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 · ⚠ 12 mo old

Data quality

274,697 of 332,346 rate rows are consumer-grade (82.7%)

57,649 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	53,869
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
per-diem day rate — not a per-procedure price	19

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 12 months old.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 · 2026-05-15
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 $3,710,000 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 $3,325,455 1.0× median
J3394 HCPCS	Inj, Lovotibeglogene Autotem	3	$3,100,000.00	$3,100,000.00	$3,100,000.00	nat. median $3,286,000 0.9× median
J3393 HCPCS	Inj, Betibeglogene Autotemce	3	$2,800,000.00	$2,800,000.00	$2,800,000.00	nat. median $3,006,423 0.9× median
J3399 HCPCS	Inj Onase Abepar-xioi Treat	4	$7,185.97	$2,391,705.69	$2,391,705.69	nat. median $2,469,189 1.0× median
5834 APR_DRG		4	$411,851.82	$1,046,510.62	$1,046,510.62	nat. median $309,665 outlier · 3.4×
5884 APR_DRG		4	$268,686.28	$682,728.66	$682,728.66	nat. median $246,434 outlier · 2.8×
5833 APR_DRG		4	$266,810.37	$677,962.01	$677,962.01	nat. median $244,017 outlier · 2.8×
0024 APR_DRG		4	$237,946.25	$604,618.61	$604,618.61	nat. median $372,987 1.6× median
Q2042 HCPCS	Tisagenlecleucel Car-pos T	6	$16,507.81	$1,157,542.25	$578,771.12	nat. median $754,974 0.8× median
Q2056 HCPCS	Ciltacabtagene Car-pos T	6	$16,507.81	$1,106,338.60	$553,169.30	nat. median $675,122 0.8× median
0114 APR_DRG		4	$209,226.61	$531,642.34	$531,642.34	nat. median $197,700 outlier · 2.7×
Q2055 HCPCS	Idecabtagene Vicleucel Car	6	$16,507.81	$1,055,244.92	$527,622.46	nat. median $625,184 0.8× median
5832 APR_DRG		4	$204,861.54	$520,550.75	$520,550.75	nat. median $156,126 outlier · 3.3×
1614 APR_DRG		4	$203,918.48	$518,154.45	$518,154.45	nat. median $207,730 outlier · 2.5×
Q2054 HCPCS	Lisocabtagene Mara Car Pos T	6	$16,507.81	$1,032,884.57	$516,442.29	nat. median $674,188 0.8× median
Q2041 HCPCS	Axicabtagene Ciloleucel Car+	6	$16,507.81	$1,005,681.46	$502,840.73	nat. median $634,511 0.8× median
6304 APR_DRG		4	$195,997.12	$498,026.37	$498,026.37	nat. median $150,721 outlier · 3.3×
8414 APR_DRG		4	$193,312.43	$491,204.61	$491,204.61	nat. median $160,267 outlier · 3.1×
Q2053 HCPCS	Brexucabtagene Car Pos T	7	$16,507.81	$4,747,210.00	$489,399.16	nat. median $620,080 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 $370,174 1.3× median
6094 APR_DRG		4	$176,662.50	$448,897.33	$448,897.33	nat. median $162,982 outlier · 2.8×
5883 APR_DRG		4	$174,746.55	$444,028.92	$444,028.92	nat. median $182,736 outlier · 2.4×
6314 APR_DRG		4	$173,438.36	$440,704.83	$440,704.83	nat. median $122,924 outlier · 3.6×
5914 APR_DRG		4	$170,686.93	$433,713.48	$433,713.48	nat. median $164,279 outlier · 2.6×
0074 APR_DRG		4	$162,015.68	$411,679.93	$411,679.93	nat. median $178,275 outlier · 2.3×
0094 APR_DRG		4	$161,203.76	$409,616.84	$409,616.84	nat. median $166,008 outlier · 2.5×
5934 APR_DRG		4	$158,270.15	$402,162.59	$402,162.59	nat. median $151,838 outlier · 2.6×
5882 APR_DRG		4	$153,336.58	$389,626.43	$389,626.43	nat. median $145,336 outlier · 2.7×
