Hospital

FREEMAN NEOSHO HOSPITAL

Neosho, MO · CCN 261331 · Rates published

200 distinct procedures filed

121 distinct payers

6,339 rate rows

2025-05-01 last MRF observed · ⚠ 18 mo old

Data quality

1,343 of 6,339 rate rows are consumer-grade (21.2%)

4,996 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	4,995
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings	1

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 18 months old.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://hospitalpricedisclosure.com/Download.aspx?pxi=kRmBnD6aD0e_NlViyBseoA-&f=iFd_cEPwhQHJy3lVvHy9uQ-
Found on page	https://hospitalpricedisclosure.com/Default.aspx?ci=LIPBmUR35JN0Gka3hlnyRA-
Discovered via	Discovered by HANK
Last fetch	success · 2026-11-03
Content fingerprint	a027a9252d31c98e… · 2,860,576 bytes · first seen 2026-05-09

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
70 MS_DRG	Nonspecific Cerebrovascular Disorders With Mcc	1	$25,592.00	$25,592.00	$25,592.00	nat. median $16,310 1.6× median
208 MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	1	$23,749.66	$23,749.66	$23,749.66	nat. median $25,366 0.9× median
565 MS_DRG	Other Musculoskeletal System And Connective Tissue Diagnoses With Cc	1	$22,990.80	$22,990.80	$22,990.80	nat. median $10,088 outlier · 2.3×
99 MS_DRG	Non-bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc	1	$18,415.99	$18,415.99	$18,415.99	nat. median $13,564 1.4× median
5092 OTHER	Level 2 Breast/Lymphatic Surgery And Related Procedures	1	$17,649.97	$17,649.97	$17,649.97	nat. median $7,071 outlier · 2.5×
559 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc	1	$17,322.18	$17,322.18	$17,322.18	nat. median $18,112 1.0× median
7048 OTHER	Alteplase Recombinant	1	$16,616.18	$16,616.18	$16,616.18	nat. median $96 outlier · 173.0×
949 MS_DRG	Aftercare With Cc/Mcc	1	$16,093.56	$16,093.56	$16,093.56	nat. median $11,791 1.4× median
57 MS_DRG	Degenerative Nervous System Disorders Without Mcc	2	$10,680.04	$21,458.08	$16,069.06	nat. median $12,544 1.3× median
948 MS_DRG	Signs And Symptoms Without Mcc	3	$9,843.12	$22,107.42	$15,640.00	nat. median $7,968 2.0× median
698 MS_DRG	Other Kidney And Urinary Tract Diagnoses With Mcc	2	$9,444.26	$20,695.40	$15,069.83	nat. median $15,902 0.9× median
391 MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	1	$14,316.91	$14,316.91	$14,316.91	nat. median $12,524 1.1× median
560 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Cc	3	$5,947.86	$17,203.43	$13,794.48	nat. median $11,475 1.2× median
438 MS_DRG	Disorders Of Pancreas Except Malignancy With Mcc	2	$3,774.96	$21,802.20	$12,788.58	nat. median $15,951 0.8× median
9300 OTHER	Omalizumab Injection	1	$12,521.19	$12,521.19	$12,521.19	nat. median $46 outlier · 275.2×
5362 OTHER	Level 2 Laparoscopy And Related Services	6	$4,110.08	$13,221.58	$12,410.53	nat. median $11,101 1.1× median
433 MS_DRG	Cirrhosis And Alcoholic Hepatitis With Cc	1	$11,750.31	$11,750.31	$11,750.31	nat. median $10,753 1.1× median
947 MS_DRG	Signs And Symptoms With Mcc	3	$1,619.80	$21,704.92	$11,730.00	nat. median $12,107 1.0× median
561 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc	2	$9,462.00	$13,794.48	$11,628.24	nat. median $8,652 1.3× median
864 MS_DRG	Fever And Inflammatory Conditions	1	$11,234.75	$11,234.75	$11,234.75	nat. median $9,213 1.2× median
