Hospital

PALESTINE REGIONAL WEST CAMPUS

Palestine, TX · CCN 453089 · Rates published

138 distinct procedures filed

23 distinct payers

7,684 rate rows

2025-01-01 last MRF observed · ⚠ 17 mo old

Data quality

370 of 7,684 rate rows are consumer-grade (4.8%)

7,314 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	7,314

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 17 months old.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=isrMqhUs7BhocHnUDZZv8A-
Found on page	https://hospitalpricedisclosure.com/default.aspx?pi=isrMqhUs7BhocHnUDZZv8A-
Discovered via	CMS hospital list
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-05-18
Content fingerprint	6374f6f42a202194… · 3,900,440 bytes · first seen 2026-05-09

Top 50 most expensive offerings

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

Code	Description	Payers	Min $	Max $	Avg median	vs national
207 MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	1	$40,582.99	$40,582.99	$40,582.99	nat. median $62,134 0.7× median
57 MS_DRG	Degenerative Nervous System Disorders Without Mcc	1	$40,082.86	$40,082.86	$40,082.86	nat. median $13,201 outlier · 3.0×
638 MS_DRG	Diabetes With Cc	2	$27,489.15	$27,489.15	$27,489.15	nat. median $9,826 outlier · 2.8×
492 MS_DRG	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc	1	$23,849.14	$23,849.14	$23,849.14	nat. median $35,489 0.7× median
853 MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	1	$23,609.59	$23,609.59	$23,609.59	nat. median $48,170 outlier · 0.5×
785 MS_DRG	Cesarean Section With Sterilization Without Cc/Mcc	3	$22,864.53	$22,864.53	$22,864.53	nat. median $10,028 outlier · 2.3×
255 MS_DRG	Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc	1	$20,392.00	$20,392.00	$20,392.00	nat. median $26,350 0.8× median
9005 OTHER	Reteplase Injection	2	$19,842.97	$19,842.97	$19,842.97	nat. median $2,916 outlier · 6.8×
982 MS_DRG	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc	2	$19,618.35	$19,618.35	$19,618.35	nat. median $24,493 0.8× median
56 MS_DRG	Degenerative Nervous System Disorders With Mcc	2	$18,677.78	$18,677.78	$18,677.78	nat. median $22,354 0.8× median
241 MS_DRG	Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc…	1	$18,199.54	$18,199.54	$18,199.54	nat. median $15,000 1.2× median
394 MS_DRG	Other Digestive System Diagnoses With Cc	1	$18,000.00	$18,000.00	$18,000.00	nat. median $10,260 1.8× median
662 MS_DRG	Minor Bladder Procedures With Mcc	1	$17,144.67	$17,144.67	$17,144.67	nat. median $29,682 0.6× median
481 MS_DRG	Hip And Femur Procedures Except Major Joint With Cc	1	$15,704.11	$15,704.11	$15,704.11	nat. median $21,532 0.7× median
233 MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	1	$15,326.40	$15,326.40	$15,326.40	nat. median $73,807 outlier · 0.2×
64 MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	1	$14,372.90	$14,372.90	$14,372.90	nat. median $20,254 0.7× median
617 MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	1	$13,664.71	$13,664.71	$13,664.71	nat. median $19,476 0.7× median
247 MS_DRG	Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc	1	$13,642.26	$13,642.26	$13,642.26	nat. median $16,343 0.8× median
854 MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Cc	1	$13,627.26	$13,627.26	$13,627.26	nat. median $20,421 0.7× median
52 MS_DRG	Spinal Disorders And Injuries With Cc/Mcc	1	$13,270.23	$13,270.23	$13,270.23	nat. median $19,132 0.7× median
