Hospital

SCOTLAND COUNTY HOSPITAL

Memphis, MO · CCN 261310 · Rates published

Your selected procedure

You selected 93350 (HCPCS)

STRESS TTE ONLY

This hospital’s price: $958 across 8 payers · range $449-$1,530

Source: https://scmohospital.net/wp-content/uploads/2025/12/430915648-1083624647_scotland-county-memorial-hospital_standardcharges.csv · observed 2025-09-16

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

11,512 distinct procedures filed

9 distinct payers

95,254 rate rows

2025-09-16 last MRF observed · ⚠ 13 mo old

Data quality

67,702 of 95,254 rate rows are consumer-grade (71.1%)

27,552 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
professional (physician) fee — not the facility price	19,578
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	3,202
placeholder amount (≤ $0.02) — excluded from medians	1,653
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	1,542
per-diem day rate — not a per-procedure price	725
percent-of-charges filed in the dollar field — excluded from medians	285
template filing: same amount across many unrelated codes — excluded	277
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings	159
exceeds 10× this hospital's gross charge — excluded from medians	131

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 13 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

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

Source MRF file	https://scmohospital.net/wp-content/uploads/2025/12/430915648-1083624647_scotland-county-memorial-hospital_standardcharges.csv
Found on page	https://scmohospital.net/about-us/price-transparency/
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-20
Content fingerprint	7c260c7bd71d00f3… · 28,464,730 bytes · first seen 2026-05-08

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code	Description	Payers	Min $	Max $	Avg median	vs national
5834 APR_DRG	Neonate With Ecmo	1	$1,105,084.26	$1,105,084.26	$1,105,084.26	nat. median $307,206 outlier · 3.6×
5833 APR_DRG	Neonate With Ecmo	1	$667,221.45	$667,221.45	$667,221.45	nat. median $244,017 outlier · 2.7×
6094 APR_DRG	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	$491,156.02	$491,156.02	$491,156.02	nat. median $165,000 outlier · 3.0×
114 APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	$482,285.70	$482,285.70	$482,285.70	nat. median $123,836 outlier · 3.9×
113 APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	$482,285.70	$482,285.70	$482,285.70	nat. median $67,735 outlier · 7.1×
5914 APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	$470,971.40	$470,971.40	$470,971.40	nat. median $162,342 outlier · 2.9×
5832 APR_DRG	Neonate With Ecmo	1	$418,696.24	$418,696.24	$418,696.24	nat. median $159,249 outlier · 2.6×
6314 APR_DRG	Neonate Birth Weight > 2499 Grams With Other Major Procedure	1	$392,604.72	$392,604.72	$392,604.72	nat. median $133,164 outlier · 2.9×
112 APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	$378,217.95	$378,217.95	$378,217.95	nat. median $67,994 outlier · 5.6×
5883 APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	1	$354,380.88	$354,380.88	$354,380.88	nat. median $175,204 outlier · 2.0×
5884 APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	1	$354,380.88	$354,380.88	$354,380.88	nat. median $247,214 1.4× median
5882 APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	1	$354,380.88	$354,380.88	$354,380.88	nat. median $145,061 outlier · 2.4×
5934 APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	$338,049.87	$338,049.87	$338,049.87	nat. median $151,838 outlier · 2.2×
5913 APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	$321,041.20	$321,041.20	$321,041.20	nat. median $101,406 outlier · 3.2×
6304 APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	$317,812.16	$317,812.16	$317,812.16	nat. median $154,011 outlier · 2.1×
5831 APR_DRG	Neonate With Ecmo	1	$305,846.91	$305,846.91	$305,846.91	nat. median $146,500 outlier · 2.1×
5912 APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	$296,500.18	$296,500.18	$296,500.18	nat. median $82,129 outlier · 3.6×
5881 APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	1	$290,026.49	$290,026.49	$290,026.49	nat. median $120,208 outlier · 2.4×
1614 APR_DRG	Implantable Heart Assist Systems	1	$277,998.14	$277,998.14	$277,998.14	nat. median $202,993 1.4× median
94 APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	1	$254,050.38	$254,050.38	$254,050.38	nat. median $163,587 1.6× median
1613 APR_DRG	Implantable Heart Assist Systems	1	$241,786.71	$241,786.71	$241,786.71	nat. median $120,517 outlier · 2.0×
6024 APR_DRG	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	$241,673.65	$241,673.65	$241,673.65	nat. median $118,620 outlier · 2.0×
8414 APR_DRG	Extensive Third Degree Burns With Skin Graft	1	$237,827.11	$237,827.11	$237,827.11	nat. median $155,939 1.5× median
6074 APR_DRG	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	$231,163.65	$231,163.65	$231,163.65	nat. median $96,883 outlier · 2.4×
6034 APR_DRG	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	1	$224,093.49	$224,093.49	$224,093.49	nat. median $107,681 outlier · 2.1×
5891 APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	1	$222,313.46	$222,313.46	$222,313.46	nat. median $93,998 outlier · 2.4×
5892 APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	1	$222,313.46	$222,313.46	$222,313.46	nat. median $89,188 outlier · 2.5×
5893 APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	1	$222,313.46	$222,313.46	$222,313.46	nat. median $71,350 outlier · 3.1×
6023 APR_DRG	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	$217,476.15	$217,476.15	$217,476.15	nat. median $88,008 outlier · 2.5×
5933 APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	$212,471.76	$212,471.76	$212,471.76	nat. median $108,695 2.0× median
5932 APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	$210,952.49	$210,952.49	$210,952.49	nat. median $85,331 outlier · 2.5×
6334 APR_DRG	Neonate Birth Weight > 2499 Grams With Major Anomaly	1	$200,309.77	$200,309.77	$200,309.77	nat. median $58,630 outlier · 3.4×
6093 APR_DRG	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	$194,807.29	$194,807.29	$194,807.29	nat. median $69,685 outlier · 2.8×
6114 APR_DRG	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	1	$194,351.35	$194,351.35	$194,351.35	nat. median $74,798 outlier · 2.6×
44 APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	$191,023.66	$191,023.66	$191,023.66	nat. median $122,016 1.6× median
8634 APR_DRG	Neonatal Aftercare	1	$185,429.33	$185,429.33	$185,429.33	nat. median $71,097 outlier · 2.6×
6073 APR_DRG	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	$169,126.43	$169,126.43	$169,126.43	nat. median $69,181 outlier · 2.4×
6124 APR_DRG	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	1	$168,608.03	$168,608.03	$168,608.03	nat. median $66,867 outlier · 2.5×
1611 APR_DRG	Implantable Heart Assist Systems	1	$151,192.47	$151,192.47	$151,192.47	nat. median $76,852 2.0× median
1612 APR_DRG	Implantable Heart Assist Systems	1	$151,192.47	$151,192.47	$151,192.47	nat. median $84,880 1.8× median
1604 APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	1	$146,978.44	$146,978.44	$146,978.44	nat. median $98,624 1.5× median
3232822 NDC	Ipilimumab 200 Mg/40 Ml Vial	8	$48,824.50	$166,003.30	$146,473.50	nat. median $73,161 outlier · 2.0×
93 APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	1	$144,732.74	$144,732.74	$144,732.74	nat. median $78,893 1.8× median
6022 APR_DRG	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	$141,154.95	$141,154.95	$141,154.95	nat. median $70,021 outlier · 2.0×
111 APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	$134,379.28	$134,379.28	$134,379.28	nat. median $34,085 outlier · 3.9×
6214 APR_DRG	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	1	$133,065.17	$133,065.17	$133,065.17	nat. median $67,978 2.0× median
54 APR_DRG	Tracheostomy With Mv >96 Hours Without Extensive Procedure	1	$130,299.60	$130,299.60	$130,299.60	nat. median $81,521 1.6× median
6303 APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	$127,979.59	$127,979.59	$127,979.59	nat. median $75,456 1.7× median
8424 APR_DRG	Burns With Skin Graft Except Extensive Third Degree Burns	1	$127,182.25	$127,182.25	$127,182.25	nat. median $82,180 1.5× median
6134 APR_DRG	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	1	$124,046.34	$124,046.34	$124,046.34	nat. median $56,191 outlier · 2.2×

