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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

GUNDERSEN ST JOSEPHS HOSPITAL AND CLINICS

Hillsboro, WI · CCN 521304 · Rates published

21,581 distinct procedures filed
23 distinct payers
332,346 rate rows
2025-06-27 last MRF observed · ⚠ 16 mo old
Data quality

274,629 of 332,346 rate rows are consumer-grade (82.6%)

57,717 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 37,012
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 16,857
template filing: same amount across many unrelated codes — excluded 2,829
exceeds 10× this hospital's gross charge — excluded from medians 636
placeholder amount (≤ $0.02) — excluded from medians 180
percent-of-charges filed in the dollar field — excluded from medians 116
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 68
per-diem day rate — not a per-procedure price 19

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 16 months old.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://bellin-ghs.pt.panaceainc.com/MRFDownload/bellin-ghs/gundersen-st-josephs
Found on page https://www.gundersenhealth.org/cost-estimates/charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-13
Content fingerprint fc91e71dcac0706a… · 2,087,345 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 3 $3,500,000.00 $3,500,000.00 $3,500,000.00 nat. median
$3,685,267
0.9× median
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 3 $3,500,000.00 $3,500,000.00 $3,500,000.00 nat. median
$3,508,750
1.0× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 3 $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 3 $3,100,000.00 $3,100,000.00 $3,100,000.00 nat. median
$3,248,446
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 3 $2,800,000.00 $2,800,000.00 $2,800,000.00 nat. median
$2,968,000
0.9× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 4 $7,185.97 $2,391,705.69 $2,391,705.69 nat. median
$2,455,111
1.0× median
5834
APR_DRG 		Neonate With Ecmo 4 $411,851.82 $1,046,510.62 $1,046,510.62 nat. median
$390,362
outlier · 2.7×
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 4 $268,686.28 $682,728.66 $682,728.66 nat. median
$286,698
outlier · 2.4×
5833
APR_DRG 		Neonate With Ecmo 4 $266,810.37 $677,962.01 $677,962.01 nat. median
$268,208
outlier · 2.5×
24
APR_DRG 		Heart And/or Lung Transplant 4 $237,946.25 $604,618.61 $604,618.61 nat. median
$225,531
outlier · 2.7×
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 6 $16,507.81 $1,157,542.25 $578,771.12 nat. median
$621,313
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 6 $16,507.81 $1,106,338.60 $553,169.30 nat. median
$599,737
0.9× median
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 $209,226.61 $531,642.34 $531,642.34 nat. median
$135,803
outlier · 3.9×
Q2055
HCPCS 		Idecabtagene Vicleucel Car 6 $16,507.81 $1,055,244.92 $527,622.46 nat. median
$574,037
0.9× median
5832
APR_DRG 		Neonate With Ecmo 4 $204,861.54 $520,550.75 $520,550.75 nat. median
$201,678
outlier · 2.6×
1614
APR_DRG 		Implantable Heart Assist Systems 4 $203,918.48 $518,154.45 $518,154.45 nat. median
$202,242
outlier · 2.6×
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 6 $16,507.81 $1,032,884.57 $516,442.29 nat. median
$579,571
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 6 $16,507.81 $1,005,681.46 $502,840.73 nat. median
$562,501
0.9× median
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 $195,997.12 $498,026.37 $498,026.37 nat. median
$187,567
outlier · 2.7×
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 4 $193,312.43 $491,204.61 $491,204.61 nat. median
$173,018
outlier · 2.8×
Q2053
HCPCS 		Brexucabtagene Car Pos T 7 $16,507.81 $4,747,210.00 $489,399.16 nat. median
$513,770
1.0× median
18
MS_DRG 		Chimeric Antigen Receptor (car) T-cell Immunotherapy 4 $301,596.05 $690,785.36 $473,293.00 nat. median
$168,055
outlier · 2.8×
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 $176,662.50 $448,897.33 $448,897.33 nat. median
$198,578
outlier · 2.3×
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 4 $174,746.55 $444,028.92 $444,028.92 nat. median
$173,134
outlier · 2.6×
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 4 $173,438.36 $440,704.83 $440,704.83 nat. median
$181,762
outlier · 2.4×
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 4 $170,686.93 $433,713.48 $433,713.48 nat. median
$171,497
outlier · 2.5×
74
APR_DRG 		Allogeneic Bone Marrow Transplant 4 $162,015.68 $411,679.93 $411,679.93 nat. median
$149,836
outlier · 2.7×
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 4 $161,203.76 $409,616.84 $409,616.84 nat. median
$152,792
outlier · 2.7×
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 4 $158,270.15 $402,162.59 $402,162.59 nat. median
$168,439
outlier · 2.4×
5882
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 4 $153,336.58 $389,626.43 $389,626.43 nat. median
$152,383
outlier · 2.6×
5831
