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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 →

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Hospital

CLINTON MEMORIAL HOSPITAL

Wilmington, OH · CCN 360175 · Rates published

317 distinct procedures filed
10 distinct payers
3,927 rate rows
2025-01-01 last MRF observed · ⚠ 21 mo old
Data quality

1,667 of 3,927 rate rows are consumer-grade (42.4%)

2,260 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 2,259
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⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 21 months old.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?pi=BVXrSlFOamIvIZGuL*_*owXg*-*
Found on page https://hospitalpricedisclosure.com/default.aspx?pi=BVXrSlFOamIvIZGuL*_*owXg*-*
Discovered viaDiscovered by HANK
Last fetch success · 2026-10-09
Content fingerprint 444d54badf36132b… · 3,141,037 bytes · first seen 2026-10-09

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
9287
OTHER 		Brentuximab Vedotin Inj 1 $83,357.09 $83,357.09 $83,357.09 nat. median
$252
outlier · 331.0×
800
MS_DRG 		Splenic Procedures With Cc 1 $76,673.75 $76,673.75 $76,673.75 nat. median
$19,759
outlier · 3.9×
207
MS_DRG 		Respiratory System Diagnosis With Ventilator Support >96 Hours 2 $54,088.16 $56,566.50 $55,327.33 nat. median
$47,121
1.2× median
870
MS_DRG 		Septicemia Or Severe Sepsis With Mv >96 Hours 2 $48,050.60 $50,674.60 $49,362.60 nat. median
$48,611
1.0× median
856
MS_DRG 		Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 1 $48,397.77 $48,397.77 $48,397.77 nat. median
$31,991
1.5× median
247
MS_DRG 		Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 1 $48,024.38 $48,024.38 $48,024.38 nat. median
$2,024
outlier · 23.7×
246
MS_DRG 		Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 1 $47,236.44 $47,236.44 $47,236.44 nat. median
$2,024
outlier · 23.3×
9057
OTHER 		Inj Nivol Relatlimab 3mg/1mg 1 $47,019.28 $47,019.28 $47,019.28 nat. median
$200
outlier · 235.1×
417
MS_DRG 		Laparoscopic Cholecystectomy Without C.d.e. With Mcc 1 $44,887.69 $44,887.69 $44,887.69 nat. median
$17,369
outlier · 2.6×
981
MS_DRG 		Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 2 $39,192.32 $39,879.78 $39,536.05 nat. median
$33,546
1.2× median
1471
OTHER 		Injection, Pertuzumab, 1 Mg 3 $12,078.44 $40,711.70 $36,780.43 nat. median
$17
outlier · 2173.8×
9390
OTHER 		Pertuzu, Trastuzu, 10 Mg 1 $32,158.53 $32,158.53 $32,158.53 nat. median
$66
outlier · 488.2×
581
MS_DRG 		Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc 1 $31,473.20 $31,473.20 $31,473.20 nat. median
$10,677
outlier · 2.9×
329
MS_DRG 		Major Small And Large Bowel Procedures With Mcc 4 $17,197.67 $40,065.67 $29,514.35 nat. median
$33,435
0.9× median
9295
OTHER 		Injection, Carfilzomib, 1 Mg 2 $11,429.37 $47,329.34 $29,379.35 nat. median
$52
outlier · 564.3×
9331
OTHER 		Inj, Polatuzumab Vedotin 1mg 1 $29,072.21 $29,072.21 $29,072.21 nat. median
$136
outlier · 213.3×
743
MS_DRG 		Uterine And Adnexa Procedures For Non-malignancy Without Cc/Mcc 1 $29,005.53 $29,005.53 $29,005.53 nat. median
$9,093
outlier · 3.2×
335
MS_DRG 		Peritoneal Adhesiolysis With Mcc 1 $28,950.70 $28,950.70 $28,950.70 nat. median
$25,494
1.1× median
987
MS_DRG 		Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 1 $28,934.40 $28,934.40 $28,934.40 nat. median
$24,316
1.2× median
853
MS_DRG 		Infectious And Parasitic Diseases With O.r. Procedures With Mcc 3 $4,577.82 $95,170.26 $28,139.52 nat. median
$34,733
0.8× median
745
MS_DRG 		D&c, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc 1 $27,980.07 $27,980.07 $27,980.07 nat. median
$8,000
outlier · 3.5×
9378
OTHER 		Daratumumab, Hyaluronidase 3 $10,159.18 $51,000.28 $27,684.05 nat. median
$54
outlier · 512.9×
327
MS_DRG 		Stomach, Esophageal And Duodenal Procedures With Cc 2 $10,938.08 $44,402.00 $27,670.04 nat. median
$18,223
1.5× median
9284
OTHER 		Ipilimumab Injection 2 $27,112.22 $27,914.18 $27,513.20 nat. median
$186
outlier · 148.1×
9494
OTHER 		Injection, Ocrelizumab 3 $300.14 $71,563.72 $27,458.63 nat. median
$62
outlier · 441.5×
956
MS_DRG 		Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 $26,195.93 $26,195.93 $26,195.93 nat. median
$27,340
1.0× median
9111
OTHER 		Inj Teclistamab Cqyv 0.5 Mg 1 $25,020.48 $25,020.48 $25,020.48 nat. median
$34
outlier · 745.1×
521
MS_DRG 		Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 1 $24,930.85 $24,930.85 $24,930.85 nat. median
$21,753
1.1× median
468
MS_DRG 		Revision Of Hip Or Knee Replacement Without Cc/Mcc 2 $22,588.93 $26,355.77 $24,472.35 nat. median
