Hospital

SAINT ALPHONSUS MEDICAL CENTER ONTARIO

Ontario, OR · CCN 380052 · Rates published

15,677 distinct procedures filed

58 distinct payers

2,457,258 rate rows

2025-01-01 last MRF observed · ⚠ 19 mo old

Data quality

2,288,216 of 2,457,258 rate rows are consumer-grade (93.1%)

169,042 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 — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	82,330
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	69,430
template filing: same amount across many unrelated codes — excluded	12,086
percent-of-charges filed in the dollar field — excluded from medians	2,300
exceeds 10× this hospital's gross charge — excluded from medians	2,178
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	570
per-diem day rate — not a per-procedure price	120
placeholder amount (≤ $0.02) — excluded from medians	28

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 19 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://trinityhealth.pt.panaceainc.com/MRFDownload/trinityhealth/saintalphonsusmedical-ontario
Found on page	https://www.saintalphonsus.org/for-patients/before-your-visit/price-estimator
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-08-18
Content fingerprint	c59279f6ab3e1a84… · 18,240,428 bytes · first seen 2026-05-09

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
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell Immunotherapy	11	$284,173.96	$685,569.68	$473,257.46	nat. median $370,165 1.3× median
J2326 HCPCS	Inj Nusinersen 0.1mg	58	$350.00	$661,923.89	$368,195.17	nat. median $2,353 outlier · 156.5×
1 MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	11	$209,077.39	$504,399.21	$348,130.54	nat. median $261,939 1.3× median
927 MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	11	$203,375.07	$490,642.36	$338,629.26	nat. median $205,166 1.7× median
'583-4 OTHER	Neonate, Transferred < 5 Days Old, Born Here	1	$296,334.89	$296,334.89	$296,334.89	nat. median $221,551 1.3× median
'002-4 OTHER	Heart And/or Lung Transplant	1	$295,762.07	$295,762.07	$295,762.07	nat. median $205,014 1.4× median
3 MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	11	$164,544.75	$396,964.21	$273,929.65	nat. median $199,832 1.4× median
'583-3 OTHER	Neonate, Transferred < 5 Days Old, Born Here	1	$248,452.48	$248,452.48	$248,452.48	nat. median $195,630 1.3× median
'588-4 OTHER	Neonate With Ecmo	1	$219,820.51	$219,820.51	$219,820.51	nat. median $202,324 1.1× median
'161-4 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	1	$208,852.94	$208,852.94	$208,852.94	nat. median $182,608 1.1× median
'001-4 OTHER	Liver Transplant And/or Intestinal Transplant	1	$191,632.02	$191,632.02	$191,632.02	nat. median $107,546 1.8× median
4 MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	11	$113,522.93	$273,874.06	$188,916.39	nat. median $132,706 1.4× median
'006-4 OTHER	Pancreas Transplant	1	$177,975.86	$177,975.86	$177,975.86	nat. median $56,683 outlier · 3.1×
'002-3 OTHER	Heart And/or Lung Transplant	1	$169,280.32	$169,280.32	$169,280.32	nat. median $89,928 1.9× median
7 MS_DRG	Lung Transplant	11	$94,767.47	$228,626.53	$157,665.79	nat. median $122,690 1.3× median
2 MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	11	$94,595.61	$228,211.90	$157,379.43	nat. median $108,240 1.5× median
'161-3 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	1	$155,855.91	$155,855.91	$155,855.91	nat. median $114,612 1.4× median
14 MS_DRG	Allogeneic Bone Marrow Transplant	11	$88,559.58	$213,650.00	$147,322.12	nat. median $114,305 1.3× median
'841-4 OTHER	Intentional Self-harm And Attempted Suicide	1	$147,132.67	$147,132.67	$147,132.67	nat. median $138,284 1.1× median
'591-4 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	1	$145,029.99	$145,029.99	$145,029.99	nat. median $119,104 1.2× median
'630-4 OTHER	Neonate Birth Weight 2000-2499 Grams, Normal Newborn Or Neonate With Other Probl…	1	$140,427.39	$140,427.39	$140,427.39	nat. median $127,072 1.1× median
J1747 HCPCS	Injection Spesolimab-sbzo 1 Mg	58	$18.05	$250,347.17	$139,255.61	nat. median $92 outlier · 1518.2×
212 MS_DRG	Concomitant Aortic And Mitral Valve Procedures	11	$83,240.30	$200,817.21	$138,459.05	nat. median $100,978 1.4× median
'593-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	$136,981.20	$136,981.20	$136,981.20	nat. median $115,906 1.2× median
'007-4 OTHER	Allogeneic Bone Marrow Transplant	1	$135,603.03	$135,603.03	$135,603.03	nat. median $131,941 1.0× median
'002-2 OTHER	Heart And/or Lung Transplant	1	$133,743.67	$133,743.67	$133,743.67	nat. median $76,713 1.7× median
5 MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	11	$79,998.02	$192,995.21	$133,056.73	nat. median $99,646 1.3× median
'588-3 OTHER	Neonate With Ecmo	1	$132,872.11	$132,872.11	$132,872.11	nat. median $131,074 1.0× median
'609-4 OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	1	$132,860.57	$132,860.57	$132,860.57	nat. median $130,670 1.0× median
215 MS_DRG	Other Heart Assist System Implant	11	$78,956.05	$190,481.47	$131,320.58	nat. median $98,002 1.3× median
'004-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	$130,238.20	$130,238.20	$130,238.20	nat. median $101,809 1.3× median
'009-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	1	$128,069.32	$128,069.32	$128,069.32	nat. median $89,522 1.4× median
'583-2 OTHER	Neonate, Transferred < 5 Days Old, Born Here	1	$126,206.11	$126,206.11	$126,206.11	nat. median $119,004 1.1× median
216 MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	11	$75,029.39	$181,008.41	$124,777.93	nat. median $92,900 1.3× median
'583-1 OTHER	Neonate, Transferred < 5 Days Old, Born Here	1	$123,161.82	$123,161.82	$123,161.82	nat. median $105,798 1.2× median
'631-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	$120,261.51	$120,261.51	$120,261.51	nat. median $112,354 1.1× median
'002-1 OTHER	Heart And/or Lung Transplant	1	$115,812.12	$115,812.12	$115,812.12	nat. median $74,149 1.6× median
453 MS_DRG	Combined Anterior/posterior Spinal Fusion W Mcc	11	$68,525.56	$165,317.91	$113,941.16	nat. median $83,623 1.4× median
'006-3 OTHER	Pancreas Transplant	1	$113,650.93	$113,650.93	$113,650.93	nat. median $47,889 outlier · 2.4×
'440-4 OTHER	Thyroid Disorders	1	$109,644.24	$109,644.24	$109,644.24	nat. median $63,941 1.7× median
20 MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	11	$65,373.45	$157,713.44	$108,689.07	nat. median $77,385 1.4× median
456 MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	11	$65,196.19	$157,285.81	$108,393.72	nat. median $80,459 1.3× median
'603-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	$108,271.47	$108,271.47	$108,271.47	nat. median $102,933 1.1× median
'001-3 OTHER	Liver Transplant And/or Intestinal Transplant	1	$107,078.85	$107,078.85	$107,078.85	nat. median $53,356 outlier · 2.0×
231 MS_DRG	Coronary Bypass With Ptca With Mcc	11	$62,774.69	$151,443.93	$104,358.98	nat. median $79,040 1.3× median
'602-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	$103,358.57	$103,358.57	$103,358.57	nat. median $66,108 1.6× median
19 MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	11	$61,836.77	$149,181.20	$102,796.20	nat. median $69,153 1.5× median
'006-2 OTHER	Pancreas Transplant	1	$102,323.03	$102,323.03	$102,323.03	nat. median $35,674 outlier · 2.9×
C9098 HCPCS	Ciltacabtagene Car Pos T	1	$102,175.83	$102,175.83	$102,175.83	nat. median $30,221 outlier · 3.4×
C9081 HCPCS	Idecabtagene Car Pos T	1	$102,175.83	$102,175.83	$102,175.83	nat. median $27,427 outlier · 3.7×

