Hospital

SYCAMORE SPRINGS

Lafayette, IN · CCN 154059 · Rates published

137 distinct procedures filed

101 distinct payers

1,891 rate rows

2026-08-17 last MRF observed

Data quality

1,496 of 1,891 rate rows are consumer-grade (79.1%)

395 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	295
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	100

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

Source MRF file	https://www.sycamorespringshealth.com/docs/bhsycamorespringslibraries/3q26/275458146_sycamore-springs_standardcharges.csv
Found on page	https://sycamorespringshealth.com/resources/accepted-insurance/#price-list
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-10-16
Content fingerprint	6b14b925beafd753… · 225,474 bytes · first seen 2026-08-17

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
7594 APR_DRG	Eating Disorders	5	$4,021.82	$4,142.48	$4,021.82	nat. median $27,181 outlier · 0.1×
7584 APR_DRG	Disorders Of Impulse Control & Development	5	$3,811.13	$3,925.47	$3,811.13	nat. median $14,512 outlier · 0.3×
876 MS_DRG	O.r. Procedures With Principal Diagnosis Of Mental Illness	11	$3,533.57	$7,031.81	$3,533.57	nat. median $33,032 outlier · 0.1×
7574 APR_DRG	Organic Mental Health Conditions And Disturbances	5	$3,441.87	$3,545.13	$3,441.87	nat. median $16,531 outlier · 0.2×
7524 APR_DRG	Personality Disorders	5	$3,216.09	$3,312.57	$3,216.09	nat. median $15,489 outlier · 0.2×
876 OTHER	O.r. Procedures With Principal Diagnosis Of Mental Illness	1	$3,034.51	$3,034.51	$3,034.51	nat. median $1,698 1.8× median
7754 APR_DRG	Alcohol Abuse And Dependence	5	$2,984.41	$3,073.94	$2,984.41	nat. median $19,303 outlier · 0.2×
7504 APR_DRG	Schizophrenia And Other Severe Psychotic Disorders	5	$2,837.64	$2,922.76	$2,837.64	nat. median $20,361 outlier · 0.1×
7724 APR_DRG	Alcohol And Drug Dependence With Rehabilitation And/or Detoxification Therapy	5	$2,605.54	$2,683.71	$2,605.54	nat. median $14,111 outlier · 0.2×
7604 APR_DRG	Other Mental Health Conditions And Disorders	5	$2,499.79	$2,574.78	$2,499.79	nat. median $11,936 outlier · 0.2×
7744 APR_DRG	Cocaine Abuse And Dependence	5	$2,420.36	$2,492.98	$2,420.36	nat. median $13,222 outlier · 0.2×
7593 APR_DRG	Eating Disorders	5	$2,399.10	$2,471.08	$2,399.10	nat. median $14,833 outlier · 0.2×
7734 APR_DRG	Opioid Abuse And Dependence	5	$2,308.85	$2,378.11	$2,308.85	nat. median $14,166 outlier · 0.2×
7514 APR_DRG	Depressive Disorders	5	$2,295.95	$2,364.83	$2,295.95	nat. median $14,895 outlier · 0.2×
56 MS_DRG	Degenerative Nervous System Disorders With Mcc	11	$2,251.74	$4,480.96	$2,251.74	nat. median $21,142 outlier · 0.1×
11800016 CDM	Semi-private Room - Detox	8	$1,869.36	$2,482.75	$2,190.66	nat. median $2,191 1.0× median
11800036 CDM	H4h Ip Psych	8	$1,869.36	$2,482.75	$2,190.66	nat. median $2,191 1.0× median
11800038 CDM	H4h Ip Rehab	8	$1,869.36	$2,482.75	$2,190.66	nat. median $2,191 1.0× median
11800022 CDM	R&b Rehab	8	$1,869.36	$2,482.75	$2,190.66	nat. median $2,191 1.0× median
H0009 HCPCS	H4h Ip Cd	8	$1,869.36	$2,482.75	$2,190.66	nat. median $350 outlier · 6.3×
11800018 CDM	Semi-private Room Bh	8	$1,869.36	$2,482.75	$2,190.66	nat. median $2,191 1.0× median
7534 APR_DRG	Bipolar Disorders	5	$2,148.08	$2,212.52	$2,148.08	nat. median $14,200 outlier · 0.2×