159 MS_DRG	Dental And Oral Diseases Without Cc/Mcc	1	$10,462.35	$10,462.35	$10,462.35	nat. median $7,479 1.4× median
872 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	6	$4,065.62	$12,788.62	$10,135.20	nat. median $10,397 1.0× median
390 MS_DRG	Gastrointestinal Obstruction Without Cc/Mcc	2	$6,253.82	$13,878.34	$10,066.08	nat. median $6,115 1.6× median
193 MS_DRG	Simple Pneumonia And Pleurisy With Mcc	7	$5,552.05	$47,923.50	$9,854.95	nat. median $12,858 0.8× median
202 MS_DRG	Bronchitis And Asthma With Cc/Mcc	4	$1,201.00	$11,848.06	$9,619.23	nat. median $9,788 1.0× median
547 MS_DRG	Connective Tissue Disorders Without Cc/Mcc	1	$9,343.80	$9,343.80	$9,343.80	nat. median $8,666 1.1× median
305 MS_DRG	Hypertension Without Mcc	1	$9,196.32	$9,196.32	$9,196.32	nat. median $8,030 1.1× median
999 MS_DRG	Ungroupable	1	$9,196.32	$9,196.32	$9,196.32	nat. median $3,786 outlier · 2.4×
66 MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	1	$8,986.69	$8,986.69	$8,986.69	nat. median $7,556 1.2× median
552 MS_DRG	Medical Back Problems Without Mcc	1	$8,957.20	$8,957.20	$8,957.20	nat. median $9,826 0.9× median
377 MS_DRG	Gastrointestinal Hemorrhage With Mcc	1	$8,957.20	$8,957.20	$8,957.20	nat. median $17,281 0.5× median
694 MS_DRG	Urinary Stones Without Mcc	1	$8,798.04	$8,798.04	$8,798.04	nat. median $8,209 1.1× median
101 MS_DRG	Seizures Without Mcc	1	$8,734.30	$8,734.30	$8,734.30	nat. median $9,267 0.9× median
871 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	11	$1,005.00	$23,997.39	$8,696.36	nat. median $18,625 outlier · 0.5×
551 MS_DRG	Medical Back Problems With Mcc	1	$8,661.24	$8,661.24	$8,661.24	nat. median $16,085 0.5× median
167 MS_DRG	Other Respiratory System O.r. Procedures With Cc	1	$8,592.00	$8,592.00	$8,592.00	nat. median $17,834 outlier · 0.5×
392 MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	6	$2,547.17	$23,373.16	$8,588.44	nat. median $8,173 1.1× median
0948 RC	Gamunex-c/gammaked	1	$8,556.03	$8,556.03	$8,556.03	nat. median $169 outlier · 50.6×
869 MS_DRG	Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc	1	$8,502.19	$8,502.19	$8,502.19	nat. median $7,878 1.1× median
5361 OTHER	Level 1 Laparoscopy And Related Services	10	$500.00	$21,915.33	$8,085.24	nat. median $6,439 1.3× median
432 MS_DRG	Cirrhosis And Alcoholic Hepatitis With Mcc	1	$8,041.64	$8,041.64	$8,041.64	nat. median $18,803 outlier · 0.4×
541 MS_DRG	Osteomyelitis Without Cc/Mcc	2	$7,883.96	$8,089.08	$7,986.52	nat. median $8,696 0.9× median
896 MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc	1	$7,930.48	$7,930.48	$7,930.48	nat. median $15,465 0.5× median
832 MS_DRG	Other Antepartum Diagnoses Without O.r. Procedures With Cc	1	$7,930.48	$7,930.48	$7,930.48	nat. median $7,660 1.0× median
191 MS_DRG	Chronic Obstructive Pulmonary Disease With Cc	5	$1,220.81	$15,860.96	$7,930.48	nat. median $8,839 0.9× median
291 MS_DRG	Heart Failure And Shock With Mcc	8	$1,799.24	$19,837.40	$7,868.68	nat. median $12,759 0.6× median
950 MS_DRG	Aftercare Without Cc/Mcc	1	$7,665.60	$7,665.60	$7,665.60	nat. median $7,060 1.1× median
373 MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc	1	$7,601.40	$7,601.40	$7,601.40	nat. median $7,836 1.0× median
728 MS_DRG	Inflammation Of The Male Reproductive System Without Mcc	1	$7,402.73	$7,402.73	$7,402.73	nat. median $8,506 0.9× median
5416 OTHER	Level 6 Gynecologic Procedures	2	$5,296.03	$9,448.80	$7,372.41	nat. median $7,744 1.0× median