Other procedures at this hospital

Browse this hospital's 15,677 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

18	MS_DRG	Chimeric Antigen Receptor (car) T-cell Immunotherapy	24	11	—	—	$284,173.96	$685,569.68	$473,257.46	2025-01-01
J2326	HCPCS	Inj Nusinersen 0.1mg	160	58	$413,702.43	$289,591.70 30% off	$350.00	$661,923.89	$368,195.17	2025-01-01
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	24	11	—	—	$209,077.39	$504,399.21	$348,130.54	2025-01-01
927	MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	24	11	—	—	$203,375.07	$490,642.36	$338,629.26	2025-01-01
'583-4	OTHER	Neonate, Transferred < 5 Days Old, Born Here	2	1	—	—	$296,334.89	$296,334.89	$296,334.89	2025-01-01
'002-4	OTHER	Heart And/or Lung Transplant	2	1	—	—	$295,762.07	$295,762.07	$295,762.07	2025-01-01
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	24	11	—	—	$164,544.75	$396,964.21	$273,929.65	2025-01-01
'583-3	OTHER	Neonate, Transferred < 5 Days Old, Born Here	2	1	—	—	$248,452.48	$248,452.48	$248,452.48	2025-01-01
'588-4	OTHER	Neonate With Ecmo	2	1	—	—	$219,820.51	$219,820.51	$219,820.51	2025-01-01
'161-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	2	1	—	—	$208,852.94	$208,852.94	$208,852.94	2025-01-01
'001-4	OTHER	Liver Transplant And/or Intestinal Transplant	2	1	—	—	$191,632.02	$191,632.02	$191,632.02	2025-01-01
4	MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	24	11	—	—	$113,522.93	$273,874.06	$188,916.39	2025-01-01
'006-4	OTHER	Pancreas Transplant	2	1	—	—	$177,975.86	$177,975.86	$177,975.86	2025-01-01
'002-3	OTHER	Heart And/or Lung Transplant	2	1	—	—	$169,280.32	$169,280.32	$169,280.32	2025-01-01
7	MS_DRG	Lung Transplant	24	11	—	—	$94,767.47	$228,626.53	$157,665.79	2025-01-01
2	MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	24	11	—	—	$94,595.61	$228,211.90	$157,379.43	2025-01-01
'161-3	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	2	1	—	—	$155,855.91	$155,855.91	$155,855.91	2025-01-01
14	MS_DRG	Allogeneic Bone Marrow Transplant	24	11	—	—	$88,559.58	$213,650.00	$147,322.12	2025-01-01
'841-4	OTHER	Intentional Self-harm And Attempted Suicide	2	1	—	—	$147,132.67	$147,132.67	$147,132.67	2025-01-01
'591-4	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	2	1	—	—	$145,029.99	$145,029.99	$145,029.99	2025-01-01
'630-4	OTHER	Neonate Birth Weight 2000-2499 Grams, Normal Newborn Or Neonate With Other Probl…	2	1	—	—	$140,427.39	$140,427.39	$140,427.39	2025-01-01
J1747	HCPCS	Injection Spesolimab-sbzo 1 Mg	160	58	$156,466.98	$109,526.89 30% off	$18.05	$250,347.17	$139,255.61	2025-01-01
212	MS_DRG	Concomitant Aortic And Mitral Valve Procedures	24	11	—	—	$83,240.30	$200,817.21	$138,459.05	2025-01-01
'593-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	2	1	—	—	$136,981.20	$136,981.20	$136,981.20	2025-01-01
'007-4	OTHER	Allogeneic Bone Marrow Transplant	2	1	—	—	$135,603.03	$135,603.03	$135,603.03	2025-01-01
'002-2	OTHER	Heart And/or Lung Transplant	2	1	—	—	$133,743.67	$133,743.67	$133,743.67	2025-01-01
5	MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	24	11	—	—	$79,998.02	$192,995.21	$133,056.73	2025-01-01
'588-3	OTHER	Neonate With Ecmo	2	1	—	—	$132,872.11	$132,872.11	$132,872.11	2025-01-01
'609-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	2	1	—	—	$132,860.57	$132,860.57	$132,860.57	2025-01-01
215	MS_DRG	Other Heart Assist System Implant	24	11	—	—	$78,956.05	$190,481.47	$131,320.58	2025-01-01
'004-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	1	—	—	$130,238.20	$130,238.20	$130,238.20	2025-01-01
'009-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	2	1	—	—	$128,069.32	$128,069.32	$128,069.32	2025-01-01
'583-2	OTHER	Neonate, Transferred < 5 Days Old, Born Here	2	1	—	—	$126,206.11	$126,206.11	$126,206.11	2025-01-01
216	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	24	11	—	—	$75,029.39	$181,008.41	$124,777.93	2025-01-01
'583-1	OTHER	Neonate, Transferred < 5 Days Old, Born Here	2	1	—	—	$123,161.82	$123,161.82	$123,161.82	2025-01-01
'631-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	2	1	—	—	$120,261.51	$120,261.51	$120,261.51	2025-01-01
'002-1	OTHER	Heart And/or Lung Transplant	2	1	—	—	$115,812.12	$115,812.12	$115,812.12	2025-01-01
453	MS_DRG	Combined Anterior/posterior Spinal Fusion W Mcc	24	11	—	—	$68,525.56	$165,317.91	$113,941.16	2025-01-01
'006-3	OTHER	Pancreas Transplant	2	1	—	—	$113,650.93	$113,650.93	$113,650.93	2025-01-01
'440-4	OTHER	Thyroid Disorders	2	1	—	—	$109,644.24	$109,644.24	$109,644.24	2025-01-01
20	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	24	11	—	—	$65,373.45	$157,713.44	$108,689.07	2025-01-01
456	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	24	11	—	—	$65,196.19	$157,285.81	$108,393.72	2025-01-01
'603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$108,271.47	$108,271.47	$108,271.47	2025-01-01
