Hospital

BOYS TOWN NATIONAL RESEARCH HOSPITAL

Boys Town, NE · CCN 283300 · Rates published

17,951 distinct procedures filed

15 distinct payers

153,652 rate rows

2025-12-29 last MRF observed

Data quality

130,298 of 153,652 rate rows are consumer-grade (84.8%)

23,354 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	20,702
placeholder amount (≤ $0.02) — excluded from medians	1,495
template filing: same amount across many unrelated codes — excluded	1,036
exceeds 10× this hospital's gross charge — excluded from medians	54
percent-of-charges filed in the dollar field — excluded from medians	51
per-diem day rate — not a per-procedure price	16

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

Source MRF file	https://media.boystown.org/raw/upload/v1776093630/cost-estimates-spreadsheet-2026_xlc7uv.zip
Found on page	https://www.boystownhospital.org/cms-hpt.txt
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-05-18
Content fingerprint	6c8e6a66b35a11e7… · 1,672,718 bytes · first seen 2026-05-14

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
J3399 HCPCS	Onasemnogene Abeparvovec-xioi 2 X 10exp13 Vg/ml IV Suspensionkit	12	$35,185.25	$2,435,952.24	$1,946,250.50	nat. median $2,468,984 0.8× median
5834 APR_DRG		3	$567,534.58	$567,534.58	$567,534.58	nat. median $309,665 1.8× median
5884 APR_DRG		3	$347,604.58	$347,604.58	$347,604.58	nat. median $246,434 1.4× median
0114 APR_DRG		3	$324,952.04	$324,952.04	$324,952.04	nat. median $197,700 1.6× median
5833 APR_DRG		3	$323,229.76	$323,229.76	$323,229.76	nat. median $244,017 1.3× median
5832 APR_DRG		3	$248,180.71	$248,180.71	$248,180.71	nat. median $156,126 1.6× median
1614 APR_DRG		3	$242,334.00	$242,334.00	$242,334.00	nat. median $207,730 1.2× median
6094 APR_DRG		3	$242,185.09	$242,185.09	$242,185.09	nat. median $162,982 1.5× median
0113 APR_DRG		3	$241,833.85	$241,833.85	$241,833.85	nat. median $128,705 1.9× median
0094 APR_DRG		3	$237,565.64	$237,565.64	$237,565.64	nat. median $166,008 1.4× median
6314 APR_DRG		3	$232,937.98	$232,937.98	$232,937.98	nat. median $122,924 1.9× median
5883 APR_DRG		3	$231,504.29	$231,504.29	$231,504.29	nat. median $182,665 1.3× median
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell Immunotherapy	1	$229,570.40	$229,570.40	$229,570.40	nat. median $370,174 0.6× median
5914 APR_DRG		3	$227,941.62	$227,941.62	$227,941.62	nat. median $164,289 1.4× median
5831 APR_DRG		3	$222,772.73	$222,772.73	$222,772.73	nat. median $144,745 1.5× median
8414 APR_DRG		3	$215,562.17	$215,562.17	$215,562.17	nat. median $160,267 1.3× median
6304 APR_DRG		3	$211,250.82	$211,250.82	$211,250.82	nat. median $150,721 1.4× median
5934 APR_DRG		3	$200,404.67	$200,404.67	$200,404.67	nat. median $151,838 1.3× median
5882 APR_DRG		3	$198,374.29	$198,374.29	$198,374.29	nat. median $145,336 1.4× median
0112 APR_DRG		3	$192,254.40	$192,254.40	$192,254.40	nat. median $93,442 outlier · 2.1×
1613 APR_DRG		3	$189,752.63	$189,752.63	$189,752.63	nat. median $119,796 1.6× median
0044 APR_DRG		3	$182,571.84	$182,571.84	$182,571.84	nat. median $195,681 0.9× median
5913 APR_DRG		3	$171,907.48	$171,907.48	$171,907.48	nat. median $102,919 1.7× median
5881 APR_DRG		3	$170,035.26	$170,035.26	$170,035.26	nat. median $124,573 1.4× median
5892 APR_DRG		3	$162,031.84	$162,031.84	$162,031.84	nat. median $89,796 1.8× median
5893 APR_DRG		3	$162,031.84	$162,031.84	$162,031.84	nat. median $69,788 outlier · 2.3×
5891 APR_DRG		3	$162,031.84	$162,031.84	$162,031.84	nat. median $93,370 1.7× median
0093 APR_DRG		3	$159,659.47	$159,659.47	$159,659.47	nat. median $78,641 outlier · 2.0×
6024 APR_DRG		3	$150,972.08	$150,972.08	$150,972.08	nat. median $118,620 1.3× median
5912 APR_DRG		3	$147,447.42	$147,447.42	$147,447.42	nat. median $81,294 1.8× median
5933 APR_DRG		3	$146,602.20	$146,602.20	$146,602.20	nat. median $108,996 1.3× median
1611 APR_DRG		3	$139,620.65	$139,620.65	$139,620.65	nat. median $76,806 1.8× median
1612 APR_DRG		3	$139,620.65	$139,620.65	$139,620.65	nat. median $85,444 1.6× median
1604 APR_DRG		3	$139,112.29	$139,112.29	$139,112.29	nat. median $97,957 1.4× median
0054 APR_DRG		3	$127,186.76	$127,186.76	$127,186.76	nat. median $149,310 0.9× median
0043 APR_DRG		3	$125,896.85	$125,896.85	$125,896.85	nat. median $113,567 1.1× median
8424 APR_DRG		3	$120,683.80	$120,683.80	$120,683.80	nat. median $80,416 1.5× median
5932 APR_DRG		3	$117,916.03	$117,916.03	$117,916.03	nat. median $86,338 1.4× median
6074 APR_DRG		3	$116,702.12	$116,702.12	$116,702.12	nat. median $95,507 1.2× median
6303 APR_DRG		3	$116,446.40	$116,446.40	$116,446.40	nat. median $72,936 1.6× median
8513 APR_DRG		3	$111,361.72	$111,361.72	$111,361.72	nat. median $26,364 outlier · 4.2×
8514 APR_DRG		3	$111,361.72	$111,361.72	$111,361.72	nat. median $70,353 1.6× median
6034 APR_DRG		3	$110,422.01	$110,422.01	$110,422.01	nat. median $109,499 1.0× median
6023 APR_DRG		3	$104,821.78	$104,821.78	$104,821.78	nat. median $86,492 1.2× median
6114 APR_DRG		3	$97,061.77	$97,061.77	$97,061.77	nat. median $72,753 1.3× median
6134 APR_DRG		3	$96,170.33	$96,170.33	$96,170.33	nat. median $55,478 1.7× median
8634 APR_DRG		3	$94,930.75	$94,930.75	$94,930.75	nat. median $69,502 1.4× median
0111 APR_DRG		3	$94,686.32	$94,686.32	$94,686.32	nat. median $85,731 1.1× median
1624 APR_DRG		3	$93,488.84	$93,488.84	$93,488.84	nat. median $81,781 1.1× median
3034 APR_DRG		3	$93,036.96	$93,036.96	$93,036.96	nat. median $84,063 1.1× median

