Price Transparency Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

Export CSV
Hospital

Pam Rehabilitation Hospital Of Fargo

Fargo, ND · CCN 353026 · Rates published

13,833 distinct procedures filed
19 distinct payers
62,466 rate rows
2025-09-11 last MRF observed
Data quality

60,883 of 62,466 rate rows are consumer-grade (97.5%)

1,583 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 — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1,490
per-diem day rate — not a per-procedure price 58
placeholder amount (≤ $0.02) — excluded from medians 20
percent-of-charges filed in the dollar field — excluded from medians 15
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/10966/850945971_pam-cubed-rehabilitation-hospital-of-fargo-llc_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/RehabHospitalFargo/10966
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 89ff38ca3f7bcfd0… · 20,500,967 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
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 2 $3,500,000.00 $3,500,000.00 $3,500,000.00 nat. median
$3,710,000
0.9× median
C9172
HCPCS 		Medicaid Fee Schedule 2 $3,500,000.00 $3,500,000.00 $3,500,000.00 nat. median
$3,570,000
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 2 $3,200,000.00 $3,200,000.00 $3,200,000.00 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 2 $3,100,000.00 $3,100,000.00 $3,100,000.00 nat. median
$3,286,000
0.9× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 2 $2,800,000.00 $2,800,000.00 $2,800,000.00 nat. median
$3,004,655
0.9× median
5834
APR_DRG 		Neonate With Ecmo 2 $221,042.48 $221,042.48 $221,042.48 nat. median
$309,665
0.7× median
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $181,314.87 $181,314.87 $181,314.87 nat. median
$246,434
0.7× median
5833
APR_DRG 		Neonate With Ecmo 2 $175,069.85 $175,069.85 $175,069.85 nat. median
$244,017
0.7× median
1614
APR_DRG 		Implantable Heart Assist Systems 2 $173,358.47 $173,358.47 $173,358.47 nat. median
$207,730
0.8× median
24
APR_DRG 		Heart And/or Lung Transplant 2 $167,295.99 $167,295.99 $167,295.99 nat. median
$234,729
0.7× median
1613
APR_DRG 		Implantable Heart Assist Systems 2 $132,810.56 $132,810.56 $132,810.56 nat. median
$119,796
1.1× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 $131,605.06 $131,605.06 $131,605.06 nat. median
$150,721
0.9× median
5832
APR_DRG 		Neonate With Ecmo 2 $129,097.22 $129,097.22 $129,097.22 nat. median
$156,126
0.8× median
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 2 $122,253.18 $122,253.18 $122,253.18 nat. median
$160,267
0.8× median
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 2 $118,251.51 $118,251.51 $118,251.51 nat. median
$151,838
0.8× median
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $116,809.84 $116,809.84 $116,809.84 nat. median
$182,665
0.6× median
5882
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $114,379.48 $114,379.48 $114,379.48 nat. median
$145,336
0.8× median
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 2 $114,191.73 $114,191.73 $114,191.73 nat. median
$164,289
0.7× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 $114,044.96 $114,044.96 $114,044.96 nat. median
$117,173
1.0× median
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 $113,463.07 $113,463.07 $113,463.07 nat. median
$162,982
0.7× median
5831
APR_DRG 		Neonate With Ecmo 2 $111,563.19 $111,563.19 $111,563.19 nat. median
$144,745
0.8× median
74
APR_DRG 		Allogeneic Bone Marrow Transplant 2 $109,676.72 $109,676.72 $109,676.72 nat. median
$187,061
0.6× median
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 $108,929.44 $108,929.44 $108,929.44 nat. median
$122,924
0.9× median
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 2 $108,635.14 $108,635.14 $108,635.14 nat. median
$105,658
1.0× median
14
APR_DRG 		Liver Transplant And/or Intestinal Transplant 2 $106,946.11 $106,946.11 $106,946.11 nat. median
$129,535
0.8× median
1612
APR_DRG 		Implantable Heart Assist Systems 2 $106,635.42 $106,635.42 $106,635.42 nat. median
$85,444
1.2× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 2 $106,356.78 $106,356.78 $106,356.78 nat. median
$164,834
0.6× median
23
APR_DRG 		Heart And/or Lung Transplant 2 $103,453.31 $103,453.31 $103,453.31 nat. median
$93,528
1.1× median
1611
APR_DRG 		Implantable Heart Assist Systems 2 $101,303.09 $101,303.09 $101,303.09 nat. median
$76,806
1.3× median
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 2 $99,999.95 $99,999.95 $99,999.95 nat. median
$111,989
0.9× median
6034
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 $95,054.35 $95,054.35 $95,054.35 nat. median
$109,499
0.9× median
64
APR_DRG 		Pancreas Transplant 2 $94,445.64 $94,445.64 $94,445.64 nat. median
$91,009
1.0× median
T2025