70 MS_DRG	Nonspecific Cerebrovascular Disorders With Mcc	1	$12,827.84	$12,827.84	$12,827.84	nat. median $17,286 0.7× median
377 MS_DRG	Gastrointestinal Hemorrhage With Mcc	1	$12,679.57	$12,679.57	$12,679.57	nat. median $18,249 0.7× median
432 MS_DRG	Cirrhosis And Alcoholic Hepatitis With Mcc	1	$12,469.70	$12,469.70	$12,469.70	nat. median $19,682 0.6× median
177 MS_DRG	Respiratory Infections And Inflammations With Mcc	3	$12,045.78	$12,045.78	$12,045.78	nat. median $16,235 0.7× median
540 MS_DRG	Osteomyelitis With Cc	4	$11,965.91	$11,965.91	$11,965.91	nat. median $13,478 0.9× median
280 MS_DRG	Acute Myocardial Infarction, Discharged Alive With Mcc	2	$11,619.22	$11,619.22	$11,619.22	nat. median $16,529 0.7× median
585 MS_DRG	Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc	1	$11,454.33	$11,454.33	$11,454.33	nat. median $19,623 0.6× median
91 MS_DRG	Other Disorders Of Nervous System With Mcc	1	$11,422.49	$11,422.49	$11,422.49	nat. median $17,987 0.6× median
533 MS_DRG	Fractures Of Femur With Mcc	1	$11,355.59	$11,355.59	$11,355.59	nat. median $16,042 0.7× median
602 MS_DRG	Cellulitis With Mcc	1	$11,107.94	$11,107.94	$11,107.94	nat. median $14,838 0.7× median
637 MS_DRG	Diabetes With Mcc	1	$11,077.65	$11,077.65	$11,077.65	nat. median $14,789 0.7× median
871 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	4	$11,032.92	$11,032.92	$11,032.92	nat. median $19,635 0.6× median
682 MS_DRG	Renal Failure With Mcc	1	$10,766.50	$10,766.50	$10,766.50	nat. median $15,223 0.7× median
784 MS_DRG	Cesarean Section With Sterilization With Cc	2	$10,722.85	$10,722.85	$10,722.85	nat. median $11,116 1.0× median
660 MS_DRG	Kidney And Ureter Procedures For Non-neoplasm With Cc	1	$10,622.37	$10,622.37	$10,622.37	nat. median $14,195 0.7× median
208 MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	3	$10,123.70	$10,123.70	$10,123.70	nat. median $26,748 outlier · 0.4×
539 MS_DRG	Osteomyelitis With Mcc	3	$10,059.77	$10,059.77	$10,059.77	nat. median $19,718 0.5× median
388 MS_DRG	Gastrointestinal Obstruction With Mcc	1	$9,847.56	$9,847.56	$9,847.56	nat. median $15,091 0.7× median
140 MS_DRG	Major Head And Neck Procedures With Mcc	1	$9,830.10	$9,830.10	$9,830.10	nat. median $40,208 outlier · 0.2×
885 MS_DRG	Psychoses	5	$9,602.97	$9,602.97	$9,602.97	nat. median $12,884 0.7× median
330 MS_DRG	Major Small And Large Bowel Procedures With Cc	1	$9,370.00	$9,370.00	$9,370.00	nat. median $24,346 outlier · 0.4×
788 MS_DRG	Cesarean Section Without Sterilization Without Cc/Mcc	2	$9,109.76	$9,109.76	$9,109.76	nat. median $10,164 0.9× median
193 MS_DRG	Simple Pneumonia And Pleurisy With Mcc	2	$9,093.10	$9,093.10	$9,093.10	nat. median $13,648 0.7× median
426 MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	1	$8,899.66	$8,899.66	$8,899.66	nat. median $98,905 outlier · 0.1×
0943 OTHER	Octagam Injection	1	$8,875.90	$8,875.90	$8,875.90	nat. median $147 outlier · 60.4×
291 MS_DRG	Heart Failure And Shock With Mcc	1	$8,801.00	$8,801.00	$8,801.00	nat. median $13,522 0.7× median
189 MS_DRG	Pulmonary Edema And Respiratory Failure	3	$8,683.94	$8,683.94	$8,683.94	nat. median $13,021 0.7× median
917 MS_DRG	Poisoning And Toxic Effects Of Drugs With Mcc	1	$8,542.67	$8,542.67	$8,542.67	nat. median $15,271 0.6× median
689 MS_DRG	Kidney And Urinary Tract Infections With Mcc	1	$8,423.64	$8,423.64	$8,423.64	nat. median $12,152 0.7× median
256 MS_DRG	Upper Limb And Toe Amputation For Circulatory System Disorders With Cc	1	$8,379.41	$8,379.41	$8,379.41	nat. median $17,337 outlier · 0.5×

