Hospital

BON SECOURS SOUTHAMPTON MEMORIAL HOSPITAL

Franklin, VA · CCN 490092 · Rates published

Your selected procedure

You selected 481 (MS_DRG)

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

This hospital’s price: $20,876 across 21 payers · range $12,934-$39,796

Source: https://www.bonsecours.com/-/media/bon-secours/patients-and-visitors/corporate/pricing/843041473_bon-secours-mercy-health-franklin-llc_standardcharges.ashx · observed 2026-04-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

191 distinct procedures filed

27 distinct payers

16,983 rate rows

2026-04-01 last MRF observed

Data quality

4,150 of 16,983 rate rows are consumer-grade (24.4%)

12,833 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	12,830
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings	3

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

Source MRF file	https://www.bonsecours.com/-/media/bon-secours/patients-and-visitors/corporate/pricing/843041473_bon-secours-mercy-health-franklin-llc_standardcharges.ashx
Found on page	https://www.bonsecours.com/patient-resources/estimate-your-cost
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-22
Content fingerprint	e3628d82d15578ae… · 4,789,003 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
853 MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	21	$30,495.86	$93,833.40	$49,223.03	nat. median $45,362 1.1× median
981 MS_DRG	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	21	$28,971.87	$89,144.20	$46,763.17	nat. median $43,609 1.1× median
463 MS_DRG	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective…	26	$7,207.47	$108,290.50	$40,385.94	nat. median $49,873 0.8× median
939 MS_DRG	O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc	21	$22,405.99	$68,941.50	$36,165.26	nat. median $32,064 1.1× median
616 MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	21	$21,534.70	$66,260.60	$34,758.92	nat. median $33,713 1.0× median
45 MS_DRG	Cva And Precerebral Occlusion With Infarction,extreme	5	$30,496.40	$32,021.22	$30,496.40	nat. median $12,256 outlier · 2.5×
208 MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	21	$16,973.22	$52,225.30	$27,396.29	nat. median $25,366 1.1× median
478 MS_DRG	Biopsies Of Musculoskeletal System And Connective Tissue With Cc	21	$15,185.56	$46,724.80	$24,510.85	nat. median $22,770 1.1× median
133 MS_DRG	Respiratory Failure,extreme	5	$24,415.50	$25,636.27	$24,415.50	nat. median $6,311 outlier · 3.9×
674 MS_DRG	Other Kidney And Urinary Tract Procedures With Cc	21	$14,440.86	$44,433.40	$23,308.83	nat. median $22,166 1.1× median
56 MS_DRG	Degenerative Nervous System Disorders With Mcc	21	$14,345.14	$44,138.90	$23,154.34	nat. median $21,142 1.1× median
481 MS_DRG	Hip And Femur Procedures Except Major Joint With Cc	21	$12,933.54	$39,795.50	$20,875.88	nat. median $20,298 1.0× median
470 MS_DRG	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without…	21	$12,692.00	$36,649.10	$20,486.00	nat. median $18,811 1.1× median
522 MS_DRG	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	21	$12,692.00	$40,236.30	$20,486.00	nat. median $20,537 1.0× median
468 MS_DRG	Revision Of Hip Or Knee Replacement Without Cc/mcc	21	$12,692.00	$52,212.00	$20,486.00	nat. median $25,650 0.8× median
854 MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Cc	10	$14,578.00	$23,977.20	$19,915.06	nat. median $19,195 1.0× median
871 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	21	$11,994.94	$36,907.50	$19,360.90	nat. median $18,625 1.0× median
617 MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	21	$11,549.10	$35,535.70	$18,641.28	nat. median $18,267 1.0× median
504 MS_DRG	Foot Procedures With Cc	21	$11,542.31	$35,514.80	$18,630.32	nat. median $17,694 1.1× median
27487 CPT	Revj Tot Knee Arthrp Fem&Entire Tibial Compone\|RIGHT Side	3	$18,322.11	$18,688.55	$18,322.11	nat. median $12,000 1.5× median
