Sheridan Memorial Hospital — Pricing

170 procedures published in this hospital's Machine-Readable File (MRF) — 154 with a comparable price, 16 with per-payer negotiated rates only. Prices shown are pre-insurance; actual cost depends on your plan, Medicare/Medicaid coverage, or cash-pay discounts.

Procedures published 170
Lowest published price $1,581
Average published price $37,144
Highest published price $296,892

Gross charges are the hospital's listed price — almost no one pays this amount. Your actual cost depends on your insurance plan. Use the cash price (when shown) as a guide for what uninsured patients are charged, and contact the hospital or your insurer for a personalized cost estimate.

Showing all 170 procedures

Published charges

Showing all 154 procedures with a comparable published price (gross, cash, or insurance-negotiated median), sorted highest to lowest. Green = this hospital prices below the median; amber = above.

Across 13 procedures, this hospital's negotiated rates average ≈145% of what Medicare pays.

DRG Description Published price Cash price vs. WY median vs. National median vs Medicare
742 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC $296,892 $237,514 $58,862 +404% $40,552 +632% —
472 CERVICAL SPINAL FUSION WITH CC $210,825 $168,660 $110,368 +91% $59,537 +254% —
454 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC $177,951 $142,361 $177,951 — $69,101 +158% —
455 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC $158,341 $126,672 $140,369 +13% $54,320 +191% —
460 SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC $132,364 $105,891 $106,080 +25% $50,815 +160% —
517 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC $127,702 $102,161 $38,461 +232% $33,137 +285% —
270 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC $110,878 $88,702 $80,443 +38% $99,423 +12% —
853 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC $93,241 $74,593 $79,521 +17% $87,018 +7% —
056 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC $89,620 $71,696 $63,851 +40% $39,409 +127% —
813 COAGULATION DISORDERS $88,472 $70,777 $24,815 +257% $30,128 +194% —
551 MEDICAL BACK PROBLEMS WITH MCC $84,684 $67,747 $28,541 +197% $31,086 +172% —
602 CELLULITIS WITH MCC $82,568 $66,055 $27,249 +203% $29,347 +181% —
355 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC $82,351 $65,881 $36,170 +128% $31,978 +158% —
074 CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC $80,131 $64,105 $25,814 +210% $23,141 +246% —
661 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC $77,084 $61,668 $21,320 +262% $24,022 +221% —
908 OTHER O.R. PROCEDURES FOR INJURIES WITH CC $76,906 $61,525 $36,262 +112% $41,660 +85% —
329 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC $76,140 $60,912 $71,853 +6% $88,050 −14% —
483 MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES $72,795 $58,236 $72,795 +0% $57,149 +27% —
467 REVISION OF HIP OR KNEE REPLACEMENT WITH CC $72,783 $58,227 $72,783 +0% $68,880 +6% —
843 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC $68,084 $54,467 $27,330 +149% $36,280 +88% —
896 ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC $67,619 $54,095 $46,625 +45% $30,275 +123% —
644 ENDOCRINE DISORDERS WITH CC $65,953 $52,763 $22,290 +196% $22,941 +187% —
208 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS $64,358 $51,486 $42,934 +50% $52,405 +23% —
544 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC $62,318 $49,854 $12,217 +410% $16,776 +271% —
432 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC $61,245 $48,996 $30,478 +101% $36,933 +66% —
071 OTHER CEREBROVASCULAR DISORDERS WITH CC $60,366 $48,293 $15,596 +287% $23,396 +158% —
657 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC $59,370 $47,496 $29,333 +102% $40,583 +46% —
251 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC $58,329 $46,663 $25,245 +131% $41,380 +41% —
884 ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY $54,608 $43,687 $25,803 +112% $25,208 +117% —
555 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC $53,049 $42,439 $22,254 +138% $23,723 +124% —
469 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT $53,008 $42,406 $52,971 +0% $65,254 −19% —
195 SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC $52,454 $41,963 $11,656 +350% $13,824 +279% —
561 AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC $51,923 $41,539 $23,480 +121% $18,150 +186% —
470 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC $49,344 $39,475 $47,428 +4% $49,197 +0% ≈222% of Medicare
480 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC $48,688 $38,950 $48,688 +0% $63,984 −24% —
521 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC $48,348 $38,678 $47,627 +2% $67,764 −29% —
559 AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC $48,146 $38,517 $34,173 +41% $30,974 +55% —
536 FRACTURES OF HIP AND PELVIS WITHOUT MCC $47,865 $38,292 $28,878 +66% $18,002 +166% —
659 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC $47,528 $38,022 $38,021 +25% $48,094 −1% —
330 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC $47,158 $37,726 $42,445 +11% $58,832 −20% —
658 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC $46,547 $37,238 $31,926 +46% $35,528 +31% —
494 LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC $45,916 $36,733 $45,916 +0% $45,963 −0% —
