Hospital

GOOD SAMARITAN HOSPITAL

Vincennes, IN · CCN 150042 · Rates published

19,775 distinct procedures filed

38 distinct payers

584,349 rate rows

2026-07-17 last MRF observed

Data quality

580,042 of 584,349 rate rows are consumer-grade (99.3%)

4,307 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
per-diem day rate — not a per-procedure price	1,580
placeholder amount (≤ $0.02) — excluded from medians	1,264
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	766
percent-of-charges filed in the dollar field — excluded from medians	588
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	109

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

Source MRF file	https://www.gshvin.org/media/dc92cfe32eb3493284a2b244c72a90dd/list-of-standard-charges.xlsx
Found on page	https://www.gshvin.org/patients-visitors/insurance-billing-and-payment/standard-hospital-charges/
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-10-12
Content fingerprint	bcdad6724dccd85d… · 13,400,290 bytes · first seen 2026-05-18

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
J1411 HCPCS	Inj Hemgenix Per Tx Dose	16	$3,654,350.00	$4,591,125.00	$3,675,000.00	nat. median $3,685,267 1.0× median
C9172 HCPCS	Inj- Beqvez- Per Tx Dose	7	$3,605,000.00	$4,506,250.00	$3,605,000.00	nat. median $3,675,000 1.0× median
J1413 HCPCS	Inj Delandistrogene Mox Rokl	16	$3,296,000.00	$4,156,818.45	$3,360,000.00	nat. median $3,325,455 1.0× median
J3394 HCPCS	Inj Lovotibeglogene Autotem	7	$3,286,000.00	$4,107,500.00	$3,286,000.00	nat. median $3,248,446 1.0× median
J3393 HCPCS	Inj Betibeglogene Autotemce	7	$2,968,000.00	$3,710,000.00	$2,968,000.00	nat. median $2,968,000 1.0× median
J3399 HCPCS	Inj Onase Abepar-xioi Treat	21	$2,206,690.98	$4,777,228.46	$2,231,250.00	nat. median $2,455,111 0.9× median
Q2056 HCPCS	Ciltacabtagene Car-pos T	25	$492,900.00	$1,522,486.65	$548,128.28	nat. median $599,737 0.9× median
Q2042 HCPCS	Tisagenlecleucel Car-pos T	20	$425,159.01	$1,554,722.04	$529,192.86	nat. median $621,313 0.9× median
Q2055 HCPCS	Idecabtagene Vicleucel Car	27	$440,475.00	$1,454,070.90	$523,328.35	nat. median $574,037 0.9× median
Q2054 HCPCS	Lisocabtagene Mara Car Pos T	27	$430,815.00	$1,422,181.86	$511,851.30	nat. median $579,571 0.9× median
Q2041 HCPCS	Axicabtagene Ciloleucel Car+	28	$395,380.00	$1,378,144.35	$485,100.00	nat. median $562,501 0.9× median
Q2053 HCPCS	Brexucabtagene Car Pos T	27	$418,950.00	$1,348,320.00	$460,530.40	nat. median $513,770 0.9× median
C9081 HCPCS	Idecabtagene Car Pos T	3	$440,475.00	$440,475.00	$440,475.00	nat. median $422,856 1.0× median
C9073 HCPCS	Brexucabtagene Autoleucel Ca	1	$384,190.00	$384,190.00	$384,190.00	nat. median $1,000,529 outlier · 0.4×
5884 APR_DRG	Neonate Bwt 1500g W Major Procedure	14	$107,773.98	$382,913.78	$382,913.78	nat. median $286,698 1.3× median
24 APR_DRG	Heart andOR Lung Transplant	14	$97,256.79	$345,546.89	$345,546.89	nat. median $225,531 1.5× median
1614 APR_DRG	Cardiac Defibrillator And Heart Assist Implant	14	$84,952.59	$334,078.32	$334,078.32	nat. median $202,242 1.7× median
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell Immunotherapy	21	$202,082.83	$715,674.96	$263,216.58	nat. median $168,055 1.6× median
14 APR_DRG	Liver Transplant andOR Intestinal Transplant	14	$70,907.22	$251,928.64	$251,928.64	nat. median $136,566 1.8× median
74 APR_DRG	Allogeneic Bone Marrow Transplant	14	$65,651.40	$233,255.07	$233,255.07	nat. median $149,836 1.6× median
44 APR_DRG	Tracheostomy W Mv 96+ Hours W Extensive Procedure	14	$64,395.16	$228,791.71	$228,791.71	nat. median $135,630 1.7× median
94 APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	14	$64,039.36	$227,527.56	$227,527.56	nat. median $152,792 1.5× median
5914 APR_DRG	Neonate Birthwt 500749g Wo Major Procedure	14	$62,682.44	$222,706.55	$222,706.55	nat. median $171,497 1.3× median
6094 APR_DRG	Neonate Bwt 15002499g W Major Procedure	14	$59,400.38	$211,045.58	$211,045.58	nat. median $198,578 1.1× median
21 APR_DRG	Heart andOR Lung Transplant	14	$45,599.51	$199,358.72	$199,358.72	nat. median $77,825 outlier · 2.6×
22 APR_DRG	Heart andOR Lung Transplant	14	$56,111.02	$199,358.72	$199,358.72	nat. median $95,481 outlier · 2.1×
23 APR_DRG	Heart andOR Lung Transplant	14	$56,111.02	$199,358.72	$199,358.72	nat. median $117,894 1.7× median
5934 APR_DRG	Neonate Birthwt 750999g Wo Major Procedure	14	$56,029.10	$199,067.66	$199,067.66	nat. median $168,439 1.2× median
1 MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	22	$147,908.31	$557,292.78	$196,600.72	nat. median $186,516 1.1× median
E0766 HCPCS	Elec Stim Cancer Treatment	1	$195,004.46	$195,004.46	$195,004.46	nat. median $16,158 outlier · 12.1×
5831 APR_DRG	Neonate W Ecmo	14	$53,152.82	$188,848.43	$188,848.43	nat. median $173,909 1.1× median
5832 APR_DRG	Neonate W Ecmo	14	$53,152.82	$188,848.43	$188,848.43	nat. median $201,678 0.9× median
5834 APR_DRG	Neonate W Ecmo	14	$53,152.82	$188,848.43	$188,848.43	nat. median $390,362 outlier · 0.5×
5833 APR_DRG	Neonate W Ecmo	14	$53,152.82	$188,848.43	$188,848.43	nat. median $268,208 0.7× median
6314 APR_DRG	Neonate Birthwt 2499g W Other Major Procedure	14	$50,914.91	$180,897.27	$180,897.27	nat. median $181,762 1.0× median
6304 APR_DRG	Neonate Birthwt 2499g W Major Cardiovascular Procedure	14	$50,362.63	$178,935.07	$178,935.07	nat. median $187,567 1.0× median
5882 APR_DRG	Neonate Bwt 1500g W Major Procedure	14	$47,183.31	$167,639.17	$167,639.17	nat. median $152,383 1.1× median
5883 APR_DRG	Neonate Bwt 1500g W Major Procedure	14	$47,183.31	$167,639.17	$167,639.17	nat. median $173,134 1.0× median
5881 APR_DRG	Neonate Bwt 1500g W Major Procedure	14	$47,183.31	$167,639.17	$167,639.17	nat. median $130,862 1.3× median
927 MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	22	$106,746.04	$487,663.91	$165,573.34	nat. median $131,925 1.3× median
64 APR_DRG	Pancreas Transplant	14	$45,555.64	$161,856.17	$161,856.17	nat. median $92,994 1.7× median
6114 APR_DRG	Neonate Birthwt 15001999g W Major Anomaly	14	$45,303.28	$160,959.55	$160,959.55	nat. median $85,322 1.9× median
5933 APR_DRG	Neonate Birthwt 750999g Wo Major Procedure	14	$44,445.19	$157,910.80	$157,910.80	nat. median $114,205 1.4× median
3 MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth…	22	$101,449.29	$400,694.58	$149,581.91	nat. median $145,435 1.0× median
54 APR_DRG	Tracheostomy W Mv 96+ Hours Without Extensive Procedure	14	$41,832.38	$148,627.66	$148,627.66	nat. median $91,350 1.6× median
6024 APR_DRG	Neonate Bwt 10001249g W Resp Dist Syndoth Maj Resp Or Maj Anom	14	$40,058.57	$142,325.44	$142,325.44	nat. median $124,731 1.1× median
72 APR_DRG	Allogeneic Bone Marrow Transplant	14	$39,624.67	$140,783.80	$140,783.80	nat. median $66,446 outlier · 2.1×
73 APR_DRG	Allogeneic Bone Marrow Transplant	14	$39,624.67	$140,783.80	$140,783.80	nat. median $81,292 1.7× median
71 APR_DRG	Allogeneic Bone Marrow Transplant	14	$38,434.91	$140,783.80	$140,783.80	nat. median $55,310 outlier · 2.5×
6074 APR_DRG	Neonate Bwt 12501499g W Resp Dist Syndoth Maj Resp Or Maj Anom	14	$38,991.16	$138,533.00	$138,533.00	nat. median $100,752 1.4× median