HCPCS 		Waiver Service, Nos 2 $88,188.00 $88,188.00 $88,188.00 nat. median
$54
outlier · 1643.5×
6024
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 $84,762.96 $84,762.96 $84,762.96 nat. median
$118,620
0.7× median
22
APR_DRG 		Heart And/or Lung Transplant 2 $76,773.78 $76,773.78 $76,773.78 nat. median
$77,804
1.0× median
5933
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 2 $76,043.63 $76,043.63 $76,043.63 nat. median
$108,996
0.7× median
5881
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 2 $75,288.89 $75,288.89 $75,288.89 nat. median
$124,573
0.6× median
43
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 2 $74,341.93 $74,341.93 $74,341.93 nat. median
$69,926
1.1× median
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 2 $73,355.49 $73,355.49 $73,355.49 nat. median
$97,957
0.7× median
B0407
LOCAL 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 11 $73,313.46 $109,970.19 $73,313.46 nat. median
$79,920
0.9× median
54
APR_DRG 		Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 $71,592.70 $71,592.70 $71,592.70 nat. median
$68,217
1.0× median
1624
APR_DRG 		Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 $69,136.26 $69,136.26 $69,136.26 nat. median
$81,781
0.8× median
5913
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 2 $66,898.87 $66,898.87 $66,898.87 nat. median
$102,919
0.7× median
6023
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 $66,837.78 $66,837.78 $66,837.78 nat. median
$86,492
0.8× median
63
APR_DRG 		Pancreas Transplant 2 $66,409.38 $66,409.38 $66,409.38 nat. median
$64,159
1.0× median
3034
APR_DRG 		Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 $66,096.45 $66,096.45 $66,096.45 nat. median
$84,063
0.8× median
21
APR_DRG 		Heart And/or Lung Transplant 2 $65,815.57 $65,815.57 $65,815.57 nat. median
$64,672
1.0× median
C0407
LOCAL 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 11 $65,196.23 $97,794.35 $65,196.23 nat. median
$70,083
0.9× median
6074
APR_DRG 		Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 $65,105.54 $65,105.54 $65,105.54 nat. median
$95,507
0.7× median
73
APR_DRG 		Allogeneic Bone Marrow Transplant 2 $64,635.41 $64,635.41 $64,635.41 nat. median
$89,273
0.7× median

Other procedures at this hospital

Browse this hospital's 13,833 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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
             
11 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $46,009.13 $46,009.13 $46,009.13 2025-09-11
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $29,734.99 $29,734.99 $29,734.99 2025-09-11
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $56,135.87 $56,135.87 $56,135.87 2025-09-11
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 2 2 — — $114,044.96 $114,044.96 $114,044.96 2025-09-11
12 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $51,819.79 $51,819.79 $51,819.79 2025-09-11
1204 APR_DRG Major Respiratory And Chest Procedures 2 2 — — $38,897.62 $38,897.62 $38,897.62 2025-09-11
1214 APR_DRG Other Respiratory And Chest Procedures 2 2 — — $31,803.99 $31,803.99 $31,803.99 2025-09-11
13 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $61,828.80 $61,828.80 $61,828.80 2025-09-11
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 2 2 — — $36,913.55 $36,913.55 $36,913.55 2025-09-11
14 APR_DRG Liver Transplant And/or Intestinal Transplant 2 2 — — $106,946.11 $106,946.11 $106,946.11 2025-09-11
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $39,377.44 $39,377.44 $39,377.44 2025-09-11
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 2 2 — — $73,355.49 $73,355.49 $73,355.49 2025-09-11
1611 APR_DRG Implantable Heart Assist Systems 2 2 — — $101,303.09 $101,303.09 $101,303.09 2025-09-11
1612 APR_DRG Implantable Heart Assist Systems 2 2 — — $106,635.42 $106,635.42 $106,635.42 2025-09-11
1613 APR_DRG Implantable Heart Assist Systems 2 2 — — $132,810.56 $132,810.56 $132,810.56 2025-09-11
1614 APR_DRG Implantable Heart Assist Systems 2 2 — — $173,358.47 $173,358.47 $173,358.47 2025-09-11
1621 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $32,026.02 $32,026.02 $32,026.02 2025-09-11
1622 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $37,528.96 $37,528.96 $37,528.96 2025-09-11
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $47,352.46 $47,352.46 $47,352.46 2025-09-11
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 2 2 — — $69,136.26 $69,136.26 $69,136.26 2025-09-11
1632 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $30,995.61 $30,995.61 $30,995.61 2025-09-11
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $39,165.10 $39,165.10 $39,165.10 2025-09-11
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 2 2 — — $58,830.72 $58,830.72 $58,830.72 2025-09-11