'001-3	OTHER	Liver Transplant And/or Intestinal Transplant	2	1	—	—	$107,078.85	$107,078.85	$107,078.85	2025-01-01
231	MS_DRG	Coronary Bypass With Ptca With Mcc	24	11	—	—	$62,774.69	$151,443.93	$104,358.98	2025-01-01
'602-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	1	—	—	$103,358.57	$103,358.57	$103,358.57	2025-01-01
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	24	11	—	—	$61,836.77	$149,181.20	$102,796.20	2025-01-01
'006-2	OTHER	Pancreas Transplant	2	1	—	—	$102,323.03	$102,323.03	$102,323.03	2025-01-01
C9073	HCPCS	Brexucabtagene Autoleucel Ca	2	1	—	—	$102,175.83	$102,175.83	$102,175.83	2025-01-01
C9098	HCPCS	Ciltacabtagene Car Pos T	2	1	—	—	$102,175.83	$102,175.83	$102,175.83	2025-01-01
Q2040	HCPCS	Tisagenlecleucel Car-pos T	2	1	—	—	$102,175.83	$102,175.83	$102,175.83	2025-01-01
C9081	HCPCS	Idecabtagene Car Pos T	2	1	—	—	$102,175.83	$102,175.83	$102,175.83	2025-01-01
C9076	HCPCS	Lisocabtagene Car Pos T	2	1	—	—	$102,175.83	$102,175.83	$102,175.83	2025-01-01
'161-2	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	2	1	—	—	$100,382.05	$100,382.05	$100,382.05	2025-01-01
233	MS_DRG	Coronary Bypass With Cardiac Catheterization With Mcc	24	11	—	—	$60,342.40	$145,576.04	$100,306.27	2025-01-01
219	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	24	11	—	—	$59,661.11	$143,932.43	$99,171.10	2025-01-01
C9031	HCPCS	Lutetium Lu 177 Dotatate, Tx	2	1	—	—	$96,265.60	$96,265.60	$96,265.60	2025-01-01
'161-1	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	2	1	—	—	$95,339.81	$95,339.81	$95,339.81	2025-01-01
J9600	HCPCS	Porfimer Per 75 Mg	158	58	$105,199.95	$73,639.97 30% off	$350.00	$168,319.92	$94,679.96	2025-01-01
957	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Mcc	24	11	—	—	$55,971.83	$135,032.04	$93,023.96	2025-01-01
'588-1	OTHER	Neonate With Ecmo	2	1	—	—	$91,278.46	$91,278.46	$91,278.46	2025-01-01
'588-2	OTHER	Neonate With Ecmo	2	1	—	—	$91,278.46	$91,278.46	$91,278.46	2025-01-01
275	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	24	11	—	—	$54,455.89	$131,374.83	$90,498.09	2025-01-01
'160-4	OTHER	Acute Bronchitis And Related Symptoms	2	1	—	—	$90,075.83	$90,075.83	$90,075.83	2025-01-01
870	MS_DRG	Septicemia Or Severe Sepsis With Mv >96 Hours	24	11	—	—	$53,909.47	$130,056.60	$89,587.64	2025-01-01
'004-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	1	—	—	$89,360.58	$89,360.58	$89,360.58	2025-01-01
928	MS_DRG	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	24	11	—	—	$53,561.12	$129,216.20	$89,007.21	2025-01-01
207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	24	11	—	—	$53,470.95	$128,998.67	$88,856.96	2025-01-01
'593-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	2	1	—	—	$88,536.75	$88,536.75	$88,536.75	2025-01-01
969	MS_DRG	HIV With Extensive O.r. Procedures With Mcc	24	11	—	—	$53,198.13	$128,340.48	$88,402.38	2025-01-01
268	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	24	11	—	—	$53,060.18	$128,007.67	$88,172.52	2025-01-01
A9542	HCPCS	Indium In-111 Ibritumomab Tiuxetan Diagnostic Per Study Dose Up To 5 Millicuries	148	56	$97,800.00	$68,460.00 30% off	$350.00	$156,480.00	$88,020.00	2025-01-01
461	MS_DRG	Bilateral Or Multiple Major Joint Procs Of Lower Extremity W Mcc	24	11	—	—	$52,781.18	$127,334.61	$87,707.67	2025-01-01
'001-2	OTHER	Liver Transplant And/or Intestinal Transplant	2	1	—	—	$87,698.30	$87,698.30	$87,698.30	2025-01-01
'005-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	2	1	—	—	$85,840.48	$85,840.48	$85,840.48	2025-01-01
459	MS_DRG	Spinal Fusion Except Cervical With Mcc	24	11	—	—	$51,346.17	$123,872.63	$85,316.62	2025-01-01
A9604	HCPCS	Samarium Sm-153 Lexidronam Therapeutic Per 150 Millicuries	160	58	$95,760.00	$67,032.00 30% off	$350.00	$153,216.00	$85,226.40	2025-01-01
0451T	OTHER	Insj/rplcmt Aortic Ventr Sys	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
33990	HCPCS	Insj Perq Vad L Hrt Arterial	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
33979	HCPCS	Insert Intracorporeal Device	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
33975	HCPCS	Implant Ventricular Device	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
0454T	OTHER	Insj/rplcmt Subq Electrode	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
33995	HCPCS	Insj Perq Vad R Hrt Venous	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
0459T	OTHER	Relocaj Rplcmt Aortic Ventr	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
33981	HCPCS	Replace Vad Pump Ext	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
0452T	OTHER	Insj/rplcmt Dev Vasc Seal	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
33991	HCPCS	Insj Perq Vad L Hrt Artl&ven	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