5831 APR_DRG		4	$148,907.12	$378,371.23	$378,371.23	nat. median $145,122 outlier · 2.6×
6034 APR_DRG		4	$146,394.39	$371,986.43	$371,986.43	nat. median $109,499 outlier · 3.4×
0014 APR_DRG		4	$144,084.26	$366,116.40	$366,116.40	nat. median $190,591 1.9× median
0044 APR_DRG		4	$143,096.45	$363,606.38	$363,606.38	nat. median $195,681 1.9× median
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 $265,286 1.3× median
1613 APR_DRG		4	$137,976.77	$350,597.35	$350,597.35	nat. median $119,796 outlier · 2.9×
0023 APR_DRG		4	$133,605.42	$339,489.79	$339,489.79	nat. median $167,082 outlier · 2.0×
5881 APR_DRG		4	$131,431.13	$333,964.95	$333,964.95	nat. median $124,573 outlier · 2.7×
5913 APR_DRG		4	$126,689.93	$321,917.63	$321,917.63	nat. median $102,636 outlier · 3.1×
0113 APR_DRG		4	$122,020.98	$310,053.87	$310,053.87	nat. median $128,705 outlier · 2.4×
1604 APR_DRG		4	$118,972.73	$302,308.31	$302,308.31	nat. median $97,957 outlier · 3.1×
6024 APR_DRG		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 $206,368 1.4× median
1612 APR_DRG		4	$110,756.13	$281,430.01	$281,430.01	nat. median $85,406 outlier · 3.3×
5933 APR_DRG		4	$109,765.96	$278,914.00	$278,914.00	nat. median $108,996 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 $202,986 1.3× median
1611 APR_DRG		4	$105,524.17	$268,135.66	$268,135.66	nat. median $76,806 outlier · 3.5×
5891 APR_DRG		4	$104,959.59	$266,701.08	$266,701.08	nat. median $93,260 outlier · 2.9×
0112 APR_DRG		4	$104,771.13	$266,222.22	$266,222.22	nat. median $93,442 outlier · 2.8×
0064 APR_DRG		4	$103,649.83	$263,373.00	$263,373.00	nat. median $98,565 outlier · 2.7×

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

5834	APR_DRG	—	4	4	—	—	$411,851.82	$1,046,510.62	$1,046,510.62	2025-06-27
5884	APR_DRG	—	4	4	—	—	$268,686.28	$682,728.66	$682,728.66	2025-06-27
5833	APR_DRG	—	4	4	—	—	$266,810.37	$677,962.01	$677,962.01	2025-06-27
0024	APR_DRG	—	4	4	—	—	$237,946.25	$604,618.61	$604,618.61	2025-06-27
0114	APR_DRG	—	4	4	—	—	$209,226.61	$531,642.34	$531,642.34	2025-06-27
5832	APR_DRG	—	4	4	—	—	$204,861.54	$520,550.75	$520,550.75	2025-06-27
1614	APR_DRG	—	4	4	—	—	$203,918.48	$518,154.45	$518,154.45	2025-06-27
6304	APR_DRG	—	4	4	—	—	$195,997.12	$498,026.37	$498,026.37	2025-06-27
8414	APR_DRG	—	4	4	—	—	$193,312.43	$491,204.61	$491,204.61	2025-06-27
6094	APR_DRG	—	4	4	—	—	$176,662.50	$448,897.33	$448,897.33	2025-06-27
5883	APR_DRG	—	4	4	—	—	$174,746.55	$444,028.92	$444,028.92	2025-06-27
6314	APR_DRG	—	4	4	—	—	$173,438.36	$440,704.83	$440,704.83	2025-06-27
5914	APR_DRG	—	4	4	—	—	$170,686.93	$433,713.48	$433,713.48	2025-06-27
0074	APR_DRG	—	4	4	—	—	$162,015.68	$411,679.93	$411,679.93	2025-06-27
0094	APR_DRG	—	4	4	—	—	$161,203.76	$409,616.84	$409,616.84	2025-06-27
5934	APR_DRG	—	4	4	—	—	$158,270.15	$402,162.59	$402,162.59	2025-06-27
5882	APR_DRG	—	4	4	—	—	$153,336.58	$389,626.43	$389,626.43	2025-06-27
5831	APR_DRG	—	4	4	—	—	$148,907.12	$378,371.23	$378,371.23	2025-06-27
6034	APR_DRG	—	4	4	—	—	$146,394.39	$371,986.43	$371,986.43	2025-06-27
0014	APR_DRG	—	4	4	—	—	$144,084.26	$366,116.40	$366,116.40	2025-06-27
0044	APR_DRG	—	4	4	—	—	$143,096.45	$363,606.38	$363,606.38	2025-06-27
1613	APR_DRG	—	4	4	—	—	$137,976.77	$350,597.35	$350,597.35	2025-06-27