APR_DRG 		Neonate With Ecmo 4 $148,907.12 $378,371.23 $378,371.23 nat. median
$173,909
outlier · 2.2×
6034
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 4 $146,394.39 $371,986.43 $371,986.43 nat. median
$115,963
outlier · 3.2×
14
APR_DRG 		Liver Transplant And/or Intestinal Transplant 4 $144,084.26 $366,116.40 $366,116.40 nat. median
$136,566
outlier · 2.7×
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 4 $143,096.45 $363,606.38 $363,606.38 nat. median
$135,630
outlier · 2.7×
1
MS_DRG 		Heart Transplant Or Implant Of Heart Assist System With Mcc 4 $225,266.97 $515,958.75 $353,510.20 nat. median
$186,516
1.9× median
1613
APR_DRG 		Implantable Heart Assist Systems 4 $137,976.77 $350,597.35 $350,597.35 nat. median
$155,539
outlier · 2.3×
23
APR_DRG 		Heart And/or Lung Transplant 4 $133,605.42 $339,489.79 $339,489.79 nat. median
$117,894
outlier · 2.9×
5881
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 4 $131,431.13 $333,964.95 $333,964.95 nat. median
$130,862
outlier · 2.6×
5913
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 4 $126,689.93 $321,917.63 $321,917.63 nat. median
$120,079
outlier · 2.7×
113
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 $122,020.98 $310,053.87 $310,053.87 nat. median
$68,335
outlier · 4.5×
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 4 $118,972.73 $302,308.31 $302,308.31 nat. median
$106,926
outlier · 2.8×
6024
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 $117,527.92 $298,637.05 $298,637.05 nat. median
$124,731
outlier · 2.4×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 4 $189,715.50 $434,530.53 $297,719.48 nat. median
$131,925
outlier · 2.3×
1612
APR_DRG 		Implantable Heart Assist Systems 4 $110,756.13 $281,430.01 $281,430.01 nat. median
$109,992
outlier · 2.6×
5933
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 4 $109,765.96 $278,914.00 $278,914.00 nat. median
$114,205
outlier · 2.4×
3
MS_DRG 		Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 4 $171,392.36 $392,562.62 $268,965.08 nat. median
$145,435
1.8× median
1611
APR_DRG 		Implantable Heart Assist Systems 4 $105,524.17 $268,135.66 $268,135.66 nat. median
$108,954
outlier · 2.5×
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 4 $104,959.59 $266,701.08 $266,701.08 nat. median
$99,483
outlier · 2.7×
112
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 $104,771.13 $266,222.22 $266,222.22 nat. median
$63,564
outlier · 4.2×
64
APR_DRG 		Pancreas Transplant 4 $103,649.83 $263,373.00 $263,373.00 nat. median
$92,994
outlier · 2.8×

Other procedures at this hospital

Browse this hospital's 21,581 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
             
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 3 3 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2025-06-27
J1414 HCPCS Inj, Beqvez, Per Tx Dose 3 3 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2025-06-27
J1413 HCPCS Inj Delandistrogene Mox Rokl 3 3 — — $3,200,000.00 $3,200,000.00 $3,200,000.00 2025-06-27
J3394 HCPCS Inj, Lovotibeglogene Autotem 3 3 — — $3,100,000.00 $3,100,000.00 $3,100,000.00 2025-06-27
J3393 HCPCS Inj, Betibeglogene Autotemce 3 3 — — $2,800,000.00 $2,800,000.00 $2,800,000.00 2025-06-27
J3399 HCPCS Inj Onase Abepar-xioi Treat 4 4 — — $7,185.97 $2,391,705.69 $2,391,705.69 2025-06-27
5834 APR_DRG Neonate With Ecmo 4 4 — — $411,851.82 $1,046,510.62 $1,046,510.62 2025-06-27
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $268,686.28 $682,728.66 $682,728.66 2025-06-27
5833 APR_DRG Neonate With Ecmo 4 4 — — $266,810.37 $677,962.01 $677,962.01 2025-06-27
24 APR_DRG Heart And/or Lung Transplant 4 4 — — $237,946.25 $604,618.61 $604,618.61 2025-06-27
Q2042 HCPCS Tisagenlecleucel Car-pos T 10 6 — — $16,507.81 $1,157,542.25 $578,771.12 2025-06-27
Q2056 HCPCS Ciltacabtagene Car-pos T 10 6 — — $16,507.81 $1,106,338.60 $553,169.30 2025-06-27
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $209,226.61 $531,642.34 $531,642.34 2025-06-27
Q2055 HCPCS Idecabtagene Vicleucel Car 10 6 — — $16,507.81 $1,055,244.92 $527,622.46 2025-06-27
5832 APR_DRG Neonate With Ecmo 4 4 — — $204,861.54 $520,550.75 $520,550.75 2025-06-27
1614 APR_DRG Implantable Heart Assist Systems 4 4 — — $203,918.48 $518,154.45 $518,154.45 2025-06-27
Q2054 HCPCS Lisocabtagene Mara Car Pos T 10 6 — — $16,507.81 $1,032,884.57 $516,442.29 2025-06-27
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 10 6 — — $16,507.81 $1,005,681.46 $502,840.73 2025-06-27
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 4 — — $195,997.12 $498,026.37 $498,026.37 2025-06-27
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 4 4 — — $193,312.43 $491,204.61 $491,204.61 2025-06-27
Q2053 HCPCS Brexucabtagene Car Pos T 12 7 — — $16,507.81 $4,747,210.00 $489,399.16 2025-06-27
18 MS_DRG Chimeric Antigen Receptor (car) T-cell Immunotherapy 10 4 — — $301,596.05 $690,785.36 $473,293.00 2025-06-27