23472 CPT	Arthroplasty Glenohumeral Joint Total Shoulder\|LEFT Side	3	$18,322.11	$18,688.55	$18,322.11	nat. median $16,661 1.1× median
435 MS_DRG	Malignancy Of Hepatobiliary System Or Pancreas With Mcc	21	$11,341.62	$34,897.30	$18,306.39	nat. median $17,657 1.0× median
205 MS_DRG	Other Respiratory System Diagnoses With Mcc	21	$11,306.43	$34,789.00	$18,249.58	nat. median $17,319 1.1× median
377 MS_DRG	Gastrointestinal Hemorrhage With Mcc	21	$11,287.90	$34,732.00	$18,219.68	nat. median $17,281 1.1× median
441 MS_DRG	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc	21	$11,082.27	$34,099.30	$17,887.77	nat. median $17,416 1.0× median
505 MS_DRG	Foot Procedures Without Cc/mcc	21	$11,070.54	$34,063.20	$17,868.84	nat. median $17,216 1.0× median
580 MS_DRG	Other Skin, Subcutaneous Tissue And Breast Procedures With Cc	21	$10,670.40	$32,832.00	$17,222.98	nat. median $16,842 1.0× median
70 MS_DRG	Other Cerebrovascular Disorders With Mcc	21	$10,280.14	$31,631.20	$16,593.06	nat. median $16,310 1.0× median
438 MS_DRG	Disorders Of Pancreas Except Malignancy With Mcc	21	$10,066.49	$30,973.80	$16,248.20	nat. median $15,951 1.0× median
280 MS_DRG	Acute Myocardial Infarction, Discharged Alive With Mcc	21	$9,905.32	$30,477.90	$15,988.06	nat. median $15,645 1.0× median
326 MS_DRG	Elective Knee Joint Replacement,moderate	5	$15,873.68	$16,667.36	$15,873.68	nat. median $46,201 outlier · 0.3×
306 MS_DRG	Cardiac Congenital And Valvular Disorders With Mcc	21	$9,730.57	$29,940.20	$15,706.00	nat. median $15,124 1.0× median
917 MS_DRG	Poisoning And Toxic Effects Of Drugs With Mcc	21	$9,684.87	$29,799.60	$15,632.24	nat. median $14,565 1.1× median
177 MS_DRG	Respiratory Infections And Inflammations With Mcc	21	$9,649.67	$29,691.30	$15,575.43	nat. median $15,375 1.0× median
494 MS_DRG	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/mcc	19	$12,390.14	$19,998.79	$14,929.31	nat. median $18,751 0.8× median
682 MS_DRG	Renal Failure With Mcc	21	$9,145.18	$28,139.00	$14,761.13	nat. median $14,433 1.0× median
64 MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	2	$14,667.94	$24,132.00	$14,667.94	nat. median $19,223 0.8× median
314 MS_DRG	Foot And Toe Procedures,moderate	5	$14,457.35	$15,180.21	$14,457.35	nat. median $19,944 0.7× median
637 MS_DRG	Diabetes With Mcc	21	$8,871.62	$27,297.30	$14,319.59	nat. median $13,945 1.0× median
602 MS_DRG	Cellulitis With Mcc	21	$8,776.53	$27,004.70	$14,166.10	nat. median $14,007 1.0× median
811 MS_DRG	Red Blood Cell Disorders With Mcc	21	$8,671.55	$26,681.70	$13,996.66	nat. median $13,623 1.0× median
175 MS_DRG	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	21	$8,481.98	$26,098.40	$13,690.67	nat. median $13,725 1.0× median
27446 CPT	Arthrp Knee Condyle&Plateau Medial/Lat Cmprt\|RIGHT Side	2	$13,415.89	$13,684.21	$13,684.21	nat. median $12,435 1.1× median
0055T CPT	Bone Surgery Using Computer	2	$13,415.89	$13,684.21	$13,550.05	nat. median $1,320 outlier · 10.3×
51701 CPT	Hc Straight Cath - Residual Urine\|UNUSUAL Non-overlapping Service	3	$13,415.89	$13,684.21	$13,415.89	nat. median $168 outlier · 79.8×
28285 CPT	Correction Hammertoe\|LEFT Foot, Second Digit\|unusual Non-overlapping Service	3	$7,582.44	$13,684.21	$13,415.89	nat. median $3,601 outlier · 3.7×
27486 CPT	Revj Total Knee Arthrp W/wo Algrft 1 Component\|RIGHT Side	3	$13,415.89	$13,684.21	$13,415.89	nat. median $8,926 1.5× median
27447 CPT	Arthrp Kne Condyle&Platu Medial&Lat Compartments\|RIGHT Side	1	$13,415.89	$13,415.89	$13,415.89	nat. median $12,737 1.1× median
27130 CPT	Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft\|LEFT Side	3	$13,415.89	$13,684.21	$13,415.89	nat. median $13,097 1.0× median
23615 CPT	Optx Prox Humeral Fx W/Int Fixj Rpr Tuberosity\|RIGHT Side	3	$13,415.89	$13,684.21	$13,415.89	nat. median $11,353 1.2× median

