Hospital

SAN GABRIEL VALLEY MEDICAL CENTER

San Gabriel, CA · CCN 050132 · Rates published

15,140 distinct procedures filed

70 distinct payers

1,543,905 rate rows

2026-05-09 last MRF observed

Data quality

1,488,215 of 1,543,905 rate rows are consumer-grade (96.4%)

55,690 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 — reason	Rows
per-diem day rate — not a per-procedure price	35,536
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	13,640
template filing: same amount across many unrelated codes — excluded	2,440
exceeds 10× this hospital's gross charge — excluded from medians	2,283
placeholder amount (≤ $0.02) — excluded from medians	1,791

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://www.ahmchealth.com/docs/PricingTransparency-San_Gabriel_Valley_Medical_Center-3456-20260701000557_07.01.26.csv
Found on page	https://www.ahmchealth.com/sgvmc/getpage.php?name=Price_Transparency
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-10-01
Content fingerprint	342e7456229c0650… · 494,893,461 bytes · first seen 2026-07-06

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
018 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	36	$2,000.00	$1,110,484.04	$391,567.01	nat. median $149,977 outlier · 2.6×
001 OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	36	$4,500.00	$829,654.95	$286,726.70	nat. median $177,883 1.6× median
007 OTHER	Lung Transplant	34	$2,300.00	$690,054.64	$243,319.69	nat. median $67,163 outlier · 3.6×
927 OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	36	$2,300.00	$698,854.41	$241,527.64	nat. median $2 outlier · 150017.2×
630-4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	15	$205,488.86	$273,985.14	$228,320.95	—
631-4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	15	$203,628.70	$271,504.93	$226,254.11	—
583-4 OTHER	Neonate With Ecmo	15	$198,900.00	$265,200.00	$221,000.00	—
583-3 OTHER	Neonate With Ecmo	15	$198,900.00	$265,200.00	$221,000.00	—
588-4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	15	$198,900.00	$265,200.00	$221,000.00	—
003 OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	37	$1,196.00	$631,440.11	$218,232.15	nat. median $119,739 1.8× median
161-4 OTHER	Implantable Heart Assist Systems	15	$191,733.80	$255,645.07	$213,037.56	—
583-2 OTHER	Neonate With Ecmo	15	$160,500.96	$214,001.28	$178,334.40	—
002-4 OTHER	Heart And/or Lung Transplant	15	$158,430.91	$211,241.21	$176,034.34	—
609-4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	15	$148,500.00	$198,000.00	$165,000.00	—
583-1 OTHER	Neonate With Ecmo	15	$143,483.18	$191,310.90	$159,425.75	—
161-3 OTHER	Implantable Heart Assist Systems	15	$137,242.31	$182,989.74	$152,491.45	—
841-4 OTHER	Extensive Third Degree Burns With Skin Graft	15	$132,591.63	$176,788.84	$147,324.03	—
004 OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	36	$2,300.00	$416,604.15	$146,898.50	nat. median $106,489 1.4× median
014 OTHER	Allogeneic Bone Marrow Transplant	35	$2,000.00	$386,351.29	$136,231.06	nat. median $77,841 1.8× median
009-4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	15	$120,495.34	$160,660.45	$133,883.71	—
007-4 OTHER	Allogeneic Bone Marrow Transplant	15	$120,253.63	$160,338.18	$133,615.15	—
588-3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	15	$118,800.00	$158,400.00	$132,000.00	—
002-3 OTHER	Heart And/or Lung Transplant	15	$117,561.11	$156,748.15	$130,623.46	—
588-2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	15	$117,000.00	$156,000.00	$130,000.00	—
161-2 OTHER	Implantable Heart Assist Systems	15	$116,514.37	$155,352.49	$129,460.41	—
863-4 OTHER	Neonatal Aftercare	15	$109,905.13	$146,540.17	$122,116.81	—
593-4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	15	$108,900.00	$145,200.00	$121,000.00	—
001-4 OTHER	Liver Transplant And/or Intestinal Transplant	15	$108,000.00	$144,000.00	$120,000.00	—
591-4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	15	$108,000.00	$144,000.00	$120,000.00	—
303-4 OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	15	$108,000.00	$144,000.00	$120,000.00	—
161-1 OTHER	Implantable Heart Assist Systems	15	$106,189.21	$141,585.61	$117,988.01	—
212 OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	36	$2,300.00	$321,387.97	$113,324.39	nat. median $106 outlier · 1070.8×
002 OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	36	$4,500.00	$325,089.38	$112,370.47	nat. median $67,041 1.7× median
005 OTHER	Liver Transplant With Mcc Or Intestinal Transplant	34	$2,300.00	$314,194.03	$110,787.74	nat. median $55,107 outlier · 2.0×
004-4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	15	$99,000.00	$132,000.00	$110,000.00	—
215 OTHER	Other Heart Assist System Implant	40	$4,100.00	$312,587.49	$108,050.35	nat. median $229 outlier · 472.4×
011-3 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	15	$96,911.84	$129,215.78	$107,679.82	—
602-4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	15	$90,000.00	$120,000.00	$100,000.00	—
607-4 OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	15	$90,000.00	$120,000.00	$100,000.00	—
593-3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	15	$89,100.00	$118,800.00	$99,000.00	—
216 OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	41	$4,100.00	$284,820.90	$98,455.41	nat. median $283 outlier · 348.3×
160-4 OTHER	Major Cardiothoracic Repair Of Heart Anomaly	15	$87,425.42	$116,567.22	$97,139.35	—
630-3 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	15	$85,500.00	$114,000.00	$95,000.00	—
002-2 OTHER	Heart And/or Lung Transplant	15	$84,612.19	$112,816.25	$94,013.54	—
611-4 OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	15	$83,700.00	$111,600.00	$93,000.00	—
453 OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	36	$3,250.00	$261,585.44	$92,237.46	nat. median $55,290 1.7× median
602-3 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	15	$82,800.00	$110,400.00	$92,000.00	—
591-3 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	15	$81,900.00	$109,200.00	$91,000.00	—
621-4 OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	15	$81,000.00	$108,000.00	$90,000.00	—
004-3 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	15	$80,285.59	$107,047.45	$89,206.21	—

