992.00 20% off $758.88 $1,119.72 $1,116.00 2026-03-18
814747 OTHER Rb ICU Medical 1 1 $1,040.00 $832.00 20% off $780.00 $780.00 $780.00 2026-07-31
816100 CDM Room & Board - Semi-private (two Beds) - Medical/surgical/gyn 8 8 $838.00 $670.40 20% off $512.86 $756.71 $754.20 2026-03-18
816129 OTHER I&d Hematoma Seroma Fluid 5 2 $3,031.00 $2,424.80 $2,273.25 $2,955.23 $2,295.98 2026-07-31
816147 OTHER Critical Care Addl 30 Min 5 2 $948.00 $758.40 20% off $711.00 $924.30 $718.11 2026-07-31
816148 OTHER Critical Care E/m 30-74 Min 5 2 $1,897.00 $1,517.60 20% off $1,422.75 $1,849.58 $1,436.98 2026-07-31
816178 OTHER Rpr Face/nk/hd/ft Cmplx 2.6-7.5 Cm 5 2 $1,091.00 $872.80 20% off $818.25 $1,063.73 $826.43 2026-07-31
816182 OTHER Rpr Sclp Extrm Cmplx 1.1-2.5 Cm 5 2 $1,144.00 $915.20 $858.00 $1,115.40 $866.58 2026-07-31
816183 OTHER Rpr Sclp Extrm Cmplx 2.6-7.5 Cm 5 2 $1,144.00 $915.20 $858.00 $1,115.40 $866.58 2026-07-31
816193 OTHER Rpr Trunk Cmplx 1.1-2.5 Cm 5 2 $1,144.00 $915.20 $858.00 $1,115.40 $866.58 2026-07-31
816218 OTHER Tx Fx Nasal Clsd Wo Stabilization 5 2 $3,848.00 $3,078.40 20% off $2,886.00 $3,751.80 $2,914.86 2026-07-31
816292 OTHER Ed Wnd Rpr Complex Trunk 2.6-7.5cm 5 2 $1,144.00 $915.20 $858.00 $1,115.40 $866.58 2026-07-31
816325 OTHER Inj Aa Strd Peripheral Nerve 5 2 $1,248.00 $998.40 20% off $936.00 $1,216.80 $945.36 2026-07-31
816358 OTHER Tx Disloc Shldr Clsd W Manip W Anes 5 2 $3,902.00 $3,121.60 20% off $2,926.50 $3,804.45 $2,955.77 2026-07-31
816424 OTHER Rmv Fecal Impaction/fb Spx Under Anes 5 2 $3,944.00 $3,155.20 20% off $2,958.00 $3,845.40 $2,987.58 2026-07-31
816802 OTHER App Skin Sub High T/a/l <100cm 1st 25cm 7 2 $2,704.00 $2,163.20 20% off $1,757.60 $2,636.40 $2,028.00 2026-07-31
816882 OTHER Tx Fx Nasal Clsd W/stabilization 5 2 $3,848.00 $3,078.40 20% off $2,886.00 $3,751.80 $2,914.86 2026-07-31
816894 OTHER Tx Fx Elbow Disl Clsd W Ans 5 2 $3,050.00 $2,440.00 20% off $2,287.50 $2,973.75 $2,310.38 2026-07-31
832093 OTHER Exc Skin Subq Tissue 14 2 $3,576.00 $2,860.80 $1,158.88 $1,504.40 $1,378.64 2026-07-31
832643 OTHER Appendectomy 14 2 $2,108.00 $1,686.40 $643.94 $835.94 $766.06 2026-07-31
832645 OTHER Appendectomy Ruptured W Infection 14 2 $2,737.00 $2,189.60 20% off $876.90 $1,138.35 $1,043.19 2026-07-31
833282 OTHER Hysterectomy Total Abdominal 14 2 $3,067.00 $2,453.60 20% off $1,009.23 $1,310.13 $1,200.61 2026-07-31
833717 OTHER Mastectomy Smpl Compl 14 2 $3,158.00 $2,526.40 20% off $959.08 $1,303.43 $1,194.47 2026-07-31
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 16 16 $10,197.93 $8,158.35 $6,241.14 $27,077.93 $11,734.56 2026-03-18
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 15 15 $3,558.80 $2,847.04 20% off $2,177.99 $10,310.80 $3,558.80 2026-03-18
87507 HCPCS Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S… 28 28 $2,258.00 $1,806.40 $62.82 $2,258.00 $1,483.85 2026-03-18
87633 HCPCS Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 52 28 $1,754.00 $1,403.20 20% off $62.82 $1,754.00 $1,073.21 2026-03-18
884 MS_DRG Organic Disturbances And Intellectual Disability 10 10 $5,443.00 $4,354.40 20% off $3,331.12 $14,372.30 $5,170.85 2026-03-18
90380 HCPCS Respiratory Syncytial Virus Antibody, 0.5 Ml Dosage For Injection Into Muscle 24 24 $970.00 $776.00 20% off $145.50 $970.00 $679.00 2026-03-18