Other procedures at this hospital

Browse this hospital's 191 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

853	MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	35	21	—	—	$30,495.86	$93,833.40	$49,223.03	2026-04-01
981	MS_DRG	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	35	21	—	—	$28,971.87	$89,144.20	$46,763.17	2026-04-01
463	MS_DRG	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	41	26	—	—	$7,207.47	$108,290.50	$40,385.94	2026-04-01
939	MS_DRG	O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc	35	21	—	—	$22,405.99	$68,941.50	$36,165.26	2026-04-01
616	MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	35	21	—	—	$21,534.70	$66,260.60	$34,758.92	2026-04-01
45	MS_DRG	Cva And Precerebral Occlusion With Infarction,extreme	6	5	—	—	$30,496.40	$32,021.22	$30,496.40	2026-04-01
208	MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	35	21	—	—	$16,973.22	$52,225.30	$27,396.29	2026-04-01
478	MS_DRG	Biopsies Of Musculoskeletal System And Connective Tissue With Cc	35	21	—	—	$15,185.56	$46,724.80	$24,510.85	2026-04-01
133	MS_DRG	Respiratory Failure,extreme	6	5	—	—	$24,415.50	$25,636.27	$24,415.50	2026-04-01
674	MS_DRG	Other Kidney And Urinary Tract Procedures With Cc	35	21	—	—	$14,440.86	$44,433.40	$23,308.83	2026-04-01
56	MS_DRG	Degenerative Nervous System Disorders With Mcc	35	21	—	—	$14,345.14	$44,138.90	$23,154.34	2026-04-01
481	MS_DRG	Hip And Femur Procedures Except Major Joint With Cc	35	21	—	—	$12,933.54	$39,795.50	$20,875.88	2026-04-01
470	MS_DRG	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without …	35	21	—	—	$12,692.00	$36,649.10	$20,486.00	2026-04-01
522	MS_DRG	Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc	35	21	—	—	$12,692.00	$40,236.30	$20,486.00	2026-04-01
468	MS_DRG	Revision Of Hip Or Knee Replacement Without Cc/mcc	35	21	—	—	$12,692.00	$52,212.00	$20,486.00	2026-04-01
854	MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Cc	14	10	—	—	$14,578.00	$23,977.20	$19,915.06	2026-04-01
871	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	35	21	—	—	$11,994.94	$36,907.50	$19,360.90	2026-04-01
617	MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	35	21	—	—	$11,549.10	$35,535.70	$18,641.28	2026-04-01
504	MS_DRG	Foot Procedures With Cc	35	21	—	—	$11,542.31	$35,514.80	$18,630.32	2026-04-01
27487	CPT	Revj Tot Knee Arthrp Fem&Entire Tibial Compone\|RIGHT Side	5	3	—	—	$18,322.11	$18,688.55	$18,322.11	2026-04-01
23472	CPT	Arthroplasty Glenohumeral Joint Total Shoulder\|LEFT Side	9	3	—	—	$18,322.11	$18,688.55	$18,322.11	2026-04-01
435	MS_DRG	Malignancy Of Hepatobiliary System Or Pancreas With Mcc	35	21	—	—	$11,341.62	$34,897.30	$18,306.39	2026-04-01
205	MS_DRG	Other Respiratory System Diagnoses With Mcc	35	21	—	—	$11,306.43	$34,789.00	$18,249.58	2026-04-01
377	MS_DRG	Gastrointestinal Hemorrhage With Mcc	35	21	—	—	$11,287.90	$34,732.00	$18,219.68	2026-04-01
441	MS_DRG	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc	35	21	—	—	$11,082.27	$34,099.30	$17,887.77	2026-04-01
505	MS_DRG	Foot Procedures Without Cc/mcc	35	21	—	—	$11,070.54	$34,063.20	$17,868.84	2026-04-01
580	MS_DRG	Other Skin, Subcutaneous Tissue And Breast Procedures With Cc	35	21	—	—	$10,670.40	$32,832.00	$17,222.98	2026-04-01
70	MS_DRG	Other Cerebrovascular Disorders With Mcc	35	21	—	—	$10,280.14	$31,631.20	$16,593.06	2026-04-01
438	MS_DRG	Disorders Of Pancreas Except Malignancy With Mcc	35	21	—	—	$10,066.49	$30,973.80	$16,248.20	2026-04-01