Other procedures at this hospital

Browse this hospital's 15,140 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

018	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	53	36	—	—	$2,000.00	$1,110,484.04	$391,567.01	2026-05-08
001	OTHER	Heart Transplant Or Implant Of Heart Assist System With Mcc	57	36	—	—	$4,500.00	$829,654.95	$286,726.70	2026-05-08
007	OTHER	Lung Transplant	51	34	—	—	$2,300.00	$690,054.64	$243,319.69	2026-05-08
927	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft	56	36	—	—	$2,300.00	$698,854.41	$241,527.64	2026-05-08
630-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	16	15	—	—	$205,488.86	$273,985.14	$228,320.95	2026-05-08
631-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	16	15	—	—	$203,628.70	$271,504.93	$226,254.11	2026-05-08
588-4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	16	15	—	—	$198,900.00	$265,200.00	$221,000.00	2026-05-08
583-3	OTHER	Neonate With Ecmo	16	15	—	—	$198,900.00	$265,200.00	$221,000.00	2026-05-08
583-4	OTHER	Neonate With Ecmo	16	15	—	—	$198,900.00	$265,200.00	$221,000.00	2026-05-08
003	OTHER	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	55	37	—	—	$1,196.00	$631,440.11	$218,232.15	2026-05-08
161-4	OTHER	Implantable Heart Assist Systems	16	15	—	—	$191,733.80	$255,645.07	$213,037.56	2026-05-08
583-2	OTHER	Neonate With Ecmo	16	15	—	—	$160,500.96	$214,001.28	$178,334.40	2026-05-08
002-4	OTHER	Heart And/or Lung Transplant	16	15	—	—	$158,430.91	$211,241.21	$176,034.34	2026-05-08
609-4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	16	15	—	—	$148,500.00	$198,000.00	$165,000.00	2026-05-08
583-1	OTHER	Neonate With Ecmo	16	15	—	—	$143,483.18	$191,310.90	$159,425.75	2026-05-08
161-3	OTHER	Implantable Heart Assist Systems	16	15	—	—	$137,242.31	$182,989.74	$152,491.45	2026-05-08
841-4	OTHER	Extensive Third Degree Burns With Skin Graft	16	15	—	—	$132,591.63	$176,788.84	$147,324.03	2026-05-08
004	OTHER	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	53	36	—	—	$2,300.00	$416,604.15	$146,898.50	2026-05-08
014	OTHER	Allogeneic Bone Marrow Transplant	52	35	—	—	$2,000.00	$386,351.29	$136,231.06	2026-05-08
009-4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	16	15	—	—	$120,495.34	$160,660.45	$133,883.71	2026-05-08
007-4	OTHER	Allogeneic Bone Marrow Transplant	16	15	—	—	$120,253.63	$160,338.18	$133,615.15	2026-05-08
588-3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	16	15	—	—	$118,800.00	$158,400.00	$132,000.00	2026-05-08
002-3	OTHER	Heart And/or Lung Transplant	16	15	—	—	$117,561.11	$156,748.15	$130,623.46	2026-05-08
588-2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	16	15	—	—	$117,000.00	$156,000.00	$130,000.00	2026-05-08
161-2	OTHER	Implantable Heart Assist Systems	16	15	—	—	$116,514.37	$155,352.49	$129,460.41	2026-05-08
863-4	OTHER	Neonatal Aftercare	16	15	—	—	$109,905.13	$146,540.17	$122,116.81	2026-05-08
593-4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	16	15	—	—	$108,900.00	$145,200.00	$121,000.00	2026-05-08
001-4	OTHER	Liver Transplant And/or Intestinal Transplant	16	15	—	—	$108,000.00	$144,000.00	$120,000.00	2026-05-08
591-4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	16	15	—	—	$108,000.00	$144,000.00	$120,000.00	2026-05-08
303-4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	16	15	—	—	$108,000.00	$144,000.00	$120,000.00	2026-05-08
161-1	OTHER	Implantable Heart Assist Systems	16	15	—	—	$106,189.21	$141,585.61	$117,988.01	2026-05-08
212	OTHER	Hip & Femur Procedures Except Major Joint Age 0-17	53	36	—	—	$2,300.00	$321,387.97	$113,324.39	2026-05-08
002	OTHER	Heart Transplant Or Implant Of Heart Assist System Without Mcc	57	36	—	—	$4,500.00	$325,089.38	$112,370.47	2026-05-08
005	OTHER	Liver Transplant With Mcc Or Intestinal Transplant	51	34	—	—	$2,300.00	$314,194.03	$110,787.74	2026-05-08
004-4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	16	15	—	—	$99,000.00	$132,000.00	$110,000.00	2026-05-08
215	OTHER	Other Heart Assist System Implant	63	40	—	—	$4,100.00	$312,587.49	$108,050.35	2026-05-08
011-3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	16	15	—	—	$96,911.84	$129,215.78	$107,679.82	2026-05-08
607-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$90,000.00	$120,000.00	$100,000.00	2026-05-08
602-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$90,000.00	$120,000.00	$100,000.00	2026-05-08
593-3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	16	15	—	—	$89,100.00	$118,800.00	$99,000.00	2026-05-08
216	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	67	41	—	—	$4,100.00	$284,820.90	$98,455.41	2026-05-08
160-4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	16	15	—	—	$87,425.42	$116,567.22	$97,139.35	2026-05-08
630-3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	16	15	—	—	$85,500.00	$114,000.00	$95,000.00	2026-05-08