Other procedures at this hospital

Browse this hospital's 11,512 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

5834	APR_DRG	Neonate With Ecmo	1	1	—	—	$1,105,084.26	$1,105,084.26	$1,105,084.26	2025-09-16
5833	APR_DRG	Neonate With Ecmo	1	1	—	—	$667,221.45	$667,221.45	$667,221.45	2025-09-16
6094	APR_DRG	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	1	—	—	$491,156.02	$491,156.02	$491,156.02	2025-09-16
113	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$482,285.70	$482,285.70	$482,285.70	2025-09-16
114	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$482,285.70	$482,285.70	$482,285.70	2025-09-16
5914	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	1	—	—	$470,971.40	$470,971.40	$470,971.40	2025-09-16
5832	APR_DRG	Neonate With Ecmo	1	1	—	—	$418,696.24	$418,696.24	$418,696.24	2025-09-16
6314	APR_DRG	Neonate Birth Weight > 2499 Grams With Other Major Procedure	1	1	—	—	$392,604.72	$392,604.72	$392,604.72	2025-09-16
112	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$378,217.95	$378,217.95	$378,217.95	2025-09-16
5884	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	1	1	—	—	$354,380.88	$354,380.88	$354,380.88	2025-09-16
5883	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	1	1	—	—	$354,380.88	$354,380.88	$354,380.88	2025-09-16
5882	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	1	1	—	—	$354,380.88	$354,380.88	$354,380.88	2025-09-16
5934	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	1	—	—	$338,049.87	$338,049.87	$338,049.87	2025-09-16
5913	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	1	—	—	$321,041.20	$321,041.20	$321,041.20	2025-09-16
6304	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	1	—	—	$317,812.16	$317,812.16	$317,812.16	2025-09-16
5831	APR_DRG	Neonate With Ecmo	1	1	—	—	$305,846.91	$305,846.91	$305,846.91	2025-09-16
5912	APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	1	1	—	—	$296,500.18	$296,500.18	$296,500.18	2025-09-16
5881	APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	1	1	—	—	$290,026.49	$290,026.49	$290,026.49	2025-09-16
1614	APR_DRG	Implantable Heart Assist Systems	1	1	—	—	$277,998.14	$277,998.14	$277,998.14	2025-09-16
94	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	1	1	—	—	$254,050.38	$254,050.38	$254,050.38	2025-09-16
1613	APR_DRG	Implantable Heart Assist Systems	1	1	—	—	$241,786.71	$241,786.71	$241,786.71	2025-09-16
6024	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$241,673.65	$241,673.65	$241,673.65	2025-09-16
8414	APR_DRG	Extensive Third Degree Burns With Skin Graft	1	1	—	—	$237,827.11	$237,827.11	$237,827.11	2025-09-16
6074	APR_DRG	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$231,163.65	$231,163.65	$231,163.65	2025-09-16
6034	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	1	1	—	—	$224,093.49	$224,093.49	$224,093.49	2025-09-16
5891	APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	1	1	—	—	$222,313.46	$222,313.46	$222,313.46	2025-09-16
5892	APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	1	1	—	—	$222,313.46	$222,313.46	$222,313.46	2025-09-16
5893	APR_DRG	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	1	1	—	—	$222,313.46	$222,313.46	$222,313.46	2025-09-16
6023	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$217,476.15	$217,476.15	$217,476.15	2025-09-16
5933	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	1	—	—	$212,471.76	$212,471.76	$212,471.76	2025-09-16
5932	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	1	—	—	$210,952.49	$210,952.49	$210,952.49	2025-09-16
6334	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Anomaly	1	1	—	—	$200,309.77	$200,309.77	$200,309.77	2025-09-16
6093	APR_DRG	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	1	—	—	$194,807.29	$194,807.29	$194,807.29	2025-09-16
6114	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	1	1	—	—	$194,351.35	$194,351.35	$194,351.35	2025-09-16
44	APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	1	—	—	$191,023.66	$191,023.66	$191,023.66	2025-09-16
8634	APR_DRG	Neonatal Aftercare	1	1	—	—	$185,429.33	$185,429.33	$185,429.33	2025-09-16
6073	APR_DRG	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$169,126.43	$169,126.43	$169,126.43	2025-09-16
6124	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$168,608.03	$168,608.03	$168,608.03	2025-09-16
1611	APR_DRG	Implantable Heart Assist Systems	1	1	—	—	$151,192.47	$151,192.47	$151,192.47	2025-09-16
1612	APR_DRG	Implantable Heart Assist Systems	1	1	—	—	$151,192.47	$151,192.47	$151,192.47	2025-09-16
1604	APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	1	1	—	—	$146,978.44	$146,978.44	$146,978.44	2025-09-16
3232822	NDC	Ipilimumab 200 Mg/40 Ml Vial	11	8	$195,298.00	$136,708.60 30% off	$48,824.50	$166,003.30	$146,473.50	2025-09-16
93	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	1	1	—	—	$144,732.74	$144,732.74	$144,732.74	2025-09-16