Other procedures at this hospital

Browse this hospital's 19,775 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

J1411	HCPCS	Inj Hemgenix Per Tx Dose	22	16	—	—	$3,654,350.00	$4,591,125.00	$3,675,000.00	2026-07-17
C9172	HCPCS	Inj- Beqvez- Per Tx Dose	7	7	—	—	$3,605,000.00	$4,506,250.00	$3,605,000.00	2026-07-17
J1413	HCPCS	Inj Delandistrogene Mox Rokl	22	16	—	—	$3,296,000.00	$4,156,818.45	$3,360,000.00	2026-07-17
J3394	HCPCS	Inj Lovotibeglogene Autotem	7	7	—	—	$3,286,000.00	$4,107,500.00	$3,286,000.00	2026-07-17
J3393	HCPCS	Inj Betibeglogene Autotemce	7	7	—	—	$2,968,000.00	$3,710,000.00	$2,968,000.00	2026-07-17
J3399	HCPCS	Inj Onase Abepar-xioi Treat	29	21	—	—	$2,206,690.98	$4,777,228.46	$2,231,250.00	2026-07-17
Q2056	HCPCS	Ciltacabtagene Car-pos T	32	25	—	—	$492,900.00	$1,522,486.65	$548,128.28	2026-07-17
Q2042	HCPCS	Tisagenlecleucel Car-pos T	22	20	—	—	$425,159.01	$1,554,722.04	$529,192.86	2026-07-17
Q2055	HCPCS	Idecabtagene Vicleucel Car	35	27	—	—	$440,475.00	$1,454,070.90	$523,328.35	2026-07-17
Q2054	HCPCS	Lisocabtagene Mara Car Pos T	36	27	—	—	$430,815.00	$1,422,181.86	$511,851.30	2026-07-17
Q2041	HCPCS	Axicabtagene Ciloleucel Car+	37	28	—	—	$395,380.00	$1,378,144.35	$485,100.00	2026-07-17
Q2053	HCPCS	Brexucabtagene Car Pos T	36	27	—	—	$418,950.00	$1,348,320.00	$460,530.40	2026-07-17
C9081	HCPCS	Idecabtagene Car Pos T	4	3	—	—	$440,475.00	$440,475.00	$440,475.00	2026-07-17
C9073	HCPCS	Brexucabtagene Autoleucel Ca	1	1	—	—	$384,190.00	$384,190.00	$384,190.00	2026-07-17
5884	APR_DRG	Neonate Bwt 1500g W Major Procedure	16	14	—	—	$107,773.98	$382,913.78	$382,913.78	2026-07-17
24	APR_DRG	Heart andOR Lung Transplant	16	14	—	—	$97,256.79	$345,546.89	$345,546.89	2026-07-17
1614	APR_DRG	Cardiac Defibrillator And Heart Assist Implant	16	14	—	—	$84,952.59	$334,078.32	$334,078.32	2026-07-17
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell Immunotherapy	25	21	—	—	$202,082.83	$715,674.96	$263,216.58	2026-07-17
14	APR_DRG	Liver Transplant andOR Intestinal Transplant	16	14	—	—	$70,907.22	$251,928.64	$251,928.64	2026-07-17
74	APR_DRG	Allogeneic Bone Marrow Transplant	16	14	—	—	$65,651.40	$233,255.07	$233,255.07	2026-07-17
44	APR_DRG	Tracheostomy W Mv 96+ Hours W Extensive Procedure	16	14	—	—	$64,395.16	$228,791.71	$228,791.71	2026-07-17
94	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	16	14	—	—	$64,039.36	$227,527.56	$227,527.56	2026-07-17
5914	APR_DRG	Neonate Birthwt 500749g Wo Major Procedure	16	14	—	—	$62,682.44	$222,706.55	$222,706.55	2026-07-17
6094	APR_DRG	Neonate Bwt 15002499g W Major Procedure	16	14	—	—	$59,400.38	$211,045.58	$211,045.58	2026-07-17
21	APR_DRG	Heart andOR Lung Transplant	16	14	—	—	$45,599.51	$199,358.72	$199,358.72	2026-07-17
22	APR_DRG	Heart andOR Lung Transplant	16	14	—	—	$56,111.02	$199,358.72	$199,358.72	2026-07-17
23	APR_DRG	Heart andOR Lung Transplant	16	14	—	—	$56,111.02	$199,358.72	$199,358.72	2026-07-17
5934	APR_DRG	Neonate Birthwt 750999g Wo Major Procedure	16	14	—	—	$56,029.10	$199,067.66	$199,067.66	2026-07-17
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	27	22	—	—	$147,908.31	$557,292.78	$196,600.72	2026-07-17
E0766	HCPCS	Elec Stim Cancer Treatment	1	1	—	—	$195,004.46	$195,004.46	$195,004.46	2026-07-17
5833	APR_DRG	Neonate W Ecmo	16	14	—	—	$53,152.82	$188,848.43	$188,848.43	2026-07-17
5834	APR_DRG	Neonate W Ecmo	16	14	—	—	$53,152.82	$188,848.43	$188,848.43	2026-07-17
5832	APR_DRG	Neonate W Ecmo	16	14	—	—	$53,152.82	$188,848.43	$188,848.43	2026-07-17
5831	APR_DRG	Neonate W Ecmo	16	14	—	—	$53,152.82	$188,848.43	$188,848.43	2026-07-17
6314	APR_DRG	Neonate Birthwt 2499g W Other Major Procedure	16	14	—	—	$50,914.91	$180,897.27	$180,897.27	2026-07-17
6304	APR_DRG	Neonate Birthwt 2499g W Major Cardiovascular Procedure	16	14	—	—	$50,362.63	$178,935.07	$178,935.07	2026-07-17
5883	APR_DRG	Neonate Bwt 1500g W Major Procedure	16	14	—	—	$47,183.31	$167,639.17	$167,639.17	2026-07-17
5881	APR_DRG	Neonate Bwt 1500g W Major Procedure	16	14	—	—	$47,183.31	$167,639.17	$167,639.17	2026-07-17
5882	APR_DRG	Neonate Bwt 1500g W Major Procedure	16	14	—	—	$47,183.31	$167,639.17	$167,639.17	2026-07-17
927	MS_DRG	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	27	22	—	—	$106,746.04	$487,663.91	$165,573.34	2026-07-17
64	APR_DRG	Pancreas Transplant	16	14	—	—	$45,555.64	$161,856.17	$161,856.17	2026-07-17
6114	APR_DRG	Neonate Birthwt 15001999g W Major Anomaly	16	14	—	—	$45,303.28	$160,959.55	$160,959.55	2026-07-17
5933	APR_DRG	Neonate Birthwt 750999g Wo Major Procedure	16	14	—	—	$44,445.19	$157,910.80	$157,910.80	2026-07-17
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth…	27	22	—	—	$101,449.29	$400,694.58	$149,581.91	2026-07-17
54	APR_DRG	Tracheostomy W Mv 96+ Hours Without Extensive Procedure	16	14	—	—	$41,832.38	$148,627.66	$148,627.66	2026-07-17