90381 HCPCS Respiratory Syncytial Virus Antibody, 1.0 Ml Dosage For Injection Into Muscle 24 24 $970.00 $776.00 20% off $145.50 $970.00 $679.00 2026-03-18
93 MS_DRG Other Disorders Of Nervous System Without Cc/mcc 14 14 $12,432.70 $9,946.16 20% off $4,172.08 $34,932.70 $8,846.82 2026-03-18
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 28 28 $1,953.00 $1,562.40 $292.95 $1,953.00 $1,313.78 2026-03-18
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 28 28 $1,149.00 $919.20 $172.35 $1,149.00 $772.93 2026-03-18
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 28 28 $1,457.00 $1,165.60 20% off $171.28 $1,457.00 $980.12 2026-03-18
948 MS_DRG Signs And Symptoms Without Mcc 12 12 $4,657.75 $3,726.20 20% off $2,850.54 $9,675.64 $4,301.75 2026-03-18
949 MS_DRG Aftercare With Cc/mcc 14 14 $21,193.80 $16,955.04 $8,334.15 $58,693.80 $13,675.26 2026-03-18
950 MS_DRG Aftercare Without Cc/mcc 13 13 $4,656.15 $3,724.92 $2,849.56 $11,856.15 $4,656.15 2026-03-18
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 28 28 $2,281.00 $1,824.80 20% off $342.15 $2,281.00 $1,591.45 2026-03-18
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 28 28 $2,382.00 $1,905.60 20% off $357.30 $2,382.00 $1,661.92 2026-03-18
97610 HCPCS Therapy Procedure Using Ultrasound 28 28 $1,223.00 $978.40 20% off $183.45 $1,223.00 $822.71 2026-03-18
99291 HCPCS Critical Care, First 30-74 Minutes 24 24 $2,263.00 $1,810.40 $339.45 $2,263.00 $1,522.32 2026-03-18
99292 HCPCS Critical Care, Each Additional 30 Minutes 24 24 $1,130.00 $904.00 20% off $169.50 $1,130.00 $788.40 2026-03-18
C8902 HCPCS Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Abdom… 28 28 $2,443.00 $1,954.40 $366.45 $2,601.24 $1,723.53 2026-03-18
C8911 HCPCS Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Chest… 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,446.15 $1,721.42 2026-03-18
ERX119489 CDM Wixela 250-50 Inhub 22 22 $1,482.03 $1,185.62 20% off $222.30 $1,333.83 $996.96 2026-03-18
ERX119493 CDM Wixela 100-50 Inhub 22 22 $1,192.76 $954.21 $178.91 $1,073.48 $802.37 2026-03-18
ERX133412 CDM Combivent Respimat 20-100 Mcg 22 22 $1,995.91 $1,596.73 $299.39 $1,796.32 $1,342.65 2026-03-18
ERX143896 CDM Pb-hyoscy-atropine-scopolamine 16.2 Mg/5ml Po Elix 22 22 $3,416.69 $2,733.35 20% off $512.50 $3,075.02 $2,217.43 2026-03-18
ERX158214 CDM Trelegy Ellipta 100-62.5-25 22 22 $1,250.18 $1,000.14 20% off $187.53 $1,125.16 $841.00 2026-03-18
ERX80581 CDM Budesonide 180 Mcg/act In Aepb 22 22 $1,047.82 $838.26 $157.17 $943.04 $704.87 2026-03-18
ERX82602 CDM Budesonide-formoterol 160-4.5 22 22 $1,329.78 $1,063.82 20% off $199.47 $1,196.80 $894.55 2026-03-18
ERX9682 CDM Santyl Ointment 22 22 $1,257.21 $1,005.77 $188.58 $1,131.49 $845.73 2026-03-18
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 28 28 $6,138.00 $4,910.40 20% off $20.53 $6,138.00 $3,866.94 2026-03-18
J0174 HCPCS Injection, Lecanemab-irmb, 1 Mg 24 24 $1,044.82 $835.86 $156.72 $1,044.82 $731.37 2026-03-18
J0248 HCPCS Injection, Remdesivir, 1 Mg 24 24 $2,059.20 $1,647.36 20% off $308.88 $2,059.20 $1,441.44 2026-03-18
J0517 HCPCS Injection, Benralizumab, 1 Mg 28 28 $23,154.32 $18,523.46 $93.33 $23,154.32 $14,587.22 2026-03-18
