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

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Hospital

LEHIGH VALLEY HOSPITAL - POCONO

East Stroudsburg, PA · CCN 390201 · Rates published

9,595 distinct procedures filed
20 distinct payers
377,798 rate rows
2025-08-01 last MRF observed · ⚠ 14 mo old
Data quality

328,153 of 377,798 rate rows are consumer-grade (86.9%)

49,645 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
placeholder amount (≤ $0.02) — excluded from medians 47,873
template filing: same amount across many unrelated codes — excluded 1,187
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 481
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 67
exceeds 10× this hospital's gross charge — excluded from medians 29
per-diem day rate — not a per-procedure price 8

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 14 months old.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://lvhn.pt.panaceainc.com/MRFDownload/lvhn/pocono
Found on page https://www.lvhn.org/get-price-quote
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-15
Content fingerprint bf6b525e80a5de82… · 507,717,559 bytes · first seen 2026-05-08

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 14 $3,570,000.00 $4,683,875.00 $3,895,500.00 nat. median
$3,508,750
1.1× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 14 $3,570,000.00 $4,652,649.17 $3,869,530.00 nat. median
$3,685,267
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 14 $3,162,000.00 $4,148,575.00 $3,450,300.00 nat. median
$3,248,446
1.1× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 14 $2,856,000.00 $3,722,119.33 $3,095,624.00 nat. median
$2,968,000
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 14 $2,368,485.25 $4,938,583.76 $2,568,519.10 nat. median
$2,455,111
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 14 $2,244,000.00 $4,752,849.20 $2,471,920.00 nat. median
$2,332,000
1.1× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 16 $565,623.84 $3,375,103.79 $636,648.23 nat. median
$621,313
1.0× median
7315390001
NDC 		Lisocabtagene Maraleucel 1.5 X 10exp6 To 70 X 10exp6 Cell/ml IV Susp 18 $516,442.29 $3,011,633.21 $568,086.52 —
C9301
HCPCS 		Obecabtagene Car Pos T 15 $283,815.00 $1,622,614.88 $328,682.82 nat. median
$377,029
0.9× median
5831
APR_DRG 		Neonate With Ecmo 8 $141,506.98 $484,571.75 $247,292.65 nat. median
$173,909
1.4× median
0-D
OTHER 		Kidney Transplant With Hemodialysis With Mcc - Deceased Donor 2 $145,141.00 $291,282.00 $218,211.50 —
1-D
OTHER 		Kidney Transplant With Hemodialysis Without Mcc - Deceased Donor 2 $145,141.00 $238,389.00 $191,765.00 —
0-L
OTHER 		Kidney Transplant With Hemodialysis With Mcc - Living Donor 2 $122,004.00 $243,226.00 $182,615.00 —
2-D
OTHER 		Kidney Transplant - Deceased Donor 2 $145,141.00 $201,892.00 $173,516.50 —
5881
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 8 $124,900.26 $316,127.86 $170,016.21 nat. median
$130,862
1.3× median
1-L
OTHER 		Kidney Transplant With Hemodialysis Without Mcc - Living Donor 2 $122,004.00 $199,061.00 $160,532.50 —
2-L
OTHER 		Kidney Transplant - Living Donor 2 $122,004.00 $171,483.00 $146,743.50 —
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 15 $22,511.00 $427,135.77 $129,739.65 nat. median
$97,418
1.3× median
5024255401
NDC 		Ocrelizumab 920 Mg-hyaluronidase-ocsq 23000 Unit/23 Ml Subcut Soln 9 $40,225.67 $160,902.69 $122,113.65 —
7
MS_DRG 		Lung Transplant 14 $104,539.23 $395,056.76 $120,040.76 nat. median
$70,649
1.7× median
5911
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 8 $54,880.49 $200,824.52 $116,714.60 nat. median
$30,994
outlier · 3.8×
5931
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 8 $18,489.11 $186,215.34 $105,044.61 nat. median
$33,329
outlier · 3.2×
426
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 14 $83,897.56 $316,660.87 $103,843.79 nat. median
$2,736
outlier · 38.0×
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 8 $14,791.42 $123,492.17 $101,232.80 nat. median
$99,483
1.0× median
8
MS_DRG 		Simultaneous Pancreas/kidney Transplant 7 $77,590.09 $275,556.00 $98,315.51 nat. median
$32,772
outlier · 3.0×
215
MS_DRG 		Other Heart Assist System Implant 15 $84,847.90 $320,270.21 $98,095.36 nat. median
$73,023
1.3× median
5
MS_DRG 		Liver Transplant With Mcc Or Intestinal Transplant 14 $85,282.49 $321,920.71 $97,928.54 nat. median
$69,922
1.4× median
19
MS_DRG 		Simultaneous Pancreas And Kidney Transplant With Hemodialysis 15 $63,616.45 $338,268.00 $95,892.12 nat. median
$45,605
outlier · 2.1×
6021
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 8 $18,804.79 $138,279.39 $78,832.33 nat. median
$29,873
outlier · 2.6×
456
MS_DRG 		Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 15 $22,511.00 $256,015.45 $78,002.49 nat. median
$59,651
1.3× median
A0407
HCPCS 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 7 $67,866.78 $89,040.29 $76,902.95 nat. median
$64,947
1.2× median
6301
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 8 $24,284.20 $230,604.13 $75,975.67 nat. median