0023	APR_DRG	—	4	4	—	—	$133,605.42	$339,489.79	$339,489.79	2025-06-27
5881	APR_DRG	—	4	4	—	—	$131,431.13	$333,964.95	$333,964.95	2025-06-27
5913	APR_DRG	—	4	4	—	—	$126,689.93	$321,917.63	$321,917.63	2025-06-27
0113	APR_DRG	—	4	4	—	—	$122,020.98	$310,053.87	$310,053.87	2025-06-27
1604	APR_DRG	—	4	4	—	—	$118,972.73	$302,308.31	$302,308.31	2025-06-27
6024	APR_DRG	—	4	4	—	—	$117,527.92	$298,637.05	$298,637.05	2025-06-27
1612	APR_DRG	—	4	4	—	—	$110,756.13	$281,430.01	$281,430.01	2025-06-27
5933	APR_DRG	—	4	4	—	—	$109,765.96	$278,914.00	$278,914.00	2025-06-27
1611	APR_DRG	—	4	4	—	—	$105,524.17	$268,135.66	$268,135.66	2025-06-27
5891	APR_DRG	—	4	4	—	—	$104,959.59	$266,701.08	$266,701.08	2025-06-27
0112	APR_DRG	—	4	4	—	—	$104,771.13	$266,222.22	$266,222.22	2025-06-27
0064	APR_DRG	—	4	4	—	—	$103,649.83	$263,373.00	$263,373.00	2025-06-27
5892	APR_DRG	—	4	4	—	—	$101,863.44	$258,833.81	$258,833.81	2025-06-27
8514	APR_DRG	—	4	4	—	—	$100,501.08	$255,372.05	$255,372.05	2025-06-27
5893	APR_DRG	—	4	4	—	—	$99,693.08	$253,318.94	$253,318.94	2025-06-27
8424	APR_DRG	—	4	4	—	—	$99,002.08	$251,563.12	$251,563.12	2025-06-27
0022	APR_DRG	—	4	4	—	—	$97,231.39	$247,063.83	$247,063.83	2025-06-27
5912	APR_DRG	—	4	4	—	—	$96,071.62	$244,116.84	$244,116.84	2025-06-27
6303	APR_DRG	—	4	4	—	—	$93,588.73	$237,807.86	$237,807.86	2025-06-27
0054	APR_DRG	—	4	4	—	—	$93,338.24	$237,171.38	$237,171.38	2025-06-27
6074	APR_DRG	—	4	4	—	—	$90,070.92	$228,869.14	$228,869.14	2025-06-27
5932	APR_DRG	—	4	4	—	—	$89,903.67	$228,444.15	$228,444.15	2025-06-27
0043	APR_DRG	—	4	4	—	—	$89,730.92	$228,005.20	$228,005.20	2025-06-27
0021	APR_DRG	—	4	4	—	—	$89,418.40	$227,211.09	$227,211.09	2025-06-27
3034	APR_DRG	—	4	4	—	—	$85,449.08	$217,125.10	$217,125.10	2025-06-27
6023	APR_DRG	—	4	4	—	—	$83,366.66	$211,833.70	$211,833.70	2025-06-27
1624	APR_DRG	—	4	4	—	—	$81,220.64	$206,380.68	$206,380.68	2025-06-27
0084	APR_DRG	—	4	4	—	—	$80,301.92	$204,046.24	$204,046.24	2025-06-27
0073	APR_DRG	—	4	4	—	—	$79,182.98	$201,203.01	$201,203.01	2025-06-27
4404	APR_DRG	—	4	4	—	—	$75,902.30	$192,866.85	$192,866.85	2025-06-27
8634	APR_DRG	—	4	4	—	—	$75,015.78	$190,614.21	$190,614.21	2025-06-27
0063	APR_DRG	—	4	4	—	—	$73,634.57	$187,104.57	$187,104.57	2025-06-27
6134	APR_DRG	—	4	4	—	—	$73,344.03	$186,366.33	$186,366.33	2025-06-27
6114	APR_DRG	—	4	4	—	—	$73,000.89	$185,494.40	$185,494.40	2025-06-27
0093	APR_DRG	—	4	4	—	—	$69,473.66	$176,531.74	$176,531.74	2025-06-27
1674	APR_DRG	—	4	4	—	—	$68,116.00	$173,081.95	$173,081.95	2025-06-27
1634	APR_DRG	—	4	4	—	—	$67,655.86	$171,912.74	$171,912.74	2025-06-27
0013	APR_DRG	—	4	4	—	—	$67,403.01	$171,270.26	$171,270.26	2025-06-27
6022	APR_DRG	—	4	4	—	—	$66,668.83	$169,404.71	$169,404.71	2025-06-27
6093	APR_DRG	—	4	4	—	—	$65,962.12	$167,608.98	$167,608.98	2025-06-27
1784	APR_DRG	—	4	4	—	—	$64,835.33	$164,745.80	$164,745.80	2025-06-27
6033	APR_DRG	—	4	4	—	—	$64,664.15	$164,310.83	$164,310.83	2025-06-27
0053	APR_DRG	—	4	4	—	—	$64,474.91	$163,829.98	$163,829.98	2025-06-27
6124	APR_DRG	—	4	4	—	—	$64,337.49	$163,480.81	$163,480.81	2025-06-27
8504	APR_DRG	—	4	4	—	—	$63,749.36	$161,986.37	$161,986.37	2025-06-27
0072	APR_DRG	—	4	4	—	—	$63,495.73	$161,341.90	$161,341.90	2025-06-27