7764 APR_DRG	Other Drug Abuse And Dependence	5	$2,145.48	$2,209.84	$2,145.48	nat. median $10,548 outlier · 0.2×
7564 APR_DRG	Acute Anxiety And Stress Syndromes	5	$2,067.15	$2,129.17	$2,067.15	nat. median $10,001 outlier · 0.2×
7704 APR_DRG	Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice	5	$1,908.03	$1,965.28	$1,908.03	nat. median $10,558 outlier · 0.2×
15851 CPT	Remove Sutures Diff Surgeon	35	$1,827.69	$2,010.46	$1,827.69	nat. median $1,899 1.0× median
7592 APR_DRG	Eating Disorders	5	$1,696.52	$1,747.41	$1,696.52	nat. median $8,783 outlier · 0.2×
883 MS_DRG	Disorders Of Personality And Impulse Control	11	$1,667.06	$3,317.46	$1,667.06	nat. median $16,489 outlier · 0.1×
886 MS_DRG	Behavioral And Developmental Disorders	11	$1,615.45	$3,214.74	$1,615.45	nat. median $16,721 outlier · 0.1×
896 MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc	11	$1,601.33	$3,186.65	$1,601.33	nat. median $15,465 outlier · 0.1×
884 MS_DRG	Organic Disturbances And Intellectual Disability	11	$1,501.88	$2,988.74	$1,501.88	nat. median $14,237 outlier · 0.1×
917 MS_DRG	Poisoning And Toxic Effects Of Drugs With Mcc	11	$1,474.45	$2,934.16	$1,474.45	nat. median $14,565 outlier · 0.1×
7503 APR_DRG	Schizophrenia And Other Severe Psychotic Disorders	5	$1,468.40	$1,512.46	$1,468.40	nat. median $9,310 outlier · 0.2×
7573 APR_DRG	Organic Mental Health Conditions And Disturbances	5	$1,399.27	$1,441.25	$1,399.27	nat. median $8,443 outlier · 0.2×
7523 APR_DRG	Personality Disorders	5	$1,350.99	$1,391.52	$1,350.99	nat. median $7,619 outlier · 0.2×
7753 APR_DRG	Alcohol Abuse And Dependence	5	$1,321.77	$1,361.42	$1,321.77	nat. median $8,306 outlier · 0.2×
895 MS_DRG	Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy	11	$1,301.98	$2,590.94	$1,301.98	nat. median $13,089 outlier · 0.1×
7591 APR_DRG	Eating Disorders	5	$1,270.74	$1,308.87	$1,270.74	nat. median $7,232 outlier · 0.2×
885 MS_DRG	Psychoses	11	$1,267.54	$2,522.41	$1,267.54	nat. median $12,307 outlier · 0.1×
7723 APR_DRG	Alcohol And Drug Dependence With Rehabilitation And/or Detoxification Therapy	5	$1,266.22	$1,304.20	$1,266.22	nat. median $6,161 outlier · 0.2×
7554 APR_DRG	Adjustment Disorders	5	$1,244.54	$1,281.88	$1,244.54	nat. median $9,097 outlier · 0.1×
7533 APR_DRG	Bipolar Disorders	5	$1,239.06	$1,276.23	$1,239.06	nat. median $8,062 outlier · 0.2×
7603 APR_DRG	Other Mental Health Conditions And Disorders	5	$1,221.64	$1,258.29	$1,221.64	nat. median $7,852 outlier · 0.2×
57 MS_DRG	Degenerative Nervous System Disorders Without Mcc	11	$1,199.92	$2,387.84	$1,199.92	nat. median $12,544 outlier · 0.1×
7513 APR_DRG	Depressive Disorders	5	$1,199.14	$1,235.11	$1,199.14	nat. median $7,613 outlier · 0.2×
917 OTHER	Poisoning And Toxic Effects Of Drugs Age >17 With Mcc	1	$1,194.79	$1,194.79	$1,194.79	nat. median $2,337 0.5× median
884 OTHER	Organic Disturbances And Intellectual Disability	1	$1,168.90	$1,168.90	$1,168.90	nat. median $943 1.2× median
7563 APR_DRG	Acute Anxiety And Stress Syndromes	5	$1,164.44	$1,199.37	$1,164.44	nat. median $6,086 outlier · 0.2×
947 MS_DRG	Signs And Symptoms With Mcc	11	$1,156.58	$2,301.59	$1,156.58	nat. median $12,107 outlier · 0.1×
947 OTHER	Signs And Symptoms With Mcc	1	$1,131.31	$1,131.31	$1,131.31	nat. median $8,014 outlier · 0.1×