$23,172
outlier · 3.3×
41
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 8 $46,694.22 $168,363.35 $75,209.52 nat. median
$43,550
1.7× median
20
MS_DRG 		Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 15 $22,511.00 $243,678.99 $74,272.65 nat. median
$56,428
1.3× median
61
APR_DRG 		Pancreas Transplant 18 $41,902.30 $241,015.82 $71,641.35 nat. median
$43,772
1.6× median
427
MS_DRG 		Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 14 $57,053.21 $214,707.52 $70,617.33 nat. median
$9,905
outlier · 7.1×
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 17 $56,912.05 $368,758.46 $69,559.17 nat. median
$66,211
1.1× median
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 15 $22,511.00 $225,635.30 $68,817.25 nat. median
$52,327
1.3× median
7995211001
NDC 		Loncastuximab Tesirine-lpyl 10 Mg Intravenous Solution 9 $27,211.07 $108,844.29 $68,027.68 —
447
MS_DRG 		Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 14 $53,885.41 $202,676.38 $66,696.40 nat. median
$2,958
outlier · 22.6×
870
MS_DRG 		Septicemia Or Severe Sepsis With Mv >96 Hours 15 $14,754.00 $210,288.04 $64,177.10 nat. median
$48,611
1.3× median
11
APR_DRG 		Liver Transplant And/or Intestinal Transplant 8 $44,740.62 $169,524.82 $63,880.47 nat. median
$48,332
1.3× median
3023789006
NDC 		Sipuleucel-t In Lactated Ringers 50 Million Cell/250 Ml IV Suspension 18 $55,536.50 $332,495.22 $62,718.81 —
A9543
HCPCS 		Y90 Ibritumomab, Rx 15 $41,945.39 $331,372.36 $62,507.01 nat. median
$65,477
1.0× median
228
MS_DRG 		Other Cardiothoracic Procedures With Mcc 15 $40,184.26 $150,640.18 $60,399.87 nat. median
$35,725
1.7× median
7598713015
NDC 		Teprotumumab-trbw 500 Mg Intravenous Solution 9 $16,582.21 $115,544.83 $60,110.50 —
207
MS_DRG 		Respiratory System Diagnosis With Ventilator Support >96 Hours 15 $14,754.00 $195,496.99 $59,705.12 nat. median
$47,121
1.3× median
573
MS_DRG 		Skin Graft For Skin Ulcer Or Cellulitis With Mcc 15 $22,511.00 $186,156.23 $56,881.01 nat. median
$43,299
1.3× median
6071
APR_DRG 		Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 8 $24,260.92 $105,974.22 $56,716.74 nat. median
$31,152
1.8× median
A0406
HCPCS 		Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 7 $49,643.04 $65,130.11 $56,251.64 nat. median
$47,427
1.2× median

Other procedures at this hospital

Browse this hospital's 9,595 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
             
J1414 HCPCS Inj, Beqvez, Per Tx Dose 15 14 — — $3,570,000.00 $4,683,875.00 $3,895,500.00 2025-08-01
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 15 14 — — $3,570,000.00 $4,652,649.17 $3,869,530.00 2025-08-01
J3394 HCPCS Inj, Lovotibeglogene Autotem 15 14 — — $3,162,000.00 $4,148,575.00 $3,450,300.00 2025-08-01
J3393 HCPCS Inj, Betibeglogene Autotemce 15 14 — — $2,856,000.00 $3,722,119.33 $3,095,624.00 2025-08-01
J3399 HCPCS Inj Onase Abepar-xioi Treat 18 14 — — $2,368,485.25 $4,938,583.76 $2,568,519.10 2025-08-01
J3392 HCPCS Inj, Exagamglogene Autotem 18 14 — — $2,244,000.00 $4,752,849.20 $2,471,920.00 2025-08-01
Q2042 HCPCS Tisagenlecleucel Car-pos T 32 16 — — $565,623.84 $3,375,103.79 $636,648.23 2025-08-01
7315390001 NDC Lisocabtagene Maraleucel 1.5 X 10exp6 To 70 X 10exp6 Cell/ml IV Susp 36 18 $3,985,128.00 $1,992,564.00 50% off $516,442.29 $3,011,633.21 $568,086.52 2025-08-01
C9301 HCPCS Obecabtagene Car Pos T 26 15 — — $283,815.00 $1,622,614.88 $328,682.82 2025-08-01
5831 APR_DRG Neonate With Ecmo 36 8 — — $141,506.98 $484,571.75 $247,292.65 2025-08-01
0-D OTHER Kidney Transplant With Hemodialysis With Mcc - Deceased Donor 2 2 — — $145,141.00 $291,282.00 $218,211.50 2025-08-01
1-D OTHER Kidney Transplant With Hemodialysis Without Mcc - Deceased Donor 2 2 — — $145,141.00 $238,389.00 $191,765.00 2025-08-01
0-L OTHER Kidney Transplant With Hemodialysis With Mcc - Living Donor 2 2 — — $122,004.00 $243,226.00 $182,615.00 2025-08-01
2-D OTHER Kidney Transplant - Deceased Donor 2 2 — — $145,141.00 $201,892.00 $173,516.50 2025-08-01
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 36 8 — — $124,900.26 $316,127.86 $170,016.21 2025-08-01
1-L OTHER Kidney Transplant With Hemodialysis Without Mcc - Living Donor 2 2 — — $122,004.00 $199,061.00 $160,532.50 2025-08-01
2-L OTHER Kidney Transplant - Living Donor 2 2 — — $122,004.00 $171,483.00 $146,743.50 2025-08-01
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 28 15 — — $22,511.00 $427,135.77 $129,739.65 2025-08-01
5024255401 NDC Ocrelizumab 920 Mg-hyaluronidase-ocsq 23000 Unit/23 Ml Subcut Soln 12 9 $287,326.24 $143,663.12 50% off $40,225.67 $160,902.69 $122,113.65 2025-08-01
7 MS_DRG Lung Transplant 26 14 — — $104,539.23 $395,056.76 $120,040.76 2025-08-01
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 36 8 — — $54,880.49 $200,824.52 $116,714.60 2025-08-01
5931 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 36 8 — — $18,489.11 $186,215.34 $105,044.61 2025-08-01
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 27 14 — — $83,897.56 $316,660.87 $103,843.79 2025-08-01