Other procedures at this hospital

Browse this hospital's 138 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

207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	1	1	—	—	$40,582.99	$40,582.99	$40,582.99	2025-01-01
57	MS_DRG	Degenerative Nervous System Disorders Without Mcc	1	1	—	—	$40,082.86	$40,082.86	$40,082.86	2025-01-01
638	MS_DRG	Diabetes With Cc	2	2	—	—	$27,489.15	$27,489.15	$27,489.15	2025-01-01
492	MS_DRG	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc	1	1	—	—	$23,849.14	$23,849.14	$23,849.14	2025-01-01
853	MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	1	1	—	—	$23,609.59	$23,609.59	$23,609.59	2025-01-01
785	MS_DRG	Cesarean Section With Sterilization Without Cc/Mcc	3	3	—	—	$22,864.53	$22,864.53	$22,864.53	2025-01-01
255	MS_DRG	Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc	1	1	—	—	$20,392.00	$20,392.00	$20,392.00	2025-01-01
9005	OTHER	Reteplase Injection	2	2	—	—	$19,842.97	$19,842.97	$19,842.97	2025-01-01
982	MS_DRG	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc	2	2	—	—	$19,618.35	$19,618.35	$19,618.35	2025-01-01
56	MS_DRG	Degenerative Nervous System Disorders With Mcc	2	2	—	—	$18,677.78	$18,677.78	$18,677.78	2025-01-01
241	MS_DRG	Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc…	1	1	—	—	$18,199.54	$18,199.54	$18,199.54	2025-01-01
394	MS_DRG	Other Digestive System Diagnoses With Cc	1	1	—	—	$18,000.00	$18,000.00	$18,000.00	2025-01-01
662	MS_DRG	Minor Bladder Procedures With Mcc	1	1	—	—	$17,144.67	$17,144.67	$17,144.67	2025-01-01
481	MS_DRG	Hip And Femur Procedures Except Major Joint With Cc	1	1	—	—	$15,704.11	$15,704.11	$15,704.11	2025-01-01
233	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	1	1	—	—	$15,326.40	$15,326.40	$15,326.40	2025-01-01
64	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	1	1	—	—	$14,372.90	$14,372.90	$14,372.90	2025-01-01
617	MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	1	1	—	—	$13,664.71	$13,664.71	$13,664.71	2025-01-01
247	MS_DRG	Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc	1	1	—	—	$13,642.26	$13,642.26	$13,642.26	2025-01-01
854	MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Cc	1	1	—	—	$13,627.26	$13,627.26	$13,627.26	2025-01-01
52	MS_DRG	Spinal Disorders And Injuries With Cc/Mcc	1	1	—	—	$13,270.23	$13,270.23	$13,270.23	2025-01-01
70	MS_DRG	Nonspecific Cerebrovascular Disorders With Mcc	2	1	—	—	$12,827.84	$12,827.84	$12,827.84	2025-01-01
377	MS_DRG	Gastrointestinal Hemorrhage With Mcc	1	1	—	—	$12,679.57	$12,679.57	$12,679.57	2025-01-01
432	MS_DRG	Cirrhosis And Alcoholic Hepatitis With Mcc	1	1	—	—	$12,469.70	$12,469.70	$12,469.70	2025-01-01
177	MS_DRG	Respiratory Infections And Inflammations With Mcc	3	3	—	—	$12,045.78	$12,045.78	$12,045.78	2025-01-01