$19,904
1.2× median
321
MS_DRG 		Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 1 $24,196.10 $24,196.10 $24,196.10 nat. median
$20,638
1.2× median
542
MS_DRG 		Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 1 $22,933.72 $22,933.72 $22,933.72 nat. median
$12,976
1.8× median
9436
OTHER 		Inj Pegfilgrast Ex Bio 0.5mg 2 $2,071.07 $43,044.39 $22,557.73 nat. median
$33
outlier · 689.8×
9402
OTHER 		Inj Labetalol Hcl Hikma, 5mg 1 $22,388.32 $22,388.32 $22,388.32 nat. median
$2
outlier · 13486.9×
813
MS_DRG 		Coagulation Disorders 1 $22,120.80 $22,120.80 $22,120.80 nat. median
$11,108
2.0× median
328
MS_DRG 		Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc 4 $10,671.11 $47,438.64 $21,855.28 nat. median
$11,909
1.8× median
337
MS_DRG 		Peritoneal Adhesiolysis Without Cc/Mcc 3 $12,437.78 $37,932.90 $21,225.20 nat. median
$11,501
1.8× median
982
MS_DRG 		Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 2 $20,665.14 $20,928.68 $20,796.91 nat. median
$17,763
1.2× median
399
MS_DRG 		Appendix Procedures Without Cc/Mcc 1 $17,476.14 $24,054.01 $20,765.07 nat. median
$8,689
outlier · 2.4×
208
MS_DRG 		Respiratory System Diagnosis With Ventilator Support <=96 Hours 4 $20,492.18 $33,562.08 $20,693.86 nat. median
$19,623
1.1× median
662
MS_DRG 		Minor Bladder Procedures With Mcc 1 $20,645.34 $20,645.34 $20,645.34 nat. median
$21,396
1.0× median
199
MS_DRG 		Pneumothorax With Mcc 1 $19,525.61 $21,561.61 $20,543.61 nat. median
$12,470
1.6× median
674
MS_DRG 		Other Kidney And Urinary Tract Procedures With Cc 1 $20,167.28 $20,167.28 $20,167.28 nat. median
$16,612
1.2× median
494
MS_DRG 		Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc 1 $19,394.87 $19,394.87 $19,394.87 nat. median
$14,553
1.3× median
100
MS_DRG 		Seizures With Mcc 1 $19,219.78 $19,219.78 $19,219.78 nat. median
$13,848
1.4× median
480
MS_DRG 		Hip And Femur Procedures Except Major Joint With Mcc 2 $13,532.24 $24,873.83 $19,203.03 nat. median
$21,963
0.9× median
5674
OTHER 		Level 4 Pathology 2 $5,300.59 $33,052.03 $19,176.31 nat. median
$832
outlier · 23.1×
264
MS_DRG 		Other Circulatory System O.r. Procedures 1 $19,112.70 $19,112.70 $19,112.70 nat. median
$23,998
0.8× median
974
MS_DRG 		HIV With Major Related Condition With Mcc 1 $19,094.10 $19,094.10 $19,094.10 nat. median
$20,400
0.9× median
91
MS_DRG 		Other Disorders Of Nervous System With Mcc 1 $19,051.43 $19,051.43 $19,051.43 nat. median
$12,760
1.5× median
5464
OTHER 		Level 4 Neurostimulator And Related Procedures 1 $18,614.29 $18,614.29 $18,614.29 nat. median
$20,658
0.9× median

Other procedures at this hospital

Browse this hospital's 317 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
9287 OTHER Brentuximab Vedotin Inj 1 1 — — $83,357.09 $83,357.09 $83,357.09 2025-01-01
800 MS_DRG Splenic Procedures With Cc 1 1 — — $76,673.75 $76,673.75 $76,673.75 2025-01-01
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 2 2 — — $54,088.16 $56,566.50 $55,327.33 2025-01-01
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 2 2 — — $48,050.60 $50,674.60 $49,362.60 2025-01-01
856 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc 1 1 — — $48,397.77 $48,397.77 $48,397.77 2025-01-01
247 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 1 1 — — $48,024.38 $48,024.38 $48,024.38 2025-01-01
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 1 1 — — $47,236.44 $47,236.44 $47,236.44 2025-01-01
9057 OTHER Inj Nivol Relatlimab 3mg/1mg 1 1 — — $47,019.28 $47,019.28 $47,019.28 2025-01-01
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 1 1 — — $44,887.69 $44,887.69 $44,887.69 2025-01-01
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 2 2 — — $39,192.32 $39,879.78 $39,536.05 2025-01-01
1471 OTHER Injection, Pertuzumab, 1 Mg 4 3 — — $12,078.44 $40,711.70 $36,780.43 2025-01-01
9390 OTHER Pertuzu, Trastuzu, 10 Mg 1 1 — — $32,158.53 $32,158.53 $32,158.53 2025-01-01
581 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc 1 1 — — $31,473.20 $31,473.20 $31,473.20 2025-01-01
329 MS_DRG Major Small And Large Bowel Procedures With Mcc 4 4 — — $17,197.67 $40,065.67 $29,514.35 2025-01-01
9295 OTHER Injection, Carfilzomib, 1 Mg 2 2 — — $11,429.37 $47,329.34 $29,379.35 2025-01-01
9331 OTHER Inj, Polatuzumab Vedotin 1mg 1 1 — — $29,072.21 $29,072.21 $29,072.21 2025-01-01
743 MS_DRG Uterine And Adnexa Procedures For Non-malignancy Without Cc/Mcc 1 1 — — $29,005.53 $29,005.53 $29,005.53 2025-01-01