Other procedures at this hospital

Browse this hospital's 200 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

70	MS_DRG	Nonspecific Cerebrovascular Disorders With Mcc	1	1	—	—	$25,592.00	$25,592.00	$25,592.00	2025-05-01
208	MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	1	1	—	—	$23,749.66	$23,749.66	$23,749.66	2025-05-01
565	MS_DRG	Other Musculoskeletal System And Connective Tissue Diagnoses With Cc	1	1	—	—	$22,990.80	$22,990.80	$22,990.80	2025-05-01
99	MS_DRG	Non-bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc	1	1	—	—	$18,415.99	$18,415.99	$18,415.99	2025-05-01
5092	OTHER	Level 2 Breast/Lymphatic Surgery And Related Procedures	1	1	—	—	$17,649.97	$17,649.97	$17,649.97	2025-05-01
559	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc	1	1	—	—	$17,322.18	$17,322.18	$17,322.18	2025-05-01
7048	OTHER	Alteplase Recombinant	1	1	—	—	$16,616.18	$16,616.18	$16,616.18	2025-05-01
949	MS_DRG	Aftercare With Cc/Mcc	1	1	—	—	$16,093.56	$16,093.56	$16,093.56	2025-05-01
57	MS_DRG	Degenerative Nervous System Disorders Without Mcc	2	2	—	—	$10,680.04	$21,458.08	$16,069.06	2025-05-01
948	MS_DRG	Signs And Symptoms Without Mcc	3	3	—	—	$9,843.12	$22,107.42	$15,640.00	2025-05-01
698	MS_DRG	Other Kidney And Urinary Tract Diagnoses With Mcc	2	2	—	—	$9,444.26	$20,695.40	$15,069.83	2025-05-01
391	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	1	1	—	—	$14,316.91	$14,316.91	$14,316.91	2025-05-01
560	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Cc	3	3	—	—	$5,947.86	$17,203.43	$13,794.48	2025-05-01
438	MS_DRG	Disorders Of Pancreas Except Malignancy With Mcc	2	2	—	—	$3,774.96	$21,802.20	$12,788.58	2025-05-01
9300	OTHER	Omalizumab Injection	1	1	—	—	$12,521.19	$12,521.19	$12,521.19	2025-05-01
5362	OTHER	Level 2 Laparoscopy And Related Services	6	6	—	—	$4,110.08	$13,221.58	$12,410.53	2025-05-01
433	MS_DRG	Cirrhosis And Alcoholic Hepatitis With Cc	1	1	—	—	$11,750.31	$11,750.31	$11,750.31	2025-05-01
947	MS_DRG	Signs And Symptoms With Mcc	3	3	—	—	$1,619.80	$21,704.92	$11,730.00	2025-05-01
561	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc	2	2	—	—	$9,462.00	$13,794.48	$11,628.24	2025-05-01
864	MS_DRG	Fever And Inflammatory Conditions	1	1	—	—	$11,234.75	$11,234.75	$11,234.75	2025-05-01
159	MS_DRG	Dental And Oral Diseases Without Cc/Mcc	1	1	—	—	$10,462.35	$10,462.35	$10,462.35	2025-05-01
872	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	6	6	—	—	$4,065.62	$12,788.62	$10,135.20	2025-05-01
390	MS_DRG	Gastrointestinal Obstruction Without Cc/Mcc	2	2	—	—	$6,253.82	$13,878.34	$10,066.08	2025-05-01
193	MS_DRG	Simple Pneumonia And Pleurisy With Mcc	7	7	—	—	$5,552.05	$47,923.50	$9,854.95	2025-05-01
202	MS_DRG	Bronchitis And Asthma With Cc/Mcc	4	4	—	—	$1,201.00	$11,848.06	$9,619.23	2025-05-01
547	MS_DRG	Connective Tissue Disorders Without Cc/Mcc	1	1	—	—	$9,343.80	$9,343.80	$9,343.80	2025-05-01
305	MS_DRG	Hypertension Without Mcc	1	1	—	—	$9,196.32	$9,196.32	$9,196.32	2025-05-01
999	MS_DRG	Ungroupable	1	1	—	—	$9,196.32	$9,196.32	$9,196.32	2025-05-01
66	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	1	1	—	—	$8,986.69	$8,986.69	$8,986.69	2025-05-01
552	MS_DRG	Medical Back Problems Without Mcc	1	1	—	—	$8,957.20	$8,957.20	$8,957.20	2025-05-01