6024	APR_DRG	Neonate Bwt 10001249g W Resp Dist Syndoth Maj Resp Or Maj Anom	16	14	—	—	$40,058.57	$142,325.44	$142,325.44	2026-07-17
71	APR_DRG	Allogeneic Bone Marrow Transplant	16	14	—	—	$38,434.91	$140,783.80	$140,783.80	2026-07-17
73	APR_DRG	Allogeneic Bone Marrow Transplant	16	14	—	—	$39,624.67	$140,783.80	$140,783.80	2026-07-17
72	APR_DRG	Allogeneic Bone Marrow Transplant	16	14	—	—	$39,624.67	$140,783.80	$140,783.80	2026-07-17
6074	APR_DRG	Neonate Bwt 12501499g W Resp Dist Syndoth Maj Resp Or Maj Anom	16	14	—	—	$38,991.16	$138,533.00	$138,533.00	2026-07-17
6214	APR_DRG	Neonate Bwt 20002499g W Major Anomaly	16	14	—	—	$37,164.24	$132,042.08	$132,042.08	2026-07-17
6023	APR_DRG	Neonate Bwt 10001249g W Resp Dist Syndoth Maj Resp Or Maj Anom	16	14	—	—	$37,016.37	$131,516.69	$131,516.69	2026-07-17
92	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	16	14	—	—	$30,776.86	$131,304.56	$131,304.56	2026-07-17
91	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	16	14	—	—	$27,699.69	$131,304.56	$131,304.56	2026-07-17
93	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	16	14	—	—	$36,358.72	$131,304.56	$131,304.56	2026-07-17
4404	APR_DRG	Kidney Transplant	16	14	—	—	$35,977.77	$127,826.62	$127,826.62	2026-07-17
1604	APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	16	14	—	—	$34,328.58	$121,967.16	$121,967.16	2026-07-17
3034	APR_DRG	Dorsal And Lumbar Fusion Proc For Curvature Of Back	16	14	—	—	$34,189.04	$121,471.37	$121,471.37	2026-07-17
8634	APR_DRG	Neonatal Aftercare	16	14	—	—	$33,396.20	$118,654.48	$118,654.48	2026-07-17
1624	APR_DRG	Cardiac Valve Procedures W Ami Or Complex Pdx	16	14	—	—	$31,766.10	$112,862.85	$112,862.85	2026-07-17
43	APR_DRG	Tracheostomy W Mv 96+ Hours W Extensive Procedure	16	14	—	—	$31,618.92	$112,339.92	$112,339.92	2026-07-17
42	APR_DRG	Tracheostomy W Mv 96+ Hours W Extensive Procedure	16	14	—	—	$31,618.92	$112,339.92	$112,339.92	2026-07-17
41	APR_DRG	Tracheostomy W Mv 96+ Hours W Extensive Procedure	16	14	—	—	$31,618.92	$112,339.92	$112,339.92	2026-07-17
6092	APR_DRG	Neonate Bwt 15002499g W Major Procedure	16	14	—	—	$27,431.32	$111,027.68	$111,027.68	2026-07-17
6091	APR_DRG	Neonate Bwt 15002499g W Major Procedure	16	14	—	—	$25,499.11	$111,027.68	$111,027.68	2026-07-17
6093	APR_DRG	Neonate Bwt 15002499g W Major Procedure	16	14	—	—	$31,249.58	$111,027.68	$111,027.68	2026-07-17
62	APR_DRG	Pancreas Transplant	16	14	—	—	$31,238.13	$110,986.98	$110,986.98	2026-07-17
61	APR_DRG	Pancreas Transplant	16	14	—	—	$31,238.13	$110,986.98	$110,986.98	2026-07-17
63	APR_DRG	Pancreas Transplant	16	14	—	—	$31,238.13	$110,986.98	$110,986.98	2026-07-17
84	APR_DRG	Autologous Bone Marrow Transplant	16	14	—	—	$28,984.94	$102,981.55	$102,981.55	2026-07-17
104	APR_DRG	Head Trauma With Deep Coma	16	14	—	—	$28,928.36	$102,780.52	$102,780.52	2026-07-17
5913	APR_DRG	Neonate Birthwt 500749g Wo Major Procedure	16	14	—	—	$28,670.79	$101,865.40	$101,865.40	2026-07-17
5911	APR_DRG	Neonate Birthwt 500749g Wo Major Procedure	16	14	—	—	$28,670.79	$101,865.40	$101,865.40	2026-07-17
5912	APR_DRG	Neonate Birthwt 500749g Wo Major Procedure	16	14	—	—	$28,670.79	$101,865.40	$101,865.40	2026-07-17
1654	APR_DRG	Coronary Bypass W Ami Or Complex Pdx	16	14	—	—	$28,443.42	$101,057.59	$101,057.59	2026-07-17
6073	APR_DRG	Neonate Bwt 12501499g W Resp Dist Syndoth Maj Resp Or Maj Anom	16	14	—	—	$28,255.63	$100,390.36	$100,390.36	2026-07-17
Q0480	HCPCS	Driver Pneumatic Vad Rep	37	28	—	—	$72,648.53	$299,999.85	$99,999.95	2026-07-17
C9150	HCPCS	Xe129 Xenon Diagnostic	1	1	—	—	$99,840.00	$99,840.00	$99,840.00	2026-07-17
5931	APR_DRG	Neonate Birthwt 750999g Wo Major Procedure	16	14	—	—	$28,004.31	$99,497.45	$99,497.45	2026-07-17
5932	APR_DRG	Neonate Birthwt 750999g Wo Major Procedure	16	14	—	—	$28,004.31	$99,497.45	$99,497.45	2026-07-17
1634	APR_DRG	Cardiac Valve Procedures Wo Ami Or Complex Pdx	16	14	—	—	$27,805.41	$98,790.76	$98,790.76	2026-07-17
4	MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face- Mouth And Nec…	27	22	—	—	$61,787.30	$271,965.60	$98,620.37	2026-07-17
3031	APR_DRG	Dorsal And Lumbar Fusion Proc For Curvature Of Back	16	14	—	—	$22,622.27	$98,520.66	$98,520.66	2026-07-17
3032	APR_DRG	Dorsal And Lumbar Fusion Proc For Curvature Of Back	16	14	—	—	$26,401.82	$98,520.66	$98,520.66	2026-07-17
3033	APR_DRG	Dorsal And Lumbar Fusion Proc For Curvature Of Back	16	14	—	—	$27,729.39	$98,520.66	$98,520.66	2026-07-17
102	APR_DRG	Head Trauma With Deep Coma	16	14	—	—	$7,527.81	$95,397.92	$95,397.92	2026-07-17
101	APR_DRG	Head Trauma With Deep Coma	16	14	—	—	$4,104.27	$95,397.92	$95,397.92	2026-07-17
103	APR_DRG	Head Trauma With Deep Coma	16	14	—	—	$12,592.86	$95,397.92	$95,397.92	2026-07-17