Other procedures at this hospital

Browse this hospital's 17,951 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

J3399	HCPCS	Onasemnogene Abeparvovec-xioi 2 X 10exp13 Vg/ml IV Suspensionkit	20	12	$2,511,290.97	$2,009,032.78	$35,185.25	$2,435,952.24	$1,946,250.50	2025-12-29
5834	APR_DRG	—	3	3	—	—	$567,534.58	$567,534.58	$567,534.58	2025-12-29
5884	APR_DRG	—	3	3	—	—	$347,604.58	$347,604.58	$347,604.58	2025-12-29
0114	APR_DRG	—	3	3	—	—	$324,952.04	$324,952.04	$324,952.04	2025-12-29
5833	APR_DRG	—	3	3	—	—	$323,229.76	$323,229.76	$323,229.76	2025-12-29
5832	APR_DRG	—	3	3	—	—	$248,180.71	$248,180.71	$248,180.71	2025-12-29
1614	APR_DRG	—	3	3	—	—	$242,334.00	$242,334.00	$242,334.00	2025-12-29
6094	APR_DRG	—	3	3	—	—	$242,185.09	$242,185.09	$242,185.09	2025-12-29
0113	APR_DRG	—	3	3	—	—	$241,833.85	$241,833.85	$241,833.85	2025-12-29
0094	APR_DRG	—	3	3	—	—	$237,565.64	$237,565.64	$237,565.64	2025-12-29
6314	APR_DRG	—	3	3	—	—	$232,937.98	$232,937.98	$232,937.98	2025-12-29
5883	APR_DRG	—	3	3	—	—	$231,504.29	$231,504.29	$231,504.29	2025-12-29
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell Immunotherapy	1	1	—	—	$229,570.40	$229,570.40	$229,570.40	2025-12-29
5914	APR_DRG	—	3	3	—	—	$227,941.62	$227,941.62	$227,941.62	2025-12-29
5831	APR_DRG	—	3	3	—	—	$222,772.73	$222,772.73	$222,772.73	2025-12-29
8414	APR_DRG	—	3	3	—	—	$215,562.17	$215,562.17	$215,562.17	2025-12-29
6304	APR_DRG	—	3	3	—	—	$211,250.82	$211,250.82	$211,250.82	2025-12-29
5934	APR_DRG	—	3	3	—	—	$200,404.67	$200,404.67	$200,404.67	2025-12-29
5882	APR_DRG	—	3	3	—	—	$198,374.29	$198,374.29	$198,374.29	2025-12-29
0112	APR_DRG	—	3	3	—	—	$192,254.40	$192,254.40	$192,254.40	2025-12-29
1613	APR_DRG	—	3	3	—	—	$189,752.63	$189,752.63	$189,752.63	2025-12-29
0044	APR_DRG	—	3	3	—	—	$182,571.84	$182,571.84	$182,571.84	2025-12-29
5913	APR_DRG	—	3	3	—	—	$171,907.48	$171,907.48	$171,907.48	2025-12-29
5881	APR_DRG	—	3	3	—	—	$170,035.26	$170,035.26	$170,035.26	2025-12-29
5893	APR_DRG	—	3	3	—	—	$162,031.84	$162,031.84	$162,031.84	2025-12-29
5892	APR_DRG	—	3	3	—	—	$162,031.84	$162,031.84	$162,031.84	2025-12-29
5891	APR_DRG	—	3	3	—	—	$162,031.84	$162,031.84	$162,031.84	2025-12-29
0093	APR_DRG	—	3	3	—	—	$159,659.47	$159,659.47	$159,659.47	2025-12-29
6024	APR_DRG	—	3	3	—	—	$150,972.08	$150,972.08	$150,972.08	2025-12-29
5912	APR_DRG	—	3	3	—	—	$147,447.42	$147,447.42	$147,447.42	2025-12-29
5933	APR_DRG	—	3	3	—	—	$146,602.20	$146,602.20	$146,602.20	2025-12-29
1611	APR_DRG	—	3	3	—	—	$139,620.65	$139,620.65	$139,620.65	2025-12-29
1612	APR_DRG	—	3	3	—	—	$139,620.65	$139,620.65	$139,620.65	2025-12-29
1604	APR_DRG	—	3	3	—	—	$139,112.29	$139,112.29	$139,112.29	2025-12-29
0054	APR_DRG	—	3	3	—	—	$127,186.76	$127,186.76	$127,186.76	2025-12-29
0043	APR_DRG	—	3	3	—	—	$125,896.85	$125,896.85	$125,896.85	2025-12-29
8424	APR_DRG	—	3	3	—	—	$120,683.80	$120,683.80	$120,683.80	2025-12-29
5932	APR_DRG	—	3	3	—	—	$117,916.03	$117,916.03	$117,916.03	2025-12-29
6074	APR_DRG	—	3	3	—	—	$116,702.12	$116,702.12	$116,702.12	2025-12-29
6303	APR_DRG	—	3	3	—	—	$116,446.40	$116,446.40	$116,446.40	2025-12-29
8513	APR_DRG	—	3	3	—	—	$111,361.72	$111,361.72	$111,361.72	2025-12-29
8514	APR_DRG	—	3	3	—	—	$111,361.72	$111,361.72	$111,361.72	2025-12-29