6022	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$141,154.95	$141,154.95	$141,154.95	2025-09-16
111	APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	1	1	—	—	$134,379.28	$134,379.28	$134,379.28	2025-09-16
6214	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	1	1	—	—	$133,065.17	$133,065.17	$133,065.17	2025-09-16
54	APR_DRG	Tracheostomy With Mv >96 Hours Without Extensive Procedure	1	1	—	—	$130,299.60	$130,299.60	$130,299.60	2025-09-16
6303	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	1	—	—	$127,979.59	$127,979.59	$127,979.59	2025-09-16
8424	APR_DRG	Burns With Skin Graft Except Extensive Third Degree Burns	1	1	—	—	$127,182.25	$127,182.25	$127,182.25	2025-09-16
6134	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	1	1	—	—	$124,046.34	$124,046.34	$124,046.34	2025-09-16
1624	APR_DRG	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	1	1	—	—	$122,215.98	$122,215.98	$122,215.98	2025-09-16
6021	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$118,145.69	$118,145.69	$118,145.69	2025-09-16
43	APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	1	—	—	$117,094.48	$117,094.48	$117,094.48	2025-09-16
5931	APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	1	1	—	—	$116,804.42	$116,804.42	$116,804.42	2025-09-16
6084	APR_DRG	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	1	1	—	—	$112,939.88	$112,939.88	$112,939.88	2025-09-16
6083	APR_DRG	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	1	1	—	—	$112,939.88	$112,939.88	$112,939.88	2025-09-16
6113	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	1	1	—	—	$112,374.64	$112,374.64	$112,374.64	2025-09-16
214	APR_DRG	Open Craniotomy Except Trauma	1	1	—	—	$108,779.40	$108,779.40	$108,779.40	2025-09-16
6033	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	1	1	—	—	$107,894.90	$107,894.90	$107,894.90	2025-09-16
6032	APR_DRG	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	1	1	—	—	$107,894.90	$107,894.90	$107,894.90	2025-09-16
3034	APR_DRG	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	1	1	—	—	$101,259.73	$101,259.73	$101,259.73	2025-09-16
6123	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$99,737.98	$99,737.98	$99,737.98	2025-09-16
6213	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	1	1	—	—	$99,325.76	$99,325.76	$99,325.76	2025-09-16
6072	APR_DRG	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$99,044.71	$99,044.71	$99,044.71	2025-09-16
6092	APR_DRG	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	1	—	—	$96,582.33	$96,582.33	$96,582.33	2025-09-16
1634	APR_DRG	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	1	1	—	—	$96,363.27	$96,363.27	$96,363.27	2025-09-16
6344	APR_DRG	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	1	1	—	—	$95,862.51	$95,862.51	$95,862.51	2025-09-16
6814	APR_DRG	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	1	1	—	—	$95,694.61	$95,694.61	$95,694.61	2025-09-16
8514	APR_DRG	Gender Related Procedures	1	1	—	—	$95,677.16	$95,677.16	$95,677.16	2025-09-16
1304	APR_DRG	Respiratory System Diagnosis With Ventilator Support > 96 Hours	1	1	—	—	$94,770.46	$94,770.46	$94,770.46	2025-09-16
6144	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	1	1	—	—	$93,898.23	$93,898.23	$93,898.23	2025-09-16
6313	APR_DRG	Neonate Birth Weight > 2499 Grams With Other Major Procedure	1	1	—	—	$93,142.49	$93,142.49	$93,142.49	2025-09-16
2994	APR_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical	1	1	—	—	$92,085.87	$92,085.87	$92,085.87	2025-09-16
6133	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	1	1	—	—	$91,473.32	$91,473.32	$91,473.32	2025-09-16
3044	APR_DRG	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	1	1	—	—	$90,632.82	$90,632.82	$90,632.82	2025-09-16
1784	APR_DRG	External Heart Assist Devices	1	1	—	—	$89,955.89	$89,955.89	$89,955.89	2025-09-16
7524	APR_DRG	Personality Disorders	1	1	—	—	$87,919.23	$87,919.23	$87,919.23	2025-09-16
9114	APR_DRG	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	1	1	—	—	$87,390.55	$87,390.55	$87,390.55	2025-09-16
6091	APR_DRG	Neonate Birth Weight 1500-2499 Grams With Major Procedure	1	1	—	—	$86,728.14	$86,728.14	$86,728.14	2025-09-16
8633	APR_DRG	Neonatal Aftercare	1	1	—	—	$85,838.12	$85,838.12	$85,838.12	2025-09-16
6224	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$85,708.52	$85,708.52	$85,708.52	2025-09-16
6223	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$85,708.52	$85,708.52	$85,708.52	2025-09-16
6333	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Anomaly	1	1	—	—	$85,566.43	$85,566.43	$85,566.43	2025-09-16
6143	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	1	1	—	—	$85,354.08	$85,354.08	$85,354.08	2025-09-16
4284	APR_DRG	Genetic Disorders	1	1	—	—	$85,188.56	$85,188.56	$85,188.56	2025-09-16