1654	APR_DRG	—	4	4	—	—	$63,184.00	$160,549.79	$160,549.79	2025-06-27
6073	APR_DRG	—	4	4	—	—	$62,350.87	$158,432.83	$158,432.83	2025-06-27
8413	APR_DRG	—	4	4	—	—	$61,864.03	$157,195.77	$157,195.77	2025-06-27
6214	APR_DRG	—	4	4	—	—	$61,797.29	$157,026.18	$157,026.18	2025-06-27
6804	APR_DRG	—	4	4	—	—	$61,744.68	$156,892.49	$156,892.49	2025-06-27
6334	APR_DRG	—	4	4	—	—	$61,174.60	$155,443.94	$155,443.94	2025-06-27
0071	APR_DRG	—	4	4	—	—	$60,321.06	$153,275.11	$153,275.11	2025-06-27
3044	APR_DRG	—	4	4	—	—	$59,911.17	$152,233.58	$152,233.58	2025-06-27
0062	APR_DRG	—	4	4	—	—	$58,958.69	$149,813.35	$149,813.35	2025-06-27
3033	APR_DRG	—	4	4	—	—	$58,230.79	$147,963.75	$147,963.75	2025-06-27
5911	APR_DRG	—	4	4	—	—	$57,751.02	$146,744.65	$146,744.65	2025-06-27
9104	APR_DRG	—	4	4	—	—	$57,195.08	$145,332.01	$145,332.01	2025-06-27
6084	APR_DRG	—	4	4	—	—	$56,907.68	$144,601.75	$144,601.75	2025-06-27
1834	APR_DRG	—	4	4	—	—	$56,502.51	$143,572.20	$143,572.20	2025-06-27
6814	APR_DRG	—	4	4	—	—	$56,261.44	$142,959.66	$142,959.66	2025-06-27
3124	APR_DRG	—	4	4	—	—	$56,105.97	$142,564.60	$142,564.60	2025-06-27
7404	APR_DRG	—	4	4	—	—	$56,031.37	$142,375.05	$142,375.05	2025-06-27
6904	APR_DRG	—	4	4	—	—	$55,732.99	$141,616.86	$141,616.86	2025-06-27
0042	APR_DRG	—	4	4	—	—	$55,370.21	$140,695.05	$140,695.05	2025-06-27
1664	APR_DRG	—	4	4	—	—	$55,330.95	$140,595.29	$140,595.29	2025-06-27
3614	APR_DRG	—	4	4	—	—	$54,360.41	$138,129.16	$138,129.16	2025-06-27
0914	APR_DRG	—	4	4	—	—	$54,197.87	$137,716.15	$137,716.15	2025-06-27
0012	APR_DRG	—	4	4	—	—	$54,146.83	$137,586.45	$137,586.45	2025-06-27
9114	APR_DRG	—	4	4	—	—	$53,639.57	$136,297.52	$136,297.52	2025-06-27
6302	APR_DRG	—	4	4	—	—	$53,556.34	$136,086.03	$136,086.03	2025-06-27
0214	APR_DRG	—	4	4	—	—	$53,312.92	$135,467.50	$135,467.50	2025-06-27
7594	APR_DRG	—	4	4	—	—	$52,614.85	$133,693.72	$133,693.72	2025-06-27
1794	APR_DRG	—	4	4	—	—	$52,544.18	$133,514.15	$133,514.15	2025-06-27
6144	APR_DRG	—	4	4	—	—	$52,526.91	$133,470.25	$133,470.25	2025-06-27
6313	APR_DRG	—	4	4	—	—	$52,079.33	$132,332.96	$132,332.96	2025-06-27
1623	APR_DRG	—	4	4	—	—	$51,886.95	$131,844.12	$131,844.12	2025-06-27
6254	APR_DRG	—	4	4	—	—	$51,388.33	$130,577.14	$130,577.14	2025-06-27
1204	APR_DRG	—	4	4	—	—	$51,144.13	$129,956.62	$129,956.62	2025-06-27
2604	APR_DRG	—	4	4	—	—	$50,733.45	$128,913.10	$128,913.10	2025-06-27
9124	APR_DRG	—	4	4	—	—	$50,161.81	$127,460.56	$127,460.56	2025-06-27
0274	APR_DRG	—	4	4	—	—	$49,973.35	$126,981.70	$126,981.70	2025-06-27
2324	APR_DRG	—	4	4	—	—	$49,634.14	$126,119.75	$126,119.75	2025-06-27
6954	APR_DRG	—	4	4	—	—	$49,389.93	$125,499.23	$125,499.23	2025-06-27
0041	APR_DRG	—	4	4	—	—	$49,136.30	$124,854.76	$124,854.76	2025-06-27
2204	APR_DRG	—	4	4	—	—	$49,082.12	$124,717.09	$124,717.09	2025-06-27
0234	APR_DRG	—	4	4	—	—	$48,947.06	$124,373.91	$124,373.91	2025-06-27
1694	APR_DRG	—	4	4	—	—	$48,761.75	$123,903.03	$123,903.03	2025-06-27
1603	APR_DRG	—	4	4	—	—	$48,185.39	$122,438.52	$122,438.52	2025-06-27
0111	APR_DRG	—	4	4	—	—	$47,775.51	$121,397.00	$121,397.00	2025-06-27
0204	APR_DRG	—	4	4	—	—	$47,763.73	$121,367.07	$121,367.07	2025-06-27
1783	APR_DRG	—	4	4	—	—	$47,757.45	$121,351.11	$121,351.11	2025-06-27
9504	APR_DRG	—	4	4	—	—	$47,144.18	$119,792.81	$119,792.81	2025-06-27