6034	APR_DRG	—	3	3	—	—	$110,422.01	$110,422.01	$110,422.01	2025-12-29
6023	APR_DRG	—	3	3	—	—	$104,821.78	$104,821.78	$104,821.78	2025-12-29
6114	APR_DRG	—	3	3	—	—	$97,061.77	$97,061.77	$97,061.77	2025-12-29
6134	APR_DRG	—	3	3	—	—	$96,170.33	$96,170.33	$96,170.33	2025-12-29
8634	APR_DRG	—	3	3	—	—	$94,930.75	$94,930.75	$94,930.75	2025-12-29
0111	APR_DRG	—	3	3	—	—	$94,686.32	$94,686.32	$94,686.32	2025-12-29
1624	APR_DRG	—	3	3	—	—	$93,488.84	$93,488.84	$93,488.84	2025-12-29
3034	APR_DRG	—	3	3	—	—	$93,036.96	$93,036.96	$93,036.96	2025-12-29
0053	APR_DRG	—	3	3	—	—	$92,302.65	$92,302.65	$92,302.65	2025-12-29
Q2056	HCPCS	Ciltacabtagene Car-pos T	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
C9098	HCPCS	Ciltacabtagene Car Pos T	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
C9076	HCPCS	Lisocabtagene Car Pos T	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
Q2055	HCPCS	Idecabtagene Vicleucel Car	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
Q2053	HCPCS	Brexucabtagene Car Pos T	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
Q2040	HCPCS	Tisagenlecleucel Car-pos T	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
Q2054	HCPCS	Lisocabtagene Mara Car Pos T	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
Q2041	HCPCS	Axicabtagene Ciloleucel Car+	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
Q2042	HCPCS	Tisagenlecleucel Car-pos T	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
C9073	HCPCS	Brexucabtagene Autoleucel Ca	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
C9081	HCPCS	Idecabtagene Car Pos T	3	3	—	—	$90,961.77	$90,961.77	$90,961.77	2025-12-29
5931	APR_DRG	—	3	3	—	—	$89,738.23	$89,738.23	$89,738.23	2025-12-29
6093	APR_DRG	—	3	3	—	—	$84,011.68	$84,011.68	$84,011.68	2025-12-29
6022	APR_DRG	—	3	3	—	—	$83,759.04	$83,759.04	$83,759.04	2025-12-29
1634	APR_DRG	—	3	3	—	—	$81,806.71	$81,806.71	$81,806.71	2025-12-29
0042	APR_DRG	—	3	3	—	—	$80,453.13	$80,453.13	$80,453.13	2025-12-29
2994	APR_DRG	—	3	3	—	—	$80,156.32	$80,156.32	$80,156.32	2025-12-29
0092	APR_DRG	—	3	3	—	—	$80,132.70	$80,132.70	$80,132.70	2025-12-29
6073	APR_DRG	—	3	3	—	—	$80,012.54	$80,012.54	$80,012.54	2025-12-29
1784	APR_DRG	—	3	3	—	—	$77,791.14	$77,791.14	$77,791.14	2025-12-29
6124	APR_DRG	—	3	3	—	—	$76,459.12	$76,459.12	$76,459.12	2025-12-29
6334	APR_DRG	—	3	3	—	—	$76,258.86	$76,258.86	$76,258.86	2025-12-29
6214	APR_DRG	—	3	3	—	—	$74,982.30	$74,982.30	$74,982.30	2025-12-29
1654	APR_DRG	—	3	3	—	—	$73,495.20	$73,495.20	$73,495.20	2025-12-29
A9543	HCPCS	Y90 Ibritumomab, Rx	3	3	—	—	$72,980.82	$72,980.82	$72,980.82	2025-12-29
A9607	HCPCS	Lutetium Lu 177 Vipivotide	3	3	—	—	$72,980.82	$72,980.82	$72,980.82	2025-12-29
C9031	HCPCS	Lutetium Lu 177 Dotatate, Tx	3	3	—	—	$72,980.82	$72,980.82	$72,980.82	2025-12-29
1674	APR_DRG	—	3	3	—	—	$72,011.19	$72,011.19	$72,011.19	2025-12-29
8413	APR_DRG	—	3	3	—	—	$70,104.05	$70,104.05	$70,104.05	2025-12-29
1834	APR_DRG	—	3	3	—	—	$70,013.67	$70,013.67	$70,013.67	2025-12-29
9104	APR_DRG	—	3	3	—	—	$69,807.24	$69,807.24	$69,807.24	2025-12-29
6313	APR_DRG	—	3	3	—	—	$68,463.93	$68,463.93	$68,463.93	2025-12-29
1623	APR_DRG	—	3	3	—	—	$68,386.90	$68,386.90	$68,386.90	2025-12-29
6804	APR_DRG	—	3	3	—	—	$67,852.86	$67,852.86	$67,852.86	2025-12-29