53	APR_DRG	Tracheostomy With Mv >96 Hours Without Extensive Procedure	1	1	—	—	$85,023.60	$85,023.60	$85,023.60	2025-09-16
42	APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	1	—	—	$84,493.64	$84,493.64	$84,493.64	2025-09-16
6071	APR_DRG	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$84,378.18	$84,378.18	$84,378.18	2025-09-16
92	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	1	1	—	—	$83,057.12	$83,057.12	$83,057.12	2025-09-16
1834	APR_DRG	Percutaneous Structural Cardiac Procedures	1	1	—	—	$81,435.99	$81,435.99	$81,435.99	2025-09-16
6804	APR_DRG	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	1	1	—	—	$80,376.05	$80,376.05	$80,376.05	2025-09-16
6904	APR_DRG	Acute Leukemia	1	1	—	—	$80,192.35	$80,192.35	$80,192.35	2025-09-16
6234	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	1	1	—	—	$79,957.77	$79,957.77	$79,957.77	2025-09-16
1654	APR_DRG	Coronary Bypass With Ami Or Complex Principal Diagnosis	1	1	—	—	$79,788.22	$79,788.22	$79,788.22	2025-09-16
6954	APR_DRG	Chemotherapy For Acute Leukemia	1	1	—	—	$79,537.47	$79,537.47	$79,537.47	2025-09-16
6122	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$79,522.13	$79,522.13	$79,522.13	2025-09-16
3033	APR_DRG	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	1	1	—	—	$79,448.38	$79,448.38	$79,448.38	2025-09-16
6082	APR_DRG	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	1	1	—	—	$78,572.78	$78,572.78	$78,572.78	2025-09-16
2604	APR_DRG	Major Pancreas, Liver And Shunt Procedures	1	1	—	—	$76,036.19	$76,036.19	$76,036.19	2025-09-16
6254	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	1	1	—	—	$75,952.70	$75,952.70	$75,952.70	2025-09-16
1674	APR_DRG	Other Cardiothoracic And Thoracic Circulatory Procedures	1	1	—	—	$74,689.68	$74,689.68	$74,689.68	2025-09-16
1623	APR_DRG	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	1	1	—	—	$74,646.51	$74,646.51	$74,646.51	2025-09-16
914	APR_DRG	Other Major Head And Neck Procedures	1	1	—	—	$74,015.51	$74,015.51	$74,015.51	2025-09-16
1794	APR_DRG	Defibrillator Implants	1	1	—	—	$73,119.07	$73,119.07	$73,119.07	2025-09-16
9104	APR_DRG	Craniotomy For Multiple Significant Trauma	1	1	—	—	$72,969.35	$72,969.35	$72,969.35	2025-09-16
2204	APR_DRG	Major Stomach, Esophageal And Duodenal Procedures	1	1	—	—	$72,698.40	$72,698.40	$72,698.40	2025-09-16
3124	APR_DRG	Skin Graft For Musculoskeletal And Connective Tissue Diagnoses	1	1	—	—	$72,372.34	$72,372.34	$72,372.34	2025-09-16
8413	APR_DRG	Extensive Third Degree Burns With Skin Graft	1	1	—	—	$71,918.60	$71,918.60	$71,918.60	2025-09-16
1783	APR_DRG	External Heart Assist Devices	1	1	—	—	$71,328.01	$71,328.01	$71,328.01	2025-09-16
1664	APR_DRG	Coronary Bypass Without Ami Or Complex Principal Diagnosis	1	1	—	—	$70,685.07	$70,685.07	$70,685.07	2025-09-16
7754	APR_DRG	Alcohol Abuse And Dependence	1	1	—	—	$70,386.53	$70,386.53	$70,386.53	2025-09-16
3214	APR_DRG	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	1	1	—	—	$70,190.92	$70,190.92	$70,190.92	2025-09-16
6302	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	1	—	—	$69,849.06	$69,849.06	$69,849.06	2025-09-16
3004	APR_DRG	Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical	1	1	—	—	$69,630.65	$69,630.65	$69,630.65	2025-09-16
1694	APR_DRG	Major Abdominal Vascular Procedures	1	1	—	—	$69,285.29	$69,285.29	$69,285.29	2025-09-16
6394	APR_DRG	Neonate Birth Weight > 2499 Grams With Other Significant Condition	1	1	—	—	$68,901.27	$68,901.27	$68,901.27	2025-09-16
52	APR_DRG	Tracheostomy With Mv >96 Hours Without Extensive Procedure	1	1	—	—	$68,691.03	$68,691.03	$68,691.03	2025-09-16
2304	APR_DRG	Major Small Bowel Procedures	1	1	—	—	$68,488.96	$68,488.96	$68,488.96	2025-09-16
1603	APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	1	1	—	—	$67,625.58	$67,625.58	$67,625.58	2025-09-16
91	APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	1	1	—	—	$67,200.32	$67,200.32	$67,200.32	2025-09-16
7924	APR_DRG	Extensive O.r. Procedures For Other Complications Of Treatment	1	1	—	—	$67,197.57	$67,197.57	$67,197.57	2025-09-16
9504	APR_DRG	Extensive O.r. Procedure Unrelated To Principal Diagnosis	1	1	—	—	$66,444.41	$66,444.41	$66,444.41	2025-09-16
7104	APR_DRG	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	1	1	—	—	$65,779.42	$65,779.42	$65,779.42	2025-09-16
6112	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	1	1	—	—	$65,414.60	$65,414.60	$65,414.60	2025-09-16
8504	APR_DRG	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	1	1	—	—	$64,825.11	$64,825.11	$64,825.11	2025-09-16
444	APR_DRG	Intracranial Hemorrhage	1	1	—	—	$64,668.05	$64,668.05	$64,668.05	2025-09-16
1303	APR_DRG	Respiratory System Diagnosis With Ventilator Support > 96 Hours	1	1	—	—	$64,600.91	$64,600.91	$64,600.91	2025-09-16
504	APR_DRG	Non-bacterial Infections Of Nervous System Except Viral Meningitis	1	1	—	—	$64,537.14	$64,537.14	$64,537.14	2025-09-16