J0561 HCPCS Injection, Penicillin G Benzathine, 100,000 Units 76 28 $1,461.39 $1,169.11 20% off $2.85 $2,994.62 $948.44 2026-03-18
J0585 HCPCS Injection, Onabotulinumtoxina, 1 Unit 28 28 $2,577.96 $2,062.37 $9.95 $2,577.96 $1,673.10 2026-03-18
J0712 HCPCS Injection, Ceftaroline Fosamil, 10 Mg 28 28 $1,019.55 $815.64 20% off $0.94 $1,019.55 $685.86 2026-03-18
J0840 HCPCS Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 28 28 $5,756.40 $4,605.12 $863.46 $5,756.40 $3,626.53 2026-03-18
J1437 HCPCS Injection, Ferric Derisomaltose, 10 Mg 28 28 $14,462.65 $11,570.12 $9.95 $14,462.65 $9,111.47 2026-03-18
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 28 28 $6,378.13 $5,102.50 20% off $0.94 $6,378.13 $4,018.22 2026-03-18
J1442 HCPCS Injection, Filgrastim (g-csf), Excludes Biosimilars, 1 Microgram 52 28 $1,246.74 $997.39 20% off $0.94 $2,481.60 $1,184.40 2026-03-18
J1568 HCPCS Injection, Immune Globulin, (octagam), Intravenous, Non-lyophilized (e.g., Liqui… 28 28 $7,692.30 $6,153.84 20% off $20.53 $7,692.30 $4,846.15 2026-03-18
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 24 24 $2,570.70 $2,056.56 $385.61 $2,570.70 $1,793.58 2026-03-18
J2356 HCPCS Injection, Tezepelumab-ekko, 1 Mg 24 24 $17,301.08 $13,840.86 20% off $1,500.00 $17,301.08 $11,638.44 2026-03-18
J2357 HCPCS Injection, Omalizumab, 5 Mg 28 28 $5,832.13 $4,665.70 20% off $20.53 $5,832.13 $3,674.24 2026-03-18
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 24 24 $7,209.00 $5,767.20 20% off $1,081.35 $7,209.00 $4,849.50 2026-03-18
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 52 28 $733.26 $586.61 $46.66 $34,849.42 $733.26 2026-03-18
J3032 HCPCS Injection, Eptinezumab-jjmr, 1 Mg 28 28 $7,682.67 $6,146.14 $9.95 $7,682.67 $4,840.08 2026-03-18
J3101 HCPCS Injection, Tenecteplase, 1 Mg 28 28 $32,857.15 $26,285.72 20% off $93.33 $32,857.15 $20,700.01 2026-03-18
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 28 28 $37,065.24 $29,652.19 20% off $9.95 $37,065.24 $23,351.10 2026-03-18
J3489 HCPCS Injection, Zoledronic Acid, 1 Mg 28 28 $1,386.00 $1,108.80 20% off $9.95 $1,386.00 $932.36 2026-03-18
J7307 HCPCS Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 28 28 $1,600.00 $1,280.00 20% off $240.00 $1,600.00 $1,040.00 2026-03-18
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 28 28 $1,011.00 $808.80 20% off $151.65 $2,381.26 $733.99 2026-03-18
P9034 HCPCS Platelets, Pheresis, Each Unit 28 28 $2,361.00 $1,888.80 20% off $354.15 $2,381.26 $1,665.68 2026-03-18
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 28 28 $2,361.00 $1,888.80 20% off $354.15 $2,381.26 $1,665.68 2026-03-18
P9040 HCPCS Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit 28 28 $1,095.00 $876.00 20% off $164.25 $2,381.26 $794.97 2026-03-18
Q0138 HCPCS Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd … 28 28 $4,726.71 $3,781.37 $0.94 $4,726.71 $3,031.45 2026-03-18
Q0249 HCPCS Injection, Tocilizumab, For Hospitalized Adults And Pediatric Patients (2 Years … 28 28 $2,103.40 $1,682.72 20% off $4.36 $2,103.40 $1,414.95 2026-03-18
Q4081 HCPCS Injection, Epoetin Alfa, 100 Units (for Esrd On Dialysis) 52 28 $4,233.24 $3,386.59 20% off $0.94 $4,233.24 $1,005.39 2026-03-18
See an error in this hospital's data? Submit a correction