002-2	OTHER	Heart And/or Lung Transplant	16	15	—	—	$84,612.19	$112,816.25	$94,013.54	2026-05-08
611-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	16	15	—	—	$83,700.00	$111,600.00	$93,000.00	2026-05-08
453	OTHER	Combined Anterior And Posterior Spinal Fusion With Mcc	52	36	—	—	$3,250.00	$261,585.44	$92,237.46	2026-05-08
602-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$82,800.00	$110,400.00	$92,000.00	2026-05-08
591-3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	16	15	—	—	$81,900.00	$109,200.00	$91,000.00	2026-05-08
621-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	16	15	—	—	$81,000.00	$108,000.00	$90,000.00	2026-05-08
004-3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	16	15	—	—	$80,285.59	$107,047.45	$89,206.21	2026-05-08
612-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$80,100.00	$106,800.00	$89,000.00	2026-05-08
456	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	53	36	—	—	$2,300.00	$250,045.70	$88,168.44	2026-05-08
005-4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	16	15	—	—	$79,200.00	$105,600.00	$88,000.00	2026-05-08
231	OTHER	Coronary Bypass With Ptca With Mcc	67	41	—	—	$4,578.00	$250,183.98	$86,486.38	2026-05-08
633-4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	16	15	—	—	$76,914.77	$102,553.02	$85,460.85	2026-05-08
006-4	OTHER	Pancreas Transplant	16	15	—	—	$76,500.00	$102,000.00	$85,000.00	2026-05-08
020	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	52	35	—	—	$2,300.00	$238,038.10	$83,934.45	2026-05-08
842-4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	16	15	—	—	$75,165.39	$100,220.52	$83,517.10	2026-05-08
162-4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	16	15	—	—	$74,764.53	$99,686.04	$83,071.70	2026-05-08
010	OTHER	Pancreas Transplant	51	34	—	—	$2,300.00	$235,445.91	$83,020.42	2026-05-08
019	OTHER	Simultaneous Pancreas And Kidney Transplant With Hemodialysis	53	36	—	—	$2,300.00	$234,101.31	$82,546.30	2026-05-08
006-3	OTHER	Pancreas Transplant	16	15	—	—	$73,538.52	$98,051.36	$81,709.47	2026-05-08
607-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$72,102.64	$96,136.85	$80,114.04	2026-05-08
603-4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	16	15	—	—	$72,000.00	$96,000.00	$80,000.00	2026-05-08
602-2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$72,000.00	$96,000.00	$80,000.00	2026-05-08
233	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	67	41	—	—	$4,100.00	$230,838.29	$79,801.34	2026-05-08
609-3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	16	15	—	—	$71,634.21	$95,512.28	$79,593.57	2026-05-08
593-2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	16	15	—	—	$71,100.00	$94,800.00	$79,000.00	2026-05-08
219	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	66	40	—	—	$2,300.00	$228,516.80	$78,999.13	2026-05-08
440-4	OTHER	Kidney Transplant	16	15	—	—	$70,473.07	$93,964.09	$78,303.41	2026-05-08
957	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Mcc	53	36	—	—	$2,300.00	$220,475.40	$77,741.68	2026-05-08
007-3	OTHER	Allogeneic Bone Marrow Transplant	16	15	—	—	$68,932.68	$91,910.24	$76,591.87	2026-05-08
001-3	OTHER	Liver Transplant And/or Intestinal Transplant	16	15	—	—	$66,333.84	$88,445.12	$73,704.27	2026-05-08
591-2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	16	15	—	—	$65,446.55	$87,262.07	$72,718.39	2026-05-08
870	OTHER	Septicemia Or Severe Sepsis With Mv >96 Hours	53	36	—	—	$2,000.00	$205,537.31	$72,474.37	2026-05-08
275	OTHER	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	61	38	—	—	$4,100.00	$208,788.56	$72,181.89	2026-05-08
955	OTHER	Craniotomy For Multiple Significant Trauma	53	36	—	—	$2,300.00	$201,765.26	$71,144.31	2026-05-08
163-4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	16	15	—	—	$63,256.68	$84,342.24	$70,285.20	2026-05-08
608-4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	16	15	—	—	$63,000.00	$84,000.00	$70,000.00	2026-05-08
928	OTHER	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	53	36	—	—	$2,300.00	$197,369.41	$69,594.29	2026-05-08
459	OTHER	Spinal Fusion Except Cervical With Mcc	52	36	—	—	$3,250.00	$195,998.37	$69,110.85	2026-05-08
232-4	OTHER	Gastric Fundoplication	16	15	—	—	$61,934.29	$82,579.06	$68,815.88	2026-05-08
603-3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	16	15	—	—	$61,873.94	$82,498.58	$68,748.82	2026-05-08
589-1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	16	15	—	—	$61,824.39	$82,432.52	$68,693.77	2026-05-08
268	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	58	38	—	—	$2,300.00	$197,036.97	$68,121.05	2026-05-08
178-4	OTHER	External Heart Assist Systems	16	15	—	—	$60,779.45	$81,039.26	$67,532.72	2026-05-08