6021	APR_DRG	Neonate Bwt 10001249g W Resp Dist Syndoth Maj Resp Or Maj Anom	16	14	—	—	$26,261.05	$93,303.75	$93,303.75	2026-07-17
6022	APR_DRG	Neonate Bwt 10001249g W Resp Dist Syndoth Maj Resp Or Maj Anom	16	14	—	—	$26,261.05	$93,303.75	$93,303.75	2026-07-17
6072	APR_DRG	Neonate Bwt 12501499g W Resp Dist Syndoth Maj Resp Or Maj Anom	16	14	—	—	$26,059.72	$92,588.43	$92,588.43	2026-07-17
53	APR_DRG	Tracheostomy W Mv 96+ Hours Without Extensive Procedure	16	14	—	—	$25,998.97	$92,372.60	$92,372.60	2026-07-17
14	MS_DRG	Allogeneic Bone Marrow Transplant	27	22	—	—	$64,775.51	$235,619.42	$91,444.05	2026-07-17
7	MS_DRG	Lung Transplant	27	22	—	—	$57,732.84	$241,704.54	$91,213.72	2026-07-17
6334	APR_DRG	Neonate Birthwt 2499g W Major Anomaly	16	14	—	—	$25,611.92	$90,997.46	$90,997.46	2026-07-17
8633	APR_DRG	Neonatal Aftercare	16	14	—	—	$23,505.05	$89,404.02	$89,404.02	2026-07-17
6124	APR_DRG	Neonate Bwt 15001999g W Resp Dist Syndoth Maj Resp Cond	16	14	—	—	$24,714.26	$87,808.11	$87,808.11	2026-07-17
3124	APR_DRG	Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses	16	14	—	—	$24,335.55	$86,462.57	$86,462.57	2026-07-17
6083	APR_DRG	Neonate Bwt 12501499g W Or Wo Other Significant Condition	16	14	—	—	$23,994.32	$85,250.23	$85,250.23	2026-07-17
6084	APR_DRG	Neonate Bwt 12501499g W Or Wo Other Significant Condition	16	14	—	—	$23,994.32	$85,250.23	$85,250.23	2026-07-17
1204	APR_DRG	Major Respiratory And Chest Procedures	16	14	—	—	$23,443.78	$83,294.19	$83,294.19	2026-07-17
6034	APR_DRG	Neonate Birthwt 10001249g W Or Wo Other Significant Condition	16	14	—	—	$23,380.95	$83,070.96	$83,070.96	2026-07-17
6033	APR_DRG	Neonate Birthwt 10001249g W Or Wo Other Significant Condition	16	14	—	—	$23,380.95	$83,070.96	$83,070.96	2026-07-17
9124	APR_DRG	Musculoskeletal And Other Procedures For Multiple Significant Trauma	16	14	—	—	$23,362.90	$83,006.83	$83,006.83	2026-07-17
6113	APR_DRG	Neonate Birthwt 15001999g W Major Anomaly	16	14	—	—	$23,128.24	$82,173.11	$82,173.11	2026-07-17
6032	APR_DRG	Neonate Birthwt 10001249g W Or Wo Other Significant Condition	16	14	—	—	$23,049.79	$81,894.38	$81,894.38	2026-07-17
3044	APR_DRG	Dorsal And Lumbar Fusion Proc Except For Curvature Of Back	16	14	—	—	$22,955.03	$81,557.69	$81,557.69	2026-07-17
1623	APR_DRG	Cardiac Valve Procedures W Ami Or Complex Pdx	16	14	—	—	$22,827.98	$81,106.30	$81,106.30	2026-07-17
13	APR_DRG	Liver Transplant andOR Intestinal Transplant	16	14	—	—	$22,758.90	$80,860.87	$80,860.87	2026-07-17
11	APR_DRG	Liver Transplant andOR Intestinal Transplant	16	14	—	—	$22,758.90	$80,860.87	$80,860.87	2026-07-17
12	APR_DRG	Liver Transplant andOR Intestinal Transplant	16	14	—	—	$22,758.90	$80,860.87	$80,860.87	2026-07-17
2604	APR_DRG	Major Pancreas, Liver & Shunt Procedures	16	14	—	—	$22,683.58	$80,593.24	$80,593.24	2026-07-17
9104	APR_DRG	Craniotomy For Multiple Significant Trauma	16	14	—	—	$22,666.92	$80,534.04	$80,534.04	2026-07-17
1664	APR_DRG	Coronary Bypass Wo Ami Or Complex Pdx	16	14	—	—	$22,539.87	$80,082.65	$80,082.65	2026-07-17
1613	APR_DRG	Cardiac Defibrillator And Heart Assist Implant	16	14	—	—	$22,253.14	$79,063.93	$79,063.93	2026-07-17
1694	APR_DRG	Major Abdominal Vascular Procedures	16	14	—	—	$22,222.94	$78,956.63	$78,956.63	2026-07-17
894	APR_DRG	Major Cranialfacial Bone Procedures	16	14	—	—	$22,035.50	$78,290.65	$78,290.65	2026-07-17
6123	APR_DRG	Neonate Bwt 15001999g W Resp Dist Syndoth Maj Resp Cond	16	14	—	—	$22,018.14	$78,228.98	$78,228.98	2026-07-17
2	MS_DRG	Heart Transplant Or Implant Of Heart Assist System Without Mcc	27	22	—	—	$75,007.25	$266,767.38	$77,970.77	2026-07-17
6954	APR_DRG	Chemotherapy For Acute Leukemia	16	14	—	—	$21,934.48	$77,931.75	$77,931.75	2026-07-17
4414	APR_DRG	Major Bladder Procedures	16	14	—	—	$21,878.94	$77,734.42	$77,734.42	2026-07-17
8414	APR_DRG	Extensive 3rd Degree Burns W Skin Graft	1	1	—	—	$76,935.80	$76,935.80	$76,935.80	2026-07-17
212	MS_DRG	Testes Procedures Age 0-17	17	14	—	—	$66,423.13	$199,269.38	$76,034.00	2026-07-17
6904	APR_DRG	Acute Leukemia	16	14	—	—	$21,315.21	$75,731.52	$75,731.52	2026-07-17
4403	APR_DRG	Kidney Transplant	16	14	—	—	$21,184.00	$75,265.33	$75,265.33	2026-07-17
1814	APR_DRG	Lower Extremity Arterial Procedures	16	14	—	—	$21,071.88	$74,866.97	$74,866.97	2026-07-17
5	MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	27	22	—	—	$55,197.93	$225,858.60	$74,327.51	2026-07-17
2304	APR_DRG	Major Small Bowel Procedures	16	14	—	—	$20,916.36	$74,314.45	$74,314.45	2026-07-17
214	APR_DRG	Craniotomy Except For Trauma	16	14	—	—	$20,862.21	$74,122.05	$74,122.05	2026-07-17
215	MS_DRG	Other Heart Assist System Implant	27	22	—	—	$59,626.10	$238,044.93	$73,946.43	2026-07-17
1324	APR_DRG	Bpd And Oth Chronic Respiratory Diseases Arising In Perinatal Period	16	14	—	—	$9,706.75	$73,412.90	$73,412.90	2026-07-17