0011	APR_DRG	—	4	4	—	—	$47,079.80	$119,629.20	$119,629.20	2025-06-27
6072	APR_DRG	—	4	4	—	—	$46,050.36	$117,013.43	$117,013.43	2025-06-27
4403	APR_DRG	—	4	4	—	—	$45,999.32	$116,883.74	$116,883.74	2025-06-27
0924	APR_DRG	—	4	4	—	—	$45,971.06	$116,811.91	$116,811.91	2025-06-27
1782	APR_DRG	—	4	4	—	—	$45,909.02	$116,654.29	$116,654.29	2025-06-27
6083	APR_DRG	—	4	4	—	—	$45,312.25	$115,137.90	$115,137.90	2025-06-27
6113	APR_DRG	—	4	4	—	—	$45,101.03	$114,601.17	$114,601.17	2025-06-27
4414	APR_DRG	—	4	4	—	—	$44,823.06	$113,894.86	$113,894.86	2025-06-27
6133	APR_DRG	—	4	4	—	—	$44,513.68	$113,108.73	$113,108.73	2025-06-27
0894	APR_DRG	—	4	4	—	—	$44,391.18	$112,797.47	$112,797.47	2025-06-27
0061	APR_DRG	—	4	4	—	—	$44,092.80	$112,039.27	$112,039.27	2025-06-27
2614	APR_DRG	—	4	4	—	—	$43,975.80	$111,741.98	$111,741.98	2025-06-27
1764	APR_DRG	—	4	4	—	—	$43,650.71	$110,915.95	$110,915.95	2025-06-27
6234	APR_DRG	—	4	4	—	—	$43,296.58	$110,016.09	$110,016.09	2025-06-27
1633	APR_DRG	—	4	4	—	—	$43,175.65	$109,708.82	$109,708.82	2025-06-27
1304	APR_DRG	—	4	4	—	—	$43,090.06	$109,491.34	$109,491.34	2025-06-27
5144	APR_DRG	—	4	4	—	—	$42,768.90	$108,675.28	$108,675.28	2025-06-27
7924	APR_DRG	—	4	4	—	—	$42,680.17	$108,449.82	$108,449.82	2025-06-27
5104	APR_DRG	—	4	4	—	—	$42,598.51	$108,242.31	$108,242.31	2025-06-27
0052	APR_DRG	—	4	4	—	—	$42,571.81	$108,174.47	$108,174.47	2025-06-27
1814	APR_DRG	—	4	4	—	—	$42,447.75	$107,859.22	$107,859.22	2025-06-27
1653	APR_DRG	—	4	4	—	—	$42,285.21	$107,446.21	$107,446.21	2025-06-27
6514	APR_DRG	—	4	4	—	—	$42,239.66	$107,330.48	$107,330.48	2025-06-27
8412	APR_DRG	—	4	4	—	—	$41,974.26	$106,656.09	$106,656.09	2025-06-27
8411	APR_DRG	—	4	4	—	—	$41,974.26	$106,656.09	$106,656.09	2025-06-27
0092	APR_DRG	—	4	4	—	—	$41,913.01	$106,500.46	$106,500.46	2025-06-27
0224	APR_DRG	—	4	4	—	—	$41,313.10	$104,976.09	$104,976.09	2025-06-27
7584	APR_DRG	—	4	4	—	—	$40,980.94	$104,132.10	$104,132.10	2025-06-27
0083	APR_DRG	—	4	4	—	—	$40,972.31	$104,110.15	$104,110.15	2025-06-27
3032	APR_DRG	—	4	4	—	—	$40,860.81	$103,826.82	$103,826.82	2025-06-27
2644	APR_DRG	—	4	4	—	—	$40,819.19	$103,721.08	$103,721.08	2025-06-27
3634	APR_DRG	—	4	4	—	—	$40,666.07	$103,332.00	$103,332.00	2025-06-27
5114	APR_DRG	—	4	4	—	—	$40,589.90	$103,138.46	$103,138.46	2025-06-27
0264	APR_DRG	—	4	4	—	—	$40,553.00	$103,044.69	$103,044.69	2025-06-27
1214	APR_DRG	—	4	4	—	—	$40,536.51	$103,002.79	$103,002.79	2025-06-27
4044	APR_DRG	—	4	4	—	—	$40,504.31	$102,920.98	$102,920.98	2025-06-27
3214	APR_DRG	—	4	4	—	—	$40,472.12	$102,839.18	$102,839.18	2025-06-27
2304	APR_DRG	—	4	4	—	—	$40,463.48	$102,817.23	$102,817.23	2025-06-27
4402	APR_DRG	—	4	4	—	—	$40,205.93	$102,162.79	$102,162.79	2025-06-27
6123	APR_DRG	—	4	4	—	—	$40,081.86	$101,847.54	$101,847.54	2025-06-27
0091	APR_DRG	—	4	4	—	—	$39,818.03	$101,177.13	$101,177.13	2025-06-27
5184	APR_DRG	—	4	4	—	—	$39,684.54	$100,837.94	$100,837.94	2025-06-27
0304	APR_DRG	—	4	4	—	—	$39,313.91	$99,896.18	$99,896.18	2025-06-27
1673	APR_DRG	—	4	4	—	—	$39,141.16	$99,457.23	$99,457.23	2025-06-27
4054	APR_DRG	—	4	4	—	—	$38,950.35	$98,972.38	$98,972.38	2025-06-27
1781	APR_DRG	—	4	4	—	—	$38,947.99	$98,966.40	$98,966.40	2025-06-27