Other procedures at this hospital

Browse this hospital's 137 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

S9480	HCPCS	H4h Iop Psych	0	0	$305.00	—	—	—	—	2026-08-17
H0035	HCPCS	H4h Php Cd	0	0	$381.54	—	—	—	—	2026-08-17
H0015	HCPCS	Alcohol And/or Drug Services	0	0	$305.00	—	—	—	—	2026-08-17
H0009	HCPCS	H4h Ip Cd	8	8	$2,920.88	$800.00 73% off	$1,869.36	$2,482.75	$2,190.66	2025-09-22
G0410	HCPCS	Php Cd Adol Group Therapy	39	18	$347.72	$250.00 28% off	$79.56	$851.70	$310.34	2025-09-22
948	MS_DRG	Signs And Symptoms Without Mcc	17	11	$2,920.88	$800.00 73% off	$714.43	$1,421.72	$714.43	2025-09-22
948	OTHER	Signs And Symptoms Without Mcc	1	1	$2,920.88	$800.00 73% off	$648.61	$648.61	$648.61	2025-09-22
947	MS_DRG	Signs And Symptoms With Mcc	17	11	$2,920.88	$800.00 73% off	$1,156.58	$2,301.59	$1,156.58	2025-09-22
947	OTHER	Signs And Symptoms With Mcc	1	1	$2,920.88	$800.00 73% off	$1,131.31	$1,131.31	$1,131.31	2025-09-22
918	MS_DRG	Poisoning And Toxic Effects Of Drugs Without Mcc	17	11	$2,920.88	$800.00 73% off	$795.45	$1,582.95	$795.45	2025-09-22
918	OTHER	Poisoning And Toxic Effects Of Drugs Age >17 Without Mcc	1	1	$2,920.88	$800.00 73% off	$498.35	$498.35	$498.35	2025-09-22
917	MS_DRG	Poisoning And Toxic Effects Of Drugs With Mcc	17	11	$2,920.88	$800.00 73% off	$1,474.45	$2,934.16	$1,474.45	2025-09-22
917	OTHER	Poisoning And Toxic Effects Of Drugs Age >17 With Mcc	1	1	$2,920.88	$800.00 73% off	$1,194.79	$1,194.79	$1,194.79	2025-09-22
90853	CPT	Iop Cd Adol Group Therap-virt	70	53	$381.54	$125.00 67% off	$186.80	$561.18	$408.21	2026-08-17
90847	CPT	Family Psytx W/pt 50 Min	40	35	$381.54	—	$408.21	$449.03	$408.21	2026-08-17
90846	CPT	Family Psytx Without Pt 50 Min	40	35	$381.54	—	$408.21	$449.03	$408.21	2026-08-17
90834	CPT	Php Indiv Therapy 31-45 Min	40	35	$381.54	—	$408.21	$449.03	$408.21	2026-08-17
90832	CPT	Php Indiv Therapy 16-30 Min	40	35	$381.54	—	$408.21	$449.03	$408.21	2026-08-17
90785	CPT	Php - Interactive Complexity	0	0	$381.54	—	—	—	—	2026-08-17
899	OTHER	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Age <=21 Withou	1	1	$2,920.88	$800.00 73% off	$788.17	$788.17	$788.17	2025-09-22
898	OTHER	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Age >21 Without	1	1	$2,920.88	$800.00 73% off	$772.97	$772.97	$772.97	2025-09-22
897	MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	17	11	$2,920.88	$800.00 73% off	$793.29	$1,578.65	$793.29	2025-09-22
896	MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc	17	11	$2,920.88	$800.00 73% off	$1,601.33	$3,186.65	$1,601.33	2025-09-22
896	OTHER	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc	1	1	$2,920.88	$800.00 73% off	$1,054.16	$1,054.16	$1,054.16	2025-09-22
895	MS_DRG	Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy	17	11	$2,920.88	$800.00 73% off	$1,301.98	$2,590.94	$1,301.98	2025-09-22
895	OTHER	Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy	1	1	$2,920.88	$800.00 73% off	$661.83	$661.83	$661.83	2025-09-22
894	MS_DRG	Alcohol, Drug Abuse Or Dependence, Left Ama	17	11	$2,920.88	$800.00 73% off	$561.20	$1,116.79	$561.20	2025-09-22