33976	HCPCS	Implant Ventricular Device	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
33983	HCPCS	Replace Vad Intra W/bp	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
0453T	OTHER	Insj/rplcmt Mech-elec Ntrfce	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
33982	HCPCS	Replace Vad Intra Without Bp	2	1	—	—	$84,056.53	$84,056.53	$84,056.53	2025-01-01
'162-4	OTHER	Implantable Heart Assist Systems	2	1	—	—	$82,677.63	$82,677.63	$82,677.63	2025-01-01
217	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	24	11	—	—	$49,288.43	$118,908.34	$81,887.99	2025-01-01
'001-1	OTHER	Liver Transplant And/or Intestinal Transplant	2	1	—	—	$80,983.79	$80,983.79	$80,983.79	2025-01-01
'007-3	OTHER	Allogeneic Bone Marrow Transplant	2	1	—	—	$80,744.34	$80,744.34	$80,744.34	2025-01-01
'303-4	OTHER	Disorders Of Gallbladder And Biliary Tract	2	1	—	—	$80,504.89	$80,504.89	$80,504.89	2025-01-01
266	MS_DRG	Endovascular Cardiac Valve Replacement W Mcc	24	11	—	—	$48,369.77	$116,692.07	$80,357.31	2025-01-01
573	MS_DRG	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	24	11	—	—	$48,153.98	$116,171.47	$79,997.75	2025-01-01
276	MS_DRG	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	24	11	—	—	$48,093.10	$116,024.59	$79,896.30	2025-01-01
16	MS_DRG	Autologous Bone Marrow Transplant With Cc/mcc	24	11	—	—	$47,837.22	$115,407.30	$79,469.98	2025-01-01
17	MS_DRG	Autologous Bone Marrow Transplant Without Cc/mcc	24	11	—	—	$47,837.22	$115,407.30	$79,469.98	2025-01-01
21	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	24	11	—	—	$47,562.86	$114,745.41	$79,012.83	2025-01-01
454	MS_DRG	Combined Anterior/posterior Spinal Fusion W Cc	24	11	—	—	$47,369.42	$114,278.72	$78,690.51	2025-01-01
955	MS_DRG	Craniotomy For Multiple Significant Trauma	24	11	—	—	$47,168.27	$113,793.46	$78,355.35	2025-01-01
'607-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	2	1	—	—	$78,238.23	$78,238.23	$78,238.23	2025-01-01
457	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	24	11	—	—	$47,053.43	$113,516.40	$78,164.01	2025-01-01
'602-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	1	—	—	$78,134.30	$78,134.30	$78,134.30	2025-01-01
820	MS_DRG	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	24	11	—	—	$46,833.02	$112,984.65	$77,796.75	2025-01-01
J9298	HCPCS	Opdualag Per 1 Each	160	58	$87,194.88	$61,036.42 30% off	$56.10	$139,511.81	$77,603.44	2025-01-01
'006-1	OTHER	Pancreas Transplant	2	1	—	—	$77,551.46	$77,551.46	$77,551.46	2025-01-01
28	MS_DRG	Spinal Procedures With Mcc	24	11	—	—	$46,674.26	$112,601.64	$77,532.22	2025-01-01
790	MS_DRG	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	24	11	—	—	$46,473.88	$112,118.24	$77,198.35	2025-01-01
232	MS_DRG	Coronary Bypass With Ptca Without Mcc	24	11	—	—	$46,076.98	$111,160.70	$76,537.02	2025-01-01
'842-4	OTHER	Extensive Third Degree Burns With Skin Graft	2	1	—	—	$76,374.24	$76,374.24	$76,374.24	2025-01-01
A9606	HCPCS	Radium Ra-223 Dichloride Therapeutic Per Microcurie	160	58	$85,076.88	$59,553.82 30% off	$48.53	$136,123.01	$75,718.42	2025-01-01
235	MS_DRG	Coronary Bypass Without Cardiac Catheterization With Mcc	24	11	—	—	$45,552.90	$109,896.38	$75,663.81	2025-01-01
218	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	24	11	—	—	$44,135.62	$106,477.17	$73,302.30	2025-01-01
'759-4	OTHER	Behavioral Disorders	2	1	—	—	$73,210.63	$73,210.63	$73,210.63	2025-01-01
576	MS_DRG	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc	24	11	—	—	$44,030.80	$106,224.31	$73,127.66	2025-01-01
'591-3	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	2	1	—	—	$73,021.99	$73,021.99	$73,021.99	2025-01-01
23	MS_DRG	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	24	11	—	—	$43,920.59	$105,958.43	$72,944.02	2025-01-01
463	MS_DRG	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	24	11	—	—	$43,881.29	$105,863.61	$72,878.54	2025-01-01
'008-4	OTHER	Autologous Bone Marrow Transplant	2	1	—	—	$72,683.23	$72,683.23	$72,683.23	2025-01-01
834	MS_DRG	Acute Leukemia Without Major O.r. Procedures With Mcc	24	11	—	—	$43,382.65	$104,660.64	$72,047.70	2025-01-01
'593-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	2	1	—	—	$71,857.87	$71,857.87	$71,857.87	2025-01-01
'163-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	2	1	—	—	$71,624.58	$71,624.58	$71,624.58	2025-01-01
'440-3	OTHER	Thyroid Disorders	2	1	—	—	$71,500.62	$71,500.62	$71,500.62	2025-01-01
'178-4	OTHER	Cardiac Pacemaker And Defibrillator Revision Except Device Replacement	2	1	—	—	$70,973.99	$70,973.99	$70,973.99	2025-01-01
405	MS_DRG	Pancreas, Liver And Shunt Procedures With Mcc	24	11	—	—	$42,659.74	$102,916.63	$70,843.18	2025-01-01
'630-3	OTHER	Neonate Birth Weight 2000-2499 Grams, Normal Newborn Or Neonate With Other Probl…	2	1	—	—	$69,761.36	$69,761.36	$69,761.36	2025-01-01