1674	APR_DRG	Other Cardiothoracic And Thoracic Vascular Procedures	16	14	—	—	$20,622.35	$73,269.83	$73,269.83	2026-07-17
6903	APR_DRG	Acute Leukemia	16	14	—	—	$18,264.07	$73,161.30	$73,161.30	2026-07-17
426	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	9	8	—	—	$73,113.08	$146,844.16	$73,113.08	2026-07-17
6031	APR_DRG	Neonate Birthwt 10001249g W Or Wo Other Significant Condition	16	14	—	—	$20,416.85	$72,539.71	$72,539.71	2026-07-17
9114	APR_DRG	Extensive Abdominalthoracic Procedures For Mult Significant Trauma	16	14	—	—	$20,316.88	$72,184.52	$72,184.52	2026-07-17
3043	APR_DRG	Dorsal And Lumbar Fusion Proc Except For Curvature Of Back	16	14	—	—	$20,155.12	$71,609.79	$71,609.79	2026-07-17
6224	APR_DRG	Neonate Bwt 20002499g W Resp Dist Syndoth Maj Resp Cond	16	14	—	—	$19,997.52	$71,049.87	$71,049.87	2026-07-17
6112	APR_DRG	Neonate Birthwt 15001999g W Major Anomaly	16	14	—	—	$19,393.91	$70,258.08	$70,258.08	2026-07-17
1214	APR_DRG	Other Respiratory And Chest Procedures	16	14	—	—	$19,742.73	$70,144.62	$70,144.62	2026-07-17
2204	APR_DRG	Major Stomach, Esophageal & Duodenal Procedures	16	14	—	—	$19,502.87	$69,292.40	$69,292.40	2026-07-17
6814	APR_DRG	Other Or Procedures For Lymphatichematopoieticother Neoplasms	16	14	—	—	$19,341.11	$68,717.68	$68,717.68	2026-07-17
81	APR_DRG	Autologous Bone Marrow Transplant	16	14	—	—	$19,337.99	$68,706.58	$68,706.58	2026-07-17
82	APR_DRG	Autologous Bone Marrow Transplant	16	14	—	—	$19,337.99	$68,706.58	$68,706.58	2026-07-17
83	APR_DRG	Autologous Bone Marrow Transplant	16	14	—	—	$19,337.99	$68,706.58	$68,706.58	2026-07-17
7104	APR_DRG	Infectious And Parasitic Diseases Including HIV W Or Procedure	16	14	—	—	$19,189.76	$68,179.95	$68,179.95	2026-07-17
216	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	27	22	—	—	$53,751.17	$192,889.62	$67,359.88	2026-07-17
1612	APR_DRG	Cardiac Defibrillator And Heart Assist Implant	16	14	—	—	$18,949.90	$67,327.74	$67,327.74	2026-07-17
6344	APR_DRG	Neonate, Birthwt >2499g W Resp Dist Synd/oth Maj Resp Cond	16	14	—	—	$18,727.74	$66,538.42	$66,538.42	2026-07-17
1763	APR_DRG	Cardiac Pacemaker And Defibrillator Device Replacement	16	14	—	—	$15,961.08	$66,368.22	$66,368.22	2026-07-17
1764	APR_DRG	Cardiac Pacemaker And Defibrillator Device Replacement	16	14	—	—	$18,679.84	$66,368.22	$66,368.22	2026-07-17
1304	APR_DRG	Respiratory System Diagnosis W Ventilator Support 96+ Hours	16	14	—	—	$18,674.28	$66,348.49	$66,348.49	2026-07-17
L8702	HCPCS	Ewhf S/d Uprt Micro Sensor	15	13	—	—	$65,871.74	$197,615.22	$65,871.74	2026-07-17
Q2043	HCPCS	Sipuleucel-t Auto Cd54+	50	36	$163,017.00	$97,810.20 40% off	$37,982.96	$166,360.71	$65,732.65	2026-07-17
A9543	HCPCS	Y90 Ibritumomab Rx	27	22	—	—	$43,768.55	$196,429.74	$65,476.58	2026-07-17
6804	APR_DRG	Major Or Procedures For Lymphatichematopoieticother Neoplasms	16	14	—	—	$18,362.57	$65,240.97	$65,240.97	2026-07-17
4402	APR_DRG	Kidney Transplant	16	14	—	—	$18,360.48	$65,233.57	$65,233.57	2026-07-17
9504	APR_DRG	Extensive Procedure Unrelated To Principal Diagnosis	16	14	—	—	$18,340.00	$65,160.81	$65,160.81	2026-07-17
234	APR_DRG	Spinal Procedures	16	14	—	—	$18,275.09	$64,930.18	$64,930.18	2026-07-17
2644	APR_DRG	Other Hepatobiliary, Pancreas & Abdominal Procedures	16	14	—	—	$18,200.46	$64,665.01	$64,665.01	2026-07-17
5891	APR_DRG	Neonate Bwt 500g Or Ga 24 Weeks	16	14	—	—	$18,182.41	$98,896.59	$64,600.88	2026-07-17
5892	APR_DRG	Neonate Bwt 500g Or Ga 24 Weeks	16	14	—	—	$18,182.41	$69,370.87	$64,600.88	2026-07-17
5893	APR_DRG	Neonate Bwt 500g Or Ga 24 Weeks	16	14	—	—	$18,182.41	$64,600.88	$64,600.88	2026-07-17
5894	APR_DRG	Neonate Bwt 500g Or Ga 24 Weeks	16	14	—	—	$11,889.12	$64,600.88	$64,600.88	2026-07-17
850	MS_DRG	Acute Leukemia With Other Procedures	9	8	—	—	$64,294.48	$129,132.41	$64,294.48	2026-07-17
1754	APR_DRG	Percutaneous Coronary Intervention Wo Ami	16	14	—	—	$18,017.18	$64,013.83	$64,013.83	2026-07-17
4401	APR_DRG	Kidney Transplant	16	14	—	—	$17,927.27	$63,694.40	$63,694.40	2026-07-17
J9029	HCPCS	Instill Adstiladrin Tx Dose	28	20	—	—	$61,800.00	$190,516.20	$63,354.77	2026-07-17
924	APR_DRG	Facial Bone Procedures Except Major Cranialfacial Bone Procedures	16	14	—	—	$17,626.31	$62,625.12	$62,625.12	2026-07-17
914	APR_DRG	Other Major Head And Neck Procedures	16	14	—	—	$17,548.90	$62,350.09	$62,350.09	2026-07-17
6082	APR_DRG	Neonate Bwt 12501499g W Or Wo Other Significant Condition	16	14	—	—	$17,278.15	$61,388.10	$61,388.10	2026-07-17
204	APR_DRG	Craniotomy For Trauma	16	14	—	—	$17,139.64	$60,896.01	$60,896.01	2026-07-17
4034	APR_DRG	Procedures For Obesity	16	14	—	—	$17,138.95	$60,893.55	$60,893.55	2026-07-17
7924	APR_DRG	Extensive Or Procedures For Other Complications Of Treatment	16	14	—	—	$17,117.08	$60,815.85	$60,815.85	2026-07-17