894	OTHER	Alcohol, Drug Abuse Or Dependence, Left Ama	1	1	$2,920.88	$800.00 73% off	$346.92	$346.92	$346.92	2025-09-22
887	OTHER	Other Mental Disorder Diagnoses	1	1	$2,920.88	$800.00 73% off	$1,111.71	$1,111.71	$1,111.71	2025-09-22
887	MS_DRG	Other Mental Disorder Diagnoses	17	11	$2,920.88	$800.00 73% off	$1,069.53	$2,128.37	$1,069.53	2025-09-22
886	MS_DRG	Behavioral And Developmental Disorders	17	11	$2,920.88	$800.00 73% off	$1,615.45	$3,214.74	$1,615.45	2025-09-22
886	OTHER	Behavioral And Developmental Disorders	1	1	$2,920.88	$800.00 73% off	$1,103.97	$1,103.97	$1,103.97	2025-09-22
885	MS_DRG	Psychoses	17	11	$2,920.88	$800.00 73% off	$1,267.54	$2,522.41	$1,267.54	2025-09-22
885	OTHER	Psychoses	1	1	$2,920.88	$800.00 73% off	$478.39	$478.39	$478.39	2025-09-22
884	MS_DRG	Organic Disturbances And Intellectual Disability	17	11	$2,920.88	$800.00 73% off	$1,501.88	$2,988.74	$1,501.88	2025-09-22
884	OTHER	Organic Disturbances And Intellectual Disability	1	1	$2,920.88	$800.00 73% off	$1,168.90	$1,168.90	$1,168.90	2025-09-22
883	MS_DRG	Disorders Of Personality And Impulse Control	17	11	$2,920.88	$800.00 73% off	$1,667.06	$3,317.46	$1,667.06	2025-09-22
883	OTHER	Disorders Of Personality And Impulse Control	1	1	$2,920.88	$800.00 73% off	$1,102.35	$1,102.35	$1,102.35	2025-09-22
882	MS_DRG	Neuroses Except Depressive	17	11	$2,920.88	$800.00 73% off	$865.05	$1,721.45	$865.05	2025-09-22
882	OTHER	Neuroses Except Depressive	1	1	$2,920.88	$800.00 73% off	$419.40	$419.40	$419.40	2025-09-22
881	MS_DRG	Depressive Neuroses	17	11	$2,920.88	$800.00 73% off	$821.98	$1,635.73	$821.98	2025-09-22
881	OTHER	Depressive Neuroses	1	1	$2,920.88	$800.00 73% off	$412.56	$412.56	$412.56	2025-09-22
880	MS_DRG	Acute Adjustment Reaction And Psychosocial Dysfunction	17	11	$2,920.88	$800.00 73% off	$861.99	$1,715.36	$861.99	2025-09-22
880	OTHER	Acute Adjustment Reaction And Psychosocial Dysfunction	1	1	$2,920.88	$800.00 73% off	$590.70	$590.70	$590.70	2025-09-22
876	MS_DRG	O.r. Procedures With Principal Diagnosis Of Mental Illness	17	11	$2,920.88	$800.00 73% off	$3,533.57	$7,031.81	$3,533.57	2025-09-22
876	OTHER	O.r. Procedures With Principal Diagnosis Of Mental Illness	1	1	$2,920.88	$800.00 73% off	$3,034.51	$3,034.51	$3,034.51	2025-09-22
7764	APR_DRG	Other Drug Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$2,145.48	$2,209.84	$2,145.48	2025-09-22
7763	APR_DRG	Other Drug Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$1,130.14	$1,164.05	$1,130.14	2025-09-22
7762	APR_DRG	Other Drug Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$597.51	$615.44	$597.51	2025-09-22
7761	APR_DRG	Other Drug Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$434.14	$447.17	$434.14	2025-09-22
7754	APR_DRG	Alcohol Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$2,984.41	$3,073.94	$2,984.41	2025-09-22
7753	APR_DRG	Alcohol Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$1,321.77	$1,361.42	$1,321.77	2025-09-22
7752	APR_DRG	Alcohol Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$728.78	$750.65	$728.78	2025-09-22
