Price Transparencybeta Hospital negotiated rates

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

WESTERN WISCONSIN HEALTH

Baldwin, WI · CCN 521347 · Rates published

18,218 distinct procedures filed
10 distinct payers
146,471 rate rows
2025-06-24 last MRF observed · ⚠ 17 mo old
Data quality

99,188 of 146,471 rate rows are consumer-grade (67.7%)

47,283 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
professional (physician) fee — not the facility price 41,975
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 4,586
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 609
exceeds 10× this hospital's gross charge — excluded from medians 51
per-diem day rate — not a per-procedure price 51
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 7
placeholder amount (≤ $0.02) — excluded from medians 3
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 1

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 17 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://westernwi.pt.panaceainc.com/MRFDownload/westernwi/westernwihealth
Found on page https://www.wwhealth.org/your-visit/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-11-07
Content fingerprint 183a9b9f005d1f2a… · 56,941,041 bytes · first seen 2026-11-06

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
5834
APR_DRG 		Neonate With Ecmo 3 $1,075,042.21 $1,075,042.21 $1,075,042.21 nat. median
$309,665
outlier · 3.5×
24
APR_DRG 		Heart And/or Lung Transplant 3 $716,656.91 $716,656.91 $716,656.91 nat. median
$243,231
outlier · 2.9×
5884
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 3 $701,342.26 $701,342.26 $701,342.26 nat. median
$249,123
outlier · 2.8×
5833
APR_DRG 		Neonate With Ecmo 3 $696,445.65 $696,445.65 $696,445.65 nat. median
$244,017
outlier · 2.9×
5832
APR_DRG 		Neonate With Ecmo 3 $534,742.81 $534,742.81 $534,742.81 nat. median
$159,829
outlier · 3.3×
6304
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 3 $511,604.33 $511,604.33 $511,604.33 nat. median
$154,211
outlier · 3.3×
6094
APR_DRG 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 3 $461,135.86 $461,135.86 $461,135.86 nat. median
$165,846
outlier · 2.8×
5883
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 3 $456,134.72 $456,134.72 $456,134.72 nat. median
$177,531
outlier · 2.6×
6314
APR_DRG 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 3 $452,720.01 $452,720.01 $452,720.01 nat. median
$138,094
outlier · 3.3×
5914
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 3 $445,538.04 $445,538.04 $445,538.04 nat. median
$165,334
outlier · 2.7×
14
APR_DRG 		Liver Transplant And/or Intestinal Transplant 3 $433,959.27 $433,959.27 $433,959.27 nat. median
$137,215
outlier · 3.2×
114
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 $420,105.23 $420,105.23 $420,105.23 nat. median
$122,909
outlier · 3.4×
5934
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 3 $413,126.97 $413,126.97 $413,126.97 nat. median
$152,569
outlier · 2.7×
1614
APR_DRG 		Implantable Heart Assist Systems 3 $409,447.06 $409,447.06 $409,447.06 nat. median
$202,660
outlier · 2.0×
23
APR_DRG 		Heart And/or Lung Transplant 3 $402,398.64 $402,398.64 $402,398.64 nat. median
$111,079
outlier · 3.6×
5882
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 3 $400,249.03 $400,249.03 $400,249.03 nat. median
$145,336
outlier · 2.8×
5831
APR_DRG 		Neonate With Ecmo 3 $388,686.97 $388,686.97 $388,686.97 nat. median
$148,245
outlier · 2.6×
8414
APR_DRG 		Extensive Third Degree Burns With Skin Graft 3 $388,151.22 $388,151.22 $388,151.22 nat. median
$160,390
outlier · 2.4×
6034
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 3 $382,128.10 $382,128.10 $382,128.10 nat. median
$107,562
outlier · 3.6×
5881
APR_DRG 		Neonate Birth Weight < 1500 Grams With Major Procedure 3 $343,070.01 $343,070.01 $343,070.01 nat. median
$122,978
outlier · 2.8×
5913
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 3 $330,694.24 $330,694.24 $330,694.24 nat. median
$103,993
outlier · 3.2×
74
APR_DRG 		Allogeneic Bone Marrow Transplant 3 $325,310.60 $325,310.60 $325,310.60 nat. median
$171,358
1.9× median
94
APR_DRG 		Extracorporeal Membrane Oxygenation (ecmo) 3 $323,680.34 $323,680.34 $323,680.34 nat. median
$165,169
2.0× median
64
APR_DRG 		Pancreas Transplant 3 $312,177.09 $312,177.09 $312,177.09 nat. median
$92,076
outlier · 3.4×
6024
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 3 $306,778.95 $306,778.95 $306,778.95 nat. median
$119,800
outlier · 2.6×
22
APR_DRG 		Heart And/or Lung Transplant 3 $292,845.76 $292,845.76 $292,845.76 nat. median
$93,125
outlier · 3.1×
44
APR_DRG 		Tracheostomy With Mv >96 Hours With Extensive Procedure 3 $287,322.75 $287,322.75 $287,322.75 nat. median
$122,016
outlier · 2.4×
5933
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 3 $286,518.18 $286,518.18 $286,518.18 nat. median
$109,393
outlier · 2.6×
1613
APR_DRG 		Implantable Heart Assist Systems 3 $277,042.98 $277,042.98 $277,042.98 nat. median
$121,888
outlier · 2.3×
5891