377	MS_DRG	Gastrointestinal Hemorrhage With Mcc	1	1	—	—	$8,957.20	$8,957.20	$8,957.20	2025-05-01
694	MS_DRG	Urinary Stones Without Mcc	1	1	—	—	$8,798.04	$8,798.04	$8,798.04	2025-05-01
101	MS_DRG	Seizures Without Mcc	1	1	—	—	$8,734.30	$8,734.30	$8,734.30	2025-05-01
871	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	11	11	—	—	$1,005.00	$23,997.39	$8,696.36	2025-05-01
551	MS_DRG	Medical Back Problems With Mcc	1	1	—	—	$8,661.24	$8,661.24	$8,661.24	2025-05-01
167	MS_DRG	Other Respiratory System O.r. Procedures With Cc	1	1	—	—	$8,592.00	$8,592.00	$8,592.00	2025-05-01
392	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	6	6	—	—	$2,547.17	$23,373.16	$8,588.44	2025-05-01
0948	RC	Gamunex-c/gammaked	1	1	—	—	$8,556.03	$8,556.03	$8,556.03	2025-05-01
869	MS_DRG	Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc	1	1	—	—	$8,502.19	$8,502.19	$8,502.19	2025-05-01
5361	OTHER	Level 1 Laparoscopy And Related Services	10	10	—	—	$500.00	$21,915.33	$8,085.24	2025-05-01
432	MS_DRG	Cirrhosis And Alcoholic Hepatitis With Mcc	1	1	—	—	$8,041.64	$8,041.64	$8,041.64	2025-05-01
541	MS_DRG	Osteomyelitis Without Cc/Mcc	2	2	—	—	$7,883.96	$8,089.08	$7,986.52	2025-05-01
896	MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc	1	1	—	—	$7,930.48	$7,930.48	$7,930.48	2025-05-01
832	MS_DRG	Other Antepartum Diagnoses Without O.r. Procedures With Cc	1	1	—	—	$7,930.48	$7,930.48	$7,930.48	2025-05-01
191	MS_DRG	Chronic Obstructive Pulmonary Disease With Cc	5	5	—	—	$1,220.81	$15,860.96	$7,930.48	2025-05-01
291	MS_DRG	Heart Failure And Shock With Mcc	8	8	—	—	$1,799.24	$19,837.40	$7,868.68	2025-05-01
950	MS_DRG	Aftercare Without Cc/Mcc	1	1	—	—	$7,665.60	$7,665.60	$7,665.60	2025-05-01
373	MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc	1	1	—	—	$7,601.40	$7,601.40	$7,601.40	2025-05-01
728	MS_DRG	Inflammation Of The Male Reproductive System Without Mcc	1	1	—	—	$7,402.73	$7,402.73	$7,402.73	2025-05-01
5416	OTHER	Level 6 Gynecologic Procedures	2	2	—	—	$5,296.03	$9,448.80	$7,372.41	2025-05-01
867	MS_DRG	Other Infectious And Parasitic Diseases Diagnoses With Mcc	1	1	—	—	$7,357.84	$7,357.84	$7,357.84	2025-05-01
623	MS_DRG	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…	1	1	—	—	$7,312.00	$7,312.00	$7,312.00	2025-05-01
682	MS_DRG	Renal Failure With Mcc	3	3	—	—	$6,087.76	$8,332.00	$7,312.00	2025-05-01
683	MS_DRG	Renal Failure With Cc	7	7	—	—	$2,010.41	$11,087.28	$7,312.00	2025-05-01
310	MS_DRG	Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc	2	2	—	—	$6,302.54	$8,263.74	$7,283.14	2025-05-01
189	MS_DRG	Pulmonary Edema And Respiratory Failure	1	1	—	—	$7,182.08	$7,182.08	$7,182.08	2025-05-01
602	MS_DRG	Cellulitis With Mcc	3	3	—	—	$6,007.34	$7,312.00	$7,165.76	2025-05-01
897	MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	8	8	—	—	$1,243.10	$10,356.18	$7,150.66	2025-05-01
190	MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	6	6	—	—	$3,652.95	$10,111.35	$7,122.49	2025-05-01
194	MS_DRG	Simple Pneumonia And Pleurisy With Cc	8	8	—	—	$4,296.00	$13,243.12	$6,626.86	2025-05-01
1823	OTHER	Injection, Dalbavancin	2	2	—	—	$3.53	$12,962.61	$6,483.07	2025-05-01
603	MS_DRG	Cellulitis Without Mcc	10	10	—	—	$1,970.99	$13,336.61	$6,280.60	2025-05-01