234	APR_DRG	Spinal Procedures	1	1	—	—	$64,153.70	$64,153.70	$64,153.70	2025-09-16
4414	APR_DRG	Major Bladder Procedures	1	1	—	—	$63,774.36	$63,774.36	$63,774.36	2025-09-16
74347303	NDC	Leuprolide Acetate 45 Mg Syringekit	11	8	$84,995.00	$59,496.50 30% off	$21,248.75	$72,245.75	$63,746.25	2025-09-16
7504	APR_DRG	Schizophrenia And Other Severe Psychotic Disorders	1	1	—	—	$63,588.24	$63,588.24	$63,588.24	2025-09-16
7594	APR_DRG	Eating Disorders	1	1	—	—	$63,212.61	$63,212.61	$63,212.61	2025-09-16
894	APR_DRG	Major Cranial Or Facial Bone Procedures	1	1	—	—	$63,006.50	$63,006.50	$63,006.50	2025-09-16
7404	APR_DRG	Mental Illness Diagnosis With O.r. Procedure	1	1	—	—	$62,590.43	$62,590.43	$62,590.43	2025-09-16
9124	APR_DRG	Musculoskeletal And Other Procedures For Multiple Significant Trauma	1	1	—	—	$62,271.71	$62,271.71	$62,271.71	2025-09-16
4014	APR_DRG	Adrenal Procedures	1	1	—	—	$62,260.69	$62,260.69	$62,260.69	2025-09-16
2993	APR_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical	1	1	—	—	$61,689.39	$61,689.39	$61,689.39	2025-09-16
1782	APR_DRG	External Heart Assist Devices	1	1	—	—	$61,338.53	$61,338.53	$61,338.53	2025-09-16
1204	APR_DRG	Major Respiratory And Chest Procedures	1	1	—	—	$61,307.30	$61,307.30	$61,307.30	2025-09-16
72893000501	NDC	PRALAtrexate 40 Mg/2 Ml Vial	11	8	$81,508.00	$57,055.60 30% off	$20,377.00	$69,281.80	$61,131.00	2025-09-16
6233	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	1	1	—	—	$60,536.69	$60,536.69	$60,536.69	2025-09-16
7584	APR_DRG	Disorders Of Impulse Control & Development	1	1	—	—	$60,117.67	$60,117.67	$60,117.67	2025-09-16
59572077501	NDC	Luspatercept-aamt 75 Mg Vial	11	8	$79,843.50	$55,890.45 30% off	$19,960.88	$67,866.98	$59,882.63	2025-09-16
41	APR_DRG	Tracheostomy With Mv >96 Hours With Extensive Procedure	1	1	—	—	$59,863.43	$59,863.43	$59,863.43	2025-09-16
7114	APR_DRG	Post-operative, Post-trauma, Other Device Infections With O.r. Procedure	1	1	—	—	$59,341.73	$59,341.73	$59,341.73	2025-09-16
24582411	NDC	Cabazitaxel 60 Mg/1.5 Ml Vial	11	8	$78,973.50	$55,281.45 30% off	$19,743.38	$67,127.48	$59,230.13	2025-09-16
5204	APR_DRG	Other GYN Procedures For Malignancy	1	1	—	—	$59,079.04	$59,079.04	$59,079.04	2025-09-16
6604	APR_DRG	Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula…	1	1	—	—	$58,545.10	$58,545.10	$58,545.10	2025-09-16
2644	APR_DRG	Other Hepatobiliary, Pancreas And Abdominal Procedures	1	1	—	—	$58,478.35	$58,478.35	$58,478.35	2025-09-16
8423	APR_DRG	Burns With Skin Graft Except Extensive Third Degree Burns	1	1	—	—	$58,397.53	$58,397.53	$58,397.53	2025-09-16
1602	APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	1	1	—	—	$57,901.54	$57,901.54	$57,901.54	2025-09-16
4234	APR_DRG	Inborn Errors Of Metabolism	1	1	—	—	$57,371.67	$57,371.67	$57,371.67	2025-09-16
1214	APR_DRG	Other Respiratory And Chest Procedures	1	1	—	—	$57,203.49	$57,203.49	$57,203.49	2025-09-16
2614	APR_DRG	Major Biliary Tract Procedures	1	1	—	—	$57,178.69	$57,178.69	$57,178.69	2025-09-16
4854	APR_DRG	Prostatectomy Procedures	1	1	—	—	$56,801.19	$56,801.19	$56,801.19	2025-09-16
1622	APR_DRG	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	1	1	—	—	$56,624.84	$56,624.84	$56,624.84	2025-09-16
3614	APR_DRG	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	1	1	—	—	$56,270.31	$56,270.31	$56,270.31	2025-09-16
1633	APR_DRG	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	1	1	—	—	$55,850.56	$55,850.56	$55,850.56	2025-09-16
6081	APR_DRG	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	1	1	—	—	$55,824.29	$55,824.29	$55,824.29	2025-09-16
1833	APR_DRG	Percutaneous Structural Cardiac Procedures	1	1	—	—	$55,094.64	$55,094.64	$55,094.64	2025-09-16
1302	APR_DRG	Respiratory System Diagnosis With Ventilator Support > 96 Hours	1	1	—	—	$54,969.13	$54,969.13	$54,969.13	2025-09-16
6903	APR_DRG	Acute Leukemia	1	1	—	—	$54,858.59	$54,858.59	$54,858.59	2025-09-16
204	APR_DRG	Open Craniotomy For Trauma	1	1	—	—	$54,854.91	$54,854.91	$54,854.91	2025-09-16
1781	APR_DRG	External Heart Assist Devices	1	1	—	—	$54,842.05	$54,842.05	$54,842.05	2025-09-16
6343	APR_DRG	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	1	1	—	—	$54,681.32	$54,681.32	$54,681.32	2025-09-16
1804	APR_DRG	Other Circulatory System Procedures	1	1	—	—	$54,572.94	$54,572.94	$54,572.94	2025-09-16
3032	APR_DRG	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	1	1	—	—	$54,456.29	$54,456.29	$54,456.29	2025-09-16
1793	APR_DRG	Defibrillator Implants	1	1	—	—	$54,028.27	$54,028.27	$54,028.27	2025-09-16
1814	APR_DRG	Lower Extremity Vascular Procedures	1	1	—	—	$53,907.03	$53,907.03	$53,907.03	2025-09-16
924	APR_DRG	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	1	1	—	—	$53,858.35	$53,858.35	$53,858.35	2025-09-16