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 36 8 — — $14,791.42 $123,492.17 $101,232.80 2025-08-01
8 MS_DRG Simultaneous Pancreas/kidney Transplant 11 7 — — $77,590.09 $275,556.00 $98,315.51 2025-08-01
215 MS_DRG Other Heart Assist System Implant 28 15 — — $84,847.90 $320,270.21 $98,095.36 2025-08-01
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 26 14 — — $85,282.49 $321,920.71 $97,928.54 2025-08-01
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 28 15 — — $63,616.45 $338,268.00 $95,892.12 2025-08-01
6021 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 36 8 — — $18,804.79 $138,279.39 $78,832.33 2025-08-01
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 28 15 — — $22,511.00 $256,015.45 $78,002.49 2025-08-01
A0407 HCPCS Traumatic Spinal Cord Injury M <24.50 And A >=61.50 28 7 — — $67,866.78 $89,040.29 $76,902.95 2025-08-01
6301 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 36 8 — — $24,284.20 $230,604.13 $75,975.67 2025-08-01
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 36 8 — — $46,694.22 $168,363.35 $75,209.52 2025-08-01
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 28 15 — — $22,511.00 $243,678.99 $74,272.65 2025-08-01
61 APR_DRG Pancreas Transplant 64 18 — — $41,902.30 $241,015.82 $71,641.35 2025-08-01
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 27 14 — — $57,053.21 $214,707.52 $70,617.33 2025-08-01
J9029 HCPCS Instill Adstiladrin, Tx Dose 34 17 — — $56,912.05 $368,758.46 $69,559.17 2025-08-01
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 28 15 — — $22,511.00 $225,635.30 $68,817.25 2025-08-01
7995211001 NDC Loncastuximab Tesirine-lpyl 10 Mg Intravenous Solution 14 9 $194,364.80 $97,182.40 50% off $27,211.07 $108,844.29 $68,027.68 2025-08-01
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 27 14 — — $53,885.41 $202,676.38 $66,696.40 2025-08-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 28 15 — — $14,754.00 $210,288.04 $64,177.10 2025-08-01
11 APR_DRG Liver Transplant And/or Intestinal Transplant 36 8 — — $44,740.62 $169,524.82 $63,880.47 2025-08-01
3023789006 NDC Sipuleucel-t In Lactated Ringers 50 Million Cell/250 Ml IV Suspension 36 18 $511,574.00 $255,787.00 50% off $55,536.50 $332,495.22 $62,718.81 2025-08-01
A9543 HCPCS Y90 Ibritumomab, Rx 29 15 — — $41,945.39 $331,372.36 $62,507.01 2025-08-01
228 MS_DRG Other Cardiothoracic Procedures With Mcc 28 15 — — $40,184.26 $150,640.18 $60,399.87 2025-08-01
7598713015 NDC Teprotumumab-trbw 500 Mg Intravenous Solution 28 9 $162,387.20 $81,193.60 50% off $16,582.21 $115,544.83 $60,110.50 2025-08-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 28 15 — — $14,754.00 $195,496.99 $59,705.12 2025-08-01
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 28 15 — — $22,511.00 $186,156.23 $56,881.01 2025-08-01
6071 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 36 8 — — $24,260.92 $105,974.22 $56,716.74 2025-08-01
A0406 HCPCS Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 28 7 — — $49,643.04 $65,130.11 $56,251.64 2025-08-01
28 MS_DRG Spinal Procedures With Mcc 28 15 — — $22,511.00 $183,777.21 $56,161.72 2025-08-01
51 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 36 8 — — $31,411.15 $109,818.96 $55,679.57 2025-08-01
A1806 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 28 7 — — $49,450.68 $72,473.96 $55,533.88 2025-08-01
33276 HCPCS Insj Phrnc Nrv Stim Sys 26 15 — — $47,880.66 $273,741.22 $55,450.03 2025-08-01
A0404 HCPCS Traumatic Spinal Cord Injury M <31.50 And A <61.50 28 7 — — $48,922.69 $64,184.48 $55,435.84 2025-08-01
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 27 14 — — $44,329.46 $166,383.44 $54,868.57 2025-08-01
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 28 15 — — $22,511.00 $176,002.31 $53,811.03 2025-08-01
0003712511 NDC Nivolumab 240 Mg-relatlimab-rmbw 80 Mg/20 Ml Intravenous Solution 28 9 $157,850.70 $78,925.35 50% off $14,732.73 $117,861.86 $53,406.15 2025-08-01
457 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 28 15 — — $22,511.00 $173,496.32 $53,053.36 2025-08-01
6091 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 36 8 — — $32,855.30 $207,855.27 $52,751.32 2025-08-01
6031 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 36 8 — — $15,795.28 $172,243.71 $51,936.32 2025-08-01
653 MS_DRG Major Bladder Procedures With Mcc 28 15 — — $22,511.00 $168,514.58 $51,547.15 2025-08-01
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 27 14 — — $41,511.87 $155,682.37 $51,381.11 2025-08-01
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 28 15 — — $22,511.00 $167,084.75 $51,114.86 2025-08-01
5024210501 NDC Polatuzumab Vedotin-piiq 140 Mg Intravenous Solution 28 9 $137,300.23 $68,650.12 50% off $18,135.21 $81,235.40 $50,772.12 2025-08-01
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 28 15 — — $22,511.00 $164,104.17 $50,213.70 2025-08-01
A0106 HCPCS Stroke M <41.50 And A <84.50 28 7 — — $44,921.86 $61,210.72 $50,047.11 2025-08-01