6084	APR_DRG	—	3	3	—	—	$66,562.95	$66,562.95	$66,562.95	2025-12-29
6254	APR_DRG	—	3	3	—	—	$66,465.39	$66,465.39	$66,465.39	2025-12-29
9114	APR_DRG	—	3	3	—	—	$66,396.58	$66,396.58	$66,396.58	2025-12-29
3044	APR_DRG	—	3	3	—	—	$65,614.00	$65,614.00	$65,614.00	2025-12-29
1664	APR_DRG	—	3	3	—	—	$65,520.55	$65,520.55	$65,520.55	2025-12-29
1794	APR_DRG	—	3	3	—	—	$64,666.08	$64,666.08	$64,666.08	2025-12-29
3033	APR_DRG	—	3	3	—	—	$64,567.49	$64,567.49	$64,567.49	2025-12-29
1603	APR_DRG	—	3	3	—	—	$64,478.14	$64,478.14	$64,478.14	2025-12-29
0914	APR_DRG	—	3	3	—	—	$64,289.17	$64,289.17	$64,289.17	2025-12-29
6144	APR_DRG	—	3	3	—	—	$64,167.99	$64,167.99	$64,167.99	2025-12-29
8504	APR_DRG	—	3	3	—	—	$63,301.20	$63,301.20	$63,301.20	2025-12-29
0214	APR_DRG	—	3	3	—	—	$63,211.85	$63,211.85	$63,211.85	2025-12-29
1783	APR_DRG	—	3	3	—	—	$62,769.21	$62,769.21	$62,769.21	2025-12-29
2993	APR_DRG	—	3	3	—	—	$62,678.84	$62,678.84	$62,678.84	2025-12-29
6033	APR_DRG	—	3	3	—	—	$62,527.87	$62,527.87	$62,527.87	2025-12-29
6021	APR_DRG	—	3	3	—	—	$62,394.36	$62,394.36	$62,394.36	2025-12-29
9124	APR_DRG	—	3	3	—	—	$61,735.02	$61,735.02	$61,735.02	2025-12-29
0052	APR_DRG	—	3	3	—	—	$61,546.06	$61,546.06	$61,546.06	2025-12-29
3004	APR_DRG	—	3	3	—	—	$61,150.66	$61,150.66	$61,150.66	2025-12-29
6904	APR_DRG	—	3	3	—	—	$60,651.54	$60,651.54	$60,651.54	2025-12-29
33991	HCPCS	Insj Perq Vad L Hrt Artl&ven	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
33981	HCPCS	Replace Vad Pump Ext	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
0452T	HCPCS	Insj/rplcmt Dev Vasc Seal	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
33976	HCPCS	Implant Ventricular Device	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
33979	HCPCS	Insert Intracorporeal Device	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
33975	HCPCS	Implant Ventricular Device	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
0459T	HCPCS	Relocaj Rplcmt Aortic Ventr	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
33983	HCPCS	Replace Vad Intra W/bp	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
0453T	HCPCS	Insj/rplcmt Mech-elec Ntrfce	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
33982	HCPCS	Replace Vad Intra Without Bp	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
33990	HCPCS	Insj Perq Vad L Hrt Arterial	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
0454T	HCPCS	Insj/rplcmt Subq Electrode	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
33995	HCPCS	Insj Perq Vad R Hrt Venous	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
0451T	HCPCS	Insj/rplcmt Aortic Ventr Sys	3	3	—	—	$59,850.35	$59,850.35	$59,850.35	2025-12-29
6072	APR_DRG	—	3	3	—	—	$59,761.13	$59,761.13	$59,761.13	2025-12-29
650	MS_DRG	Kidney Transplant With Hemodialysis With Mcc	1	1	—	—	$59,648.73	$59,648.73	$59,648.73	2025-12-29
2604	APR_DRG	—	3	3	—	—	$58,978.56	$58,978.56	$58,978.56	2025-12-29
1633	APR_DRG	—	3	3	—	—	$58,811.16	$58,811.16	$58,811.16	2025-12-29
0091	APR_DRG	—	3	3	—	—	$58,679.70	$58,679.70	$58,679.70	2025-12-29
1694	APR_DRG	—	3	3	—	—	$58,415.76	$58,415.76	$58,415.76	2025-12-29
0234	APR_DRG	—	3	3	—	—	$57,635.24	$57,635.24	$57,635.24	2025-12-29
7404	APR_DRG	—	3	3	—	—	$57,479.14	$57,479.14	$57,479.14	2025-12-29
