I am comparing the billed with what is reasonable because we are a 3rd party insurance for the purposes of bodily injury. Usually the providers increase their billed amounts because they hope to make money. Our claimant's are usually represented by Plaintiff's attorneys
Do you have a UB-04 or an itemized statement (or both)? Do you have a copy of the medical records?
A UB-04 is a facility claim form - for an inpatient stay, the UB-04 will have the aggregate facility charges rolled up by revenue code. The itemized statement will have the detailed description of each line item for the entire stay, from room and board charges down to a tablet of Tylenol. The itemized statement is probably going to be more useful to you for analysis than the UB-04, but it is good to have copies of both on hand.
If you're looking to determine whether charges billed are accurate for the patient's stay, you'd need someone who understands inpatient documentation to go through the chart and compare the documentation to the itemized statement. This would help ensure that every line item in the chart was documented and supported in the medical record. If itemized statement says that a dose of medication was given on a specific date, you'd expect to see that dose documented appropriately in the chart.
If you're looking for something to tell you whether $XX,XXX total billed charges are reasonable for DRG 956, that doesn't really exist to the best of my knowledge. (A national or regional average like that also wouldn't be terribly useful for evaluating a specific hospital stay for a specific patient, because there are so many variables. Dates of service, health of the patient, cost of providing care - these things can all vary widely.)
If you're looking to estimate what a reasonable payment to the provider for DRG 956 might be, you could price out the claim and use Medicare rates as a tool to negotiate a settlement. (Keep in mind that most commercial and other insurance types do pay more than Medicare. You shouldn't anticipate paying the provider exactly what Medicare would, of course - Medicare rates are a good reference because they are publicly available and commercial insurance rates aren't often readily available.)