280	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Mcc	35	21	—	—	$9,905.32	$30,477.90	$15,988.06	2026-04-01
326	MS_DRG	Elective Knee Joint Replacement,moderate	6	5	—	—	$15,873.68	$16,667.36	$15,873.68	2026-04-01
306	MS_DRG	Cardiac Congenital And Valvular Disorders With Mcc	35	21	—	—	$9,730.57	$29,940.20	$15,706.00	2026-04-01
917	MS_DRG	Poisoning And Toxic Effects Of Drugs With Mcc	35	21	—	—	$9,684.87	$29,799.60	$15,632.24	2026-04-01
177	MS_DRG	Respiratory Infections And Inflammations With Mcc	35	21	—	—	$9,649.67	$29,691.30	$15,575.43	2026-04-01
494	MS_DRG	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/mcc	31	19	—	—	$12,390.14	$19,998.79	$14,929.31	2026-04-01
682	MS_DRG	Renal Failure With Mcc	35	21	—	—	$9,145.18	$28,139.00	$14,761.13	2026-04-01
64	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	3	2	—	—	$14,667.94	$24,132.00	$14,667.94	2026-04-01
314	MS_DRG	Foot And Toe Procedures,moderate	6	5	—	—	$14,457.35	$15,180.21	$14,457.35	2026-04-01
637	MS_DRG	Diabetes With Mcc	35	21	—	—	$8,871.62	$27,297.30	$14,319.59	2026-04-01
602	MS_DRG	Cellulitis With Mcc	35	21	—	—	$8,776.53	$27,004.70	$14,166.10	2026-04-01
811	MS_DRG	Red Blood Cell Disorders With Mcc	35	21	—	—	$8,671.55	$26,681.70	$13,996.66	2026-04-01
175	MS_DRG	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	35	21	—	—	$8,481.98	$26,098.40	$13,690.67	2026-04-01
27446	CPT	Arthrp Knee Condyle&Plateau Medial/Lat Cmprt\|RIGHT Side	3	2	—	—	$13,415.89	$13,684.21	$13,684.21	2026-04-01
0055T	CPT	Bone Surgery Using Computer	2	2	—	—	$13,415.89	$13,684.21	$13,550.05	2026-04-01
51701	CPT	Hc Straight Cath - Residual Urine\|UNUSUAL Non-overlapping Service	5	3	—	—	$13,415.89	$13,684.21	$13,415.89	2026-04-01
28285	CPT	Correction Hammertoe\|LEFT Foot, Second Digit\|unusual Non-overlapping Service	7	3	—	—	$7,582.44	$13,684.21	$13,415.89	2026-04-01
27486	CPT	Revj Total Knee Arthrp W/wo Algrft 1 Component\|RIGHT Side	3	3	—	—	$13,415.89	$13,684.21	$13,415.89	2026-04-01
27447	CPT	Arthrp Kne Condyle&Platu Medial&Lat Compartments\|RIGHT Side	1	1	—	—	$13,415.89	$13,415.89	$13,415.89	2026-04-01
27130	CPT	Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft\|LEFT Side	8	3	—	—	$13,415.89	$13,684.21	$13,415.89	2026-04-01
23615	CPT	Optx Prox Humeral Fx W/Int Fixj Rpr Tuberosity\|RIGHT Side	6	3	—	—	$13,415.89	$13,684.21	$13,415.89	2026-04-01
20985	CPT	Cptr-asst Surgical Navigation Image-less	5	3	—	—	$13,415.89	$13,684.21	$13,415.89	2026-04-01
919	MS_DRG	Complications Of Treatment With Mcc	3	3	—	—	$11,305.19	$13,679.73	$13,411.50	2026-04-01
640	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…	35	21	—	—	$8,247.33	$25,376.40	$13,311.93	2026-04-01
193	MS_DRG	Simple Pneumonia And Pleurisy With Mcc	35	21	—	—	$8,116.42	$24,973.60	$13,100.62	2026-04-01
180	MS_DRG	Respiratory Neoplasms With Mcc	24	16	—	—	$1,178.00	$33,554.00	$12,959.69	2026-04-01
426	MS_DRG	Non-hypovolemic Sodium Disorders,major	6	5	—	—	$12,879.88	$13,523.87	$12,879.88	2026-04-01
501	MS_DRG	Soft Tissue Procedures With Cc	41	26	—	—	$9,119.94	$33,213.90	$12,834.88	2026-04-01
896	MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc	35	21	—	—	$1,235.00	$20,941.20	$12,813.95	2026-04-01
291	MS_DRG	Heart Failure And Shock With Mcc	35	21	—	—	$7,927.47	$24,392.20	$12,795.63	2026-04-01
391	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	35	21	—	—	$7,831.75	$24,097.70	$12,641.15	2026-04-01
469	MS_DRG	Acute Kidney Injury,major	6	5	—	—	$12,532.14	$13,158.75	$12,532.14	2026-04-01
698	MS_DRG	Other Kidney And Urinary Tract Diagnoses With Mcc	38	22	—	—	$1,178.00	$31,433.60	$12,425.18	2026-04-01