7751	APR_DRG	Alcohol Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$479.41	$493.79	$479.41	2025-09-22
7744	APR_DRG	Cocaine Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$2,420.36	$2,492.98	$2,420.36	2025-09-22
7743	APR_DRG	Cocaine Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$973.50	$1,002.70	$973.50	2025-09-22
7742	APR_DRG	Cocaine Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$556.22	$572.91	$556.22	2025-09-22
7741	APR_DRG	Cocaine Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$416.17	$428.66	$416.17	2025-09-22
7734	APR_DRG	Opioid Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$2,308.85	$2,378.11	$2,308.85	2025-09-22
7733	APR_DRG	Opioid Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$1,077.88	$1,110.22	$1,077.88	2025-09-22
7732	APR_DRG	Opioid Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$555.54	$572.20	$555.54	2025-09-22
7731	APR_DRG	Opioid Abuse And Dependence	5	5	$2,920.88	$800.00 73% off	$374.47	$385.71	$374.47	2025-09-22
7724	APR_DRG	Alcohol And Drug Dependence With Rehabilitation And/or Detoxification Therapy	5	5	$2,920.88	$800.00 73% off	$2,605.54	$2,683.71	$2,605.54	2025-09-22
7723	APR_DRG	Alcohol And Drug Dependence With Rehabilitation And/or Detoxification Therapy	5	5	$2,920.88	$800.00 73% off	$1,266.22	$1,304.20	$1,266.22	2025-09-22
7722	APR_DRG	Alcohol And Drug Dependence With Rehabilitation And/or Detoxification Therapy	5	5	$2,920.88	$800.00 73% off	$817.94	$842.48	$817.94	2025-09-22
7721	APR_DRG	Alcohol And Drug Dependence With Rehabilitation And/or Detoxification Therapy	5	5	$2,920.88	$800.00 73% off	$621.52	$640.16	$621.52	2025-09-22
7704	APR_DRG	Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice	5	5	$2,920.88	$800.00 73% off	$1,908.03	$1,965.28	$1,908.03	2025-09-22
7703	APR_DRG	Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice	5	5	$2,920.88	$800.00 73% off	$890.92	$917.65	$890.92	2025-09-22
7702	APR_DRG	Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice	5	5	$2,920.88	$800.00 73% off	$516.58	$532.08	$516.58	2025-09-22
7701	APR_DRG	Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice	5	5	$2,920.88	$800.00 73% off	$329.48	$339.37	$329.48	2025-09-22
7604	APR_DRG	Other Mental Health Conditions And Disorders	5	5	$2,920.88	$800.00 73% off	$2,499.79	$2,574.78	$2,499.79	2025-09-22
7603	APR_DRG	Other Mental Health Conditions And Disorders	5	5	$2,920.88	$800.00 73% off	$1,221.64	$1,258.29	$1,221.64	2025-09-22
7602	APR_DRG	Other Mental Health Conditions And Disorders	5	5	$2,920.88	$800.00 73% off	$777.89	$801.23	$777.89	2025-09-22
7601	APR_DRG	Other Mental Health Conditions And Disorders	5	5	$2,920.88	$800.00 73% off	$647.72	$667.15	$647.72	2025-09-22
7594	APR_DRG	Eating Disorders	5	5	$2,920.88	$800.00 73% off	$4,021.82	$4,142.48	$4,021.82	2025-09-22
7593	APR_DRG	Eating Disorders	5	5	$2,920.88	$800.00 73% off	$2,399.10	$2,471.08	$2,399.10	2025-09-22
7592	APR_DRG	Eating Disorders	5	5	$2,920.88	$800.00 73% off	$1,696.52	$1,747.41	$1,696.52	2025-09-22
7591	APR_DRG	Eating Disorders	5	5	$2,920.88	$800.00 73% off	$1,270.74	$1,308.87	$1,270.74	2025-09-22