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 4 — — $176,662.50 $448,897.33 $448,897.33 2025-06-27
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $174,746.55 $444,028.92 $444,028.92 2025-06-27
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 4 4 — — $173,438.36 $440,704.83 $440,704.83 2025-06-27
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 4 4 — — $170,686.93 $433,713.48 $433,713.48 2025-06-27
74 APR_DRG Allogeneic Bone Marrow Transplant 4 4 — — $162,015.68 $411,679.93 $411,679.93 2025-06-27
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 4 4 — — $161,203.76 $409,616.84 $409,616.84 2025-06-27
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 4 4 — — $158,270.15 $402,162.59 $402,162.59 2025-06-27
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $153,336.58 $389,626.43 $389,626.43 2025-06-27
5831 APR_DRG Neonate With Ecmo 4 4 — — $148,907.12 $378,371.23 $378,371.23 2025-06-27
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 4 4 — — $146,394.39 $371,986.43 $371,986.43 2025-06-27
14 APR_DRG Liver Transplant And/or Intestinal Transplant 4 4 — — $144,084.26 $366,116.40 $366,116.40 2025-06-27
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $143,096.45 $363,606.38 $363,606.38 2025-06-27
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 10 4 — — $225,266.97 $515,958.75 $353,510.20 2025-06-27
1613 APR_DRG Implantable Heart Assist Systems 4 4 — — $137,976.77 $350,597.35 $350,597.35 2025-06-27
23 APR_DRG Heart And/or Lung Transplant 4 4 — — $133,605.42 $339,489.79 $339,489.79 2025-06-27
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 4 4 — — $131,431.13 $333,964.95 $333,964.95 2025-06-27
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 4 4 — — $126,689.93 $321,917.63 $321,917.63 2025-06-27
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $122,020.98 $310,053.87 $310,053.87 2025-06-27
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 4 4 — — $118,972.73 $302,308.31 $302,308.31 2025-06-27
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $117,527.92 $298,637.05 $298,637.05 2025-06-27
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 10 4 — — $189,715.50 $434,530.53 $297,719.48 2025-06-27
1612 APR_DRG Implantable Heart Assist Systems 4 4 — — $110,756.13 $281,430.01 $281,430.01 2025-06-27
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 4 4 — — $109,765.96 $278,914.00 $278,914.00 2025-06-27
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 10 4 — — $171,392.36 $392,562.62 $268,965.08 2025-06-27
1611 APR_DRG Implantable Heart Assist Systems 4 4 — — $105,524.17 $268,135.66 $268,135.66 2025-06-27
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 4 4 — — $104,959.59 $266,701.08 $266,701.08 2025-06-27
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $104,771.13 $266,222.22 $266,222.22 2025-06-27
64 APR_DRG Pancreas Transplant 4 4 — — $103,649.83 $263,373.00 $263,373.00 2025-06-27
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 4 4 — — $101,863.44 $258,833.81 $258,833.81 2025-06-27
8514 APR_DRG Gender Related Procedures 4 4 — — $100,501.08 $255,372.05 $255,372.05 2025-06-27
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 4 4 — — $99,693.08 $253,318.94 $253,318.94 2025-06-27
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 4 4 — — $99,002.08 $251,563.12 $251,563.12 2025-06-27
22 APR_DRG Heart And/or Lung Transplant 4 4 — — $97,231.39 $247,063.83 $247,063.83 2025-06-27
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 4 4 — — $96,071.62 $244,116.84 $244,116.84 2025-06-27
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 4 — — $93,588.73 $237,807.86 $237,807.86 2025-06-27
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 4 4 — — $93,338.24 $237,171.38 $237,171.38 2025-06-27
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $90,070.92 $228,869.14 $228,869.14 2025-06-27
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 4 4 — — $89,903.67 $228,444.15 $228,444.15 2025-06-27
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $89,730.92 $228,005.20 $228,005.20 2025-06-27
21 APR_DRG Heart And/or Lung Transplant 4 4 — — $89,418.40 $227,211.09 $227,211.09 2025-06-27
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $85,449.08 $217,125.10 $217,125.10 2025-06-27
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $83,366.66 $211,833.70 $211,833.70 2025-06-27
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 4 4 — — $81,220.64 $206,380.68 $206,380.68 2025-06-27
84 APR_DRG Autologous Bone Marrow Transplant 4 4 — — $80,301.92 $204,046.24 $204,046.24 2025-06-27
73 APR_DRG Allogeneic Bone Marrow Transplant 4 4 — — $79,182.98 $201,203.01 $201,203.01 2025-06-27
4404 APR_DRG Kidney Transplant 4 4 — — $75,902.30 $192,866.85 $192,866.85 2025-06-27
8634 APR_DRG Neonatal Aftercare 4 4 — — $75,015.78 $190,614.21 $190,614.21 2025-06-27
63 APR_DRG Pancreas Transplant 4 4 — — $73,634.57 $187,104.57 $187,104.57 2025-06-27
