|
467
|
MS_DRG
|
Revision Of Hip Or Knee Replacement With Cc
|
1
|
1
|
—
|
—
|
$84,665.63
|
$84,665.63
|
$84,665.63
|
2026-04-01
|
|
468
|
MS_DRG
|
Revision Of Hip Or Knee Replacement Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$79,447.72
|
$79,447.72
|
$79,447.72
|
2026-04-01
|
|
492
|
MS_DRG
|
Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc
|
1
|
1
|
—
|
—
|
$73,516.12
|
$73,516.12
|
$73,516.12
|
2026-04-01
|
|
659
|
MS_DRG
|
Kidney And Ureter Procedures For Non-neoplasm With Mcc
|
1
|
1
|
—
|
—
|
$72,763.14
|
$72,763.14
|
$72,763.14
|
2026-04-01
|
|
829
|
MS_DRG
|
Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce…
|
1
|
1
|
—
|
—
|
$64,798.65
|
$64,798.65
|
$64,798.65
|
2026-04-01
|
|
368
|
MS_DRG
|
Major Esophageal Disorders With Mcc
|
1
|
1
|
—
|
—
|
$59,068.53
|
$59,068.53
|
$59,068.53
|
2026-04-01
|
|
500
|
MS_DRG
|
Soft Tissue Procedures With Mcc
|
1
|
1
|
—
|
—
|
$57,557.84
|
$57,557.84
|
$57,557.84
|
2026-04-01
|
|
326
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Mcc
|
1
|
1
|
—
|
—
|
$57,146.85
|
$57,146.85
|
$57,146.85
|
2026-04-01
|
|
380
|
MS_DRG
|
Complicated Peptic Ulcer With Mcc
|
1
|
1
|
—
|
—
|
$52,219.12
|
$52,219.12
|
$52,219.12
|
2026-04-01
|
|
196
|
MS_DRG
|
Interstitial Lung Disease With Mcc
|
1
|
1
|
—
|
—
|
$50,583.24
|
$50,583.24
|
$50,583.24
|
2026-04-01
|
|
815
|
MS_DRG
|
Reticuloendothelial And Immunity Disorders With Cc
|
1
|
1
|
—
|
—
|
$50,332.12
|
$50,332.12
|
$50,332.12
|
2026-04-01
|
|
330
|
MS_DRG
|
Major Small And Large Bowel Procedures With Cc
|
1
|
1
|
—
|
—
|
$48,967.47
|
$48,967.47
|
$48,967.47
|
2026-04-01
|
|
596
|
MS_DRG
|
Major Skin Disorders Without Mcc
|
1
|
1
|
—
|
—
|
$48,129.58
|
$48,129.58
|
$48,129.58
|
2026-04-01
|
|
73
|
MS_DRG
|
Cranial And Peripheral Nerve Disorders With Mcc
|
1
|
1
|
—
|
—
|
$45,896.68
|
$45,896.68
|
$45,896.68
|
2026-04-01
|
|
557
|
MS_DRG
|
Tendonitis, Myositis And Bursitis With Mcc
|
1
|
1
|
—
|
—
|
$44,936.58
|
$44,936.58
|
$44,936.58
|
2026-04-01
|
|
331
|
MS_DRG
|
Major Small And Large Bowel Procedures Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$42,942.19
|
$42,942.19
|
$42,942.19
|
2026-04-01
|
|
554
|
MS_DRG
|
Bone Diseases And Arthropathies Without Mcc
|
1
|
1
|
—
|
—
|
$42,474.95
|
$42,474.95
|
$42,474.95
|
2026-04-01
|
|
186
|
MS_DRG
|
Pleural Effusion With Mcc
|
1
|
1
|
—
|
—
|
$41,288.64
|
$41,288.64
|
$41,288.64
|
2026-04-01
|
|
853
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedures With Mcc
|
1
|
1
|
—
|
—
|
$40,561.96
|
$40,561.96
|
$40,561.96
|
2026-04-01
|
|
785
|
MS_DRG
|
Cesarean Section With Sterilization Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$39,712.45
|
$39,712.45
|
$39,712.45
|
2026-04-01
|
|
445
|
MS_DRG
|
Disorders Of The Biliary Tract With Cc
|
1
|
1
|
—
|
—
|
$38,681.63
|
$38,681.63
|
$38,681.63
|
2026-04-01
|
|
786
|
MS_DRG
|
Cesarean Section Without Sterilization With Mcc
|
2
|
2
|
—
|
—
|
$34,976.29
|
$41,402.86
|
$38,189.57
|
2026-04-01
|
|
481
|
MS_DRG
|
Hip And Femur Procedures Except Major Joint With Cc
|
3
|
2
|
—
|
—
|
$29,694.83
|
$64,382.75
|
$37,850.21
|
2026-04-01
|
|
788
|
MS_DRG
|
Cesarean Section Without Sterilization Without Cc/Mcc
|
3
|
3
|
—
|
—
|
$29,284.97
|
$37,654.15
|
$37,223.84
|
2026-04-01
|
|
787
|
MS_DRG
|
Cesarean Section Without Sterilization With Cc
|
4
|
4
|
—
|
—
|
$27,288.76
|
$42,510.24
|
$36,901.13
|
2026-04-01
|
|
5115
|
OTHER
|
Level 5 Musculoskeletal Procedures
|
8
|
7
|
—
|
—
|
$16,484.98
|
$49,519.19
|
$36,664.35
|
2026-04-01
|
|
64
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction With Mcc
|
1
|
1
|
—
|
—
|
$36,637.33
|
$36,637.33
|
$36,637.33
|
2026-04-01
|
|
375
|
MS_DRG
|
Digestive Malignancy With Cc
|
1
|
1
|
—
|
—
|
$35,617.78
|
$35,617.78
|
$35,617.78
|
2026-04-01
|
|
854
|
MS_DRG
|
Infectious And Parasitic Diseases With O.r. Procedures With Cc
|
1
|
1
|
—
|
—
|
$35,011.10
|
$35,011.10
|
$35,011.10
|
2026-04-01
|
|
470
|
MS_DRG
|
Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without …
|
1
|
1
|
—
|
—
|
$34,902.47
|
$34,902.47
|
$34,902.47
|
2026-04-01
|
|
432
|
MS_DRG
|
Cirrhosis And Alcoholic Hepatitis With Mcc
|
3
|
3
|
—
|
—
|
$24,993.11
|
$47,762.94
|
$33,738.23
|
2026-04-01
|
|
305
|
MS_DRG
|
Hypertension Without Mcc
|
2
|
2
|
—
|
—
|
$22,333.09
|
$44,737.81
|
$33,535.45
|
2026-04-01
|
|
194
|
MS_DRG
|
Simple Pneumonia And Pleurisy With Cc
|
3
|
2
|
—
|
—
|
$6,794.50
|
$47,761.27
|
$33,280.34
|
2026-04-01
|
|
916
|
MS_DRG
|
Allergic Reactions Without Mcc
|
1