6083	APR_DRG	—	3	3	—	—	$57,457.57	$57,457.57	$57,457.57	2025-12-29
1204	APR_DRG	—	3	3	—	—	$56,859.86	$56,859.86	$56,859.86	2025-12-29
6814	APR_DRG	—	3	3	—	—	$56,767.43	$56,767.43	$56,767.43	2025-12-29
3124	APR_DRG	—	3	3	—	—	$56,660.62	$56,660.62	$56,660.62	2025-12-29
1304	APR_DRG	—	3	3	—	—	$56,191.28	$56,191.28	$56,191.28	2025-12-29
2204	APR_DRG	—	3	3	—	—	$56,005.39	$56,005.39	$56,005.39	2025-12-29
6954	APR_DRG	—	3	3	—	—	$55,822.59	$55,822.59	$55,822.59	2025-12-29
0041	APR_DRG	—	3	3	—	—	$55,661.35	$55,661.35	$55,661.35	2025-12-29
0204	APR_DRG	—	3	3	—	—	$55,222.82	$55,222.82	$55,222.82	2025-12-29
0894	APR_DRG	—	3	3	—	—	$55,189.95	$55,189.95	$55,189.95	2025-12-29
3614	APR_DRG	—	3	3	—	—	$55,128.33	$55,128.33	$55,128.33	2025-12-29
4284	APR_DRG	—	3	3	—	—	$55,061.58	$55,061.58	$55,061.58	2025-12-29
2614	APR_DRG	—	3	3	—	—	$54,839.75	$54,839.75	$54,839.75	2025-12-29
9504	APR_DRG	—	3	3	—	—	$54,831.53	$54,831.53	$54,831.53	2025-12-29
6092	APR_DRG	—	3	3	—	—	$54,818.18	$54,818.18	$54,818.18	2025-12-29
1653	APR_DRG	—	3	3	—	—	$54,615.86	$54,615.86	$54,615.86	2025-12-29
6234	APR_DRG	—	3	3	—	—	$53,563.19	$53,563.19	$53,563.19	2025-12-29
0274	APR_DRG	—	3	3	—	—	$53,200.65	$53,200.65	$53,200.65	2025-12-29
6302	APR_DRG	—	3	3	—	—	$53,070.23	$53,070.23	$53,070.23	2025-12-29
6123	APR_DRG	—	3	3	—	—	$52,948.01	$52,948.01	$52,948.01	2025-12-29
0924	APR_DRG	—	3	3	—	—	$52,610.13	$52,610.13	$52,610.13	2025-12-29
7907	MS_DRG	Level 3: Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	1	1	—	—	$52,306.38	$52,306.38	$52,306.38	2025-12-29
4014	APR_DRG	—	3	3	—	—	$52,179.82	$52,179.82	$52,179.82	2025-12-29
5204	APR_DRG	—	3	3	—	—	$51,987.77	$51,987.77	$51,987.77	2025-12-29
6133	APR_DRG	—	3	3	—	—	$51,968.25	$51,968.25	$51,968.25	2025-12-29
6113	APR_DRG	—	3	3	—	—	$51,763.88	$51,763.88	$51,763.88	2025-12-29
1622	APR_DRG	—	3	3	—	—	$51,701.23	$51,701.23	$51,701.23	2025-12-29
4414	APR_DRG	—	3	3	—	—	$51,462.97	$51,462.97	$51,462.97	2025-12-29
1782	APR_DRG	—	3	3	—	—	$51,107.63	$51,107.63	$51,107.63	2025-12-29
6032	APR_DRG	—	3	3	—	—	$51,018.28	$51,018.28	$51,018.28	2025-12-29
1833	APR_DRG	—	3	3	—	—	$50,875.53	$50,875.53	$50,875.53	2025-12-29
5114	APR_DRG	—	3	3	—	—	$49,799.23	$49,799.23	$49,799.23	2025-12-29
6224	APR_DRG	—	3	3	—	—	$49,582.53	$49,582.53	$49,582.53	2025-12-29
3214	APR_DRG	—	3	3	—	—	$49,427.46	$49,427.46	$49,427.46	2025-12-29
0224	APR_DRG	—	3	3	—	—	$49,395.62	$49,395.62	$49,395.62	2025-12-29
7924	APR_DRG	—	3	3	—	—	$49,247.73	$49,247.73	$49,247.73	2025-12-29
1793	APR_DRG	—	3	3	—	—	$49,245.68	$49,245.68	$49,245.68	2025-12-29
8423	APR_DRG	—	3	3	—	—	$48,747.58	$48,747.58	$48,747.58	2025-12-29
6514	APR_DRG	—	3	3	—	—	$48,739.37	$48,739.37	$48,739.37	2025-12-29
8633	APR_DRG	—	3	3	—	—	$48,562.72	$48,562.72	$48,562.72	2025-12-29
3043	APR_DRG	—	3	3	—	—	$48,370.67	$48,370.67	$48,370.67	2025-12-29
1602	APR_DRG	—	3	3	—	—	$48,307.00	$48,307.00	$48,307.00	2025-12-29
S2235	HCPCS	Implant Auditory Brain Imp	3	3	—	—	$48,255.81	$48,255.81	$48,255.81	2025-12-29
0304	APR_DRG	—	3	3	—	—	$48,219.70	$48,219.70	$48,219.70	2025-12-29
1704	APR_DRG	—	3	3	—	—	$48,182.73	$48,182.73	$48,182.73	2025-12-29
1814	APR_DRG	—	3	3	—	—	$48,075.92	$48,075.92	$48,075.92	2025-12-29