540	MS_DRG	Osteomyelitis With Cc	4	4	—	—	$11,965.91	$11,965.91	$11,965.91	2025-01-01
280	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Mcc	2	2	—	—	$11,619.22	$11,619.22	$11,619.22	2025-01-01
585	MS_DRG	Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc	1	1	—	—	$11,454.33	$11,454.33	$11,454.33	2025-01-01
91	MS_DRG	Other Disorders Of Nervous System With Mcc	1	1	—	—	$11,422.49	$11,422.49	$11,422.49	2025-01-01
533	MS_DRG	Fractures Of Femur With Mcc	1	1	—	—	$11,355.59	$11,355.59	$11,355.59	2025-01-01
602	MS_DRG	Cellulitis With Mcc	1	1	—	—	$11,107.94	$11,107.94	$11,107.94	2025-01-01
637	MS_DRG	Diabetes With Mcc	1	1	—	—	$11,077.65	$11,077.65	$11,077.65	2025-01-01
871	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	4	4	—	—	$11,032.92	$11,032.92	$11,032.92	2025-01-01
682	MS_DRG	Renal Failure With Mcc	2	1	—	—	$10,766.50	$10,766.50	$10,766.50	2025-01-01
784	MS_DRG	Cesarean Section With Sterilization With Cc	2	2	—	—	$10,722.85	$10,722.85	$10,722.85	2025-01-01
660	MS_DRG	Kidney And Ureter Procedures For Non-neoplasm With Cc	1	1	—	—	$10,622.37	$10,622.37	$10,622.37	2025-01-01
208	MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	3	3	—	—	$10,123.70	$10,123.70	$10,123.70	2025-01-01
539	MS_DRG	Osteomyelitis With Mcc	3	3	—	—	$10,059.77	$10,059.77	$10,059.77	2025-01-01
388	MS_DRG	Gastrointestinal Obstruction With Mcc	1	1	—	—	$9,847.56	$9,847.56	$9,847.56	2025-01-01
140	MS_DRG	Major Head And Neck Procedures With Mcc	1	1	—	—	$9,830.10	$9,830.10	$9,830.10	2025-01-01
885	MS_DRG	Psychoses	8	5	—	—	$9,602.97	$9,602.97	$9,602.97	2025-01-01
330	MS_DRG	Major Small And Large Bowel Procedures With Cc	1	1	—	—	$9,370.00	$9,370.00	$9,370.00	2025-01-01
788	MS_DRG	Cesarean Section Without Sterilization Without Cc/Mcc	3	2	—	—	$9,109.76	$9,109.76	$9,109.76	2025-01-01
193	MS_DRG	Simple Pneumonia And Pleurisy With Mcc	3	2	—	—	$9,093.10	$9,093.10	$9,093.10	2025-01-01
426	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	1	1	—	—	$8,899.66	$8,899.66	$8,899.66	2025-01-01
0943	OTHER	Octagam Injection	1	1	—	—	$8,875.90	$8,875.90	$8,875.90	2025-01-01
291	MS_DRG	Heart Failure And Shock With Mcc	2	1	—	—	$8,801.00	$8,801.00	$8,801.00	2025-01-01
189	MS_DRG	Pulmonary Edema And Respiratory Failure	4	3	—	—	$8,683.94	$8,683.94	$8,683.94	2025-01-01
917	MS_DRG	Poisoning And Toxic Effects Of Drugs With Mcc	1	1	—	—	$8,542.67	$8,542.67	$8,542.67	2025-01-01
689	MS_DRG	Kidney And Urinary Tract Infections With Mcc	1	1	—	—	$8,423.64	$8,423.64	$8,423.64	2025-01-01
256	MS_DRG	Upper Limb And Toe Amputation For Circulatory System Disorders With Cc	1	1	—	—	$8,379.41	$8,379.41	$8,379.41	2025-01-01
463	MS_DRG	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	1	1	—	—	$8,242.75	$8,242.75	$8,242.75	2025-01-01
