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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

Gaylord Hospital Inc

Wallingford, CT · CCN 072003 · Rates published

13,646 distinct procedures filed
8 distinct payers
145,354 rate rows
2026-04-21 last MRF observed
Data quality

88,086 of 145,354 rate rows are consumer-grade (60.6%)

57,268 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
professional (physician) fee — not the facility price 56,516
per-diem day rate — not a per-procedure price 655
exceeds 10× this hospital's gross charge — excluded from medians 78
percent-of-charges filed in the dollar field — excluded from medians 11
placeholder amount (≤ $0.02) — excluded from medians 8
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/8046/060646649-1730137753_gaylord-hospital-inc_standardcharges.csv
Found on page https://www.gaylord.org/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-05-19
Content fingerprint 8ee3e11b124b7ff4… · 44,364,588 bytes · first seen 2026-05-17

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
J3391
HCPCS 		Inj, Atidarsagene Autotemcel 4 $4,505,000.00 $4,505,000.00 $4,505,000.00 nat. median
$4,505,000
1.0× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 4 $3,685,266.67 $3,685,266.67 $3,685,266.67 nat. median
$3,710,000
1.0× median
J3389
HCPCS 		Topi Adm Prad Zami Per Treat 4 $3,335,820.00 $3,335,820.00 $3,335,820.00 nat. median
$3,335,820
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 4 $3,327,859.73 $3,327,859.73 $3,327,859.73 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 4 $3,252,508.08 $3,252,508.08 $3,252,508.08 nat. median
$3,286,000
1.0× median
J3387
HCPCS 		Inj Elivaldogene Autotemecel 4 $3,180,000.00 $3,180,000.00 $3,180,000.00 nat. median
$3,180,000
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 4 $2,939,968.89 $2,939,968.89 $2,939,968.89 nat. median
$3,004,655
1.0× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 4 $2,588,981.23 $2,588,981.23 $2,588,981.23 nat. median
$2,468,984
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 4 $2,332,000.00 $2,332,000.00 $2,332,000.00 nat. median
$2,448,600
1.0× median
Q2057
HCPCS 		Afamitresgene Autoleucel 4 $770,620.00 $770,620.00 $770,620.00 nat. median
$824,563
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 4 $587,649.57 $587,649.57 $587,649.57 nat. median
$674,867
0.9× median
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 4 $566,531.30 $566,531.30 $566,531.30 nat. median
$753,246
0.8× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 4 $562,201.24 $562,201.24 $562,201.24 nat. median
$673,137
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 4 $558,081.73 $558,081.73 $558,081.73 nat. median
$625,184
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 4 $532,192.24 $532,192.24 $532,192.24 nat. median
$634,303
0.8× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 4 $489,450.20 $489,450.20 $489,450.20 nat. median
$619,808
0.8× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 4 $278,250.00 $278,250.00 $278,250.00 nat. median
$324,450
0.9× median
J3403
HCPCS 		Revakinagene, Per Implant 4 $265,000.00 $265,000.00 $265,000.00 nat. median
$265,000
1.0× median
J3402
HCPCS 		Inj. Remestemcel-l-rknd/ Td 4 $201,669.02 $201,669.02 $201,669.02 nat. median
$209,753
1.0× median
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 4 $192,376.33 $192,376.33 $192,376.33 nat. median
$202,976
0.9× median
4
MS_DRG 		Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And… 4 $134,060.25 $134,060.25 $134,060.25 nat. median
$133,161
1.0× median
163
MS_DRG 		Major Chest Procedures With Mcc 4 $110,638.90 $110,638.90 $110,638.90 nat. median
$44,937
outlier · 2.5×
165
MS_DRG 		Major Chest Procedures Without Cc/mcc 4 $110,638.90 $110,638.90 $110,638.90 nat. median
$19,858
outlier · 5.6×
164
MS_DRG 		Major Chest Procedures With Cc 4 $110,638.90 $110,638.90 $110,638.90 nat. median
$25,705
outlier · 4.3×
166
MS_DRG 		Other Respiratory System O.r. Procedures With Mcc 4 $109,224.94 $109,224.94 $109,224.94 nat. median
$37,476
outlier · 2.9×
11
MS_DRG 		Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 4 $109,224.94 $109,224.94 $109,224.94 nat. median