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 28 15 — — $22,511.00 $163,266.83 $49,960.54 2025-08-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 28 15 — — $22,511.00 $163,112.66 $49,913.92 2025-08-01
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 28 15 — — $22,511.00 $163,094.52 $49,908.44 2025-08-01
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 28 15 — — $22,511.00 $155,165.46 $47,511.13 2025-08-01
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 28 15 — — $31,643.92 $118,204.46 $47,463.99 2025-08-01
A0505 HCPCS Non-traumatic Spinal Cord Injury M <39.50 28 7 — — $41,807.14 $63,525.28 $47,355.82 2025-08-01
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 28 15 — — $37,488.00 $154,004.66 $47,160.18 2025-08-01
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 28 15 — — $22,511.00 $153,533.09 $47,017.61 2025-08-01
278 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 28 15 — — $39,990.00 $151,244.76 $46,325.74 2025-08-01
6 MS_DRG Liver Transplant Without Mcc 26 14 — — $39,116.91 $146,586.47 $44,917.33 2025-08-01
L2006 HCPCS Kaf Sng/dbl Swg/stn Mcpr Cus 26 15 — — $38,584.77 $220,595.21 $44,684.57 2025-08-01
6311 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 36 8 — — $6,325.78 $204,062.25 $44,642.18 2025-08-01
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 28 15 — — $22,511.00 $144,358.59 $44,243.74 2025-08-01
A0405 HCPCS Traumatic Spinal Cord Injury M >=31.50 And M <41.50 28 7 — — $38,905.26 $51,042.63 $44,085.25 2025-08-01
799 MS_DRG Splenic Procedures With Mcc 28 15 — — $22,511.00 $143,732.85 $44,054.55 2025-08-01
A0105 HCPCS Stroke M <41.50 And A >=84.50 28 7 — — $39,496.69 $53,816.32 $44,000.79 2025-08-01
4401 APR_DRG Kidney Transplant 62 17 — — $24,966.86 $107,923.64 $43,755.48 2025-08-01
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 28 15 — — $22,511.00 $141,456.61 $43,366.35 2025-08-01
A0205 HCPCS Traumatic Brain Injury M <35.50 28 7 — — $38,029.38 $55,568.56 $43,020.59 2025-08-01
163 MS_DRG Major Chest Procedures With Mcc 28 15 — — $22,511.00 $139,331.51 $42,723.84 2025-08-01
650 MS_DRG Kidney Transplant With Hemodialysis With Mcc 26 14 — — $37,191.56 $139,274.07 $42,706.48 2025-08-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 28 15 — — $22,511.00 $138,808.55 $42,565.73 2025-08-01
7289300803 NDC Vincristine Sulfate Liposomal 5 Mg/31 Ml(0.16 Mg/ml)(final Conc)iv Kit 14 9 $119,883.26 $59,941.63 50% off $3,933.90 $67,134.63 $41,959.14 2025-08-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 28 15 — — $22,511.00 $136,381.16 $41,831.82 2025-08-01
6081 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 36 8 — — $13,876.59 $66,955.36 $41,494.73 2025-08-01
901 MS_DRG Wound Debridements For Injuries With Mcc 28 15 — — $22,511.00 $133,929.58 $41,090.60 2025-08-01
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 27 14 — — $33,022.47 $123,440.12 $40,873.40 2025-08-01
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 28 15 — — $21,439.00 $132,789.95 $40,746.04 2025-08-01
A1705 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 28 7 — — $35,043.60 $55,221.06 $40,730.46 2025-08-01
1601 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 36 8 — — $22,522.32 $139,980.06 $40,625.85 2025-08-01
458 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 28 15 — — $22,511.00 $130,528.82 $40,062.41 2025-08-01
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 28 15 — — $22,511.00 $128,947.85 $39,584.41 2025-08-01
140 MS_DRG Major Head And Neck Procedures With Mcc 28 15 — — $22,511.00 $127,844.49 $39,250.81 2025-08-01
402 MS_DRG Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical 27 14 — — $31,659.04 $118,261.89 $39,185.82 2025-08-01
A1805 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 28 7 — — $34,820.53 $51,032.10 $39,103.26 2025-08-01
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 28 15 — — $22,511.00 $124,235.14 $38,159.55 2025-08-01
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 28 15 — — $22,511.00 $124,050.75 $38,103.79 2025-08-01
A0305 HCPCS Non-traumatic Brain Injury M <42.50 And A <78.50 28 7 — — $33,801.40 $50,219.15 $37,973.52 2025-08-01
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 28 15 — — $25,361.64 $94,344.71 $37,948.35 2025-08-01
31 MS_DRG Ventricular Shunt Procedures With Mcc 28 15 — — $22,511.00 $126,677.65 $37,803.36 2025-08-01
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 28 15 — — $22,511.00 $122,953.43 $37,772.03 2025-08-01
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 28 15 — — $25,244.63 $93,900.34 $37,771.13 2025-08-01
6121 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 36 8 — — $19,579.93 $75,697.80 $37,678.36 2025-08-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 28 15 — — $22,511.00 $126,647.42 $37,642.07 2025-08-01
33287 HCPCS Rmv&rplcmt Phrnc Nrv Stim Pg 26 15 — — $32,423.98 $185,373.00 $37,549.83 2025-08-01
0674T CPT Laps Insj Nw/rpcmt Prm Isdss 26 15 — — $32,423.98 $185,373.00 $37,549.83 2025-08-01
A0604 HCPCS Neurological M <43.50 28 7 — — $32,125.34 $52,449.48 $37,407.23 2025-08-01