918	MS_DRG	Poisoning And Toxic Effects Of Drugs Without Mcc	1	1	—	—	$6,229.20	$6,229.20	$6,229.20	2025-05-01
9008	OTHER	Inj Tezepelumab-ekko, 1mg	1	1	—	—	$6,118.90	$6,118.90	$6,118.90	2025-05-01
178	MS_DRG	Respiratory Infections And Inflammations With Cc	5	5	—	—	$4,188.00	$14,700.66	$5,947.86	2025-05-01
605	MS_DRG	Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc	1	1	—	—	$5,947.86	$5,947.86	$5,947.86	2025-05-01
98	MS_DRG	Non-bacterial Infection Of Nervous System Except Viral Meningitis With Cc	1	1	—	—	$5,583.06	$5,583.06	$5,583.06	2025-05-01
935	MS_DRG	Non-extensive Burns	1	1	—	—	$5,566.40	$5,566.40	$5,566.40	2025-05-01
83	MS_DRG	Traumatic Stupor And Coma >1 Hour With Cc	1	1	—	—	$5,566.40	$5,566.40	$5,566.40	2025-05-01
571	MS_DRG	Skin Debridement With Cc	2	2	—	—	$5,484.00	$5,563.72	$5,523.86	2025-05-01
192	MS_DRG	Chronic Obstructive Pulmonary Disease Without Cc/Mcc	5	5	—	—	$1,982.62	$8,957.20	$5,410.14	2025-05-01
439	MS_DRG	Disorders Of Pancreas Except Malignancy With Cc	4	4	—	—	$1,182.65	$8,089.08	$5,393.10	2025-05-01
554	MS_DRG	Bone Diseases And Arthropathies Without Mcc	1	1	—	—	$5,374.32	$5,374.32	$5,374.32	2025-05-01
862	MS_DRG	Postoperative And Post-traumatic Infections With Mcc	1	1	—	—	$5,374.32	$5,374.32	$5,374.32	2025-05-01
5183	OTHER	Level 3 Vascular Procedures	9	9	—	—	$3,002.30	$21,596.56	$5,219.83	2025-05-01
690	MS_DRG	Kidney And Urinary Tract Infections Without Mcc	14	14	—	—	$1,184.64	$15,573.00	$5,012.91	2025-05-01
863	MS_DRG	Postoperative And Post-traumatic Infections Without Mcc	1	1	—	—	$4,598.16	$4,598.16	$4,598.16	2025-05-01
640	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…	1	1	—	—	$4,590.96	$4,590.96	$4,590.96	2025-05-01
689	MS_DRG	Kidney And Urinary Tract Infections With Mcc	3	3	—	—	$4,348.18	$8,759.35	$4,534.49	2025-05-01
176	MS_DRG	Pulmonary Embolism Without Mcc	4	4	—	—	$1,478.82	$9,872.02	$4,464.86	2025-05-01
894	MS_DRG	Alcohol, Drug Abuse Or Dependence, Left Ama	2	2	—	—	$2,855.85	$6,066.81	$4,461.33	2025-05-01
177	MS_DRG	Respiratory Infections And Inflammations With Mcc	6	6	—	—	$1,375.00	$8,989.84	$4,455.08	2025-05-01
563	MS_DRG	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…	1	1	—	—	$4,452.63	$4,452.63	$4,452.63	2025-05-01
9139	OTHER	Rabies Vaccine, IM	2	2	—	—	$397.99	$8,290.96	$4,344.47	2025-05-01
5054	OTHER	Level 4 Skin Procedures	1	1	—	—	$4,304.93	$4,304.93	$4,304.93	2025-05-01
868	MS_DRG	Other Infectious And Parasitic Diseases Diagnoses With Cc	1	1	—	—	$4,255.02	$4,255.02	$4,255.02	2025-05-01
1214	OTHER	Inj Ivig Privigen 500 Mg	4	4	—	—	$30.97	$9,664.02	$4,246.75	2025-05-01
5341	OTHER	Level 1 Abdominal/Peritoneal/Biliary And Related Procedures	1	1	—	—	$4,180.21	$4,180.21	$4,180.21	2025-05-01
280	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Mcc	1	1	—	—	$4,166.00	$4,166.00	$4,166.00	2025-05-01
203	MS_DRG	Bronchitis And Asthma Without Cc/Mcc	1	1	—	—	$4,114.68	$4,114.68	$4,114.68	2025-05-01
183	MS_DRG	Major Chest Trauma With Mcc	1	1	—	—	$4,043.97	$4,043.97	$4,043.97	2025-05-01
5313	OTHER	Level 3 Lower Gi Procedures	4	4	—	—	$3,359.98	$4,313.08	$4,016.96	2025-05-01
558	MS_DRG	Tendonitis, Myositis And Bursitis Without Mcc	3	3	—	—	$1,982.62	$5,912.97	$3,965.24	2025-05-01
137	MS_DRG	Mouth Procedures With Cc/Mcc	1	1	—	—	$3,965.24	$3,965.24	$3,965.24	2025-05-01