1652 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $33,047.48 $33,047.48 $33,047.48 2025-09-11
1653 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $39,734.31 $39,734.31 $39,734.31 2025-09-11
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 2 2 — — $53,799.39 $53,799.39 $53,799.39 2025-09-11
1663 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 2 2 — — $33,034.82 $33,034.82 $33,034.82 2025-09-11
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 2 2 — — $48,495.37 $48,495.37 $48,495.37 2025-09-11
1673 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 2 2 — — $32,960.31 $32,960.31 $32,960.31 2025-09-11
1674 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 2 2 — — $52,918.74 $52,918.74 $52,918.74 2025-09-11
1694 APR_DRG Major Abdominal Vascular Procedures 2 2 — — $45,390.00 $45,390.00 $45,390.00 2025-09-11
1704 APR_DRG Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock 2 2 — — $32,005.90 $32,005.90 $32,005.90 2025-09-11
1754 APR_DRG Percutaneous Cardiac Intervention Without Ami 2 2 — — $29,944.34 $29,944.34 $29,944.34 2025-09-11
1764 APR_DRG Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 2 2 — — $36,868.10 $36,868.10 $36,868.10 2025-09-11
1781 APR_DRG External Heart Assist Systems 2 2 — — $35,925.61 $35,925.61 $35,925.61 2025-09-11
1782 APR_DRG External Heart Assist Systems 2 2 — — $40,278.95 $40,278.95 $40,278.95 2025-09-11
1783 APR_DRG External Heart Assist Systems 2 2 — — $43,232.33 $43,232.33 $43,232.33 2025-09-11
1784 APR_DRG External Heart Assist Systems 2 2 — — $58,438.08 $58,438.08 $58,438.08 2025-09-11
1793 APR_DRG Defibrillator Implants 2 2 — — $34,715.65 $34,715.65 $34,715.65 2025-09-11
1794 APR_DRG Defibrillator Implants 2 2 — — $47,610.99 $47,610.99 $47,610.99 2025-09-11
1814 APR_DRG Lower Extremity Arterial Procedures 2 2 — — $37,528.96 $37,528.96 $37,528.96 2025-09-11
1824 APR_DRG Other Peripheral Vascular Procedures 2 2 — — $31,884.46 $31,884.46 $31,884.46 2025-09-11
1832 APR_DRG Percutaneous Structural Cardiac Procedures 2 2 — — $30,085.16 $30,085.16 $30,085.16 2025-09-11
1833 APR_DRG Percutaneous Structural Cardiac Procedures 2 2 — — $35,030.06 $35,030.06 $35,030.06 2025-09-11
1834 APR_DRG Percutaneous Structural Cardiac Procedures 2 2 — — $49,867.75 $49,867.75 $49,867.75 2025-09-11
204 APR_DRG Open Craniotomy For Trauma 2 2 — — $39,077.92 $39,077.92 $39,077.92 2025-09-11
21 APR_DRG Heart And/or Lung Transplant 2 2 — — $65,815.57 $65,815.57 $65,815.57 2025-09-11
214 APR_DRG Open Craniotomy Except Trauma 2 2 — — $42,357.64 $42,357.64 $42,357.64 2025-09-11
22 APR_DRG Heart And/or Lung Transplant 2 2 — — $76,773.78 $76,773.78 $76,773.78 2025-09-11
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 2 2 — — $40,121.00 $40,121.00 $40,121.00 2025-09-11
2224 APR_DRG Other Stomach, Esophageal And Duodenal Procedures 2 2 — — $29,471.24 $29,471.24 $29,471.24 2025-09-11
224 APR_DRG Ventricular Shunt Procedures 2 2 — — $32,368.74 $32,368.74 $32,368.74 2025-09-11
2294 APR_DRG Other Digestive System And Abdominal Procedures 2 2 — — $29,457.08 $29,457.08 $29,457.08 2025-09-11
23 APR_DRG Heart And/or Lung Transplant 2 2 — — $103,453.31 $103,453.31 $103,453.31 2025-09-11
2304 APR_DRG Major Small Bowel Procedures 2 2 — — $35,959.89 $35,959.89 $35,959.89 2025-09-11
2314 APR_DRG Major Large Bowel Procedures 2 2 — — $31,640.08 $31,640.08 $31,640.08 2025-09-11
2324 APR_DRG Gastric Fundoplication 2 2 — — $29,541.27 $29,541.27 $29,541.27 2025-09-11
234 APR_DRG Spinal Procedures 2 2 — — $42,946.23 $42,946.23 $42,946.23 2025-09-11
24 APR_DRG Heart And/or Lung Transplant 2 2 — — $167,295.99 $167,295.99 $167,295.99 2025-09-11
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 2 2 — — $41,818.97 $41,818.97 $41,818.97 2025-09-11
2614 APR_DRG Major Biliary Tract Procedures 2 2 — — $36,757.84 $36,757.84 $36,757.84 2025-09-11
264 APR_DRG Other Nervous System And Related Procedures 2 2 — — $32,563.94 $32,563.94 $32,563.94 2025-09-11
2644 APR_DRG Other Hepatobiliary, Pancreas And Abdominal Procedures 2 2 — — $32,650.37 $32,650.37 $32,650.37 2025-09-11
274 APR_DRG Other Open Craniotomy 2 2 — — $37,336.00 $37,336.00 $37,336.00 2025-09-11
294 APR_DRG Other Percutaneous Intracranial Procedures 2 2 — — $30,269.19 $30,269.19 $30,269.19 2025-09-11
3031 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $30,272.91 $30,272.91 $30,272.91 2025-09-11
3032 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $36,360.72 $36,360.72 $36,360.72 2025-09-11
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $50,045.82 $50,045.82 $50,045.82 2025-09-11
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 2 2 — — $66,096.45 $66,096.45 $66,096.45 2025-09-11
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 2 2 — — $33,048.97 $33,048.97 $33,048.97 2025-09-11