|
1
|
—
|
—
|
$33,235.11
|
$33,235.11
|
$33,235.11
|
2026-04-01
|
|
190
|
MS_DRG
|
Chronic Obstructive Pulmonary Disease With Mcc
|
2
|
2
|
—
|
—
|
$32,294.40
|
$32,905.18
|
$32,599.79
|
2026-04-01
|
|
154
|
MS_DRG
|
Other Ear, Nose, Mouth And Throat Diagnoses With Mcc
|
1
|
1
|
—
|
—
|
$31,677.12
|
$31,677.12
|
$31,677.12
|
2026-04-01
|
|
798
|
MS_DRG
|
Vaginal Delivery With Sterilization And/Or D&c Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$30,504.67
|
$30,504.67
|
$30,504.67
|
2026-04-01
|
|
433
|
MS_DRG
|
Cirrhosis And Alcoholic Hepatitis With Cc
|
3
|
3
|
—
|
—
|
$20,794.43
|
$66,330.24
|
$30,260.93
|
2026-04-01
|
|
314
|
MS_DRG
|
Other Circulatory System Diagnoses With Mcc
|
1
|
1
|
—
|
—
|
$29,391.95
|
$29,391.95
|
$29,391.95
|
2026-04-01
|
|
291
|
MS_DRG
|
Heart Failure And Shock With Mcc
|
4
|
3
|
—
|
—
|
$17,102.98
|
$47,072.88
|
$28,831.20
|
2026-04-01
|
|
371
|
MS_DRG
|
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc
|
1
|
1
|
—
|
—
|
$28,562.60
|
$28,562.60
|
$28,562.60
|
2026-04-01
|
|
193
|
MS_DRG
|
Simple Pneumonia And Pleurisy With Mcc
|
4
|
4
|
—
|
—
|
$5,364.69
|
$90,029.28
|
$28,478.41
|
2026-04-01
|
|
540
|
MS_DRG
|
Osteomyelitis With Cc
|
1
|
1
|
—
|
—
|
$28,304.29
|
$28,304.29
|
$28,304.29
|
2026-04-01
|
|
296
|
MS_DRG
|
Cardiac Arrest, Unexplained With Mcc
|
1
|
1
|
—
|
—
|
$28,103.70
|
$28,103.70
|
$28,103.70
|
2026-04-01
|
|
60
|
MS_DRG
|
Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$27,957.37
|
$27,957.37
|
$27,957.37
|
2026-04-01
|
|
5114
|
OTHER
|
Level 4 Musculoskeletal Procedures
|
5
|
5
|
—
|
—
|
$9,767.45
|
$49,318.03
|
$27,785.28
|
2026-04-01
|
|
56
|
MS_DRG
|
Degenerative Nervous System Disorders With Mcc
|
1
|
1
|
—
|
—
|
$27,780.02
|
$27,780.02
|
$27,780.02
|
2026-04-01
|
|
59
|
MS_DRG
|
Multiple Sclerosis And Cerebellar Ataxia With Cc
|
1
|
1
|
—
|
—
|
$27,250.24
|
$27,250.24
|
$27,250.24
|
2026-04-01
|
|
482
|
MS_DRG
|
Hip And Femur Procedures Except Major Joint Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$26,404.21
|
$26,404.21
|
$26,404.21
|
2026-04-01
|
|
292
|
MS_DRG
|
Heart Failure And Shock With Cc
|
1
|
1
|
—
|
—
|
$25,876.32
|
$25,876.32
|
$25,876.32
|
2026-04-01
|
|
896
|
MS_DRG
|
Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc
|
3
|
3
|
—
|
—
|
$4,415.34
|
$34,489.14
|
$25,845.63
|
2026-04-01
|
|
5361
|
OTHER
|
Level 1 Laparoscopy And Related Services
|
9
|
8
|
—
|
—
|
$11,203.11
|
$33,835.90
|
$25,828.74
|
2026-04-01
|
|
394
|
MS_DRG
|
Other Digestive System Diagnoses With Cc
|
1
|
1
|
—
|
—
|
$25,060.85
|
$25,060.85
|
$25,060.85
|
2026-04-01
|
|
638
|
MS_DRG
|
Diabetes With Cc
|
1
|
1
|
—
|
—
|
$25,018.85
|
$25,018.85
|
$25,018.85
|
2026-04-01
|
|
768
|
MS_DRG
|
Vaginal Delivery With O.r. Procedures Except Sterilization And/Or D&c
|
2
|
2
|
—
|
—
|
$23,648.27
|
$26,020.47
|
$24,834.37
|
2026-04-01
|
|
584
|
MS_DRG
|
Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc
|
1
|
1
|
—
|
—
|
$24,789.90
|
$24,789.90
|
$24,789.90
|
2026-04-01
|
|
917
|
MS_DRG
|
Poisoning And Toxic Effects Of Drugs With Mcc
|
4
|
4
|
—
|
—
|
$11,205.71
|
$34,248.71
|
$24,575.52
|
2026-04-01
|
|
698
|
MS_DRG
|
Other Kidney And Urinary Tract Diagnoses With Mcc
|
2
|
2
|
—
|
—
|
$23,193.59
|
$25,730.48
|
$24,462.03
|
2026-04-01
|
|
501
|
MS_DRG
|
Soft Tissue Procedures With Cc
|
1
|
1
|
—
|
—
|
$24,313.29
|
$24,313.29
|
$24,313.29
|
2026-04-01
|
|
806
|
MS_DRG
|
Vaginal Delivery Without Sterilization Or D&c With Cc
|
3
|
3
|
—
|
—
|
$14,078.53
|
$36,066.28
|
$24,252.58
|
2026-04-01
|
|
946
|
MS_DRG
|
Rehabilitation Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$24,110.33
|
$24,110.33
|
$24,110.33
|
2026-04-01
|
|
280
|
MS_DRG
|
Acute Myocardial Infarction, Discharged Alive With Mcc
|
6
|
4
|
—
|
—
|
$8,286.65
|
$52,614.94
|
$23,829.72
|
2026-04-01
|
|
897
|
MS_DRG
|
Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc
|
4
|
4
|
—
|
—
|
$7,506.27
|
$31,504.35
|
$23,141.64
|
2026-04-01
|
|
864
|
MS_DRG
|
Fever And Inflammatory Conditions
|
1
|
1
|
—
|
—
|
$23,122.16
|
$23,122.16
|
$23,122.16
|
2026-04-01
|
|
281
|
MS_DRG
|
Acute Myocardial Infarction, Discharged Alive With Cc
|
2
|
2
|
—
|
—
|
$13,627.34
|
$32,370.60
|
$22,998.97
|
2026-04-01
|
|
92
|
MS_DRG
|
Other Disorders Of Nervous System With Cc
|
1
|
1
|
—
|
—
|
$22,781.40
|
$22,781.40
|
$22,781.40
|
2026-04-01
|
|
391
|
MS_DRG
|
Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc
|
3
|
3
|
—
|
—
|
$15,196.57
|
$25,807.14
|
$22,523.65
|
2026-04-01
|
|
388
|