1663	APR_DRG	—	3	3	—	—	$48,068.74	$48,068.74	$48,068.74	2025-12-29
C9052	HCPCS	Injection, Ravulizumab-cwv	3	3	—	—	$47,914.10	$47,914.10	$47,914.10	2025-12-29
Q9995	HCPCS	Inj. Emicizumab-kxwh, 0.5 Mg	3	3	—	—	$47,914.10	$47,914.10	$47,914.10	2025-12-29
Q2043	HCPCS	Sipuleucel-t Auto Cd54+	5	4	—	—	$47,914.10	$107,778.77	$47,914.10	2025-12-29
J9600	HCPCS	Porfimer Sodium Injection	3	3	—	—	$47,914.10	$47,914.10	$47,914.10	2025-12-29
J9226	HCPCS	Supprelin La Implant	5	4	—	—	$47,914.10	$89,317.42	$47,914.10	2025-12-29
C9085	HCPCS	Inj Avalglucosid Alfa-ngpt	3	3	—	—	$47,914.10	$47,914.10	$47,914.10	2025-12-29
1214	APR_DRG	—	3	3	—	—	$47,661.02	$47,661.02	$47,661.02	2025-12-29
5124	APR_DRG	—	3	3	—	—	$47,641.50	$47,641.50	$47,641.50	2025-12-29
2304	APR_DRG	—	3	3	—	—	$47,375.51	$47,375.51	$47,375.51	2025-12-29
3032	APR_DRG	—	3	3	—	—	$46,959.58	$46,959.58	$46,959.58	2025-12-29
4054	APR_DRG	—	3	3	—	—	$46,843.52	$46,843.52	$46,843.52	2025-12-29
2644	APR_DRG	—	3	3	—	—	$46,752.12	$46,752.12	$46,752.12	2025-12-29
7104	APR_DRG	—	3	3	—	—	$46,583.69	$46,583.69	$46,583.69	2025-12-29
1764	APR_DRG	—	3	3	—	—	$46,393.70	$46,393.70	$46,393.70	2025-12-29
4044	APR_DRG	—	3	3	—	—	$46,283.81	$46,283.81	$46,283.81	2025-12-29
6344	APR_DRG	—	3	3	—	—	$46,256.08	$46,256.08	$46,256.08	2025-12-29
4034	APR_DRG	—	3	3	—	—	$46,154.41	$46,154.41	$46,154.41	2025-12-29
2992	APR_DRG	—	3	3	—	—	$46,098.95	$46,098.95	$46,098.95	2025-12-29
1781	APR_DRG	—	3	3	—	—	$45,996.25	$45,996.25	$45,996.25	2025-12-29
8412	APR_DRG	—	3	3	—	—	$45,933.60	$45,933.60	$45,933.60	2025-12-29
8411	APR_DRG	—	3	3	—	—	$45,933.60	$45,933.60	$45,933.60	2025-12-29
1673	APR_DRG	—	3	3	—	—	$45,708.69	$45,708.69	$45,708.69	2025-12-29
7114	APR_DRG	—	3	3	—	—	$45,417.02	$45,417.02	$45,417.02	2025-12-29
0294	APR_DRG	—	3	3	—	—	$45,112.00	$45,112.00	$45,112.00	2025-12-29
4844	APR_DRG	—	3	3	—	—	$45,107.89	$45,107.89	$45,107.89	2025-12-29
9103	APR_DRG	—	3	3	—	—	$45,061.68	$45,061.68	$45,061.68	2025-12-29
4854	APR_DRG	—	3	3	—	—	$45,003.14	$45,003.14	$45,003.14	2025-12-29
33240	HCPCS	Insrt Pulse Gen W/singl Lead	4	4	—	—	$19,932.20	$44,959.19	$44,959.19	2025-12-29
33264	HCPCS	Rmvl & Rplcmt Dfb Gen Mlt Ld	4	4	—	—	$28,019.23	$44,959.19	$44,959.19	2025-12-29
33263	HCPCS	Rmvl & Rplcmt Dfb Gen 2 Lead	4	4	—	—	$19,932.20	$44,959.19	$44,959.19	2025-12-29
0294T	HCPCS	Ins Lt Atrl Mont Pres Lead	3	3	—	—	$44,959.19	$44,959.19	$44,959.19	2025-12-29
33262	HCPCS	Rmvl& Replc Pulse Gen 1 Lead	4	4	—	—	$19,932.20	$44,959.19	$44,959.19	2025-12-29
0409T	HCPCS	Insj/rplc Car Modulj Pls Gn	4	4	—	—	$19,932.20	$44,959.19	$44,959.19	2025-12-29
0614T	HCPCS	Rmvl&rplcmt Ss Impl Dfb Pg	4	4	—	—	$19,932.20	$44,959.19	$44,959.19	2025-12-29
33249	HCPCS	Insj/rplcmt Defib W/lead(s)	4	4	—	—	$28,019.23	$44,959.19	$44,959.19	2025-12-29
33289	HCPCS	Tcat Impl Wrls P-art Prs Snr	4	4	—	—	$23,851.54	$44,959.19	$44,959.19	2025-12-29
33230	HCPCS	Insrt Pulse Gen W/dual Leads	4	4	—	—	$19,932.20	$44,959.19	$44,959.19	2025-12-29
C9741	HCPCS	Impl Pressure Sensor W/angio	3	3	—	—	$44,959.19	$44,959.19	$44,959.19	2025-12-29
G0448	HCPCS	Place Perm Pacing Cardiovert	3	3	—	—	$44,959.19	$44,959.19	$44,959.19	2025-12-29
0520T	HCPCS	Rmvl&rplcmt Pg Wcs New Eltrd	4	4	—	—	$19,932.20	$44,959.19	$44,959.19	2025-12-29