189	MS_DRG	Pulmonary Edema And Respiratory Failure	35	21	—	—	$7,628.60	$23,472.60	$12,313.23	2026-04-01
308	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Mcc	35	21	—	—	$7,434.70	$22,876.00	$12,000.27	2026-04-01
831	MS_DRG	Other Antepartum Diagnoses Without O.r. Procedures With Mcc	35	21	—	—	$7,425.44	$22,847.50	$11,985.32	2026-04-01
304	MS_DRG	Hypertension With Mcc	35	21	—	—	$7,348.25	$22,610.00	$11,860.73	2026-04-01
689	MS_DRG	Kidney And Urinary Tract Infections With Mcc	35	21	—	—	$7,164.85	$22,045.70	$11,564.71	2026-04-01
947	MS_DRG	Signs And Symptoms With Mcc	20	15	—	—	$7,838.55	$24,118.60	$11,169.60	2026-04-01
190	MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	35	21	—	—	$6,840.05	$21,046.30	$11,040.45	2026-04-01
466	MS_DRG	Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure,major	12	5	—	—	$7,884.54	$12,934.65	$10,298.74	2026-04-01
543	MS_DRG	Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With…	35	21	—	—	$6,347.90	$19,532.00	$10,246.08	2026-04-01
644	MS_DRG	Endocrine Disorders With Cc	35	21	—	—	$6,329.38	$19,475.00	$10,216.18	2026-04-01
872	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	35	21	—	—	$6,318.88	$19,442.70	$10,199.23	2026-04-01
65	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	35	21	—	—	$6,238.60	$19,195.70	$10,069.66	2026-04-01
553	MS_DRG	Bone Diseases And Arthropathies With Mcc	38	22	—	—	$1,178.00	$24,629.70	$9,878.39	2026-04-01
57	MS_DRG	Degenerative Nervous System Disorders Without Mcc	21	14	—	—	$8,000.33	$24,616.40	$9,873.44	2026-04-01
178	MS_DRG	Respiratory Infections And Inflammations With Cc	35	21	—	—	$6,026.80	$18,544.00	$9,727.79	2026-04-01
565	MS_DRG	Other Musculoskeletal System And Connective Tissue Diagnoses With Cc	25	18	—	—	$6,016.92	$18,513.60	$9,711.84	2026-04-01
202	MS_DRG	Bronchitis And Asthma With Cc/mcc	35	21	—	—	$5,997.16	$18,452.80	$9,679.95	2026-04-01
552	MS_DRG	Medical Back Problems Without Mcc	35	21	—	—	$5,936.03	$18,264.70	$9,581.28	2026-04-01
48	MS_DRG	Peripheral, Cranial And Autonomic Nerve Disorders,minor	12	5	—	—	$7,651.31	$11,051.22	$9,279.42	2026-04-01
281	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Cc	35	21	—	—	$5,675.44	$17,462.90	$9,160.67	2026-04-01
812	MS_DRG	Red Blood Cell Disorders Without Mcc	35	21	—	—	$5,669.89	$17,445.80	$9,151.70	2026-04-01
605	MS_DRG	Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc	35	21	—	—	$5,656.30	$17,404.00	$9,129.77	2026-04-01
101	MS_DRG	Seizures Without Mcc	35	21	—	—	$5,573.56	$17,149.40	$8,996.21	2026-04-01
638	MS_DRG	Diabetes With Cc	35	21	—	—	$5,534.04	$17,027.80	$8,932.43	2026-04-01
563	MS_DRG	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…	35	21	—	—	$5,529.71	$17,014.50	$8,925.45	2026-04-01
558	MS_DRG	Tendonitis, Myositis And Bursitis Without Mcc	35	21	—	—	$5,515.51	$16,970.80	$8,902.52	2026-04-01
422	MS_DRG	Hypovolemia And Related Electrolyte Disorders,major	12	5	—	—	$7,198.99	$10,509.50	$8,783.99	2026-04-01
720	MS_DRG	Septicemia And Disseminated Infections,major	18	5	—	—	$5,942.39	$13,635.18	$8,779.29	2026-04-01
420	MS_DRG	Diabetes,major	12	5	—	—	$6,544.53	$11,214.47	$8,776.10	2026-04-01
683	MS_DRG	Renal Failure With Cc	35	21	—	—	$5,408.07	$16,640.20	$8,729.10	2026-04-01
603	MS_DRG	Cellulitis Without Mcc	35	21	—	—	$5,377.81	$16,547.10	$8,680.26	2026-04-01
199	MS_DRG	Hypertension,major	12	5	—	—	$6,750.90	$10,723.21	$8,650.51	2026-04-01
68	MS_DRG	Precerebral Occlusion Without Infarction Without Mcc	35	21	—	—	$5,337.67	$16,423.60	$8,615.47	2026-04-01