207	OTHER	Respiratory System Diagnosis With Ventilator Support >96 Hours	53	36	—	—	$2,000.00	$191,140.56	$67,397.94	2026-05-08
006-2	OTHER	Pancreas Transplant	16	15	—	—	$60,406.52	$80,542.02	$67,118.35	2026-05-08
217	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	66	40	—	—	$2,300.00	$190,866.91	$65,988.94	2026-05-08
969	OTHER	HIV With Extensive O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$186,935.99	$65,915.37	2026-05-08
005-3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	16	15	—	—	$59,060.71	$78,747.61	$65,623.01	2026-05-08
165-4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	16	15	—	—	$58,592.29	$78,123.05	$65,102.54	2026-05-08
167-4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	16	15	—	—	$58,483.29	$77,977.72	$64,981.43	2026-05-08
008-4	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	16	15	—	—	$58,371.59	$77,828.78	$64,857.32	2026-05-08
276	OTHER	Non-maligant Breast Disorders	53	36	—	—	$2,300.00	$183,113.91	$64,567.67	2026-05-08
573	OTHER	Skin Graft For Skin Ulcer Or Cellulitis With Mcc	53	36	—	—	$2,300.00	$182,048.80	$64,192.10	2026-05-08
461	OTHER	Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc	53	36	—	—	$2,300.00	$181,416.23	$63,969.05	2026-05-08
454	OTHER	Combined Anterior And Posterior Spinal Fusion With Cc	52	36	—	—	$3,250.00	$180,815.99	$63,757.40	2026-05-08
028	OTHER	Spinal Procedures With Mcc	52	35	—	—	$2,300.00	$179,733.20	$63,375.60	2026-05-08
016	OTHER	Autologous Bone Marrow Transplant With Cc/mcc	53	36	—	—	$2,000.00	$178,450.37	$62,923.26	2026-05-08
017	OTHER	Autologous Bone Marrow Transplant Without Cc/mcc	53	36	—	—	$2,000.00	$178,450.37	$62,923.26	2026-05-08
622-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$56,332.15	$75,109.54	$62,591.28	2026-05-08
232	OTHER	Coronary Bypass With Ptca Without Mcc	66	40	—	—	$5,475.00	$180,592.40	$62,438.51	2026-05-08
009-3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	16	15	—	—	$56,044.79	$74,726.39	$62,271.99	2026-05-08
613-4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	16	15	—	—	$55,800.00	$74,400.00	$62,000.00	2026-05-08
790	OTHER	Extreme Immaturity Or Respiratory Distress Syndrome, Neonate	53	36	—	—	$2,000.00	$175,769.92	$61,978.11	2026-05-08
001-2	OTHER	Liver Transplant And/or Intestinal Transplant	16	15	—	—	$55,343.96	$73,791.95	$61,493.29	2026-05-08
304-4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	16	15	—	—	$55,159.30	$73,545.73	$61,288.11	2026-05-08
266	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc	58	38	—	—	$2,300.00	$177,123.37	$61,239.76	2026-05-08
218	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	64	40	—	—	$2,300.00	$175,902.33	$60,817.82	2026-05-08
820	OTHER	Lymphoma And Leukemia With Major O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$172,165.59	$60,707.19	2026-05-08
631-3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	16	15	—	—	$54,483.69	$72,644.92	$60,537.43	2026-05-08
183-4	OTHER	Percutaneous Structural Cardiac Procedures	16	15	—	—	$54,337.76	$72,450.35	$60,375.29	2026-05-08
007-2	OTHER	Allogeneic Bone Marrow Transplant	16	15	—	—	$54,298.13	$72,397.50	$60,331.25	2026-05-08
625-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	16	15	—	—	$54,149.49	$72,199.32	$60,166.10	2026-05-08
235	OTHER	Coronary Bypass Without Cardiac Catheterization With Mcc	66	40	—	—	$2,300.00	$173,986.90	$60,155.93	2026-05-08
623-4	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	16	15	—	—	$53,913.48	$71,884.64	$59,903.87	2026-05-08
457	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	53	36	—	—	$2,300.00	$169,726.40	$59,847.11	2026-05-08
007-1	OTHER	Allogeneic Bone Marrow Transplant	16	15	—	—	$53,528.83	$71,371.78	$59,476.48	2026-05-08
023	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	52	35	—	—	$2,300.00	$168,717.18	$58,913.10	2026-05-08
607-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$52,455.97	$69,941.29	$58,284.41	2026-05-08
004-2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	16	15	—	—	$52,270.40	$69,693.86	$58,078.22	2026-05-08
179-4	OTHER	Defibrillator Implants	16	15	—	—	$52,069.52	$69,426.02	$57,855.02	2026-05-08
910-4	OTHER	Craniotomy For Multiple Significant Trauma	16	15	—	—	$51,992.06	$69,322.74	$57,768.95	2026-05-08
303-3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	16	15	—	—	$51,920.88	$69,227.84	$57,689.87	2026-05-08
021	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc	52	35	—	—	$2,300.00	$163,485.76	$57,646.60	2026-05-08
834	OTHER	Acute Leukemia Without Major O.r. Procedures With Mcc	53	36	—	—	$2,000.00	$163,485.76	$57,646.60	2026-05-08
166-4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	16	15	—	—	$51,576.78	$68,769.04	$57,307.53	2026-05-08
1690159	OTHER	Nail Lapidus	137	38	$260,300.00	$78,090.00 70% off	$1,000.00	$260,300.00	$57,266.00	2026-05-09