335 MS_DRG Peritoneal Adhesiolysis With Mcc 1 1 — — $28,950.70 $28,950.70 $28,950.70 2025-01-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 1 1 — — $28,934.40 $28,934.40 $28,934.40 2025-01-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 5 3 — — $4,577.82 $95,170.26 $28,139.52 2025-01-01
745 MS_DRG D&c, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc 1 1 — — $27,980.07 $27,980.07 $27,980.07 2025-01-01
9378 OTHER Daratumumab, Hyaluronidase 3 3 — — $10,159.18 $51,000.28 $27,684.05 2025-01-01
327 MS_DRG Stomach, Esophageal And Duodenal Procedures With Cc 2 2 — — $10,938.08 $44,402.00 $27,670.04 2025-01-01
9284 OTHER Ipilimumab Injection 2 2 — — $27,112.22 $27,914.18 $27,513.20 2025-01-01
9494 OTHER Injection, Ocrelizumab 4 3 — — $300.14 $71,563.72 $27,458.63 2025-01-01
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 1 1 — — $26,195.93 $26,195.93 $26,195.93 2025-01-01
9111 OTHER Inj Teclistamab Cqyv 0.5 Mg 1 1 — — $25,020.48 $25,020.48 $25,020.48 2025-01-01
521 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc 1 1 — — $24,930.85 $24,930.85 $24,930.85 2025-01-01
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/Mcc 2 2 — — $22,588.93 $26,355.77 $24,472.35 2025-01-01
321 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ A… 1 1 — — $24,196.10 $24,196.10 $24,196.10 2025-01-01
542 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 1 1 — — $22,933.72 $22,933.72 $22,933.72 2025-01-01
9436 OTHER Inj Pegfilgrast Ex Bio 0.5mg 2 2 — — $2,071.07 $43,044.39 $22,557.73 2025-01-01
9402 OTHER Inj Labetalol Hcl Hikma, 5mg 1 1 — — $22,388.32 $22,388.32 $22,388.32 2025-01-01
813 MS_DRG Coagulation Disorders 1 1 — — $22,120.80 $22,120.80 $22,120.80 2025-01-01
328 MS_DRG Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc 4 4 — — $10,671.11 $47,438.64 $21,855.28 2025-01-01
337 MS_DRG Peritoneal Adhesiolysis Without Cc/Mcc 3 3 — — $12,437.78 $37,932.90 $21,225.20 2025-01-01
982 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 2 2 — — $20,665.14 $20,928.68 $20,796.91 2025-01-01
399 MS_DRG Appendix Procedures Without Cc/Mcc 2 1 — — $17,476.14 $24,054.01 $20,765.07 2025-01-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 4 4 — — $20,492.18 $33,562.08 $20,693.86 2025-01-01
662 MS_DRG Minor Bladder Procedures With Mcc 1 1 — — $20,645.34 $20,645.34 $20,645.34 2025-01-01
199 MS_DRG Pneumothorax With Mcc 2 1 — — $19,525.61 $21,561.61 $20,543.61 2025-01-01
674 MS_DRG Other Kidney And Urinary Tract Procedures With Cc 1 1 — — $20,167.28 $20,167.28 $20,167.28 2025-01-01
494 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc 1 1 — — $19,394.87 $19,394.87 $19,394.87 2025-01-01
100 MS_DRG Seizures With Mcc 1 1 — — $19,219.78 $19,219.78 $19,219.78 2025-01-01
480 MS_DRG Hip And Femur Procedures Except Major Joint With Mcc 2 2 — — $13,532.24 $24,873.83 $19,203.03 2025-01-01
5674 OTHER Level 4 Pathology 2 2 — — $5,300.59 $33,052.03 $19,176.31 2025-01-01
264 MS_DRG Other Circulatory System O.r. Procedures 1 1 — — $19,112.70 $19,112.70 $19,112.70 2025-01-01
974 MS_DRG HIV With Major Related Condition With Mcc 1 1 — — $19,094.10 $19,094.10 $19,094.10 2025-01-01
91 MS_DRG Other Disorders Of Nervous System With Mcc 1 1 — — $19,051.43 $19,051.43 $19,051.43 2025-01-01
5464 OTHER Level 4 Neurostimulator And Related Procedures 1 1 — — $18,614.29 $18,614.29 $18,614.29 2025-01-01
808 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 1 — — $18,580.41 $18,580.41 $18,580.41 2025-01-01
330 MS_DRG Major Small And Large Bowel Procedures With Cc 5 5 — — $13,782.96 $20,506.16 $18,471.08 2025-01-01
41 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe… 1 1 — — $18,319.89 $18,319.89 $18,319.89 2025-01-01
40 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc 1 1 — — $17,980.19 $17,980.19 $17,980.19 2025-01-01
331 MS_DRG Major Small And Large Bowel Procedures Without Cc/Mcc 6 5 — — $12,817.80 $43,219.32 $17,919.72 2025-01-01
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 1 1 — — $17,860.49 $17,860.49 $17,860.49 2025-01-01
770 MS_DRG Abortion With D&c, Aspiration Curettage Or Hysterotomy 1 1 — — $16,725.46 $16,725.46 $16,725.46 2025-01-01
522 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 5 4 — — $6,335.94 $47,404.85 $16,677.55 2025-01-01
9453 OTHER Injection, Nivolumab 4 2 — — $11,779.44 $26,385.04 $16,360.20 2025-01-01
481 MS_DRG Hip And Femur Procedures Except Major Joint With Cc 4 4 — — $15,567.85 $17,930.81 $16,020.48 2025-01-01
9131 OTHER Inj, Ado-trastuzumab Emt 1mg 2 1 — — $12,119.05 $19,409.67 $15,764.36 2025-01-01
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 1 1 — — $15,574.21 $15,574.21 $15,574.21 2025-01-01