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 3 $273,972.29 $273,972.29 $273,972.29 nat. median
$95,269
outlier · 2.9×
21
APR_DRG 		Heart And/or Lung Transplant 3 $269,314.23 $269,314.23 $269,314.23 nat. median
$73,922
outlier · 3.6×
5892
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 3 $265,890.53 $265,890.53 $265,890.53 nat. median
$90,073
outlier · 3.0×
5893
APR_DRG 		Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational… 3 $260,225.30 $260,225.30 $260,225.30 nat. median
$71,594
outlier · 3.6×
5912
APR_DRG 		Neonate Birth Weight 500-749 Grams Without Major Procedure 3 $250,772.33 $250,772.33 $250,772.33 nat. median
$83,372
outlier · 3.0×
113
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 $245,005.41 $245,005.41 $245,005.41 nat. median
$67,440
outlier · 3.6×
6303
APR_DRG 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 3 $244,291.34 $244,291.34 $244,291.34 nat. median
$76,612
outlier · 3.2×
1604
APR_DRG 		Major Cardiothoracic Repair Of Heart Anomaly 3 $238,884.85 $238,884.85 $238,884.85 nat. median
$99,544
outlier · 2.4×
6074
APR_DRG 		Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 3 $235,108.92 $235,108.92 $235,108.92 nat. median
$96,980
outlier · 2.4×
5932
APR_DRG 		Neonate Birth Weight 750-999 Grams Without Major Procedure 3 $234,672.35 $234,672.35 $234,672.35 nat. median
$86,338
outlier · 2.7×
4404
APR_DRG 		Kidney Transplant 3 $228,605.86 $228,605.86 $228,605.86 nat. median
$78,303
outlier · 2.9×
1612
APR_DRG 		Implantable Heart Assist Systems 3 $222,386.76 $222,386.76 $222,386.76 nat. median
$85,665
outlier · 2.6×
63
APR_DRG 		Pancreas Transplant 3 $221,775.81 $221,775.81 $221,775.81 nat. median
$74,184
outlier · 3.0×
6023
APR_DRG 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 3 $217,609.03 $217,609.03 $217,609.03 nat. median
$89,743
outlier · 2.4×
1611
APR_DRG 		Implantable Heart Assist Systems 3 $211,881.53 $211,881.53 $211,881.53 nat. median
$77,137
outlier · 2.7×
112
APR_DRG 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 3 $210,369.52 $210,369.52 $210,369.52 nat. median
$67,645
outlier · 3.1×
13
APR_DRG 		Liver Transplant And/or Intestinal Transplant 3 $203,007.34 $203,007.34 $203,007.34 nat. median
$73,704
outlier · 2.8×
8514
APR_DRG 		Gender Related Procedures 3 $201,795.68 $201,795.68 $201,795.68 nat. median
$69,605
outlier · 2.9×
8424
APR_DRG 		Burns With Skin Graft Except Extensive Third Degree Burns 3 $198,785.86 $198,785.86 $198,785.86 nat. median
$83,417
outlier · 2.4×
8634
APR_DRG 		Neonatal Aftercare 3 $195,811.03 $195,811.03 $195,811.03 nat. median
$71,420
outlier · 2.7×
6134
APR_DRG 		Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 3 $191,447.33 $191,447.33 $191,447.33 nat. median
$56,729
outlier · 3.4×

Other procedures at this hospital

Browse this hospital's 18,218 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
             
0451T OTHER Insj/rplcmt Aortic Ventr Sys 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
0452T OTHER Insj/rplcmt Dev Vasc Seal 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
0453T OTHER Insj/rplcmt Mech-elec Ntrfce 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
0454T OTHER Insj/rplcmt Subq Electrode 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
0459T OTHER Relocaj Rplcmt Aortic Ventr 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 2 1 — — $105,208.60 $105,208.60 $105,208.60 2025-06-24
11 APR_DRG Liver Transplant And/or Intestinal Transplant 6 3 — — $141,796.98 $141,796.98 $141,796.98 2025-06-24
111 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 6 3 — — $95,928.23 $95,928.23 $95,928.23 2025-06-24
112 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 6 3 — — $210,369.52 $210,369.52 $210,369.52 2025-06-24
113 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 6 3 — — $245,005.41 $245,005.41 $245,005.41 2025-06-24
114 APR_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 6 3 — — $420,105.23 $420,105.23 $420,105.23 2025-06-24
12 APR_DRG Liver Transplant And/or Intestinal Transplant 6 3 — — $163,081.78 $163,081.78 $163,081.78 2025-06-24
1204 APR_DRG Major Respiratory And Chest Procedures 6 3 — — $102,692.07 $102,692.07 $102,692.07 2025-06-24
1214 APR_DRG Other Respiratory And Chest Procedures 6 3 — — $81,393.08 $81,393.08 $81,393.08 2025-06-24
13 APR_DRG Liver Transplant And/or Intestinal Transplant 6 3 — — $203,007.34 $203,007.34 $203,007.34 2025-06-24
1303 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 6 3 — — $66,004.95 $66,004.95 $66,004.95 2025-06-24
1304 APR_DRG Respiratory System Diagnosis With Ventilator Support > 96 Hours 6 3 — — $86,520.35 $86,520.35 $86,520.35 2025-06-24
14 APR_DRG Liver Transplant And/or Intestinal Transplant 6 3 — — $433,959.27 $433,959.27 $433,959.27 2025-06-24
1602 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 6 3 — — $60,516.63 $60,516.63 $60,516.63 2025-06-24
1603 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 6 3 — — $96,751.24 $96,751.24 $96,751.24 2025-06-24