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 4 4 — — $73,344.03 $186,366.33 $186,366.33 2025-06-27
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 4 4 — — $73,000.89 $185,494.40 $185,494.40 2025-06-27
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 10 4 — — $113,000.15 $258,819.21 $177,330.51 2025-06-27
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 4 4 — — $69,473.66 $176,531.74 $176,531.74 2025-06-27
1674 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 4 4 — — $68,116.00 $173,081.95 $173,081.95 2025-06-27
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 4 4 — — $67,655.86 $171,912.74 $171,912.74 2025-06-27
13 APR_DRG Liver Transplant And/or Intestinal Transplant 4 4 — — $67,403.01 $171,270.26 $171,270.26 2025-06-27
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $66,668.83 $169,404.71 $169,404.71 2025-06-27
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 4 — — $65,962.12 $167,608.98 $167,608.98 2025-06-27
426 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 5 3 — — $97,106.96 $191,877.90 $165,824.12 2025-06-27
1784 APR_DRG External Heart Assist Systems 4 4 — — $64,835.33 $164,745.80 $164,745.80 2025-06-27
14 MS_DRG Allogeneic Bone Marrow Transplant 10 4 — — $104,777.45 $239,985.67 $164,426.67 2025-06-27
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 4 4 — — $64,664.15 $164,310.83 $164,310.83 2025-06-27
7 MS_DRG Lung Transplant 10 4 — — $104,513.55 $239,381.21 $164,012.52 2025-06-27
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 4 4 — — $64,474.91 $163,829.98 $163,829.98 2025-06-27
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $64,337.49 $163,480.81 $163,480.81 2025-06-27
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 4 4 — — $63,749.36 $161,986.37 $161,986.37 2025-06-27
72 APR_DRG Allogeneic Bone Marrow Transplant 4 4 — — $63,495.73 $161,341.90 $161,341.90 2025-06-27
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 4 4 — — $63,184.00 $160,549.79 $160,549.79 2025-06-27
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $62,350.87 $158,432.83 $158,432.83 2025-06-27
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 4 4 — — $61,864.03 $157,195.77 $157,195.77 2025-06-27
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 4 4 — — $61,797.29 $157,026.18 $157,026.18 2025-06-27
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 4 4 — — $61,744.68 $156,892.49 $156,892.49 2025-06-27
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 4 4 — — $61,174.60 $155,443.94 $155,443.94 2025-06-27
71 APR_DRG Allogeneic Bone Marrow Transplant 4 4 — — $60,321.06 $153,275.11 $153,275.11 2025-06-27
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 4 4 — — $59,911.17 $152,233.58 $152,233.58 2025-06-27
62 APR_DRG Pancreas Transplant 4 4 — — $58,958.69 $149,813.35 $149,813.35 2025-06-27
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $58,230.79 $147,963.75 $147,963.75 2025-06-27
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 4 4 — — $57,751.02 $146,744.65 $146,744.65 2025-06-27
850 MS_DRG Acute Leukemia With Other Procedures 5 3 — — $85,394.31 $168,734.37 $145,823.09 2025-06-27
9104 APR_DRG Craniotomy For Multiple Significant Trauma 4 4 — — $57,195.08 $145,332.01 $145,332.01 2025-06-27
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 4 4 — — $56,907.68 $144,601.75 $144,601.75 2025-06-27
1834 APR_DRG Percutaneous Structural Cardiac Procedures 4 4 — — $56,502.51 $143,572.20 $143,572.20 2025-06-27
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 4 4 — — $56,261.44 $142,959.66 $142,959.66 2025-06-27
3124 APR_DRG Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 4 4 — — $56,105.97 $142,564.60 $142,564.60 2025-06-27
7404 APR_DRG Mental Illness Diagnosis With O.r. Procedure 4 4 — — $56,031.37 $142,375.05 $142,375.05 2025-06-27
6904 APR_DRG Acute Leukemia 4 4 — — $55,732.99 $141,616.86 $141,616.86 2025-06-27
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $55,370.21 $140,695.05 $140,695.05 2025-06-27
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 4 4 — — $55,330.95 $140,595.29 $140,595.29 2025-06-27
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 10 4 — — $88,126.52 $201,847.84 $138,296.46 2025-06-27
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 4 4 — — $54,360.41 $138,129.16 $138,129.16 2025-06-27
914 APR_DRG Other Major Head And Neck Procedures 4 4 — — $54,197.87 $137,716.15 $137,716.15 2025-06-27
12 APR_DRG Liver Transplant And/or Intestinal Transplant 4 4 — — $54,146.83 $137,586.45 $137,586.45 2025-06-27
212 MS_DRG Concomitant Aortic And Mitral Valve Procedures 10 4 — — $87,120.48 $199,543.57 $136,717.68 2025-06-27
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 4 4 — — $53,639.57 $136,297.52 $136,297.52 2025-06-27
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 4 4 — — $53,556.34 $136,086.03 $136,086.03 2025-06-27