653	MS_DRG	Major Bladder Procedures With Mcc	24	11	—	—	$41,953.80	$101,213.54	$69,666.93	2025-01-01
27800000002-25809	CDM	Device Impella 5.5 Smartassist	146	56	$77,355.00	$54,148.50 30% off	$350.00	$123,768.00	$69,619.50	2025-01-01
27800000002-25808	CDM	Device Impella 5.5 Smartassist	146	56	$77,355.00	$54,148.50 30% off	$350.00	$123,768.00	$69,619.50	2025-01-01
J3357	HCPCS	Ustekinumab Sub Cu Inj 1 Mg	160	58	$76,829.58	$53,780.71 30% off	$45.77	$122,927.33	$68,378.32	2025-01-01
'609-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	2	1	—	—	$67,739.54	$67,739.54	$67,739.54	2025-01-01
8	MS_DRG	Simultaneous Pancreas/kidney Transplant	24	11	—	—	$40,783.12	$98,389.28	$67,716.33	2025-01-01
220	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	24	11	—	—	$40,651.34	$98,071.35	$67,496.75	2025-01-01
234	MS_DRG	Coronary Bypass With Cardiac Catheterization Without Mcc	24	11	—	—	$40,291.42	$97,203.06	$66,897.05	2025-01-01
466	MS_DRG	Revision Of Hip Or Knee Replacement With Mcc	24	11	—	—	$40,204.34	$96,992.96	$66,751.95	2025-01-01
11	MS_DRG	Tracheostomy For Face,mouth & Neck Diagnoses W Mcc	24	11	—	—	$39,970.82	$96,429.59	$66,362.86	2025-01-01
326	MS_DRG	Stomach, Esophageal And Duodenal Procedures With Mcc	24	11	—	—	$39,375.07	$94,992.36	$65,370.22	2025-01-01
270	MS_DRG	Other Major Cardiovascular Procedures With Mcc	24	11	—	—	$39,204.75	$94,581.46	$65,086.43	2025-01-01
'007-2	OTHER	Allogeneic Bone Marrow Transplant	2	1	—	—	$64,997.83	$64,997.83	$64,997.83	2025-01-01
'165-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	2	1	—	—	$64,927.00	$64,927.00	$64,927.00	2025-01-01
S2235	HCPCS	Implant Auditory Brain Imp	2	1	—	—	$64,859.47	$64,859.47	$64,859.47	2025-01-01
228	MS_DRG	Other Cardiothoracic Procedures With Mcc	24	11	—	—	$39,064.49	$94,243.08	$64,852.72	2025-01-01
853	MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	24	11	—	—	$38,760.84	$93,510.53	$64,346.78	2025-01-01
C9085	HCPCS	Inj Avalglucosid Alfa-ngpt	2	1	—	—	$63,940.39	$63,940.39	$63,940.39	2025-01-01
J9376	HCPCS	Inj Pozelimab-bbfg, 1 Mg	2	1	—	—	$63,940.39	$63,940.39	$63,940.39	2025-01-01
C9146	HCPCS	Inj, Elahere, 1 Mg	2	1	—	—	$63,940.39	$63,940.39	$63,940.39	2025-01-01
C9149	HCPCS	Inj, Teplizumab-mzwv, 5 Mcg	2	1	—	—	$63,940.39	$63,940.39	$63,940.39	2025-01-01
C9052	HCPCS	Injection, Ravulizumab-cwv	2	1	—	—	$63,940.39	$63,940.39	$63,940.39	2025-01-01
Q9995	HCPCS	Inj. Emicizumab-kxwh, 0.5 Mg	2	1	—	—	$63,940.39	$63,940.39	$63,940.39	2025-01-01
799	MS_DRG	Splenic Procedures With Mcc	24	11	—	—	$38,416.34	$92,679.43	$63,772.77	2025-01-01
'167-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	2	1	—	—	$63,699.74	$63,699.74	$63,699.74	2025-01-01
471	MS_DRG	Cervical Spinal Fusion With Mcc	24	11	—	—	$38,141.98	$92,017.52	$63,315.62	2025-01-01
267	MS_DRG	Endovascular Cardiac Valve Replacement Without Mcc	24	11	—	—	$37,842.95	$91,296.12	$62,817.38	2025-01-01
'005-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	2	1	—	—	$62,263.06	$62,263.06	$62,263.06	2025-01-01
6	MS_DRG	Liver Transplant Without Mcc	24	11	—	—	$37,509.24	$90,491.04	$62,261.35	2025-01-01
10	MS_DRG	Pancreas Transplant	24	11	—	—	$37,329.67	$90,057.83	$61,962.14	2025-01-01
837	MS_DRG	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	24	11	—	—	$36,890.38	$88,998.03	$61,918.90	2025-01-01
'183-4	OTHER	Other Peripheral Vascular And Related Procedures	2	1	—	—	$61,890.41	$61,890.41	$61,890.41	2025-01-01
239	MS_DRG	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	24	11	—	—	$37,277.26	$89,931.40	$61,874.82	2025-01-01
'690-4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	2	1	—	—	$61,741.05	$61,741.05	$61,741.05	2025-01-01
'009-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	2	1	—	—	$61,721.80	$61,721.80	$61,721.80	2025-01-01
277	MS_DRG	Cardiac Defibrillator Implant Without Mcc	24	11	—	—	$37,089.22	$89,477.73	$61,561.49	2025-01-01
'303-3	OTHER	Disorders Of Gallbladder And Biliary Tract	2	1	—	—	$61,359.94	$61,359.94	$61,359.94	2025-01-01
981	MS_DRG	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	24	11	—	—	$36,765.53	$88,696.84	$61,022.16	2025-01-01
'004-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	1	—	—	$60,945.72	$60,945.72	$60,945.72	2025-01-01
163	MS_DRG	Major Chest Procedures With Mcc	24	11	—	—	$36,558.98	$88,198.55	$60,678.01	2025-01-01
'611-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	2	1	—	—	$60,589.25	$60,589.25	$60,589.25	2025-01-01
'440-2	OTHER	Thyroid Disorders	2	1	—	—	$60,443.73	$60,443.73	$60,443.73	2025-01-01
'695-4	OTHER	Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior	2	1	—	—	$60,398.30	$60,398.30	$60,398.30	2025-01-01
221	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	24	11	—	—	$17,099.48	$86,990.02	$59,843.34	2025-01-01
'602-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	2	1	—	—	$59,733.09	$59,733.09	$59,733.09	2025-01-01