51	APR_DRG	Tracheostomy W Mv 96+ Hours Without Extensive Procedure	16	14	—	—	$17,058.07	$60,606.19	$60,606.19	2026-07-17
52	APR_DRG	Tracheostomy W Mv 96+ Hours Without Extensive Procedure	16	14	—	—	$17,058.07	$60,606.19	$60,606.19	2026-07-17
6143	APR_DRG	Neonate Bwt 15001999g W Or Wo Other Significant Condition	16	14	—	—	$16,871.66	$59,943.90	$59,943.90	2026-07-17
6144	APR_DRG	Neonate Bwt 15001999g W Or Wo Other Significant Condition	16	14	—	—	$16,871.66	$59,943.90	$59,943.90	2026-07-17
3174	APR_DRG	Tendon, Muscle & Other Soft Tissue Procedures	16	14	—	—	$16,837.30	$59,821.80	$59,821.80	2026-07-17
1653	APR_DRG	Coronary Bypass W Ami Or Complex Pdx	16	14	—	—	$16,733.85	$59,454.27	$59,454.27	2026-07-17
6122	APR_DRG	Neonate Bwt 15001999g W Resp Dist Syndoth Maj Resp Cond	16	14	—	—	$16,719.62	$59,403.71	$59,403.71	2026-07-17
7114	APR_DRG	Postop Posttrauma Other Device Infections W Or Procedure	16	14	—	—	$16,710.25	$59,370.41	$59,370.41	2026-07-17
231	MS_DRG	Coronary Bypass With Ptca With Mcc	27	22	—	—	$43,951.42	$166,185.36	$59,143.61	2026-07-17
456	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature- Malignancy- Infection Or Ex…	27	22	—	—	$46,546.34	$167,757.01	$59,110.80	2026-07-17
893	APR_DRG	Major Cranialfacial Bone Procedures	16	14	—	—	$16,526.62	$58,717.98	$58,717.98	2026-07-17
4054	APR_DRG	Other Procedures For Endocrine, Nutritional & Metabolic Disorders	16	14	—	—	$16,441.58	$58,415.82	$58,415.82	2026-07-17
429	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	9	8	—	—	$58,213.24	$116,918.53	$58,213.24	2026-07-17
244	APR_DRG	Extracranial Vascular Procedures	16	14	—	—	$16,373.54	$58,174.09	$58,174.09	2026-07-17
1633	APR_DRG	Cardiac Valve Procedures Wo Ami Or Complex Pdx	16	14	—	—	$16,083.69	$57,144.28	$57,144.28	2026-07-17
G2171	HCPCS	Avf Use Magnetic/art/ven	6	4	—	—	$2,500.00	$57,830.40	$57,027.20	2026-07-17
G2170	HCPCS	Avf By Tissue W Thermal E	6	4	—	—	$2,500.00	$57,830.40	$57,027.20	2026-07-17
20	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	27	22	—	—	$52,126.12	$199,896.33	$56,262.47	2026-07-17
10	MS_DRG	Pancreas Transplant	27	22	—	—	$19,584.64	$111,765.51	$55,647.57	2026-07-17
213	APR_DRG	Craniotomy Except For Trauma	16	14	—	—	$15,660.89	$55,642.10	$55,642.10	2026-07-17
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	25	21	—	—	$36,064.60	$147,888.23	$55,328.61	2026-07-17
E0194	HCPCS	Air Fluidized Bed	1	1	—	—	$55,198.08	$55,198.08	$55,198.08	2026-07-17
3214	APR_DRG	Cervical Spinal Fusion And Other Backneck Proc Exc Disc Excisdecomp	16	14	—	—	$15,510.93	$55,109.31	$55,109.31	2026-07-17
1611	APR_DRG	Cardiac Defibrillator And Heart Assist Implant	16	14	—	—	$15,458.52	$54,923.08	$54,923.08	2026-07-17
453	MS_DRG	Combined Anterior/posterior Spinal Fusion W Mcc	18	15	—	—	$49,770.12	$181,265.04	$54,648.43	2026-07-17
233	MS_DRG	Coronary Bypass With Cardiac Catheterization With Mcc	27	22	—	—	$41,582.44	$153,349.02	$54,554.58	2026-07-17
219	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	27	22	—	—	$41,963.53	$160,940.34	$54,003.90	2026-07-17
3042	APR_DRG	Dorsal And Lumbar Fusion Proc Except For Curvature Of Back	16	14	—	—	$15,144.72	$53,808.17	$53,808.17	2026-07-17
1603	APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	16	14	—	—	$15,135.00	$53,773.64	$53,773.64	2026-07-17
2444	APR_DRG	Diverticulitis And Diverticulosis	16	14	—	—	$10,075.80	$53,353.08	$53,353.08	2026-07-17
1622	APR_DRG	Cardiac Valve Procedures W Ami Or Complex Pdx	16	14	—	—	$14,979.83	$53,222.35	$53,222.35	2026-07-17
9514	APR_DRG	Moderately Extensive Procedure Unrelated To Principal Diagnosis	16	14	—	—	$14,797.59	$52,574.86	$52,574.86	2026-07-17
1744	APR_DRG	Percutaneous Coronary Intervention W Ami	16	14	—	—	$14,789.26	$52,545.26	$52,545.26	2026-07-17
9123	APR_DRG	Musculoskeletal And Other Procedures For Multiple Significant Trauma	16	14	—	—	$14,764.61	$52,457.69	$52,457.69	2026-07-17
6213	APR_DRG	Neonate Bwt 20002499g W Major Anomaly	16	14	—	—	$14,709.77	$52,262.83	$52,262.83	2026-07-17
957	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Mcc	27	22	—	—	$40,172.96	$146,727.90	$52,096.40	2026-07-17
9102	APR_DRG	Craniotomy For Multiple Significant Trauma	16	14	—	—	$14,636.53	$52,002.60	$52,002.60	2026-07-17
9103	APR_DRG	Craniotomy For Multiple Significant Trauma	16	14	—	—	$14,636.53	$52,002.60	$52,002.60	2026-07-17
9101	APR_DRG	Craniotomy For Multiple Significant Trauma	16	14	—	—	$13,920.63	$52,002.60	$52,002.60	2026-07-17
1632	APR_DRG	Cardiac Valve Procedures Wo Ami Or Complex Pdx	16	14	—	—	$14,527.88	$51,616.57	$51,616.57	2026-07-17
2314	APR_DRG	Major Large Bowel Procedures	16	14	—	—	$14,496.29	$51,504.34	$51,504.34	2026-07-17
1663	APR_DRG	Coronary Bypass Wo Ami Or Complex Pdx	16	14	—	—	$14,477.20	$51,436.51	$51,436.51	2026-07-17