742	MS_DRG	Uterine And Adnexa Procedures For Non-malignancy With Cc/Mcc	2	1	—	—	$8,179.88	$8,179.88	$8,179.88	2025-01-01
552	MS_DRG	Medical Back Problems Without Mcc	1	1	—	—	$7,976.24	$7,976.24	$7,976.24	2025-01-01
743	MS_DRG	Uterine And Adnexa Procedures For Non-malignancy Without Cc/Mcc	2	2	—	—	$7,824.67	$7,824.67	$7,824.67	2025-01-01
9512	OTHER	Rbc Leukocytes Reduced	3	3	—	—	$7,726.48	$7,726.48	$7,726.48	2025-01-01
5442	OTHER	Level 2 Nerve Injections	2	2	—	—	$7,553.68	$7,553.68	$7,553.68	2025-01-01
65	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	1	1	—	—	$7,262.51	$7,262.51	$7,262.51	2025-01-01
639	MS_DRG	Diabetes Without Cc/Mcc	1	1	—	—	$7,091.96	$7,091.96	$7,091.96	2025-01-01
416	MS_DRG	Cholecystectomy Except By Laparoscope Without C.d.e. Without Cc/Mcc	1	1	—	—	$6,858.58	$6,858.58	$6,858.58	2025-01-01
566	MS_DRG	Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc	3	3	—	—	$6,807.50	$6,807.50	$6,807.50	2025-01-01
66	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	1	1	—	—	$6,634.58	$6,634.58	$6,634.58	2025-01-01
683	MS_DRG	Renal Failure With Cc	1	1	—	—	$6,502.51	$6,502.51	$6,502.51	2025-01-01
139	MS_DRG	Salivary Gland Procedures	1	1	—	—	$6,398.34	$6,398.34	$6,398.34	2025-01-01
5443	OTHER	Level 3 Nerve Injections	1	1	—	—	$6,212.58	$6,212.58	$6,212.58	2025-01-01
560	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Cc	4	4	—	—	$6,168.86	$6,168.86	$6,168.86	2025-01-01
805	MS_DRG	Vaginal Delivery Without Sterilization Or D&c With Mcc	1	1	—	—	$5,955.70	$5,955.70	$5,955.70	2025-01-01
872	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	2	2	—	—	$5,942.23	$5,942.23	$5,942.23	2025-01-01
281	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Cc	1	1	—	—	$5,870.76	$5,870.76	$5,870.76	2025-01-01
787	MS_DRG	Cesarean Section Without Sterilization With Cc	1	1	—	—	$5,760.01	$5,760.01	$5,760.01	2025-01-01
690	MS_DRG	Kidney And Urinary Tract Infections Without Mcc	3	2	—	—	$5,356.10	$5,356.10	$5,356.10	2025-01-01
389	MS_DRG	Gastrointestinal Obstruction With Cc	2	2	—	—	$5,294.35	$5,294.35	$5,294.35	2025-01-01
641	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	3	2	—	—	$5,195.10	$5,195.10	$5,195.10	2025-01-01
282	MS_DRG	Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc	1	1	—	—	$4,993.24	$4,993.24	$4,993.24	2025-01-01
812	MS_DRG	Red Blood Cell Disorders Without Mcc	2	2	—	—	$4,898.47	$4,898.47	$4,898.47	2025-01-01
5041	OTHER	Critical Care	7	6	—	—	$4,693.98	$4,693.98	$4,693.98	2025-01-01
640	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…	3	3	—	—	$4,423.06	$4,423.06	$4,423.06	2025-01-01
194	MS_DRG	Simple Pneumonia And Pleurisy With Cc	2	2	—	—	$4,422.81	$4,422.81	$4,422.81	2025-01-01
5673	OTHER	Level 3 Pathology	6	4	—	—	$4,342.72	$4,342.72	$4,342.72	2025-01-01