641	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	7	7	—	—	$1,719.45	$8,493.28	$3,965.24	2025-05-01
389	MS_DRG	Gastrointestinal Obstruction With Cc	3	3	—	—	$2,956.48	$9,227.39	$3,965.24	2025-05-01
195	MS_DRG	Simple Pneumonia And Pleurisy Without Cc/Mcc	4	4	—	—	$2,929.86	$5,947.86	$3,850.27	2025-05-01
436	MS_DRG	Malignancy Of Hepatobiliary System Or Pancreas With Cc	1	1	—	—	$3,774.96	$3,774.96	$3,774.96	2025-05-01
64	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	1	1	—	—	$3,774.96	$3,774.96	$3,774.96	2025-05-01
179	MS_DRG	Respiratory Infections And Inflammations Without Cc/Mcc	1	1	—	—	$3,774.96	$3,774.96	$3,774.96	2025-05-01
312	MS_DRG	Syncope And Collapse	3	3	—	—	$1,982.62	$5,484.00	$3,774.96	2025-05-01
604	MS_DRG	Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc	1	1	—	—	$3,759.02	$3,759.02	$3,759.02	2025-05-01
638	MS_DRG	Diabetes With Cc	6	6	—	—	$2,080.00	$12,633.81	$3,695.01	2025-05-01
617	MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	2	2	—	—	$2,504.88	$4,851.64	$3,678.26	2025-05-01
71	MS_DRG	Nonspecific Cerebrovascular Disorders With Cc	1	1	—	—	$3,656.00	$3,656.00	$3,656.00	2025-05-01
309	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Cc	2	2	—	—	$3,530.94	$3,593.88	$3,562.41	2025-05-01
440	MS_DRG	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	4	4	—	—	$1,828.00	$8,865.33	$3,409.25	2025-05-01
5415	OTHER	Level 5 Gynecologic Procedures	2	2	—	—	$615.30	$5,963.30	$3,289.30	2025-05-01
639	MS_DRG	Diabetes Without Cc/Mcc	4	4	—	—	$1,774.35	$5,406.96	$3,147.44	2025-05-01
557	MS_DRG	Tendonitis, Myositis And Bursitis With Mcc	1	1	—	—	$3,114.60	$3,114.60	$3,114.60	2025-05-01
5182	OTHER	Level 2 Vascular Procedures	5	5	—	—	$1,360.68	$3,385.61	$3,109.99	2025-05-01
5691	OTHER	Level 1 Drug Administration	7	7	—	—	$762.39	$20,876.09	$3,076.00	2025-05-01
1829	OTHER	Penicillin G Benzathine Inj	2	2	—	—	$1,824.19	$4,186.61	$3,005.40	2025-05-01
5692	OTHER	Level 2 Drug Administration	1	1	—	—	$2,981.54	$2,981.54	$2,981.54	2025-05-01
153	MS_DRG	Otitis Media And Uri Without Mcc	2	2	—	—	$2,719.80	$3,006.85	$2,863.32	2025-05-01
75	MS_DRG	Viral Meningitis With Cc/Mcc	2	2	—	—	$1,693.45	$3,981.40	$2,837.43	2025-05-01
9133	OTHER	Rabies Ig, Im/sc	4	4	—	—	$135.00	$6,274.47	$2,831.11	2025-05-01
684	MS_DRG	Renal Failure Without Cc/Mcc	2	2	—	—	$1,983.52	$3,656.00	$2,819.76	2025-05-01
951	MS_DRG	Other Factors Influencing Health Status	3	3	—	—	$1,982.62	$6,007.34	$2,710.38	2025-05-01
9272	OTHER	Inj, Denosumab	3	3	—	—	$2,648.46	$2,691.05	$2,648.46	2025-05-01
5072	OTHER	Level 2 Excision/ Biopsy/ Incision And Drainage	12	12	—	—	$1,434.96	$6,997.21	$2,503.57	2025-05-01
308	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Mcc	3	3	—	—	$1,421.85	$7,312.00	$2,491.00	2025-05-01
5091	OTHER	Level 1 Breast/Lymphatic Surgery And Related Procedures	6	6	—	—	$300.91	$11,093.56	$2,475.48	2025-05-01
65	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	4	4	—	—	$1,899.62	$15,798.05	$2,387.05	2025-05-01
5041	OTHER	Critical Care	27	27	—	—	$986.20	$8,635.61	$2,363.77	2025-05-01
5112	OTHER	Level 2 Musculoskeletal Procedures	8	8	—	—	$1,245.44	$7,283.09	$2,351.62	2025-05-01
175	MS_DRG	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	1	1	—	—	$2,084.76	$2,084.76	$2,084.76	2025-05-01
