APR-DRG 042

Degenerative nervous system disorder stay, moderate severity

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

facility

Payers reporting APR-DRG 042

25 payers file a negotiated rate for this code. Each is shown once, under the terms the most hospitals file it under; rates under different terms (billing class, payment method, setting) are never blended, so open a payer to see them all. Figures are hospital-level averages; the median is across hospitals.

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare case rate · inpatient · +6 other terms	24	$62,046	$59,160	$9,561 – $74,903
2	Molina facility · case rate · inpatient · +8 other terms	15	$18,516	$18,489	$3,081 – $52,301
3	Humana facility · case rate · inpatient · +7 other terms	13	$30,660	$18,491	$3,081 – $51,803
4	Aetna case rate · inpatient · +7 other terms	9	$86,771	$68,053	$23,145 – $104,128
5	Highmark fee schedule · inpatient · +2 other terms	9	$12,014	$12,849	$6,461 – $26,137
6	Wellmark case rate · inpatient · +1 other terms	9	$145,000	$138,903	$108,559 – $174,415
7	Blue Cross Blue Shield facility · case rate · inpatient · +5 other terms	8	$19,457	$21,309	$5,456 – $89,565
8	Aetna Better Health facility · case rate · inpatient · +2 other terms	6	$5,730	$9,187	$3,081 – $78,851
9	Kaiser case rate · inpatient · +3 other terms	5	$54,927	$57,980	$53,925 – $66,589
10	Anthem facility · case rate · inpatient · +6 other terms	4	$18,278	$15,072	$10,797 – $30,660
11	Caresource facility · case rate · inpatient · +3 other terms	4	$26,992	$28,496	$10,797 – $64,239
12	Medicaid case rate · inpatient · +2 other terms	4	$86,912	$75,289	$40,422 – $86,912
13	Amerihealth Caritas case rate · inpatient · +1 other terms	3	$62,170	$62,170	$62,170 – $62,170
14	Medical Mutual per diem · both · +3 other terms	2	$3,906	$3,906	$3,588 – $4,224
15	Ucare facility · case rate · inpatient	2	$12,577	$12,483	$7,524 – $18,564
16	WellCare case rate · inpatient · +1 other terms	2	$16,608	$16,608	$11,787 – $21,430
17	Bcbs Ny fee schedule · inpatient · +1 other terms	1	$22,328	$22,328	$9,485 – $48,575
18	Carefirst facility · case rate · inpatient	1	$13,073	$13,073	$13,073 – $13,073
19	Cigna per diem · inpatient · +3 other terms	1	$2,598	$2,598	$2,598 – $2,598
20	Excellus per diem · inpatient · +2 other terms	1	$1,557	$1,557	$1,203 – $2,441
21	Magellan fee schedule · inpatient	1	$18,833	$18,833	$18,833 – $18,833
22	Premera facility · case rate · inpatient	1	$13,073	$13,073	$13,073 – $13,073
23	Regence facility · case rate · inpatient	1	$13,073	$13,073	$13,073 – $13,073
24	Sanford Health Plan case rate · inpatient	1	$19,603	$19,603	$16,833 – $22,582
25	Superior Healthplan facility · case rate · inpatient	1	$15,915	$15,915	$7,385 – $28,754