8633	APR_DRG	—	4	4	—	—	$38,858.48	$98,738.94	$98,738.94	2025-06-27
1824	APR_DRG	—	4	4	—	—	$38,750.12	$98,463.59	$98,463.59	2025-06-27
1622	APR_DRG	—	4	4	—	—	$38,593.86	$98,066.54	$98,066.54	2025-06-27
3043	APR_DRG	—	4	4	—	—	$38,534.18	$97,914.90	$97,914.90	2025-06-27
6224	APR_DRG	—	4	4	—	—	$38,443.09	$97,683.45	$97,683.45	2025-06-27
4014	APR_DRG	—	4	4	—	—	$38,401.48	$97,577.70	$97,577.70	2025-06-27
9103	APR_DRG	—	4	4	—	—	$38,354.36	$97,457.99	$97,457.99	2025-06-27
4034	APR_DRG	—	4	4	—	—	$38,315.89	$97,360.22	$97,360.22	2025-06-27
7104	APR_DRG	—	4	4	—	—	$38,034.78	$96,645.92	$96,645.92	2025-06-27
1793	APR_DRG	—	4	4	—	—	$38,029.28	$96,631.95	$96,631.95	2025-06-27
1833	APR_DRG	—	4	4	—	—	$37,840.83	$96,153.09	$96,153.09	2025-06-27
4401	APR_DRG	—	4	4	—	—	$37,090.94	$94,247.63	$94,247.63	2025-06-27
6504	APR_DRG	—	4	4	—	—	$36,796.48	$93,499.41	$93,499.41	2025-06-27
3254	APR_DRG	—	4	4	—	—	$36,613.52	$93,034.52	$93,034.52	2025-06-27
7114	APR_DRG	—	4	4	—	—	$36,561.69	$92,902.83	$92,902.83	2025-06-27
8423	APR_DRG	—	4	4	—	—	$36,556.20	$92,888.86	$92,888.86	2025-06-27
6092	APR_DRG	—	4	4	—	—	$36,392.87	$92,473.85	$92,473.85	2025-06-27
6344	APR_DRG	—	4	4	—	—	$36,379.52	$92,439.93	$92,439.93	2025-06-27
4474	APR_DRG	—	4	4	—	—	$36,293.15	$92,220.46	$92,220.46	2025-06-27
6143	APR_DRG	—	4	4	—	—	$36,059.15	$91,625.87	$91,625.87	2025-06-27
6032	APR_DRG	—	4	4	—	—	$36,055.22	$91,615.89	$91,615.89	2025-06-27
5124	APR_DRG	—	4	4	—	—	$35,904.46	$91,232.81	$91,232.81	2025-06-27
4424	APR_DRG	—	4	4	—	—	$35,879.33	$91,168.96	$91,168.96	2025-06-27
1704	APR_DRG	—	4	4	—	—	$35,763.12	$90,873.66	$90,873.66	2025-06-27
1663	APR_DRG	—	4	4	—	—	$35,544.04	$90,316.99	$90,316.99	2025-06-27
9514	APR_DRG	—	4	4	—	—	$35,383.07	$89,907.96	$89,907.96	2025-06-27
7934	APR_DRG	—	4	4	—	—	$35,253.51	$89,578.74	$89,578.74	2025-06-27
1754	APR_DRG	—	4	4	—	—	$35,251.94	$89,574.75	$89,574.75	2025-06-27
3154	APR_DRG	—	4	4	—	—	$35,094.11	$89,173.71	$89,173.71	2025-06-27
0294	APR_DRG	—	4	4	—	—	$35,072.90	$89,119.84	$89,119.84	2025-06-27
0504	APR_DRG	—	4	4	—	—	$35,058.77	$89,083.92	$89,083.92	2025-06-27
2314	APR_DRG	—	4	4	—	—	$34,899.37	$88,678.89	$88,678.89	2025-06-27
0244	APR_DRG	—	4	4	—	—	$34,759.60	$88,323.73	$88,323.73	2025-06-27
4804	APR_DRG	—	4	4	—	—	$34,757.24	$88,317.75	$88,317.75	2025-06-27
3104	APR_DRG	—	4	4	—	—	$34,699.92	$88,172.09	$88,172.09	2025-06-27
6233	APR_DRG	—	4	4	—	—	$34,604.91	$87,930.67	$87,930.67	2025-06-27
6091	APR_DRG	—	4	4	—	—	$34,573.50	$87,850.86	$87,850.86	2025-06-27
0082	APR_DRG	—	4	4	—	—	$34,517.75	$87,709.19	$87,709.19	2025-06-27
3204	APR_DRG	—	4	4	—	—	$34,249.99	$87,028.81	$87,028.81	2025-06-27
2294	APR_DRG	—	4	4	—	—	$34,213.08	$86,935.04	$86,935.04	2025-06-27
3134	APR_DRG	—	4	4	—	—	$34,062.32	$86,551.95	$86,551.95	2025-06-27
3094	APR_DRG	—	4	4	—	—	$33,986.15	$86,358.41	$86,358.41	2025-06-27
6082	APR_DRG	—	4	4	—	—	$33,935.90	$86,230.71	$86,230.71	2025-06-27
0913	APR_DRG	—	4	4	—	—	$33,897.42	$86,132.95	$86,132.95	2025-06-27
6312	APR_DRG	—	4	4	—	—	$33,821.25	$85,939.41	$85,939.41	2025-06-27
2224	APR_DRG	—	4	4	—	—	$33,674.42	$85,566.30	$85,566.30	2025-06-27
5194	APR_DRG	—	4	4	—	—	$33,610.81	$85,404.68	$85,404.68	2025-06-27
2234	APR_DRG	—	4	4	—	—	$33,399.59	$84,867.96	$84,867.96	2025-06-27