342	MS_DRG	Fractures And Dislocations Except Femur, Pelvis And Back,minor	6	5	—	—	$8,560.20	$8,988.20	$8,560.20	2026-04-01
560	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Cc	15	11	—	—	$8,497.99	$11,223.84	$8,497.99	2026-04-01
292	MS_DRG	Heart Failure And Shock With Cc	23	16	—	—	$5,242.58	$16,131.00	$8,461.98	2026-04-01
662	MS_DRG	Sickle Cell Anemia Crisis,minor	6	5	—	—	$8,413.19	$8,833.85	$8,413.19	2026-04-01
191	MS_DRG	Chronic Obstructive Pulmonary Disease With Cc	35	21	—	—	$5,205.53	$16,017.00	$8,402.18	2026-04-01
103	MS_DRG	Headaches Without Mcc	19	14	—	—	$5,201.82	$16,005.60	$8,396.20	2026-04-01
816	MS_DRG	Toxic Effects Of Non-medicinal Substances,major	6	5	—	—	$8,261.95	$8,675.05	$8,261.95	2026-04-01
728	MS_DRG	Inflammation Of The Male Reproductive System Without Mcc	35	21	—	—	$5,009.16	$15,412.80	$8,085.23	2026-04-01
690	MS_DRG	Kidney And Urinary Tract Infections Without Mcc	35	21	—	—	$4,998.66	$15,380.50	$8,068.29	2026-04-01
600	MS_DRG	Non-malignant Breast Disorders With Cc/mcc	38	22	—	—	$1,178.00	$19,790.40	$8,067.01	2026-04-01
194	MS_DRG	Simple Pneumonia And Pleurisy With Cc	47	26	—	—	$4,976.43	$15,312.10	$8,032.41	2026-04-01
948	MS_DRG	Signs And Symptoms Without Mcc	35	21	—	—	$4,943.09	$15,209.50	$7,978.58	2026-04-01
392	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	35	21	—	—	$4,814.03	$14,812.40	$7,770.27	2026-04-01
27664	CPT	Rpr Extensor Tendon Leg Primary Without Graft Each\|LEFT Side	3	2	—	—	$7,582.44	$7,734.09	$7,734.09	2026-04-01
28750	CPT	Arthrodesis Great Toe Metatarsophalangeal Joint\|RIGHT Foot, Great Toe	9	3	—	—	$7,582.44	$13,684.21	$7,734.09	2026-04-01
29823	CPT	Surgical Arthroscopy Shoulder Xtnsv Dbrdmt 3+\|left Side	2	1	—	—	$7,734.09	$7,734.09	$7,734.09	2026-04-01
29824	CPT	Surgical Arthroscopy Shoulder Dstl Claviculc\|LEFT Side	5	2	—	—	$7,582.44	$7,734.09	$7,734.09	2026-04-01
566	MS_DRG	Antepartum Without O.r. Procedure,major	6	5	—	—	$7,679.58	$8,063.56	$7,679.58	2026-04-01
27822	CPT	Open Tx Trimalleolar Ankle Fx Without Fixj Pst Lip\|LEFT Side	2	2	—	—	$7,582.44	$7,734.09	$7,658.26	2026-04-01
27310	CPT	Arthrt Kne W/Expl Drg/Rmvl Fb\|left Side	4	3	—	—	$7,582.44	$7,734.09	$7,658.26	2026-04-01
28308	CPT	Osteot W/wo Lngth Shrt/Corrj Metar Xcp 1st Ea\|LEFT Side	2	2	—	—	$7,582.44	$7,734.09	$7,658.26	2026-04-01
378	MS_DRG	Gastrointestinal Hemorrhage With Cc	38	22	—	—	$1,178.00	$18,633.30	$7,633.88	2026-04-01
74	MS_DRG	Cranial And Peripheral Nerve Disorders Without Mcc	21	15	—	—	$1,178.00	$19,805.60	$7,615.03	2026-04-01
29888	CPT	Arthrs Aided Ant Cruciate Ligm Rpr/Agmntj/Rcnstj\|RIGHT Side	13	3	—	—	$7,582.44	$7,734.09	$7,582.44	2026-04-01
28119	CPT	Ostectomy Calcaneus Spur W/wo Plntar Fascial Rls\|RIGHT Side	7	3	—	—	$7,582.44	$7,734.09	$7,582.44	2026-04-01
29826	CPT	Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls\|LEFT Side	3	2	—	—	$7,582.44	$7,734.09	$7,582.44	2026-04-01
27650	CPT	Repair Primary Open/Prq Ruptured Achilles Tendon\|RIGHT Side	9	3	—	—	$7,582.44	$7,734.09	$7,582.44	2026-04-01
29827	CPT	Surgical Arthroscopy Shoulder W/Rotator Cuff Rpr\|LEFT Side	6	3	—	—	$7,582.44	$7,734.09	$7,582.44	2026-04-01
27814	CPT	Open Treatment Bimalleolar Ankle Fracture	6	3	—	—	$7,582.44	$7,734.09	$7,582.44	2026-04-01
23430	CPT	Tenodesis Long Tendon Biceps\|LEFT Side	5	3	—	—	$7,582.44	$7,734.09	$7,582.44	2026-04-01
25609	CPT	Optx Dstl Radl I-artic Fx/Epiphysl Sep 3 Frag\|RIGHT Side	10	3	—	—	$7,582.44	$7,734.09	$7,582.44	2026-04-01