6813	APR_DRG	Other Or Procedures For Lymphatichematopoieticother Neoplasms	16	14	—	—	$13,731.30	$51,235.48	$51,235.48	2026-07-17
J9226	HCPCS	Supprelin La Implant	35	24	—	—	$40,116.00	$133,736.25	$51,205.74	2026-07-17
1704	APR_DRG	Permanent Cardiac Pacemaker Implant W Ami, Heart Failure Or Shock	16	14	—	—	$14,318.56	$50,872.89	$50,872.89	2026-07-17
1824	APR_DRG	Other Peripheral Vascular Procedures	16	14	—	—	$14,290.44	$50,772.99	$50,772.99	2026-07-17
5114	APR_DRG	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	16	14	—	—	$14,278.99	$50,732.29	$50,732.29	2026-07-17
1302	APR_DRG	Respiratory System Diagnosis W Ventilator Support 96+ Hours	16	14	—	—	$14,263.37	$50,676.79	$50,676.79	2026-07-17
1303	APR_DRG	Respiratory System Diagnosis W Ventilator Support 96+ Hours	16	14	—	—	$14,263.37	$50,676.79	$50,676.79	2026-07-17
1301	APR_DRG	Respiratory System Diagnosis W Ventilator Support 96+ Hours	16	14	—	—	$14,263.37	$50,676.79	$50,676.79	2026-07-17
1652	APR_DRG	Coronary Bypass W Ami Or Complex Pdx	16	14	—	—	$14,150.90	$50,277.20	$50,277.20	2026-07-17
0424T	CPT	Insj/rplc Nstim Apnea Compl	8	8	—	—	$2,243.40	$50,086.75	$50,086.75	2026-07-17
2634	APR_DRG	Cholecystectomy	16	14	—	—	$14,079.39	$50,023.13	$50,023.13	2026-07-17
2244	APR_DRG	Peritoneal Adhesiolysis	16	14	—	—	$13,967.96	$49,627.24	$49,627.24	2026-07-17
1813	APR_DRG	Lower Extremity Arterial Procedures	16	14	—	—	$13,963.10	$49,609.98	$49,609.98	2026-07-17
427	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	9	8	—	—	$49,573.31	$99,565.65	$49,573.31	2026-07-17
892	APR_DRG	Major Cranialfacial Bone Procedures	16	14	—	—	$11,457.52	$49,529.81	$49,529.81	2026-07-17
275	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	17	14	—	—	$43,389.92	$130,169.76	$49,324.14	2026-07-17
224	APR_DRG	Ventricular Shunt Procedures	16	14	—	—	$13,777.39	$48,950.15	$48,950.15	2026-07-17
404	APR_DRG	Spinal Disorders And Injuries	16	14	—	—	$13,701.37	$48,680.06	$48,680.06	2026-07-17
2203	APR_DRG	Major Stomach, Esophageal & Duodenal Procedures	16	14	—	—	$13,672.91	$48,578.93	$48,578.93	2026-07-17
870	MS_DRG	Septicemia Or Severe Sepsis With Mv >96 Hours	27	22	—	—	$33,850.33	$134,459.82	$48,552.91	2026-07-17
6071	APR_DRG	Neonate Bwt 12501499g W Resp Dist Syndoth Maj Resp Or Maj Anom	16	14	—	—	$13,571.20	$48,217.57	$48,217.57	2026-07-17
4424	APR_DRG	Kidney And Urinary Tract Procedures For Malignancy	16	14	—	—	$13,564.60	$48,194.13	$48,194.13	2026-07-17
6303	APR_DRG	Neonate Birthwt 2499g W Major Cardiovascular Procedure	16	14	—	—	$13,555.93	$48,163.30	$48,163.30	2026-07-17
6301	APR_DRG	Neonate Birthwt 2499g W Major Cardiovascular Procedure	16	14	—	—	$13,555.93	$48,163.30	$48,163.30	2026-07-17
6302	APR_DRG	Neonate Birthwt 2499g W Major Cardiovascular Procedure	16	14	—	—	$13,555.93	$48,163.30	$48,163.30	2026-07-17
8424	APR_DRG	Burns With Skin Graft Except Extensive 3rd Degree Burns	1	1	—	—	$47,998.02	$47,998.02	$47,998.02	2026-07-17
955	MS_DRG	Craniotomy For Multiple Significant Trauma	27	22	—	—	$32,545.41	$133,372.80	$47,658.14	2026-07-17
1693	APR_DRG	Major Abdominal Vascular Procedures	16	14	—	—	$13,322.31	$47,333.28	$47,333.28	2026-07-17
6333	APR_DRG	Neonate Birthwt 2499g W Major Anomaly	16	14	—	—	$13,284.82	$47,200.08	$47,200.08	2026-07-17
2614	APR_DRG	Major Biliary Tract Procedures	16	14	—	—	$13,250.80	$47,079.22	$47,079.22	2026-07-17
3094	APR_DRG	Other Significant Hip And Femur Surgery	16	14	—	—	$13,213.31	$46,946.02	$46,946.02	2026-07-17
2274	APR_DRG	Hernia Procedures Except Inguinal, Femoral & Umbilical	16	14	—	—	$13,202.21	$46,906.56	$46,906.56	2026-07-17
447	MS_DRG	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	9	8	—	—	$46,795.47	$93,986.48	$46,795.47	2026-07-17
928	MS_DRG	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	27	22	—	—	$33,157.72	$128,021.79	$46,615.40	2026-07-17
3134	APR_DRG	Knee And Lower Leg Procedures Except Foot	16	14	—	—	$13,109.18	$46,576.03	$46,576.03	2026-07-17
268	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	27	22	—	—	$36,303.34	$137,031.84	$46,536.53	2026-07-17
6133	APR_DRG	Neonate Birthwt 15001999g W Congenitalperinatal Infection	16	14	—	—	$13,076.20	$46,458.86	$46,458.86	2026-07-17
6134	APR_DRG	Neonate Birthwt 15001999g W Congenitalperinatal Infection	16	14	—	—	$13,076.20	$47,731.03	$46,458.86	2026-07-17
6223	APR_DRG	Neonate Bwt 20002499g W Resp Dist Syndoth Maj Resp Cond	16	14	—	—	$13,065.79	$46,421.86	$46,421.86	2026-07-17
984	APR_DRG	Other Ear, Nose, Mouth & Throat Procedures	16	14	—	—	$13,062.31	$46,409.53	$46,409.53	2026-07-17
2294	APR_DRG	Other Digestive System And Abdominal Procedures	16	14	—	—	$13,044.96	$46,347.87	$46,347.87	2026-07-17
6313	APR_DRG	Neonate Birthwt 2499g W Other Major Procedure	16	14	—	—	$12,974.84	$46,098.74	$46,098.74	2026-07-17
L7181	HCPCS	Electronic Elbo Simultaneous	37	28	—	—	$37,858.44	$141,711.21	$46,040.03	2026-07-17