C9741	HCPCS	Impl Pressure Sensor W/angio	2	1	—	—	$59,702.19	$59,702.19	$59,702.19	2025-01-01
G0448	HCPCS	Place Perm Pacing Cardiovert	2	1	—	—	$59,702.19	$59,702.19	$59,702.19	2025-01-01
'304-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	2	1	—	—	$59,484.41	$59,484.41	$59,484.41	2025-01-01
'863-4	OTHER	Signs, Symptoms And Other Factors Influencing Health Status	2	1	—	—	$59,479.78	$59,479.78	$59,479.78	2025-01-01
455	MS_DRG	Combined Anterior/posterior Spinal Fusion Without Cc/mcc	24	11	—	—	$35,726.64	$86,190.52	$59,291.15	2025-01-01
'607-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	2	1	—	—	$58,857.68	$58,857.68	$58,857.68	2025-01-01
826	MS_DRG	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …	24	11	—	—	$34,055.79	$82,159.60	$58,389.69	2025-01-01
245	MS_DRG	Aicd Generator Procedures	24	11	—	—	$35,154.79	$84,810.94	$58,338.32	2025-01-01
458	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	24	11	—	—	$35,151.71	$84,803.51	$58,333.19	2025-01-01
'608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$58,331.83	$58,331.83	$58,331.83	2025-01-01
'166-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	2	1	—	—	$58,248.67	$58,248.67	$58,248.67	2025-01-01
329	MS_DRG	Major Small And Large Bowel Procedures With Mcc	24	11	—	—	$35,042.27	$84,539.48	$58,150.85	2025-01-01
823	MS_DRG	Lymphoma And Non-acute Leukemia With Other Procedures With Mcc	24	11	—	—	$34,927.44	$84,262.45	$57,959.51	2025-01-01
650	MS_DRG	Kidney Transplant With Hemodialysis With Mcc	24	11	—	—	$34,893.53	$84,180.64	$57,903.01	2025-01-01
'179-4	OTHER	External Heart Assist Systems	2	1	—	—	$57,770.55	$57,770.55	$57,770.55	2025-01-01
278	MS_DRG	Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures …	24	11	—	—	$34,607.60	$83,490.84	$57,426.60	2025-01-01
'613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$57,130.74	$57,130.74	$57,130.74	2025-01-01
856	MS_DRG	Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc	24	11	—	—	$34,360.98	$82,895.87	$57,015.68	2025-01-01
25	MS_DRG	Craniotomy And Endovascular Intracranial Procedures With Mcc	24	11	—	—	$34,265.42	$82,665.32	$56,856.44	2025-01-01
'162-3	OTHER	Implantable Heart Assist Systems	2	1	—	—	$56,462.45	$56,462.45	$56,462.45	2025-01-01
'680-4	OTHER	Other Anemia And Disorders Of Blood And Blood-forming Organs	2	1	—	—	$56,209.91	$56,209.91	$56,209.91	2025-01-01
319	MS_DRG	Other Endovascular Cardiac Valve Procedures With Mcc	24	11	—	—	$33,848.47	$81,659.44	$56,161.72	2025-01-01
'910-4	OTHER	HIV With Multiple Significant HIV Related Conditions	2	1	—	—	$56,123.68	$56,123.68	$56,123.68	2025-01-01
901	MS_DRG	Wound Debridements For Injuries With Mcc	24	11	—	—	$33,585.67	$81,025.43	$55,723.84	2025-01-01
'612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	2	1	—	—	$55,411.50	$55,411.50	$55,411.50	2025-01-01
474	MS_DRG	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	24	11	—	—	$33,393.00	$80,560.61	$55,402.81	2025-01-01
356	MS_DRG	Other Digestive System O.r. Procedures With Mcc	24	11	—	—	$33,207.26	$80,112.52	$55,093.33	2025-01-01
'911-4	OTHER	HIV With One Significant HIV Condition Or Without Significant Related Conditions	2	1	—	—	$55,041.16	$55,041.16	$55,041.16	2025-01-01
'603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$54,865.62	$54,865.62	$54,865.62	2025-01-01
'169-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	2	1	—	—	$54,122.65	$54,122.65	$54,122.65	2025-01-01
'091-4	OTHER	Major Cranial Or Facial Bone Procedures	2	1	—	—	$53,729.98	$53,729.98	$53,729.98	2025-01-01
'312-4	OTHER	Vertebral And Intervertebral Spinal Procedures Including Disc Procedures	2	1	—	—	$53,700.73	$53,700.73	$53,700.73	2025-01-01
269	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	24	11	—	—	$32,281.66	$77,879.51	$53,551.09	2025-01-01
'912-4	OTHER	Craniotomy For Multiple Significant Trauma	2	1	—	—	$53,549.05	$53,549.05	$53,549.05	2025-01-01
323	MS_DRG	Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc	24	11	—	—	$32,138.32	$77,533.70	$53,312.24	2025-01-01
31	MS_DRG	Ventricular Shunt Procedures With Mcc	24	11	—	—	$31,957.98	$77,098.62	$53,011.76	2025-01-01
791	MS_DRG	Prematurity With Major Problems	24	11	—	—	$31,812.32	$76,747.22	$52,769.06	2025-01-01
J2350	HCPCS	Injection Ocrelizumab 1 Mg	160	58	$59,143.14	$41,400.20 30% off	$17.63	$94,629.02	$52,637.40	2025-01-01
27800000002-25881	CDM	Valve Sapien Thv Edwards Resilia 20mm	146	56	$58,446.00	$40,912.20 30% off	$350.00	$93,513.60	$52,601.40	2025-01-01
27800000002-25880	CDM	Valve Sapien Thv Edwards Resilia 26mm	146	56	$58,446.00	$40,912.20 30% off	$350.00	$93,513.60	$52,601.40	2025-01-01
27800000002-25878	CDM	Valve Sapien Thv Edwards Resilia 23mm	146	56	$58,446.00	$40,912.20 30% off	$350.00	$93,513.60	$52,601.40	2025-01-01