854 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Cc 3 2 — — $6,347.43 $16,429.32 $15,254.30 2025-01-01
1490 OTHER Inj Pembrolizumab 8 5 — — $5,068.56 $25,148.83 $15,048.01 2025-01-01
843 MS_DRG Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 1 1 — — $15,002.86 $15,002.86 $15,002.86 2025-01-01
70 MS_DRG Nonspecific Cerebrovascular Disorders With Mcc 1 1 — — $14,937.45 $14,937.45 $14,937.45 2025-01-01
9276 OTHER Cabazitaxel Injection 2 2 — — $14,853.66 $14,962.54 $14,908.10 2025-01-01
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 11 7 — — $6,044.66 $17,480.00 $14,883.70 2025-01-01
501 MS_DRG Soft Tissue Procedures With Cc 1 1 — — $14,874.18 $14,874.18 $14,874.18 2025-01-01
9377 OTHER Inj. Isatuximab-irfc 10 Mg 2 2 — — $13,763.70 $15,965.70 $14,864.70 2025-01-01
380 MS_DRG Complicated Peptic Ulcer With Mcc 1 1 — — $14,710.35 $14,710.35 $14,710.35 2025-01-01
666 MS_DRG Prostatectomy With Cc 2 2 — — $14,461.18 $14,616.25 $14,538.72 2025-01-01
322 MS_DRG Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc 5 4 — — $11,629.75 $78,623.55 $14,507.47 2025-01-01
551 MS_DRG Medical Back Problems With Mcc 1 1 — — $14,443.38 $14,443.38 $14,443.38 2025-01-01
785 MS_DRG Cesarean Section With Sterilization Without Cc/Mcc 4 4 — — $5,607.43 $19,387.31 $14,204.02 2025-01-01
623 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 2 2 — — $13,914.39 $14,174.50 $14,044.44 2025-01-01
9492 OTHER Inj., Durvalumab, 10 Mg 2 2 — — $8,435.74 $19,331.31 $13,883.53 2025-01-01
177 MS_DRG Respiratory Infections And Inflammations With Mcc 5 5 — — $12,812.59 $17,655.54 $13,820.27 2025-01-01
682 MS_DRG Renal Failure With Mcc 4 4 — — $3,742.51 $15,988.10 $13,484.75 2025-01-01
841 MS_DRG Lymphoma And Non-acute Leukemia With Cc 1 1 — — $13,398.44 $13,398.44 $13,398.44 2025-01-01
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 1 1 — — $13,366.29 $13,366.29 $13,366.29 2025-01-01
9347 OTHER Inj Luspatercept-aamt 0.25mg 1 1 — — $13,012.71 $13,012.71 $13,012.71 2025-01-01
377 MS_DRG Gastrointestinal Hemorrhage With Mcc 4 4 — — $7,580.09 $15,204.58 $12,776.53 2025-01-01
9367 OTHER Inj Ruxience, 10 Mg 2 2 — — $5,249.91 $20,212.14 $12,731.02 2025-01-01
9186 OTHER Inj., Rituximab, 10 Mg 1 1 — — $12,669.72 $12,669.72 $12,669.72 2025-01-01
438 MS_DRG Disorders Of Pancreas Except Malignancy With Mcc 3 2 — — $7,222.69 $16,957.21 $12,570.80 2025-01-01
670 MS_DRG Transurethral Procedures Without Cc/Mcc 1 1 — — $12,527.73 $12,527.73 $12,527.73 2025-01-01
482 MS_DRG Hip And Femur Procedures Except Major Joint Without Cc/Mcc 7 6 — — $11,924.81 $35,402.32 $12,461.90 2025-01-01
9483 OTHER Inj, Atezolizumab,10 Mg 2 2 — — $11,544.04 $13,170.44 $12,357.24 2025-01-01
669 MS_DRG Transurethral Procedures With Cc 3 2 — — $11,945.00 $13,099.69 $12,349.73 2025-01-01
299 MS_DRG Peripheral Vascular Disorders With Mcc 1 1 — — $12,181.66 $12,181.66 $12,181.66 2025-01-01
296 MS_DRG Cardiac Arrest, Unexplained With Mcc 1 1 — — $12,110.26 $12,110.26 $12,110.26 2025-01-01
358 MS_DRG Other Digestive System O.r. Procedures Without Cc/Mcc 1 1 — — $12,032.61 $12,032.61 $12,032.61 2025-01-01
917 MS_DRG Poisoning And Toxic Effects Of Drugs With Mcc 3 3 — — $6,809.72 $18,755.80 $11,919.83 2025-01-01
418 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Cc 2 2 — — $9,637.84 $13,905.28 $11,771.56 2025-01-01
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 5 3 — — $6,049.54 $14,412.64 $11,766.72 2025-01-01
1613 OTHER Trastuzumab Injection 1 1 — — $11,681.63 $11,681.63 $11,681.63 2025-01-01
176 MS_DRG Pulmonary Embolism Without Mcc 1 1 — — $11,662.56 $11,662.56 $11,662.56 2025-01-01
166 MS_DRG Other Respiratory System O.r. Procedures With Mcc 1 1 — — $11,607.70 $11,607.70 $11,607.70 2025-01-01
621 MS_DRG O.r. Procedures For Obesity Without Cc/Mcc 2 2 — — $11,336.32 $11,815.00 $11,575.66 2025-01-01
384 MS_DRG Uncomplicated Peptic Ulcer Without Mcc 1 1 — — $11,506.98 $11,506.98 $11,506.98 2025-01-01
282 MS_DRG Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc 2 2 — — $6,253.79 $16,479.20 $11,366.49 2025-01-01
5791 OTHER Pulmonary Treatment 7 4 — — $4,559.17 $27,332.71 $11,319.02 2025-01-01
535 MS_DRG Fractures Of Hip And Pelvis With Mcc 1 1 — — $11,052.23 $11,052.23 $11,052.23 2025-01-01
784 MS_DRG Cesarean Section With Sterilization With Cc 5 5 — — $6,459.31 $22,861.58 $11,040.72 2025-01-01
346 MS_DRG Minor Small And Large Bowel Procedures Without Cc/Mcc 1 1 — — $11,013.96 $11,013.96 $11,013.96 2025-01-01
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 10 7 — — $1,122.17 $23,311.95 $10,936.93 2025-01-01
9353 OTHER Inj Fam-trastu Deru-nxki 1mg 2 2 — — $10,552.27 $11,306.38 $10,929.33 2025-01-01