2303	APR_DRG	Major Small Bowel Procedures	16	14	—	—	$12,936.65	$45,963.07	$45,963.07	2026-07-17
1673	APR_DRG	Other Cardiothoracic And Thoracic Vascular Procedures	16	14	—	—	$12,929.71	$45,938.41	$45,938.41	2026-07-17
1621	APR_DRG	Cardiac Valve Procedures W Ami Or Complex Pdx	16	14	—	—	$12,876.60	$45,749.71	$45,749.71	2026-07-17
494	APR_DRG	Bacterial And Tuberculous Infections Of Nervous System	16	14	—	—	$12,872.44	$45,734.91	$45,734.91	2026-07-17
3041	APR_DRG	Dorsal And Lumbar Fusion Proc Except For Curvature Of Back	16	14	—	—	$12,804.75	$45,494.41	$45,494.41	2026-07-17
6803	APR_DRG	Major Or Procedures For Lymphatichematopoieticother Neoplasms	16	14	—	—	$12,727.34	$45,219.38	$45,219.38	2026-07-17
207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	27	22	—	—	$30,699.36	$130,004.82	$45,137.84	2026-07-17
217	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	27	22	—	—	$35,149.17	$125,706.24	$45,072.93	2026-07-17
L7180	HCPCS	Electronic Elbow Sequential	37	28	—	—	$25,912.94	$137,637.84	$44,716.65	2026-07-17
8632	APR_DRG	Neonatal Aftercare	16	14	—	—	$10,340.39	$44,674.26	$44,674.26	2026-07-17
222	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization With Ami- Hf Or Shock…	10	9	—	—	$44,309.85	$154,149.80	$44,486.84	2026-07-17
1203	APR_DRG	Major Respiratory And Chest Procedures	16	14	—	—	$12,476.02	$44,326.47	$44,326.47	2026-07-17
969	MS_DRG	HIV With Extensive O.r. Procedures With Mcc	27	22	—	—	$31,058.50	$143,502.48	$44,140.47	2026-07-17
264	APR_DRG	Other Nervous System And Related Procedures	16	14	—	—	$12,369.80	$43,949.07	$43,949.07	2026-07-17
504	APR_DRG	Nonbacterial Infections Of Nervous System Exc Viral Meningitis	16	14	—	—	$12,239.63	$43,486.58	$43,486.58	2026-07-17
4844	APR_DRG	Other Male Reproductive System And Related Procedures	16	14	—	—	$12,223.31	$43,428.62	$43,428.62	2026-07-17
7934	APR_DRG	Moderately Extensive Or Procedures For Other Complications Of Treatment	16	14	—	—	$12,194.50	$43,326.25	$43,326.25	2026-07-17
276	MS_DRG	Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator	17	14	—	—	$38,298.43	$114,895.29	$43,233.83	2026-07-17
6312	APR_DRG	Neonate Birthwt 2499g W Other Major Procedure	16	14	—	—	$12,159.44	$43,201.69	$43,201.69	2026-07-17
317	MS_DRG	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	9	8	—	—	$43,177.99	$86,720.96	$43,177.99	2026-07-17
573	MS_DRG	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	27	22	—	—	$28,449.73	$116,235.90	$42,981.17	2026-07-17
3213	APR_DRG	Cervical Spinal Fusion And Other Backneck Proc Exc Disc Excisdecomp	16	14	—	—	$12,074.74	$42,900.76	$42,900.76	2026-07-17
461	MS_DRG	Bilateral Or Multiple Major Joint Procs Of Lower Extremity W Mcc	27	22	—	—	$28,789.61	$126,149.48	$42,831.11	2026-07-17
2603	APR_DRG	Major Pancreas, Liver & Shunt Procedures	16	14	—	—	$12,050.79	$42,815.66	$42,815.66	2026-07-17
K0606	HCPCS	Aed Garment W Elec Analysis	1	1	—	—	$42,713.76	$42,713.76	$42,713.76	2026-07-17
232	MS_DRG	Coronary Bypass With Ptca Without Mcc	27	22	—	—	$31,930.81	$115,984.44	$42,635.69	2026-07-17
28	MS_DRG	Spinal Procedures With Mcc	27	22	—	—	$29,922.18	$116,374.50	$42,431.89	2026-07-17
17	MS_DRG	Autologous Bone Marrow Transplant Without Cc/mcc	27	22	—	—	$23,804.36	$114,281.05	$42,127.58	2026-07-17
16	MS_DRG	Autologous Bone Marrow Transplant With Cc/mcc	27	22	—	—	$35,211.30	$127,190.30	$42,127.58	2026-07-17
0266T	CPT	Implt/rpl Crtd Sns Dev Total	24	20	—	—	$212.98	$122,940.46	$41,881.96	2026-07-17
2824	APR_DRG	Disorders Of Pancreas Except Malignancy	16	14	—	—	$11,772.05	$41,825.31	$41,825.31	2026-07-17
266	MS_DRG	Endovascular Cardiac Valve Replacement W Mcc	27	22	—	—	$38,116.74	$131,553.62	$41,812.80	2026-07-17
8504	APR_DRG	Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service	16	14	—	—	$11,761.64	$41,788.31	$41,788.31	2026-07-17
6914	APR_DRG	Lymphoma, Myeloma & Non-acute Leukemia	16	14	—	—	$11,735.60	$41,695.81	$41,695.81	2026-07-17
6142	APR_DRG	Neonate Bwt 15001999g W Or Wo Other Significant Condition	16	14	—	—	$11,731.09	$41,679.78	$41,679.78	2026-07-17
6222	APR_DRG	Neonate Bwt 20002499g W Resp Dist Syndoth Maj Resp Cond	16	14	—	—	$11,694.99	$41,551.51	$41,551.51	2026-07-17
218	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	27	22	—	—	$27,843.03	$117,586.26	$41,523.15	2026-07-17
6924	APR_DRG	Radiotherapy	16	14	—	—	$11,680.41	$41,499.72	$41,499.72	2026-07-17
790	MS_DRG	Extreme Immaturity Or Respiratory Distress Syndrome- Neonate	27	22	—	—	$29,829.05	$119,217.78	$41,491.75	2026-07-17
1602	APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	16	14	—	—	$11,592.93	$41,188.92	$41,188.92	2026-07-17
235	MS_DRG	Coronary Bypass Without Cardiac Catheterization With Mcc	27	22	—	—	$31,496.87	$118,602.00	$41,068.79	2026-07-17

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