$52,857
outlier · 2.1×
140
MS_DRG 		Major Head And Neck Procedures With Mcc 4 $109,224.94 $109,224.94 $109,224.94 nat. median
$40,208
outlier · 2.7×
981
MS_DRG 		Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 4 $109,210.94 $109,210.94 $109,210.94 nat. median
$46,084
outlier · 2.4×
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 4 $108,243.35 $108,243.35 $108,243.35 nat. median
$111,989
1.0× median
987
MS_DRG 		Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 4 $99,537.21 $99,537.21 $99,537.21 nat. median
$33,845
outlier · 2.9×
870
MS_DRG 		Septicemia Or Severe Sepsis With Mv >96 Hours 4 $96,695.29 $96,695.29 $96,695.29 nat. median
$66,526
1.5× median
K1007
HCPCS 		Bil Hkaf Pc S/d Micro Sensor 4 $95,081.03 $95,081.03 $95,081.03 nat. median
$96,983
1.0× median
207
MS_DRG 		Respiratory System Diagnosis With Ventilator Support >96 Hours 4 $90,745.46 $90,745.46 $90,745.46 nat. median
$62,134
1.5× median
173
MS_DRG 		Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 4 $73,605.27 $73,605.27 $73,605.27 nat. median
$29,766
outlier · 2.5×
12
MS_DRG 		Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 4 $73,605.27 $73,605.27 $73,605.27 nat. median
$40,914
1.8× median
167
MS_DRG 		Other Respiratory System O.r. Procedures With Cc 4 $73,605.27 $73,605.27 $73,605.27 nat. median
$18,895
outlier · 3.9×
168
MS_DRG 		Other Respiratory System O.r. Procedures Without Cc/mcc 4 $73,605.27 $73,605.27 $73,605.27 nat. median
$14,494
outlier · 5.1×
853
MS_DRG 		Infectious And Parasitic Diseases With O.r. Procedures With Mcc 4 $70,754.02 $70,754.02 $70,754.02 nat. median
$48,170
1.5× median
L8702
HCPCS 		Ewhf S/d Uprt Micro Sensor 4 $68,801.71 $68,801.71 $68,801.71 nat. median
$70,825
1.0× median
40
MS_DRG 		Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 4 $68,551.41 $68,551.41 $68,551.41 nat. median
$37,698
1.8× median
799
MS_DRG 		Splenic Procedures With Mcc 4 $65,135.51 $65,135.51 $65,135.51 nat. median
$45,376
1.4× median
356
MS_DRG 		Other Digestive System O.r. Procedures With Mcc 4 $65,135.51 $65,135.51 $65,135.51 nat. median
$42,444
1.5× median
573
MS_DRG 		Skin Graft For Skin Ulcer Or Cellulitis With Mcc 4 $64,888.18 $64,888.18 $64,888.18 nat. median
$59,793
1.1× median
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 4 $64,274.79 $64,274.79 $64,274.79 nat. median
$69,774
0.9× median
38240
CPT 		Transplt Allo Hct/donor 4 $64,263.52 $64,263.52 $64,263.52 nat. median
$15,979
outlier · 4.0×
582
MS_DRG 		Mastectomy For Malignancy With Cc/mcc 4 $63,301.56 $63,301.56 $63,301.56 nat. median
$18,913
outlier · 3.3×
579
MS_DRG 		Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 4 $63,301.56 $63,301.56 $63,301.56 nat. median
$31,571
outlier · 2.0×
856
MS_DRG 		Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 4 $62,886.24 $62,886.24 $62,886.24 nat. median
$43,963
1.4× median
205
MS_DRG 		Other Respiratory System Diagnoses With Mcc 4 $61,196.95 $61,196.95 $61,196.95 nat. median
$18,292
outlier · 3.3×
619
MS_DRG 		O.r. Procedures For Obesity With Mcc 4 $61,019.62 $61,019.62 $61,019.62 nat. median
$27,946
outlier · 2.2×

Other procedures at this hospital

Browse this hospital's 13,646 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
             
J3391 HCPCS Inj, Atidarsagene Autotemcel 4 4 — — $4,505,000.00 $4,505,000.00 $4,505,000.00 2026-04-21
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 4 4 — — $3,685,266.67 $3,685,266.67 $3,685,266.67 2026-04-21
J3389 HCPCS Topi Adm Prad Zami Per Treat 4 4 — — $3,335,820.00 $3,335,820.00 $3,335,820.00 2026-04-21
J1413 HCPCS Inj Delandistrogene Mox Rokl 4 4 — — $3,327,859.73 $3,327,859.73 $3,327,859.73 2026-04-21
J3394 HCPCS Inj, Lovotibeglogene Autotem 4 4 — — $3,252,508.08 $3,252,508.08 $3,252,508.08 2026-04-21
J3387 HCPCS Inj Elivaldogene Autotemecel 4 4 — — $3,180,000.00 $3,180,000.00 $3,180,000.00 2026-04-21
J3393 HCPCS Inj, Betibeglogene Autotemce 4 4 — — $2,939,968.89 $2,939,968.89 $2,939,968.89 2026-04-21
J3399 HCPCS Inj Onase Abepar-xioi Treat 4 4 — — $2,588,981.23 $2,588,981.23 $2,588,981.23 2026-04-21
J3392 HCPCS Inj, Exagamglogene Autotem 4 4 — — $2,332,000.00 $2,332,000.00 $2,332,000.00 2026-04-21