653	OTHER	Major Bladder Procedures With Mcc	55	37	—	—	$2,300.00	$164,877.50	$57,008.11	2026-05-08
608-3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	16	15	—	—	$51,161.51	$68,215.34	$56,846.12	2026-05-08
008	OTHER	Simultaneous Pancreas And Kidney Transplant	54	34	—	—	$2,300.00	$160,949.52	$56,752.30	2026-05-08
680-4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	16	15	—	—	$50,885.86	$67,847.81	$56,539.84	2026-05-08
463	OTHER	Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective …	53	36	—	—	$2,300.00	$159,769.61	$56,336.25	2026-05-08
011	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc	53	36	—	—	$2,300.00	$159,619.55	$56,283.34	2026-05-08
576	OTHER	Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc	53	36	—	—	$2,300.00	$159,601.91	$56,277.12	2026-05-08
162-3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	16	15	—	—	$50,638.13	$67,517.51	$56,264.59	2026-05-08
091-4	OTHER	Other Major Head And Neck Procedures	16	15	—	—	$50,301.23	$67,068.31	$55,890.26	2026-05-08
405	OTHER	Pancreas, Liver And Shunt Procedures With Mcc	56	36	—	—	$2,300.00	$160,584.64	$55,524.69	2026-05-08
634-4	OTHER	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	16	15	—	—	$49,890.46	$66,520.62	$55,433.85	2026-05-08
234	OTHER	Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc	67	41	—	—	$4,100.00	$157,392.24	$54,421.53	2026-05-08
220	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	66	40	—	—	$2,300.00	$156,700.80	$54,182.60	2026-05-08
850-4	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	16	15	—	—	$48,562.67	$64,750.22	$53,958.52	2026-05-08
466	OTHER	Revision Of Hip Or Knee Replacement With Mcc	53	36	—	—	$2,300.00	$150,754.41	$53,157.41	2026-05-08
239	OTHER	Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc	53	36	—	—	$2,300.00	$149,056.67	$52,558.77	2026-05-08
270	OTHER	Other Major Cardiovascular Procedures With Mcc	64	39	—	—	$2,500.00	$151,884.22	$52,518.19	2026-05-08
837	OTHER	Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…	53	36	—	—	$2,000.00	$148,182.79	$52,250.63	2026-05-08
278	OTHER	Cellulitis Age >17 Without Cc	53	36	—	—	$2,300.00	$148,068.04	$52,210.17	2026-05-08
853	OTHER	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$148,009.20	$52,189.42	2026-05-08
326	OTHER	Stomach, Esophageal And Duodenal Procedures With Mcc	56	36	—	—	$2,300.00	$150,295.41	$51,969.17	2026-05-08
630-2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	16	15	—	—	$46,676.37	$62,235.16	$51,862.63	2026-05-08
178-3	OTHER	External Heart Assist Systems	16	15	—	—	$46,572.78	$62,097.04	$51,747.53	2026-05-08
912-4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	16	15	—	—	$46,389.01	$61,852.02	$51,543.35	2026-05-08
911-4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	16	15	—	—	$46,333.16	$61,777.55	$51,481.29	2026-05-08
169-4	OTHER	Major Abdominal Vascular Procedures	16	15	—	—	$46,230.47	$61,640.63	$51,367.19	2026-05-08
228	OTHER	Other Cardiothoracic Procedures With Mcc	62	39	—	—	$2,299.99	$147,479.60	$50,996.15	2026-05-08
006	OTHER	Liver Transplant Without Mcc	51	34	—	—	$2,300.00	$143,533.96	$50,611.41	2026-05-08
841-3	OTHER	Extensive Third Degree Burns With Skin Graft	16	15	—	—	$45,266.61	$60,355.48	$50,296.23	2026-05-08
021-4	OTHER	Open Craniotomy Except Trauma	16	15	—	—	$45,256.70	$60,342.26	$50,285.22	2026-05-08
011-4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	16	15	—	—	$45,018.90	$60,025.20	$50,021.00	2026-05-08
245	OTHER	Aicd Generator Procedures	56	38	—	—	$3,250.00	$144,640.25	$50,014.99	2026-05-08
023-4	OTHER	Spinal Procedures	16	15	—	—	$45,011.67	$60,015.56	$50,012.97	2026-05-08
001-1	OTHER	Liver Transplant And/or Intestinal Transplant	16	15	—	—	$45,000.00	$60,000.00	$50,000.00	2026-05-08
002-1	OTHER	Heart And/or Lung Transplant	16	15	—	—	$45,000.00	$60,000.00	$50,000.00	2026-05-08
588-1	OTHER	Female Reproductive System Reconstructive Procedures	16	15	—	—	$45,000.00	$60,000.00	$50,000.00	2026-05-08
011-2	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	16	15	—	—	$45,000.00	$60,000.00	$50,000.00	2026-05-08
006-1	OTHER	Pancreas Transplant	16	15	—	—	$45,000.00	$60,000.00	$50,000.00	2026-05-08
826	OTHER	Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.r. …	53	36	—	—	$2,300.00	$141,365.44	$49,846.77	2026-05-08
471	OTHER	Cervical Spinal Fusion With Mcc	61	39	—	—	$2,957.00	$143,772.27	$49,715.05	2026-05-08
799	OTHER	Splenectomy With Mcc	53	36	—	—	$2,300.00	$140,756.38	$49,632.01	2026-05-08
120-4	OTHER	Major Respiratory And Chest Procedures	16	15	—	—	$44,391.01	$59,188.02	$49,323.35	2026-05-08
440-3	OTHER	Kidney Transplant	16	15	—	—	$44,037.00	$58,716.00	$48,930.00	2026-05-08
823	OTHER	Lymphoma And Non-acute Leukemia With Other Procedures With Mcc	53	36	—	—	$2,300.00	$138,540.84	$48,850.79	2026-05-08