27800000002-25879	CDM	Valve Sapien Thv Edwards Resilia 29mm	146	56	$58,446.00	$40,912.20 30% off	$350.00	$93,513.60	$52,601.40	2025-01-01
'440-1	OTHER	Thyroid Disorders	2	1	—	—	$52,393.39	$52,393.39	$52,393.39	2025-01-01
'178-3	OTHER	Cardiac Pacemaker And Defibrillator Revision Except Device Replacement	2	1	—	—	$52,307.16	$52,307.16	$52,307.16	2025-01-01
166	MS_DRG	Other Respiratory System O.r. Procedures With Mcc	24	11	—	—	$31,504.82	$76,005.37	$52,256.69	2025-01-01
'441-4	OTHER	Kidney Transplant	2	1	—	—	$52,225.55	$52,225.55	$52,225.55	2025-01-01
958	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Cc	24	11	—	—	$31,404.62	$75,763.66	$52,089.75	2025-01-01
236	MS_DRG	Coronary Bypass Without Cardiac Catheterization Without Mcc	24	11	—	—	$31,376.88	$75,696.72	$52,043.52	2025-01-01
'260-4	OTHER	Other Digestive System Diagnoses	2	1	—	—	$52,023.83	$52,023.83	$52,023.83	2025-01-01
628	MS_DRG	Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc	24	11	—	—	$31,171.10	$75,200.29	$51,700.66	2025-01-01
0312T	OTHER	Laps Impltj Nstim Vagus	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
0424T	OTHER	Insj/rplc Nstim Apnea Compl	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
0427T	OTHER	Insj/rplc Nstim Apnea Pls Gn	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
0466T	OTHER	Insj Ch Wal Respir Eltrd/ra	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
61889	HCPCS	Ins Sk-mnt Crnl Nstm Pg/rcvr	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
0431T	OTHER	Rmvl/rplc Nstim Apnea Pls Gn	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
61867	HCPCS	Implant Neuroelectrode	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
61863	HCPCS	Implant Neuroelectrode	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
61868	HCPCS	Implant Neuroelectrde Addl	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
61864	HCPCS	Implant Neuroelectrde Addl	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
61850	HCPCS	Implant Neuroelectrodes	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
0316T	OTHER	Replc Vagus Nerve Pls Gen	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
61860	HCPCS	Implant Neuroelectrodes	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
61870	HCPCS	Implant Neuroelectrodes	2	1	—	—	$51,631.90	$51,631.90	$51,631.90	2025-01-01
12	MS_DRG	Tracheostomy For Face,mouth & Neck Diagnoses W Cc	24	11	—	—	$31,097.12	$75,021.80	$51,577.38	2025-01-01
'752-4	OTHER	Major Depressive Disorders And Other Or Unspecified Psychoses	2	1	—	—	$51,010.61	$51,010.61	$51,010.61	2025-01-01
616	MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	24	11	—	—	$30,733.36	$74,144.23	$50,971.27	2025-01-01
27800000002-26188	CDM	Implant Gammatile Therapy Device 6pk	146	56	$56,108.16	$39,275.71 30% off	$350.00	$89,773.06	$50,497.34	2025-01-01
423	MS_DRG	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	24	11	—	—	$30,372.67	$73,274.07	$50,370.30	2025-01-01
27800000002-26240	CDM	Valve Sapien 3 Ultra Thv 23mm W/command System	146	56	$55,867.50	$39,107.25 30% off	$350.00	$89,388.00	$50,280.75	2025-01-01
27800000002-26241	CDM	Valve Sapien 3 Ultra Thv 26mm W/command System	146	56	$55,867.50	$39,107.25 30% off	$350.00	$89,388.00	$50,280.75	2025-01-01
27800000002-26239	CDM	Valve Sapien 3 Ultra Thv 20mm W/command System	146	56	$55,867.50	$39,107.25 30% off	$350.00	$89,388.00	$50,280.75	2025-01-01
27800000002-26140	CDM	Valve Sapien 3 Thv 29mm W/command System	146	56	$55,867.50	$39,107.25 30% off	$350.00	$89,388.00	$50,280.75	2025-01-01
34	MS_DRG	Carotid Artery Stent Procedures With Mcc	24	11	—	—	$30,299.46	$73,097.44	$50,248.31	2025-01-01
273	MS_DRG	Percutaneous Intracardiac Procedures W Mcc	24	11	—	—	$30,265.55	$73,015.64	$50,191.81	2025-01-01
'021-4	OTHER	Open Craniotomy For Trauma	2	1	—	—	$50,135.20	$50,135.20	$50,135.20	2025-01-01
736	MS_DRG	Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc	24	11	—	—	$30,190.02	$72,833.43	$50,065.96	2025-01-01
956	MS_DRG	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	24	11	—	—	$30,120.66	$72,666.08	$49,950.38	2025-01-01
'023-4	OTHER	Ventricular Shunt Procedures	2	1	—	—	$49,736.38	$49,736.38	$49,736.38	2025-01-01
40	MS_DRG	Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc	24	11	—	—	$29,907.18	$72,151.06	$49,594.68	2025-01-01
A9543	HCPCS	Yttrium Y-90 Ibritumomab Tiuxetan Therapeutic Per Treatment Dose Up To 40 Millic…	160	58	$55,035.00	$38,524.50 30% off	$350.00	$278,930.23	$49,531.50	2025-01-01
622	MS_DRG	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…	24	11	—	—	$29,715.28	$71,688.11	$49,274.94	2025-01-01
'007-1	OTHER	Allogeneic Bone Marrow Transplant	2	1	—	—	$49,199.74	$49,199.74	$49,199.74	2025-01-01
'005-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	2	1	—	—	$48,928.73	$48,928.73	$48,928.73	2025-01-01