1604 APR_DRG Major Cardiothoracic Repair Of Heart Anomaly 6 3 — — $238,884.85 $238,884.85 $238,884.85 2025-06-24
1611 APR_DRG Implantable Heart Assist Systems 6 3 — — $211,881.53 $211,881.53 $211,881.53 2025-06-24
1612 APR_DRG Implantable Heart Assist Systems 6 3 — — $222,386.76 $222,386.76 $222,386.76 2025-06-24
1613 APR_DRG Implantable Heart Assist Systems 6 3 — — $277,042.98 $277,042.98 $277,042.98 2025-06-24
1614 APR_DRG Implantable Heart Assist Systems 6 3 — — $409,447.06 $409,447.06 $409,447.06 2025-06-24
1621 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 6 3 — — $66,656.11 $66,656.11 $66,656.11 2025-06-24
1622 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 6 3 — — $77,492.44 $77,492.44 $77,492.44 2025-06-24
1623 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 6 3 — — $104,183.58 $104,183.58 $104,183.58 2025-06-24
1624 APR_DRG Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 6 3 — — $163,082.57 $163,082.57 $163,082.57 2025-06-24
1632 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 6 3 — — $65,095.23 $65,095.23 $65,095.23 2025-06-24
1633 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 6 3 — — $86,692.21 $86,692.21 $86,692.21 2025-06-24
1634 APR_DRG Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 6 3 — — $135,845.91 $135,845.91 $135,845.91 2025-06-24
1651 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 6 3 — — $59,159.13 $59,159.13 $59,159.13 2025-06-24
1652 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 6 3 — — $66,384.93 $66,384.93 $66,384.93 2025-06-24
1653 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 6 3 — — $84,904.28 $84,904.28 $84,904.28 2025-06-24
1654 APR_DRG Coronary Bypass With Ami Or Complex Principal Diagnosis 6 3 — — $126,866.87 $126,866.87 $126,866.87 2025-06-24
1663 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 6 3 — — $71,368.72 $71,368.72 $71,368.72 2025-06-24
1664 APR_DRG Coronary Bypass Without Ami Or Complex Principal Diagnosis 6 3 — — $111,098.78 $111,098.78 $111,098.78 2025-06-24
1673 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 6 3 — — $78,591.37 $78,591.37 $78,591.37 2025-06-24
1674 APR_DRG Other Cardiothoracic And Thoracic Circulatory Procedures 6 3 — — $136,769.83 $136,769.83 $136,769.83 2025-06-24
1693 APR_DRG Major Abdominal Vascular Procedures 6 3 — — $61,833.13 $61,833.13 $61,833.13 2025-06-24
1694 APR_DRG Major Abdominal Vascular Procedures 6 3 — — $97,908.51 $97,908.51 $97,908.51 2025-06-24
1704 APR_DRG Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock 6 3 — — $71,808.61 $71,808.61 $71,808.61 2025-06-24
1714 APR_DRG Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock 6 3 — — $61,916.70 $61,916.70 $61,916.70 2025-06-24
1744 APR_DRG Percutaneous Cardiac Intervention With Ami 6 3 — — $62,865.84 $62,865.84 $62,865.84 2025-06-24
1754 APR_DRG Percutaneous Cardiac Intervention Without Ami 6 3 — — $70,782.21 $70,782.21 $70,782.21 2025-06-24
1764 APR_DRG Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 6 3 — — $87,646.08 $87,646.08 $87,646.08 2025-06-24
1781 APR_DRG External Heart Assist Devices 6 3 — — $78,203.51 $78,203.51 $78,203.51 2025-06-24
1782 APR_DRG External Heart Assist Devices 6 3 — — $92,180.53 $92,180.53 $92,180.53 2025-06-24
1783 APR_DRG External Heart Assist Devices 6 3 — — $95,891.97 $95,891.97 $95,891.97 2025-06-24
1784 APR_DRG External Heart Assist Devices 6 3 — — $130,182.57 $130,182.57 $130,182.57 2025-06-24
1792 APR_DRG Defibrillator Implants 6 3 — — $62,236.76 $62,236.76 $62,236.76 2025-06-24
1793 APR_DRG Defibrillator Implants 6 3 — — $76,358.83 $76,358.83 $76,358.83 2025-06-24
1794 APR_DRG Defibrillator Implants 6 3 — — $105,503.24 $105,503.24 $105,503.24 2025-06-24
18 MS_DRG Chimeric Antigen Receptor (car) T-cell Immunotherapy 2 1 — — $140,857.31 $140,857.31 $140,857.31 2025-06-24
1804 APR_DRG Other Circulatory System Procedures 6 3 — — $63,174.86 $63,174.86 $63,174.86 2025-06-24
1814 APR_DRG Lower Extremity Vascular Procedures 6 3 — — $85,230.65 $85,230.65 $85,230.65 2025-06-24
1824 APR_DRG Other Peripheral Vascular And Related Procedures 6 3 — — $77,806.19 $77,806.19 $77,806.19 2025-06-24
1831 APR_DRG Percutaneous Structural Cardiac Procedures 6 3 — — $59,652.62 $59,652.62 $59,652.62 2025-06-24
1832 APR_DRG Percutaneous Structural Cardiac Procedures 6 3 — — $62,555.24 $62,555.24 $62,555.24 2025-06-24
1833 APR_DRG Percutaneous Structural Cardiac Procedures 6 3 — — $75,980.43 $75,980.43 $75,980.43 2025-06-24
1834 APR_DRG Percutaneous Structural Cardiac Procedures 6 3 — — $113,451.14 $113,451.14 $113,451.14 2025-06-24
203 APR_DRG Open Craniotomy For Trauma 6 3 — — $59,740.92 $59,740.92 $59,740.92 2025-06-24
204 APR_DRG Open Craniotomy For Trauma 6 3 — — $95,904.58 $95,904.58 $95,904.58 2025-06-24
21 APR_DRG Heart And/or Lung Transplant 6 3 — — $269,314.23 $269,314.23 $269,314.23 2025-06-24
213 APR_DRG Open Craniotomy Except Trauma 6 3 — — $66,148.43 $66,148.43 $66,148.43 2025-06-24
214 APR_DRG Open Craniotomy Except Trauma 6 3 — — $107,046.78 $107,046.78 $107,046.78 2025-06-24