Q2057 HCPCS Afamitresgene Autoleucel 4 4 — — $770,620.00 $770,620.00 $770,620.00 2026-04-21
Q2056 HCPCS Ciltacabtagene Car-pos T 4 4 — — $587,649.57 $587,649.57 $587,649.57 2026-04-21
Q2042 HCPCS Tisagenlecleucel Car-pos T 4 4 — — $566,531.30 $566,531.30 $566,531.30 2026-04-21
Q2054 HCPCS Lisocabtagene Mara Car Pos T 4 4 — — $562,201.24 $562,201.24 $562,201.24 2026-04-21
Q2055 HCPCS Idecabtagene Vicleucel Car 4 4 — — $558,081.73 $558,081.73 $558,081.73 2026-04-21
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 4 4 — — $532,192.24 $532,192.24 $532,192.24 2026-04-21
Q2053 HCPCS Brexucabtagene Car Pos T 4 4 — — $489,450.20 $489,450.20 $489,450.20 2026-04-21
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 4 4 — — $278,250.00 $278,250.00 $278,250.00 2026-04-21
J3403 HCPCS Revakinagene, Per Implant 4 4 — — $265,000.00 $265,000.00 $265,000.00 2026-04-21
J3402 HCPCS Inj. Remestemcel-l-rknd/ Td 4 4 — — $201,669.02 $201,669.02 $201,669.02 2026-04-21
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mo… 4 4 — — $192,376.33 $192,376.33 $192,376.33 2026-04-21
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And … 4 4 — — $134,060.25 $134,060.25 $134,060.25 2026-04-21
164 MS_DRG Major Chest Procedures With Cc 4 4 — — $110,638.90 $110,638.90 $110,638.90 2026-04-21
163 MS_DRG Major Chest Procedures With Mcc 4 4 — — $110,638.90 $110,638.90 $110,638.90 2026-04-21
165 MS_DRG Major Chest Procedures Without Cc/mcc 4 4 — — $110,638.90 $110,638.90 $110,638.90 2026-04-21
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 4 4 — — $109,224.94 $109,224.94 $109,224.94 2026-04-21
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 4 4 — — $109,224.94 $109,224.94 $109,224.94 2026-04-21
140 MS_DRG Major Head And Neck Procedures With Mcc 4 4 — — $109,224.94 $109,224.94 $109,224.94 2026-04-21
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 4 4 — — $109,210.94 $109,210.94 $109,210.94 2026-04-21
Q0480 HCPCS Driver Pneumatic Vad, Rep 4 4 — — $108,243.35 $108,243.35 $108,243.35 2026-04-21
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 4 4 — — $99,537.21 $99,537.21 $99,537.21 2026-04-21
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 4 4 — — $96,695.29 $96,695.29 $96,695.29 2026-04-21
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 4 4 — — $95,081.03 $95,081.03 $95,081.03 2026-04-21
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 4 4 — — $90,745.46 $90,745.46 $90,745.46 2026-04-21
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 4 4 — — $73,605.27 $73,605.27 $73,605.27 2026-04-21
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 4 4 — — $73,605.27 $73,605.27 $73,605.27 2026-04-21
168 MS_DRG Other Respiratory System O.r. Procedures Without Cc/mcc 4 4 — — $73,605.27 $73,605.27 $73,605.27 2026-04-21
167 MS_DRG Other Respiratory System O.r. Procedures With Cc 4 4 — — $73,605.27 $73,605.27 $73,605.27 2026-04-21
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 4 4 — — $70,754.02 $70,754.02 $70,754.02 2026-04-21
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 4 4 — — $68,801.71 $68,801.71 $68,801.71 2026-04-21
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 4 4 — — $68,551.41 $68,551.41 $68,551.41 2026-04-21
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 4 4 — — $65,135.51 $65,135.51 $65,135.51 2026-04-21
799 MS_DRG Splenic Procedures With Mcc 4 4 — — $65,135.51 $65,135.51 $65,135.51 2026-04-21
573 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Mcc 4 4 — — $64,888.18 $64,888.18 $64,888.18 2026-04-21
J9029 HCPCS Instill Adstiladrin, Tx Dose 4 4 — — $64,274.79 $64,274.79 $64,274.79 2026-04-21
38240 CPT Transplt Allo Hct/donor 4 4 — — $64,263.52 $64,263.52 $64,263.52 2026-04-21
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 4 4 — — $63,301.56 $63,301.56 $63,301.56 2026-04-21
582 MS_DRG Mastectomy For Malignancy With Cc/mcc 4 4 — — $63,301.56 $63,301.56 $63,301.56 2026-04-21
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 4 4 — — $62,886.24 $62,886.24 $62,886.24 2026-04-21
205 MS_DRG Other Respiratory System Diagnoses With Mcc 4 4 — — $61,196.95 $61,196.95 $61,196.95 2026-04-21