713 MS_DRG Transurethral Prostatectomy With Cc/Mcc 1 1 — — $10,903.32 $10,903.32 $10,903.32 2025-01-01
388 MS_DRG Gastrointestinal Obstruction With Mcc 1 1 — — $10,800.77 $10,800.77 $10,800.77 2025-01-01
381 MS_DRG Complicated Peptic Ulcer With Cc 1 1 — — $10,741.93 $10,741.93 $10,741.93 2025-01-01
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 15 7 — — $4,050.00 $20,962.36 $10,491.71 2025-01-01
371 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 1 1 — — $10,171.92 $10,171.92 $10,171.92 2025-01-01
809 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 2 2 — — $9,901.04 $10,167.33 $10,034.19 2025-01-01
1712 OTHER Paclitaxel Protein Bound 3 2 — — $6,218.49 $12,756.84 $10,033.90 2025-01-01
693 MS_DRG Urinary Stones With Mcc 1 1 — — $10,029.40 $10,029.40 $10,029.40 2025-01-01
5183 OTHER Level 3 Vascular Procedures 2 2 — — $6,492.98 $13,546.24 $10,019.61 2025-01-01
291 MS_DRG Heart Failure And Shock With Mcc 10 6 — — $1,565.52 $17,924.46 $9,981.34 2025-01-01
200 MS_DRG Pneumothorax With Cc 2 2 — — $7,672.34 $12,019.64 $9,845.99 2025-01-01
9002 OTHER Tenecteplase Injection 6 4 — — $8,937.83 $15,399.35 $9,723.28 2025-01-01
637 MS_DRG Diabetes With Mcc 4 4 — — $5,418.39 $12,736.16 $9,711.58 2025-01-01
786 MS_DRG Cesarean Section Without Sterilization With Mcc 4 4 — — $5,295.21 $14,712.59 $9,670.24 2025-01-01
698 MS_DRG Other Kidney And Urinary Tract Diagnoses With Mcc 1 1 — — $9,385.50 $9,385.50 $9,385.50 2025-01-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 13 8 — — $2,099.70 $50,010.74 $9,338.30 2025-01-01
5623 OTHER Level 3 Radiation Therapy 10 7 — — $114.82 $30,177.72 $9,266.89 2025-01-01
71 MS_DRG Nonspecific Cerebrovascular Disorders With Cc 1 1 — — $9,082.99 $9,082.99 $9,082.99 2025-01-01
667 MS_DRG Prostatectomy Without Cc/Mcc 1 1 — — $8,998.25 $8,998.25 $8,998.25 2025-01-01
602 MS_DRG Cellulitis With Mcc 4 4 — — $7,038.87 $12,318.34 $8,972.52 2025-01-01
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 5 5 — — $6,956.04 $9,226.00 $8,451.27 2025-01-01
811 MS_DRG Red Blood Cell Disorders With Mcc 1 1 — — $8,349.49 $8,349.49 $8,349.49 2025-01-01
661 MS_DRG Kidney And Ureter Procedures For Non-neoplasm Without Cc/Mcc 5 4 — — $5,069.43 $14,866.31 $8,312.82 2025-01-01
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 14 7 — — $4,199.90 $19,868.98 $8,230.14 2025-01-01
920 MS_DRG Complications Of Treatment With Cc 1 1 — — $8,162.58 $8,162.58 $8,162.58 2025-01-01
206 MS_DRG Other Respiratory System Diagnoses Without Mcc 1 1 — — $8,081.61 $8,081.61 $8,081.61 2025-01-01
659 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Mcc 3 3 — — $6,437.48 $21,353.13 $8,048.76 2025-01-01
805 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Mcc 5 5 — — $4,664.23 $9,968.38 $7,972.52 2025-01-01
281 MS_DRG Acute Myocardial Infarction, Discharged Alive With Cc 5 5 — — $6,904.32 $24,854.66 $7,952.68 2025-01-01
287 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc 1 1 — — $7,877.64 $7,877.64 $7,877.64 2025-01-01
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc 4 3 — — $5,957.75 $13,923.28 $7,861.41 2025-01-01
445 MS_DRG Disorders Of The Biliary Tract With Cc 1 1 — — $7,833.41 $7,833.41 $7,833.41 2025-01-01
629 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Cc 1 1 — — $7,786.30 $7,786.30 $7,786.30 2025-01-01
644 MS_DRG Endocrine Disorders With Cc 3 3 — — $7,066.59 $8,677.40 $7,665.23 2025-01-01
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 5 5 — — $4,863.63 $9,545.46 $7,548.14 2025-01-01
378 MS_DRG Gastrointestinal Hemorrhage With Cc 4 4 — — $1,302.87 $13,712.58 $7,531.74 2025-01-01
742 MS_DRG Uterine And Adnexa Procedures For Non-malignancy With Cc/Mcc 1 1 — — $7,509.67 $7,509.67 $7,509.67 2025-01-01
393 MS_DRG Other Digestive System Diagnoses With Mcc 1 1 — — $7,491.48 $7,491.48 $7,491.48 2025-01-01
305 MS_DRG Hypertension Without Mcc 2 2 — — $5,766.59 $9,179.53 $7,473.06 2025-01-01
312 MS_DRG Syncope And Collapse 2 2 — — $4,411.46 $10,513.38 $7,462.42 2025-01-01
1476 OTHER Obinutuzumab Inj 1 1 — — $7,459.29 $7,459.29 $7,459.29 2025-01-01
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 2 2 — — $4,610.28 $10,039.28 $7,324.78 2025-01-01
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 7 5 — — $4,422.17 $17,679.36 $7,300.00 2025-01-01
552 MS_DRG Medical Back Problems Without Mcc 1 1 — — $7,266.28 $7,266.28 $7,266.28 2025-01-01
563 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 1 1 — — $7,235.80 $7,235.80 $7,235.80 2025-01-01
394 MS_DRG Other Digestive System Diagnoses With Cc 2 2 — — $6,485.70 $7,930.74 $7,208.22 2025-01-01