MS_DRG
|
Gastrointestinal Obstruction With Mcc
|
1
|
1
|
—
|
—
|
$22,379.52
|
$22,379.52
|
$22,379.52
|
2026-04-01
|
|
810
|
MS_DRG
|
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co…
|
1
|
1
|
—
|
—
|
$21,986.69
|
$21,986.69
|
$21,986.69
|
2026-04-01
|
|
93
|
MS_DRG
|
Other Disorders Of Nervous System Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$21,750.29
|
$21,750.29
|
$21,750.29
|
2026-04-01
|
|
53
|
MS_DRG
|
Spinal Disorders And Injuries Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$21,679.40
|
$21,679.40
|
$21,679.40
|
2026-04-01
|
|
559
|
MS_DRG
|
Aftercare, Musculoskeletal System And Connective Tissue With Mcc
|
2
|
2
|
—
|
—
|
$9,433.58
|
$32,881.63
|
$21,157.60
|
2026-04-01
|
|
377
|
MS_DRG
|
Gastrointestinal Hemorrhage With Mcc
|
3
|
3
|
—
|
—
|
$20,750.79
|
$58,910.46
|
$20,880.86
|
2026-04-01
|
|
372
|
MS_DRG
|
Major Gastrointestinal Disorders And Peritoneal Infections With Cc
|
1
|
1
|
—
|
—
|
$20,836.21
|
$20,836.21
|
$20,836.21
|
2026-04-01
|
|
103
|
MS_DRG
|
Headaches Without Mcc
|
1
|
1
|
—
|
—
|
$20,468.95
|
$20,468.95
|
$20,468.95
|
2026-04-01
|
|
776
|
MS_DRG
|
Postpartum And Post Abortion Diagnoses Without O.r. Procedures
|
1
|
1
|
—
|
—
|
$20,434.94
|
$20,434.94
|
$20,434.94
|
2026-04-01
|
|
69
|
MS_DRG
|
Transient Ischemia Without Thrombolytic
|
5
|
5
|
—
|
—
|
$12,899.61
|
$43,669.89
|
$19,965.22
|
2026-04-01
|
|
439
|
MS_DRG
|
Disorders Of Pancreas Except Malignancy With Cc
|
2
|
2
|
—
|
—
|
$13,252.58
|
$26,634.40
|
$19,943.49
|
2026-04-01
|
|
418
|
MS_DRG
|
Laparoscopic Cholecystectomy Without C.d.e. With Cc
|
4
|
4
|
—
|
—
|
$774.24
|
$38,904.41
|
$19,409.87
|
2026-04-01
|
|
812
|
MS_DRG
|
Red Blood Cell Disorders Without Mcc
|
3
|
3
|
—
|
—
|
$450.02
|
$26,138.37
|
$19,005.49
|
2026-04-01
|
|
603
|
MS_DRG
|
Cellulitis Without Mcc
|
2
|
2
|
—
|
—
|
$17,950.15
|
$19,868.50
|
$18,909.33
|
2026-04-01
|
|
399
|
MS_DRG
|
Appendix Procedures Without Cc/Mcc
|
2
|
2
|
—
|
—
|
$5,409.58
|
$32,140.92
|
$18,775.25
|
2026-04-01
|
|
66
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$18,680.87
|
$18,680.87
|
$18,680.87
|
2026-04-01
|
|
309
|
MS_DRG
|
Cardiac Arrhythmia And Conduction Disorders With Cc
|
2
|
2
|
—
|
—
|
$11,149.73
|
$26,012.13
|
$18,580.93
|
2026-04-01
|
|
5113
|
OTHER
|
Level 3 Musculoskeletal Procedures
|
2
|
2
|
—
|
—
|
$12,463.44
|
$24,560.52
|
$18,511.98
|
2026-04-01
|
|
699
|
MS_DRG
|
Other Kidney And Urinary Tract Diagnoses With Cc
|
2
|
2
|
—
|
—
|
$17,295.55
|
$19,434.64
|
$18,365.10
|
2026-04-01
|
|
871
|
MS_DRG
|
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc
|
7
|
6
|
—
|
—
|
$1,109.18
|
$42,577.98
|
$18,362.55
|
2026-04-01
|
|
379
|
MS_DRG
|
Gastrointestinal Hemorrhage Without Cc/Mcc
|
2
|
2
|
—
|
—
|
$14,797.50
|
$21,543.72
|
$18,170.61
|
2026-04-01
|
|
392
|
MS_DRG
|
Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc
|
4
|
4
|
—
|
—
|
$5,525.54
|
$26,627.03
|
$18,050.90
|
2026-04-01
|
|
563
|
MS_DRG
|
Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…
|
2
|
2
|
—
|
—
|
$10,538.34
|
$25,418.95
|
$17,978.65
|
2026-04-01
|
|
71
|
MS_DRG
|
Other Cerebrovascular Disorders With Cc
|
2
|
2
|
—
|
—
|
$4,143.61
|
$31,597.19
|
$17,870.40
|
2026-04-01
|
|
389
|
MS_DRG
|
Gastrointestinal Obstruction With Cc
|
2
|
2
|
—
|
—
|
$3,928.37
|
$31,811.72
|
$17,870.05
|
2026-04-01
|
|
918
|
MS_DRG
|
Poisoning And Toxic Effects Of Drugs Without Mcc
|
1
|
1
|
—
|
—
|
$17,821.20
|
$17,821.20
|
$17,821.20
|
2026-04-01
|
|
881
|
MS_DRG
|
Depressive Neuroses
|
1
|
1
|
—
|
—
|
$17,531.27
|
$17,531.27
|
$17,531.27
|
2026-04-01
|
|
807
|
MS_DRG
|
Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc
|
4
|
4
|
—
|
—
|
$7,214.09
|
$25,395.65
|
$17,374.78
|
2026-04-01
|
|
441
|
MS_DRG
|
Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc
|
2
|
2
|
—
|
—
|
$8,789.61
|
$25,631.17
|
$17,210.39
|
2026-04-01
|
|
872
|
MS_DRG
|
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc
|
6
|
6
|
—
|
—
|
$7,686.34
|
$32,496.45
|
$17,196.57
|
2026-04-01
|
|
637
|
MS_DRG
|
Diabetes With Mcc
|
2
|
2
|
—
|
—
|
$14,936.87
|
$18,661.30
|
$16,799.08
|
2026-04-01
|
|
5342
|
OTHER
|
Level 2 Abdominal/Peritoneal/Biliary And Related Procedures
|
2
|
2
|
—
|
—
|
$14,578.02
|
$18,995.23
|
$16,786.62
|
2026-04-01
|
|
312
|
MS_DRG
|
Syncope And Collapse
|
1
|
1
|
—
|
—
|
$16,698.30
|
$16,698.30
|
$16,698.30
|
2026-04-01
|
|
809
|
MS_DRG
|
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co…
|
2
|
2
|
—
|
—
|
$14,951.95
|
$17,954.47
|
$16,453.21
|
2026-04-01