22 APR_DRG Heart And/or Lung Transplant 6 3 — — $292,845.76 $292,845.76 $292,845.76 2025-06-24
2204 APR_DRG Major Stomach, Esophageal And Duodenal Procedures 6 3 — — $98,551.78 $98,551.78 $98,551.78 2025-06-24
2224 APR_DRG Other Stomach, Esophageal And Duodenal Procedures 6 3 — — $67,614.72 $67,614.72 $67,614.72 2025-06-24
2234 APR_DRG Other Small And Large Bowel Procedures 6 3 — — $67,062.89 $67,062.89 $67,062.89 2025-06-24
224 APR_DRG Ventricular Shunt Procedures 6 3 — — $82,952.39 $82,952.39 $82,952.39 2025-06-24
2244 APR_DRG Peritoneal Adhesiolysis 6 3 — — $64,869.76 $64,869.76 $64,869.76 2025-06-24
2274 APR_DRG Hernia Procedures Except Inguinal, Femoral And Umbilical 6 3 — — $65,883.55 $65,883.55 $65,883.55 2025-06-24
2294 APR_DRG Other Digestive System And Abdominal Procedures 6 3 — — $68,696.30 $68,696.30 $68,696.30 2025-06-24
23 APR_DRG Heart And/or Lung Transplant 6 3 — — $402,398.64 $402,398.64 $402,398.64 2025-06-24
2304 APR_DRG Major Small Bowel Procedures 6 3 — — $81,246.45 $81,246.45 $81,246.45 2025-06-24
2314 APR_DRG Major Large Bowel Procedures 6 3 — — $70,074.29 $70,074.29 $70,074.29 2025-06-24
2324 APR_DRG Gastric Fundoplication 6 3 — — $99,660.17 $99,660.17 $99,660.17 2025-06-24
233 APR_DRG Spinal Procedures 6 3 — — $62,250.95 $62,250.95 $62,250.95 2025-06-24
234 APR_DRG Spinal Procedures 6 3 — — $98,280.60 $98,280.60 $98,280.60 2025-06-24
24 APR_DRG Heart And/or Lung Transplant 6 3 — — $716,656.91 $716,656.91 $716,656.91 2025-06-24
244 APR_DRG Open Extracranial Vascular Procedures 6 3 — — $69,793.65 $69,793.65 $69,793.65 2025-06-24
2604 APR_DRG Major Pancreas, Liver And Shunt Procedures 6 3 — — $101,867.48 $101,867.48 $101,867.48 2025-06-24
2614 APR_DRG Major Biliary Tract Procedures 6 3 — — $88,298.81 $88,298.81 $88,298.81 2025-06-24
2634 APR_DRG Cholecystectomy 6 3 — — $58,336.12 $58,336.12 $58,336.12 2025-06-24
264 APR_DRG Other Nervous System And Related Procedures 6 3 — — $81,426.19 $81,426.19 $81,426.19 2025-06-24
2644 APR_DRG Other Hepatobiliary, Pancreas And Abdominal Procedures 6 3 — — $81,960.67 $81,960.67 $81,960.67 2025-06-24
274 APR_DRG Other Open Craniotomy 6 3 — — $100,341.28 $100,341.28 $100,341.28 2025-06-24
294 APR_DRG Other Percutaneous Intracranial Procedures 6 3 — — $70,422.73 $70,422.73 $70,422.73 2025-06-24
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 2 1 — — $80,047.03 $80,047.03 $80,047.03 2025-06-24
303 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 6 3 — — $58,783.89 $58,783.89 $58,783.89 2025-06-24
3031 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 6 3 — — $65,319.11 $65,319.11 $65,319.11 2025-06-24
3032 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 6 3 — — $82,044.24 $82,044.24 $82,044.24 2025-06-24
3033 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 6 3 — — $116,921.35 $116,921.35 $116,921.35 2025-06-24
3034 APR_DRG Dorsal And Lumbar Fusion Procedure For Curvature Of Back 6 3 — — $171,572.84 $171,572.84 $171,572.84 2025-06-24
304 APR_DRG Percutaneous Intracranial And Extracranial Vascular Procedures 6 3 — — $78,938.23 $78,938.23 $78,938.23 2025-06-24
3043 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 6 3 — — $77,372.62 $77,372.62 $77,372.62 2025-06-24
3044 APR_DRG Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 6 3 — — $120,295.39 $120,295.39 $120,295.39 2025-06-24
3054 APR_DRG Amputation Of Lower Limb Except Toes 6 3 — — $65,932.43 $65,932.43 $65,932.43 2025-06-24
3094 APR_DRG Other Significant Hip And Femur Surgery 6 3 — — $68,240.65 $68,240.65 $68,240.65 2025-06-24
3104 APR_DRG Vertebral And Intervertebral Spinal Procedures Including Disc Procedures 6 3 — — $69,673.82 $69,673.82 $69,673.82 2025-06-24
3123 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 6 3 — — $59,649.47 $59,649.47 $59,649.47 2025-06-24
3124 APR_DRG Skin Graft For Musculoskeletal And Connective Tissue Diagnoses 6 3 — — $112,654.93 $112,654.93 $112,654.93 2025-06-24
3134 APR_DRG Knee And Lower Leg Procedures Except Foot 6 3 — — $68,393.58 $68,393.58 $68,393.58 2025-06-24
3154 APR_DRG Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement 6 3 — — $70,465.30 $70,465.30 $70,465.30 2025-06-24
3164 APR_DRG Hand And Wrist Procedures 6 3 — — $58,468.56 $58,468.56 $58,468.56 2025-06-24
3174 APR_DRG Tendon, Muscle And Other Soft Tissue Procedures 6 3 — — $62,689.26 $62,689.26 $62,689.26 2025-06-24
3204 APR_DRG Other Musculoskeletal System And Connective Tissue Procedures 6 3 — — $68,770.40 $68,770.40 $68,770.40 2025-06-24
3214 APR_DRG Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 6 3 — — $81,263.79 $81,263.79 $81,263.79 2025-06-24
3244 APR_DRG Elective Hip Joint Replacement 6 3 — — $59,589.56 $59,589.56 $59,589.56 2025-06-24
3254 APR_DRG Non-elective Or Complex Knee Joint Replacement 6 3 — — $73,516.12 $73,516.12 $73,516.12 2025-06-24
33975 HCPCS Implant Ventricular Device 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
33976 HCPCS Implant Ventricular Device 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
33979 HCPCS Insert Intracorporeal Device 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