0893	APR_DRG	—	4	4	—	—	$33,380.74	$84,820.07	$84,820.07	2025-06-27
1621	APR_DRG	—	4	4	—	—	$33,197.00	$84,353.18	$84,353.18	2025-06-27
4444	APR_DRG	—	4	4	—	—	$33,197.00	$84,353.18	$84,353.18	2025-06-27
1652	APR_DRG	—	4	4	—	—	$33,061.94	$84,010.00	$84,010.00	2025-06-27
0051	APR_DRG	—	4	4	—	—	$33,054.09	$83,990.05	$83,990.05	2025-06-27
9524	APR_DRG	—	4	4	—	—	$33,043.88	$83,964.11	$83,964.11	2025-06-27
0213	APR_DRG	—	4	4	—	—	$32,944.16	$83,710.71	$83,710.71	2025-06-27
1303	APR_DRG	—	4	4	—	—	$32,872.70	$83,529.15	$83,529.15	2025-06-27
3054	APR_DRG	—	4	4	—	—	$32,836.58	$83,437.36	$83,437.36	2025-06-27
2274	APR_DRG	—	4	4	—	—	$32,812.24	$83,375.51	$83,375.51	2025-06-27
4234	APR_DRG	—	4	4	—	—	$32,806.74	$83,361.55	$83,361.55	2025-06-27
0984	APR_DRG	—	4	4	—	—	$32,765.91	$83,257.79	$83,257.79	2025-06-27
6914	APR_DRG	—	4	4	—	—	$32,628.50	$82,908.62	$82,908.62	2025-06-27
3031	APR_DRG	—	4	4	—	—	$32,531.13	$82,661.21	$82,661.21	2025-06-27
1632	APR_DRG	—	4	4	—	—	$32,419.63	$82,377.89	$82,377.89	2025-06-27
2244	APR_DRG	—	4	4	—	—	$32,307.34	$82,092.57	$82,092.57	2025-06-27
6903	APR_DRG	—	4	4	—	—	$32,275.14	$82,010.76	$82,010.76	2025-06-27
4844	APR_DRG	—	4	4	—	—	$31,931.22	$81,136.84	$81,136.84	2025-06-27
4434	APR_DRG	—	4	4	—	—	$31,902.95	$81,065.01	$81,065.01	2025-06-27
6122	APR_DRG	—	4	4	—	—	$31,673.66	$80,482.40	$80,482.40	2025-06-27
1804	APR_DRG	—	4	4	—	—	$31,463.22	$79,947.67	$79,947.67	2025-06-27
1744	APR_DRG	—	4	4	—	—	$31,309.32	$79,556.60	$79,556.60	2025-06-27
3174	APR_DRG	—	4	4	—	—	$31,221.37	$79,333.14	$79,333.14	2025-06-27
1832	APR_DRG	—	4	4	—	—	$31,154.63	$79,163.54	$79,163.54	2025-06-27
0233	APR_DRG	—	4	4	—	—	$31,003.08	$78,778.46	$78,778.46	2025-06-27
1792	APR_DRG	—	4	4	—	—	$30,996.01	$78,760.50	$78,760.50	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
14	MS_DRG	Allogeneic Bone Marrow Transplant	10	4	—	—	$104,777.45	$239,985.67	$164,426.67	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
Q2041	HCPCS	Axicabtagene Ciloleucel Car+	10	6	—	—	$16,507.81	$1,005,681.46	$502,840.73	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
C9073	HCPCS	Brexucabtagene Autoleucel Ca	4	4	—	—	$16,507.81	$101,686.69	$101,686.69	2025-06-27
Q2053	HCPCS	Brexucabtagene Car Pos T	12	7	—	—	$16,507.81	$4,747,210.00	$489,399.16	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
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
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
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
18	MS_DRG	Chimeric Antigen Receptor (car) T-cell Immunotherapy	10	4	—	—	$301,596.05	$690,785.36	$473,293.00	2025-06-27
C9098	HCPCS	Ciltacabtagene Car Pos T	4	4	—	—	$16,507.81	$101,686.69	$101,686.69	2025-06-27
Q2056	HCPCS	Ciltacabtagene Car-pos T	10	6	—	—	$16,507.81	$1,106,338.60	$553,169.30	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
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
212	MS_DRG	Concomitant Aortic And Mitral Valve Procedures	10	4	—	—	$87,120.48	$199,543.57	$136,717.68	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
233	MS_DRG	Coronary Bypass With Cardiac Catheterization With Mcc	10	4	—	—	$62,509.16	$143,173.00	$98,095.27	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