7584	APR_DRG	Disorders Of Impulse Control & Development	5	5	$2,920.88	$800.00 73% off	$3,811.13	$3,925.47	$3,811.13	2025-09-22
7583	APR_DRG	Disorders Of Impulse Control & Development	5	5	$2,920.88	$800.00 73% off	$1,130.83	$1,164.75	$1,130.83	2025-09-22
7582	APR_DRG	Disorders Of Impulse Control & Development	5	5	$2,920.88	$800.00 73% off	$691.20	$711.94	$691.20	2025-09-22
7581	APR_DRG	Disorders Of Impulse Control & Development	5	5	$2,920.88	$800.00 73% off	$540.31	$556.52	$540.31	2025-09-22
7574	APR_DRG	Organic Mental Health Conditions And Disturbances	5	5	$2,920.88	$800.00 73% off	$3,441.87	$3,545.13	$3,441.87	2025-09-22
7573	APR_DRG	Organic Mental Health Conditions And Disturbances	5	5	$2,920.88	$800.00 73% off	$1,399.27	$1,441.25	$1,399.27	2025-09-22
7572	APR_DRG	Organic Mental Health Conditions And Disturbances	5	5	$2,920.88	$800.00 73% off	$979.26	$1,008.63	$979.26	2025-09-22
7571	APR_DRG	Organic Mental Health Conditions And Disturbances	5	5	$2,920.88	$800.00 73% off	$652.11	$671.67	$652.11	2025-09-22
7564	APR_DRG	Acute Anxiety And Stress Syndromes	5	5	$2,920.88	$800.00 73% off	$2,067.15	$2,129.17	$2,067.15	2025-09-22
7563	APR_DRG	Acute Anxiety And Stress Syndromes	5	5	$2,920.88	$800.00 73% off	$1,164.44	$1,199.37	$1,164.44	2025-09-22
7562	APR_DRG	Acute Anxiety And Stress Syndromes	5	5	$2,920.88	$800.00 73% off	$831.94	$856.89	$831.94	2025-09-22
7561	APR_DRG	Acute Anxiety And Stress Syndromes	5	5	$2,920.88	$800.00 73% off	$542.51	$558.78	$542.51	2025-09-22
7554	APR_DRG	Adjustment Disorders	5	5	$2,920.88	$800.00 73% off	$1,244.54	$1,281.88	$1,244.54	2025-09-22
7553	APR_DRG	Adjustment Disorders	5	5	$2,920.88	$800.00 73% off	$902.85	$929.94	$902.85	2025-09-22
7552	APR_DRG	Adjustment Disorders	5	5	$2,920.88	$800.00 73% off	$454.86	$468.50	$454.86	2025-09-22
7551	APR_DRG	Adjustment Disorders	5	5	$2,920.88	$800.00 73% off	$326.46	$336.26	$326.46	2025-09-22
7534	APR_DRG	Bipolar Disorders	5	5	$2,920.88	$800.00 73% off	$2,148.08	$2,212.52	$2,148.08	2025-09-22
7533	APR_DRG	Bipolar Disorders	5	5	$2,920.88	$800.00 73% off	$1,239.06	$1,276.23	$1,239.06	2025-09-22
7532	APR_DRG	Bipolar Disorders	5	5	$2,920.88	$800.00 73% off	$674.60	$694.84	$674.60	2025-09-22
7531	APR_DRG	Bipolar Disorders	5	5	$2,920.88	$800.00 73% off	$506.71	$521.91	$506.71	2025-09-22
7524	APR_DRG	Personality Disorders	5	5	$2,920.88	$800.00 73% off	$3,216.09	$3,312.57	$3,216.09	2025-09-22
7523	APR_DRG	Personality Disorders	5	5	$2,920.88	$800.00 73% off	$1,350.99	$1,391.52	$1,350.99	2025-09-22
7522	APR_DRG	Personality Disorders	5	5	$2,920.88	$800.00 73% off	$606.43	$624.62	$606.43	2025-09-22
7521	APR_DRG	Personality Disorders	5	5	$2,920.88	$800.00 73% off	$460.48	$474.29	$460.48	2025-09-22
7514	APR_DRG	Depressive Disorders	5	5	$2,920.88	$800.00 73% off	$2,295.95	$2,364.83	$2,295.95	2025-09-22
7513	APR_DRG	Depressive Disorders	5	5	$2,920.88	$800.00 73% off	$1,199.14	$1,235.11	$1,199.14	2025-09-22
7512	APR_DRG	Depressive Disorders	5	5	$2,920.88	$800.00 73% off	$590.52	$608.23	$590.52	2025-09-22