33231	HCPCS	Insrt Pulse Gen W/mult Leads	4	4	—	—	$28,019.23	$44,959.19	$44,959.19	2025-12-29
33270	HCPCS	Ins/rep Subq Defibrillator	4	4	—	—	$28,019.23	$44,959.19	$44,959.19	2025-12-29
0571T	HCPCS	Insj/rplcmt Icds Ss Eltrd	4	4	—	—	$28,019.23	$44,959.19	$44,959.19	2025-12-29
0414T	HCPCS	Rmvl & Rpl Car Modulj Pls Gn	4	4	—	—	$19,932.20	$44,959.19	$44,959.19	2025-12-29
0264	APR_DRG	—	3	3	—	—	$44,831.63	$44,831.63	$44,831.63	2025-12-29
0213	APR_DRG	—	3	3	—	—	$44,484.51	$44,484.51	$44,484.51	2025-12-29
1754	APR_DRG	—	3	3	—	—	$44,348.94	$44,348.94	$44,348.94	2025-12-29
1652	APR_DRG	—	3	3	—	—	$44,036.73	$44,036.73	$44,036.73	2025-12-29
6091	APR_DRG	—	3	3	—	—	$44,033.65	$44,033.65	$44,033.65	2025-12-29
4474	APR_DRG	—	3	3	—	—	$43,926.84	$43,926.84	$43,926.84	2025-12-29
4424	APR_DRG	—	3	3	—	—	$43,789.23	$43,789.23	$43,789.23	2025-12-29
4484	APR_DRG	—	3	3	—	—	$43,558.15	$43,558.15	$43,558.15	2025-12-29
1632	APR_DRG	—	3	3	—	—	$43,405.13	$43,405.13	$43,405.13	2025-12-29
6504	APR_DRG	—	3	3	—	—	$43,384.59	$43,384.59	$43,384.59	2025-12-29
6143	APR_DRG	—	3	3	—	—	$43,338.37	$43,338.37	$43,338.37	2025-12-29
1621	APR_DRG	—	3	3	—	—	$43,080.60	$43,080.60	$43,080.60	2025-12-29
9514	APR_DRG	—	3	3	—	—	$42,993.30	$42,993.30	$42,993.30	2025-12-29
0913	APR_DRG	—	3	3	—	—	$42,956.33	$42,956.33	$42,956.33	2025-12-29
3003	APR_DRG	—	3	3	—	—	$42,756.06	$42,756.06	$42,756.06	2025-12-29
6071	APR_DRG	—	3	3	—	—	$42,721.15	$42,721.15	$42,721.15	2025-12-29
1303	APR_DRG	—	3	3	—	—	$42,390.45	$42,390.45	$42,390.45	2025-12-29
0434	APR_DRG	—	3	3	—	—	$42,332.94	$42,332.94	$42,332.94	2025-12-29
5144	APR_DRG	—	3	3	—	—	$42,118.30	$42,118.30	$42,118.30	2025-12-29
2314	APR_DRG	—	3	3	—	—	$41,820.47	$41,820.47	$41,820.47	2025-12-29
1824	APR_DRG	—	3	3	—	—	$41,593.50	$41,593.50	$41,593.50	2025-12-29
2224	APR_DRG	—	3	3	—	—	$41,538.04	$41,538.04	$41,538.04	2025-12-29
2294	APR_DRG	—	3	3	—	—	$41,239.19	$41,239.19	$41,239.19	2025-12-29
5184	APR_DRG	—	3	3	—	—	$41,172.43	$41,172.43	$41,172.43	2025-12-29
0893	APR_DRG	—	3	3	—	—	$41,153.94	$41,153.94	$41,153.94	2025-12-29
4444	APR_DRG	—	3	3	—	—	$41,135.46	$41,135.46	$41,135.46	2025-12-29
6903	APR_DRG	—	3	3	—	—	$40,971.14	$40,971.14	$40,971.14	2025-12-29
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	1	1	—	—	$40,970.07	$40,970.07	$40,970.07	2025-12-29
4834	APR_DRG	—	3	3	—	—	$40,948.54	$40,948.54	$40,948.54	2025-12-29
1693	APR_DRG	—	3	3	—	—	$40,833.52	$40,833.52	$40,833.52	2025-12-29
1832	APR_DRG	—	3	3	—	—	$40,781.14	$40,781.14	$40,781.14	2025-12-29
3134	APR_DRG	—	3	3	—	—	$40,720.55	$40,720.55	$40,720.55	2025-12-29
1792	APR_DRG	—	3	3	—	—	$40,715.42	$40,715.42	$40,715.42	2025-12-29
3031	APR_DRG	—	3	3	—	—	$40,706.17	$40,706.17	$40,706.17	2025-12-29
3094	APR_DRG	—	3	3	—	—	$40,615.80	$40,615.80	$40,615.80	2025-12-29
5194	APR_DRG	—	3	3	—	—	$40,323.10	$40,323.10	$40,323.10	2025-12-29
6233	APR_DRG	—	3	3	—	—	$40,285.10	$40,285.10	$40,285.10	2025-12-29
5134	APR_DRG	—	3	3	—	—	$40,177.27	$40,177.27	$40,177.27	2025-12-29
3154	APR_DRG	—	3	3	—	—	$39,996.52	$39,996.52	$39,996.52	2025-12-29
3254	APR_DRG	—	3	3	—	—	$39,941.06	$39,941.06	$39,941.06	2025-12-29
0984	APR_DRG	—	3	3	—	—	$39,847.60	$39,847.60	$39,847.60	2025-12-29
2324	APR_DRG	—	3	3	—	—	$39,833.22	$39,833.22	$39,833.22	2025-12-29