3043 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 2 2 — — $34,285.01 $34,285.01 $34,285.01 2025-09-11
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 2 2 — — $50,732.01 $50,732.01 $50,732.01 2025-09-11
3094 APR_DRG Other Significant Hip And Femur Surgery 2 2 — — $30,029.28 $30,029.28 $30,029.28 2025-09-11
3124 APR_DRG Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 2 2 — — $45,063.66 $45,063.66 $45,063.66 2025-09-11
3214 APR_DRG Cervical Spinal Fusion And Other Back Or Neck Procedures Except Disc Excision Or… 2 2 — — $33,291.86 $33,291.86 $33,291.86 2025-09-11
3254 APR_DRG Non-elective Or Complex Knee Joint Replacement 2 2 — — $32,435.80 $32,435.80 $32,435.80 2025-09-11
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 2 2 — — $38,163.00 $38,163.00 $38,163.00 2025-09-11
4014 APR_DRG Adrenal Procedures 2 2 — — $35,217.82 $35,217.82 $35,217.82 2025-09-11
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 2 2 — — $34,609.11 $34,609.11 $34,609.11 2025-09-11
4054 APR_DRG Other Procedures For Endocrine, Nutritional And Metabolic Disorders 2 2 — — $32,296.47 $32,296.47 $32,296.47 2025-09-11
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $34,130.79 $34,130.79 $34,130.79 2025-09-11
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $51,110.50 $51,110.50 $51,110.50 2025-09-11
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $74,341.93 $74,341.93 $74,341.93 2025-09-11
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 2 2 — — $108,635.14 $108,635.14 $108,635.14 2025-09-11
4401 APR_DRG Kidney Transplant 2 2 — — $31,719.80 $31,719.80 $31,719.80 2025-09-11
4402 APR_DRG Kidney Transplant 2 2 — — $35,523.29 $35,523.29 $35,523.29 2025-09-11
4403 APR_DRG Kidney Transplant 2 2 — — $41,418.88 $41,418.88 $41,418.88 2025-09-11
4404 APR_DRG Kidney Transplant 2 2 — — $62,836.11 $62,836.11 $62,836.11 2025-09-11
4414 APR_DRG Major Bladder Procedures 2 2 — — $42,350.19 $42,350.19 $42,350.19 2025-09-11
4424 APR_DRG Kidney And Urinary Tract Procedures For Malignancy 2 2 — — $29,866.11 $29,866.11 $29,866.11 2025-09-11
4474 APR_DRG Other Kidney, Urinary Tract And Related Procedures 2 2 — — $31,276.50 $31,276.50 $31,276.50 2025-09-11
51 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $32,045.39 $32,045.39 $32,045.39 2025-09-11
5104 APR_DRG Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced… 2 2 — — $35,946.48 $35,946.48 $35,946.48 2025-09-11
5114 APR_DRG Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 2 2 — — $32,449.95 $32,449.95 $32,449.95 2025-09-11
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $38,589.92 $38,589.92 $38,589.92 2025-09-11
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $52,719.81 $52,719.81 $52,719.81 2025-09-11
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 2 2 — — $71,592.70 $71,592.70 $71,592.70 2025-09-11
5831 APR_DRG Neonate With Ecmo 2 2 — — $111,563.19 $111,563.19 $111,563.19 2025-09-11
5832 APR_DRG Neonate With Ecmo 2 2 — — $129,097.22 $129,097.22 $129,097.22 2025-09-11
5833 APR_DRG Neonate With Ecmo 2 2 — — $175,069.85 $175,069.85 $175,069.85 2025-09-11
5834 APR_DRG Neonate With Ecmo 2 2 — — $221,042.48 $221,042.48 $221,042.48 2025-09-11
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $75,288.89 $75,288.89 $75,288.89 2025-09-11
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $114,379.48 $114,379.48 $114,379.48 2025-09-11
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $116,809.84 $116,809.84 $116,809.84 2025-09-11
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 2 2 — — $181,314.87 $181,314.87 $181,314.87 2025-09-11
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 2 2 — — $35,424.94 $35,424.94 $35,424.94 2025-09-11
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $35,598.54 $35,598.54 $35,598.54 2025-09-11
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $66,898.87 $66,898.87 $66,898.87 2025-09-11
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 2 2 — — $114,191.73 $114,191.73 $114,191.73 2025-09-11
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $60,271.65 $60,271.65 $60,271.65 2025-09-11
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $76,043.63 $76,043.63 $76,043.63 2025-09-11
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 2 2 — — $118,251.51 $118,251.51 $118,251.51 2025-09-11
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $50,999.49 $50,999.49 $50,999.49 2025-09-11
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $66,837.78 $66,837.78 $66,837.78 2025-09-11
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $84,762.96 $84,762.96 $84,762.96 2025-09-11
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $46,256.49 $46,256.49 $46,256.49 2025-09-11
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 2 2 — — $95,054.35 $95,054.35 $95,054.35 2025-09-11