33981 HCPCS Replace Vad Pump Ext 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
33982 HCPCS Replace Vad Intra Without Bp 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
33983 HCPCS Replace Vad Intra W/bp 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
33990 HCPCS Insj Perq Vad L Hrt Arterial 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
33991 HCPCS Insj Perq Vad L Hrt Artl&ven 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
33995 HCPCS Insj Perq Vad R Hrt Venous 6 3 — — $65,666.96 $65,666.96 $65,666.96 2025-06-24
3614 APR_DRG Skin Graft For Skin And Subcutaneous Tissue Diagnoses 6 3 — — $109,150.04 $109,150.04 $109,150.04 2025-06-24
3634 APR_DRG Breast Procedures Except Mastectomy 6 3 — — $81,653.23 $81,653.23 $81,653.23 2025-06-24
4014 APR_DRG Adrenal Procedures 6 3 — — $77,106.16 $77,106.16 $77,106.16 2025-06-24
4034 APR_DRG Procedures For Obesity 6 3 — — $76,934.31 $76,934.31 $76,934.31 2025-06-24
4044 APR_DRG Thyroid, Parathyroid And Thyroglossal Procedures 6 3 — — $81,328.44 $81,328.44 $81,328.44 2025-06-24
4054 APR_DRG Other Procedures For Endocrine, Nutritional And Metabolic Disorders 6 3 — — $78,208.24 $78,208.24 $78,208.24 2025-06-24
41 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 6 3 — — $98,660.57 $98,660.57 $98,660.57 2025-06-24
42 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 6 3 — — $111,177.61 $111,177.61 $111,177.61 2025-06-24
4234 APR_DRG Inborn Errors Of Metabolism 6 3 — — $65,872.52 $65,872.52 $65,872.52 2025-06-24
43 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 6 3 — — $180,170.33 $180,170.33 $180,170.33 2025-06-24
434 APR_DRG Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies 6 3 — — $58,913.17 $58,913.17 $58,913.17 2025-06-24
44 APR_DRG Tracheostomy With Mv >96 Hours With Extensive Procedure 6 3 — — $287,322.75 $287,322.75 $287,322.75 2025-06-24
4401 APR_DRG Kidney Transplant 6 3 — — $111,712.10 $111,712.10 $111,712.10 2025-06-24
4402 APR_DRG Kidney Transplant 6 3 — — $121,093.96 $121,093.96 $121,093.96 2025-06-24
4403 APR_DRG Kidney Transplant 6 3 — — $138,542.77 $138,542.77 $138,542.77 2025-06-24
4404 APR_DRG Kidney Transplant 6 3 — — $228,605.86 $228,605.86 $228,605.86 2025-06-24
4414 APR_DRG Major Bladder Procedures 6 3 — — $90,000.02 $90,000.02 $90,000.02 2025-06-24
4424 APR_DRG Kidney And Urinary Tract Procedures For Malignancy 6 3 — — $72,041.95 $72,041.95 $72,041.95 2025-06-24
4434 APR_DRG Kidney And Urinary Tract Procedures For Non-malignancy 6 3 — — $64,057.79 $64,057.79 $64,057.79 2025-06-24
4444 APR_DRG Renal Dialysis Access Device Procedures 6 3 — — $66,656.11 $66,656.11 $66,656.11 2025-06-24
4474 APR_DRG Other Kidney, Urinary Tract And Related Non-percutaneous Procedures 6 3 — — $72,872.85 $72,872.85 $72,872.85 2025-06-24
4804 APR_DRG — 6 3 — — $69,788.92 $69,788.92 $69,788.92 2025-06-24
4834 APR_DRG Penis, Testes And Scrotal Procedures 6 3 — — $62,220.99 $62,220.99 $62,220.99 2025-06-24
4844 APR_DRG Other Male Reproductive System And Related Procedures 6 3 — — $64,114.55 $64,114.55 $64,114.55 2025-06-24
494 APR_DRG Bacterial And Tuberculous Infections Of Nervous System 6 3 — — $62,146.89 $62,146.89 $62,146.89 2025-06-24
504 APR_DRG Non-bacterial Infections Of Nervous System Except Viral Meningitis 6 3 — — $70,394.35 $70,394.35 $70,394.35 2025-06-24
51 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 6 3 — — $66,369.16 $66,369.16 $66,369.16 2025-06-24
5104 APR_DRG — 6 3 — — $85,533.37 $85,533.37 $85,533.37 2025-06-24
5114 APR_DRG Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy 6 3 — — $81,500.29 $81,500.29 $81,500.29 2025-06-24
5124 APR_DRG Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy 6 3 — — $72,092.41 $72,092.41 $72,092.41 2025-06-24
5144 APR_DRG Female Reproductive System Reconstructive Procedures 6 3 — — $85,875.50 $85,875.50 $85,875.50 2025-06-24
5184 APR_DRG Other Female Reproductive System And Related Procedures 6 3 — — $79,682.41 $79,682.41 $79,682.41 2025-06-24
5194 APR_DRG Uterine And Adnexa Procedures For Leiomyoma 6 3 — — $67,487.01 $67,487.01 $67,487.01 2025-06-24
52 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 6 3 — — $85,479.76 $85,479.76 $85,479.76 2025-06-24
53 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 6 3 — — $129,458.89 $129,458.89 $129,458.89 2025-06-24
54 APR_DRG Tracheostomy With Mv >96 Hours Without Extensive Procedure 6 3 — — $187,413.46 $187,413.46 $187,413.46 2025-06-24
5484 APR_DRG Postpartum And Post Abortion Diagnosis With O.r. Procedure 6 3 — — $58,500.09 $58,500.09 $58,500.09 2025-06-24
5831 APR_DRG Neonate With Ecmo 6 3 — — $388,686.97 $388,686.97 $388,686.97 2025-06-24
5832 APR_DRG Neonate With Ecmo 6 3 — — $534,742.81 $534,742.81 $534,742.81 2025-06-24
5833 APR_DRG Neonate With Ecmo 6 3 — — $696,445.65 $696,445.65 $696,445.65 2025-06-24
5834 APR_DRG Neonate With Ecmo 6 3 — — $1,075,042.21 $1,075,042.21 $1,075,042.21 2025-06-24
5881 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 6 3 — — $343,070.01 $343,070.01 $343,070.01 2025-06-24