214 APR_DRG Open Craniotomy Except Trauma 4 4 — — $53,312.92 $135,467.50 $135,467.50 2025-06-27
7594 APR_DRG Eating Disorders 4 4 — — $52,614.85 $133,693.72 $133,693.72 2025-06-27
5 MS_DRG Liver Transplant With Mcc Or Intestinal Transplant 10 4 — — $85,165.17 $195,065.06 $133,649.23 2025-06-27
1794 APR_DRG Defibrillator Implants 4 4 — — $52,544.18 $133,514.15 $133,514.15 2025-06-27
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 4 4 — — $52,526.91 $133,470.25 $133,470.25 2025-06-27
215 MS_DRG Other Heart Assist System Implant 10 4 — — $84,728.52 $194,064.95 $132,964.00 2025-06-27
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 4 4 — — $52,079.33 $132,332.96 $132,332.96 2025-06-27
429 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion With Mcc 5 3 — — $77,317.36 $152,774.77 $132,030.53 2025-06-27
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 4 4 — — $51,886.95 $131,844.12 $131,844.12 2025-06-27
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 4 4 — — $51,388.33 $130,577.14 $130,577.14 2025-06-27
1204 APR_DRG Major Respiratory And Chest Procedures 4 4 — — $51,144.13 $129,956.62 $129,956.62 2025-06-27
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 4 4 — — $50,733.45 $128,913.10 $128,913.10 2025-06-27
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 4 4 — — $50,161.81 $127,460.56 $127,460.56 2025-06-27
274 APR_DRG Other Open Craniotomy 4 4 — — $49,973.35 $126,981.70 $126,981.70 2025-06-27
2324 APR_DRG Gastric Fundoplication 4 4 — — $49,634.14 $126,119.75 $126,119.75 2025-06-27
6954 APR_DRG Chemotherapy For Acute Leukemia 4 4 — — $49,389.93 $125,499.23 $125,499.23 2025-06-27
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 4 4 — — $49,136.30 $124,854.76 $124,854.76 2025-06-27
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 4 4 — — $49,082.12 $124,717.09 $124,717.09 2025-06-27
234 APR_DRG Spinal Procedures 4 4 — — $48,947.06 $124,373.91 $124,373.91 2025-06-27
1694 APR_DRG Major Abdominal Vascular Procedures 4 4 — — $48,761.75 $123,903.03 $123,903.03 2025-06-27
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 4 4 — — $48,185.39 $122,438.52 $122,438.52 2025-06-27
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 4 4 — — $47,775.51 $121,397.00 $121,397.00 2025-06-27
204 APR_DRG Open Craniotomy For Trauma 4 4 — — $47,763.73 $121,367.07 $121,367.07 2025-06-27
1783 APR_DRG External Heart Assist Systems 4 4 — — $47,757.45 $121,351.11 $121,351.11 2025-06-27
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 10 4 — — $77,181.58 $176,779.20 $121,120.63 2025-06-27
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 4 4 — — $47,144.18 $119,792.81 $119,792.81 2025-06-27
11 APR_DRG Liver Transplant And/or Intestinal Transplant 4 4 — — $47,079.80 $119,629.20 $119,629.20 2025-06-27
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $46,050.36 $117,013.43 $117,013.43 2025-06-27
4403 APR_DRG Kidney Transplant 4 4 — — $45,999.32 $116,883.74 $116,883.74 2025-06-27
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 4 4 — — $45,971.06 $116,811.91 $116,811.91 2025-06-27
1782 APR_DRG External Heart Assist Systems 4 4 — — $45,909.02 $116,654.29 $116,654.29 2025-06-27
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 4 4 — — $45,312.25 $115,137.90 $115,137.90 2025-06-27
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 4 4 — — $45,101.03 $114,601.17 $114,601.17 2025-06-27
4414 APR_DRG Major Bladder Procedures 4 4 — — $44,823.06 $113,894.86 $113,894.86 2025-06-27
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 4 4 — — $44,513.68 $113,108.73 $113,108.73 2025-06-27
894 APR_DRG Major Cranial Or Facial Bone Procedures 4 4 — — $44,391.18 $112,797.47 $112,797.47 2025-06-27
427 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 5 3 — — $65,842.03 $130,100.16 $112,434.75 2025-06-27
61 APR_DRG Pancreas Transplant 4 4 — — $44,092.80 $112,039.27 $112,039.27 2025-06-27
2614 APR_DRG Major Biliary Tract Procedures 4 4 — — $43,975.80 $111,741.98 $111,741.98 2025-06-27
1764 APR_DRG Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 4 4 — — $43,650.71 $110,915.95 $110,915.95 2025-06-27
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 4 4 — — $43,296.58 $110,016.09 $110,016.09 2025-06-27
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 4 4 — — $43,175.65 $109,708.82 $109,708.82 2025-06-27
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 4 4 — — $43,090.06 $109,491.34 $109,491.34 2025-06-27
5144 APR_DRG Female Reproductive System Reconstructive Procedures 4 4 — — $42,768.90 $108,675.28 $108,675.28 2025-06-27
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 4 4 — — $42,680.17 $108,449.82 $108,449.82 2025-06-27
5104 APR_DRG Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced… 4 4 — — $42,598.51 $108,242.31 $108,242.31 2025-06-27
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 4 4 — — $42,571.81 $108,174.47 $108,174.47 2025-06-27