140	MS_DRG	Chronic Obstructive Pulmonary Disease,moderate	10	5	—	—	$7,200.40	$10,117.67	$7,560.42	2026-04-01
351	MS_DRG	Other Musculoskeletal System And Connective Tissue Diagnoses,moderate	6	5	—	—	$7,543.88	$7,921.07	$7,543.88	2026-04-01
305	MS_DRG	Hypertension Without Mcc	35	21	—	—	$4,662.74	$14,346.90	$7,526.08	2026-04-01
179	MS_DRG	Respiratory Infections And Inflammations Without Cc/mcc	35	21	—	—	$4,662.13	$14,345.00	$7,525.09	2026-04-01
442	MS_DRG	Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc	24	17	—	—	$1,178.00	$11,583.60	$7,376.81	2026-04-01
198	MS_DRG	Angina Pectoris And Coronary Atherosclerosis,moderate	3	3	—	—	$6,917.70	$7,263.58	$7,263.58	2026-04-01
884	MS_DRG	Organic Disturbances And Intellectual Disability	38	22	—	—	$1,054.00	$19,306.80	$7,182.15	2026-04-01
153	MS_DRG	Otitis Media And Uri Without Mcc	17	13	—	—	$5,334.77	$13,522.30	$7,093.51	2026-04-01
176	MS_DRG	Pulmonary Embolism Without Mcc	22	15	—	—	$5,029.54	$9,774.00	$7,080.86	2026-04-01
897	MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	38	22	—	—	$1,178.00	$16,773.20	$6,937.62	2026-04-01
312	MS_DRG	Syncope And Collapse	38	22	—	—	$1,178.00	$16,560.40	$6,857.98	2026-04-01
918	MS_DRG	Poisoning And Toxic Effects Of Drugs Without Mcc	38	22	—	—	$1,178.00	$16,284.90	$6,754.86	2026-04-01
536	MS_DRG	Fractures Of Hip And Pelvis Without Mcc	38	22	—	—	$1,178.00	$15,344.40	$6,402.81	2026-04-01
192	MS_DRG	Chronic Obstructive Pulmonary Disease Without Cc/mcc	35	21	—	—	$3,964.35	$12,198.00	$6,398.81	2026-04-01
439	MS_DRG	Disorders Of Pancreas Except Malignancy With Cc	17	13	—	—	$6,049.91	$16,343.80	$6,358.73	2026-04-01
639	MS_DRG	Diabetes Without Cc/mcc	23	17	—	—	$4,082.46	$7,470.00	$6,204.46	2026-04-01
282	MS_DRG	Acute Myocardial Infarction, Discharged Alive Without Cc/mcc	49	27	—	—	$1,178.00	$13,738.90	$6,200.91	2026-04-01
641	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	38	22	—	—	$1,178.00	$14,785.80	$6,193.72	2026-04-01
69	MS_DRG	Transient Ischemia Without Thrombolytic	16	11	—	—	$4,940.62	$15,201.90	$5,944.31	2026-04-01
775	MS_DRG	Alcohol Abuse And Dependence,minor	12	5	—	—	$4,798.86	$6,882.15	$5,796.61	2026-04-01
951	MS_DRG	Other Factors Influencing Health Status	44	27	—	—	$1,178.00	$30,740.38	$5,541.65	2026-04-01
309	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Cc	24	16	—	—	$5,199.58	$8,871.60	$5,525.08	2026-04-01
66	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc	18	13	—	—	$4,226.17	$8,212.80	$5,418.26	2026-04-01
916	MS_DRG	Allergic Reactions Without Mcc	38	22	—	—	$1,178.00	$12,659.70	$5,397.90	2026-04-01
313	MS_DRG	Chest Pain	22	14	—	—	$4,405.25	$7,110.46	$5,346.50	2026-04-01
303	MS_DRG	Atherosclerosis Without Mcc	17	14	—	—	$5,340.16	$12,790.80	$5,340.16	2026-04-01
395	MS_DRG	Other Digestive System Diagnoses Without Cc/mcc	25	16	—	—	$4,007.58	$12,331.00	$5,171.42	2026-04-01
440	MS_DRG	Disorders Of Pancreas Except Malignancy Without Cc/mcc	31	21	—	—	$1,178.00	$11,806.60	$4,978.98	2026-04-01
195	MS_DRG	Simple Pneumonia And Pleurisy Without Cc/mcc	26	17	—	—	$3,845.17	$11,831.30	$4,721.10	2026-04-01
66174	CPT	Transluminal Dilation Aqueous Canal, Without Retention Device/Stent\|LEFT Side	9	3	—	—	$4,319.25	$4,405.64	$4,319.25	2026-04-01
65820	CPT	Goniotomy\|RIGHT Side	10	3	—	—	$4,319.25	$4,405.64	$4,319.25	2026-04-01
11042	CPT	Hc Debride Subq First 20 Sq Cm\|UNUSUAL Non-overlapping Service	3	2	—	—	$3,419.10	$3,487.49	$3,487.49	2026-04-01
25606	CPT	Perq Skel Fixj Distal Radial Fx/Epiphysl Sep\|RIGHT Side	13	3	—	—	$3,419.10	$3,487.49	$3,419.10	2026-04-01