|
|
5375
|
OTHER
|
Level 5 Urology And Related Services
|
3
|
3
|
—
|
—
|
$10,427.74
|
$22,789.41
|
$16,304.14
|
2026-04-01
|
|
689
|
MS_DRG
|
Kidney And Urinary Tract Infections With Mcc
|
1
|
1
|
—
|
—
|
$16,072.34
|
$16,072.34
|
$16,072.34
|
2026-04-01
|
|
5694
|
OTHER
|
Level 4 Drug Administration
|
8
|
6
|
—
|
—
|
$572.99
|
$82,864.06
|
$15,921.07
|
2026-04-01
|
|
177
|
MS_DRG
|
Respiratory Infections And Inflammations With Mcc
|
3
|
3
|
—
|
—
|
$5,953.66
|
$18,962.54
|
$15,866.30
|
2026-04-01
|
|
561
|
MS_DRG
|
Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$15,199.94
|
$15,199.94
|
$15,199.94
|
2026-04-01
|
|
5183
|
OTHER
|
Level 3 Vascular Procedures
|
5
|
5
|
—
|
—
|
$6,110.04
|
$17,108.92
|
$15,183.75
|
2026-04-01
|
|
522
|
MS_DRG
|
Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc
|
1
|
1
|
—
|
—
|
$15,173.99
|
$15,173.99
|
$15,173.99
|
2026-04-01
|
|
919
|
MS_DRG
|
Complications Of Treatment With Mcc
|
1
|
1
|
—
|
—
|
$15,168.12
|
$15,168.12
|
$15,168.12
|
2026-04-01
|
|
176
|
MS_DRG
|
Pulmonary Embolism Without Mcc
|
2
|
2
|
—
|
—
|
$13,301.75
|
$16,467.35
|
$14,884.55
|
2026-04-01
|
|
694
|
MS_DRG
|
Urinary Stones Without Mcc
|
1
|
1
|
—
|
—
|
$14,546.09
|
$14,546.09
|
$14,546.09
|
2026-04-01
|
|
5414
|
OTHER
|
Level 4 Gynecologic Procedures
|
2
|
2
|
—
|
—
|
$8,132.88
|
$20,856.96
|
$14,494.92
|
2026-04-01
|
|
308
|
MS_DRG
|
Cardiac Arrhythmia And Conduction Disorders With Mcc
|
3
|
3
|
—
|
—
|
$2,411.61
|
$38,865.28
|
$14,277.05
|
2026-04-01
|
|
945
|
MS_DRG
|
Rehabilitation With Cc/Mcc
|
2
|
2
|
—
|
—
|
$195.53
|
$27,569.87
|
$13,882.70
|
2026-04-01
|
|
5431
|
OTHER
|
Level 1 Nerve Procedures
|
5
|
5
|
—
|
—
|
$6,614.05
|
$22,675.82
|
$13,756.42
|
2026-04-01
|
|
86
|
MS_DRG
|
Traumatic Stupor And Coma <1 Hour With Cc
|
1
|
1
|
—
|
—
|
$13,697.95
|
$13,697.95
|
$13,697.95
|
2026-04-01
|
|
536
|
MS_DRG
|
Fractures Of Hip And Pelvis Without Mcc
|
1
|
1
|
—
|
—
|
$13,560.37
|
$13,560.37
|
$13,560.37
|
2026-04-01
|
|
951
|
MS_DRG
|
Other Factors Influencing Health Status
|
1
|
1
|
—
|
—
|
$12,975.36
|
$12,975.36
|
$12,975.36
|
2026-04-01
|
|
390
|
MS_DRG
|
Gastrointestinal Obstruction Without Cc/Mcc
|
2
|
2
|
—
|
—
|
$4,616.38
|
$21,219.53
|
$12,917.95
|
2026-04-01
|
|
374
|
MS_DRG
|
Digestive Malignancy With Mcc
|
3
|
3
|
—
|
—
|
$988.80
|
$13,372.47
|
$12,302.11
|
2026-04-01
|
|
199
|
MS_DRG
|
Pneumothorax With Mcc
|
1
|
1
|
—
|
—
|
$12,158.76
|
$12,158.76
|
$12,158.76
|
2026-04-01
|
|
444
|
MS_DRG
|
Disorders Of The Biliary Tract With Mcc
|
1
|
1
|
—
|
—
|
$11,985.25
|
$11,985.25
|
$11,985.25
|
2026-04-01
|
|
5091
|
OTHER
|
Level 1 Breast/Lymphatic Surgery And Related Procedures
|
1
|
1
|
—
|
—
|
$11,861.56
|
$11,861.56
|
$11,861.56
|
2026-04-01
|
|
682
|
MS_DRG
|
Renal Failure With Mcc
|
2
|
2
|
—
|
—
|
$2,592.10
|
$20,342.69
|
$11,467.40
|
2026-04-01
|
|
556
|
MS_DRG
|
Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc
|
1
|
1
|
—
|
—
|
$11,172.61
|
$11,172.61
|
$11,172.61
|
2026-04-01
|
|
310
|
MS_DRG
|
Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc
|
2
|
2
|
—
|
—
|
$4,660.65
|
$17,111.32
|
$10,885.99
|
2026-04-01
|
|
5073
|
OTHER
|
Level 3 Excision/ Biopsy/ Incision And Drainage
|
2
|
2
|
—
|
—
|
$8,045.36
|
$13,721.09
|
$10,883.23
|
2026-04-01
|
|
202
|
MS_DRG
|
Bronchitis And Asthma With Cc/Mcc
|
1
|
1
|
—
|
—
|
$10,869.41
|
$10,869.41
|
$10,869.41
|
2026-04-01
|
|
315
|
MS_DRG
|
Other Circulatory System Diagnoses With Cc
|
2
|
2
|
—
|
—
|
$4,135.25
|
$17,269.94
|
$10,702.59
|
2026-04-01
|
|
293
|
MS_DRG
|
Heart Failure And Shock Without Cc/Mcc
|
2
|
2
|
—
|
—
|
$7,855.98
|
$13,444.83
|
$10,650.40
|
2026-04-01
|
|
189
|
MS_DRG
|
Pulmonary Edema And Respiratory Failure
|
3
|
3
|
—
|
—
|
$6,922.16
|
$16,645.27
|
$10,617.23
|
2026-04-01
|
|
101
|
MS_DRG
|
Seizures Without Mcc
|
4
|
3
|
—
|
—
|
$8,060.95
|
$22,762.21
|
$10,568.79
|
2026-04-01
|
|
5313
|
OTHER
|
Level 3 Lower Gi Procedures
|
2
|
2
|
—
|
—
|
$9,393.13
|
$11,735.40
|
$10,564.26
|
2026-04-01
|
|
683
|
MS_DRG
|
Renal Failure With Cc
|
4
|
3
|
—
|
—
|
$2,260.58
|
$25,452.99
|
$10,395.95
|
2026-04-01
|
|
208
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support <=96 Hours
|
2
|
2
|
—
|
—
|
$469.74
|
$20,319.30
|
$10,394.52
|
2026-04-01
|
|
935
|
MS_DRG
|
Non-extensive Burns
|
1
|
1
|
—
|
—
|
$10,068.46
|
$10,068.46
|
$10,068.46
|
2026-04-01
|
|
894
|
MS_DRG
|
Alcohol, Drug Abuse Or Dependence, Left Ama
|
1
|
1
|
—
|
—
|
$9,935.42
|
$9,935.42
|
$9,935.42
|
2026-04-01
|
|
5491