6393	APR_DRG	Neonate Birth Weight > 2499 Grams With Other Significant Condition	1	1	—	—	$53,828.78	$53,828.78	$53,828.78	2025-09-16
274	APR_DRG	Other Open Craniotomy	1	1	—	—	$53,603.93	$53,603.93	$53,603.93	2025-09-16
3043	APR_DRG	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	1	1	—	—	$53,600.26	$53,600.26	$53,600.26	2025-09-16
6253	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	1	1	—	—	$53,493.07	$53,493.07	$53,493.07	2025-09-16
3134	APR_DRG	Knee And Lower Leg Procedures Except Foot	1	1	—	—	$53,459.73	$53,459.73	$53,459.73	2025-09-16
1824	APR_DRG	Other Peripheral Vascular And Related Procedures	1	1	—	—	$53,231.03	$53,231.03	$53,231.03	2025-09-16
6514	APR_DRG	Other Procedures Of Blood And Blood-forming Organs	1	1	—	—	$52,953.64	$52,953.64	$52,953.64	2025-09-16
5114	APR_DRG	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	1	1	—	—	$52,696.46	$52,696.46	$52,696.46	2025-09-16
1673	APR_DRG	Other Cardiothoracic And Thoracic Circulatory Procedures	1	1	—	—	$52,624.82	$52,624.82	$52,624.82	2025-09-16
5124	APR_DRG	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	1	1	—	—	$52,438.37	$52,438.37	$52,438.37	2025-09-16
6624	APR_DRG	Sickle Cell Anemia Crisis	1	1	—	—	$52,385.81	$52,385.81	$52,385.81	2025-09-16
7934	APR_DRG	Moderately Extensive O.r. Procedures For Other Complications Of Treatment	1	1	—	—	$51,763.28	$51,763.28	$51,763.28	2025-09-16
7574	APR_DRG	Organic Mental Health Conditions And Disturbances	1	1	—	—	$51,351.32	$51,351.32	$51,351.32	2025-09-16
4424	APR_DRG	Kidney And Urinary Tract Procedures For Malignancy	1	1	—	—	$51,335.26	$51,335.26	$51,335.26	2025-09-16
6364	APR_DRG	Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection	1	1	—	—	$51,244.61	$51,244.61	$51,244.61	2025-09-16
1653	APR_DRG	Coronary Bypass With Ami Or Complex Principal Diagnosis	1	1	—	—	$51,231.47	$51,231.47	$51,231.47	2025-09-16
7614	APR_DRG	Schizoaffective Disorders	1	1	—	—	$51,129.12	$51,129.12	$51,129.12	2025-09-16
3094	APR_DRG	Other Significant Hip And Femur Surgery	1	1	—	—	$50,879.69	$50,879.69	$50,879.69	2025-09-16
4054	APR_DRG	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	1	1	—	—	$50,489.34	$50,489.34	$50,489.34	2025-09-16
51144005001	NDC	Brentuximab Vedotin 50 Mg Vial	11	8	$67,100.00	$46,970.00 30% off	$16,775.00	$57,035.00	$50,325.00	2025-09-16
1663	APR_DRG	Coronary Bypass Without Ami Or Complex Principal Diagnosis	1	1	—	—	$50,289.10	$50,289.10	$50,289.10	2025-09-16
6132	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	1	1	—	—	$50,254.66	$50,254.66	$50,254.66	2025-09-16
1704	APR_DRG	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	1	1	—	—	$50,136.64	$50,136.64	$50,136.64	2025-09-16
4034	APR_DRG	Procedures For Obesity	1	1	—	—	$50,100.81	$50,100.81	$50,100.81	2025-09-16
7724	APR_DRG	Alcohol And Drug Dependence With Rehabilitation And/or Detoxification Therapy	1	1	—	—	$50,005.77	$50,005.77	$50,005.77	2025-09-16
304	APR_DRG	Percutaneous Intracranial And Extracranial Vascular Procedures	1	1	—	—	$49,720.56	$49,720.56	$49,720.56	2025-09-16
893	APR_DRG	Major Cranial Or Facial Bone Procedures	1	1	—	—	$49,258.56	$49,258.56	$49,258.56	2025-09-16
294	APR_DRG	Other Percutaneous Intracranial Procedures	1	1	—	—	$49,240.19	$49,240.19	$49,240.19	2025-09-16
2244	APR_DRG	Peritoneal Adhesiolysis	1	1	—	—	$49,236.52	$49,236.52	$49,236.52	2025-09-16
224	APR_DRG	Ventricular Shunt Procedures	1	1	—	—	$49,203.45	$49,203.45	$49,203.45	2025-09-16
984	APR_DRG	Other Ear, Nose, Mouth, Throat, Craniofacial, And Neck Procedures	1	1	—	—	$49,195.18	$49,195.18	$49,195.18	2025-09-16
1924	APR_DRG	Cardiac Catheterization For Other Non-coronary Conditions	1	1	—	—	$49,115.28	$49,115.28	$49,115.28	2025-09-16
6142	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	1	1	—	—	$49,082.03	$49,082.03	$49,082.03	2025-09-16
2992	APR_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical	1	1	—	—	$48,949.95	$48,949.95	$48,949.95	2025-09-16
9514	APR_DRG	Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis	1	1	—	—	$48,590.82	$48,590.82	$48,590.82	2025-09-16
1754	APR_DRG	Percutaneous Cardiac Intervention Without Ami	1	1	—	—	$48,553.16	$48,553.16	$48,553.16	2025-09-16
2294	APR_DRG	Other Digestive System And Abdominal Procedures	1	1	—	—	$48,513.67	$48,513.67	$48,513.67	2025-09-16
4044	APR_DRG	Thyroid, Parathyroid And Thyroglossal Procedures	1	1	—	—	$48,359.36	$48,359.36	$48,359.36	2025-09-16
1621	APR_DRG	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	1	1	—	—	$48,193.11	$48,193.11	$48,193.11	2025-09-16
6504	APR_DRG	Splenic Procedures	1	1	—	—	$48,177.50	$48,177.50	$48,177.50	2025-09-16
4474	APR_DRG	Other Kidney, Urinary Tract And Related Non-percutaneous Procedures	1	1	—	—	$47,869.80	$47,869.80	$47,869.80	2025-09-16
38240	HCPCS	Transplt Allo Hct/donor	3	3	—	—	$44,480.70	$55,459.50	$47,594.35	2025-09-16