1814 APR_DRG Lower Extremity Arterial Procedures 4 4 — — $42,447.75 $107,859.22 $107,859.22 2025-06-27
1653 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 4 4 — — $42,285.21 $107,446.21 $107,446.21 2025-06-27
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 4 4 — — $42,239.66 $107,330.48 $107,330.48 2025-06-27
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 4 4 — — $41,974.26 $106,656.09 $106,656.09 2025-06-27
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 4 4 — — $41,974.26 $106,656.09 $106,656.09 2025-06-27
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 4 4 — — $41,913.01 $106,500.46 $106,500.46 2025-06-27
231 MS_DRG Coronary Bypass With Ptca With Mcc 10 4 — — $67,767.30 $155,216.43 $106,346.85 2025-06-27
456 MS_DRG Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex… 10 4 — — $67,729.72 $155,130.34 $106,287.86 2025-06-27
447 MS_DRG Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall… 5 3 — — $62,152.57 $122,809.99 $106,134.46 2025-06-27
224 APR_DRG Ventricular Shunt Procedures 4 4 — — $41,313.10 $104,976.09 $104,976.09 2025-06-27
7584 APR_DRG Behavioral Disorders 4 4 — — $40,980.94 $104,132.10 $104,132.10 2025-06-27
83 APR_DRG Autologous Bone Marrow Transplant 4 4 — — $40,972.31 $104,110.15 $104,110.15 2025-06-27
3032 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $40,860.81 $103,826.82 $103,826.82 2025-06-27
2644 APR_DRG Other Hepatobiliary, Pancreas And Abdominal Procedures 4 4 — — $40,819.19 $103,721.08 $103,721.08 2025-06-27
3634 APR_DRG Breast Procedures Except Mastectomy 4 4 — — $40,666.07 $103,332.00 $103,332.00 2025-06-27
5114 APR_DRG Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 4 4 — — $40,589.90 $103,138.46 $103,138.46 2025-06-27
264 APR_DRG Other Nervous System And Related Procedures 4 4 — — $40,553.00 $103,044.69 $103,044.69 2025-06-27
1214 APR_DRG Other Respiratory And Chest Procedures 4 4 — — $40,536.51 $103,002.79 $103,002.79 2025-06-27
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 4 4 — — $40,504.31 $102,920.98 $102,920.98 2025-06-27
3214 APR_DRG Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 4 4 — — $40,472.12 $102,839.18 $102,839.18 2025-06-27
2304 APR_DRG Major Small Bowel Procedures 4 4 — — $40,463.48 $102,817.23 $102,817.23 2025-06-27
4402 APR_DRG Kidney Transplant 4 4 — — $40,205.93 $102,162.79 $102,162.79 2025-06-27
790 MS_DRG Extreme Immaturity Or Respiratory Distress Syndrome, Neonate 7 3 — — $55,108.30 $108,890.90 $101,893.87 2025-06-27
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $40,081.86 $101,847.54 $101,847.54 2025-06-27
C9076 HCPCS Lisocabtagene Car Pos T 4 4 — — $16,507.81 $101,686.69 $101,686.69 2025-06-27
C9073 HCPCS Brexucabtagene Autoleucel Ca 4 4 — — $16,507.81 $101,686.69 $101,686.69 2025-06-27
Q2040 HCPCS Tisagenlecleucel Car-pos T 4 4 — — $16,507.81 $101,686.69 $101,686.69 2025-06-27
C9081 HCPCS Idecabtagene Car Pos T 4 4 — — $16,507.81 $101,686.69 $101,686.69 2025-06-27
C9098 HCPCS Ciltacabtagene Car Pos T 4 4 — — $16,507.81 $101,686.69 $101,686.69 2025-06-27
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 4 4 — — $39,818.03 $101,177.13 $101,177.13 2025-06-27
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 10 4 — — $64,466.07 $147,655.17 $101,166.24 2025-06-27
5184 APR_DRG Other Female Reproductive System And Related Procedures 4 4 — — $39,684.54 $100,837.94 $100,837.94 2025-06-27
10 MS_DRG Pancreas Transplant 10 4 — — $63,761.52 $146,041.44 $100,060.59 2025-06-27
Q0480 HCPCS Driver Pneumatic Vad, Rep 6 3 — — $99,999.95 $99,999.95 $99,999.95 2025-06-27
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 4 4 — — $39,313.91 $99,896.18 $99,896.18 2025-06-27
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 10 4 — — $63,396.05 $145,204.35 $99,487.06 2025-06-27
1673 APR_DRG Other Cardiothoracic And Thoracic Vascular Procedures 4 4 — — $39,141.16 $99,457.23 $99,457.23 2025-06-27
4054 APR_DRG Other Procedures For Endocrine, Nutritional And Metabolic Disorders 4 4 — — $38,950.35 $98,972.38 $98,972.38 2025-06-27
1781 APR_DRG External Heart Assist Systems 4 4 — — $38,947.99 $98,966.40 $98,966.40 2025-06-27
8633 APR_DRG Neonatal Aftercare 4 4 — — $38,858.48 $98,738.94 $98,738.94 2025-06-27
1824 APR_DRG Other Peripheral Vascular And Related Procedures 4 4 — — $38,750.12 $98,463.59 $98,463.59 2025-06-27
233 MS_DRG Coronary Bypass With Cardiac Catheterization With Mcc 10 4 — — $62,509.16 $143,173.00 $98,095.27 2025-06-27
1622 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 4 4 — — $38,593.86 $98,066.54 $98,066.54 2025-06-27
317 MS_DRG Concomitant Left Atrial Appendage Closure And Cardiac Ablation 5 3 — — $57,347.93 $113,316.29 $97,929.85 2025-06-27
3043 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 4 4 — — $38,534.18 $97,914.90 $97,914.90 2025-06-27
6224 APR_DRG Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $38,443.09 $97,683.45 $97,683.45 2025-06-27