955	MS_DRG	Craniotomy For Multiple Significant Trauma	10	4	—	—	$54,607.14	$125,073.97	$85,694.68	2025-06-27
Q0480	HCPCS	Driver Pneumatic Vad, Rep	6	3	—	—	$99,999.95	$99,999.95	$99,999.95	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
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
790	MS_DRG	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	7	3	—	—	$55,108.30	$108,890.90	$101,893.87	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
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
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
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
C9081	HCPCS	Idecabtagene Car Pos T	4	4	—	—	$16,507.81	$101,686.69	$101,686.69	2025-06-27
Q2055	HCPCS	Idecabtagene Vicleucel Car	10	6	—	—	$16,507.81	$1,055,244.92	$527,622.46	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
J3399	HCPCS	Inj Onase Abepar-xioi Treat	4	4	—	—	$7,185.97	$2,391,705.69	$2,391,705.69	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
J3393	HCPCS	Inj, Betibeglogene Autotemce	3	3	—	—	$2,800,000.00	$2,800,000.00	$2,800,000.00	2025-06-27
J1411	HCPCS	Inj, Hemgenix, Per Tx Dose	3	3	—	—	$3,500,000.00	$3,500,000.00	$3,500,000.00	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
0451T	HCPCS	Insj/rplcmt Aortic Ventr Sys	4	4	—	—	$13,580.40	$83,654.13	$83,654.13	2025-06-27
0452T	HCPCS	Insj/rplcmt Dev Vasc Seal	4	4	—	—	$13,580.40	$83,654.13	$83,654.13	2025-06-27
0453T	HCPCS	Insj/rplcmt Mech-elec Ntrfce	4	4	—	—	$13,580.40	$83,654.13	$83,654.13	2025-06-27
0454T	HCPCS	Insj/rplcmt Subq Electrode	4	4	—	—	$13,580.40	$83,654.13	$83,654.13	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
C9076	HCPCS	Lisocabtagene Car Pos T	4	4	—	—	$16,507.81	$101,686.69	$101,686.69	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
5	MS_DRG	Liver Transplant With Mcc Or Intestinal Transplant	10	4	—	—	$85,165.17	$195,065.06	$133,649.23	2025-06-27
7	MS_DRG	Lung Transplant	10	4	—	—	$104,513.55	$239,381.21	$164,012.52	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
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
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
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
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
215	MS_DRG	Other Heart Assist System Implant	10	4	—	—	$84,728.52	$194,064.95	$132,964.00	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
10	MS_DRG	Pancreas Transplant	10	4	—	—	$63,761.52	$146,041.44	$100,060.59	2025-06-27
0459T	HCPCS	Relocaj Rplcmt Aortic Ventr	4	4	—	—	$13,580.40	$83,654.13	$83,654.13	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
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
19	MS_DRG	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	10	4	—	—	$63,396.05	$145,204.35	$99,487.06	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
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
Q2042	HCPCS	Tisagenlecleucel Car-pos T	10	6	—	—	$16,507.81	$1,157,542.25	$578,771.12	2025-06-27
Q2040	HCPCS	Tisagenlecleucel Car-pos T	4	4	—	—	$16,507.81	$101,686.69	$101,686.69	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
T2025	HCPCS	Waiver Service, Nos	3	3	—	—	$88,188.00	$88,188.00	$88,188.00	2025-06-27

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