5882 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 6 3 — — $400,249.03 $400,249.03 $400,249.03 2025-06-24
5883 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 6 3 — — $456,134.72 $456,134.72 $456,134.72 2025-06-24
5884 APR_DRG Neonate Birth Weight < 1500 Grams With Major Procedure 6 3 — — $701,342.26 $701,342.26 $701,342.26 2025-06-24
5891 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 6 3 — — $273,972.29 $273,972.29 $273,972.29 2025-06-24
5892 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 6 3 — — $265,890.53 $265,890.53 $265,890.53 2025-06-24
5893 APR_DRG Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 6 3 — — $260,225.30 $260,225.30 $260,225.30 2025-06-24
5911 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 6 3 — — $150,745.43 $150,745.43 $150,745.43 2025-06-24
5912 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 6 3 — — $250,772.33 $250,772.33 $250,772.33 2025-06-24
5913 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 6 3 — — $330,694.24 $330,694.24 $330,694.24 2025-06-24
5914 APR_DRG Neonate Birth Weight 500-749 Grams Without Major Procedure 6 3 — — $445,538.04 $445,538.04 $445,538.04 2025-06-24
5932 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 6 3 — — $234,672.35 $234,672.35 $234,672.35 2025-06-24
5933 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 6 3 — — $286,518.18 $286,518.18 $286,518.18 2025-06-24
5934 APR_DRG Neonate Birth Weight 750-999 Grams Without Major Procedure 6 3 — — $413,126.97 $413,126.97 $413,126.97 2025-06-24
6022 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $174,023.27 $174,023.27 $174,023.27 2025-06-24
6023 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $217,609.03 $217,609.03 $217,609.03 2025-06-24
6024 APR_DRG Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $306,778.95 $306,778.95 $306,778.95 2025-06-24
6032 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 6 3 — — $94,113.66 $94,113.66 $94,113.66 2025-06-24
6033 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 6 3 — — $168,790.52 $168,790.52 $168,790.52 2025-06-24
6034 APR_DRG Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 6 3 — — $382,128.10 $382,128.10 $382,128.10 2025-06-24
6071 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $66,640.19 $66,640.19 $66,640.19 2025-06-24
6072 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $120,203.63 $120,203.63 $120,203.63 2025-06-24
6073 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $162,752.26 $162,752.26 $162,752.26 2025-06-24
6074 APR_DRG Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $235,108.92 $235,108.92 $235,108.92 2025-06-24
6082 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 6 3 — — $88,581.66 $88,581.66 $88,581.66 2025-06-24
6083 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 6 3 — — $118,276.96 $118,276.96 $118,276.96 2025-06-24
6084 APR_DRG Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 6 3 — — $148,544.11 $148,544.11 $148,544.11 2025-06-24
6091 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 6 3 — — $90,245.98 $90,245.98 $90,245.98 2025-06-24
6092 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 6 3 — — $94,995.01 $94,995.01 $94,995.01 2025-06-24
6093 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 6 3 — — $172,178.59 $172,178.59 $172,178.59 2025-06-24
6094 APR_DRG Neonate Birth Weight 1500-2499 Grams With Major Procedure 6 3 — — $461,135.86 $461,135.86 $461,135.86 2025-06-24
61 APR_DRG Pancreas Transplant 6 3 — — $132,800.60 $132,800.60 $132,800.60 2025-06-24
6112 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 6 3 — — $66,703.73 $66,703.73 $66,703.73 2025-06-24
6113 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 6 3 — — $117,725.60 $117,725.60 $117,725.60 2025-06-24
6114 APR_DRG Neonate Birth Weight 1500-1999 Grams With Major Anomaly 6 3 — — $190,551.63 $190,551.63 $190,551.63 2025-06-24
6122 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $82,676.63 $82,676.63 $82,676.63 2025-06-24
6123 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $104,624.26 $104,624.26 $104,624.26 2025-06-24
6124 APR_DRG Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $167,937.87 $167,937.87 $167,937.87 2025-06-24
6132 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 6 3 — — $60,895.03 $60,895.03 $60,895.03 2025-06-24
6133 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 6 3 — — $116,192.47 $116,192.47 $116,192.47 2025-06-24
6134 APR_DRG Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 6 3 — — $191,447.33 $191,447.33 $191,447.33 2025-06-24
6143 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 6 3 — — $94,123.91 $94,123.91 $94,123.91 2025-06-24
6144 APR_DRG Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 6 3 — — $137,109.12 $137,109.12 $137,109.12 2025-06-24
62 APR_DRG Pancreas Transplant 6 3 — — $177,574.37 $177,574.37 $177,574.37 2025-06-24
6213 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 6 3 — — $79,505.83 $79,505.83 $79,505.83 2025-06-24