4014 APR_DRG Adrenal Procedures 4 4 — — $38,401.48 $97,577.70 $97,577.70 2025-06-27
9103 APR_DRG Craniotomy For Multiple Significant Trauma 4 4 — — $38,354.36 $97,457.99 $97,457.99 2025-06-27
4034 APR_DRG Procedures For Obesity 4 4 — — $38,315.89 $97,360.22 $97,360.22 2025-06-27
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 10 4 — — $61,878.18 $141,727.79 $97,105.08 2025-06-27
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 4 4 — — $38,034.78 $96,645.92 $96,645.92 2025-06-27
1793 APR_DRG Defibrillator Implants 4 4 — — $38,029.28 $96,631.95 $96,631.95 2025-06-27
1833 APR_DRG Percutaneous Structural Cardiac Procedures 4 4 — — $37,840.83 $96,153.09 $96,153.09 2025-06-27
A9513 HCPCS Lutetium Lu 177 Dotatat Ther 4 4 — — $15,552.92 $95,804.65 $95,804.65 2025-06-27
C9031 HCPCS Lutetium Lu 177 Dotatate, Tx 4 4 — — $15,552.92 $95,804.65 $95,804.65 2025-06-27
4401 APR_DRG Kidney Transplant 4 4 — — $37,090.94 $94,247.63 $94,247.63 2025-06-27
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 10 4 — — $59,692.55 $136,721.75 $93,675.18 2025-06-27
6504 APR_DRG Splenic Procedures 4 4 — — $36,796.48 $93,499.41 $93,499.41 2025-06-27
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 3 1 — — $93,216.70 $93,216.70 $93,216.70 2025-06-27
3254 APR_DRG Non-elective Or Complex Knee Joint Replacement 4 4 — — $36,613.52 $93,034.52 $93,034.52 2025-06-27
7114 APR_DRG Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 4 4 — — $36,561.69 $92,902.83 $92,902.83 2025-06-27
8423 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 4 4 — — $36,556.20 $92,888.86 $92,888.86 2025-06-27
6092 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 4 — — $36,392.87 $92,473.85 $92,473.85 2025-06-27
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 4 4 — — $36,379.52 $92,439.93 $92,439.93 2025-06-27
4474 APR_DRG Other Kidney, Urinary Tract And Related Procedures 4 4 — — $36,293.15 $92,220.46 $92,220.46 2025-06-27
6143 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 4 4 — — $36,059.15 $91,625.87 $91,625.87 2025-06-27
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 4 4 — — $36,055.22 $91,615.89 $91,615.89 2025-06-27
5124 APR_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy 4 4 — — $35,904.46 $91,232.81 $91,232.81 2025-06-27
4424 APR_DRG Kidney And Urinary Tract Procedures For Malignancy 4 4 — — $35,879.33 $91,168.96 $91,168.96 2025-06-27
1704 APR_DRG Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock 4 4 — — $35,763.12 $90,873.66 $90,873.66 2025-06-27
1663 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 4 4 — — $35,544.04 $90,316.99 $90,316.99 2025-06-27
9514 APR_DRG Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 4 4 — — $35,383.07 $89,907.96 $89,907.96 2025-06-27
7934 APR_DRG Moderately Extensive O.r. Procedures For Other Complications Of Treatment 4 4 — — $35,253.51 $89,578.74 $89,578.74 2025-06-27
1754 APR_DRG Percutaneous Cardiac Intervention Without Ami 4 4 — — $35,251.94 $89,574.75 $89,574.75 2025-06-27
3154 APR_DRG Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement 4 4 — — $35,094.11 $89,173.71 $89,173.71 2025-06-27
294 APR_DRG Other Percutaneous Intracranial Procedures 4 4 — — $35,072.90 $89,119.84 $89,119.84 2025-06-27
504 APR_DRG Non-bacterial Infections Of Nervous System Except Viral Meningitis 4 4 — — $35,058.77 $89,083.92 $89,083.92 2025-06-27
275 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc 10 4 — — $56,516.07 $129,446.24 $88,690.35 2025-06-27
2314 APR_DRG Major Large Bowel Procedures 4 4 — — $34,899.37 $88,678.89 $88,678.89 2025-06-27
244 APR_DRG Open Extracranial Vascular Procedures 4 4 — — $34,759.60 $88,323.73 $88,323.73 2025-06-27
4804 APR_DRG Major Male Pelvic Procedures 4 4 — — $34,757.24 $88,317.75 $88,317.75 2025-06-27
T2025 HCPCS Waiver Service, Nos 3 3 — — $88,188.00 $88,188.00 $88,188.00 2025-06-27
3104 APR_DRG Vertebral And Intervertebral Spinal Procedures Including Disc Procedures 4 4 — — $34,699.92 $88,172.09 $88,172.09 2025-06-27
6233 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 4 4 — — $34,604.91 $87,930.67 $87,930.67 2025-06-27
6091 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 4 4 — — $34,573.50 $87,850.86 $87,850.86 2025-06-27
82 APR_DRG Autologous Bone Marrow Transplant 4 4 — — $34,517.75 $87,709.19 $87,709.19 2025-06-27
870 MS_DRG Septicemia Or Severe Sepsis With Mv >96 Hours 10 4 — — $55,632.38 $127,422.21 $87,303.59 2025-06-27
428 MS_DRG Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit… 5 3 — — $51,023.01 $100,818.60 $87,129.13 2025-06-27
3204 APR_DRG Other Musculoskeletal System And Connective Tissue Procedures 4 4 — — $34,249.99 $87,028.81 $87,028.81 2025-06-27
2294 APR_DRG Other Digestive System And Abdominal Procedures 4 4 — — $34,213.08 $86,935.04 $86,935.04 2025-06-27
430 MS_DRG Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc 5 3 — — $50,711.54 $100,203.15 $86,597.25 2025-06-27