A1504 HCPCS Pulmonary M <45.50 28 7 — — $33,234.53 $47,900.37 $37,170.54 2025-08-01
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 28 15 — — $27,518.60 $102,536.77 $37,025.51 2025-08-01
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 28 15 — — $22,511.00 $120,423.27 $37,007.05 2025-08-01
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 28 15 — — $22,511.00 $120,338.63 $36,981.46 2025-08-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 28 15 — — $22,511.00 $119,274.57 $36,659.75 2025-08-01
0074501501 NDC Risankizumab-rzaa 60 Mg/ml Intravenous Solution 28 9 $108,292.59 $54,146.29 50% off $10,107.31 $80,858.47 $36,638.99 2025-08-01
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 28 15 — — $22,511.00 $119,029.71 $36,585.71 2025-08-01
876 MS_DRG O.r. Procedures With Principal Diagnosis Of Mental Illness 28 15 — — $22,511.00 $118,787.88 $36,512.60 2025-08-01
6111 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 36 8 — — $12,242.76 $85,890.83 $36,462.87 2025-08-01
0408T CPT Insj/rplc Cardiac Modulj Sys 28 15 — — $16,520.92 $195,032.88 $36,454.75 2025-08-01
0571T CPT Insj/rplcmt Icds Ss Eltrd 28 15 — — $23,533.24 $195,032.88 $36,454.75 2025-08-01
1831 APR_DRG Percutaneous Structural Cardiac Procedures 36 8 — — $28,233.20 $66,478.89 $36,307.59 2025-08-01
279 MS_DRG Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures … 28 15 — — $26,025.44 $96,865.81 $36,101.43 2025-08-01
A1304 HCPCS Rheumatoid Other Arthritis M <44.50 And A >=64.50 28 7 — — $32,178.55 $45,103.52 $35,916.71 2025-08-01
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 28 15 — — $22,511.00 $116,717.19 $35,886.55 2025-08-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 28 15 — — $22,511.00 $116,390.72 $35,787.83 2025-08-01
467 MS_DRG Revision Of Hip Or Knee Replacement With Cc 28 15 — — $27,782.85 $103,540.37 $35,667.43 2025-08-01
A2005 HCPCS Miscellaneous M <46.50 And A <77.50 28 7 — — $30,872.91 $46,779.95 $35,607.12 2025-08-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 28 15 — — $22,511.00 $128,666.69 $35,532.84 2025-08-01
A0403 HCPCS Traumatic Spinal Cord Injury M >=41.50 And M <47.50 28 7 — — $31,333.36 $41,108.31 $35,504.84 2025-08-01
A0104 HCPCS Stroke M >=41.50 And M <50.50 28 7 — — $31,585.07 $43,037.46 $35,187.57 2025-08-01
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 28 15 — — $26,537.22 $98,809.53 $35,167.15 2025-08-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 28 15 — — $22,511.00 $114,026.81 $35,073.12 2025-08-01
6131 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 36 8 — — $16,192.44 $86,293.53 $34,874.85 2025-08-01
A1704 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50 28 7 — — $29,861.96 $47,055.84 $34,707.43 2025-08-01
791 MS_DRG Prematurity With Major Problems 27 15 — — $32,834.63 $122,726.72 $34,679.78 2025-08-01
64582 HCPCS Opn Mpltj Hpglsl Nstm Ary Pg 28 15 — — $21,089.53 $185,373.00 $34,649.16 2025-08-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 28 15 — — $23,179.19 $86,055.92 $34,642.65 2025-08-01
A1604 HCPCS Pain Syndrome M <43.50 28 7 — — $29,855.82 $49,439.91 $34,436.85 2025-08-01
A0304 HCPCS Non-traumatic Brain Injury M <42.50 And A >=78.50 28 7 — — $30,649.84 $45,535.26 $34,432.54 2025-08-01
A1305 HCPCS Rheumatoid Other Arthritis M <51.50 And A <64.50 28 7 — — $30,815.60 $43,193.31 $34,395.31 2025-08-01
A0904 HCPCS Other Orthopedic M <44.5 28 7 — — $29,935.63 $45,103.52 $34,387.37 2025-08-01
L6700 HCPCS Ue Add Ext Power Myoel 26 15 — — $29,510.19 $168,714.39 $34,175.40 2025-08-01
A0504 HCPCS Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 28 7 — — $30,087.06 $45,716.38 $34,079.39 2025-08-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 28 15 — — $22,511.00 $109,531.76 $33,714.08 2025-08-01
64568 HCPCS Opn Impltj Crnl Nrv Nea&pg 35 18 — — $853.60 $185,373.00 $33,695.51 2025-08-01
0187001050_2 NDC Sodium Benzoate-sod Phenylacet 20 %-10 % Intravenous Solution (peds/nicu) 24 9 $121,790.91 $60,895.45 50% off $8,883.57 $124,799.86 $33,672.32 2025-08-01
A0204 HCPCS Traumatic Brain Injury M >=35.50 And M <49.50 28 7 — — $29,690.05 $43,380.75 $33,586.32 2025-08-01
1671 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 36 8 — — $23,244.74 $80,142.79 $33,497.11 2025-08-01
A1204 HCPCS Osteoarthritis M <49.50 And A <74.50 28 7 — — $29,123.18 $45,990.18 $33,379.18 2025-08-01
802 MS_DRG Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc 28 15 — — $22,511.00 $108,364.92 $33,361.29 2025-08-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 28 15 — — $14,754.00 $108,358.87 $33,359.46 2025-08-01
A2004 HCPCS Miscellaneous M <46.50 And A >=77.50 29 7 — — $49.73 $44,381.14 $33,115.79 2025-08-01
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 28 15 — — $22,511.00 $107,349.22 $33,054.19 2025-08-01
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 28 15 — — $22,511.00 $115,987.36 $32,864.09 2025-08-01
A0805 HCPCS Replacement Of Lower-extremity Joint M <42.50 28 7 — — $28,783.47 $43,412.34 $32,803.97 2025-08-01