|
OTHER
|
Level 1 Intraocular Procedures
|
8
|
6
|
—
|
—
|
$4,666.61
|
$14,495.96
|
$9,806.72
|
2026-04-01
|
|
5312
|
OTHER
|
Level 2 Lower Gi Procedures
|
10
|
7
|
—
|
—
|
$3,102.50
|
$10,802.88
|
$9,583.06
|
2026-04-01
|
|
5415
|
OTHER
|
Level 5 Gynecologic Procedures
|
2
|
2
|
—
|
—
|
$8,693.11
|
$9,955.98
|
$9,324.55
|
2026-04-01
|
|
811
|
MS_DRG
|
Red Blood Cell Disorders With Mcc
|
1
|
1
|
—
|
—
|
$8,974.26
|
$8,974.26
|
$8,974.26
|
2026-04-01
|
|
355
|
MS_DRG
|
Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$8,859.05
|
$8,859.05
|
$8,859.05
|
2026-04-01
|
|
5341
|
OTHER
|
Level 1 Abdominal/Peritoneal/Biliary And Related Procedures
|
3
|
3
|
—
|
—
|
$6,202.26
|
$18,925.72
|
$8,616.80
|
2026-04-01
|
|
5302
|
OTHER
|
Level 2 Upper Gi Procedures
|
4
|
3
|
—
|
—
|
$4,921.02
|
$13,228.29
|
$8,531.15
|
2026-04-01
|
|
5311
|
OTHER
|
Level 1 Lower Gi Procedures
|
9
|
7
|
—
|
—
|
$3,105.95
|
$9,874.00
|
$8,512.50
|
2026-04-01
|
|
5374
|
OTHER
|
Level 4 Urology And Related Services
|
3
|
3
|
—
|
—
|
$4,627.39
|
$22,388.02
|
$8,139.33
|
2026-04-01
|
|
5181
|
OTHER
|
Level 1 Vascular Procedures
|
1
|
1
|
—
|
—
|
$8,128.46
|
$8,128.46
|
$8,128.46
|
2026-04-01
|
|
641
|
MS_DRG
|
Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…
|
2
|
2
|
—
|
—
|
$6,594.78
|
$9,569.33
|
$8,082.06
|
2026-04-01
|
|
5163
|
OTHER
|
Level 3 ENT Procedures
|
1
|
1
|
—
|
—
|
$7,643.58
|
$7,643.58
|
$7,643.58
|
2026-04-01
|
|
65
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours
|
1
|
1
|
—
|
—
|
$7,399.29
|
$7,399.29
|
$7,399.29
|
2026-04-01
|
|
558
|
MS_DRG
|
Tendonitis, Myositis And Bursitis Without Mcc
|
2
|
2
|
—
|
—
|
$543.20
|
$13,685.88
|
$7,114.54
|
2026-04-01
|
|
792
|
MS_DRG
|
Prematurity Without Major Problems
|
1
|
1
|
—
|
—
|
$6,859.35
|
$6,859.35
|
$6,859.35
|
2026-04-01
|
|
74
|
MS_DRG
|
Cranial And Peripheral Nerve Disorders Without Mcc
|
2
|
2
|
—
|
—
|
$1,289.20
|
$11,576.15
|
$6,432.67
|
2026-04-01
|
|
5072
|
OTHER
|
Level 2 Excision/ Biopsy/ Incision And Drainage
|
4
|
3
|
—
|
—
|
$5,290.02
|
$13,314.72
|
$6,345.35
|
2026-04-01
|
|
57
|
MS_DRG
|
Degenerative Nervous System Disorders Without Mcc
|
1
|
1
|
—
|
—
|
$6,289.70
|
$6,289.70
|
$6,289.70
|
2026-04-01
|
|
793
|
MS_DRG
|
Full Term Neonate With Major Problems
|
1
|
1
|
—
|
—
|
$6,222.86
|
$6,222.86
|
$6,222.86
|
2026-04-01
|
|
552
|
MS_DRG
|
Medical Back Problems Without Mcc
|
1
|
1
|
—
|
—
|
$6,091.70
|
$6,091.70
|
$6,091.70
|
2026-04-01
|
|
5301
|
OTHER
|
Level 1 Upper Gi Procedures
|
8
|
5
|
—
|
—
|
$786.62
|
$11,739.84
|
$5,968.60
|
2026-04-01
|
|
832
|
MS_DRG
|
Other Antepartum Diagnoses Without O.r. Procedures With Cc
|
2
|
2
|
—
|
—
|
$3,807.60
|
$7,653.99
|
$5,730.80
|
2026-04-01
|
|
794
|
MS_DRG
|
Neonate With Other Significant Problems
|
2
|
2
|
—
|
—
|
$4,911.20
|
$6,520.25
|
$5,715.73
|
2026-04-01
|
|
100
|
MS_DRG
|
Seizures With Mcc
|
1
|
1
|
—
|
—
|
$5,389.29
|
$5,389.29
|
$5,389.29
|
2026-04-01
|
|
560
|
MS_DRG
|
Aftercare, Musculoskeletal System And Connective Tissue With Cc
|
3
|
2
|
—
|
—
|
$279.03
|
$35,696.26
|
$4,597.36
|
2026-04-01
|
|
139
|
MS_DRG
|
Salivary Gland Procedures
|
1
|
1
|
—
|
—
|
$4,471.56
|
$4,471.56
|
$4,471.56
|
2026-04-01
|
|
178
|
MS_DRG
|
Respiratory Infections And Inflammations With Cc
|
1
|
1
|
—
|
—
|
$4,457.88
|
$4,457.88
|
$4,457.88
|
2026-04-01
|
|
565
|
MS_DRG
|
Other Musculoskeletal System And Connective Tissue Diagnoses With Cc
|
1
|
1
|
—
|
—
|
$4,442.61
|
$4,442.61
|
$4,442.61
|
2026-04-01
|
|
795
|
MS_DRG
|
Normal Newborn
|
5
|
5
|
—
|
—
|
$319.72
|
$6,283.82
|
$4,419.32
|
2026-04-01
|
|
378
|
MS_DRG
|
Gastrointestinal Hemorrhage With Cc
|
3
|
3
|
—
|
—
|
$3,147.95
|
$20,918.99
|
$4,223.66
|
2026-04-01
|
|
5112
|
OTHER
|
Level 2 Musculoskeletal Procedures
|
10
|
7
|
—
|
—
|
$438.00
|
$13,333.86
|
$4,135.87
|
2026-04-01
|
|
640
|
MS_DRG
|
Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…
|
4
|
3
|
—
|
—
|
$652.02
|
$13,357.95
|
$4,111.91
|
2026-04-01
|
|
284
|
MS_DRG
|
Acute Myocardial Infarction, Expired With Cc
|
1
|
1
|
—
|
—
|
$4,058.68
|
$4,058.68
|
$4,058.68
|
2026-04-01
|
|
54
|
MS_DRG
|
Nervous System Neoplasms With Mcc
|
1
|
1
|
—
|
—
|
$3,849.50
|
$3,849.50
|
$3,849.50
|
2026-04-01
|
|
5691
|
OTHER
|
Level 1 Drug Administration
|
3
|
3
|
—
|
—
|
$1,628.11
|
$4,420.10
|
$3,816.13
|
2026-04-01
|
|
5153
|
OTHER
|
Level 3 Airway Endoscopy
|
1
|
1
|
—
|
—
|
$3,609.47
|
$3,609.47
|
$3,609.47
|
2026-04-01
|
|
5053
|
OTHER
|
Level 3 Skin Procedures
|
1
|
1
|
—
|
—
|