622 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 4 4 — — $61,019.62 $61,019.62 $61,019.62 2026-04-21
619 MS_DRG O.r. Procedures For Obesity With Mcc 4 4 — — $61,019.62 $61,019.62 $61,019.62 2026-04-21
551 MS_DRG Medical Back Problems With Mcc 4 4 — — $60,940.29 $60,940.29 $60,940.29 2026-04-21
61 MS_DRG Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic A… 4 4 — — $60,702.30 $60,702.30 $60,702.30 2026-04-21
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 4 4 — — $60,702.30 $60,702.30 $60,702.30 2026-04-21
901 MS_DRG Wound Debridements For Injuries With Mcc 4 4 — — $59,876.32 $59,876.32 $59,876.32 2026-04-21
263 MS_DRG Vein Ligation And Stripping 4 4 — — $59,293.01 $59,293.01 $59,293.01 2026-04-21
245 MS_DRG Aicd Generator Procedures 4 4 — — $59,293.01 $59,293.01 $59,293.01 2026-04-21
264 MS_DRG Other Circulatory System O.r. Procedures 4 4 — — $59,293.01 $59,293.01 $59,293.01 2026-04-21
982 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 4 4 — — $59,153.01 $59,153.01 $59,153.01 2026-04-21
743 MS_DRG Uterine And Adnexa Procedures For Non-malignancy Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
787 MS_DRG Cesarean Section Without Sterilization With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
353 MS_DRG Hernia Procedures Except Inguinal And Femoral With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
745 MS_DRG D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
41 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
32 MS_DRG Ventricular Shunt Procedures With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
37 MS_DRG Extracranial Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
485 MS_DRG Knee Procedures With Principal Diagnosis Of Infection With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
850 MS_DRG Acute Leukemia With Other Procedures 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
495 MS_DRG Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Wit… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
741 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy Without… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
474 MS_DRG Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
38 MS_DRG Extracranial Procedures With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
233 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
39 MS_DRG Extracranial Procedures Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
747 MS_DRG Vagina, Cervix And Vulva Procedures Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
271 MS_DRG Other Major Cardiovascular Procedures With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
466 MS_DRG Revision Of Hip Or Knee Replacement With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
817 MS_DRG Other Antepartum Diagnoses With O.r. Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
272 MS_DRG Other Major Cardiovascular Procedures Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
820 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
783 MS_DRG Cesarean Section With Sterilization With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
826 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
42 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
23 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
231 MS_DRG Coronary Bypass With Ptca With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
734 MS_DRG Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
36 MS_DRG Carotid Artery Stent Procedures Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
257 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
827 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
469 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
755 MS_DRG Malignancy, Female Reproductive System With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
269 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
754 MS_DRG Malignancy, Female Reproductive System With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
241 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
519 MS_DRG Back And Neck Procedures Except Spinal Fusion With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