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 28 15 — — $22,511.00 $106,424.22 $32,774.53 2025-08-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 28 15 — — $22,511.00 $105,883.12 $32,610.93 2025-08-01
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 28 15 — — $22,511.00 $113,116.92 $32,553.48 2025-08-01
651 MS_DRG Kidney Transplant With Hemodialysis Without Mcc 26 14 — — $28,159.33 $104,970.20 $32,334.93 2025-08-01
332 MS_DRG Rectal Resection With Mcc 28 15 — — $22,511.00 $104,855.33 $32,300.18 2025-08-01
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 28 15 — — $22,511.00 $104,740.46 $32,265.45 2025-08-01
A1804 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 28 7 — — $28,720.03 $42,091.85 $32,253.10 2025-08-01
271 MS_DRG Other Major Cardiovascular Procedures With Cc 28 15 — — $22,511.00 $104,120.77 $32,078.09 2025-08-01
665 MS_DRG Prostatectomy With Mcc 28 15 — — $22,511.00 $103,794.29 $31,979.39 2025-08-01
5047498079 NDC Rozanolixizumab-noli 140 Mg/ml Subcutaneous Solution 42 9 $85,269.94 $42,634.97 50% off $8,953.34 $71,626.75 $31,976.23 2025-08-01
252 MS_DRG Other Vascular Procedures With Mcc 28 15 — — $22,511.00 $103,697.56 $31,950.14 2025-08-01
A1203 HCPCS Osteoarthritis M <49.50 And A >=74.50 28 7 — — $27,770.47 $43,856.73 $31,829.99 2025-08-01
1301 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 36 8 — — $23,142.03 $50,698.06 $31,564.09 2025-08-01
619 MS_DRG O.r. Procedures For Obesity With Mcc 28 15 — — $22,221.69 $82,419.37 $31,283.35 2025-08-01
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 28 15 — — $22,511.00 $101,469.68 $31,276.56 2025-08-01
C9760 HCPCS Non-blind Interatrial Shunt 28 15 — — $19,291.61 $167,287.48 $31,268.69 2025-08-01
264 MS_DRG Other Circulatory System O.r. Procedures 28 15 — — $22,511.00 $105,653.38 $31,251.32 2025-08-01
451 MS_DRG Single Level Spinal Fusion Except Cervical Without Mcc 27 14 — — $25,083.05 $93,286.69 $31,046.43 2025-08-01
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 28 15 — — $22,511.00 $99,813.14 $30,775.71 2025-08-01
A1703 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50 28 7 — — $26,385.02 $41,573.75 $30,665.10 2025-08-01
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 28 15 — — $22,511.00 $98,486.08 $30,374.48 2025-08-01
8631 APR_DRG Neonatal Aftercare 36 8 — — $9,704.37 $88,261.26 $30,105.25 2025-08-01
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 28 15 — — $22,511.00 $97,316.22 $30,020.78 2025-08-01
A1503 HCPCS Pulmonary M >=45.50 And M <56.50 28 7 — — $26,837.29 $38,680.01 $30,014.74 2025-08-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 28 15 — — $22,511.00 $98,528.40 $29,987.61 2025-08-01
A0603 HCPCS Neurological M >=43.50 And M <52.50 28 7 — — $25,615.54 $41,822.27 $29,827.41 2025-08-01
7269495401 NDC Pegaspargase 750 Unit/ml Injection Solution 43 19 $178,767.68 $89,383.84 50% off $24,363.48 $157,861.80 $29,777.58 2025-08-01
840 MS_DRG Lymphoma And Non-acute Leukemia With Mcc 28 15 — — $22,511.00 $96,400.28 $29,743.86 2025-08-01
A0303 HCPCS Non-traumatic Brain Injury M >=42.50 And M <52.50 28 7 — — $26,434.14 $39,273.92 $29,697.40 2025-08-01
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 28 15 — — $22,511.00 $95,946.85 $29,606.76 2025-08-01
500 MS_DRG Soft Tissue Procedures With Mcc 28 15 — — $22,511.00 $95,786.63 $29,558.32 2025-08-01
3982212012 NDC Neomycin 40 Mg-polymyxin B 200000 Unit/ml Gu Irrigation Solution 144 9 $75,935.88 $37,967.94 50% off $2,410.47 $159,535.09 $29,543.54 2025-08-01
A1803 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 28 7 — — $26,264.28 $38,490.47 $29,494.78 2025-08-01
7290385301 NDC Mirvetuximab Soravtansine-gynx 5 Mg/ml Intravenous Solution 28 9 $141,361.71 $70,680.85 50% off $6,357.42 $132,895.44 $29,326.76 2025-08-01
5114400301 NDC Tisotumab Vedotin-tftv 40 Mg Intravenous Solution 24 9 $133,502.83 $66,751.42 50% off $6,980.54 $121,601.01 $29,161.21 2025-08-01
662 MS_DRG Minor Bladder Procedures With Mcc 28 15 — — $22,511.00 $94,302.39 $29,109.56 2025-08-01
6141 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 36 8 — — $10,046.75 $61,801.62 $28,921.78 2025-08-01
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 28 15 — — $22,511.00 $93,480.16 $28,860.97 2025-08-01
A0903 HCPCS Other Orthopedic M >=44.50 And M <51.50 28 7 — — $24,983.20 $37,641.72 $28,698.17 2025-08-01
A0503 HCPCS Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50 28 7 — — $25,310.62 $38,458.88 $28,668.76 2025-08-01
1012251001 NDC Poractant Alfa 120 Mg/1.5 Ml Intratracheal Suspension 24 9 $69,587.46 $34,793.73 50% off $9,060.29 $58,453.47 $28,646.83 2025-08-01
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 28 15 — — $22,511.00 $92,760.71 $28,643.46 2025-08-01
211 APR_DRG Open Craniotomy Except Trauma 36 8 — — $16,070.54 $62,726.56 $28,487.86 2025-08-01
A1303 HCPCS Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50 28 7 — — $25,480.48 $35,714.68 $28,441.53 2025-08-01
A0402 HCPCS Traumatic Spinal Cord Injury M >=47.50 And M <56.50 28 7 — — $24,968.87 $32,757.75 $28,292.40 2025-08-01