6222	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$47,445.65	$47,445.65	$47,445.65	2025-09-16
9524	APR_DRG	Non-extensive O.r. Procedure Unrelated To Principal Diagnosis	1	1	—	—	$46,994.48	$46,994.48	$46,994.48	2025-09-16
6363	APR_DRG	Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection	1	1	—	—	$46,753.93	$46,753.93	$46,753.93	2025-09-16
4484	APR_DRG	Other Kidney, Urinary Tract And Related Percutaneous Procedures	1	1	—	—	$46,481.05	$46,481.05	$46,481.05	2025-09-16
64764030020	NDC	Vedolizumab 300 Mg/20 Ml Vial	11	8	$61,775.50	$43,242.85 30% off	$15,443.88	$52,509.18	$46,331.63	2025-09-16
4283	APR_DRG	Genetic Disorders	1	1	—	—	$46,316.73	$46,316.73	$46,316.73	2025-09-16
494	APR_DRG	Bacterial And Tuberculous Infections Of Nervous System	1	1	—	—	$46,309.55	$46,309.55	$46,309.55	2025-09-16
6212	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	1	1	—	—	$46,030.99	$46,030.99	$46,030.99	2025-09-16
6914	APR_DRG	Lymphoma, Myeloma And Non-acute Leukemia	1	1	—	—	$45,938.22	$45,938.22	$45,938.22	2025-09-16
3123	APR_DRG	Skin Graft For Musculoskeletal And Connective Tissue Diagnoses	1	1	—	—	$45,800.45	$45,800.45	$45,800.45	2025-09-16
1693	APR_DRG	Major Abdominal Vascular Procedures	1	1	—	—	$45,778.41	$45,778.41	$45,778.41	2025-09-16
3031	APR_DRG	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	1	1	—	—	$45,623.18	$45,623.18	$45,623.18	2025-09-16
3234	APR_DRG	Non-elective Or Complex Hip Joint Replacement	1	1	—	—	$45,466.12	$45,466.12	$45,466.12	2025-09-16
264	APR_DRG	Other Nervous System And Related Procedures	1	1	—	—	$45,071.17	$45,071.17	$45,071.17	2025-09-16
3054	APR_DRG	Amputation Of Lower Limb Except Toes	1	1	—	—	$45,070.25	$45,070.25	$45,070.25	2025-09-16
293	APR_DRG	Other Percutaneous Intracranial Procedures	1	1	—	—	$44,969.22	$44,969.22	$44,969.22	2025-09-16
434	APR_DRG	Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies	1	1	—	—	$44,927.88	$44,927.88	$44,927.88	2025-09-16
1832	APR_DRG	Percutaneous Structural Cardiac Procedures	1	1	—	—	$44,657.85	$44,657.85	$44,657.85	2025-09-16
3254	APR_DRG	Non-elective Or Complex Knee Joint Replacement	1	1	—	—	$44,560.49	$44,560.49	$44,560.49	2025-09-16
9304	APR_DRG	Multiple Significant Trauma Without O.r. Procedure	1	1	—	—	$44,321.68	$44,321.68	$44,321.68	2025-09-16
2224	APR_DRG	Other Stomach, Esophageal And Duodenal Procedures	1	1	—	—	$43,867.95	$43,867.95	$43,867.95	2025-09-16
6121	APR_DRG	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	1	1	—	—	$43,821.56	$43,821.56	$43,821.56	2025-09-16
6993050	OTHER	Implant Cochlear Device	3	3	—	—	$40,944.65	$44,740.70	$43,810.78	2025-09-16
213	APR_DRG	Open Craniotomy Except Trauma	1	1	—	—	$43,407.79	$43,407.79	$43,407.79	2025-09-16
3003	APR_DRG	Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical	1	1	—	—	$43,344.41	$43,344.41	$43,344.41	2025-09-16
33276	HCPCS	Insj Phrnc Nrv Stim Sys	3	3	—	—	$40,500.45	$44,550.50	$43,335.48	2025-09-16
6301	APR_DRG	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	1	1	—	—	$43,318.78	$43,318.78	$43,318.78	2025-09-16
5194	APR_DRG	Uterine And Adnexa Procedures For Leiomyoma	1	1	—	—	$43,064.27	$43,064.27	$43,064.27	2025-09-16
233	APR_DRG	Spinal Procedures	1	1	—	—	$43,055.09	$43,055.09	$43,055.09	2025-09-16
2314	APR_DRG	Major Large Bowel Procedures	1	1	—	—	$43,029.37	$43,029.37	$43,029.37	2025-09-16
1301	APR_DRG	Respiratory System Diagnosis With Ventilator Support > 96 Hours	1	1	—	—	$42,896.01	$42,896.01	$42,896.01	2025-09-16
5484	APR_DRG	Postpartum And Post Abortion Diagnosis With O.r. Procedure	1	1	—	—	$42,874.01	$42,874.01	$42,874.01	2025-09-16
8632	APR_DRG	Neonatal Aftercare	1	1	—	—	$42,837.86	$42,837.86	$42,837.86	2025-09-16
3154	APR_DRG	Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement	1	1	—	—	$42,766.68	$42,766.68	$42,766.68	2025-09-16
4444	APR_DRG	Renal Dialysis Access Device Procedures	1	1	—	—	$42,614.21	$42,614.21	$42,614.21	2025-09-16
2603	APR_DRG	Major Pancreas, Liver And Shunt Procedures	1	1	—	—	$42,566.45	$42,566.45	$42,566.45	2025-09-16
5184	APR_DRG	Other Female Reproductive System And Related Procedures	1	1	—	—	$42,407.55	$42,407.55	$42,407.55	2025-09-16
2234	APR_DRG	Other Small And Large Bowel Procedures	1	1	—	—	$42,365.30	$42,365.30	$42,365.30	2025-09-16
8904	APR_DRG	HIV With Multiple Major HIV Related Conditions	1	1	—	—	$42,362.99	$42,362.99	$42,362.99	2025-09-16
7204	APR_DRG	Septicemia And Disseminated Infections	1	1	—	—	$42,271.54	$42,271.54	$42,271.54	2025-09-16
4844	APR_DRG	Other Male Reproductive System And Related Procedures	1	1	—	—	$42,133.84	$42,133.84	$42,133.84	2025-09-16
2824	APR_DRG	Disorders Of Pancreas Except Malignancy	1	1	—	—	$41,967.13	$41,967.13	$41,967.13	2025-09-16
1831	APR_DRG	Percutaneous Structural Cardiac Procedures	1	1	—	—	$41,900.54	$41,900.54	$41,900.54	2025-09-16
6252	APR_DRG	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	1	1	—	—	$41,860.41	$41,860.41	$41,860.41	2025-09-16
