Hospital

GUNDERSEN ST JOSEPHS HOSPITAL AND CLINICS

Hillsboro, WI · CCN 521304 · Rates published

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You selected 93350 (HCPCS)

HCHG 93350 ECHOCARDIOGRAPHY, TRANSTHORACIC, W/EXERCISE, CONTRAST

This hospital’s price: $1,718 across 22 payers · range $138-$5,123

Source: https://bellin-ghs.pt.panaceainc.com/MRFDownload/bellin-ghs/gundersen-st-josephs · observed 2025-06-27

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

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 — reason	Rows
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⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 16 months old.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 via	Discovered by HANK
Last fetch	not_modified · 2026-10-25
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 $3,705,478 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 $3,710,000 0.9× median
J1413 HCPCS	Inj Delandistrogene Mox Rokl	3	$3,200,000.00	$3,200,000.00	$3,200,000.00	nat. median $3,324,572 1.0× median
J3394 HCPCS	Inj, Lovotibeglogene Autotem	3	$3,100,000.00	$3,100,000.00	$3,100,000.00	nat. median $3,286,000 0.9× median
J3393 HCPCS	Inj, Betibeglogene Autotemce	3	$2,800,000.00	$2,800,000.00	$2,800,000.00	nat. median $2,994,107 0.9× median
J3399 HCPCS	Inj Onase Abepar-xioi Treat	4	$7,185.97	$2,391,705.69	$2,391,705.69	nat. median $2,467,386 1.0× median
5834 APR_DRG	Neonate With Ecmo	4	$411,851.82	$1,046,510.62	$1,046,510.62	nat. median $307,206 outlier · 3.4×
5884 APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$268,686.28	$682,728.66	$682,728.66	nat. median $247,214 outlier · 2.8×
5833 APR_DRG	Neonate With Ecmo	4	$266,810.37	$677,962.01	$677,962.01	nat. median $244,017 outlier · 2.8×
24 APR_DRG	Heart And/or Lung Transplant	4	$237,946.25	$604,618.61	$604,618.61	nat. median $241,437 outlier · 2.5×
Q2042 HCPCS	Tisagenlecleucel Car-pos T	6	$16,507.81	$1,157,542.25	$578,771.12	nat. median $739,258 0.8× median
Q2056 HCPCS	Ciltacabtagene Car-pos T	6	$16,507.81	$1,106,338.60	$553,169.30	nat. median $646,415 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 $123,836 outlier · 4.3×
Q2055 HCPCS	Idecabtagene Vicleucel Car	6	$16,507.81	$1,055,244.92	$527,622.46	nat. median $622,450 0.8× median
5832 APR_DRG	Neonate With Ecmo	4	$204,861.54	$520,550.75	$520,550.75	nat. median $159,249 outlier · 3.3×
1614 APR_DRG	Implantable Heart Assist Systems	4	$203,918.48	$518,154.45	$518,154.45	nat. median $202,993 outlier · 2.6×
Q2054 HCPCS	Lisocabtagene Mara Car Pos T	6	$16,507.81	$1,032,884.57	$516,442.29	nat. median $640,950 0.8× median
Q2041 HCPCS	Axicabtagene Ciloleucel Car+	6	$16,507.81	$1,005,681.46	$502,840.73	nat. median $608,239 0.8× 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 $154,011 outlier · 3.2×
8414 APR_DRG	Extensive Third Degree Burns With Skin Graft	4	$193,312.43	$491,204.61	$491,204.61	nat. median $155,939 outlier · 3.1×
Q2053 HCPCS	Brexucabtagene Car Pos T	7	$16,507.81	$4,747,210.00	$489,399.16	nat. median $591,721 0.8× median
18 MS_DRG	Chimeric Antigen Receptor (car) T-cell Immunotherapy	4	$301,596.05	$690,785.36	$473,293.00	nat. median $359,454 1.3× median
6094 APR_DRG	Neonate Birth Weight 1500-2499 Grams With Major Procedure	4	$176,662.50	$448,897.33	$448,897.33	nat. median $165,000 outlier · 2.7×
5883 APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$174,746.55	$444,028.92	$444,028.92	nat. median $175,204 outlier · 2.5×
6314 APR_DRG	Neonate Birth Weight > 2499 Grams With Other Major Procedure	4	$173,438.36	$440,704.83	$440,704.83	nat. median $133,164 outlier · 3.3×
5914 APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	4	$170,686.93	$433,713.48	$433,713.48	nat. median $162,342 outlier · 2.7×
74 APR_DRG	Allogeneic Bone Marrow Transplant	4	$162,015.68	$411,679.93	$411,679.93	nat. median $170,082 outlier · 2.4×
94 APR_DRG	Extracorporeal Membrane Oxygenation (ecmo)	4	$161,203.76	$409,616.84	$409,616.84	nat. median $163,587 outlier · 2.5×
5934 APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	4	$158,270.15	$402,162.59	$402,162.59	nat. median $151,838 outlier · 2.6×
5882 APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$153,336.58	$389,626.43	$389,626.43	nat. median $145,061 outlier · 2.7×
5831 APR_DRG	Neonate With Ecmo	4	$148,907.12	$378,371.23	$378,371.23	nat. median $146,500 outlier · 2.6×
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 $107,681 outlier · 3.5×
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 $122,016 outlier · 3.0×
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 $249,036 1.4× median
1613 APR_DRG	Implantable Heart Assist Systems	4	$137,976.77	$350,597.35	$350,597.35	nat. median $120,517 outlier · 2.9×
23 APR_DRG	Heart And/or Lung Transplant	4	$133,605.42	$339,489.79	$339,489.79	nat. median $110,944 outlier · 3.1×
5881 APR_DRG	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$131,431.13	$333,964.95	$333,964.95	nat. median $120,208 outlier · 2.8×
5913 APR_DRG	Neonate Birth Weight 500-749 Grams Without Major Procedure	4	$126,689.93	$321,917.63	$321,917.63	nat. median $101,406 outlier · 3.2×
113 APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	4	$122,020.98	$310,053.87	$310,053.87	nat. median $67,735 outlier · 4.6×
1604 APR_DRG	Major Cardiothoracic Repair Of Heart Anomaly	4	$118,972.73	$302,308.31	$302,308.31	nat. median $98,624 outlier · 3.1×
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 $118,620 outlier · 2.5×
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 $198,418 1.5× median
1612 APR_DRG	Implantable Heart Assist Systems	4	$110,756.13	$281,430.01	$281,430.01	nat. median $84,880 outlier · 3.3×
5933 APR_DRG	Neonate Birth Weight 750-999 Grams Without Major Procedure	4	$109,765.96	$278,914.00	$278,914.00	nat. median $108,695 outlier · 2.6×
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 $190,559 1.4× median
1611 APR_DRG	Implantable Heart Assist Systems	4	$105,524.17	$268,135.66	$268,135.66	nat. median $76,852 outlier · 3.5×
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 $93,998 outlier · 2.8×
112 APR_DRG	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	4	$104,771.13	$266,222.22	$266,222.22	nat. median $67,994 outlier · 3.9×
64 APR_DRG	Pancreas Transplant	4	$103,649.83	$263,373.00	$263,373.00	nat. median $91,106 outlier · 2.9×

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.

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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