742 MS_DRG Uterine And Adnexa Procedures For Non-malignancy With Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
31 MS_DRG Ventricular Shunt Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
234 MS_DRG Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
274 MS_DRG Percutaneous And Other Intracardiac Procedures Without Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
35 MS_DRG Carotid Artery Stent Procedures With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
823 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
235 MS_DRG Coronary Bypass Without Cardiac Catheterization With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
829 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Proce… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
737 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
740 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
746 MS_DRG Vagina, Cervix And Vulva Procedures With Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
843 MS_DRG Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
483 MS_DRG Major Joint Or Limb Reattachment Procedures Of Upper Extremities 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
266 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
492 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
73 MS_DRG Cranial And Peripheral Nerve Disorders With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
739 MS_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
784 MS_DRG Cesarean Section With Sterilization With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
25 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
824 MS_DRG Lymphoma And Non-acute Leukemia With Other Procedures With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
385 MS_DRG Inflammatory Bowel Disease With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
744 MS_DRG D&C, Conization, Laparoscopy And Tubal Interruption With Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
970 MS_DRG HIV With Extensive O.r. Procedures Without Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
215 MS_DRG Other Heart Assist System Implant 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
736 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
735 MS_DRG Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
267 MS_DRG Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
270 MS_DRG Other Major Cardiovascular Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
738 MS_DRG Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
236 MS_DRG Coronary Bypass Without Cardiac Catheterization Without Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
54 MS_DRG Nervous System Neoplasms With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
917 MS_DRG Poisoning And Toxic Effects Of Drugs With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
918 MS_DRG Poisoning And Toxic Effects Of Drugs Without Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
232 MS_DRG Coronary Bypass With Ptca Without Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
518 MS_DRG Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
857 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
33 MS_DRG Ventricular Shunt Procedures Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
963 MS_DRG Other Multiple Significant Trauma With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
405 MS_DRG Pancreas, Liver And Shunt Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
228 MS_DRG Other Cardiothoracic Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
786 MS_DRG Cesarean Section Without Sterilization With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
423 MS_DRG Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
750 MS_DRG Other Female Reproductive System O.r. Procedures Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
808 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
499 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
748 MS_DRG Female Reproductive System Reconstructive Procedures 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
643 MS_DRG Endocrine Disorders With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