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $39,218.74 $39,218.74 $39,218.74 2025-09-11
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $50,648.57 $50,648.57 $50,648.57 2025-09-11
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $65,105.54 $65,105.54 $65,105.54 2025-09-11
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 2 2 — — $39,258.97 $39,258.97 $39,258.97 2025-09-11
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 2 2 — — $41,222.18 $41,222.18 $41,222.18 2025-09-11
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $56,527.76 $56,527.76 $56,527.76 2025-09-11
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 2 2 — — $113,463.07 $113,463.07 $113,463.07 2025-09-11
61 APR_DRG Pancreas Transplant 2 2 — — $45,315.49 $45,315.49 $45,315.49 2025-09-11
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 2 2 — — $32,224.95 $32,224.95 $32,224.95 2025-09-11
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 2 2 — — $49,475.11 $49,475.11 $49,475.11 2025-09-11
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $33,272.49 $33,272.49 $33,272.49 2025-09-11
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $47,310.74 $47,310.74 $47,310.74 2025-09-11
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 2 2 — — $30,268.44 $30,268.44 $30,268.44 2025-09-11
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 2 2 — — $46,417.42 $46,417.42 $46,417.42 2025-09-11
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 2 2 — — $37,301.72 $37,301.72 $37,301.72 2025-09-11
62 APR_DRG Pancreas Transplant 2 2 — — $57,649.81 $57,649.81 $57,649.81 2025-09-11
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 2 2 — — $38,814.18 $38,814.18 $38,814.18 2025-09-11
6224 APR_DRG Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 2 2 — — $30,635.75 $30,635.75 $30,635.75 2025-09-11
63 APR_DRG Pancreas Transplant 2 2 — — $66,409.38 $66,409.38 $66,409.38 2025-09-11
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $40,344.51 $40,344.51 $40,344.51 2025-09-11
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $63,588.61 $63,588.61 $63,588.61 2025-09-11
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 2 2 — — $131,605.06 $131,605.06 $131,605.06 2025-09-11
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $41,831.63 $41,831.63 $41,831.63 2025-09-11
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 2 2 — — $108,929.44 $108,929.44 $108,929.44 2025-09-11
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 2 2 — — $35,278.16 $35,278.16 $35,278.16 2025-09-11
64 APR_DRG Pancreas Transplant 2 2 — — $94,445.64 $94,445.64 $94,445.64 2025-09-11
6504 APR_DRG Splenectomy 2 2 — — $31,758.54 $31,758.54 $31,758.54 2025-09-11
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 2 2 — — $34,995.05 $34,995.05 $34,995.05 2025-09-11
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 2 2 — — $47,413.56 $47,413.56 $47,413.56 2025-09-11
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 2 2 — — $40,430.19 $40,430.19 $40,430.19 2025-09-11
6904 APR_DRG Acute Leukemia 2 2 — — $38,700.18 $38,700.18 $38,700.18 2025-09-11
6954 APR_DRG Chemotherapy For Acute Leukemia 2 2 — — $36,422.56 $36,422.56 $36,422.56 2025-09-11
71 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $45,018.22 $45,018.22 $45,018.22 2025-09-11
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 2 2 — — $32,545.32 $32,545.32 $32,545.32 2025-09-11
7114 APR_DRG Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 2 2 — — $30,700.57 $30,700.57 $30,700.57 2025-09-11
72 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $50,558.42 $50,558.42 $50,558.42 2025-09-11
73 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $64,635.41 $64,635.41 $64,635.41 2025-09-11
74 APR_DRG Allogeneic Bone Marrow Transplant 2 2 — — $109,676.72 $109,676.72 $109,676.72 2025-09-11
7404 APR_DRG Mental Illness Diagnosis With O.r. Procedure 2 2 — — $41,283.28 $41,283.28 $41,283.28 2025-09-11
7594 APR_DRG Eating Disorders 2 2 — — $38,630.89 $38,630.89 $38,630.89 2025-09-11
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 2 2 — — $35,290.83 $35,290.83 $35,290.83 2025-09-11
83 APR_DRG Autologous Bone Marrow Transplant Or T-cell Immunotherapy 2 2 — — $34,935.44 $34,935.44 $34,935.44 2025-09-11
84 APR_DRG Autologous Bone Marrow Transplant Or T-cell Immunotherapy 2 2 — — $55,480.97 $55,480.97 $55,480.97 2025-09-11
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $44,865.48 $44,865.48 $44,865.48 2025-09-11
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 2 2 — — $122,253.18 $122,253.18 $122,253.18 2025-09-11
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 2 2 — — $61,783.35 $61,783.35 $61,783.35 2025-09-11
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 2 2 — — $43,056.50 $43,056.50 $43,056.50 2025-09-11