812	MS_DRG	Red Blood Cell Disorders Without Mcc	3	3	—	—	$2,022.27	$2,530.85	$2,083.00	2025-05-01
9512	OTHER	Rbc Leukocytes Reduced	2	2	—	—	$561.83	$3,559.76	$2,060.80	2025-05-01
316	MS_DRG	Other Circulatory System Diagnoses Without Cc/Mcc	1	1	—	—	$2,041.34	$2,041.34	$2,041.34	2025-05-01
540	MS_DRG	Osteomyelitis With Cc	1	1	—	—	$2,010.41	$2,010.41	$2,010.41	2025-05-01
206	MS_DRG	Other Respiratory System Diagnoses Without Mcc	1	1	—	—	$2,002.45	$2,002.45	$2,002.45	2025-05-01
93	MS_DRG	Other Disorders Of Nervous System Without Cc/Mcc	1	1	—	—	$1,990.70	$1,990.70	$1,990.70	2025-05-01
866	MS_DRG	Viral Illness Without Mcc	1	1	—	—	$1,983.52	$1,983.52	$1,983.52	2025-05-01
74	MS_DRG	Cranial And Peripheral Nerve Disorders Without Mcc	3	3	—	—	$1,970.99	$4,004.89	$1,983.52	2025-05-01
5721	OTHER	Level 1 Diagnostic Tests And Related Services	1	1	—	—	$1,910.25	$1,910.25	$1,910.25	2025-05-01
5071	OTHER	Level 1 Excision/ Biopsy/ Incision And Drainage	3	3	—	—	$1,134.00	$3,008.01	$1,830.65	2025-05-01
593	MS_DRG	Skin Ulcers With Cc	1	1	—	—	$1,828.00	$1,828.00	$1,828.00	2025-05-01
379	MS_DRG	Gastrointestinal Hemorrhage Without Cc/Mcc	1	1	—	—	$1,799.24	$1,799.24	$1,799.24	2025-05-01
72	MS_DRG	Nonspecific Cerebrovascular Disorders Without Cc/Mcc	2	2	—	—	$1,478.82	$2,083.00	$1,780.91	2025-05-01
5781	OTHER	Resuscitation And Cardioversion	3	3	—	—	$450.94	$1,721.18	$1,687.78	2025-05-01
5791	OTHER	Pulmonary Treatment	2	2	—	—	$311.60	$3,015.14	$1,663.37	2025-05-01
5302	OTHER	Level 2 Upper Gi Procedures	4	4	—	—	$1,135.68	$2,111.58	$1,627.30	2025-05-01
5312	OTHER	Level 2 Lower Gi Procedures	28	28	—	—	$787.62	$5,447.44	$1,577.89	2025-05-01
184	MS_DRG	Major Chest Trauma With Cc	1	1	—	—	$1,478.82	$1,478.82	$1,478.82	2025-05-01
5673	OTHER	Level 3 Pathology	1	1	—	—	$1,452.91	$1,452.91	$1,452.91	2025-05-01
5311	OTHER	Level 1 Lower Gi Procedures	29	29	—	—	$514.42	$5,357.08	$1,424.60	2025-05-01
5572	OTHER	Level 2 Imaging With Contrast	33	33	—	—	$326.38	$7,450.36	$1,408.23	2025-05-01
181	MS_DRG	Respiratory Neoplasms With Cc	1	1	—	—	$1,360.38	$1,360.38	$1,360.38	2025-05-01
5442	OTHER	Level 2 Nerve Injections	6	6	—	—	$525.24	$2,874.38	$1,330.27	2025-05-01
5025	OTHER	Level 5 Type A Ed Visits	66	65	—	—	$599.14	$7,217.43	$1,294.67	2025-05-01
607	MS_DRG	Minor Skin Disorders Without Mcc	1	1	—	—	$1,268.04	$1,268.04	$1,268.04	2025-05-01
92	MS_DRG	Other Disorders Of Nervous System With Cc	1	1	—	—	$1,122.10	$1,122.10	$1,122.10	2025-05-01
5573	OTHER	Level 3 Imaging With Contrast	15	15	—	—	$574.77	$4,982.24	$1,105.20	2025-05-01
5301	OTHER	Level 1 Upper Gi Procedures	17	17	—	—	$556.40	$2,278.00	$1,091.11	2025-05-01
5024	OTHER	Level 4 Type A Ed Visits	72	71	—	—	$72.61	$9,343.99	$1,064.38	2025-05-01
5413	OTHER	Level 3 Gynecologic Procedures	1	1	—	—	$997.29	$997.29	$997.29	2025-05-01
5053	OTHER	Level 3 Skin Procedures	1	1	—	—	$945.44	$945.44	$945.44	2025-05-01
5693	OTHER	Level 3 Drug Administration	10	10	—	—	$127.25	$4,322.05	$942.10	2025-05-01
5523	OTHER	Level 3 Imaging Without Contrast	49	49	—	—	$277.19	$3,494.51	$880.40	2025-05-01
5571	OTHER	Level 1 Imaging With Contrast	33	33	—	—	$218.22	$5,463.18	$870.35	2025-05-01