$3,567.88
|
$3,567.88
|
$3,567.88
|
2026-04-01
|
|
789
|
MS_DRG
|
Neonates, Died Or Transferred To Another Acute Care Facility
|
3
|
3
|
—
|
—
|
$461.42
|
$4,239.73
|
$3,524.75
|
2026-04-01
|
|
5041
|
OTHER
|
Critical Care
|
13
|
9
|
—
|
—
|
$165.74
|
$12,034.16
|
$3,517.95
|
2026-04-01
|
|
5025
|
OTHER
|
Level 5 Type A Ed Visits
|
20
|
12
|
—
|
—
|
$291.65
|
$5,009.53
|
$2,973.96
|
2026-04-01
|
|
5573
|
OTHER
|
Level 3 Imaging With Contrast
|
5
|
5
|
—
|
—
|
$1,420.90
|
$11,104.26
|
$2,867.61
|
2026-04-01
|
|
5481
|
OTHER
|
Laser Eye Procedures
|
3
|
3
|
—
|
—
|
$1,845.26
|
$3,007.26
|
$2,842.18
|
2026-04-01
|
|
5241
|
OTHER
|
Level 1 Blood Product Exchange And Related Services
|
4
|
3
|
—
|
—
|
$1,633.92
|
$3,594.24
|
$2,706.45
|
2026-04-01
|
|
N905
|
OTHER
|
Not Recognized By Opps
|
9
|
7
|
—
|
—
|
$407.09
|
$3,304.38
|
$2,652.10
|
2026-04-01
|
|
5442
|
OTHER
|
Level 2 Nerve Injections
|
3
|
3
|
—
|
—
|
$1,686.72
|
$3,657.56
|
$2,615.70
|
2026-04-01
|
|
5071
|
OTHER
|
Level 1 Excision/ Biopsy/ Incision And Drainage
|
5
|
4
|
—
|
—
|
$107.58
|
$12,371.36
|
$2,536.01
|
2026-04-01
|
|
5781
|
OTHER
|
Resuscitation And Cardioversion
|
7
|
5
|
—
|
—
|
$1,358.55
|
$4,281.19
|
$2,456.91
|
2026-04-01
|
|
5673
|
OTHER
|
Level 3 Pathology
|
2
|
2
|
—
|
—
|
$193.75
|
$4,426.21
|
$2,309.98
|
2026-04-01
|
|
5572
|
OTHER
|
Level 2 Imaging With Contrast
|
9
|
7
|
—
|
—
|
$1,028.74
|
$3,174.64
|
$2,240.81
|
2026-04-01
|
|
5571
|
OTHER
|
Level 1 Imaging With Contrast
|
12
|
7
|
—
|
—
|
$594.80
|
$5,106.81
|
$1,980.89
|
2026-04-01
|
|
5162
|
OTHER
|
Level 2 ENT Procedures
|
1
|
1
|
—
|
—
|
$1,928.89
|
$1,928.89
|
$1,928.89
|
2026-04-01
|
|
5412
|
OTHER
|
Level 2 Gynecologic Procedures
|
2
|
2
|
—
|
—
|
$1,474.89
|
$2,168.43
|
$1,821.66
|
2026-04-01
|
|
5182
|
OTHER
|
Level 2 Vascular Procedures
|
1
|
1
|
—
|
—
|
$1,813.03
|
$1,813.03
|
$1,813.03
|
2026-04-01
|
|
690
|
MS_DRG
|
Kidney And Urinary Tract Infections Without Mcc
|
4
|
4
|
—
|
—
|
$474.60
|
$45,847.78
|
$1,750.64
|
2026-04-01
|
|
5672
|
OTHER
|
Level 2 Pathology
|
5
|
4
|
—
|
—
|
$344.93
|
$3,074.40
|
$1,556.35
|
2026-04-01
|
|
5693
|
OTHER
|
Level 3 Drug Administration
|
9
|
7
|
—
|
—
|
$515.54
|
$172,206.06
|
$1,504.85
|
2026-04-01
|
|
5735
|
OTHER
|
Level 5 Minor Procedures
|
2
|
2
|
—
|
—
|
$1,271.08
|
$1,516.39
|
$1,393.74
|
2026-04-01
|
|
5024
|
OTHER
|
Level 4 Type A Ed Visits
|
22
|
14
|
—
|
—
|
$192.17
|
$3,017.51
|
$1,247.15
|
2026-04-01
|
|
5722
|
OTHER
|
Level 2 Diagnostic Tests And Related Services
|
9
|
6
|
—
|
—
|
$535.38
|
$1,986.01
|
$1,220.08
|
2026-04-01
|
|
5524
|
OTHER
|
Level 4 Imaging Without Contrast
|
14
|
9
|
—
|
—
|
$725.15
|
$2,636.71
|
$1,086.01
|
2026-04-01
|
|
5523
|
OTHER
|
Level 3 Imaging Without Contrast
|
12
|
8
|
—
|
—
|
$451.72
|
$2,085.72
|
$1,080.72
|
2026-04-01
|
|
686
|
MS_DRG
|
Kidney And Urinary Tract Neoplasms With Mcc
|
1
|
1
|
—
|
—
|
$1,023.54
|
$1,023.54
|
$1,023.54
|
2026-04-01
|
|
5052
|
OTHER
|
Level 2 Skin Procedures
|
8
|
7
|
—
|
—
|
$297.18
|
$2,976.83
|
$996.11
|
2026-04-01
|
|
5373
|
OTHER
|
Level 3 Urology And Related Services
|
6
|
6
|
—
|
—
|
$228.42
|
$1,554.18
|
$949.49
|
2026-04-01
|
|
5411
|
OTHER
|
Level 1 Gynecologic Procedures
|
7
|
7
|
—
|
—
|
$99.73
|
$1,344.99
|
$906.89
|
2026-04-01
|
|
5022
|
OTHER
|
Level 2 Type A Ed Visits
|
16
|
11
|
—
|
—
|
$81.86
|
$2,081.77
|
$793.87
|
2026-04-01
|
|
282
|
MS_DRG
|
Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc
|
1
|
1
|
—
|
—
|
$734.01
|
$734.01
|
$734.01
|
2026-04-01
|
|
0874
|
OTHER
|
Synvisc Or Synvisc-one
|
1
|
1
|
—
|
—
|
$706.36
|
$706.36
|
$706.36
|
2026-04-01
|
|
5023
|
OTHER
|
Level 3 Type A Ed Visits
|
22
|
14
|
—
|
—
|
$148.61
|
$1,503.49
|
$696.87
|
2026-04-01
|
|
55
|
MS_DRG
|
Nervous System Neoplasms Without Mcc
|
1
|
1
|
—
|
—
|
$600.89
|
$600.89
|
$600.89
|
2026-04-01
|
|
9398
|
OTHER
|
Covid-19 Vaccine Administration
|
11
|
7
|
—
|
—
|
$241.00
|
$838.87
|
$537.10
|
2026-04-01
|
|
5671
|
OTHER
|
Level 1 Pathology
|
5
|
5
|
—
|
—
|
$255.62
|
$989.03
|
$520.08
|
2026-04-01
|
|
1417
|
OTHER
|
Gel-one
|
2
|
2
|
—
|
—
|
$323.64
|
$679.50
|
$501.57
|
2026-04-01
|
|
5441
|
OTHER
|
Level 1 Nerve Injections
|
10
|
7
|
—
|
—
|
$316.15
|
$1,518.76
|
$477.44
|
2026-04-01
|
|
N801
|
OTHER
|
Therapy Services
|
16
|
11
|
—
|
—
|
$21.68
|
$1,463.61
|
$463.09
|
2026-04-01
|
|
N809
|
OTHER
|
Other Medicine
|
7
|
5
|
—
|
—
|
$20.72
|
$1,168.42
|
$446.18
|
2026-04-01
|
|
5372
|
OTHER
|
Level 2 Urology And Related Services
|
3
|
2
|
—