758 MS_DRG Infections, Female Reproductive System With Cc 1 1 — — $7,162.43 $7,162.43 $7,162.43 2025-01-01
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/Mcc 2 2 — — $5,488.48 $8,757.19 $7,122.84 2025-01-01
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 5 5 — — $3,566.62 $8,664.05 $7,113.34 2025-01-01
798 MS_DRG Vaginal Delivery With Sterilization And/Or D&c Without Cc/Mcc 4 4 — — $3,680.85 $18,151.38 $7,088.79 2025-01-01
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 5 4 — — $4,575.68 $10,063.52 $7,088.51 2025-01-01
605 MS_DRG Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc 2 2 — — $6,275.85 $7,827.69 $7,051.77 2025-01-01
683 MS_DRG Renal Failure With Cc 4 4 — — $6,394.41 $7,741.60 $7,034.12 2025-01-01
9195 OTHER Injection, Udenyca 0.5 Mg 4 3 — — $1,480.28 $15,280.12 $6,907.23 2025-01-01
948 MS_DRG Signs And Symptoms Without Mcc 3 2 — — $6,513.51 $14,860.33 $6,897.85 2025-01-01
395 MS_DRG Other Digestive System Diagnoses Without Cc/Mcc 1 1 — — $6,874.19 $6,874.19 $6,874.19 2025-01-01
565 MS_DRG Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 1 1 — — $6,836.38 $6,836.38 $6,836.38 2025-01-01
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 3 2 — — $6,612.73 $10,072.65 $6,809.57 2025-01-01
1233 OTHER Inj, Vasopressin, 1 Unit 1 1 — — $6,796.00 $6,796.00 $6,796.00 2025-01-01
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 4 3 — — $6,083.72 $13,598.48 $6,708.27 2025-01-01
314 MS_DRG Other Circulatory System Diagnoses With Mcc 1 1 — — $6,694.01 $6,694.01 $6,694.01 2025-01-01
543 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 1 1 — — $6,691.83 $6,691.83 $6,691.83 2025-01-01
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 11 6 — — $4,442.08 $25,646.60 $6,675.75 2025-01-01
158 MS_DRG Dental And Oral Diseases With Cc 1 1 — — $6,609.55 $6,609.55 $6,609.55 2025-01-01
638 MS_DRG Diabetes With Cc 10 6 — — $4,149.23 $10,043.73 $6,585.61 2025-01-01
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 9 6 — — $5,000.30 $9,015.55 $6,577.65 2025-01-01
5612 OTHER Level 2 Therapeutic Radiation Treatment Preparation 10 5 — — $2,050.64 $29,474.73 $6,537.70 2025-01-01
9430 OTHER Piflu F-18, Dia 1 Millicurie 1 1 — — $6,532.41 $6,532.41 $6,532.41 2025-01-01
603 MS_DRG Cellulitis Without Mcc 7 5 — — $3,545.99 $8,008.16 $6,503.08 2025-01-01
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/Mcc 6 5 — — $3,827.74 $11,263.20 $6,474.76 2025-01-01
726 MS_DRG Benign Prostatic Hypertrophy Without Mcc 2 2 — — $6,321.73 $6,540.49 $6,431.11 2025-01-01
897 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 3 2 — — $6,252.64 $8,398.78 $6,374.05 2025-01-01
436 MS_DRG Malignancy Of Hepatobiliary System Or Pancreas With Cc 1 1 — — $6,299.10 $6,299.10 $6,299.10 2025-01-01
205 MS_DRG Other Respiratory System Diagnoses With Mcc 1 1 — — $6,294.15 $6,294.15 $6,294.15 2025-01-01
9214 OTHER Bevacizumab Injection 1 1 — — $6,251.30 $6,251.30 $6,251.30 2025-01-01
9329 OTHER Inj Mvasi 10 Mg 1 1 — — $6,249.76 $6,249.76 $6,249.76 2025-01-01
0965 OTHER Albumin (human), 25%, 50ml 2 1 — — $770.62 $11,684.42 $6,227.52 2025-01-01
311 MS_DRG Angina Pectoris 1 1 — — $6,176.08 $6,176.08 $6,176.08 2025-01-01
1207 OTHER Octreotide Injection, Depot 2 1 — — $4,161.48 $7,843.99 $6,002.73 2025-01-01
9126 OTHER Natalizumab Injection 1 1 — — $5,932.93 $5,932.93 $5,932.93 2025-01-01
387 MS_DRG Inflammatory Bowel Disease Without Cc/Mcc 1 1 — — $5,921.09 $5,921.09 $5,921.09 2025-01-01
812 MS_DRG Red Blood Cell Disorders Without Mcc 2 2 — — $4,657.95 $6,917.14 $5,787.55 2025-01-01
9237 OTHER Inj, Lanreotide Acetate 1 1 — — $5,780.10 $5,780.10 $5,780.10 2025-01-01
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 3 3 — — $5,335.11 $8,671.33 $5,759.48 2025-01-01
202 MS_DRG Bronchitis And Asthma With Cc/Mcc 4 4 — — $4,281.65 $21,846.48 $5,676.98 2025-01-01
9350 OTHER Inj., Trazimera, 10 Mg 2 2 — — $1,467.89 $9,866.63 $5,667.26 2025-01-01
5622 OTHER Level 2 Radiation Therapy 12 6 — — $882.58 $27,006.42 $5,615.51 2025-01-01
807 MS_DRG Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc 14 7 — — $4,336.74 $11,207.95 $5,597.04 2025-01-01
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 2 2 — — $4,233.79 $6,919.24 $5,576.51 2025-01-01
389 MS_DRG Gastrointestinal Obstruction With Cc 2 2 — — $4,280.01 $6,862.25 $5,571.13 2025-01-01
787 MS_DRG Cesarean Section Without Sterilization With Cc 8 5 — — $2,030.78 $23,599.63 $5,449.32 2025-01-01
639 MS_DRG Diabetes Without Cc/Mcc 3 3 — — $4,755.24 $6,408.25 $5,407.04 2025-01-01