5052	OTHER	Level 2 Skin Procedures	14	14	—	—	$483.87	$3,806.57	$796.57	2025-05-01
5592	OTHER	Level 2 Nuclear Medicine And Related Services	11	11	—	—	$422.47	$1,702.14	$705.40	2025-05-01
5524	OTHER	Level 4 Imaging Without Contrast	23	23	—	—	$27.00	$4,088.57	$685.20	2025-05-01
5441	OTHER	Level 1 Nerve Injections	8	8	—	—	$383.44	$1,897.40	$644.26	2025-05-01
5412	OTHER	Level 2 Gynecologic Procedures	3	3	—	—	$500.04	$2,075.00	$617.40	2025-05-01
5591	OTHER	Level 1 Nuclear Medicine And Related Services	10	10	—	—	$470.32	$2,478.10	$551.77	2025-05-01
N801	OTHER	Therapy Services	14	14	—	—	$173.25	$1,072.82	$448.10	2025-05-01
5111	OTHER	Level 1 Musculoskeletal Procedures	1	1	—	—	$444.69	$444.69	$444.69	2025-05-01
5371	OTHER	Level 1 Urology And Related Services	1	1	—	—	$429.03	$429.03	$429.03	2025-05-01
5023	OTHER	Level 3 Type A Ed Visits	63	61	—	—	$51.00	$2,622.35	$427.61	2025-05-01
5241	OTHER	Level 1 Blood Product Exchange And Related Services	3	3	—	—	$147.78	$1,992.48	$413.05	2025-05-01
5722	OTHER	Level 2 Diagnostic Tests And Related Services	1	1	—	—	$401.20	$401.20	$401.20	2025-05-01
5771	OTHER	Cardiac Rehabilitation	2	2	—	—	$176.59	$584.62	$380.61	2025-05-01
N900	OTHER	Non-covered Services	12	12	—	—	$1.03	$1,311.20	$321.54	2025-05-01
5051	OTHER	Level 1 Skin Procedures	1	1	—	—	$296.49	$296.49	$296.49	2025-05-01
5734	OTHER	Level 4 Minor Procedures	3	3	—	—	$154.09	$2,057.26	$256.32	2025-05-01
5522	OTHER	Level 2 Imaging Without Contrast	62	61	—	—	$42.70	$3,100.00	$232.78	2025-05-01
5012	OTHER	Clinic Visits And Related Services	11	11	—	—	$163.95	$2,635.34	$203.65	2025-05-01
5671	OTHER	Level 1 Pathology	5	5	—	—	$86.02	$422.78	$172.70	2025-05-01
5022	OTHER	Level 2 Type A Ed Visits	40	39	—	—	$37.14	$709.00	$169.72	2025-05-01
N804	OTHER	Mammography Services	51	51	—	—	$88.99	$654.25	$157.88	2025-05-01
5733	OTHER	Level 3 Minor Procedures	18	18	—	—	$69.71	$458.49	$151.34	2025-05-01
N800	OTHER	Clinical Diagnostic Lab Services	85	82	—	—	$4.29	$2,051.00	$144.40	2025-05-01
5521	OTHER	Level 1 Imaging Without Contrast	60	59	—	—	$55.10	$2,317.83	$117.22	2025-05-01
9042	OTHER	Glucagon Hydrochloride	1	1	—	—	$105.72	$105.72	$105.72	2025-05-01
5021	OTHER	Level 1 Type A Ed Visits	37	37	—	—	$42.20	$873.50	$93.59	2025-05-01
5672	OTHER	Level 2 Pathology	1	1	—	—	$92.80	$92.80	$92.80	2025-05-01
N902	OTHER	Packaged Services	6	6	—	—	$1.35	$1,156.10	$61.12	2025-05-01
5732	OTHER	Level 2 Minor Procedures	2	2	—	—	$49.20	$50.20	$49.70	2025-05-01
N806	OTHER	Pharmacy Services	1	1	—	—	$45.47	$45.47	$45.47	2025-05-01
5731	OTHER	Level 1 Minor Procedures	1	1	—	—	$21.00	$21.00	$21.00	2025-05-01
9226	OTHER	Inj, Calcium Gluconate, Nos	1	1	—	—	$7.22	$7.22	$7.22	2025-05-01
9360	OTHER	Inj Heparin, Pfizer, 1000u	1	1	—	—	$5.25	$5.25	$5.25	2025-05-01
9369	OTHER	Inj, Metronidazole, 10 Mg	1	1	—	—	$5.25	$5.25	$5.25	2025-05-01
0724	RC	Inj. Olanzapine, 0.5mg	1	1	—	—	$5.25	$5.25	$5.25	2025-05-01
9402	OTHER	Inj Labetalol Hcl Hikma, 5mg	1	1	—	—	$3.32	$3.32	$3.32	2025-05-01
0963	RC	Albumin (human), 5%, 250 Ml	1	1	—	—	$2.45	$2.45	$2.45	2025-05-01
9170	OTHER	Inj Midazolam (wg Crit Care)	1	1	—	—	$1.92	$1.92	$1.92	2025-05-01
9292	OTHER	Inj, Clindamycin (baxter)	1	1	—	—	$1.49	$1.49	$1.49	2025-05-01

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