478 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC $43,442 $34,753 $37,923 +15% $50,139 −13% —
391 ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC $41,932 $33,545 $31,115 +35% $27,244 +54% —
331 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC $41,298 $33,038 $41,298 +0% $44,117 −6% —
560 AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC $41,144 $32,915 $25,353 +62% $24,452 +68% —
983 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC $40,705 $32,564 $24,011 +70% $30,930 +32% —
039 EXTRACRANIAL PROCEDURES WITHOUT CC/MCC $40,591 $32,473 $18,150 +124% $25,267 +61% —
707 MAJOR MALE PELVIC PROCEDURES WITH CC/MCC $40,175 $32,140 $35,693 +13% $43,080 −7% —
863 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC $38,536 $30,828 $17,544 +120% $20,007 +93% —
243 PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC $38,168 $30,535 $36,237 +5% $50,011 −24% —
282 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC $36,466 $29,173 $11,421 +219% $18,623 +96% —
786 CESAREAN SECTION WITHOUT STERILIZATION WITH MCC $36,107 $28,886 $29,165 +24% $27,118 +33% —
482 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC $35,138 $28,111 $35,138 +0% $39,747 −12% ≈190% of Medicare
070 OTHER CEREBROVASCULAR DISORDERS WITH MCC $34,994 $27,995 $28,474 +23% $30,814 +14% —
064 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC $34,732 $27,786 $31,862 +9% $35,714 −3% —
254 OTHER VASCULAR PROCEDURES WITHOUT CC/MCC $34,194 $27,355 $27,599 +24% $38,836 −12% —
072 OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC $33,085 $26,468 $15,229 +117% $16,654 +99% —
383 UNCOMPLICATED PEPTIC ULCER WITH MCC $32,835 $26,268 $22,238 +48% $26,634 +23% —
299 PERIPHERAL VASCULAR DISORDERS WITH MCC $31,677 $25,342 $21,220 +49% $25,731 +23% —
244 PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC $31,586 $25,268 $29,110 +9% $40,063 −21% —
549 SEPTIC ARTHRITIS WITH CC $30,837 $24,670 $17,711 +74% $20,938 +47% —
308 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC $30,345 $24,276 $24,544 +24% $26,488 +15% —
548 SEPTIC ARTHRITIS WITH MCC $30,032 $24,026 $30,526 −2% $31,019 −3% —
708 MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC $29,697 $23,758 $26,453 +12% $32,911 −10% —
696 KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC $29,217 $23,374 $11,008 +165% $14,441 +102% —
682 RENAL FAILURE WITH MCC $29,054 $23,243 $23,877 +22% $27,854 +4% —
949 AFTERCARE WITH CC/MCC $28,771 $23,017 $22,920 +26% $23,953 +20% —
287 CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC $28,667 $22,933 $17,212 +67% $31,190 −8% —
638 DIABETES WITH CC $28,070 $22,456 $18,509 +52% $18,821 +49% —
854 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC $26,739 $21,391 $32,419 −18% $43,524 −39% —
093 OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC $26,452 $21,162 $18,161 +46% $17,522 +51% —
617 AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC $26,309 $21,047 $31,576 −17% $42,881 −39% —
281 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC $25,188 $20,150 $16,368 +54% $20,463 +23% —
743 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC $25,051 $20,041 $21,768 +15% $27,369 −8% —
768 VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C $24,872 $19,898 $17,611 +41% $17,103 +45% —
375 DIGESTIVE MALIGNANCY WITH CC $24,173 $19,338 $21,615 +12% $27,219 −11% —
788 CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC $24,150 $19,320 $24,036 +0% $20,084 +20% —
917 POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC $23,681 $18,945 $25,388 −7% $28,134 −16% —
066 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC $23,630 $18,904 $17,817 +33% $19,483 +21% —
377 GASTROINTESTINAL HEMORRHAGE WITH MCC $23,410 $18,728 $27,512 −15% $37,842 −38% —
179 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC $23,348 $18,678 $15,452 +51% $14,444 +62% —
787 CESAREAN SECTION WITHOUT STERILIZATION WITH CC $23,265 $18,612 $24,819 −6% $23,571 −1% —
698 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC $22,757 $18,206 $22,270 +2% $30,058 −24% —
378 GASTROINTESTINAL HEMORRHAGE WITH CC $22,670 $18,136 $17,646 +28% $21,886 +4% —
092 OTHER DISORDERS OF NERVOUS SYSTEM WITH CC $21,506 $17,205 $16,321 +32% $24,136 −11% —
945 REHABILITATION WITH CC/MCC $21,284 $17,027 $21,284 — $23,834 −11% —
785 CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC $21,010 $16,808 $23,582 −11% $19,815 +6% —
292 HEART FAILURE AND SHOCK WITH CC $20,779 $16,623 $13,633 +52% $16,212 +28% —
808 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC $20,043 $16,034 $34,837 −42% $36,334 −45% —
065 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS $19,963 $15,971 $16,162 +24% $23,469 −15% ≈173% of Medicare
689 KIDNEY AND URINARY TRACT INFECTIONS WITH MCC $19,864 $15,891 $18,675 +6% $22,982 −14% ≈143% of Medicare
872 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC $19,789 $15,831 $18,502 +7% $22,781 −13% ≈171% of Medicare
784 CESAREAN SECTION WITH STERILIZATION WITH CC $19,128 $15,303 $22,202 −14% $22,560 −15% —
832 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC $18,979 $15,183 $10,838 +75% $12,895 +47% —
315 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC $18,966 $15,173 $13,097 +45% $20,777 −9% —
639 DIABETES WITHOUT CC/MCC $18,432 $14,746 $14,628 +26% $13,910 +33% —