788 MS_DRG Cesarean Section Without Sterilization Without Cc/Mcc 8 5 — — $3,594.40 $18,381.12 $5,398.03 2025-01-01
768 MS_DRG Vaginal Delivery With O.r. Procedures Except Sterilization And/Or D&c 3 3 — — $5,262.16 $8,804.80 $5,282.66 2025-01-01
9201 OTHER Rabies Ig Ht&sol Human Im/sc 3 2 — — $1,458.30 $12,587.04 $5,108.39 2025-01-01
916 MS_DRG Allergic Reactions Without Mcc 1 1 — — $5,068.15 $5,068.15 $5,068.15 2025-01-01
9291 OTHER Inj, Clindamycin Phosp 300mg 11 6 — — $2,700.11 $18,542.12 $4,995.41 2025-01-01
951 MS_DRG Other Factors Influencing Health Status 2 2 — — $2,099.70 $7,550.90 $4,825.30 2025-01-01
793 MS_DRG Full Term Neonate With Major Problems 8 5 — — $2,035.15 $15,304.06 $4,769.07 2025-01-01
386 MS_DRG Inflammatory Bowel Disease With Cc 2 2 — — $1,823.29 $7,674.93 $4,749.11 2025-01-01
373 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc 1 1 — — $4,740.15 $4,740.15 $4,740.15 2025-01-01
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 8 5 — — $4,664.23 $8,908.52 $4,739.50 2025-01-01
101 MS_DRG Seizures Without Mcc 1 1 — — $4,501.93 $4,501.93 $4,501.93 2025-01-01
684 MS_DRG Renal Failure Without Cc/Mcc 1 1 — — $4,420.42 $4,420.42 $4,420.42 2025-01-01
149 MS_DRG Dysequilibrium 1 1 — — $4,411.68 $4,411.68 $4,411.68 2025-01-01
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc 4 4 — — $3,865.76 $4,960.12 $4,371.58 2025-01-01
5731 OTHER Level 1 Minor Procedures 12 8 — — $191.36 $21,168.31 $4,215.90 2025-01-01
168 MS_DRG Other Respiratory System O.r. Procedures Without Cc/Mcc 1 1 — — $4,173.66 $4,173.66 $4,173.66 2025-01-01
390 MS_DRG Gastrointestinal Obstruction Without Cc/Mcc 3 3 — — $3,764.56 $4,669.42 $4,138.17 2025-01-01
894 MS_DRG Alcohol, Drug Abuse Or Dependence, Left Ama 2 2 — — $3,980.03 $4,244.85 $4,112.44 2025-01-01
918 MS_DRG Poisoning And Toxic Effects Of Drugs Without Mcc 1 1 — — $4,083.33 $4,083.33 $4,083.33 2025-01-01
9348 OTHER Inj., Zirabev, 10 Mg 4 4 — — $1,503.61 $22,620.87 $4,059.67 2025-01-01
1660 OTHER Injection, Oritavancin 1 1 — — $3,876.56 $3,876.56 $3,876.56 2025-01-01
5613 OTHER Level 3 Therapeutic Radiation Treatment Preparation 8 5 — — $1,977.84 $25,193.61 $3,770.94 2025-01-01
5673 OTHER Level 3 Pathology 19 8 — — $198.77 $17,459.17 $3,636.42 2025-01-01
9004 OTHER Injection, Inclisiran, 1 Mg 5 4 — — $266.86 $5,464.11 $3,456.60 2025-01-01
1489 OTHER Inj Vedolizumab IV 1 Mg 2 2 — — $264.03 $6,633.39 $3,448.71 2025-01-01
9161 OTHER Inj Cefazolin Sodium, Baxter 24 9 — — $480.90 $15,721.53 $3,328.51 2025-01-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 1 1 — — $3,083.69 $3,083.69 $3,083.69 2025-01-01
833 MS_DRG Other Antepartum Diagnoses Without O.r. Procedures Without Cc/Mcc 3 3 — — $1,591.74 $3,443.40 $3,031.18 2025-01-01
9272 OTHER Inj, Denosumab 9 6 — — $1,541.08 $6,890.16 $2,907.11 2025-01-01
792 MS_DRG Prematurity Without Major Problems 2 2 — — $1,974.60 $3,802.63 $2,888.61 2025-01-01
776 MS_DRG Postpartum And Post Abortion Diagnoses Without O.r. Procedures 2 2 — — $2,033.05 $3,724.97 $2,879.01 2025-01-01
660 MS_DRG Kidney And Ureter Procedures For Non-neoplasm With Cc 1 1 — — $2,787.19 $2,787.19 $2,787.19 2025-01-01
379 MS_DRG Gastrointestinal Hemorrhage Without Cc/Mcc 3 3 — — $1,489.15 $6,571.81 $2,762.88 2025-01-01
5091 OTHER Level 1 Breast/Lymphatic Surgery And Related Procedures 1 1 — — $2,714.24 $2,714.24 $2,714.24 2025-01-01
9173 OTHER Injection, Fulphila 1 1 — — $2,540.04 $2,540.04 $2,540.04 2025-01-01
5182 OTHER Level 2 Vascular Procedures 8 6 — — $1,364.89 $23,878.69 $2,502.11 2025-01-01
5801 OTHER Ventilation Initiation And Management 1 1 — — $2,496.13 $2,496.13 $2,496.13 2025-01-01
1685 OTHER Darbepoetin Alfa, Non-esrd 1 1 — — $2,407.40 $2,407.40 $2,407.40 2025-01-01
0902 RC Injection,onabotulinumtoxinA 5 5 — — $1,257.71 $8,051.46 $2,371.73 2025-01-01
5723 OTHER Level 3 Diagnostic Tests And Related Services 5 4 — — $454.22 $3,087.29 $2,246.42 2025-01-01
794 MS_DRG Neonate With Other Significant Problems 10 6 — — $1,749.00 $5,437.19 $2,204.56 2025-01-01
159 MS_DRG Dental And Oral Diseases Without Cc/Mcc 1 1 — — $2,193.91 $2,193.91 $2,193.91 2025-01-01
5691 OTHER Level 1 Drug Administration 10 7 — — $20.17 $36,448.63 $2,168.68 2025-01-01
9522 OTHER Rbc Leukoreduced Irradiated 3 3 — — $1,405.14 $2,710.45 $2,118.95 2025-01-01
153 MS_DRG Otitis Media And Uri Without Mcc 1 1 — — $2,088.81 $2,088.81 $2,088.81 2025-01-01
769 MS_DRG Postpartum And Post Abortion Diagnoses With O.r. Procedures 1 1 — — $2,034.90 $2,034.90 $2,034.90 2025-01-01
5401 OTHER Dialysis 4 3 — — $627.62 $11,268.72 $2,029.75 2025-01-01