8633 APR_DRG Neonatal Aftercare 2 2 — — $31,121.53 $31,121.53 $31,121.53 2025-09-11
8634 APR_DRG Neonatal Aftercare 2 2 — — $48,503.57 $48,503.57 $48,503.57 2025-09-11
894 APR_DRG Major Cranial Or Facial Bone Procedures 2 2 — — $39,849.80 $39,849.80 $39,849.80 2025-09-11
9104 APR_DRG Craniotomy For Multiple Significant Trauma 2 2 — — $47,908.27 $47,908.27 $47,908.27 2025-09-11
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 2 2 — — $45,261.10 $45,261.10 $45,261.10 2025-09-11
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 2 2 — — $43,975.15 $43,975.15 $43,975.15 2025-09-11
914 APR_DRG Other Major Head And Neck Procedures 2 2 — — $44,827.48 $44,827.48 $44,827.48 2025-09-11
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $35,752.76 $35,752.76 $35,752.76 2025-09-11
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 2 2 — — $35,462.94 $35,462.94 $35,462.94 2025-09-11
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $49,019.14 $49,019.14 $49,019.14 2025-09-11
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 2 2 — — $106,356.78 $106,356.78 $106,356.78 2025-09-11
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 2 2 — — $39,457.16 $39,457.16 $39,457.16 2025-09-11
A0105 LOCAL Stroke M <41.50 And A >=84.50 13 11 — — $33,467.75 $50,201.63 $33,467.75 2025-09-11
A0106 LOCAL Stroke M <41.50 And A <84.50 13 11 — — $38,064.80 $57,097.20 $38,064.80 2025-09-11
A0205 LOCAL Traumatic Brain Injury M <35.50 13 11 — — $32,224.42 $48,336.63 $32,224.42 2025-09-11
A0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50 13 11 — — $41,454.93 $62,182.40 $41,454.93 2025-09-11
A0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50 13 11 — — $32,966.60 $49,449.90 $32,966.60 2025-09-11
A0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 13 11 — — $42,065.33 $63,098.00 $42,065.33 2025-09-11
A0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50 13 11 — — $57,507.31 $86,260.97 $57,507.31 2025-09-11
A0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50 13 11 — — $35,425.53 $53,138.30 $35,425.53 2025-09-11
A1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 13 11 — — $29,694.39 $44,541.59 $29,694.39 2025-09-11
A1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 13 11 — — $29,505.38 $44,258.07 $29,505.38 2025-09-11
A1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 13 11 — — $41,902.32 $62,853.48 $41,902.32 2025-09-11
A1903 LOCAL Guillain-barré M >=38.50 And M <51.50 13 11 — — $30,700.16 $46,050.24 $30,700.16 2025-09-11
A1904 LOCAL Guillain-barré M <38.50 13 11 — — $44,721.94 $67,082.91 $44,721.94 2025-09-11
A5102 LOCAL Expired, Orthopedic, Length Of Stay Is 14 Days Or More 13 11 — — $31,085.13 $46,627.70 $31,085.13 2025-09-11
A5104 LOCAL Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More 13 11 — — $41,330.08 $61,995.12 $41,330.08 2025-09-11
A9543 HCPCS Y90 Ibritumomab, Rx 2 2 — — $31,500.00 $31,500.00 $31,500.00 2025-09-11
B0104 LOCAL Stroke M >=41.50 And M <50.50 13 11 — — $35,435.94 $53,153.91 $35,435.94 2025-09-11
B0105 LOCAL Stroke M <41.50 And A >=84.50 13 11 — — $44,310.96 $66,466.44 $44,310.96 2025-09-11
B0106 LOCAL Stroke M <41.50 And A <84.50 13 11 — — $50,399.32 $75,598.98 $50,399.32 2025-09-11
B0204 LOCAL Traumatic Brain Injury M >=35.50 And M <49.50 13 11 — — $35,718.59 $53,577.89 $35,718.59 2025-09-11
B0205 LOCAL Traumatic Brain Injury M <35.50 13 11 — — $45,753.71 $68,630.57 $45,753.71 2025-09-11
B0303 LOCAL Non-traumatic Brain Injury M >=42.50 And M <52.50 13 11 — — $32,337.13 $48,505.70 $32,337.13 2025-09-11
B0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50 13 11 — — $37,492.55 $56,238.83 $37,492.55 2025-09-11
B0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50 13 11 — — $41,349.15 $62,023.73 $41,349.15 2025-09-11
B0403 LOCAL Traumatic Spinal Cord Injury M >=41.50 And M <47.50 13 11 — — $33,847.52 $50,771.28 $33,847.52 2025-09-11
B0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50 13 11 — — $52,847.84 $79,271.76 $52,847.84 2025-09-11
B0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50 13 11 — — $42,027.18 $63,040.77 $42,027.18 2025-09-11
B0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 13 11 — — $53,626.44 $80,439.66 $53,626.44 2025-09-11
B0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50 13 11 — — $73,313.46 $109,970.19 $73,313.46 2025-09-11
B0503 LOCAL Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50 13 11 — — $31,666.04 $47,499.06 $31,666.04 2025-09-11
B0504 LOCAL Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 13 11 — — $37,641.69 $56,462.54 $37,641.69 2025-09-11
B0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50 13 11 — — $52,305.07 $78,457.61 $52,305.07 2025-09-11