3134 APR_DRG Knee And Lower Leg Procedures Except Foot 4 4 — — $34,062.32 $86,551.95 $86,551.95 2025-06-27
3094 APR_DRG Other Significant Hip And Femur Surgery 4 4 — — $33,986.15 $86,358.41 $86,358.41 2025-06-27
6082 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 4 4 — — $33,935.90 $86,230.71 $86,230.71 2025-06-27
913 APR_DRG Other Major Head And Neck Procedures 4 4 — — $33,897.42 $86,132.95 $86,132.95 2025-06-27
6312 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 4 4 — — $33,821.25 $85,939.41 $85,939.41 2025-06-27
955 MS_DRG Craniotomy For Multiple Significant Trauma 10 4 — — $54,607.14 $125,073.97 $85,694.68 2025-06-27
2224 APR_DRG Other Stomach, Esophageal And Duodenal Procedures 4 4 — — $33,674.42 $85,566.30 $85,566.30 2025-06-27
5194 APR_DRG Uterine And Adnexa Procedures For Leiomyoma 4 4 — — $33,610.81 $85,404.68 $85,404.68 2025-06-27
2234 APR_DRG Other Small And Large Bowel Procedures 4 4 — — $33,399.59 $84,867.96 $84,867.96 2025-06-27
893 APR_DRG Major Cranial Or Facial Bone Procedures 4 4 — — $33,380.74 $84,820.07 $84,820.07 2025-06-27
4444 APR_DRG Renal Dialysis Access Device Procedures 4 4 — — $33,197.00 $84,353.18 $84,353.18 2025-06-27
1621 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 4 4 — — $33,197.00 $84,353.18 $84,353.18 2025-06-27
1652 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 4 4 — — $33,061.94 $84,010.00 $84,010.00 2025-06-27
51 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 4 4 — — $33,054.09 $83,990.05 $83,990.05 2025-06-27
9524 APR_DRG Non-extensive O.r. Procedure Unrelated To Principal Diagnosis 4 4 — — $33,043.88 $83,964.11 $83,964.11 2025-06-27
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 10 4 — — $53,412.37 $122,337.41 $83,819.73 2025-06-27
213 APR_DRG Open Craniotomy Except Trauma 4 4 — — $32,944.16 $83,710.71 $83,710.71 2025-06-27
268 MS_DRG Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc 10 4 — — $53,322.00 $122,130.43 $83,677.91 2025-06-27
0459T OTHER Relocaj Rplcmt Aortic Ventr 4 4 — — $13,580.40 $83,654.13 $83,654.13 2025-06-27
0453T OTHER Insj/rplcmt Mech-elec Ntrfce 4 4 — — $13,580.40 $83,654.13 $83,654.13 2025-06-27
0451T OTHER Insj/rplcmt Aortic Ventr Sys 4 4 — — $13,580.40 $83,654.13 $83,654.13 2025-06-27
0454T OTHER Insj/rplcmt Subq Electrode 4 4 — — $13,580.40 $83,654.13 $83,654.13 2025-06-27
0452T OTHER Insj/rplcmt Dev Vasc Seal 4 4 — — $13,580.40 $83,654.13 $83,654.13 2025-06-27
1303 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 4 4 — — $32,872.70 $83,529.15 $83,529.15 2025-06-27
3054 APR_DRG Amputation Of Lower Limb Except Toes 4 4 — — $32,836.58 $83,437.36 $83,437.36 2025-06-27
2274 APR_DRG Hernia Procedures Except Inguinal, Femoral And Umbilical 4 4 — — $32,812.24 $83,375.51 $83,375.51 2025-06-27
4234 APR_DRG Inborn Errors Of Metabolism 4 4 — — $32,806.74 $83,361.55 $83,361.55 2025-06-27
984 APR_DRG Other Ear, Nose, Mouth, Throat, Craniofacial, And Neck Procedures 4 4 — — $32,765.91 $83,257.79 $83,257.79 2025-06-27
6914 APR_DRG Lymphoma, Myeloma And Non-acute Leukemia 4 4 — — $32,628.50 $82,908.62 $82,908.62 2025-06-27
3031 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 4 4 — — $32,531.13 $82,661.21 $82,661.21 2025-06-27
1632 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 4 4 — — $32,419.63 $82,377.89 $82,377.89 2025-06-27
2244 APR_DRG Peritoneal Adhesiolysis 4 4 — — $32,307.34 $82,092.57 $82,092.57 2025-06-27
6903 APR_DRG Acute Leukemia 4 4 — — $32,275.14 $82,010.76 $82,010.76 2025-06-27
450 MS_DRG Single Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomically … 5 3 — — $47,741.43 $94,334.38 $81,525.36 2025-06-27
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 10 4 — — $51,719.36 $118,459.70 $81,162.90 2025-06-27
4844 APR_DRG Other Male Reproductive System And Related Procedures 4 4 — — $31,931.22 $81,136.84 $81,136.84 2025-06-27
4434 APR_DRG Kidney And Urinary Tract Procedures For Non-malignancy 4 4 — — $31,902.95 $81,065.01 $81,065.01 2025-06-27
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 10 4 — — $51,644.99 $118,289.35 $81,046.19 2025-06-27
6122 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 4 4 — — $31,673.66 $80,482.40 $80,482.40 2025-06-27
1804 APR_DRG Other Circulatory System Procedures 4 4 — — $31,463.22 $79,947.67 $79,947.67 2025-06-27
1744 APR_DRG Percutaneous Cardiac Intervention With Ami 4 4 — — $31,309.32 $79,556.60 $79,556.60 2025-06-27
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 10 4 — — $50,576.57 $115,842.20 $79,369.52 2025-06-27
3174 APR_DRG Tendon, Muscle And Other Soft Tissue Procedures 4 4 — — $31,221.37 $79,333.14 $79,333.14 2025-06-27
1832 APR_DRG Percutaneous Structural Cardiac Procedures 4 4 — — $31,154.63 $79,163.54 $79,163.54 2025-06-27
233 APR_DRG Spinal Procedures 4 4 — — $31,003.08 $78,778.46 $78,778.46 2025-06-27
1792 APR_DRG Defibrillator Implants 4 4 — — $30,996.01 $78,760.50 $78,760.50 2025-06-27
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