24	MS_DRG	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	24	11	—	—	$29,431.66	$71,003.89	$48,802.38	2025-01-01
140	MS_DRG	Major Head And Neck Procedures With Mcc	24	11	—	—	$29,349.20	$70,804.95	$48,664.98	2025-01-01
'841-3	OTHER	Intentional Self-harm And Attempted Suicide	2	1	—	—	$48,656.18	$48,656.18	$48,656.18	2025-01-01
'608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	2	1	—	—	$48,529.14	$48,529.14	$48,529.14	2025-01-01
'681-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	2	1	—	—	$48,414.42	$48,414.42	$48,414.42	2025-01-01
'591-2	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	2	1	—	—	$48,357.45	$48,357.45	$48,357.45	2025-01-01
876	MS_DRG	O.r. Procedures With Principal Diagnosis Of Mental Illness	24	11	—	—	$28,990.06	$69,938.53	$48,066.57	2025-01-01
'178-2	OTHER	Cardiac Pacemaker And Defibrillator Revision Except Device Replacement	2	1	—	—	$48,025.60	$48,025.60	$48,025.60	2025-01-01
'165-3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	2	1	—	—	$47,970.94	$47,970.94	$47,970.94	2025-01-01
408	MS_DRG	Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With…	24	11	—	—	$28,918.38	$69,765.60	$47,947.15	2025-01-01
907	MS_DRG	Other O.r. Procedures For Injuries With Mcc	24	11	—	—	$28,897.58	$69,715.40	$47,912.47	2025-01-01
22	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…	24	11	—	—	$27,026.35	$68,890.46	$47,802.86	2025-01-01
'950-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	2	1	—	—	$47,689.15	$47,689.15	$47,689.15	2025-01-01
'020-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	2	1	—	—	$47,667.60	$47,667.60	$47,667.60	2025-01-01
'220-4	OTHER	Other Circulatory System Diagnoses	2	1	—	—	$47,656.04	$47,656.04	$47,656.04	2025-01-01
673	MS_DRG	Other Kidney And Urinary Tract Procedures With Mcc	24	11	—	—	$28,731.88	$69,315.66	$47,636.39	2025-01-01
'160-3	OTHER	Acute Bronchitis And Related Symptoms	2	1	—	—	$47,309.58	$47,309.58	$47,309.58	2025-01-01
'163-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	2	1	—	—	$47,130.18	$47,130.18	$47,130.18	2025-01-01
460	MS_DRG	Spinal Fusion Except Cervical Without Mcc	24	11	—	—	$28,422.83	$68,570.08	$47,121.45	2025-01-01
518	MS_DRG	Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…	24	11	—	—	$28,375.82	$68,456.68	$47,043.12	2025-01-01
332	MS_DRG	Rectal Resection With Mcc	24	11	—	—	$28,189.32	$68,006.73	$46,942.76	2025-01-01
'850-4	OTHER	Partial Thickness Burns Without Skin Graft	2	1	—	—	$46,923.07	$46,923.07	$46,923.07	2025-01-01
97	MS_DRG	Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc	24	11	—	—	$28,260.99	$68,179.64	$46,851.79	2025-01-01
J9309	HCPCS	Polatuzumab Per 140 Mg	160	58	$52,629.12	$36,840.38 30% off	$37.21	$84,206.59	$46,839.92	2025-01-01
C2616	HCPCS	Brachytherapy Source Non-stranded Yttrium-90 Per Source	160	58	$51,900.00	$36,330.00 30% off	$350.00	$83,040.00	$46,710.00	2025-01-01
'120-4	OTHER	Other Ear, Nose, Mouth, Throat And Cranial Or Facial Diagnoses	2	1	—	—	$46,702.88	$46,702.88	$46,702.88	2025-01-01
94	MS_DRG	Bacterial And Tuberculous Infections Of Nervous System With Mcc	24	11	—	—	$28,151.55	$67,915.62	$46,669.43	2025-01-01
739	MS_DRG	Uterine,adnexa Proc For Non-ovarian/adnexal Malig W Mcc	24	11	—	—	$28,102.23	$67,796.63	$46,587.26	2025-01-01
27800000002-26244	CDM	Kit Mitraclip G4 Syst Cds0701nt/ntw/xt/xtw	146	56	$51,570.00	$36,099.00 30% off	$350.00	$82,512.00	$46,413.00	2025-01-01
27800000002-25864	CDM	Valve Aortic 26mm Evolut Fx	146	56	$51,570.00	$36,099.00 30% off	$350.00	$82,512.00	$46,413.00	2025-01-01
27800000002-25866	CDM	Valve Mitral Tendyne 33mm Lp	146	56	$51,570.00	$36,099.00 30% off	$350.00	$82,512.00	$46,413.00	2025-01-01
'607-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	2	1	—	—	$46,368.73	$46,368.73	$46,368.73	2025-01-01
'027-4	OTHER	Other Nervous System And Related Procedures	2	1	—	—	$46,341.78	$46,341.78	$46,341.78	2025-01-01
'181-4	OTHER	Other Circulatory System Procedures	2	1	—	—	$46,227.06	$46,227.06	$46,227.06	2025-01-01
'089-4	OTHER	Eye Infections And Other Eye Disorders	2	1	—	—	$46,178.56	$46,178.56	$46,178.56	2025-01-01
495	MS_DRG	Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit…	24	11	—	—	$27,831.72	$67,144.02	$46,136.52	2025-01-01
335	MS_DRG	Peritoneal Adhesiolysis With Mcc	24	11	—	—	$27,783.94	$67,028.75	$46,056.91	2025-01-01
265	MS_DRG	Aicd Lead Procedures	24	11	—	—	$27,468.73	$66,268.31	$45,531.71	2025-01-01
'004-1	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	2	1	—	—	$45,487.93	$45,487.93	$45,487.93	2025-01-01
414	MS_DRG	Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc	24	11	—	—	$27,400.14	$66,102.83	$45,417.42	2025-01-01
93655	HCPCS	Icar Cath Abltj Dscrt Arrhyt	2	1	—	—	$45,327.71	$45,327.71	$45,327.71	2025-01-01

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