|
—
|
$312.75
|
$727.41
|
$440.60
|
2026-04-01
|
|
5734
|
OTHER
|
Level 4 Minor Procedures
|
11
|
8
|
—
|
—
|
$78.70
|
$524.95
|
$429.00
|
2026-04-01
|
|
5692
|
OTHER
|
Level 2 Drug Administration
|
14
|
9
|
—
|
—
|
$115.55
|
$4,990.11
|
$424.33
|
2026-04-01
|
|
5111
|
OTHER
|
Level 1 Musculoskeletal Procedures
|
2
|
2
|
—
|
—
|
$303.00
|
$545.38
|
$424.19
|
2026-04-01
|
|
5721
|
OTHER
|
Level 1 Diagnostic Tests And Related Services
|
5
|
5
|
—
|
—
|
$203.28
|
$443.94
|
$395.29
|
2026-04-01
|
|
5522
|
OTHER
|
Level 2 Imaging Without Contrast
|
14
|
10
|
—
|
—
|
$91.64
|
$1,019.51
|
$393.52
|
2026-04-01
|
|
5733
|
OTHER
|
Level 3 Minor Procedures
|
13
|
9
|
—
|
—
|
$120.00
|
$724.77
|
$366.52
|
2026-04-01
|
|
5051
|
OTHER
|
Level 1 Skin Procedures
|
9
|
6
|
—
|
—
|
$129.58
|
$660.85
|
$364.00
|
2026-04-01
|
|
5791
|
OTHER
|
Pulmonary Treatment
|
7
|
6
|
—
|
—
|
$174.92
|
$521.97
|
$363.79
|
2026-04-01
|
|
0790
|
OTHER
|
Inj, Methylpred Acetate 1 Mg
|
11
|
7
|
—
|
—
|
$162.47
|
$560.47
|
$346.72
|
2026-04-01
|
|
949
|
MS_DRG
|
Aftercare With Cc/Mcc
|
1
|
1
|
—
|
—
|
$330.00
|
$330.00
|
$330.00
|
2026-04-01
|
|
153
|
MS_DRG
|
Otitis Media And Uri Without Mcc
|
1
|
1
|
—
|
—
|
$315.77
|
$315.77
|
$315.77
|
2026-04-01
|
|
0875
|
OTHER
|
Euflexxa Inj Per Dose
|
6
|
5
|
—
|
—
|
$65.00
|
$543.13
|
$307.86
|
2026-04-01
|
|
5732
|
OTHER
|
Level 2 Minor Procedures
|
11
|
8
|
—
|
—
|
$125.40
|
$459.35
|
$301.91
|
2026-04-01
|
|
N900
|
OTHER
|
Non-covered Services
|
10
|
9
|
—
|
—
|
$54.00
|
$342.00
|
$294.83
|
2026-04-01
|
|
N804
|
OTHER
|
Mammography Services
|
14
|
9
|
—
|
—
|
$87.18
|
$435.13
|
$289.92
|
2026-04-01
|
|
0764
|
OTHER
|
Ketorolac Tromethamine Inj
|
6
|
6
|
—
|
—
|
$177.35
|
$543.99
|
$286.80
|
2026-04-01
|
|
5741
|
OTHER
|
Level 1 Electronic Analysis Of Devices
|
8
|
6
|
—
|
—
|
$77.15
|
$745.46
|
$273.08
|
2026-04-01
|
|
N800
|
OTHER
|
Clinical Diagnostic Lab Services
|
19
|
12
|
—
|
—
|
$2.75
|
$486.98
|
$263.57
|
2026-04-01
|
|
5823
|
OTHER
|
Level 3 Health And Behavior Services
|
6
|
5
|
—
|
—
|
$129.00
|
$342.24
|
$257.88
|
2026-04-01
|
|
N701
|
OTHER
|
Other Non-opps Clinic Visits
|
8
|
7
|
—
|
—
|
$61.00
|
$404.43
|
$256.88
|
2026-04-01
|
|
5012
|
OTHER
|
Clinic Visits And Related Services
|
11
|
8
|
—
|
—
|
$127.49
|
$482.21
|
$256.49
|
2026-04-01
|
|
0877
|
OTHER
|
Orthovisc Inj Per Dose
|
2
|
2
|
—
|
—
|
$212.30
|
$298.70
|
$255.50
|
2026-04-01
|
|
5821
|
OTHER
|
Level 1 Health And Behavior Services
|
11
|
8
|
—
|
—
|
$106.35
|
$871.97
|
$254.88
|
2026-04-01
|
|
N902
|
OTHER
|
Packaged Services
|
10
|
8
|
—
|
—
|
$8.01
|
$471.61
|
$254.50
|
2026-04-01
|
|
5021
|
OTHER
|
Level 1 Type A Ed Visits
|
18
|
12
|
—
|
—
|
$70.83
|
$719.14
|
$252.45
|
2026-04-01
|
|
N700
|
OTHER
|
Non-opps Clinic Services
|
16
|
10
|
—
|
—
|
$81.25
|
$459.35
|
$237.30
|
2026-04-01
|
|
5731
|
OTHER
|
Level 1 Minor Procedures
|
8
|
6
|
—
|
—
|
$35.97
|
$493.32
|
$207.26
|
2026-04-01
|
|
9011
|
OTHER
|
Mmrv Vaccine Sc
|
3
|
3
|
—
|
—
|
$5.24
|
$290.00
|
$180.98
|
2026-04-01
|
|
N903
|
OTHER
|
Influenza Vaccines & Pneumococcal Pneumonia Vaccines
|
5
|
5
|
—
|
—
|
$8.01
|
$349.78
|
$174.71
|
2026-04-01
|
|
N999
|
OTHER
|
Other Non-covered Services
|
1
|
1
|
—
|
—
|
$166.86
|
$166.86
|
$166.86
|
2026-04-01
|
|
5521
|
OTHER
|
Level 1 Imaging Without Contrast
|
17
|
11
|
—
|
—
|
$13.09
|
$448.66
|
$161.48
|
2026-04-01
|
|
0801
|
OTHER
|
Inj, Methylpred Sod Succ 5mg
|
1
|
1
|
—
|
—
|
$144.46
|
$144.46
|
$144.46
|
2026-04-01
|
|
5102
|
OTHER
|
Level 2 Strapping And Cast Application
|
1
|
1
|
—
|
—
|
$122.95
|
$122.95
|
$122.95
|
2026-04-01
|
|
N907
|
OTHER
|
Not Billable To Fi
|
13
|
9
|
—
|
—
|
$14.33
|
$2,060.97
|
$89.07
|
2026-04-01
|
|
5822
|
OTHER
|
Level 2 Health And Behavior Services
|
1
|
1
|
—
|
—
|
$81.12
|
$81.12
|
$81.12
|
2026-04-01
|
|
N806
|
OTHER
|
Pharmacy Services
|
1
|
1
|
—
|
—
|
$41.70
|
$41.70
|
$41.70
|
2026-04-01
|
|
33
|
MS_DRG
|
Ventricular Shunt Procedures Without Cc/Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
215
|
MS_DRG
|
Other Heart Assist System Implant
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
329
|
MS_DRG
|
Major Small And Large Bowel Procedures With Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
328
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
214
|
MS_DRG
|
No Longer Valid
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
156
|
MS_DRG
|
Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
327
|
MS_DRG
|