612-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$43,929.80	$58,573.07	$48,810.89	2026-05-08
981	OTHER	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	61	39	—	—	$2,957.00	$140,729.89	$48,663.74	2026-05-08
277	OTHER	Cellulitis Age >17 W Cc	53	36	—	—	$2,300.00	$137,728.72	$48,564.43	2026-05-08
681-4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	16	15	—	—	$43,605.51	$58,140.68	$48,450.57	2026-05-08
220-4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	16	15	—	—	$43,592.00	$58,122.66	$48,435.55	2026-05-08
483-4	OTHER	Penis, Testes And Scrotal Procedures	16	15	—	—	$43,409.13	$57,878.84	$48,232.37	2026-05-08
267	OTHER	Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc	62	39	—	—	$4,100.00	$139,282.31	$48,163.52	2026-05-08
163	OTHER	Major Chest Procedures With Mcc	53	36	—	—	$2,300.00	$136,472.35	$48,121.42	2026-05-08
455	OTHER	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	52	36	—	—	$3,250.00	$136,366.45	$48,084.08	2026-05-08
690-4	OTHER	Acute Leukemia	16	15	—	—	$43,273.11	$57,697.48	$48,081.23	2026-05-08
260-4	OTHER	Major Pancreas, Liver And Shunt Procedures	16	15	—	—	$43,265.01	$57,686.68	$48,072.23	2026-05-08
329	OTHER	Major Small And Large Bowel Procedures With Mcc	53	36	—	—	$2,300.00	$135,963.37	$47,941.95	2026-05-08
740-4	OTHER	Mental Illness Diagnosis With O.r. Procedure	16	15	—	—	$38,930.31	$51,907.08	$47,516.24	2026-05-08
089-4	OTHER	Major Cranial Or Facial Bone Procedures	16	15	—	—	$42,675.88	$56,901.17	$47,417.64	2026-05-08
312-4	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	16	15	—	—	$42,544.36	$56,725.81	$47,271.51	2026-05-08
950-4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	16	15	—	—	$42,516.43	$56,688.58	$47,240.48	2026-05-08
020-4	OTHER	Open Craniotomy For Trauma	16	15	—	—	$42,510.12	$56,680.16	$47,233.47	2026-05-08
613-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	16	15	—	—	$42,478.60	$56,638.13	$47,198.44	2026-05-08
650	OTHER	Kidney Transplant With Hemodialysis With Mcc	58	37	—	—	$2,300.00	$136,416.48	$47,173.21	2026-05-08
856	OTHER	Postoperative Or Post-traumatic Infections With O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$133,600.70	$47,108.85	2026-05-08
221	OTHER	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	66	40	—	—	$2,300.00	$135,983.96	$47,023.75	2026-05-08
1655997	OTHER	Implant, Knee System	68	36	$177,925.00	$53,377.50 70% off	$1,000.00	$177,925.00	$47,016.68	2026-05-09
474	OTHER	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	53	36	—	—	$2,300.00	$132,809.20	$46,829.76	2026-05-08
165-3	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	16	15	—	—	$42,052.51	$56,070.01	$46,725.01	2026-05-08
025	OTHER	Craniotomy And Endovascular Intracranial Procedures With Mcc	52	35	—	—	$2,300.00	$132,444.35	$46,701.11	2026-05-08
361-4	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	16	15	—	—	$41,985.85	$55,981.14	$46,650.95	2026-05-08
441-4	OTHER	Major Bladder Procedures	16	15	—	—	$41,863.35	$55,817.80	$46,514.83	2026-05-08
163-3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	16	15	—	—	$41,669.67	$55,559.56	$46,299.63	2026-05-08
901	OTHER	Wound Debridements For Injuries With Mcc	53	36	—	—	$2,300.00	$131,214.46	$46,267.44	2026-05-08
130-4	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	16	15	—	—	$41,403.93	$55,205.24	$46,004.37	2026-05-08
1646143	OTHER	Implant, Shoulder System	68	36	$173,938.00	$52,181.40 70% off	$1,000.00	$173,938.00	$45,963.12	2026-05-09
178-2	OTHER	External Heart Assist Systems	16	15	—	—	$41,336.37	$55,115.16	$45,929.30	2026-05-08
005-1	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	16	15	—	—	$41,333.67	$55,111.56	$45,926.30	2026-05-08
636-4	OTHER	Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection	16	15	—	—	$41,301.23	$55,068.31	$45,890.26	2026-05-08
160-3	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	16	15	—	—	$41,294.03	$55,058.71	$45,882.26	2026-05-08
609-2	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	16	15	—	—	$40,703.10	$54,270.80	$45,225.67	2026-05-08
1656977	OTHER	Imp, Hemi Arthroplasty	137	38	$173,938.00	$52,181.40 70% off	$1,000.00	$173,938.00	$45,223.88	2026-05-09
1655086	OTHER	Implant, Hip System	137	38	$173,938.00	$52,181.40 70% off	$1,000.00	$173,938.00	$45,223.88	2026-05-09
1656811	OTHER	Implant, Knee System	137	38	$173,938.00	$52,181.40 70% off	$1,000.00	$173,938.00	$45,223.88	2026-05-09
1686103	OTHER	Implant, Shoulder System	137	38	$173,938.00	$52,181.40 70% off	$1,000.00	$173,938.00	$45,223.88	2026-05-09
933	OTHER	Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft	53	36	—	—	$2,000.00	$128,166.24	$45,192.61	2026-05-08
458	OTHER	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	53	36	—	—	$2,300.00	$127,904.39	$45,100.28	2026-05-08
319	OTHER	Other Endovascular Cardiac Valve Procedures With Mcc	58	37	—	—	$4,000.00	$130,105.22	$44,992.30	2026-05-08