637 DIABETES WITH MCC $18,088 $14,470 $23,050 −22% $28,819 −37% —
392 ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC $17,936 $14,349 $12,604 +42% $17,322 +4% ≈224% of Medicare
552 MEDICAL BACK PROBLEMS WITHOUT MCC $17,754 $14,203 $18,482 −4% $21,213 −16% —
660 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC $17,703 $14,162 $21,411 −17% $30,358 −42% —
372 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC $17,547 $14,037 $16,765 +5% $22,850 −23% —
189 PULMONARY EDEMA AND RESPIRATORY FAILURE $17,540 $14,032 $19,598 −10% $25,704 −32% ≈123% of Medicare
603 CELLULITIS WITHOUT MCC $17,397 $13,918 $15,317 +14% $18,530 −6% —
194 SIMPLE PNEUMONIA AND PLEURISY WITH CC $17,167 $13,733 $14,980 +15% $18,204 −6% —
690 KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC $17,019 $13,615 $15,804 +8% $17,466 −3% —
433 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC $16,529 $13,223 $16,400 +1% $23,749 −30% —
389 GASTROINTESTINAL OBSTRUCTION WITH CC $15,921 $12,737 $12,964 +23% $17,388 −8% —
293 HEART FAILURE AND SHOCK WITHOUT CC/MCC $15,785 $12,628 $13,195 +20% $11,955 +32% —
812 RED BLOOD CELL DISORDERS WITHOUT MCC $15,756 $12,605 $17,264 −9% $20,488 −23% —
982 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC $15,567 $12,454 $39,546 −61% $51,985 −70% —
580 OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC $15,417 $12,334 $27,790 −45% $36,242 −57% —
310 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC $15,362 $12,290 $12,768 +20% $13,384 +15% —
683 RENAL FAILURE WITH CC $15,280 $12,224 $15,280 +0% $18,620 −18% —
793 FULL TERM NEONATE WITH MAJOR PROBLEMS $15,154 $12,123 $13,930 +9% $16,719 −9% —
439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC $14,924 $11,939 $14,764 +1% $19,096 −22% —
894 ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA $14,515 $11,612 $14,515 +0% $12,013 +21% —
687 KIDNEY AND URINARY TRACT NEOPLASMS WITH CC $13,992 $11,194 $15,347 −9% $18,478 −24% —
640 MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC $13,701 $10,961 $20,918 −35% $24,480 −44% —
202 BRONCHITIS AND ASTHMA WITH CC/MCC $13,611 $10,889 $15,239 −11% $17,273 −21% —
805 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC $13,294 $10,635 $16,035 −17% $15,370 −14% —
312 SYNCOPE AND COLLAPSE $13,232 $10,586 $13,744 −4% $19,342 −32% —
918 POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC $13,172 $10,537 $13,696 −4% $15,045 −12% —
809 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC $13,138 $10,511 $19,152 −31% $22,032 −40% —
309 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC $13,102 $10,482 $12,766 +3% $16,865 −22% ≈160% of Medicare
125 OTHER DISORDERS OF THE EYE WITHOUT MCC $13,010 $10,408 $12,694 +2% $15,876 −18% —
390 GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC $12,873 $10,299 $10,211 +26% $13,318 −3% —
394 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC $12,677 $10,142 $14,905 −15% $18,918 −33% —
522 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC $12,280 $9,824 $45,963 −73% $56,519 −78% ≈49% of Medicare
641 MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC $12,169 $9,735 $12,424 −2% $16,745 −27% ≈145% of Medicare
806 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC $12,164 $9,731 $12,024 +1% $13,090 −7% —
807 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC $11,747 $9,397 $11,135 +5% $12,044 −2% —
186 PLEURAL EFFUSION WITH MCC $11,636 $9,309 $24,688 −53% $32,468 −64% —
897 ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC $11,481 $9,185 $13,617 −16% $16,049 −28% —
180 RESPIRATORY NEOPLASMS WITH MCC $11,346 $9,076 $27,647 −59% $36,658 −69% —
798 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC $11,041 $8,832 $13,283 −17% $18,238 −39% —
300 PERIPHERAL VASCULAR DISORDERS WITH CC $10,606 $8,485 $13,789 −23% $19,579 −46% —
539 OSTEOMYELITIS WITH MCC $10,493 $8,395 $25,784 −59% $33,746 −69% —
601 NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC $10,373 $8,298 $10,085 +3% $10,975 −5% —
191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC $10,105 $8,084 $13,505 −25% $18,278 −45% —
791 PREMATURITY WITH MAJOR PROBLEMS $8,822 $7,057 $14,858 −41% $39,563 −78% —
203 BRONCHITIS AND ASTHMA WITHOUT CC/MCC $8,789 $7,031 $11,056 −20% $12,279 −28% —
177 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC $8,011 $6,409 $26,979 −70% $31,840 −75% ≈43% of Medicare
792 PREMATURITY WITHOUT MAJOR PROBLEMS $7,376 $5,901 $7,376 +0% $11,633 −37% —
176 PULMONARY EMBOLISM WITHOUT MCC $7,155 $5,724 $12,980 −45% $18,081 −60% —
379 GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC $6,946 $5,557 $10,069 −31% $14,134 −51% —
885 PSYCHOSES $6,568 $5,255 $20,061 −67% $21,489 −69% —
440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC $6,356 $5,085 $9,799 −35% $15,070 −58% —
789 NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY $4,827 $3,862 $17,371 −72% $14,284 −66% —
054 NERVOUS SYSTEM NEOPLASMS WITH MCC $3,962 $3,170 $19,130 −79% $29,484 −87% —
193 SIMPLE PNEUMONIA AND PLEURISY WITH MCC $3,807 $3,045 $20,532 −81% $26,158 −85% ≈25% of Medicare
794 NEONATE WITH OTHER SIGNIFICANT PROBLEMS $3,121 $2,497 $6,340 −51% $7,961 −61% —
291 HEART FAILURE AND SHOCK WITH MCC $2,309 $1,847 $22,026 −90% $25,020 −91% ≈15% of Medicare
880 ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION $1,581 $1,265 $8,096 −80% $15,636 −90% —

