Look up real Medicare rates for 1,300+ medical services. See what Medicare pays, what hospitals charge, and what SFH members pay. No login required.
| Procedure | Medicare | Carrier Est. | Best Price | Savings |
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A Diagnosis-Related Group (DRG) is how Medicare pays hospitals for inpatient stays. Each admission is assigned a DRG based on diagnosis, procedures performed, and complications. The payment is a fixed amount per DRG regardless of how many days the patient stays. MCC (Major Complication/Comorbidity) pays the most; CC (Complication/Comorbidity) pays a mid-range; and without CC/MCC pays the least for the same procedure.
| Procedure | DRG | Complexity | Medicare IPPS | Hospital Est. | Related CPTs |
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J-codes are HCPCS codes for drugs administered by a healthcare provider — infusions, injections, and chemotherapy agents billed on the medical side of your plan (not through the pharmacy benefit). Medicare reimburses these at ASP + 6% (Average Sales Price plus a 6% margin). Hospitals often bill 3–5x this amount because there’s no pharmacy benefit manager checking the price.
These drugs drive the biggest medical-side spend for employer health plans. Click any card to see it in the full table.
| J-Code | Drug | Dosage | Units | ASP+6% | Total | 350% |
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