A2003 HCPCS Miscellaneous M >=46.50 And M <55.50 28 7 — — $24,496.13 $37,119.42 $28,253.47 2025-08-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 28 15 — — $21,400.28 $79,299.74 $28,113.51 2025-08-01
570 MS_DRG Skin Debridement With Mcc 28 15 — — $22,511.00 $90,995.34 $28,109.71 2025-08-01
0187001050 NDC Sodium Benzoate 10 %-sodium Phenylacetate 10 % Intravenous Solution 24 9 $74,530.12 $37,265.07 50% off $8,883.57 $65,251.27 $28,088.10 2025-08-01
1691 APR_DRG Major Abdominal Vascular Procedures 36 8 — — $21,183.62 $57,371.90 $27,977.33 2025-08-01
A1603 HCPCS Pain Syndrome M >=43.50 And M <58.50 28 7 — — $24,097.08 $39,903.64 $27,794.50 2025-08-01
911 APR_DRG Other Major Head And Neck Procedures 36 8 — — $12,100.33 $63,767.65 $27,673.79 2025-08-01
0923T CPT Rmvl&rplcmt Perm Ccm-d Pg 26 15 — — $23,882.81 $136,541.77 $27,658.40 2025-08-01
250 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc 28 15 — — $18,927.32 $69,907.59 $27,604.03 2025-08-01
A0103 HCPCS Stroke M >=50.50 And M <63.50 28 7 — — $24,747.85 $33,722.33 $27,572.59 2025-08-01
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 28 15 — — $22,511.00 $89,133.23 $27,546.72 2025-08-01
243 MS_DRG Permanent Cardiac Pacemaker Implant With Cc 28 15 — — $18,451.36 $68,099.89 $27,481.51 2025-08-01
A0804 HCPCS Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 28 7 — — $23,998.85 $36,196.96 $27,352.21 2025-08-01
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 28 15 — — $22,511.00 $93,220.19 $27,319.20 2025-08-01
668 MS_DRG Transurethral Procedures With Mcc 28 15 — — $22,511.00 $88,156.83 $27,251.50 2025-08-01
800 MS_DRG Splenic Procedures With Cc 28 15 — — $22,511.00 $88,081.26 $27,228.65 2025-08-01
A0203 HCPCS Traumatic Brain Injury M >=49.50 And M <61.50 28 7 — — $23,937.45 $34,977.55 $27,079.65 2025-08-01
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 28 15 — — $22,511.00 $86,669.57 $26,801.83 2025-08-01
891 APR_DRG Major Cranial Or Facial Bone Procedures 36 8 — — $13,712.24 $52,229.18 $26,735.24 2025-08-01
510 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc 28 15 — — $22,511.00 $86,397.50 $26,719.58 2025-08-01
301 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 36 8 — — $14,840.04 $46,255.63 $26,593.82 2025-08-01
0817T CPT Opn Insj/rplcmt Ins Ptn Subf 26 15 — — $22,816.89 $130,447.74 $26,423.97 2025-08-01
0680T CPT Insj/rplcmt Pg Only Isdss 26 15 — — $22,816.89 $130,447.74 $26,423.97 2025-08-01
0816T CPT Opn Insj/rplcmt Ins Ptn Subq 26 15 — — $22,816.89 $130,447.74 $26,423.97 2025-08-01
A1502 HCPCS Pulmonary M >=56.50 And M <68.50 28 7 — — $23,614.11 $34,034.03 $26,409.86 2025-08-01
J9600 HCPCS Porfimer Sodium Injection 30 16 — — $15,332.23 $141,288.03 $26,408.97 2025-08-01
654 MS_DRG Major Bladder Procedures With Cc 28 15 — — $22,511.00 $85,309.26 $26,390.56 2025-08-01
201 APR_DRG Open Craniotomy For Trauma 36 8 — — $17,109.32 $56,196.86 $26,372.92 2025-08-01
0310450525 NDC Tremelimumab-actl 20 Mg/ml Intravenous Solution 28 9 $152,972.21 $76,486.11 50% off $3,294.79 $158,149.72 $26,358.29 2025-08-01
406 MS_DRG Pancreas, Liver And Shunt Procedures With Cc 28 15 — — $22,511.00 $84,895.12 $26,265.34 2025-08-01
6231 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 36 8 — — $9,294.88 $50,941.38 $26,056.69 2025-08-01
1012251003 NDC Poractant Alfa 240 Mg/3 Ml Intratracheal Suspension 24 9 $63,265.14 $31,632.57 50% off $8,237.12 $53,142.72 $26,044.15 2025-08-01
A1702 HCPCS Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50 28 7 — — $22,204.10 $34,985.98 $25,806.20 2025-08-01
231 APR_DRG Spinal Procedures 36 8 — — $13,810.17 $57,589.78 $25,726.62 2025-08-01
0614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 28 15 — — $16,520.92 $136,541.77 $25,521.83 2025-08-01
0414T CPT Rmvl & Rpl Car Modulj Pls Gn 28 15 — — $16,520.92 $136,541.77 $25,521.83 2025-08-01
0409T CPT Insj/rplc Car Modulj Pls Gn 28 15 — — $16,520.92 $136,541.77 $25,521.83 2025-08-01
0515T CPT Insj Wcs Lv Compl Sys 28 15 — — $16,520.92 $136,541.77 $25,521.83 2025-08-01
963 MS_DRG Other Multiple Significant Trauma With Mcc 28 15 — — $14,754.00 $82,123.12 $25,427.24 2025-08-01
A0602 HCPCS Neurological M >=52.50 And M <64.50 28 7 — — $21,739.55 $35,493.54 $25,314.79 2025-08-01
61 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 28 15 — — $14,754.00 $81,721.08 $25,305.69 2025-08-01
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 28 15 — — $21,966.99 $81,452.04 $25,224.35 2025-08-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 28 15 — — $14,754.00 $81,128.59 $25,126.56 2025-08-01
263 MS_DRG Vein Ligation And Stripping 28 15 — — $21,868.29 $81,077.20 $25,111.01 2025-08-01
8501 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 28 7 — — $14,396.32 $75,006.01 $25,061.40 2025-08-01
A0502 HCPCS Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 28 7 — — $22,079.27 $33,551.75 $25,010.85 2025-08-01
A1302 HCPCS Rheumatoid Other Arthritis M >=51.50 And M <62.50 28 7 — — $22,396.46 $31,393.02 $25,000.25 2025-08-01
577 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 28 15 — — $21,714.68 $80,493.78 $24,934.62 2025-08-01