273 MS_DRG Percutaneous And Other Intracardiac Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
749 MS_DRG Other Female Reproductive System O.r. Procedures With Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
34 MS_DRG Carotid Artery Stent Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
498 MS_DRG Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
693 MS_DRG Urinary Stones With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
256 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
821 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
254 MS_DRG Other Vascular Procedures Without Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
562 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
252 MS_DRG Other Vascular Procedures With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
250 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
251 MS_DRG Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
253 MS_DRG Other Vascular Procedures With Cc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
202 MS_DRG Bronchitis And Asthma With Cc/mcc 4 4 — — $58,905.68 $58,905.68 $58,905.68 2026-04-21
463 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 4 4 — — $58,849.69 $58,849.69 $58,849.69 2026-04-21
828 MS_DRG Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. … 4 4 — — $58,677.02 $58,677.02 $58,677.02 2026-04-21
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 4 4 — — $58,677.02 $58,677.02 $58,677.02 2026-04-21
955 MS_DRG Craniotomy For Multiple Significant Trauma 4 4 — — $58,677.02 $58,677.02 $58,677.02 2026-04-21
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 4 4 — — $58,677.02 $58,677.02 $58,677.02 2026-04-21
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 4 4 — — $58,677.02 $58,677.02 $58,677.02 2026-04-21
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 4 4 — — $58,677.02 $58,677.02 $58,677.02 2026-04-21
908 MS_DRG Other O.r. Procedures For Injuries With Cc 4 4 — — $58,677.02 $58,677.02 $58,677.02 2026-04-21
822 MS_DRG Lymphoma And Leukemia With Major O.r. Procedures Without Cc/mcc 4 4 — — $58,677.02 $58,677.02 $58,677.02 2026-04-21
500 MS_DRG Soft Tissue Procedures With Mcc 4 4 — — $57,477.72 $57,477.72 $57,477.72 2026-04-21
A9543 HCPCS Y90 Ibritumomab, Rx 4 4 — — $56,824.55 $56,824.55 $56,824.55 2026-04-21
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 4 4 — — $55,951.77 $55,951.77 $55,951.77 2026-04-21
515 MS_DRG Other Musculoskeletal System And Connective Tissue O.r. Procedures With Mcc 4 4 — — $55,951.77 $55,951.77 $55,951.77 2026-04-21
28 MS_DRG Spinal Procedures With Mcc 4 4 — — $55,951.77 $55,951.77 $55,951.77 2026-04-21
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 4 4 — — $55,863.10 $55,863.10 $55,863.10 2026-04-21
653 MS_DRG Major Bladder Procedures With Mcc 4 4 — — $55,863.10 $55,863.10 $55,863.10 2026-04-21
665 MS_DRG Prostatectomy With Mcc 4 4 — — $55,863.10 $55,863.10 $55,863.10 2026-04-21
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 4 4 — — $55,317.12 $55,317.12 $55,317.12 2026-04-21
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 4 4 — — $55,102.46 $55,102.46 $55,102.46 2026-04-21
570 MS_DRG Skin Debridement With Mcc 4 4 — — $54,939.13 $54,939.13 $54,939.13 2026-04-21
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 4 4 — — $54,404.11 $54,404.11 $54,404.11 2026-04-21
974 MS_DRG HIV With Major Related Condition With Mcc 4 4 — — $53,179.84 $53,179.84 $53,179.84 2026-04-21
581 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/mcc 4 4 — — $52,022.54 $52,022.54 $52,022.54 2026-04-21
580 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Cc 4 4 — — $52,022.54 $52,022.54 $52,022.54 2026-04-21
583 MS_DRG Mastectomy For Malignancy Without Cc/mcc 4 4 — — $52,022.54 $52,022.54 $52,022.54 2026-04-21
82 MS_DRG Traumatic Stupor And Coma >1 Hour With Mcc 4 4 — — $50,067.26 $50,067.26 $50,067.26 2026-04-21
919 MS_DRG Complications Of Treatment With Mcc 4 4 — — $50,043.93 $50,043.93 $50,043.93 2026-04-21
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 4 4 — — $49,987.93 $49,987.93 $49,987.93 2026-04-21