0943 RC Octagam Injection 2 2 — — $1,814.65 $2,118.53 $1,966.59 2025-01-01
9245 OTHER Romiplostim Injection 2 2 — — $615.21 $3,214.32 $1,914.77 2025-01-01
795 MS_DRG Normal Newborn 12 7 — — $1,043.24 $2,499.82 $1,903.63 2025-01-01
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 1 1 — — $1,748.91 $1,748.91 $1,748.91 2025-01-01
1232 OTHER Mitomycin Injection 3 3 — — $548.63 $1,731.81 $1,727.52 2025-01-01
5041 OTHER Critical Care 15 6 — — $260.76 $7,608.34 $1,638.31 2025-01-01
5241 OTHER Level 1 Blood Product Exchange And Related Services 14 8 — — $472.96 $9,847.26 $1,548.24 2025-01-01
789 MS_DRG Neonates, Died Or Transferred To Another Acute Care Facility 5 4 — — $1,097.00 $5,342.32 $1,532.01 2025-01-01
0810 RC Goserelin Acetate Implant 1 1 — — $1,478.93 $1,478.93 $1,478.93 2025-01-01
5312 OTHER Level 2 Lower Gi Procedures 3 2 — — $950.07 $3,011.38 $1,425.11 2025-01-01
5694 OTHER Level 4 Drug Administration 10 6 — — $383.02 $9,484.44 $1,380.63 2025-01-01
5594 OTHER Level 4 Nuclear Medicine And Related Services 18 8 — — $200.00 $7,445.55 $1,367.40 2025-01-01
5593 OTHER Level 3 Nuclear Medicine And Related Services 27 9 — — $325.97 $8,574.58 $1,349.27 2025-01-01
5671 OTHER Level 1 Pathology 28 9 — — $768.55 $5,309.50 $1,326.26 2025-01-01
9010 OTHER Inj Efgartigimod 2mg 2 2 — — $688.80 $1,841.60 $1,265.20 2025-01-01
5733 OTHER Level 3 Minor Procedures 23 9 — — $52.71 $22,956.75 $1,175.69 2025-01-01
9290 OTHER Inj, Bupivacaine, Nos, 0.5mg 16 7 — — $275.08 $13,317.05 $1,143.22 2025-01-01
1847 OTHER Injection, Inflectra 1 1 — — $1,063.67 $1,063.67 $1,063.67 2025-01-01
5693 OTHER Level 3 Drug Administration 21 9 — — $228.55 $39,516.64 $1,044.27 2025-01-01
5672 OTHER Level 2 Pathology 24 9 — — $129.20 $6,590.41 $1,031.62 2025-01-01
9139 OTHER Rabies Vaccine, IM 3 3 — — $601.71 $1,354.36 $1,007.06 2025-01-01
1686 OTHER Epoetin Alfa, Non-esrd 2 2 — — $315.35 $1,636.52 $975.94 2025-01-01
5025 OTHER Level 5 Type A Ed Visits 30 9 — — $400.48 $5,921.80 $934.95 2025-01-01
5361 OTHER Level 1 Laparoscopy And Related Services 1 1 — — $924.89 $924.89 $924.89 2025-01-01
5724 OTHER Level 4 Diagnostic Tests And Related Services 21 8 — — $708.83 $4,264.58 $904.77 2025-01-01
1488 OTHER Injection, Ramucirumab 1 1 — — $881.48 $881.48 $881.48 2025-01-01
5573 OTHER Level 3 Imaging With Contrast 5 3 — — $706.51 $2,965.26 $845.59 2025-01-01
0948 RC Gamunex-c/gammaked 1 1 — — $784.97 $784.97 $784.97 2025-01-01
9512 OTHER Rbc Leukocytes Reduced 2 2 — — $86.21 $1,246.55 $666.38 2025-01-01
9217 OTHER Leuprolide Acetate Suspnsion 10 7 — — $308.26 $7,148.81 $592.71 2025-01-01
5781 OTHER Resuscitation And Cardioversion 8 6 — — $468.86 $6,332.73 $575.82 2025-01-01
9207 OTHER Injection, Bortezomib, 0.1mg 2 2 — — $554.06 $582.80 $568.43 2025-01-01
9120 OTHER Injection, Fulvestrant 4 3 — — $108.67 $6,036.24 $546.62 2025-01-01
7048 OTHER Alteplase Recombinant 5 4 — — $465.59 $4,037.95 $532.92 2025-01-01
1297 OTHER Ferumoxytol, Non-esrd 15 9 — — $41.01 $6,914.72 $529.76 2025-01-01
5592 OTHER Level 2 Nuclear Medicine And Related Services 17 8 — — $232.18 $1,575.96 $526.48 2025-01-01
1670 OTHER Tetanus Immune Globulin Inj 2 1 — — $300.28 $735.72 $518.00 2025-01-01
5442 OTHER Level 2 Nerve Injections 1 1 — — $502.33 $502.33 $502.33 2025-01-01
5024 OTHER Level 4 Type A Ed Visits 33 9 — — $138.09 $3,929.36 $498.67 2025-01-01
5524 OTHER Level 4 Imaging Without Contrast 27 8 — — $51.40 $2,463.70 $467.72 2025-01-01
5572 OTHER Level 2 Imaging With Contrast 26 9 — — $270.16 $3,940.00 $458.39 2025-01-01
1829 OTHER Penicillin G Benzathine Inj 2 2 — — $400.34 $404.23 $402.28 2025-01-01
5591 OTHER Level 1 Nuclear Medicine And Related Services 18 7 — — $272.55 $1,464.22 $374.98 2025-01-01
5411 OTHER Level 1 Gynecologic Procedures 12 7 — — $204.02 $1,406.40 $324.24 2025-01-01
5722 OTHER Level 2 Diagnostic Tests And Related Services 23 8 — — $225.18 $1,173.84 $323.65 2025-01-01
9097 OTHER Inj Retacrit Non-esrd Use 3 3 — — $153.27 $344.35 $300.34 2025-01-01
9193 OTHER Nivestym 1 1 — — $294.56 $294.56 $294.56 2025-01-01
5571 OTHER Level 1 Imaging With Contrast 27 9 — — $9.11 $5,562.41 $291.42 2025-01-01
5523 OTHER Level 3 Imaging Without Contrast 28 9 — — $171.12 $2,793.12 $283.67 2025-01-01
5051 OTHER Level 1 Skin Procedures 2 2 — — $253.65 $294.26 $273.95 2025-01-01
5052 OTHER Level 2 Skin Procedures 1 1 — — $261.85 $261.85 $261.85 2025-01-01
9357 OTHER Inj. Eptinezumab-jjmr 1 Mg 2 2 — — $181.97 $321.12 $251.55 2025-01-01
N801 OTHER Therapy Services 19 9 — — $89.32 $1,276.16 $236.44 2025-01-01
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