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc 28 15 — — $21,612.80 $80,106.85 $24,817.64 2025-08-01
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/mcc 28 15 — — $21,564.25 $79,922.45 $24,761.89 2025-08-01
3121 APR_DRG Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 36 8 — — $11,145.78 $66,012.61 $24,731.65 2025-08-01
A0302 HCPCS Non-traumatic Brain Injury M >=52.50 And M <65.50 28 7 — — $21,968.76 $32,639.82 $24,682.10 2025-08-01
7011434001 NDC Toripalimab-tpzi 240 Mg/6 Ml (40 Mg/ml) Intravenous Solution 28 9 $67,553.60 $33,776.80 50% off $9,055.66 $39,437.40 $24,648.37 2025-08-01
A1202 HCPCS Osteoarthritis M >=49.50 And M <61.50 28 7 — — $21,436.68 $33,852.91 $24,569.53 2025-08-01
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 28 15 — — $21,346.16 $79,094.18 $24,511.47 2025-08-01
A0803 HCPCS Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 28 7 — — $21,422.35 $32,309.16 $24,414.15 2025-08-01
64580 HCPCS Opn Impltj Nea Neuromuscular 28 15 — — $14,670.16 $130,447.74 $24,382.76 2025-08-01
749 MS_DRG Other Female Reproductive System O.r. Procedures With Cc/mcc 28 15 — — $21,124.10 $78,250.79 $24,328.62 2025-08-01
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 28 15 — — $21,089.88 $78,120.80 $24,307.44 2025-08-01
Q0483 HCPCS Monitor Elec Vad, Rep 27 16 — — $10,923.19 $128,829.96 $24,301.29 2025-08-01
6801 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 36 8 — — $12,515.30 $72,646.60 $24,213.42 2025-08-01
253 MS_DRG Other Vascular Procedures With Cc 28 15 — — $20,840.74 $77,174.64 $24,153.26 2025-08-01
9121 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 36 8 — — $16,081.51 $59,018.31 $24,137.48 2025-08-01
L5858 HCPCS Stance Phase Only 27 16 — — $10,971.23 $127,701.10 $24,088.35 2025-08-01
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 28 15 — — $20,802.54 $77,029.54 $24,083.03 2025-08-01
A0902 HCPCS Other Orthopedic M >=51.50 And M <63.50 28 7 — — $20,920.97 $31,521.50 $24,032.03 2025-08-01
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 28 15 — — $20,617.09 $76,325.20 $24,014.85 2025-08-01
164 MS_DRG Major Chest Procedures With Cc 28 15 — — $20,554.21 $76,086.39 $23,975.94 2025-08-01
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/mcc 28 15 — — $20,436.41 $75,639.00 $23,903.03 2025-08-01
271 APR_DRG Other Open Craniotomy 36 8 — — $14,496.98 $58,797.04 $23,737.49 2025-08-01
61885 HCPCS Insrt/redo Neurostim 1 Array 35 18 — — $853.60 $130,447.74 $23,711.67 2025-08-01
61891 HCPCS Rev/rplcmt Sk-mnt Crnl Nstm 35 18 — — $853.60 $130,447.74 $23,711.67 2025-08-01
64590 HCPCS Ins/rpl Prph Sac/gstr Npg/r 35 18 — — $853.60 $130,447.74 $23,711.67 2025-08-01
A2002 HCPCS Miscellaneous M >=55.50 And M <66.50 28 7 — — $20,456.42 $30,997.08 $23,593.50 2025-08-01
6211 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 36 8 — — $4,779.60 $72,708.48 $23,552.96 2025-08-01
2601 APR_DRG Major Pancreas, Liver And Shunt Procedures 36 8 — — $14,642.83 $59,691.46 $23,539.99 2025-08-01
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 28 15 — — $19,846.63 $73,399.03 $23,538.03 2025-08-01
0801T CPT Tcat Rmv&rpl 2chmbr Ldls Pm 26 15 — — $20,291.77 $116,011.22 $23,499.66 2025-08-01
0795T CPT Tcat Ins 2chmbr Ldls Pm Cmpl 26 15 — — $20,291.77 $116,011.22 $23,499.66 2025-08-01
0796T CPT Tcat Ins 2chmbr Ldls Pm Ra 26 15 — — $20,291.77 $116,011.22 $23,499.66 2025-08-01
0802T CPT Tcat Rmv&rpl2chmb Ldls Pm Ra 26 15 — — $20,291.77 $116,011.22 $23,499.66 2025-08-01
0797T CPT Tcat Ins 2chmbr Ldls Pm Rv 26 15 — — $20,291.77 $116,011.22 $23,499.66 2025-08-01
0803T CPT Tcat Rmv&rpl2chmb Ldls Pm Rv 26 15 — — $20,291.77 $116,011.22 $23,499.66 2025-08-01
135 MS_DRG Sinus And Mastoid Procedures With Cc/mcc 28 15 — — $19,711.32 $72,885.14 $23,454.29 2025-08-01
1201 APR_DRG Major Respiratory And Chest Procedures 36 8 — — $13,644.46 $60,174.70 $23,405.50 2025-08-01
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 28 15 — — $19,630.93 $72,579.83 $23,404.54 2025-08-01
L6975 HCPCS Interscap-thor Myoelectronic 27 16 — — $10,632.57 $123,759.07 $23,344.76 2025-08-01
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 28 15 — — $19,435.93 $71,839.22 $23,283.86 2025-08-01
330 MS_DRG Major Small And Large Bowel Procedures With Cc 28 15 — — $19,334.05 $71,452.29 $23,220.81 2025-08-01
827 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 28 15 — — $19,303.81 $71,337.42 $23,202.10 2025-08-01
1811 APR_DRG Lower Extremity Arterial Procedures 36 8 — — $11,249.87 $49,942.69 $23,016.40 2025-08-01
3251 APR_DRG Non-elective Or Complex Knee Joint Replacement 36 8 — — $15,365.25 $43,078.95 $22,962.17 2025-08-01
A1802 HCPCS Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 28 7 — — $20,442.09 $29,958.79 $22,956.99 2025-08-01
674 MS_DRG Other Kidney And Urinary Tract Procedures With Cc 28 15 — — $18,893.90 $69,780.62 $22,948.42 2025-08-01
54410 HCPCS Remove/replace Penis Prosth 28 15 — — $13,085.10 $122,443.48 $22,886.63 2025-08-01
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