392	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	2	2	—	—	$4,085.73	$4,085.73	$4,085.73	2025-01-01
616	MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	1	1	—	—	$4,000.00	$4,000.00	$4,000.00	2025-01-01
807	MS_DRG	Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc	4	1	—	—	$3,966.74	$3,966.74	$3,966.74	2025-01-01
626	MS_DRG	Thyroid, Parathyroid And Thyroglossal Procedures With Cc	2	2	—	—	$3,928.58	$3,928.58	$3,928.58	2025-01-01
176	MS_DRG	Pulmonary Embolism Without Mcc	1	1	—	—	$3,917.85	$3,917.85	$3,917.85	2025-01-01
9201	OTHER	Rabies Ig Ht&sol Human Im/sc	1	1	—	—	$3,906.08	$3,906.08	$3,906.08	2025-01-01
191	MS_DRG	Chronic Obstructive Pulmonary Disease With Cc	3	2	—	—	$3,827.55	$3,827.55	$3,827.55	2025-01-01
603	MS_DRG	Cellulitis Without Mcc	2	2	—	—	$3,713.43	$3,713.43	$3,713.43	2025-01-01
5592	OTHER	Level 2 Nuclear Medicine And Related Services	3	3	—	—	$3,334.43	$3,334.43	$3,334.43	2025-01-01
561	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc	1	1	—	—	$3,307.36	$3,307.36	$3,307.36	2025-01-01
339	MS_DRG	Appendectomy With Complicated Principal Diagnosis With Cc	1	1	—	—	$3,200.05	$3,200.05	$3,200.05	2025-01-01
768	MS_DRG	Vaginal Delivery With O.r. Procedures Except Sterilization And/Or D&c	2	2	—	—	$3,197.32	$3,197.32	$3,197.32	2025-01-01
5724	OTHER	Level 4 Diagnostic Tests And Related Services	7	5	—	—	$3,019.78	$3,019.78	$3,019.78	2025-01-01
794	MS_DRG	Neonate With Other Significant Problems	1	1	—	—	$2,888.80	$2,888.80	$2,888.80	2025-01-01
513	MS_DRG	Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc	1	1	—	—	$2,800.09	$2,800.09	$2,800.09	2025-01-01
563	MS_DRG	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…	1	1	—	—	$2,550.04	$2,550.04	$2,550.04	2025-01-01
5154	OTHER	Level 4 Airway Endoscopy	1	1	—	—	$2,526.22	$2,526.22	$2,526.22	2025-01-01
5572	OTHER	Level 2 Imaging With Contrast	13	10	—	—	$2,514.04	$2,514.04	$2,514.04	2025-01-01
5691	OTHER	Level 1 Drug Administration	2	2	—	—	$2,493.18	$2,493.18	$2,493.18	2025-01-01
581	MS_DRG	Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc	1	1	—	—	$2,457.29	$2,457.29	$2,457.29	2025-01-01
5241	OTHER	Level 1 Blood Product Exchange And Related Services	6	4	—	—	$2,319.59	$2,319.59	$2,319.59	2025-01-01
806	MS_DRG	Vaginal Delivery Without Sterilization Or D&c With Cc	1	1	—	—	$2,312.68	$2,312.68	$2,312.68	2025-01-01
5731	OTHER	Level 1 Minor Procedures	1	1	—	—	$1,740.75	$1,740.75	$1,740.75	2025-01-01
5591	OTHER	Level 1 Nuclear Medicine And Related Services	5	3	—	—	$1,665.11	$1,665.11	$1,665.11	2025-01-01
1446	OTHER	Visualization Adjunct	1	1	—	—	$1,613.50	$1,613.50	$1,613.50	2025-01-01
5524	OTHER	Level 4 Imaging Without Contrast	13	9	—	—	$1,610.42	$1,610.42	$1,610.42	2025-01-01