6214 APR_DRG Neonate Birth Weight 2000-2499 Grams With Major Anomaly 6 3 — — $161,307.26 $161,307.26 $161,307.26 2025-06-24
6223 APR_DRG Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $59,345.49 $59,345.49 $59,345.49 2025-06-24
6224 APR_DRG Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 6 3 — — $100,346.64 $100,346.64 $100,346.64 2025-06-24
6233 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 6 3 — — $90,327.96 $90,327.96 $90,327.96 2025-06-24
6234 APR_DRG Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection 6 3 — — $113,015.51 $113,015.51 $113,015.51 2025-06-24
6253 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 6 3 — — $65,650.21 $65,650.21 $65,650.21 2025-06-24
6254 APR_DRG Neonate Birth Weight 2000-2499 Grams With Other Significant Condition 6 3 — — $134,137.13 $134,137.13 $134,137.13 2025-06-24
6264 APR_DRG Neonate Birth Weight 2000-2499 Grams, Normal Newborn Or Neonate With Other Probl… 6 3 — — $64,382.26 $64,382.26 $64,382.26 2025-06-24
63 APR_DRG Pancreas Transplant 6 3 — — $221,775.81 $221,775.81 $221,775.81 2025-06-24
6301 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 6 3 — — $66,703.73 $66,703.73 $66,703.73 2025-06-24
6302 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 6 3 — — $139,796.21 $139,796.21 $139,796.21 2025-06-24
6303 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 6 3 — — $244,291.34 $244,291.34 $244,291.34 2025-06-24
6304 APR_DRG Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 6 3 — — $511,604.33 $511,604.33 $511,604.33 2025-06-24
6312 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 6 3 — — $88,282.42 $88,282.42 $88,282.42 2025-06-24
6313 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 6 3 — — $135,940.82 $135,940.82 $135,940.82 2025-06-24
6314 APR_DRG Neonate Birth Weight > 2499 Grams With Other Major Procedure 6 3 — — $452,720.01 $452,720.01 $452,720.01 2025-06-24
6333 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 6 3 — — $58,992.95 $58,992.95 $58,992.95 2025-06-24
6334 APR_DRG Neonate Birth Weight > 2499 Grams With Major Anomaly 6 3 — — $159,681.89 $159,681.89 $159,681.89 2025-06-24
6344 APR_DRG Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 6 3 — — $94,960.17 $94,960.17 $94,960.17 2025-06-24
6364 APR_DRG Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection 6 3 — — $71,395.37 $71,395.37 $71,395.37 2025-06-24
6394 APR_DRG Neonate Birth Weight > 2499 Grams With Other Significant Condition 6 3 — — $70,048.75 $70,048.75 $70,048.75 2025-06-24
64 APR_DRG Pancreas Transplant 6 3 — — $312,177.09 $312,177.09 $312,177.09 2025-06-24
6404 APR_DRG Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem 6 3 — — $58,902.14 $58,902.14 $58,902.14 2025-06-24
6504 APR_DRG Splenic Procedures 6 3 — — $73,883.48 $73,883.48 $73,883.48 2025-06-24
6514 APR_DRG Other Procedures Of Blood And Blood-forming Organs 6 3 — — $84,812.84 $84,812.84 $84,812.84 2025-06-24
6804 APR_DRG Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 6 3 — — $123,976.87 $123,976.87 $123,976.87 2025-06-24
6814 APR_DRG Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 6 3 — — $112,967.11 $112,967.11 $112,967.11 2025-06-24
6903 APR_DRG Acute Leukemia 6 3 — — $64,805.12 $64,805.12 $64,805.12 2025-06-24
6904 APR_DRG Acute Leukemia 6 3 — — $111,906.02 $111,906.02 $111,906.02 2025-06-24
6914 APR_DRG Lymphoma, Myeloma And Non-acute Leukemia 6 3 — — $65,514.62 $65,514.62 $65,514.62 2025-06-24
6954 APR_DRG Chemotherapy For Acute Leukemia 6 3 — — $99,169.83 $99,169.83 $99,169.83 2025-06-24
71 APR_DRG Allogeneic Bone Marrow Transplant 6 3 — — $121,118.40 $121,118.40 $121,118.40 2025-06-24
7104 APR_DRG Infectious And Parasitic Diseases Including HIV With O.r. Procedure 6 3 — — $76,369.86 $76,369.86 $76,369.86 2025-06-24
7114 APR_DRG Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 6 3 — — $73,412.07 $73,412.07 $73,412.07 2025-06-24
72 APR_DRG Allogeneic Bone Marrow Transplant 6 3 — — $127,492.81 $127,492.81 $127,492.81 2025-06-24
73 APR_DRG Allogeneic Bone Marrow Transplant 6 3 — — $158,991.16 $158,991.16 $158,991.16 2025-06-24
734 APR_DRG Orbit And Eye Procedures 6 3 — — $60,953.36 $60,953.36 $60,953.36 2025-06-24
74 APR_DRG Allogeneic Bone Marrow Transplant 6 3 — — $325,310.60 $325,310.60 $325,310.60 2025-06-24
7404 APR_DRG Mental Illness Diagnosis With O.r. Procedure 6 3 — — $112,505.15 $112,505.15 $112,505.15 2025-06-24
7584 APR_DRG Disorders Of Impulse Control & Development 6 3 — — $82,285.46 $82,285.46 $82,285.46 2025-06-24
7594 APR_DRG Eating Disorders 6 3 — — $105,645.14 $105,645.14 $105,645.14 2025-06-24
7924 APR_DRG Extensive O.r. Procedures For Other Complications Of Treatment 6 3 — — $85,697.34 $85,697.34 $85,697.34 2025-06-24
7934 APR_DRG Moderately Extensive O.r. Procedures For Other Complications Of Treatment 6 3 — — $70,785.36 $70,785.36 $70,785.36 2025-06-24
82 APR_DRG Autologous Bone Marrow Transplant 6 3 — — $69,308.04 $69,308.04 $69,308.04 2025-06-24
83 APR_DRG Autologous Bone Marrow Transplant 6 3 — — $82,268.12 $82,268.12 $82,268.12 2025-06-24