2274	APR_DRG	—	3	3	—	—	$39,809.60	$39,809.60	$39,809.60	2025-12-29
J9266	HCPCS	Pegaspargase Injection	4	3	—	—	$35,185.25	$44,329.51	$39,757.38	2025-12-29
0233	APR_DRG	—	3	3	—	—	$39,697.66	$39,697.66	$39,697.66	2025-12-29
6082	APR_DRG	—	3	3	—	—	$39,694.58	$39,694.58	$39,694.58	2025-12-29
2234	APR_DRG	—	3	3	—	—	$39,687.39	$39,687.39	$39,687.39	2025-12-29
1804	APR_DRG	—	3	3	—	—	$39,524.10	$39,524.10	$39,524.10	2025-12-29
1651	APR_DRG	—	3	3	—	—	$39,460.42	$39,460.42	$39,460.42	2025-12-29
6312	APR_DRG	—	3	3	—	—	$39,436.80	$39,436.80	$39,436.80	2025-12-29
1744	APR_DRG	—	3	3	—	—	$39,418.31	$39,418.31	$39,418.31	2025-12-29
3054	APR_DRG	—	3	3	—	—	$39,195.46	$39,195.46	$39,195.46	2025-12-29
1714	APR_DRG	—	3	3	—	—	$39,182.10	$39,182.10	$39,182.10	2025-12-29
9524	APR_DRG	—	3	3	—	—	$39,159.51	$39,159.51	$39,159.51	2025-12-29
9123	APR_DRG	—	3	3	—	—	$39,158.48	$39,158.48	$39,158.48	2025-12-29
0504	APR_DRG	—	3	3	—	—	$39,088.65	$39,088.65	$39,088.65	2025-12-29
2244	APR_DRG	—	3	3	—	—	$39,074.27	$39,074.27	$39,074.27	2025-12-29
4234	APR_DRG	—	3	3	—	—	$38,974.65	$38,974.65	$38,974.65	2025-12-29
7934	APR_DRG	—	3	3	—	—	$38,865.79	$38,865.79	$38,865.79	2025-12-29
1662	APR_DRG	—	3	3	—	—	$38,490.93	$38,490.93	$38,490.93	2025-12-29
9113	APR_DRG	—	3	3	—	—	$38,422.12	$38,422.12	$38,422.12	2025-12-29
2991	APR_DRG	—	3	3	—	—	$38,345.10	$38,345.10	$38,345.10	2025-12-29
0244	APR_DRG	—	3	3	—	—	$38,320.45	$38,320.45	$38,320.45	2025-12-29
0316T	HCPCS	Replc Vagus Nerve Pls Gen	3	3	—	—	$38,276.36	$38,276.36	$38,276.36	2025-12-29
0431T	HCPCS	Rmvl/rplc Nstim Apnea Pls Gn	4	4	—	—	$25,645.15	$38,276.36	$38,276.36	2025-12-29
0427T	HCPCS	Insj/rplc Nstim Apnea Pls Gn	4	4	—	—	$25,645.15	$38,276.36	$38,276.36	2025-12-29
0312T	HCPCS	Laps Impltj Nstim Vagus	3	3	—	—	$38,276.36	$38,276.36	$38,276.36	2025-12-29
0424T	HCPCS	Insj/rplc Nstim Apnea Compl	3	3	—	—	$38,276.36	$38,276.36	$38,276.36	2025-12-29
64590	HCPCS	Insrt/redo Pn/gastr Stimul	4	4	—	—	$18,794.04	$38,276.36	$38,276.36	2025-12-29
64575	HCPCS	Opn Impltj Nea Perph Nerve	4	4	—	—	$10,440.79	$38,276.36	$38,276.36	2025-12-29
64580	HCPCS	Opn Impltj Nea Neuromuscular	4	4	—	—	$18,794.04	$38,276.36	$38,276.36	2025-12-29
64582	HCPCS	Opn Mpltj Hpglsl Nstm Ary Pg	4	4	—	—	$25,645.15	$38,276.36	$38,276.36	2025-12-29
64553	HCPCS	Implant Neuroelectrodes	4	4	—	—	$10,440.79	$38,276.36	$38,276.36	2025-12-29
63664	HCPCS	Revise Spine Eltrd Plate	4	4	—	—	$10,440.79	$38,276.36	$38,276.36	2025-12-29
63685	HCPCS	Insrt/redo Spine N Generator	4	4	—	—	$25,645.15	$38,276.36	$38,276.36	2025-12-29
63655	HCPCS	Implant Neuroelectrodes	4	4	—	—	$18,794.04	$38,276.36	$38,276.36	2025-12-29
64568	HCPCS	Opn Impltj Crnl Nrv Nea&pg	4	4	—	—	$25,645.15	$38,276.36	$38,276.36	2025-12-29
64569	HCPCS	Revise/repl Vagus N Eltrd	4	4	—	—	$10,440.79	$38,276.36	$38,276.36	2025-12-29
61886	HCPCS	Implant Neurostim Arrays	4	4	—	—	$25,645.15	$38,276.36	$38,276.36	2025-12-29
61867	HCPCS	Implant Neuroelectrode	3	3	—	—	$38,276.36	$38,276.36	$38,276.36	2025-12-29
61864	HCPCS	Implant Neuroelectrde Addl	3	3	—	—	$38,276.36	$38,276.36	$38,276.36	2025-12-29
61868	HCPCS	Implant Neuroelectrde Addl	3	3	—	—	$38,276.36	$38,276.36	$38,276.36	2025-12-29

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