B0603 LOCAL Neurological M >=43.50 And M <52.50 13 11 — — $34,435.37 $51,653.06 $34,435.37 2025-09-11
B0604 LOCAL Neurological M <43.50 13 11 — — $43,185.54 $64,778.31 $43,185.54 2025-09-11
B0703 LOCAL Fracture Of Lower Extremity M >=41.50 And M <52.50 13 11 — — $33,035.97 $49,553.96 $33,035.97 2025-09-11
B0704 LOCAL Fracture Of Lower Extremity M <41.50 13 11 — — $40,357.26 $60,535.89 $40,357.26 2025-09-11
B0804 LOCAL Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 13 11 — — $29,803.64 $44,705.46 $29,803.64 2025-09-11
B0805 LOCAL Replacement Of Lower-extremity Joint M <42.50 13 11 — — $35,744.60 $53,616.90 $35,744.60 2025-09-11
B0903 LOCAL Other Orthopedic M >=44.50 And M <51.50 13 11 — — $30,993.22 $46,489.83 $30,993.22 2025-09-11
B0904 LOCAL Other Orthopedic M <44.5 13 11 — — $37,137.07 $55,705.61 $37,137.07 2025-09-11
B1003 LOCAL Amputation Lower Extremity M >=47.50 And M <55.50 13 11 — — $31,168.36 $46,752.54 $31,168.36 2025-09-11
B1004 LOCAL Amputation Lower Extremity M <47.50 13 11 — — $39,902.93 $59,854.40 $39,902.93 2025-09-11
B1103 LOCAL Amputation Non-lower Extremity M <52.50 13 11 — — $34,778.72 $52,168.08 $34,778.72 2025-09-11
B1203 LOCAL Osteoarthritis M <49.50 And A >=74.50 13 11 — — $36,110.49 $54,165.74 $36,110.49 2025-09-11
B1204 LOCAL Osteoarthritis M <49.50 And A <74.50 13 11 — — $37,867.12 $56,800.68 $37,867.12 2025-09-11
B1304 LOCAL Rheumatoid Other Arthritis M <44.50 And A >=64.50 13 11 — — $37,137.07 $55,705.61 $37,137.07 2025-09-11
B1305 LOCAL Rheumatoid Other Arthritis M <51.50 And A <64.50 13 11 — — $35,564.26 $53,346.39 $35,564.26 2025-09-11
B1403 LOCAL Cardiac M >=45.50 And M <55.50 13 11 — — $30,367.22 $45,550.83 $30,367.22 2025-09-11
B1404 LOCAL Cardiac M <45.50 13 11 — — $37,209.90 $55,814.85 $37,209.90 2025-09-11
B1503 LOCAL Pulmonary M >=45.50 And M <56.50 13 11 — — $31,848.12 $47,772.18 $31,848.12 2025-09-11
B1504 LOCAL Pulmonary M <45.50 13 11 — — $39,439.93 $59,159.90 $39,439.93 2025-09-11
B1603 LOCAL Pain Syndrome M >=43.50 And M <58.50 13 11 — — $32,855.62 $49,283.43 $32,855.62 2025-09-11
B1604 LOCAL Pain Syndrome M <43.50 13 11 — — $40,707.54 $61,061.31 $40,707.54 2025-09-11
B1703 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50 13 11 — — $34,230.75 $51,346.13 $34,230.75 2025-09-11
B1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50 13 11 — — $38,744.56 $58,116.84 $38,744.56 2025-09-11
B1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 13 11 — — $45,467.59 $68,201.39 $45,467.59 2025-09-11
B1803 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 13 11 — — $31,692.06 $47,538.09 $31,692.06 2025-09-11
B1804 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 13 11 — — $34,657.33 $51,986.00 $34,657.33 2025-09-11
B1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 13 11 — — $42,018.51 $63,027.77 $42,018.51 2025-09-11
B1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 13 11 — — $59,673.18 $89,509.77 $59,673.18 2025-09-11
B1903 LOCAL Guillain-barré M >=38.50 And M <51.50 13 11 — — $43,549.70 $65,324.55 $43,549.70 2025-09-11
B1904 LOCAL Guillain-barré M <38.50 13 11 — — $63,437.87 $95,156.81 $63,437.87 2025-09-11
B2003 LOCAL Miscellaneous M >=46.50 And M <55.50 13 11 — — $30,563.17 $45,844.76 $30,563.17 2025-09-11
B2004 LOCAL Miscellaneous M <46.50 And A >=77.50 13 11 — — $36,542.28 $54,813.42 $36,542.28 2025-09-11
B2005 LOCAL Miscellaneous M <46.50 And A <77.50 13 11 — — $38,517.40 $57,776.10 $38,517.40 2025-09-11
B2102 LOCAL Burns M <52.50 13 11 — — $40,189.05 $60,283.58 $40,189.05 2025-09-11
C0104 LOCAL Stroke M >=41.50 And M <50.50 13 11 — — $30,731.37 $46,097.06 $30,731.37 2025-09-11
C0105 LOCAL Stroke M <41.50 And A >=84.50 13 11 — — $38,428.96 $57,643.44 $38,428.96 2025-09-11
C0106 LOCAL Stroke M <41.50 And A <84.50 13 11 — — $43,709.23 $65,563.85 $43,709.23 2025-09-11
C0205 LOCAL Traumatic Brain Injury M <35.50 13 11 — — $37,683.30 $56,524.95 $37,683.30 2025-09-11
C0304 LOCAL Non-traumatic Brain Injury M <42.50 And A >=78.50 13 11 — — $29,996.12 $44,994.18 $29,996.12 2025-09-11
C0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50 13 11 — — $33,081.05 $49,621.58 $33,081.05 2025-09-11
C0403 LOCAL Traumatic Spinal Cord Injury M >=41.50 And M <47.50 13 11 — — $30,100.17 $45,150.26 $30,100.17 2025-09-11
C0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50 13 11 — — $46,997.05 $70,495.58 $46,997.05 2025-09-11
C0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50 13 11 — — $37,374.64 $56,061.96 $37,374.64 2025-09-11
C0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 13 11 — — $47,688.95 $71,533.43 $47,688.95 2025-09-11
C0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50 13 11 — — $65,196.23 $97,794.35 $65,196.23 2025-09-11
C0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50 13 11 — — $40,691.93 $61,037.90 $40,691.93 2025-09-11