84 APR_DRG Autologous Bone Marrow Transplant 6 3 — — $161,237.89 $161,237.89 $161,237.89 2025-06-24
8411 APR_DRG Extensive Third Degree Burns With Skin Graft 6 3 — — $84,279.93 $84,279.93 $84,279.93 2025-06-24
8412 APR_DRG Extensive Third Degree Burns With Skin Graft 6 3 — — $84,279.93 $84,279.93 $84,279.93 2025-06-24
8413 APR_DRG Extensive Third Degree Burns With Skin Graft 6 3 — — $124,216.52 $124,216.52 $124,216.52 2025-06-24
8414 APR_DRG Extensive Third Degree Burns With Skin Graft 6 3 — — $388,151.22 $388,151.22 $388,151.22 2025-06-24
8423 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 6 3 — — $73,401.03 $73,401.03 $73,401.03 2025-06-24
8424 APR_DRG Burns With Skin Graft Except Extensive Third Degree Burns 6 3 — — $198,785.86 $198,785.86 $198,785.86 2025-06-24
8504 APR_DRG Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 6 3 — — $128,002.06 $128,002.06 $128,002.06 2025-06-24
8513 APR_DRG Gender Related Procedures 6 3 — — $58,758.66 $58,758.66 $58,758.66 2025-06-24
8514 APR_DRG Gender Related Procedures 6 3 — — $201,795.68 $201,795.68 $201,795.68 2025-06-24
8633 APR_DRG Neonatal Aftercare 6 3 — — $101,430.91 $101,430.91 $101,430.91 2025-06-24
8634 APR_DRG Neonatal Aftercare 6 3 — — $195,811.03 $195,811.03 $195,811.03 2025-06-24
893 APR_DRG Major Cranial Or Facial Bone Procedures 6 3 — — $67,025.05 $67,025.05 $67,025.05 2025-06-24
894 APR_DRG Major Cranial Or Facial Bone Procedures 6 3 — — $89,132.86 $89,132.86 $89,132.86 2025-06-24
91 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 6 3 — — $79,950.44 $79,950.44 $79,950.44 2025-06-24
9103 APR_DRG Craniotomy For Multiple Significant Trauma 6 3 — — $77,011.56 $77,011.56 $77,011.56 2025-06-24
9104 APR_DRG Craniotomy For Multiple Significant Trauma 6 3 — — $114,841.75 $114,841.75 $114,841.75 2025-06-24
9114 APR_DRG Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 6 3 — — $107,702.67 $107,702.67 $107,702.67 2025-06-24
9124 APR_DRG Musculoskeletal And Other Procedures For Multiple Significant Trauma 6 3 — — $100,719.68 $100,719.68 $100,719.68 2025-06-24
913 APR_DRG Other Major Head And Neck Procedures 6 3 — — $68,062.49 $68,062.49 $68,062.49 2025-06-24
914 APR_DRG Other Major Head And Neck Procedures 6 3 — — $108,823.67 $108,823.67 $108,823.67 2025-06-24
92 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 6 3 — — $84,156.95 $84,156.95 $84,156.95 2025-06-24
924 APR_DRG Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 6 3 — — $92,305.09 $92,305.09 $92,305.09 2025-06-24
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 2 1 — — $88,604.66 $88,604.66 $88,604.66 2025-06-24
93 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 6 3 — — $139,495.86 $139,495.86 $139,495.86 2025-06-24
94 APR_DRG Extracorporeal Membrane Oxygenation (ecmo) 6 3 — — $323,680.34 $323,680.34 $323,680.34 2025-06-24
9504 APR_DRG Extensive O.r. Procedure Unrelated To Principal Diagnosis 6 3 — — $94,660.60 $94,660.60 $94,660.60 2025-06-24
9514 APR_DRG Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 6 3 — — $71,045.51 $71,045.51 $71,045.51 2025-06-24
9524 APR_DRG Non-extensive O.r. Procedure Unrelated To Principal Diagnosis 6 3 — — $66,348.66 $66,348.66 $66,348.66 2025-06-24
984 APR_DRG Other Ear, Nose, Mouth, Throat, Craniofacial, And Neck Procedures 6 3 — — $65,790.53 $65,790.53 $65,790.53 2025-06-24
A9513 HCPCS Lutetium Lu 177 Dotatat Ther 6 3 — — $75,204.89 $75,204.89 $75,204.89 2025-06-24
A9543 HCPCS Y90 Ibritumomab, Rx 10 3 — — $33,075.00 $75,204.89 $75,204.89 2025-06-24
A9607 HCPCS Lutetium Lu 177 Vipivotide 6 3 — — $75,204.89 $75,204.89 $75,204.89 2025-06-24
C9073 HCPCS Brexucabtagene Autoleucel Ca 6 3 — — $79,822.18 $79,822.18 $79,822.18 2025-06-24
C9076 HCPCS Lisocabtagene Car Pos T 6 3 — — $79,822.18 $79,822.18 $79,822.18 2025-06-24
C9081 HCPCS Idecabtagene Car Pos T 6 3 — — $79,822.18 $79,822.18 $79,822.18 2025-06-24
C9098 HCPCS Ciltacabtagene Car Pos T 6 3 — — $79,822.18 $79,822.18 $79,822.18 2025-06-24
J3392 HCPCS Inj, Exagamglogene Autotem 6 3 — — $79,822.18 $79,822.18 $79,822.18 2025-06-24
J3393 HCPCS Inj, Betibeglogene Autotemce 6 3 — — $79,822.18 $79,822.18 $79,822.18 2025-06-24
J3394 HCPCS Inj, Lovotibeglogene Autotem 6 3 — — $79,822.18 $79,822.18 $79,822.18 2025-06-24
Q0480 HCPCS Driver Pneumatic Vad, Rep 2 1 — — $68,078.22 $68,078.22 $68,078.22 2025-06-24
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 8 4 — — $79,822.18 $597,425.08 $79,822.18 2025-06-24
Q2042 HCPCS Tisagenlecleucel Car-pos T 8 4 — — $79,822.18 $687,637.97 $79,822.18 2025-06-24
Q2053 HCPCS Brexucabtagene Car Pos T 8 4 — — $79,822.18 $581,455.14 $79,822.18 2025-06-24
Q2054 HCPCS Lisocabtagene Mara Car Pos T 8 4 — — $79,822.18 $613,585.09 $79,822.18 2025-06-24
Q2055 HCPCS Idecabtagene Vicleucel Car 8 4 — — $79,822.18 $626,868.24 $79,822.18 2025-06-24
Q2056 HCPCS Ciltacabtagene Car-pos T 8 4 — — $79,822.18 $657,220.45 $79,822.18 2025-06-24
T2025 HCPCS Waiver Service, Nos 4 1 — — $92,597.40 $103,241.69 $97,919.54 2025-06-24
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