53 MS_DRG Spinal Disorders And Injuries Without Cc/mcc 4 4 — — $49,609.94 $49,609.94 $49,609.94 2026-04-21
52 MS_DRG Spinal Disorders And Injuries With Cc/mcc 4 4 — — $49,609.94 $49,609.94 $49,609.94 2026-04-21
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 4 4 — — $49,609.94 $49,609.94 $49,609.94 2026-04-21
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 4 4 — — $49,609.94 $49,609.94 $49,609.94 2026-04-21
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 4 4 — — $49,609.94 $49,609.94 $49,609.94 2026-04-21
448 MS_DRG Multiple Level Spinal Fusion Except Cervical Without Mcc 4 4 — — $49,609.94 $49,609.94 $49,609.94 2026-04-21
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 4 4 — — $49,609.94 $49,609.94 $49,609.94 2026-04-21
438 MS_DRG Disorders Of Pancreas Except Malignancy With Mcc 4 4 — — $48,891.30 $48,891.30 $48,891.30 2026-04-21
666 MS_DRG Prostatectomy With Cc 4 4 — — $48,835.30 $48,835.30 $48,835.30 2026-04-21
674 MS_DRG Other Kidney And Urinary Tract Procedures With Cc 4 4 — — $48,835.30 $48,835.30 $48,835.30 2026-04-21
654 MS_DRG Major Bladder Procedures With Cc 4 4 — — $48,835.30 $48,835.30 $48,835.30 2026-04-21
675 MS_DRG Other Kidney And Urinary Tract Procedures Without Cc/mcc 4 4 — — $48,835.30 $48,835.30 $48,835.30 2026-04-21
L7181 HCPCS Electronic Elbo Simultaneous 4 4 — — $48,155.50 $48,155.50 $48,155.50 2026-04-21
288 MS_DRG Acute And Subacute Endocarditis With Mcc 4 4 — — $47,552.00 $47,552.00 $47,552.00 2026-04-21
393 MS_DRG Other Digestive System Diagnoses With Mcc 4 4 — — $47,412.01 $47,412.01 $47,412.01 2026-04-21
388 MS_DRG Gastrointestinal Obstruction With Mcc 4 4 — — $46,110.04 $46,110.04 $46,110.04 2026-04-21
L7180 HCPCS Electronic Elbow Sequential 4 4 — — $46,081.51 $46,081.51 $46,081.51 2026-04-21
189 MS_DRG Pulmonary Edema And Respiratory Failure 4 4 — — $45,671.39 $45,671.39 $45,671.39 2026-04-21
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 4 4 — — $45,657.39 $45,657.39 $45,657.39 2026-04-21
539 MS_DRG Osteomyelitis With Mcc 4 4 — — $45,232.73 $45,232.73 $45,232.73 2026-04-21
33276 CPT Insj Phrnc Nrv Stim Sys 4 4 — — $45,000.50 $45,000.50 $45,000.50 2026-04-21
64568 CPT Opn Impltj Crnl Nrv Nea&pg 4 4 — — $45,000.50 $45,000.50 $45,000.50 2026-04-21
64654 CPT 1st Opn Implt Bat Modulj Sys 4 4 — — $45,000.50 $45,000.50 $45,000.50 2026-04-21
0620T CPT Evasc Ven Artlz Tibl/prnl Vn 4 4 — — $45,000.50 $45,000.50 $45,000.50 2026-04-21
380 MS_DRG Complicated Peptic Ulcer With Mcc 4 4 — — $44,691.42 $44,691.42 $44,691.42 2026-04-21
414 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. With Mcc 4 4 — — $44,691.42 $44,691.42 $44,691.42 2026-04-21
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 4 4 — — $44,691.42 $44,691.42 $44,691.42 2026-04-21
411 MS_DRG Cholecystectomy With C.d.e. With Mcc 4 4 — — $44,691.42 $44,691.42 $44,691.42 2026-04-21
464 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 4 4 — — $44,504.75 $44,504.75 $44,504.75 2026-04-21
620 MS_DRG O.r. Procedures For Obesity With Cc 4 4 — — $44,271.43 $44,271.43 $44,271.43 2026-04-21
623 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 4 4 — — $44,271.43 $44,271.43 $44,271.43 2026-04-21
488 MS_DRG Knee Procedures Without Principal Diagnosis Of Infection With Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
304 MS_DRG Hypertension With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
604 MS_DRG Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
670 MS_DRG Transurethral Procedures Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
661 MS_DRG Kidney And Ureter Procedures For Non-neoplasm Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
672 MS_DRG Urethral Procedures Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
671 MS_DRG Urethral Procedures With Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
662 MS_DRG Minor Bladder Procedures With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
606 MS_DRG Minor Skin Disorders With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
663 MS_DRG Minor Bladder Procedures With Cc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
374 MS_DRG Digestive Malignancy With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