5571	OTHER	Level 1 Imaging With Contrast	9	6	—	—	$1,575.55	$1,575.55	$1,575.55	2025-01-01
795	MS_DRG	Normal Newborn	2	2	—	—	$1,555.93	$1,555.93	$1,555.93	2025-01-01
5781	OTHER	Resuscitation And Cardioversion	3	3	—	—	$1,554.11	$1,554.11	$1,554.11	2025-01-01
5771	OTHER	Cardiac Rehabilitation	5	4	—	—	$1,539.59	$1,539.59	$1,539.59	2025-01-01
5072	OTHER	Level 2 Excision/ Biopsy/ Incision And Drainage	2	2	—	—	$1,539.26	$1,539.26	$1,539.26	2025-01-01
5672	OTHER	Level 2 Pathology	3	2	—	—	$1,410.38	$1,410.38	$1,410.38	2025-01-01
1232	OTHER	Mitomycin Injection	1	1	—	—	$1,405.62	$1,405.62	$1,405.62	2025-01-01
5401	OTHER	Dialysis	1	1	—	—	$1,386.31	$1,386.31	$1,386.31	2025-01-01
5732	OTHER	Level 2 Minor Procedures	1	1	—	—	$1,013.00	$1,013.00	$1,013.00	2025-01-01
343	MS_DRG	Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc	1	1	—	—	$1,013.00	$1,013.00	$1,013.00	2025-01-01
9139	OTHER	Rabies Vaccine, IM	3	2	—	—	$1,011.64	$1,011.64	$1,011.64	2025-01-01
5722	OTHER	Level 2 Diagnostic Tests And Related Services	10	7	—	—	$1,007.85	$1,007.85	$1,007.85	2025-01-01
5522	OTHER	Level 2 Imaging Without Contrast	18	13	—	—	$903.01	$903.01	$903.01	2025-01-01
5573	OTHER	Level 3 Imaging With Contrast	1	1	—	—	$834.12	$834.12	$834.12	2025-01-01
N801	OTHER	Therapy Services	18	13	—	—	$800.30	$800.30	$800.30	2025-01-01
5734	OTHER	Level 4 Minor Procedures	7	4	—	—	$702.99	$702.99	$702.99	2025-01-01
5061	OTHER	Hyperbaric Oxygen	1	1	—	—	$355.42	$355.42	$355.42	2025-01-01
5012	OTHER	Clinic Visits And Related Services	5	4	—	—	$313.40	$313.40	$313.40	2025-01-01
N900	OTHER	Non-covered Services	2	2	—	—	$310.88	$310.88	$310.88	2025-01-01
5022	OTHER	Level 2 Type A Ed Visits	18	13	—	—	$259.54	$259.54	$259.54	2025-01-01
N804	OTHER	Mammography Services	18	9	—	—	$234.72	$234.72	$234.72	2025-01-01
5721	OTHER	Level 1 Diagnostic Tests And Related Services	5	4	—	—	$210.00	$210.00	$210.00	2025-01-01
5021	OTHER	Level 1 Type A Ed Visits	11	9	—	—	$184.11	$184.11	$184.11	2025-01-01
1829	OTHER	Penicillin G Benzathine Inj	2	2	—	—	$146.84	$146.84	$146.84	2025-01-01
5671	OTHER	Level 1 Pathology	0	0	—	—	—	—	—	2025-01-01
5593	OTHER	Level 3 Nuclear Medicine And Related Services	0	0	—	—	—	—	—	2025-01-01
5025	OTHER	Level 5 Type A Ed Visits	0	0	—	—	—	—	—	2025-01-01
N800	OTHER	Clinical Diagnostic Lab Services	0	0	—	—	—	—	—	2025-01-01
5521	OTHER	Level 1 Imaging Without Contrast	0	0	—	—	—	—	—	2025-01-01
5523	OTHER	Level 3 Imaging Without Contrast	0	0	—	—	—	—	—	2025-01-01
N902	OTHER	Packaged Services	0	0	—	—	—	—	—	2025-01-01
5733	OTHER	Level 3 Minor Procedures	0	0	—	—	—	—	—	2025-01-01
5023	OTHER	Level 3 Type A Ed Visits	0	0	—	—	—	—	—	2025-01-01
5024	OTHER	Level 4 Type A Ed Visits	0	0	—	—	—	—	—	2025-01-01

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