027-4	OTHER	Other Open Craniotomy	16	15	—	—	$40,122.98	$53,497.31	$44,581.09	2026-05-08
356	OTHER	Other Digestive System O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$126,365.52	$44,557.66	2026-05-08
323	OTHER	Urinary Stones W Cc, &/or Esw Lithotripsy	53	36	—	—	$2,300.00	$126,180.16	$44,492.30	2026-05-08
140	OTHER	Major Head And Neck Procedures With Mcc	53	36	—	—	$2,300.01	$125,291.59	$44,178.98	2026-05-08
303-1	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	16	15	—	—	$39,568.98	$52,758.64	$43,965.53	2026-05-08
162-2	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	16	15	—	—	$39,564.48	$52,752.64	$43,960.53	2026-05-08
031	OTHER	Ventricular Shunt Procedures With Mcc	52	35	—	—	$2,300.00	$124,155.85	$43,778.51	2026-05-08
673	OTHER	Other Kidney And Urinary Tract Procedures With Mcc	53	36	—	—	$2,300.00	$124,126.45	$43,768.14	2026-05-08
261-4	OTHER	Major Biliary Tract Procedures	16	15	—	—	$39,362.70	$52,483.60	$43,736.33	2026-05-08
793	OTHER	Full Term Neonate With Major Problems	53	36	—	—	$2,000.00	$123,564.46	$43,569.98	2026-05-08
005-2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	16	15	—	—	$39,178.03	$52,237.37	$43,531.14	2026-05-08
181-4	OTHER	Lower Extremity Arterial Procedures	16	15	—	—	$39,008.67	$52,011.56	$43,342.97	2026-05-08
269	OTHER	Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc	58	38	—	—	$2,300.00	$123,276.13	$43,050.38	2026-05-08
1661140	OTHER	Implant Knee System	68	36	$162,840.00	$48,852.00 70% off	$1,000.00	$162,840.00	$43,030.47	2026-05-09
440-2	OTHER	Kidney Transplant	16	15	—	—	$38,717.71	$51,623.62	$43,019.68	2026-05-08
958	OTHER	Other O.r. Procedures For Multiple Significant Trauma With Cc	53	36	—	—	$2,300.00	$121,778.46	$42,940.22	2026-05-08
176-4	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	16	15	—	—	$38,602.41	$51,469.88	$42,891.57	2026-05-08
401-4	OTHER	Adrenal Procedures	16	15	—	—	$38,473.60	$51,298.13	$42,748.44	2026-05-08
614-3	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	16	15	—	—	$38,449.27	$51,265.69	$42,721.41	2026-05-08
791	OTHER	Prematurity With Major Problems	53	36	—	—	$2,000.00	$120,310.30	$42,422.53	2026-05-08
236	OTHER	Coronary Bypass Without Cardiac Catheterization Without Mcc	66	40	—	—	$2,300.00	$121,846.13	$42,138.32	2026-05-08
510-4	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	16	15	—	—	$37,865.55	$50,487.40	$42,072.83	2026-05-08
012	OTHER	Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc	53	36	—	—	$2,300.00	$121,599.00	$42,052.92	2026-05-08
004-1	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	16	15	—	—	$37,833.12	$50,444.16	$42,036.80	2026-05-08
589-3	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	16	15	—	—	$37,811.50	$50,415.34	$42,012.78	2026-05-08
178-1	OTHER	External Heart Assist Systems	16	15	—	—	$37,789.88	$50,386.51	$41,988.76	2026-05-08
303-2	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	16	15	—	—	$37,676.38	$50,235.17	$41,862.64	2026-05-08
423	OTHER	Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc	55	37	—	—	$2,300.00	$120,530.91	$41,683.83	2026-05-08
739	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy With Mc…	53	36	—	—	$2,300.00	$117,985.80	$41,602.89	2026-05-08
695-4	OTHER	Chemotherapy For Acute Leukemia	16	15	—	—	$37,220.57	$49,627.43	$41,356.19	2026-05-08
736	OTHER	Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc	53	36	—	—	$2,300.00	$116,711.84	$41,153.68	2026-05-08
792-4	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	16	15	—	—	$37,031.40	$49,375.20	$41,146.00	2026-05-08
609-1	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	16	15	—	—	$36,921.50	$49,228.67	$41,023.89	2026-05-08
608-2	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	16	15	—	—	$36,789.98	$49,053.31	$40,877.76	2026-05-08
628	OTHER	Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc	54	37	—	—	$2,300.00	$116,950.15	$40,842.10	2026-05-08
907	OTHER	Other O.r. Procedures For Injuries With Mcc	55	37	—	—	$2,300.00	$118,068.21	$40,832.83	2026-05-08
230-4	OTHER	Major Small Bowel Procedures	16	15	—	—	$36,679.19	$48,905.58	$40,754.65	2026-05-08
234-4	OTHER	Appendectomy Without Complex Principal Diagnosis	16	15	—	—	$36,676.48	$48,901.97	$40,751.64	2026-05-08
034	OTHER	Carotid Artery Stent Procedures With Mcc	52	35	—	—	$2,300.00	$115,273.05	$40,646.35	2026-05-08
321-4	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	16	15	—	—	$36,445.87	$48,594.49	$40,495.41	2026-05-08
616	OTHER	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	53	36	—	—	$2,300.00	$114,575.65	$40,400.44	2026-05-08
179-3	OTHER	Defibrillator Implants	16	15	—	—	$36,342.28	$48,456.37	$40,380.31	2026-05-08
904	OTHER	Skin Grafts For Injuries With Cc/mcc	53	36	—	—	$2,300.00	$114,460.93	$40,359.99	2026-05-08