7511	APR_DRG	Depressive Disorders	5	5	$2,920.88	$800.00 73% off	$439.63	$452.82	$439.63	2025-09-22
7504	APR_DRG	Schizophrenia And Other Severe Psychotic Disorders	5	5	$2,920.88	$800.00 73% off	$2,837.64	$2,922.76	$2,837.64	2025-09-22
7503	APR_DRG	Schizophrenia And Other Severe Psychotic Disorders	5	5	$2,920.88	$800.00 73% off	$1,468.40	$1,512.46	$1,468.40	2025-09-22
7502	APR_DRG	Schizophrenia And Other Severe Psychotic Disorders	5	5	$2,920.88	$800.00 73% off	$979.67	$1,009.06	$979.67	2025-09-22
7501	APR_DRG	Schizophrenia And Other Severe Psychotic Disorders	5	5	$2,920.88	$800.00 73% off	$708.35	$729.60	$708.35	2025-09-22
57	MS_DRG	Degenerative Nervous System Disorders Without Mcc	17	11	$2,920.88	$800.00 73% off	$1,199.92	$2,387.84	$1,199.92	2025-09-22
56	MS_DRG	Degenerative Nervous System Disorders With Mcc	17	11	$2,920.88	$800.00 73% off	$2,251.74	$4,480.96	$2,251.74	2025-09-22
4274F	CPT	Flu Immuno Admind Rcvd	0	0	$23,248.39	—	—	—	—	2026-08-17
4149F	CPT	Hep B Vac Injxn Admin/recvd	0	0	$23,248.39	—	—	—	—	2026-08-17
4148F	CPT	Hep A Vac Injxn Admin/recvd	0	0	$23,248.39	—	—	—	—	2026-08-17
4037F	CPT	Influenza Imm Order/admin	0	0	$23,248.39	—	—	—	—	2026-08-17
4004F	CPT	Pt Tobacco Screen Rcvd Tlk	0	0	$21,468.48	—	—	—	—	2026-08-17
4001F	CPT	Tobacco Use Txmnt Pharmacol	0	0	$21,468.48	—	—	—	—	2026-08-17
18300008	CDM	Php Psy Group Therapy Child-vi	30	18	$365.11	$250.00 32% off	$79.56	$851.70	$427.99	2025-09-22
18300006	CDM	Php Psy Adol Group Therapy-vir	30	18	$365.11	$250.00 32% off	$79.56	$851.70	$427.99	2025-09-22
18300005	CDM	Php Psy Adol Group Therapy	30	18	$365.11	$250.00 32% off	$79.56	$851.70	$427.99	2025-09-22
18300004	CDM	Php Psy Adult Group Therapy-vi	30	18	$365.11	$250.00 32% off	$79.56	$851.70	$427.99	2025-09-22
18300003	CDM	Php Psy Adult Group Therapy	30	18	$365.11	$250.00 32% off	$79.56	$851.70	$427.99	2025-09-22
17700010	CDM	Iop Psy Group Therapy Child Vi	30	18	$291.87	$125.00 57% off	$186.80	$561.18	$282.00	2025-09-22
17600009	CDM	Iop Cd Group Therapy Child Vir	30	18	$291.87	$125.00 57% off	$186.80	$561.18	$282.00	2025-09-22
15851	CPT	Remove Sutures Diff Surgeon	40	35	$24,341.40	—	$1,827.69	$2,010.46	$1,827.69	2026-08-17
11800038	CDM	H4h Ip Rehab	8	8	$2,920.88	$800.00 73% off	$1,869.36	$2,482.75	$2,190.66	2025-09-22
11800036	CDM	H4h Ip Psych	8	8	$2,920.88	$800.00 73% off	$1,869.36	$2,482.75	$2,190.66	2025-09-22
11800022	CDM	R&b Rehab	8	8	$2,920.88	$800.00 73% off	$1,869.36	$2,482.75	$2,190.66	2025-09-22
11800018	CDM	Semi-private Room Bh	8	8	$2,920.88	$800.00 73% off	$1,869.36	$2,482.75	$2,190.66	2025-09-22
11800016	CDM	Semi-private Room - Detox	8	8	$2,920.88	$800.00 73% off	$1,869.36	$2,482.75	$2,190.66	2025-09-22
0915	RC	—	45	40	$381.54	—	$314.00	$940.00	$524.58	2026-08-17
0914	RC	—	45	40	$915.01	—	$314.00	$940.00	$524.58	2026-08-17
0913	RC	—	45	40	$915.01	—	$314.00	$940.00	$524.58	2026-08-17
0912	RC	—	45	40	$1,526.17	—	$314.00	$940.00	$524.58	2026-08-17
0906	RC	—	44	39	$305.00	—	$182.00	$746.00	$316.00	2026-08-17
0905	RC	—	44	39	$305.00	—	$182.00	$746.00	$316.00	2026-08-17

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