Procedures with negotiated rates only

These 16 procedures have published per-payer insurance agreements but no single comparable dollar amount in the MRF — typically because the agreement is expressed as a percentage of charge, a fee schedule reference, or a contract algorithm. The number of payers indicates how many insurance plans have a negotiated rate on file.

DRG Description Insurance rate range Payers
178 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC — 16 plans
181 RESPIRATORY NEOPLASMS WITH CC — 16 plans
057 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC $9,538 – $9,538 · median $9,538 1 plans
101 SEIZURES WITHOUT MCC $6,645 – $6,645 · median $6,645 1 plans
175 PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE $10,112 – $10,112 · median $10,112 1 plans
190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC $8,155 – $8,155 · median $8,155 1 plans
246 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS $22,052 – $22,052 · median $22,052 1 plans
247 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC $14,057 – $14,057 · median $14,057 1 plans
280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC $11,809 – $11,809 · median $11,809 1 plans
481 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC $15,419 – $15,419 · median $15,419 1 plans
486 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC $15,394 – $15,394 · median $15,394 1 plans
795 NORMAL NEWBORN $1,471 – $1,471 · median $1,471 1 plans
811 RED BLOOD CELL DISORDERS WITH MCC $10,338 – $10,338 · median $10,338 1 plans
871 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC $14,300 – $14,300 · median $14,300 1 plans
881 DEPRESSIVE NEUROSES $6,927 – $6,927 · median $6,927 1 plans
951 OTHER FACTORS INFLUENCING HEALTH STATUS $4,093 – $4,093 · median $4,093 1 plans
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