29881	CPT	Arthrs Kne Surg W/Meniscectomy Med/Lat W/Shvg\|RIGHT Side	9	3	—	—	$3,419.10	$3,487.49	$3,419.10	2026-04-01
24359	CPT	Tnot Elbow Lateral/Medial Debride Open Tdn Rpr\|RIGHT Side	4	3	—	—	$3,419.10	$3,487.49	$3,419.10	2026-04-01
29875	CPT	Arthroscopy Knee Synovectomy Limited Spx\|LEFT Side	3	3	—	—	$3,419.10	$3,487.49	$3,419.10	2026-04-01
27340	CPT	Excision Prepatellar Bursa\|LEFT Side	2	1	—	—	$3,419.10	$3,419.10	$3,419.10	2026-04-01
28160	CPT	Hemiphalangectomy/Interphalangeal Joint Exc Toe	8	3	—	—	$3,419.10	$3,487.49	$3,419.10	2026-04-01
29876	CPT	Arthroscopy Knee Synovectomy 2/>Compartments\|RIGHT Side	18	3	—	—	$3,419.10	$7,734.09	$3,419.10	2026-04-01
58558	CPT	Hysteroscopy Bx Endometrium&/Polypc W/wo D&c	6	3	—	—	$3,382.66	$3,450.31	$3,382.66	2026-04-01
20680	CPT	Removal Implant Deep\|LEFT Side	14	3	—	—	$3,035.31	$3,096.01	$3,035.31	2026-04-01
66982	CPT	Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx Wo Ecp\|LEFT Side	10	3	—	—	$2,411.58	$2,459.81	$2,411.58	2026-04-01
66984	CPT	Xcapsl Ctrc Rmvl Insj Io Lens Prosth Without Ecp\|LEFT Side	12	3	—	—	$2,411.58	$2,459.81	$2,411.58	2026-04-01
43251	CPT	Egd Removal Tumor Polyp/Other Lesion Snare Tech	2	1	—	—	$2,045.28	$2,045.28	$2,045.28	2026-04-01
64721	CPT	Neuroplasty &/Transpos Median Nrv Carpal Tunne\|LEFT Side	12	3	—	—	$2,040.52	$2,081.33	$2,040.52	2026-04-01
64718	CPT	Neuroplasty &/Transposition Ulnar Nerve Elbow	7	3	—	—	$2,040.52	$2,081.33	$2,040.52	2026-04-01
43249	CPT	Egd Balloon Dilation Esophagus <30 Mm Diam	4	2	—	—	$2,005.18	$2,045.28	$2,025.23	2026-04-01
43239	CPT	Egd Transoral Biopsy Single/Multiple	20	3	—	—	$947.76	$2,045.28	$2,005.18	2026-04-01
28108	CPT	Exc/Curtg Cst/B9 Tum Phalanges Foot	5	3	—	—	$1,680.28	$1,713.89	$1,680.28	2026-04-01
27570	CPT	Hc Manipulatn Knee Jt W/Anesthesia\|LEFT Side	10	3	—	—	$1,680.28	$1,713.89	$1,680.28	2026-04-01
26055	CPT	Tendon Sheath Incision\|LEFT Side	4	3	—	—	$1,680.28	$1,713.89	$1,680.28	2026-04-01
11750	CPT	Hc Removal Of Nail Bed\|LEFT Foot, Great Toe	6	3	—	—	$1,680.28	$1,713.89	$1,680.28	2026-04-01
45384	CPT	Colsc Flx W/Removal Lesion By Hot Bx Forceps\|PREVENTIVE Services	5	3	—	—	$1,250.44	$1,275.45	$1,250.44	2026-04-01
45380	CPT	Colonoscopy W/Biopsy Single/Multiple\|SEPARATE Structure	26	3	—	—	$1,250.44	$1,275.45	$1,250.44	2026-04-01
45381	CPT	Colsc Flx With Directed Submucosal Njx Any Sbst\|PREVENTIVE Services	7	3	—	—	$1,250.44	$1,275.45	$1,250.44	2026-04-01
45385	CPT	Colsc Flx W/Rmvl Of Tumor Polyp Lesion Snare Tq	22	3	—	—	$1,250.44	$1,275.45	$1,250.44	2026-04-01
45388	CPT	Colonoscopy Flx Ablation Tumor Polyp/Other Les\|COLORECTAL Cancer Screen	7	3	—	—	$1,250.44	$1,275.45	$1,250.44	2026-04-01
G0105	HCPCS	Colorectal Scrn; Hi Risk Ind	7	3	—	—	$971.77	$991.20	$971.77	2026-04-01
45378	CPT	Colonoscopy Flx Dx W/Collj Spec When Pfrmd	17	3	—	—	$971.77	$991.20	$971.77	2026-04-01
45330	CPT	Sigmoidoscopy Flx Dx W/Collj Spec Br/Wa If Pfrmd	5	3	—	—	$971.77	$991.20	$971.77	2026-04-01
G0121	HCPCS	Colon Ca Scrn Not Hi Rsk Ind\|DOCUMENTATION On File	10	3	—	—	$971.77	$991.20	$971.77	2026-04-01
43450	CPT	Dilation Esoph Unguided Sound/Bougie 1/Mult Pass	6	3	—	—	$947.76	$966.72	$947.76	2026-04-01
43235	CPT	Hc Egd Diagnostic Brush Wash	7	3	—	—	$947.76	$966.72	$947.76	2026-04-01
11403	CPT	Hc Excis Benign Les 2.1-3.0	5	3	—	—	$739.97	$754.77	$739.97	2026-04-01
26725	CPT	Hc Ed Clsd Tx Finger Fx W Manip\|RIGHT Hand, Fifth Digit	5	3	—	—	$257.76	$262.91	$257.76	2026-04-01

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