511-4	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	16	15	—	—	$36,305.34	$48,407.12	$40,339.27	2026-05-08
183-3	OTHER	Percutaneous Structural Cardiac Procedures	16	15	—	—	$36,294.53	$48,392.71	$40,327.26	2026-05-08
166	OTHER	Other Respiratory System O.r. Procedures With Mcc	53	36	—	—	$2,300.00	$114,143.19	$40,247.95	2026-05-08
092-4	OTHER	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	16	15	—	—	$36,191.84	$48,255.79	$40,213.16	2026-05-08
273	OTHER	Percutaneous And Other Intracardiac Procedures With Mcc	58	37	—	—	$2,300.00	$115,908.57	$40,086.55	2026-05-08
639-4	OTHER	Neonate Birth Weight > 2499 Grams With Other Significant Condition	16	15	—	—	$35,992.76	$47,990.35	$39,991.96	2026-05-08
956	OTHER	Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma	53	36	—	—	$2,300.00	$113,322.28	$39,958.49	2026-05-08
304-3	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	16	15	—	—	$35,888.27	$47,851.03	$39,875.86	2026-05-08
024	OTHER	Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi…	52	35	—	—	$2,300.00	$112,713.22	$39,743.73	2026-05-08
121-4	OTHER	Other Respiratory And Chest Procedures	16	15	—	—	$35,580.20	$47,440.26	$39,533.55	2026-05-08
167-3	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	16	15	—	—	$35,380.21	$47,173.62	$39,311.35	2026-05-08
622	OTHER	Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor…	53	36	—	—	$2,300.00	$110,956.66	$39,124.35	2026-05-08
1669888	OTHER	Implant Knee System	69	37	$156,070.00	$46,821.00 70% off	$1,000.00	$156,070.00	$39,017.50	2026-05-09
166-3	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	16	15	—	—	$35,073.04	$46,764.05	$38,970.04	2026-05-08
008-3	OTHER	Autologous Bone Marrow Transplant Or T-cell Immunotherapy	16	15	—	—	$34,981.15	$46,641.54	$38,867.95	2026-05-08
165-2	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	16	15	—	—	$34,978.46	$46,637.94	$38,864.95	2026-05-08
040	OTHER	Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc	55	35	—	—	$2,500.00	$111,842.25	$38,681.41	2026-05-08
440-1	OTHER	Kidney Transplant	16	15	—	—	$34,716.32	$46,288.43	$38,573.69	2026-05-08
030-4	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	16	15	—	—	$34,682.08	$46,242.78	$38,535.65	2026-05-08
170-4	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	16	15	—	—	$34,474.00	$45,965.33	$38,304.44	2026-05-08
460	OTHER	Spinal Fusion Except Cervical Without Mcc	52	36	—	—	$3,250.00	$108,482.16	$38,251.82	2026-05-08
612-2	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	16	15	—	—	$34,424.45	$45,899.27	$38,249.39	2026-05-08
325-4	OTHER	Non-elective Or Complex Knee Joint Replacement	16	15	—	—	$34,378.51	$45,838.02	$38,198.35	2026-05-08
162-1	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	16	15	—	—	$34,356.00	$45,808.00	$38,173.33	2026-05-08
094	OTHER	Bacterial And Tuberculous Infections Of Nervous System With Mcc	53	36	—	—	$2,000.00	$108,211.44	$38,156.36	2026-05-08
264-4	OTHER	Other Hepatobiliary, Pancreas And Abdominal Procedures	16	15	—	—	$34,154.21	$45,538.94	$37,949.12	2026-05-08
335	OTHER	Peritoneal Adhesiolysis With Mcc	53	36	—	—	$2,300.00	$107,467.04	$37,893.88	2026-05-08
405-4	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	16	15	—	—	$33,791.18	$45,054.91	$37,545.76	2026-05-08
802	OTHER	Other O.r. Procedures Of The Blood And Blood Forming Organs With Mcc	53	36	—	—	$2,300.00	$106,331.31	$37,493.41	2026-05-08
097	OTHER	Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc	53	36	—	—	$2,000.00	$106,325.41	$37,491.33	2026-05-08
518	OTHER	Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurost…	53	36	—	—	$2,300.00	$106,307.77	$37,485.11	2026-05-08
404-4	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	16	15	—	—	$33,666.88	$44,889.17	$37,407.64	2026-05-08
710-4	OTHER	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	16	15	—	—	$33,619.13	$44,825.51	$37,354.59	2026-05-08
512-4	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	16	15	—	—	$33,603.81	$44,805.08	$37,337.57	2026-05-08
265	OTHER	Aicd Lead Procedures	53	36	—	—	$2,300.00	$105,813.46	$37,310.81	2026-05-08
651-4	OTHER	Other Procedures Of Blood And Blood-forming Organs	16	15	—	—	$33,511.03	$44,681.38	$37,234.48	2026-05-08
492	OTHER	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc	53	36	—	—	$2,300.00	$105,342.71	$37,144.82	2026-05-08
182-4	OTHER	Other Peripheral Vascular And Related Procedures	16	15	—	—	$33,367.81	$44,490.41	$37,075.34	2026-05-08
759-4	OTHER	Eating Disorders	16	15	—	—	$27,723.19	$44,462.40	$36,964.26	2026-05-08
022	OTHER	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/…	52	35	—	—	$2,300.00	$104,730.73	$36,929.03	2026-05-08
175-4	OTHER	Percutaneous Cardiac Intervention Without Ami	16	15	—	—	$33,229.98	$44,306.64	$36,922.20	2026-05-08

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