326 MS_DRG Stomach, Esophageal And Duodenal Procedures With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
306 MS_DRG Cardiac Congenital And Valvular Disorders With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
574 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis With Cc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
157 MS_DRG Dental And Oral Diseases With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
575 MS_DRG Skin Graft For Skin Ulcer Or Cellulitis Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
576 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
577 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
155 MS_DRG Other Ear, Nose, Mouth And Throat Diagnoses With Cc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
617 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
578 MS_DRG Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
154 MS_DRG Other Ear, Nose, Mouth And Throat Diagnoses With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
717 MS_DRG Other Male Reproductive System O.r. Procedures Except Malignancy With Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
658 MS_DRG Kidney And Ureter Procedures For Neoplasm Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
667 MS_DRG Prostatectomy Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
715 MS_DRG Other Male Reproductive System O.r. Procedures For Malignancy With Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
152 MS_DRG Otitis Media And Uri With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
660 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Cc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
198 MS_DRG Interstitial Lung Disease Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
711 MS_DRG Testes Procedures With Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
143 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
142 MS_DRG Major Head And Neck Procedures Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
283 MS_DRG Acute Myocardial Infarction, Expired With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
78 MS_DRG Inpatient DRG 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
707 MS_DRG Major Male Pelvic Procedures With Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
144 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures With Cc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
141 MS_DRG Major Head And Neck Procedures With Cc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
818 MS_DRG Other Antepartum Diagnoses With O.r. Procedures With Cc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
136 MS_DRG Sinus And Mastoid Procedures Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
135 MS_DRG Sinus And Mastoid Procedures With Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
137 MS_DRG Mouth Procedures With Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
138 MS_DRG Mouth Procedures Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
139 MS_DRG Salivary Gland Procedures 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
145 MS_DRG Other Ear, Nose, Mouth And Throat O.r. Procedures Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
655 MS_DRG Major Bladder Procedures Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
709 MS_DRG Penis Procedures With Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
117 MS_DRG Intraocular Procedures Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
312 MS_DRG Syncope And Collapse 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
116 MS_DRG Intraocular Procedures With Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
668 MS_DRG Transurethral Procedures With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
114 MS_DRG Orbital Procedures Without Cc/mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
625 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
115 MS_DRG Extraocular Procedures Except Orbit 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
656 MS_DRG Kidney And Ureter Procedures For Neoplasm With Mcc 4 4 — — $44,075.43 $44,075.43 $44,075.43 2026-04-21
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