C0604 LOCAL Neurological M <43.50 13 11 — — $32,331.93 $48,497.90 $32,331.93 2025-09-11
C0704 LOCAL Fracture Of Lower Extremity M <41.50 13 11 — — $31,218.65 $46,827.98 $31,218.65 2025-09-11
C0904 LOCAL Other Orthopedic M <44.5 13 11 — — $29,744.68 $44,617.02 $29,744.68 2025-09-11
C1004 LOCAL Amputation Lower Extremity M <47.50 13 11 — — $33,001.29 $49,501.94 $33,001.29 2025-09-11
C1304 LOCAL Rheumatoid Other Arthritis M <44.50 And A >=64.50 13 11 — — $30,705.36 $46,058.04 $30,705.36 2025-09-11
C1504 LOCAL Pulmonary M <45.50 13 11 — — $32,011.13 $48,016.70 $32,011.13 2025-09-11
C1604 LOCAL Pain Syndrome M <43.50 13 11 — — $30,235.43 $45,353.15 $30,235.43 2025-09-11
C1704 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50 13 11 — — $30,115.78 $45,173.67 $30,115.78 2025-09-11
C1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 13 11 — — $35,342.30 $53,013.45 $35,342.30 2025-09-11
C1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 13 11 — — $33,519.78 $50,279.67 $33,519.78 2025-09-11
C1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 13 11 — — $47,603.98 $71,405.97 $47,603.98 2025-09-11
C1903 LOCAL Guillain-barré M >=38.50 And M <51.50 13 11 — — $33,479.89 $50,219.84 $33,479.89 2025-09-11
C1904 LOCAL Guillain-barré M <38.50 13 11 — — $48,771.01 $73,156.52 $48,771.01 2025-09-11
C2005 LOCAL Miscellaneous M <46.50 And A <77.50 13 11 — — $30,766.06 $46,149.09 $30,766.06 2025-09-11
C2102 LOCAL Burns M <52.50 13 11 — — $30,538.89 $45,808.34 $30,538.89 2025-09-11
C9172 HCPCS Medicaid Fee Schedule 2 2 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2025-09-11
D0105 LOCAL Stroke M <41.50 And A >=84.50 13 11 — — $35,116.86 $52,675.29 $35,116.86 2025-09-11
D0106 LOCAL Stroke M <41.50 And A <84.50 13 11 — — $39,942.81 $59,914.22 $39,942.81 2025-09-11
D0205 LOCAL Traumatic Brain Injury M <35.50 13 11 — — $34,227.28 $51,340.92 $34,227.28 2025-09-11
D0305 LOCAL Non-traumatic Brain Injury M <42.50 And A <78.50 13 11 — — $30,388.03 $45,582.05 $30,388.03 2025-09-11
D0404 LOCAL Traumatic Spinal Cord Injury M <31.50 And A <61.50 13 11 — — $45,621.92 $68,432.88 $45,621.92 2025-09-11
D0405 LOCAL Traumatic Spinal Cord Injury M >=31.50 And M <41.50 13 11 — — $36,280.43 $54,420.65 $36,280.43 2025-09-11
D0406 LOCAL Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 13 11 — — $46,293.01 $69,439.52 $46,293.01 2025-09-11
D0407 LOCAL Traumatic Spinal Cord Injury M <24.50 And A >=61.50 13 11 — — $63,288.74 $94,933.11 $63,288.74 2025-09-11
D0505 LOCAL Non-traumatic Spinal Cord Injury M <39.50 13 11 — — $38,442.83 $57,664.25 $38,442.83 2025-09-11
D0604 LOCAL Neurological M <43.50 13 11 — — $30,183.41 $45,275.12 $30,183.41 2025-09-11
D0704 LOCAL Fracture Of Lower Extremity M <41.50 13 11 — — $29,573.01 $44,359.52 $29,573.01 2025-09-11
D1004 LOCAL Amputation Lower Extremity M <47.50 13 11 — — $30,145.26 $45,217.89 $30,145.26 2025-09-11
D1504 LOCAL Pulmonary M <45.50 13 11 — — $30,105.37 $45,158.06 $30,105.37 2025-09-11
D1705 LOCAL Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 13 11 — — $32,730.77 $49,096.16 $32,730.77 2025-09-11
D1805 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 13 11 — — $31,822.11 $47,733.17 $31,822.11 2025-09-11
D1806 LOCAL Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 13 11 — — $45,193.61 $67,790.42 $45,193.61 2025-09-11
D1903 LOCAL Guillain-barré M >=38.50 And M <51.50 13 11 — — $31,241.19 $46,861.79 $31,241.19 2025-09-11
D1904 LOCAL Guillain-barré M <38.50 13 11 — — $45,509.21 $68,263.82 $45,509.21 2025-09-11
D2102 LOCAL Burns M <52.50 13 11 — — $30,538.89 $45,808.34 $30,538.89 2025-09-11
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 2 2 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2025-09-11
J1413 HCPCS Inj Delandistrogene Mox Rokl 2 2 — — $3,200,000.00 $3,200,000.00 $3,200,000.00 2025-09-11
J3393 HCPCS Inj, Betibeglogene Autotemce 2 2 — — $2,800,000.00 $2,800,000.00 $2,800,000.00 2025-09-11
J3394 HCPCS Inj, Lovotibeglogene Autotem 2 2 — — $3,100,000.00 $3,100,000.00 $3,100,000.00 2025-09-11
J9029 HCPCS Instill Adstiladrin, Tx Dose 2 2 — — $63,354.77 $63,354.77 $63,354.77 2025-09-11
J9226 HCPCS Supprelin La Implant 2 2 — — $45,350.21 $45,350.21 $45,350.21 2025-09-11
L7180 HCPCS Electronic Elbow Sequential 2 2 — — $45,879.28 $45,879.28 $45,879.28 2025-09-11
L7181 HCPCS Electronic Elbo Simultaneous 2 2 — — $47,237.07 $47,237.07 $47,237.07 2025-09-11
Q0480 HCPCS Driver Pneumatic Vad, Rep 2 2 — — $99,999.95 $99,999.95 $99,999.95 2025-09-11
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 2 2 — — $55,015.22 $55,015.22 $55,015.22 2025-09-11
T2025 HCPCS Waiver Service, Nos 2 2 — — $88,188.00 $88,188.00 $88,188.00 2025-09-11
See an error in this hospital's data? Submit a correction