			"Proposed Costs for Hospital Outpatient Services, by Low Volume APC Group for CY 2026"							
APC	SI	Payment Rate	Single Frequency	Total Frequency	Minimum Cost 	Maximum Cost 	Median Cost 	Mean Cost	Geometric Mean Cost 	CV
1503	S	$150.50 	52758	52960	$16.32 	"$3,866.58 "	$258.39 	$381.89 	$253.80 	107.120
1504	S	$250.50 	1192	1227	$12.02 	"$4,222.56 "	$189.87 	$299.64 	$192.70 	96.290
1505	S	$350.50 	71999	72912	$25.10 	"$4,021.36 "	$300.76 	$456.90 	$318.90 	104.570
1507	S	$550.50 	431	467	"$1,302.19 "	"$1,302.19 "	"$1,302.19 "	"$1,302.19 "	"$1,302.10 "	0.000
1509	S	$750.50 	1590	1596	$61.28 	"$4,365.65 "	$582.56 	$851.27 	$648.50 	64.920
1521	S	"$1,950.50 "	28	28	$598.52 	"$3,267.83 "	"$1,009.25 "	"$1,545.47 "	"$1,322.30 "	59.710
1525	S	"$3,750.50 "	31	31	"$1,625.76 "	"$6,856.67 "	"$2,915.04 "	"$3,573.50 "	"$3,341.00 "	39.150
1534	S	"$8,250.50 "	7	7	"$4,871.13 "	"$15,676.67 "	"$13,197.72 "	"$10,830.99 "	"$9,788.40 "	43.180
1551	T	"$1,250.50 "	4	4	"$1,064.15 "	"$1,639.13 "	"$1,566.94 "	"$1,459.29 "	"$1,437.80 "	18.640
1563	T	"$4,250.50 "	42	42	"$1,696.72 "	"$8,407.55 "	"$4,000.73 "	"$4,327.48 "	"$4,040.40 "	37.900
1576	S	"$17,500.50 "	7	7	"$2,062.49 "	"$14,434.54 "	"$7,187.70 "	"$6,755.08 "	"$5,590.10 "	61.390
1590	T	"$17,500.50 "	11	11	"$4,183.46 "	"$21,809.32 "	"$13,260.23 "	"$13,294.00 "	"$11,729.80 "	47.740
1592	T	"$27,500.50 "	2	2	"$10,474.70 "	"$10,692.01 "	"$10,583.35 "	"$10,583.36 "	"$10,582.80 "	1.450
5244	J1	"$64,120.76 "	246	254	"$10,095.23 "	"$275,497.30 "	"$61,454.32 "	"$65,119.18 "	"$58,572.90 "	46.170
5494	J1	"$14,408.18 "	212	214	"$5,605.11 "	"$30,947.15 "	"$13,886.42 "	"$14,632.53 "	"$13,893.20 "	32.420
5495	J1	"$14,285.37 "	247	249	"$1,412.74 "	"$81,245.97 "	"$13,013.22 "	"$14,507.81 "	"$9,965.00 "	79.600
5496	J1	"$16,645.08 "	57	58	"$2,332.74 "	"$31,505.17 "	"$16,904.26 "	"$16,532.83 "	"$14,849.80 "	41.300
5881	J1	"$13,949.61 "	352	354	$467.15 	"$177,607.50 "	"$8,756.72 "	"$14,166.82 "	"$8,385.40 "	117.000