8451001	NDC	Gemtuzumab Ozogamicin 4.5 Mg Vial	11	8	$55,247.50	$38,673.25 30% off	$13,811.88	$46,960.38	$41,435.63	2025-09-16
7214	APR_DRG	Post-operative, Post-traumatic, Other Device Infections	1	1	—	—	$41,312.57	$41,312.57	$41,312.57	2025-09-16
1714	APR_DRG	Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock	1	1	—	—	$41,307.20	$41,307.20	$41,307.20	2025-09-16
3224	APR_DRG	Shoulder And Elbow Joint Replacement	1	1	—	—	$41,177.69	$41,177.69	$41,177.69	2025-09-16
6264	APR_DRG	Neonate Birth Weight 2000-2499 Grams, Normal Newborn Or Neonate With Other Probl…	1	1	—	—	$41,159.32	$41,159.32	$41,159.32	2025-09-16
50242012047	NDC	Tenecteplase 50 Mg Vial	11	8	$54,762.00	$38,333.40 30% off	$13,690.50	$46,547.70	$41,071.50	2025-09-16
1764	APR_DRG	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	1	1	—	—	$40,979.30	$40,979.30	$40,979.30	2025-09-16
1652	APR_DRG	Coronary Bypass With Ami Or Complex Principal Diagnosis	1	1	—	—	$40,798.36	$40,798.36	$40,798.36	2025-09-16
1651	APR_DRG	Coronary Bypass With Ami Or Complex Principal Diagnosis	1	1	—	—	$40,798.36	$40,798.36	$40,798.36	2025-09-16
7593	APR_DRG	Eating Disorders	1	1	—	—	$40,757.98	$40,757.98	$40,757.98	2025-09-16
3174	APR_DRG	Tendon, Muscle And Other Soft Tissue Procedures	1	1	—	—	$40,688.14	$40,688.14	$40,688.14	2025-09-16
1774	APR_DRG	Cardiac Pacemaker And Defibrillator Revision Except Device Replacement	1	1	—	—	$40,593.53	$40,593.53	$40,593.53	2025-09-16
6458250	OTHER	Opn Mpltj Hpglsl Nstm Ary Pg	3	3	—	—	$37,913.83	$42,863.96	$40,567.80	2025-09-16
6456850	OTHER	Opn Impltj Crnl Nrv Nea&pg	3	3	—	—	$37,913.83	$42,863.96	$40,567.80	2025-09-16
2991	APR_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical	1	1	—	—	$40,554.04	$40,554.04	$40,554.04	2025-09-16
273	APR_DRG	Other Open Craniotomy	1	1	—	—	$40,470.46	$40,470.46	$40,470.46	2025-09-16
3204	APR_DRG	Other Musculoskeletal System And Connective Tissue Procedures	1	1	—	—	$40,348.30	$40,348.30	$40,348.30	2025-09-16
4694	APR_DRG	Acute Kidney Injury	1	1	—	—	$40,317.51	$40,317.51	$40,317.51	2025-09-16
3244	APR_DRG	Elective Hip Joint Replacement	1	1	—	—	$40,292.27	$40,292.27	$40,292.27	2025-09-16
7514	APR_DRG	Depressive Disorders	1	1	—	—	$40,273.02	$40,273.02	$40,273.02	2025-09-16
3213	APR_DRG	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	1	1	—	—	$40,160.01	$40,160.01	$40,160.01	2025-09-16
5404	APR_DRG	Cesarean Section Without Sterilization	1	1	—	—	$40,047.62	$40,047.62	$40,047.62	2025-09-16
1203	APR_DRG	Major Respiratory And Chest Procedures	1	1	—	—	$39,907.42	$39,907.42	$39,907.42	2025-09-16
3464	APR_DRG	Connective Tissue Disorders	1	1	—	—	$39,705.07	$39,705.07	$39,705.07	2025-09-16
8164	APR_DRG	Toxic Effects Of Non-medicinal Substances	1	1	—	—	$39,673.79	$39,673.79	$39,673.79	2025-09-16
3084	APR_DRG	Hip And Femur Fracture Repair	1	1	—	—	$39,422.46	$39,422.46	$39,422.46	2025-09-16
3104	APR_DRG	Vertebral And Intervertebral Spinal Procedures Including Disc Procedures	1	1	—	—	$38,925.56	$38,925.56	$38,925.56	2025-09-16
5474	APR_DRG	Antepartum With O.r. Procedure	1	1	—	—	$38,920.80	$38,920.80	$38,920.80	2025-09-16
4434	APR_DRG	Kidney And Urinary Tract Procedures For Non-malignancy	1	1	—	—	$38,909.03	$38,909.03	$38,909.03	2025-09-16
7744	APR_DRG	Cocaine Abuse And Dependence	1	1	—	—	$38,851.64	$38,851.64	$38,851.64	2025-09-16
5144	APR_DRG	Female Reproductive System Reconstructive Procedures	1	1	—	—	$38,779.52	$38,779.52	$38,779.52	2025-09-16
7244	APR_DRG	Other Infectious And Parasitic Diseases	1	1	—	—	$38,728.06	$38,728.06	$38,728.06	2025-09-16
1213	APR_DRG	Other Respiratory And Chest Procedures	1	1	—	—	$38,650.93	$38,650.93	$38,650.93	2025-09-16
6953	APR_DRG	Chemotherapy For Acute Leukemia	1	1	—	—	$38,570.10	$38,570.10	$38,570.10	2025-09-16
78100768	NDC	Ofatumumab 20 Mg/0.4 Ml Pen.injctr	11	8	$51,409.00	$35,986.30 30% off	$12,852.25	$43,697.65	$38,556.75	2025-09-16
6404	APR_DRG	Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem	1	1	—	—	$38,336.26	$38,336.26	$38,336.26	2025-09-16
734	APR_DRG	Orbit And Eye Procedures	1	1	—	—	$38,267.92	$38,267.92	$38,267.92	2025-09-16
2324	APR_DRG	Gastric Fundoplication	1	1	—	—	$38,204.54	$38,204.54	$38,204.54	2025-09-16
2794	APR_DRG	Hepatic Coma And Other Major Acute Liver Disorders	1	1	—	—	$38,140.88	$38,140.88	$38,140.88	2025-09-16
9103	APR_DRG	Craniotomy For Multiple Significant Trauma	1	1	—	—	$37,985.03	$37,985.03	$37,985.03	2025-09-16
4624	APR_DRG	Nephritis And Nephrosis	1	1	—	—	$37,852.11	$37,852.11	$37,852.11	2025-09-16
1334	APR_DRG	Respiratory Failure	1	1	—	—	$37,812.41	$37,812.41	$37,812.41	2025-09-16
7944	APR_DRG	Non-extensive O.r. Procedures For Other Complications Of Treatment	1	1	—	—	$37,658.04	$37,658.04	$37,658.04	2025-09-16

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