Stomach, Esophageal And Duodenal Procedures With Cc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
213
|
MS_DRG
|
Endovascular Abdominal Aorta With Iliac Branch Procedures
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
325
|
MS_DRG
|
Coronary Intravascular Lithotripsy Without Intraluminal Device
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
324
|
MS_DRG
|
Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
212
|
MS_DRG
|
Concomitant Aortic And Mitral Valve Procedures
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
155
|
MS_DRG
|
Other Ear, Nose, Mouth And Throat Diagnoses With Cc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
126
|
MS_DRG
|
Acute & Subacute Endocarditis
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
323
|
MS_DRG
|
Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
322
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
211
|
MS_DRG
|
Hip & Femur Procedures Except Major Joint Age >17 Without Cc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
321
|
MS_DRG
|
Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A…
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
320
|
MS_DRG
|
Other Endovascular Cardiac Valve Procedures Without Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
210
|
MS_DRG
|
Hip & Femur Procedures Except Major Joint Age >17 W Cc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
32
|
MS_DRG
|
Ventricular Shunt Procedures With Cc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
319
|
MS_DRG
|
Other Endovascular Cardiac Valve Procedures With Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
21
|
MS_DRG
|
Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
318
|
MS_DRG
|
Percutaneous Coronary Atherectomy Without Intraluminal Device
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
317
|
MS_DRG
|
Concomitant Left Atrial Appendage Closure And Cardiac Ablation
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
209
|
MS_DRG
|
Complex Aortic Arch Procedures
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
125
|
MS_DRG
|
Other Disorders Of The Eye Without Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
111
|
MS_DRG
|
Major Cardiovascular Procedures Without Cc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
316
|
MS_DRG
|
Other Circulatory System Diagnoses Without Cc/Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
313
|
MS_DRG
|
Chest Pain
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
207
|
MS_DRG
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
152
|
MS_DRG
|
Otitis Media And Uri With Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
311
|
MS_DRG
|
Angina Pectoris
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
206
|
MS_DRG
|
Other Respiratory System Diagnoses Without Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
31
|
MS_DRG
|
Ventricular Shunt Procedures With Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
205
|
MS_DRG
|
Other Respiratory System Diagnoses With Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
151
|
MS_DRG
|
Epistaxis Without Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
124
|
MS_DRG
|
Other Disorders Of The Eye With Mcc Or Thrombolytic Agent
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
204
|
MS_DRG
|
Respiratory Signs And Symptoms
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
307
|
MS_DRG
|
Cardiac Congenital And Valvular Disorders Without Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
306
|
MS_DRG
|
Cardiac Congenital And Valvular Disorders With Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
203
|
MS_DRG
|
Bronchitis And Asthma Without Cc/Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
150
|
MS_DRG
|
Epistaxis With Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
304
|
MS_DRG
|
Hypertension With Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
303
|
MS_DRG
|
Atherosclerosis Without Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
302
|
MS_DRG
|
Atherosclerosis With Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
201
|
MS_DRG
|
Pneumothorax Without Cc/Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
149
|
MS_DRG
|
Dysequilibrium
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
123
|
MS_DRG
|
Neurological Eye Disorders
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
110
|
MS_DRG
|
Major Cardiovascular Procedures W Cc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|
|
301
|
MS_DRG
|
Peripheral Vascular Disorders Without Cc/Mcc
|
0
|
0
|
—
|
—
|
—
|
—
|
—
|
2026-04-01
|